This project investigates the impact of Daoist Zhanzhuang (sometimes spelled as Chan Chuang) on human flourishing, and explores the physiological, psychological, and spiritual mechanisms. This study will be a two-arm randomized controlled trial, with mixed-methods and repeated-measures assessment of outcome variables. The two arms will include an active control condition (i.e., sham wall squat) and the Daoist Zhanzhuang condition. Outcome variables will include physiological measures of heart rate variability and inflammatory biomarkers, psychological scales of human flourishing variables, phenomenological interviews of mystical experiences, and daily ecological momentary assessment of human flourishing and mysticism. Randomly assigned into two conditions, 120 participants will complete a three-week intensive practice phase with 9 in-person sessions, followed by a nine-week self-guided practice phase with 4 in-person check-in sessions, and 3 follow-up practice and assessment sessions. Complete assessment (physiological measures, psychological scales, and phenomenological interviews) will be administered at five time points: T1 at about two weeks before the intervention, T2 at the end of the three-week intensive practice, T3 at the end of the 3-month intervention, T4 at the 6-month follow-up, and T5 at the 12-month follow-up. In addition, daily ecological momentary assessment of flourishing variables and practice-induced experiences will be administered daily after the practice for the entire 3-month intervention period.
Zhanzhuang, "standing like a tree," is a standing meditation rooted in Daoism, with its earliest form documented on a Chinese silk manuscript called Daoyintu, dating back two thousand years. By aligning the human body, Zhanzhuang promotes the circulation and accumulation of qi, fostering enhanced energy, health, and healing. In Daoist theology, qi acts as an intermediary connecting physical energy (jing) and the spirit (shen). Zhanzhuang serves as a foundational practice that establishes conditions for the convergence of the physical and non-physical aspects of human being. One of the greatest Daoist spiritual achievements lies not in transcending the body but in the harmonious integration of body and spirit. While many definitions of spirituality emphasize transcendence and non-physicality, the study of Zhanzhuang suggests that immanence and embodiment are equally significant in defining spirituality. Data from eight clinical trials demonstrate that Zhanzhuang can improve physical endurance, reduce fatigue, enhance body awareness and emotional regulation, and promote better quality of life. However, none of the studies included an active control group, so it is difficult to dissect the effects from merely extra exercise. Overall, existing studies have construed Zhanzhuang (or more generally qigong) as an out-of-the-box alternative behavioral medicine approach, without trying to understand why and how it works. None have examined its spiritual underpinnings. This decontextualized scholarly work can be a disservice to both the Daoist community, where Zhanzhuang practice originates and is taught, and to the public they serve. Zhanzhuang could offer more than being another complementary therapy. Among many benefits, the practice shows that there is a spiritual aspect that resides within one's physical body, and the spirit and the body can join each other to make genuine flourishing possible. In addition to documenting the effects of Zhanzhuang on human flourishing, the current study will show why and how Zhanzhuang works. Primary hypotheses posit that Zhanzhuang fosters enhanced energy, resilience, and healing. These effects will be evidenced through physiological changes, such as increased parasympathetic activity and improved immune functioning, as well as psychological responses, including elevated vitality, enhanced stress coping abilities, and overall well-being. These effects may be partially attributed to an augmented interoceptive awareness and a deepened psychological insight into previously avoided emotions. Furthermore, the study explores the potential moderation of these effects by acquired mystical experiences, serving as indicators of spiritual progress within the practice of Zhanzhuang. Lastly, the research will delve into the trajectory of change and within-subject causal processes, examining the relationship between mystical experiences and human flourishing over the 3-month practice period through intensive longitudinal measures.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
DOUBLE
Enrollment
120
Each session of practice will last 30 minutes, and participants are expected to participate every day for 3 months. During the initial 3 weeks, participants will engage in in-person sessions 3 times a week. On non-session days, they can choose to either attend a Zoom practice session with the coach or submit a recording of their individual practice for fidelity check. In Week 4, participants will attend an in-person session for both practice and assessment. Over the subsequent 8 weeks, participants will either attend in-person or Zoom sessions, with a total of 3 check-in sessions.
Same as the Zhanzhuang group.
University of North Carolina at Charlotte
Charlotte, North Carolina, United States
RECRUITINGIncreased heart rate variability
HRV will be collected using the H10 wear link and chest band (Polar Electro, Kempele, Finland) during several study activities, including 5 minutes of normal breathing at rest, a 5-minute paced-breathing task and during the 30-min intervention practice period. The normal and paced breathing assessments will occur at all data collection visits to estimate basal autonomic nervous system functioning.
Time frame: Day 1 in-person session, baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Decreased inflammatory biomarker CRP
Saliva will be collected via approved methods (IBC BIO-23-0032). Salivary inflammatory biomarkers will be assessed in-house at the Biobehavioral Core Lab. Salivary C-reactive protein (sCRP) will be quantified using commercially available enzyme immunoassays according to manufacturer instructions. CRP is a protein produced by the liver in response to the cell mediated biomarker cytokines.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Decreased perceived stress
The 4-item Perceived Stress Scale measured on visual analogue ranging from 0 to 100, higher scores suggesting worse outcome.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Increased resilience
Brief Resilience Scale measured on visual analogue ranging from 0 to 100, higher scores suggesting better outcome.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Decreased fatigue
The 10-item Fatigue Assessment Scale measured on visual analogue ranging from 0 to 100, higher scores suggesting worse outcome.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Increased vitality
The 6-item Subjective Vitality Scale measured on visual analogue ranging from 0 to 100, higher scores suggesting better outcome.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Increased mystical experiences
The brief 8-item Mysticism Scale measured on visual analogue ranging from 0 to 100, higher scores suggesting better outcome.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Increased overall human flourishing
The 12-item Human Flourishing Measure measured on visual analogue ranging from 0 to 100, higher scores suggesting better outcome.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Decreased inflammatory biomarker cytokine IL-1ß
Saliva will be collected via approved methods (IBC BIO-23-0032). Salivary inflammatory biomarkers will be assessed in-house at the Biobehavioral Core Lab. Plates will be read with a QuickPlex SQ 120 imager and data analyzed using the Discovery Workbench 4.0 for cytokines, including Interleukin (IL)-1ß.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Decreased inflammatory biomarker cytokine IL-6
Saliva will be collected via approved methods (IBC BIO-23-0032). Salivary inflammatory biomarkers will be assessed in-house at the Biobehavioral Core Lab. Plates will be read with a QuickPlex SQ 120 imager and data analyzed using the Discovery Workbench 4.0 for cytokines, including Interleukin (IL)-6.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Decreased inflammatory biomarker cytokine TNF-a
Saliva will be collected via approved methods (IBC BIO-23-0032). Salivary inflammatory biomarkers will be assessed in-house at the Biobehavioral Core Lab. Plates will be read with a QuickPlex SQ 120 imager and data analyzed using the Discovery Workbench 4.0 for cytokines, including TNF-a.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Increased interoceptive awareness
The subscales Noticing, Attention Regulation, Emotional Awareness, Self-Regulation, and Body Listening of Multidimensional Assessment of Interoceptive Awareness - 2 measured on visual analogue ranging from 0 to 100, higher scores suggesting better outcome.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Reduced depression
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Patient-Reported Outcomes Measurement Information System measured on visual analogue ranging from 0 to 100, higher scores suggesting worse outcome.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).
Reduced anxiety
Patient-Reported Outcomes Measurement Information System measured on visual analogue ranging from 0 to 100, higher scores suggesting worse outcome.
Time frame: baseline T1 (before the intervention), the end of three-week intensive practice (T2), the end of the 3-month intervention (T3), the 6-month follow-up (T4), and the 12-month follow-up (T5).