Journal of Psychosocial Nursing and Mental Health Services

CNE Article 

Mindfulness-Based Stress Reduction for Stress, Anxiety, and Psychological Well-Being: Effects in a Republic of Korea Navy Fleet Crew

Hyekyung Kang, PhD, RN; Jeong-bok Seo, RN; In-Young Hwang, RN

Abstract

The purpose of the current study was to investigate the effects of a mindfulness-based stress reduction (MBSR) program on perceived stress, depression, anxiety, and psychological well-being of a Republic of Korea (ROK) Navy fleet crew. A quasi-experimental study with a non-equivalent control group pretest/post-test design was used. Participants were randomized to an experimental group (n = 18) and control group (n = 21). The experimental group received MBSR for 90 minutes per week for eight sessions. Data were analyzed using descriptive statistics and Shapiro-Wilk, chi-square, Mann-Whitney U, and t tests. Results showed significant decreases in perceived stress (t = −8.24, p = 0.015) and anxiety (t = −0.25, p = 0.041) and improved psychological well-being (t = 2.58, p = 0.023) in the experimental group compared to the control group. No differences were found for depression between groups. These findings indicate that MBSR was effective in addressing perceived stress, anxiety, and psychological well-being of a ROK Navy fleet crew. This study suggests MBSR can be expanded to other populations at high risk for stress and anxiety. [Journal of Psychosocial Nursing and Mental Health Services, 58(11), 48–55.]

Abstract

The purpose of the current study was to investigate the effects of a mindfulness-based stress reduction (MBSR) program on perceived stress, depression, anxiety, and psychological well-being of a Republic of Korea (ROK) Navy fleet crew. A quasi-experimental study with a non-equivalent control group pretest/post-test design was used. Participants were randomized to an experimental group (n = 18) and control group (n = 21). The experimental group received MBSR for 90 minutes per week for eight sessions. Data were analyzed using descriptive statistics and Shapiro-Wilk, chi-square, Mann-Whitney U, and t tests. Results showed significant decreases in perceived stress (t = −8.24, p = 0.015) and anxiety (t = −0.25, p = 0.041) and improved psychological well-being (t = 2.58, p = 0.023) in the experimental group compared to the control group. No differences were found for depression between groups. These findings indicate that MBSR was effective in addressing perceived stress, anxiety, and psychological well-being of a ROK Navy fleet crew. This study suggests MBSR can be expanded to other populations at high risk for stress and anxiety. [Journal of Psychosocial Nursing and Mental Health Services, 58(11), 48–55.]

Military tension on the Korean Peninsula is high. The Republic of Korea (ROK) Navy is defending its waters along the East Sea and West Sea, with intensive military maritime training in preparation for imminent threats and provocations. Thus, fleet crews experience stress and anxiety, which affect their psychological well-being, placing their overall mental health at risk (Meyer & Wynn, 2018; Seol & Park, 2015).

Many Korean soldiers are young, as they must serve in the military for 18 months between the ages of 19 and 30. The remainder are voluntary soldiers, such as officers and noncommissioned officers, who range in age from 20 to mid-50s. Stress and psychological well-being must be managed to aid in adjustment to military life. Poorly managed stress can lead to problems such as depression and suicide (Hong & Yang, 2013; Kang et al., 2011; Serpa et al., 2014). The mental health of fleet crews is directly related to military strength; therefore, the management of stress and psychological well-being of those protecting our seas is of utmost importance in this recent crisis of the Korean Peninsula.

Due to the current situation, programs for reducing stress are currently offered to military personnel in some units. However, most of these programs are only offered once and are not regularly continued. Although the Navy is promoting mental health by implementing a “forest healing program” for the crews of the Cheonan battleship (which was attacked in 2010) and some submarine personnel (Yoon, 2018), there are considerable limitations, such as time and space. Thus, there is a need for a continuous and accessible intervention program that can improve psychological well-being, enhance one's ability to cope with stress, and alleviate tension in Navy fleet crews.

The current researchers aimed to provide a mindfulness-based stress reduction (MBSR) program suited to military bases and naval vessels to promote stress relief and psychological well-being in military personnel. MBSR, which is based on Buddhist meditation, relaxation, attention, awareness, and insight, was introduced by Kabat-Zinn (2013) as a part of psychotherapy for patients with chronic pain. Mindfulness meditation has produced demonstrable effects on brain structures that are important in integrating information about the internal physiological state of the body and its response to stress (Davidson et al., 2003; Johnson et al., 2014; Kabat-Zinn, 2013). A mind and body therapy with scientific evidence, MBSR improves not only stress-related disorders (Johnson et al., 2014; Kim et al., 2015) but also enhances recovery from psychological imbalances such as depression, anxiety, adjustment disorders, and suicidal ideation (Montero-Martin et al., 2019; Parswani et al., 2013; Serpa et al., 2014). MBSR has also demonstrated improvements in emotional control, self-understanding, and self-awareness (Rice et al., 2019; Wang & Cho, 2011). Moreover, this program is sustainable as it is based on mind and body training that connects one's consciousness with one's body and does not require special equipment or tools. Due to its considerable effect on psychological and physical well-being (Barbosa et al., 2013; Lee et al., 2017), MBSR has been used in a variety of clinical areas, such as chronic pain, binge eating, and smartphone addiction in adolescents (Brintz et al., 2020; Lee & Jeon, 2012; Park, 2012).

By implementing a highly practical meditation program that can effectively manage stress and maintain psychological well-being, the current study aimed to reduce stress and relax the mind and body of military personnel who perform various missions. The specific purpose of this study was to verify the effects of the MBSR program on perceived stress, depression, anxiety, and psychological well-being of a ROK Navy fleet crew.

Method

Study Design

The current quasi-experimental study used a non-equivalent control group pretest/posttest design to examine the effects of a MBSR program on perceived stress, depression, anxiety, and psychological well-being of a ROK Navy fleet crew.

Participants

According to a prior study, which confirmed the effects of MBSR for maladjusted military soldiers (Cho et al., 2012), and the equation of Cohen et al. (1983), the required sample size, calculated using G*power, was ≤17 for the experimental and control groups to achieve a significance of 0.05, an effect size of 0.5, and power of 0.8. Therefore, 30 participants were assigned to each group considering a maximum dropout rate given the characteristics of the military unit, such as emergency missions and training and military leave.

This study was approved by the Institutional Review Board at the Medical Research Ethics Review Committee of the Armed Forces Medical Command, Korea. Participants were recruited from a convenience sample of one naval fleet preparing for deployment. After recruiting applicants through posters on bulletin boards, information on the research process was provided to those who wanted to participate. Participants were randomized into two groups (N = 60). Written informed consent was obtained from all participants prior to the baseline assessment. Participants were assigned a unique study participant identification number for use throughout the study.

Inclusion criteria were Navy fleet crew who (a) have not participated in similar meditation programs in the past; (b) do not regularly perform activities such as exercise or yoga to reduce stress; (c) are not receiving counseling or psychotherapy; and (d) understand the purpose of the study and provided signed consent. To facilitate participation in the study, the auditorium, adjacent to the fleet mooring quay, was used.

The MBSR program was conducted from May to July 2017. Before the start of the program, a pretest was conducted, and at the end of the program, a posttest was conducted using the same measurement instruments. The control group was observed at a separate site during the study period. From a starting sample of 60 participants, nine dropped out due to personal circumstances, two were reassigned to other fleets, six did not complete all questionnaires, and four did not respond to the follow-up survey. Hence, the final number of study participants was 39, including 18 in the experimental group and 21 in the control group.

The control group was provided with a shortened MBSR program after the study was completed.

Intervention

The MBSR program was modified to match the actual situation of the naval fleet. The program is composed of eight sessions. Each session was conducted once per week for 60 minutes to minimize the burden of participating in the program during military unit life and to appropriately account for various unit training schedules. The first 10 minutes included an introduction and the opening and relaxing of the mind. The next 45 minutes were spent on meditation training of the mind and body. The remaining 5 minutes were used as closing time to summarize and reflect upon the feeling of mindfulness. Yoga mats were placed in the auditorium for all participants at each session. Ten minutes after the start of the session, participants were allowed to take their desired position, such as sitting on a mat or chair, leaning against a wall, or lying down at any time during the session, so that discomfort in meditation was minimized as much as possible. Meditative music was played during the entire session for relaxation of the mind and body and to lessen tension. If necessary, a work-book, which was modified and produced by the researcher (J.S.), was provided in accordance with the session, such that one could meditate alone in the military unit. On the program off days, participants were encouraged to practice mindfulness meditation and self-examination in their military units.

A colonel at the Naval Hospital (J.-B.S.) who had studied mindfulness meditation, had worked in a military hospital for 19 years, and had experience operating the program, conducted the MBSR intervention with assistance from a naval nurse officer (I.-Y.H). The composition and proceedings of the MBSR intervention program are provided in Table 1.

Mindfulness-Based Stress Reduction Program for Republic of Korea Naval Fleet Crew

Table 1:

Mindfulness-Based Stress Reduction Program for Republic of Korea Naval Fleet Crew

Instruments

Perceived Stress. To measure perceived stress, the Perceived Stress Scale (PSS), which was developed by Cohen et al. (1983), modified by Cohen and Williamson (1988), and translated by Lee (2005), was used. The PSS evaluates the degree to which an individual perceives life experiences as stressful during the previous 1 month. The tool comprises 10 items measured on a 5-point Likert scale, with scores ranging from 10 to 50. Four items are reverse scored. A higher total score indicates a higher level of perceived stress. Cronbach's alpha in previous research was 0.87 (Lee, 2005), whereas Cronbach's alpha in the current study was 0.82.

Depression. The Korean version (Chon & Rhee, 1992) of the Center for Epidemiologic Studies-Depression (CES-D) scale was used to measure depression. This 20-question tool measures the frequency of depressive symptoms over the past 1 week using a 4-point Likert scale, ranging from 0 = very rarely to 3 = almost every day. Scores range from 0 to 60 points, with higher scores indicating a greater degree of depression. Cronbach's alpha for the current study was 0.82.

Anxiety. The Korean version (Lee et al., 2016) of the Beck Anxiety Inventory (BAI) (Beck et al., 1988), which is a self-report questionnaire, was used to measure anxiety. Clinically, this tool is used to distinguish anxiety from depression and can help categorize participants into anxiety and non-anxiety groups. The BAI comprises 21 items scored on a 4-point Likert scale, ranging from 0 = I did not feel it at all to 3 = I felt it strongly. Scores range from 0 to 63, with higher scores indicating greater anxiety. Cronbach's alpha for the current study was 0.80.

Psychological Well-Being. The Psychological Well-Being Scale (PWBS), which was developed by Ryff (1989) and revised and supplemented by the Korean version (Kim et al., 2001), was used to measure psychological well-being. This self-report questionnaire comprises 46 questions with six subdomains of psychological well-being, including self-acceptance, environmental insight, positive interpersonal relationships, autonomy, the purpose of life, and personal growth. Each question is rated on a 5-point Likert scale, ranging from 1 = not at all to 5 = strongly agree. Scores range from 46 to 230, with higher scores indicating greater psychological well-being. Cronbach's alpha in the current study was 0.77.

Data Analysis

Data were analyzed using SPSS 18.0 software. Normality of the measured variables was verified with the Shapiro-Wilk test. Homogeneity between the experimental and control groups was tested using the χ2 test, Fisher's exact probability test, t test, and Mann-Whitney U test. Postintervention changes were examined using the t test and Mann-Whitney U test.

Results

Homogeneity of Participants

Results of the homogeneity test for the general characteristics of the experimental and control groups and the dependent variables before the intervention showed no statistically significant differences; thus, the two groups were homogeneous (Table 2).

Homogeneity Test for General Characteristics and Dependent Variables Between Groups (N = 39)

Table 2:

Homogeneity Test for General Characteristics and Dependent Variables Between Groups (N = 39)

Experimental Effects

Regarding perceived stress, mean score in the experimental group decreased by 3.11 points from 33.15 at pretest to 30.04 at posttest, and in the control group, mean score decreased by 1.13 points from 32.71 pretest to 31.58 at posttest. As there was a significant difference between the groups, the first hypothesis was supported (t = −8.24, p = 0.015) (Table 3).

Comparison of Pretest and Posttest Dependent Variables Between Groups (N = 39)

Table 3:

Comparison of Pretest and Posttest Dependent Variables Between Groups (N = 39)

Regarding depression, mean score in the experimental group decreased by 0.76 points from 14.28 at pretest to 13.52 at posttest, and in the control group, virtually no change was noted (14.14 at pretest and 14.15 at posttest). As there was no statistically significant difference between groups, the second hypothesis was rejected (t = −2.06, p = 0.066) (Table 3).

Regarding anxiety, mean score in the experimental group decreased by 1.60 points from 10.55 at pretest to 8.95 at posttest, and mean score in the control group decreased by 0.04 points from 9.59 at pretest to 9.55 at posttest. A statistically significant difference was noted between groups; thus, the third hypothesis was supported (t = −0.25, p = 0.041) (Table 3).

Regarding psychological well-being, the mean score of the experimental group increased by 1.58 points from 132.92 at pretest to 134.50 at post-test, and the mean score of the control group increased by 0.66 points from 140.75 at pretest to 141.41 at posttest. A statistically significant difference was noted between groups; thus, the fourth hypothesis was supported (t = 2.58, p = 0.023) (Table 3).

Discussion

As a result of the MBSR program, which was modified and supplemented for a Navy fleet crew, the experimental group showed a decrease in perceived stress and anxiety and improvement in psychological well-being compared to the control group. MBSR had minimal effect on depression in this study.

In the experimental group, there was a significant decrease in perceived stress after the MBSR program. This result supports previous studies that applied the MBSR program to military soldiers (Guo et al., 2019; Jang, 2016). Perceived stress levels of all participants in the experimental and control groups were higher than perceived stress levels of citizens of similar ages (Ko & Lee, 2003). High stress can lead to difficulty in adapting to military service (Kang, 2011; Song & Lindquist, 2015; Whang, 2015). Therefore, stress must be addressed and managed in fleet crews. Soldiers in many countries are exposed to tension and stressful situations for actual training. The current study shows how MBSR can be applied to populations at high risk of stress.

In many cases, higher stress can lead to depression (Fiksdal et al., 2019; Hammen, 2018). The stress levels of the fleet crew who participated in the current study were high. Therefore, stress management is needed to prevent worsening stress as well as depression. After the MBSR program, depression was slightly reduced in the experimental group, but the difference was not significant compared to the control group. This result is similar to a prior study involving the ROK Army (Jang, 2016). However, MBSR may be more effective in reducing depression among individuals with anxiety disorders (Goldin & Gross, 2010; Serpa et al., 2014) than individuals who experience tension in particular situations, such as soldiers. The ROK Navy fleet crew had been under strain for a long time due to preparations regarding North Korea's threats. In addition, the ROK Navy suffered severe effects after the Battle of Yeonpyeong-Sea in 2002 and the North Korean attack of the Cheonan battleship in 2010 (Kim, 2020; Lynam, 2010). Along with North Korea's provocations, marine accidents caused by various military training can result in fleet crews having higher levels of anxiety than citizens.

As anxiety increases, the risk of accidents increases, so evaluation and management of anxiety is important. Many international studies have demonstrated the positive effect of MBSR on reducing anxiety (Goldin & Gross, 2010; Montero-Martin et al., 2019; Parswani et al., 2013; Serpa et al., 2014; Song & Lindquist, 2015). The current study also showed that the level of anxiety in the experimental group after the intervention was significantly lower than that of the control group.

The MBSR program has few restrictions regarding movement and space and does not require participants to have special equipment and skills. Thus, instructors and participants can focus on stress reduction and mental and physical stability without burden. In the current study, the program was facilitated by a naval nursing officer interested and experienced in MBSR. Provision of the program by military medical personnel who understand the situation of soldiers is a better approach to achieve effectiveness and acceptability of the MBSR program.

Psychological well-being is the result of the interaction between environmental stimuli and individual response. Accordingly, it is an important psychological factor for military personnel. As low psychological well-being of soldiers can cause worry, anxiety, and adjustment disorder, which can further lead to various problems such as desertion and suicide, interventions are needed to increase psychological well-being. Interventions such as MBSR in the field of counseling and psychotherapy have been consistently used as auxiliary strategies to promote positive emotions and happiness or subjective well-being. Recently, the MBSR program has evolved into a proactive method that aims to improve quality of life by having a desirable effect on mental health (Guo et al., 2019; Song et al., 2010). In the Army, MBSR was applied to soldiers with maladjustment disorders and was found to affect psychological acceptance, internal control, and military life adjustment (Cho et al., 2012; Montero-Martin et al., 2019). In the current study, psychological well-being of the fleet crew was significantly increased compared to the control group after the MBSR program. Thus, applying the MBSR program to fleet crews will help promote healthy military life and accident prevention.

Limitations

The sample size was small, as only one fleet was involved, and the fleet crew had not undergone any stress management programs until recently. As the results are not generalizable to other populations, findings of the current study need to be verified in subsequent studies.

Conclusion

To promote stress management and relaxation of the mind and body in a Navy fleet crew, the current study evaluated the effects of a MBSR program on perceived stress, depression, anxiety, and psychological well-being. Results showed that MBSR has positive effects on perceived stress, anxiety, and psychological well-being, but not depression. This study has significance as it provides rationale and basic data for use of the MBSR program for naval soldiers and potential use in other groups that experience high stress. In addition, this study showed that MBSR may be a more effective program if facilitated by a nursing officer with a high understanding of the military.

References

  • Barbosa, P., Raymond, G., Zlotnick, C., Wilk, J., Toomey, R. III. & Mitchell, J. III.. (2013). Mindfulness-based stress reduction training is associated with greater empathy and reduced anxiety for graduate healthcare students. Education for Health, 26(1), 9–14 doi:10.4103/1357-6283.112794 [CrossRef] PMID:23823667
  • Beck, A. T., Epstein, N., Brown, G. & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897 doi:10.1037/0022-006X.56.6.893 [CrossRef] PMID:3204199
  • Brintz, C. E., Miller, S., Olmsted, K. R., Bartoszek, M., Cartwright, J., Kizakevich, P. N., Butler, M., Asefnia, N., Buben, A. & Gaylord, S. A. (2020). Adapting mindfulness training for military service members with chronic pain. Military Medicine, 185(3–4), 385–393 doi:10.1093/milmed/usz312 [CrossRef] PMID:31621856
  • Cho, Y. J., Cheon, S. M., Cha, M. J. & Lee, Y. S. (2012). Effects of the mindfulness meditation program on psychological acceptance, internal control and military life adaptation of maladjusted military soldiers [article in Korean]. Journal of Rehabilitation Psychology, 9(2), 295–318 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART001692402
  • Chon, K. K. & Rhee, M. G. (1992). Preliminary development of Korean version of CES-D [article in Korean]. Korean Journal of Clinical Psychology, 11(1), 65–76 https://www.dbpia.co.kr/journal/articleDetail?nodeId=NODE06370644#none
  • Cohen, S., Kamarck, T. & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396 doi:10.2307/2136404 [CrossRef] PMID:6668417
  • Cohen, S. & Williamson, G. (1988). Perceived stress in a probability sample of the United States. In Spacapan, S. & Oskamp, S. (Eds.), The social psychology of health: Claremont symposium on applied social psychology (pp. 31–67). Sage.
  • Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., Urbanowski, F., Harrington, A., Bonus, K. & Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564–570 doi:10.1097/01.PSY.0000077505.67574.E3 [CrossRef] PMID:12883106
  • Fiksdal, A., Hanlin, L., Kuras, Y., Gianferante, D., Chen, X., Thoma, M. V. & Rohleder, N. (2019). Associations between symptoms of depression and anxiety and cortisol responses to and recovery from acute stress. Psycho-neuroendocrinology, 102, 44–52 doi:10.1016/j.psyneuen.2018.11.035 [CrossRef] PMID:30513499
  • Goldin, P. R. & Gross, J. J. (2010). Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion (Washington, D.C.), 10(1), 83–91. doi:10.1037/a0018441 [CrossRef] PMID:20141305
  • Guo, D., Sun, L., Yu, X., Liu, T., Wu, L., Sun, Z., Zhang, F., Zhou, Y., Shen, M. & Liu, W. (2019). Mindfulness-based stress reduction improves the general health and stress of Chinese military recruits: A pilot study. Psychiatry Research, 281, 112571 doi:10.1016/j.psychres.2019.112571 [CrossRef] PMID:31590104
  • Hammen, C. (2018). Risk factors for depression: An autobiographical review. Annual Review of Psychology, 14(14), 1–28. doi:10.1146/annurev-clinpsy-050817-084811 [CrossRef] PMID:29328780
  • Hong, J. D. & Yang, N. N. (2013). An effect of soldier stress on suicidal ideation: Self-esteem, alienation, frustration mediating effect [article in Korean]. Korea Journal of Counseling, 14(2), 1423–1441 doi:10.15703/kjc.14.2.201304.1423 [CrossRef]
  • Jang, K. H. (2016). The effects of a military adjustment program based on Buddhist meditation on service persons [article in Korean]. Association of Eastern-Asia Buddhist Culture, 25, 411–433 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002097212
  • Johnson, D. C., Thom, N. J., Stanley, E. A., Haase, L., Simmons, A. N., Shih, P. A., Thompson, W. K., Potterat, E. G., Minor, T. R. & Paulus, M. P. (2014). Modifying resilience mechanisms in at-risk individuals: A controlled study of mindfulness training in Marines preparing for deployment. The American Journal of Psychiatry, 171(8), 844–853 doi:10.1176/appi.ajp.2014.13040502 [CrossRef] PMID:24832476
  • Kabat-Zinn, J. (2013).Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Bantam Books.
  • Kang, J. H., Jung, S. O., Yoon, Y. K., Roh, M. Y., Choi, Y. H. & Kim, J. E. (2011). The relationships among depression level, stress, and perceived organizational support in Korean navy sailors [article in Korean]. Journal of Military Nursing Research, 29(2), 66–76 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART001587352
  • Kim, D. Y. (2020, August20). 18th anniversary of Second Yeonpyeong Battle. https://www.msn.com/ko-kr/news/other/18th-anniversary-of-second-yeonpyeong-battle-the-western-sea-border-now/vi-BB1657CJ
  • Kim, J. E., Kim, J. H. & Kim, M. H. (2015). The effects of mindfulness meditation on chronic headaches, stress, and negative emotions in high school teachers [article in Korean]. The Korean Journal of Health Psychology, 20(1), 35–52 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART001587352
  • Kim, M. S., Kim, H. W. & Cha, K. H. (2001). Analyses on the construct of psychological well-being (PWB) of Korean male and female adults [article in Korean]. The Korean Journal of Social and Personality Psychology, 15(2), 19–39 https://www.dbpia.co.kr/journal/articleDetail?nodeId=NODE06373119&language=ko_KR
  • Ko, H. J. & Lee, M. G. (2013). The effects of flow on stress and well-being in Korean college students: The moderating effect of flow and the mediating effect of coping strategies [article in Korean]. Korea Journal of Stress Research, 21(4), 283–292 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART001843458
  • Lee, D. Y., Park, J. K. & Choi, M. Y. (2017). The relation between stress of clinical practice and burnout among nursing students: The mediation effect of spiritual well-being [article in Korean]. The Journal of Korean Academic Society of Nursing Education, 23(3), 300–308 doi:10.5977/jkasne.2017.23.300 [CrossRef]
  • Lee, H. K., Lee, E. H., Hwang, S. T., Hong, S. H. & Kim, J. H. (2016). Psychometric properties of the Beck Anxiety Inventory in the community-dwelling sample of Korean adults. Korean Journal of Clinical Psychology, 35(4), 822–830 doi:10.15842/kjcp.2016.35.4.010 [CrossRef]
  • Lee, I. S. & Jeon, J. S. (2012). Clinical application of mindful eating for obese individuals [article in Korean. Korean Society for Meditation, 3(1), 51–64 http://www.newnonmun.com/?m=hnm_article&uid=48077&tran_lang=0&init=
  • Lee, J. E. (2005). The effects of self-complexity and self-efficacy on depression and perceived stress [Master's thesis]. Ajou University, Seoul, Korea.
  • Lynam, J. (2010, May20). North Korean torpedo sank South's navy ship. https://www.bbc.com/news/10129703
  • Meyer, E. G. & Wynn, G. H. (2018). The importance of US military cultural competence. In Roberts, L. W. & Warner, C. H. (Eds.), Military and veteran mental health (pp. 15–33). Springer New York. doi:10.1007/978-1-4939-7438-2_2 [CrossRef]
  • Montero-Marin, J., Collado-Navarro, C., Navarro-Gil, M., Lopez-Montoyo, A., Demarzo, M., Herrera-Mercadal, P., Barcelo-Soler, A. & Garcia-Campayo, J. (2019). Attachment-based compassion therapy and adapted mindfulness-based stress reduction for the treatment of depressive, anxious and adjustment disorders in mental health settings: A randomised controlled clinical trial protocol. BMJ Open, 9(10), e029909 doi:10.1136/bmjopen-2019-029909 [CrossRef] PMID:31597650
  • Park, S. G. (2012). Mediating effects of mindfulness on the relationship between smart-phone addiction and anxiety [article in Korean]. Journal of Rehabilitation Psychology, 23(3), 503–511 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002146693
  • Parswani, M. J., Sharma, M. P. & Iyengar, S. (2013). Mindfulness-based stress reduction program in coronary heart disease: A randomized control trial. International Journal of Yoga, 6(2), 111–117 doi:10.4103/0973-6131.113405 [CrossRef] PMID:23930029
  • Rice, V. J., Liu, B., Allison, S. C. & Schroeder, P. J. (2019). Mindfulness training offered in person and in a virtual world—Weekly self-reports of stress, energy, pain, and sleepiness among US military active duty and veteran personnel. Mindfulness, 10, 1815–1827.
  • 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(6), 1069.
  • Seol, J. H. & Park, S. H. (2015). The effect of stress and cognitive emotion regulation strategies on psychological health problems in Korean navy personnel: The moderated mediating effect of perceived social support [article in Korean]. Korean Journal of Clinical Psychology, 34(2), 553–578 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART001996647
  • Serpa, J. G., Taylor, S. L. & Tillisch, K. (2014). Mindfulness-based stress reduction (MBSR) reduces anxiety, depression, and suicidal ideation in veterans. Medical Care, 52(12, Suppl. 5), S19–S24 doi:10.1097/MLR.0000000000000202 [CrossRef] PMID:25397818
  • Song, Y. & Lindquist, R. (2015). Effects of mindfulness-based stress reduction on depression, anxiety, stress and mindfulness in Korean nursing students. Nurse Education Today, 35(1), 86–90 doi:10.1016/j.nedt.2014.06.010 [CrossRef] PMID:25066651
  • Song, Y. S., Lindquist, R. & Choi, E. J. (2010). Critical review of the effects of mindfulness-based stress reduction (MBSR) on stress and health-related quality of life (QOL) [article in Korean]. Journal Korean Academy Adult Nursing, 22(2), 121–129 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART001440071
  • Wang, I. S. & Cho, O. K. (2011). Effects of loving-kindness meditation on self-compassion, mindfulness, self-esteem, positive and negative affect, and perceived stress [article in Korean]. The Korean Journal of Health Psychology, 16(4), 675–690 doi:10.17315/kjhp.2011.16.4.003 [CrossRef]
  • Whang, J. W. (2015). Research of the depression level of a soldier and satisfaction of suicide prevention education [article in Korean]. Korean Academy of Military Social Welfare, 8(1), 53–67 https://www.earticle.net/Article/A250242
  • Yoon, B. (2018). The Navy takes care of the health of special workers. http://kookbang.dema.mil.kr/newsWeb/20180131/5/BBSMSTR_000000010024/view.do

Mindfulness-Based Stress Reduction Program for Republic of Korea Naval Fleet Crew

SessionTopicContentOther
1Eating meditationIntroduction; explanation of group rules and participation requirements Feel and eat dry grapes slowlyQuestions and feedback
2Breathing meditationSense of awareness to focus attention on breathHomework
3Body scanAwareness of body sensations, thoughts, and emotions through scanning the whole body with natural breathingHomework
4Yoga meditationFocus attention on a moving body with breathing meditationHomework
5Sitting meditationFacing and shaking, accepting, letting go, breathing meditation in a sitting position See each other, smile at each other, and feel each other by shaking handsHomework
6Yoga meditationFocus attention on a moving body with breathing meditationHomework
7Body scanAwareness of body sensations, thoughts, and emotions through scanning the whole body with natural breathingHomework
8Forgiveness meditationAttention to greater compassion for self, others, and humanityProgram review, reflection, and questionnaire

Homogeneity Test for General Characteristics and Dependent Variables Between Groups (N = 39)

Characteristicn (%)χ2/t or Zp Value
Experimental Group (n = 18)Control Group (n = 21)
Rank0.0870.994
  Soldier for duty11 (61.1)15 (71.4)
  Professional soldier7 (38.9)6 (28.6)
Religious2.580.256
  Yes10 (55.6)11 (52.4)
  No8 (44.4)10 (47.6)
Education1.2450.763
  College or higher5 (27.8)5 (23.8)
  High school13 (77.2)16 (76.2)
Regular exercise1.230.332
  Yes8 (44.4)15 (71.4)
  No10 (55.6)6 (28.6)
Drink alcohol2.26a0.548
  Yes7 (38.9)18 (85.7)
  No11 (61.1)3 (14.3)
Smoke1.1120.244
  Yes6 (33.3)9 (42.9)
  No12 (66.7)12 (57.1)
Stress management required0.12a0.261
  Want15 (83.3)17 (81)
  Do not want3 (16.7)4 (19.0)
Mean (SD)
Ageb (year)26.64 (7.97)26.25 (8.69)0.4290.882
Duration for servicec (months)32.55 (10.25)29.46 (11.52)0.0670.051
Perceived stress (PSSd)33.15 (7.15)32.71 (9.52)0.5540.684
Depression (CES-De)14.28 (9.80)14.14 (10.75)0.823h0.421
Anxiety (BAIf)10.55 (8.73)9.59 (7.45)1.0250.115
Psychological well-being (PWBSg)132.92 (6.20)140.75 (4.52)−3.5810.682

Comparison of Pretest and Posttest Dependent Variables Between Groups (N = 39)

CharacteristicMean (SD)t or Zp Value
PretestPosttestDifference (Pre–Post)
Perceived stress (PSSa)−8.240.015
  Experimental group33.15 (7.15)30.04 (3.77)−3.11 (2.32)
  Control group32.71 (9.52)31.58 (6.97)−1.13 (1.38)
Depression (CES-Db)−2.06e0.066
  Experimental group14.28 (9.80)13.52 (2.33)−0.76 (4.21)
  Control group14.14 (10.75)14.15 (1.25)0.01 (1.88)
Anxiety (BAIc)−0.250.041
  Experimental group10.55 (8.73)8.95 (5.23)−1.60 (2.50)
  Control group9.59 (7.45)9.55 (8.59)−0.04 (1.74)
Psychological well-being (PWBSd)2.580.023
  Experimental group132.92 (6.20)134.50 (5.44)1.58 (2.59)
  Control group140.75 (4.52)141.41 (9.60)0.66 (6.83)
Authors

Dr. Kang is Assistant Professor, College of Nursing, Kyungbok University, Namyangju-si, Gyeonggi-do, Ms. Seo is Colonel, Naval Nurse Officer, Navy Headquarters, Gyeryong-si, Chungcheongnam-do, and Ms. Hwang is Major, Naval Nurse Officer, Maritime Medical Center, Changwon-si, Gyeongsangnam-do, Republic of Korea.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Hyekyung Kang, PhD, RN, Assistant Professor, College of Nursing, Kyungbok University, Postal No. 12051, 425, Kyeongbokdae-ro, Jinjeop-eup, Namyangju-si, Gyeonggi-do, Republic of Korea; email: hkkang@kbu.ac.kr.

Received: February 28, 2020
Accepted: June 23, 2020

10.3928/02793695-20201013-06

Sign up to receive

Journal E-contents