Journal of Personality and Social Psychology Copyright 1989 by the American Psychological Association, Inc.

1989, Vol. 57, No. 6,950-964 0022-3514/89/J00.75

Transcendental Meditation, Mindfulness, and Longevity:

An Experimental Study With the Elderly
Charles N. Alexander Ellen J. Langer and Ronnie I. Newman
Maharishi International University Harvard University

Howard M. Chandler John L. Davies

Maharishi International University University of Maryland, College Park

Can direct change in state of consciousness through specific mental techniques extend human life
and reverse age-related declines? To address this question, 73 residents of 8 homes for the elderly
(mean age = 81 years) were randomly assigned among no treatment and 3 treatments highly similar
in external structure and expectations: the Transcendental Meditation (TM) program, mindfulness
training (MF) in active distinction making, or a relaxation (low mindfulness) program. A planned
comparison indicated that the "restful alert" TM group improved most, followed by MF, in contrast
to relaxation and no-treatment groups, on paired associate learning; 2 measures of cognitive flexibil-
ity; mental health; systolic blood pressure; and ratings of behavioral flexibility, aging, and treatment
efficacy. The MF group improved most, followed by TM, on perceived control and word fluency.
After 3 years, survival rate was 100% for TM and 87.5% for MF in contrast to lower rates for other
groups.

William James (1890), who introduced consciousness to
American psychology, contended that beyond the range of nor-
mal waking consciousness lies the possibility of special or ex-
ceptional states that are completely "discontinuous" with dis-
cursive thought. According to James (1902/1960), though sta-
tistically rare, these states of heightened awareness could be
elicited under specifiable conditions and could be highly posi-
tive and pervasive in their influence on thought and behavior.
He argued for the "adaptation" value of these experiences and
challenged scientific psychology to rigorously examine their oc-
currence. With the onset of the behaviorist revolution, however,
this challenge went largely unheeded (Hilgard, 1980). Study of
exceptional states proved problematic because these states oc-
cur rarely, are difficult to describe, and are confounded with
expectation and belief. Furthermore, the problem of self-selec-
tion makes it difficult to determine to what degree experiences
of exceptional states foster exceptional people or vice versa.
Nevertheless, recently, researchers have again begun to recog-
nize and investigate these phenomena (e.g., Alexander, Davies,
et al., in press; Alexander, Druker, & Langer, in press; Csikszent-
mihalyi, 1982; Hilgard, 1980; Hunt, 1989; Kramer, in press;
Pascual-Leone, in press-a, in press-b; Pribram, 1986; Shapiro
& Walsh, 1984; Wilber, Engler, & Brown, 1986).
We are grateful to the residents and staff at all participating homes
(including Baptist Home of Massachusetts, Carlton-WUliard Homes,
Inc., Morville House, Mount Pleasant, Neville Manor, Rogerson House,
and Somerville Home for the Aged) for their cooperation, and to the
Society for the Psychological Study of Social Issues and the National
Institute of Mental Health for providing funds for the project.
Charles N. Alexander, Howard M. Chandler, and John L. Davies were
at Harvard University when the data for this article were collected.
Correspondence concerning this article should be addressed to
Charles N. Alexander, Department of Psychology, Maharishi Interna-
tional University, Fairfield, Iowa 52556.
Transcendental Meditation and Transcendental
Consciousness
James (1902/1960, p. 386) suggested that exceptional states
could be systematically cultivated, and he pointed particularly
to the ancient Indian tradition of yoga as a source of such prac-
tices. He thus anticipated a promising research area: the experi-
mental investigation of meditation, as particularly found in the
growing body of research on the correlates and consequences of
the Transcendental Meditation (TM) program (e.g., Alexander,
Cranson, Boyer, & Orme-Johnson, 1987; Dillbeck & Orme-
Johnson, 1987; Orme-Johnson & Farrow, 1977; Wallace,
1970). Maharishi Mahesh Yogi (Maharishi, 1969), who intro-
duced TM as a simple mental technique derived from the Vedic
tradition of India, proposed that through this procedure, a
"fourth major state of consciousness" can be regularly experi-
enced. This fourth state is referred to in Maharishi's Vedic psy-
chology as transcendental consciousness (Maharishi, 1969;
Orme-Johnson, 1988) because^! is said to transcend or be dis-
continuous with the three ordinary states of waking, dreaming,
and sleep, as typically described conceptually and psychophysi-
ologically (e.g., see Natsoulas's sixth definition of "normal"
waking consciousness: 1978, p. 912, and 1983, p. 49; see also,
Gackenbach, 1987; Rechtschaffen & Kales, 1968).
This state is also traditionally described as "pure" conscious-
ness (Dillbeck, 1983; Maharishi, 1969) in that it is said to be
experienced as a purely content-free, silent state of awareness.
Although devoid of specific thought content, pure conscious-
ness is not experienced as emptiness (Knibbeler, 1985; cf., Nat-
soulas's concern, 1983, p. 29). Rather, in this state, knower,
known, and process of knowing are said to converge in one uni-
fied field of consciousness (Maharishi, 1986), in which subjects
report a self-referral state of being aware simply of awareness
itself (Alexander, Davies, et al. in press; Dillbeck & Alexander,
in press). In a series of studies with long-term meditators, Far-

950
 TRANSCENDENTAL MEDITATION, MINDFULNESS, AND LONGEVITY
row and Hebert (1982) and Badawi, Wallace, Orme-Johnson,
and Rouzere (1984) found that experiences of pure conscious-
ness (as indicated by subsequent button press during TM) are
highly correlated with elevated bilateral and homolateral alpha
electroencephalographic (EEG) phase coherence in frontal and
central regions (suggesting a more integrated or heightened
awareness), virtual respiratory suspension without compensa-
tory hyperventilation, and decreased heart rate (indicating a
quiescent physiological condition).1 These and earlier studies
led researchers to propose that during TM, deep rest and
heightened awareness are experienced as complementary as-
pects of a unified state of "restful alertness," which is especially
distinct during reported subperiods of pure consciousness (Al-
exander, Cranson, Boyer, & Orme-Johnson, 1987; Wallace,
1970).
In addition, research indicates that this state of restful alert-
ness may enhance postmeditation cognitive and physiological
adaptive efficiency (e.g., Alexander, 1982; Dillbeck, 1982; Dill-
beck & Orme-Johnson, 1987; Goleman & Schwartz, 1976;
Orme-Johnson, 1973,1987). This suggests that pure conscious-
ness may be directly experienced and of practical significance.
In contrast, Kant's (1787/1965) concept of a transcendental ego
was claimed to be an epistemological necessity but not subject
to direct experience—a claim with which the pragmatist James
(1890, pp. 360-373) had difficulty.
Nevertheless, some researchers have challenged whether
meditation produces an exceptional state of consciousness. In-
stead, they have suggested that the correlates and consequences
of meditation may be accounted for by simply resting with eyes
closed or expectation of positive outcome (e.g., Holmes, 1984;
Smith, 1976). However, Dillbeck and Orme-Johnson (1987)
pointed out that research reviews (such as Holmes, 1984) that
rely on a "vote-counting" narrative approach typically lack
sufficient statistical power to detect the presence of even rela-
tively large effect size differences (see Hedges & Olkin, 1980).
Instead, using quantitative meta-analysis (see Glass, McGaw. &
Smith, 1981), they found that the effect size for TM was approx-
imately twice as large as for simple eyes-closed rest across sev-
eral indicators of somatic arousal reduction. Furthermore, they
cited a number of findings (e.g., improved reflex response: War-
shal, 1980) suggesting that greater alertness is equally funda-
mental to the effects of TM.
Hence, an examination of the comparative effects of TM and
relaxation procedures on subsequent adaptability and alert-
ness, rather than only on somatic arousal reduction during the
practice (cf., Holmes, 1984) or lower anxiety and tension after-
ward (Smith, 1976) may provide an important test of the pro-
posed distinction between them.
Mindlessness and Mindfulness
As James (1890) originally pointed out, waking conscious-
ness is not in itself a homogeneous state. Langer (1982, 1989a,
1989b) has recently identified what appear to be at least two
major modes within the ordinary range of waking conscious-
ness: mindlessness and mindfulness. According to Langer
(1982, 1989a, 1989b) many individuals spend substantial por-
tions of their waking day in a low-mindful (mindless) state.
Mindlessness is described as a distinct, molar style of cognitive
951
functioning in which the individual processes cues from the en-
vironment in a relatively automatic but inflexible manner, with-
out reference to novel (or simply other) aspects of these cues—
one deals with an already constructed environment (Langer &
Piper, 1987). By default, old categories and previously made dis-
tinctions are relied on uncritically, leading to rigid behavior that
is rule governed rather than rule guided. It is not that mindless-
ness necessarily involves the complete absence of cognition, but
rather, that information is processed automatically through
preformed categories which are, themselves, no longer accessi-
ble for conscious consideration.
In contrast, mindfulness is described as a general style or
mode of functioning through which the individual actively en-
gages in reconstructing the environment through creating new
categories or distinctions, thus directing attention to new con-
textual cues that may be consciously controlled or manipulated
as appropriate. According to Langer (1982, 1989a, 1989b), the
distinctions made can be major or minor; what is important is
that they are mindfully drawn. There is growing evidence for
the adaptive influence of mindful functioning on behavior and,
conversely, for the deleterious effects of excessive mindlessness
(e.g., Langer, 1982, 1989a, 1989b; Langer, Perlmuter, Chano-
witz, & Rubin, 1988; Langer & Piper, 1987).
Transcendental Meditation, Mindfulness, and Longevity
Given the potential significance of both transcendental con-
sciousness and mindfulness-mindlessness for an expanded the-
ory of consciousness or cognition, it is important to determine
whether techniques for their induction do, in fact, produce dis-
tinctive correlates and consequences. Elsewhere, we have re-
cently addressed the issue of the psychophysiological and sub-
jective correlates of pure consciousness (Alexander & Boyer,
1989; Alexander, Cranson, Boyer, & Orme-Johnson, 1987; Al-
exander, Dixon, Chandler, & Davies, in press; Alexander & Lar-
imore, in press). Though the current study will also consider the
subjective correlates of both TM and mindfulness, its primary
purpose is to evaluate whether these procedures produce sig-
nificant consequences for the psychological and biological adap-
tation of the organism.
Possibly the most far-reaching claim of these procedures is
1
Electroencephalographic (EEG) coherence is defined as the degree
of phase relationship between Fourier frequency components of two
EEG signals (Gevins & Schaffer, 1980). High correlations also have been
observed between elevated frontal alpha EEG coherence during TM
and several objective indicators of enhanced alertness or awareness—
including faster paired H-reflex recovery time during the practice
(Haynes, Hebert, Reber, & Orme-Johnson, 1977) and measures of fluid
intelligence, verbal creativity, and concept formation outside of the
practice (e.g., Dillbeck & Veslev, 1986; Hernandez, Arenander, & Boyer,
1988; Orme-Johnson & Haynes, 1981). Interestingly, although several
authors (e.g., Ornstem, 1977) initially suggested that experience during
meditation may relate to right intrahemispheric "syncretic" functions
(cf., Tucker, 1981), significant assymetries between hemispheres in EEG
power or coherence have not been found during TM (e.g., Orme-John-
son&Haynes, 1981;Bennet&Trinder, 1977). Instead, increased inter-
hemispheric coherence observed by some researchers suggests that TM
(especially during pure consciousness experience) may be a more
"global" neurophysidogical phenomenon (e.g., Badawi et al., 1984).
952 ALEXANDER, LANGER, NEWMAN, CHANDLER, DAVIES
that they can not only enhance adaptive efficiency over the short
term but literally extend human life—an ultimate test of in-
creased adaptation. Several studies suggest that TM may be
effective in reducing negative outcomes associated with aging.
Wallace, Dillbeck, Jacobe, and Harrington (1982) found that,
controlling for age and diet, long-term meditators were substan-
tially younger biologically than their chronological age (mean
chronological age was 55 years) on the Morgan scale (Morgan
& Fevens, 1972) compared with short-term meditators, who
were in turn younger biologically than controls or population
norms. Similar results were obtained for an even younger popu-
lation and were confirmed in a longitudinal study showing fur-
ther reduction of biological age in the same meditating subjects
over an 18-month period (Toomey, Chalmers, & Clements, in
press). Correlations between length of time meditating and im-
provement on a number of age-related psychological and physi-
ological variables have also been reported (e.g., Jedrczak, 1986;
Wallace, Silver, Mills, Dillbeck, & Wagoner, 1983). In a field
study of health insurance utilization over a 5-year period
(Orme-Johnson, 1987), TM participants had approximately
half as many hospitalizations and outpatient visits as matched
comparison groups with the same insurance carrier. This con-
trast was most extreme among older adults. The apparent bene-
ficial effect on aging of the restful alertness experienced during
TM may be jointly due to the role of deep rest in counteracting
"wear and tear," and of increased mental stimulation for pre-
venting "atrophy" of functions (e.g., Rosenfeld, 1976; Timiras,
1978).
Nevertheless, as yet there have been no prospective experi-
ments directly evaluating the effects of TM (or other forms of
meditation) on an advanced elderly population, which would
allow direct assessment of longevity. Moreover, no prior study
on TM and aging has systematically controlled for all major
confounding variables to which apparent age-related improve-
ments might be attributed: self-selection, expectation of results,
attention, demand characteristics, time spent resting with eyes
closed, and degree of subjects' perceived control over treatment.
Several field studies have also provided evidence for the bene-
ficial effects of mindful functioning for the elderly (Langer,
Beck, Janoff-Bulman, & Timko, 1984; Langer et ah, in press;
Langer, Field, Pachas, &Abrams, 1989; Langer & Rodin, 1976;
Langer, Rodin, Beck, Weinman, & Spitzer, 1979; Rodin &
Langer, 1977). These studies found that increasing cognitive de-
mands made on the institutionalized elderly encouraged in-
creased mindful information processing and resulted in im-
provement on measures of physical and psychological health.
Moreover, mortality rates were reduced relative to those of con-
trol groups. In a highly routinized environment, with few op-
portunities for stimulation, the need to cultivate a mindful ori-
entation may become acute. In contrast, extreme reliance on
mindless information processing in such environments can
yield negative consequences—including poorer judgment and
performance and even premature death (Piper & Langer, 1984).
These mindfulness studies, however, are subject to some of the
same potential confounds found in some of the TM studies—
for example, degree of perceived control over treatment (Rodin
& Langer, 1977). Furthermore, although these studies used
treatments that readily allowed for a mindfulness interpreta-
tion, the mindfulness prediction was assessed largely retrospec-
tively.
The current prospective experiment examines the prediction
that change in state of consciousness or cognitive mode through
the TM program and mindfulness training, respectively, will
reverse age-related declines and enhance longevity in the ad-
vanced elderly, in comparison to a mental relaxation (low mind-
ful) and a no-treatment comparison group. Participants are
randomly assigned to a no-treatment condition or to one of the
three experimental procedures, designed to be highly similar in
their external structure (following the standardized format for
teaching TM) and in expectation-fostering conditions and,
hence, differing only in their purely mental elements.
The mindfulness training procedure (MF) was developed
with the aim of directly fostering a mindful style of information
processing through active engagement with novelty. The TM
program is said to free attention from the constraints of lan-
guage-based thought, regardless of its degree of novelty (Alex-
ander, Davies, et ah, in press). During TM, the thinking process
is said to be transcended, as awareness becomes gradually set-
tled or de-excited, and is eventually experienced as free of all
content (thoughts and percepts), remaining silently awake
within itself. With repeated exposure, this self-referral state is
said to gradually become maintained after the practice (Mahar-
ishi, 1986). To the extent that awareness has become differenti-
ated or freed from conceptual boundaries during daily activity,
incoming stimuli may no longer occasion rigid (mindless) re-
sponse sets during activity. The environment is viewed afresh,
so that stimuli can be associated with different responses as ap-
propriate, and adaptability can be enhanced. This may be con-
trasted with the decline in flexibility commonly associated with
aging (Chown, 1961). Thus, although TM is designed to induce
a more settled state during the practice, it also appears to be an
effective procedure for enhancing alertness and general pre-
paredness for engagement in more adaptive and potentially
mindful interaction afterlhe practice.
The mental relaxation procedure (MR) was developed to test
the view that TM is reducible to simple relaxation, practiced
while sitting with eyes closed, with an expectancy component
(Holmes, 1984; Smith, 1976). From the perspective of mindful-
ness theory, however, passive repetition of the already familiar
or overlearned in such relaxation procedures (see the Treat-
ments section)—in the absence of a transcending or alerting
component—might be expected to be an exercise in low mind-
fulness.
Mindfulness theory predicts better results for mindfulness
training and TM than for the relaxation or no-treatment condi-
tions. The relative effectiveness of TM and MF treatments is
less critical from the perspective of mindfulness theory, because
the MF procedure, although ideal for the purposes of this com-
parative study, does not represent an optimal program of mind-
fulness training, in that it parallels the TM format, which pre-
cludes active engagement of the external environment during
the practice.
According to Maharishi's Vedic psychology, however, because
TM incorporates an especially deep state of rest with enhanced
alertness as complementary aspects of a distinctive self-referen-
tial mode of functioning (particularly during subperiods of
pure consciousness), it should have greater impact than either
 TRANSCENDENTAL MEDITATION, MINDFULNESS, AND LONGEVITY
the relaxation or mindfulness condition alone, each of which
focuses on only one of these dimensions within the ordinary
range of waking state cognitive activity.
Taking into account both the Vedic and mindfulness perspec-
tives, it is predicted (in the context of this experiment) that TM
will produce the largest treatment effects, followed by mindful-
ness, which will in turn produce larger effects than both the
relaxation and no-treatment conditions.
Contrary to this hypothesis, an extreme expectancy or pla-
cebo orientation (Smith, 1976) would hold that all three treat-
ments should give rise to similar positive results compared to
the no-treatment condition. According to the view that TM is
simply a relaxation procedure (Holmes, 1984), the TM and MR
treatments should produce similar results in contrast to the MF
treatment and the no-treatment (NT) conditions.
Method
Subjects
Subjects were 73 volunteers (60 women and 13 men) from six retire-
ment homes, one nursing home and one apartment complex for the
elderly. Mean age was 80.7 years. After pretesting, 77 subjects were ini-
tially assigned to one of the four conditions by stratified random assign-
ment, excluding only those subjects who were clearly unable to remem-
ber instructions from day to day. Twice as many subjects were assigned
to each treatment as were assigned to no treatment. An equal propor-
tion of subjects who initially scored normal, borderline, or deteriorated
on the Dementia Screening Test DST (Farmer et al., 1987) were ran-
domly assigned to each condition within each of the eight homes. After
assignment to specific treatment programs, 4 subjects dropped out prior
to actual instruction (1 in TM, 2 in MF, and 1 in MR). Final group sizes
at pretest were as follows: TM, 20; MF, 21; MR, 21; and NT, 11). For
some comparisons, numbers were reduced where subjects failed to com-
plete specific tasks. After 36 months, when survival rate was assessed,
data were unavailable for a few subjects who changed residence—thus
reducing the NT group's size still further (n = 8). When cell sizes are
small, reliability of frequency estimates is reduced. In order to supple-
ment NT size, the 4 assigned but untreated subjects along with the 10
subjects rated as normal or borderline on the DST (but not assigned
after pretesting because of scheduling constraints) were also included
(« = 22). This procedure could only be applied in the case of survival
rate because presence of subjects at posttest was not required for its
determination.
One-way analyses of variance revealed no differences among the four
groups in gender, age, length of residence, or education. Also there was
no difference in mental or physical health at pretest as indicated by the
rating of nursing home staff, overall DST score, self-rating depression
score, or level of systolic blood pressure.
Procedure
Orientation and Assessment
Two project administrators met with residents of each home and ex-
plained that as part of a research project they would be offered simple
mental techniques that were thought to be beneficial for the mental and
physical well-being of other age groups, and that the project was an at-
tempt to document the value of these programs for an elderly popula-
tion. No deception was involved, in that there were research literatures
supporting the construction of each procedure. The programs to be
offered were described in general terms, and interested residents were
953
invited to attend a second meeting during which testing procedures
were explained and informed consent forms signed.
Most tests were individually administered, generally over four I'/i
hour sessions, following the same order of tests for all subjects. Pretest-
ing took place prior to assignment of subjects to the four treatment
conditions; posttesting took place after a 12-week treatment period, and
included some additional measures. Test administrators and retirement
home staff were blind to subjects' assigned programs. Staff ratings of
mental health were assessed after an 18-month interval, and longevity
(survival rate) after 36 months.
Treatments
The three treatment conditions were similar structurally. They
differed only in terms of the precise mental procedure to be followed
while sitting with eyes closed. Each treatment was introduced, taught,
and practiced with the use of standard materials and procedures care-
fully designed at each step to match the form, complexity, and expecta-
tion-fostering aspects of those used by the International Meditation So-
ciety and affiliated organizations teaching the TM program (following
Smith, 1976). Furthermore, subjects in each condition were given the
same expectations for positive outcomes in the areas of mental function-
ing and physical health.
After instruction, subjects met individually with their instructors for
about Vi hr each week to verify according to standard procedures the
correctness and regularity of practice. Subjects were instructed to prac-
tice their program for 20 min twice daily (morning and afternoon) sit-
ting comfortably in their own room with eyes closed, and using a time-
piece to ensure correct length of practice. They were also requested not
to reveal details of their program to anyone outside their own group.
The distinctive features of the three treatments were as follows:
The Transcendental Meditation technique. The TM technique was
taught according to standard procedures, except that subjects did not
pay their own course fees. The meditation procedure is described as
allowing the attention effortlessly to turn "inwards towards subtler levels
of a thought until the mind transcends the subtlest state of thought and
arrives at the source of thought," experienced as periods of content-free
pure consciousness (Maharishi, 1969, p. 470). The technique involves
both a mantra, or meaningless sound selected for its value in facilitating
the transcending or settling-down process, and a specific procedure for
using it mentally without effort, again to facilitate transcending. The
practice has been described in detail by Maharishi (1969), Roth (1987),
and Wallace (1987) and is said not to require any changes in life style
or belief system.
Mindfulness training. The mindful, guided attention technique in-
volved both a structured word-production task and an unstructured
creative mental activity task. The word-production exercise required
subjects to think of a word, take its last letter and find a new word begin-
ning with that letter. The technique began easily enough. However, sub-
jects were not permitted to use any word more than once per session,
and the level of demand of the program was continually increased by
the instructors to keep it novel and hence more mindfulness inducing.
After the technique was mastered, subjects were instructed to produce
words relating to specific categories (e.g., animals, springtime, foods,
places).
The creative mental activity task did not specify rules for thinking
nor particular target thoughts. Rather, the individual was asked to think
about any topic in new and creative ways. Illustrations were provided of
such activity: for example, thinking of unusual uses for common ob-
jects, or picking a controversial topic and arguing the side contrary to
one's established opinion. Subjects were asked not to lapse into day-
dreaming but rather to actively direct their thinking during the process.
They were instructed to produce words for approximately 6 min, en-
gage in creative mental activity for 6 min, and close with another 6 min
of word production followed by 2 min of rest.
954 ALEXANDER, LANGER, NEWMAN, CHANDLER, DAVIES
Mental relaxation. Consistent with the view that TM is equivalent to
any of a range of relaxation or meditative techniques (Holmes, 1984;
Smith, 1976), the cortical deaclivation technique replaces the vehicle of
attention (the mantra or sound used in TM) with a familiar verse,
phrase, brief song, or poem chosen by the subject. Instructions for the
use of the mental stimuli incorporate only what are considered essential
elements of TM, as analyzed by Smith (1976) and others—time spent
sitting with eyes closed, expectation of benefit, instructions for general
relaxation, sustained voluntary regulation of attention, "passive" men-
tal attitude, and repetition of noncognitively arousing (relatively simple)
mental stimuli. However, this approach holds as nonessential the sound
quality of the mantra and the specific procedure for using it, both of
which, according to Maharishi's Vedic psychology (Maharishi, 1969)
especially foster restful alertness and, ultimately, the state of pure con-
sciousness.
The MR technique required that subjects sit comfortably with eyes
closed, relax for a few minutes, and then silently repeat to themselves
the familiar and brief mental stimuli that they found pleasant or com-
fortable. They were asked to continue repeating the same item through-
out each sitting, though after each week of practice, if a subject wished,
he could select another item. The last 2 min of each session were again
spent just sitting easily with eyes closed, without further repetition.
No-treatment (delayed start) control. Subjects in the NT group were
informed that their valuable role in the research was as a comparison,
delayed-start group. They were pre- and posttested and had no other
exposure to project personnel until after the experiment, when they
were given the opportunity to learn any of the three treatment pro-
grams.
Instructors
All 21 instructors (7 for each of the three treatment conditions) were
volunteers, matched for gender, race, and level of education (graduate
students, professionals, or college seniors) and of comparable age and
religious and socioeconomic background. Instructors for the TM pro-
gram had been trained by the International Meditation Society over a
minimum period of 3 months. Instructors for the mindfulness training
and mental relaxation conditions were selected on the basis of their ma-
turity and commitment to helping the elderly and were trained by proj-
ect administrators. The training format was identical for these two treat-
ments. They were given the rationale for their treatment program, sup-
ported by a teaching manual and charts describing claimed
physiological correlates of the practice, the projected results of each
treatment being the same as those described for the TM group (in accor-
dance with research and professional opinion in favor of each). Training
sessions were held over a period of 2 months, and extensive home study
of teaching manuals and preparation of materials was required so that
instructors could pass a final exam to verify their competence and con-
fidence in presenting each of the steps of instruction (cf., Smith, 1976).
Although instructors knew that several treatments were being com-
pared, they were blind to the content of other treatment conditions.
Through exposure to selected theoretical and research literature that
supported their treatment, they were led to believe that it was favored
at least as much as the other programs. Instructors signed agreements
not to reveal the content of their own treatment outside the guidelines
given for teaching. Furthermore, they were blind to the test instruments
being used. All instructors were highly motivated, as evidenced by their
willingness to devote considerable time without pay over many weeks
in preparation, teaching, and follow-up treatment.
The effectiveness of the instructors and their equivalence in arousing
subjects' expectations were assessed through evaluations of subjects' ex-
pectancy of benefit at the time of instruction and subjects' rating of
instructor competence and likeableness at the time of posttest. Further-
more, dropouts from the study were administered a questionnaire to
determine the contribution of quality of instructors to their decision to
drop out.
Dependent Variables
Cognitive Functioning
Dementia Screening Test. The DST (Phase 1), a test battery devel-
oped for the Framingham Heart Study (Fanner et al., 1987), provides
an operational definition of dementia that can be used to assess the func-
tioning of elderly subjects. The DST was used primarily for matching
subjects on levels of dementia for the purpose of stratified random as-
signment of subjects to treatments at pretest. DST score in the present
study was defined as the mean z score across all subtests completed by
each subject (DST administered at both pre- and posttest).
Associate Learning subtest. Scores on the Associate Learning subtest
of the DST (taken from the Wechsler Memory Scale—difiicult word
pairs only, Wechsler, 1945) were examined separately in light of research
indicating improved learning performance associated with both TM
(Dillbeck, 1982) and mindfulness (Langer et al., 1979), in contrast to
studies indicating decline in performance on paired associate learning
with aging (Arenberg & Robertson-Tchabo, 1977; pre- and posttest).
Word Fluency sublest. Scores on the Word Fluency subtest of the
DST (taken from Benton & Hampsher, 1978, the Multilingual Aphasia
Examination) are also examined separately. The task is closely related
to the word-production task, which was basic to the mindfulness train-
ing procedure, and constitutes a minimum test of the effectiveness of
mindfulness training. Subjects were scored for the number of words
generated within 60s, beginning with each given letter, excluding proper
names and changes of tense (pre- and posttest).
Overlearned Verbal Task (OVT). The OVT was developed for this
study, on the basis of mindfulness theory, as a simple measure of cogni-
tive flexibility, or the ability to adjust from overlearned to more adaptive
responses as required. Lack of such flexibility, reflecting "premature
cognitive commitment," is a primary characteristic of mindlessness and
has been observed on similar tasks requiring deviation from overlearned
verbal behaviors (e.g., Chanowitz & Langer, 1981). This test takes ad-
vantage of overlearning by this elderly population of the original U.S.
"Pledge of Allegiance" before it was changed in 1954 to include the
words "under God." Subjects were asked to recite the pledge after re-
viewing an updated typewritten copy for 1 'A min, and were scored cor-
rect if the two new words ("under God") were included in their correct
sequence (posttest only). The OVT minimizes reactive measurement
effects (Webb, Campbell, Schwartz, & Sechrest, 1966) through appear-
ing to be a simple test of recall rather than of cognitive flexibility (post-
test only).
Stroop Color-Word Interference Test (CW1T). A second measure of
cognitive flexibility, the CWIT (Stroop, 1935), requires sustained atten-
tion to the inhibition of the familiar reading response in favor of a more
novel color-naming response. The test involves timing subjects' perfor-
mance in reading words (color names printed in black across the page),
then in naming colors (groups of colored As in the same format), and,
finally, in naming colors of words (denoting conflicting color names,
same format). The interference score is the additional time (resulting
from the overlearned reading response) taken on the third as compared
to the second task (Jensen, 1965) and is reported to deteriorate with
advanced age (Comalli, Wapner, & Werner, 1962), with poor perfor-
mance also being associated with defensive rigidity scores on the Minne-
sota Multiphasic Personality Inventory (Dahlstrom, Welsh, & Dahl-
strom, 1975; see Bush, 1975). Thecognitive flexibility score in the pres-
ent study is defined as the best (lowest) interference score over four trials
after covarying for score on an initial comparison trial (posttest only).
Object Uses Test (OUT). The OUT was included as a measure of
mindfulness, and, hence, as a predictor of greater longevity. It was
scored for the number of different uses a subject can give for a series of
 TRANSCENDENTAL MEDITATION, MINDFULNESS, AND LONGEVITY
objects (ceramic mug, pen, wire stripper, and magnetized change
holder) shown to him or her. Langer and Piper (1987) discussed sponta-
neous generation of novel uses as a measure of mindfulness with non-
nursing home populations. For this advanced elderly nursing home pop-
ulation, it was decided to add a single standard prompt for each object
to make the task somewhat less demanding. The task was untimed.
Health
Blood pressure. Systolic blood pressure was tested with an aneroid
sphygmomanometer, the appearance of the first heart sound being taken
as systolic pressure. The average of three readings taken at 2-min inter-
vals was recorded with subjects sitting at rest, following Morgan's proce-
dure for assessing biological age (Morgan & Fevens, 1972). For a few
subjects in each group who were not available for this procedure, a regis-
tered nurse took a single recording, using a standard mercury sphygmo-
manometer (pre- and posttest).
Nurses' mental health improvement ratings. These were given by
nursing home staff after a mean period of 18 months for all surviving
subjects. Subjects were rated for mental health on a 5-point scale, rang-
ing from considerably worse (1) to much better (5) over the 18-month
period (posttest only).
Longevity (survival rate). The percentage of subjects in each group
still alive after a mean period of 36 months was assessed from nursing
home records.
Personality and Self-Report
State- Trait Anxiety Inventory (STAI) A- Trait scale The STAI A-Trait
scale (Spielberger, Gorsuch. & Lushene, 1970) is the most widely used
psychometric measure of "trait" anxiety—the general tendency to be
anxious (pre- and posttest).
Self-Rating Depression Scale (SDS). Elderly depressives sometimes
perform as poorly on cognitive tasks as elderly persons with dementia
(e.g., Whitehead, 1973). The SDS (Zung, 1965) was used to assess the
potential mediating role of depression in cognitive functioning. The
SDS covers a broad range of depressive symptoms, and is short (20
items), simple, and self-administered (pre- and posttest).
Internal Locus of Control Scale (LOC-I Scale). This revised version
of Rotter's (1966) original Internal-External Locus of Control Scale
includes an Internal (I) scale factorially independent from Chance (C)
and Powerful Others (P) scales (Levenson, 1974). The LOC-I scale was
included to assess the hypothesized relationship between mindfulness
and control. According to Langer (1989a, 1989b; Piper & Langer, 1984),
a mindful person actively engages in making choices and discrimina-
tions, regardless of apparent environmental constraints; this is said to
foster a generalized expectation of control over outcomes through inter-
nal means (pre- and posttest).
Rating of regularity of practice. On the basis of weekly records main-
tained by the instructors, frequency of practice by the subjects was esti-
mated both for the 3 months as a whole and for the last month alone on
the basis of a 5-point Liken scale, with 1 signifying never or very rarely
and 5 signifying always or almost always.
Self-report assessment of general outcomes. Subjects rated on a series
of 7-point Likert scales how they felt generally "these days" compared
to 3 months before (posttest only).
Subject Evaluation of Program Effectiveness
Posttested subjects were asked to rate how they felt during and imme-
diately following practice of their program on a series of 7-point scales.
They were also asked whether "the program itself was valuable to you."
In order to supplement this data on self-report experience of programs,
subjects were further requested to list up to five adjectives (or descriptive
955
phrases) describing how they felt during and immediately after their
program in comparison to immediately before. To evaluate these lists,
semantically similar responses occurring with greatest frequency across
groups were clustered. Two very clear response categories were identi-
fied: Most common were adjectives referring to relaxation (in order of
frequency: relaxed, restful, quiet, calm, and peaceful); also common
were adjectives indicating boredom or frustration (in order of fre-
quency: bored, frustrated, nervous, impatient, and restless). Thus, pres-
ence of one or more relaxation descriptors or boredom descriptors was
also scored. Subjects also were given the opportunity to provide a more
detailed open-ended description of experiences during and after their
program.
Dropout Form
Subjects who completely discontinued practice of their treatment
prior to completion of the 3-month period were given a dropout form
to complete (soon after dropping out) by the project administrators.
They were asked to evaluate on a series of 10-point scales various rea-
sons why they may have dropped out Items focused on the following
possible reasons: difficulties in performing techniques, lack of immedi-
ate and long-term benefits, difficulties with the instructors, and negative
feedback from practitioners of other programs or nursing home staff
regarding their program.
Data Analysis
Treatment effects were assessed using analysis of covariance, adjusted
for pretest level on those variables for which pretest scores were avail-
able. This procedure controls for initial differences within and between
groups and is generally held to be more precise and, hence, statistically
more powerful than simple change score analysis (Judd & Kenny, 1981).
Prediction of consistent differential treatment effects allowed us to
minimize Type 1 errors by conservatively using the same overall
planned contrast for each measure—a 1 degree of freedom F test for
unequal sample sizes (Kepple, 1973, p. 353). A priori contrasts of this
type are considered preferable to using unfocused, omnibus F tests (Ro-
senthal & Rosnow, 1984, p. 344-345). In accordance with our predic-
tion that TM would perform the best, followed by mindfulness training,
in comparison to both relaxation and no-treatment conditions, the four
groups were assigned contrast coefficients of 3,1, -2, and —2, respec-
tively, and directional testing was applied.
For the final set of analyses on subjective evaluation of the three treat-
ments alone (excluding the no-treatment group), it was necessary to
assign different coefficients. Although mindfulness training was pre-
dicted to produce beneficial effects, because the particular tasks in-
volved required effort, it was expected that, in general, subjective experi-
ence of this treatment would not be more enjoyable than relaxation.
Therefore contrast coefficients of 2,—1, and-1 were assigned for TM,
mindfulness, and relaxation groups, respectively, on treatment evalua-
tion questions.
A test of proportions was used in the analyses involving proportional
data (e.g., survival rate). When the treatment dimension can be ordered
from more to less, contrasts can be also directly computed for a test of
proportions and directional testing can be used (Rosenthal & Rosnow,
1984, p. 406). In this case, the treatments were ranked in terms of their
predicted effects, the same contrast weights described earlier were ap-
plied, and a Z test of significance of the contrast (Rosenthal and Ros-
now, 1984, p. 407) was computed.
For cognitive, health, personality, and general outcome measures that
were significant on the overall contrast, the Fischer LSD test was used
for additional pairwise comparisons (Carmer & Swanson, 1973) to de-
termine whether specific groups differed from other groups in the direc-
tion predicted. Similarly, where an overall test of proportions was sig-
956 ALEXANDER, LANGER, NEWMAN, CHANDLER, DAV1ES

nificant for these measures, Z tests of the significance of specific pair- Table 1
wise differences were computed. In each case, all significant painvise Cognitive Performance Scores for the Elderly After 3 Months
differences are reported. Practice of Assigned Treatment
In computing chi square (or its Z standard normal deviate equivalent)
it was once thought that expected frequency should not fall below 5 per Trans- Mind-
cell. Evidence now indicates, however, that "very useable" chi-square cendental fulness Relax- No
values can be obtained even with expected frequencies as low as 1, as Measure meditation training ation treatment
long as the total number of independent observations is not too low. An
JV of 20 is considered sufficient, but small expected frequencies may Dementia Screening
Test(z-scored:
work "quite well" with an even smaller N(Rosenthal & Rosnow, 1984,
adjusted means) -0.02 0.04 0.03 -0.30
p. 384; cf. Camilli & Hopkins, 1978). None of the significant pairwise
Associate Learning
Z tests had an N less than 20. Nevertheless, because of the relatively Scale "(adjusted
small no-treatment group size at posttest, it was decided to additionally means) 5.98 5.01 5.61 3.17
compute Fischer exact tests for all significant pairwise Z tests involving Word Fluency
the no-treatment group to secure a more conservative "second opinion" Scale***
for these comparisons (Rosenthal & Rosnow, 1984, p. 395). (adjusted means) 36.87 39.15 33.37 31.79
Overlearned Verbal
Task****
Results (% correct at
posttest) 77.8 50.0 27.3 28.6
Before assessing the relative effects of the treatments used, a CWIT interference
check of the manipulations was conducted to determine score* (posttest
whether the groups were equivalent with regard to expectancy means) 20.74 25.64 26.26 25.90
of benefit, perceived competence and likeableness of instruc-
Note. CWIT = Stroop(1935) Color-Word Interference Test.
tors, and regularity of practice. After group assignment and two
*p<.10. **p<.05. ***p<.025. *"*/><.OOI.
meetings with their instructors for the purpose of introduction
to their respective programs, subjects rated on six 7-point scales
how much they expected to benefit in terms of physical health,
relief from worries, ability to deal with problems, clear think- p < .01, Fischer exact p = .034. Although MF scored highest
ing, personal relationships, and personal development. A total followed by TM on the Word Fluency scale, this difference was
expectancy score was derived as the sum of the six scale scores. not statistically significant; no pairwise differences on the Word
There were no differences in mean expectancy scores among Fluency scale or the CWIT reached significance.
the three treatment groups. Similarly, at time of posttesting,
there were no differences in the rating of the competence or Health
likeableness of instructors. Finally, among those completing the
posttest, there was no significant difference between the three Adjusted means (posttest levels after covarying for pretest lev-
groups on degree of regularity of practice either for all 3 months els) for systolic blood pressure after 3 months, mean mental
of treatment or for the last month alone. health ratings after 18 months, and survival rates after 36
months are presented in Table 2 for each group. On the overall
planned contrast, the four groups differed as predicted on both
Cognitive Functioning
blood pressure, f\l, 55) = 6.35, p < .01, and nurses' mental
Adjusted means (posttest scores after covarying for pretest health rating, fX 1,56) = 6.73, /;< .01.
scores) for the DST, the Associate Learning scale and the Word Specific pairwise comparisons for blood pressure indicated
Fluency scale, together with proportion of subjects correct on that both TM (t = 2.49, p < .01) and MF (t = 1.92, p < .05)
the OVT Task and means at posttest for the CWIT are presented differed as predicted from MR. For mental health, both TM
for each group in Table 1. and MF differed as predicted from both MR (* = 2.17, p < .025;
There were no significant differences among groups on the and t = 2.05, p < .025, respectively) and NT (t = 1.79, p < .05;
DST. On the overall patterned contrast, groups differed as pre- and t = 1.67, p = .05, respectively).
dicted on the Associate Learning scale, F( 1,51) = 3.20, p < .05, The most critical and long term of all the indexes tested is
the Word Fluency scale, F( 1,52) = 4.70, p < .025, and the OVT, survival rate, which is illustrated for each group in Figure 1.
Z(N = 48) = 3.15, p< .001. There was also a trend in the ex- Over this 36-month period, on the overall planned comparison,
pected direction on the CWIT, F( 1,40) = 2.22, p < . 10. In other the survival rates for the four experimental groups—ranging
words, on these measures, the overall prediction was statistically from 65% up to 100%—markedly differed as predicted, Z(N =
supported: In general, TM scored higher than MF, and MF 77) = 3.54, p < .00025. The survival rate for the remaining
scored higher than MR and NT. 478 elderly residents in the seven homes (for which data was
Specific pairwise comparisons for the Associate Learning available) was 62.5%. This percentage was derived using the fol-
scale indicated that the TM group differed as predicted from lowing formula: 100-100 [(total reported deaths in the 7
NT (t = 2.32, p < .025). There were also trends for both MF homes - deaths of subjects in experiment)/(total population in
( r = 1 . 4 5 , / > < . 1 0 ) a n d M R ( i = 1.93, p < .10, two-tailed test) the 7 homes - total number of subjects in experiment)].
in comparison to NT. For the OVT, the TM group differed as Specific pairwise comparisons indicated, as predicted, a
predicted from each of the other groups, MF: Z(« = 30) = 1.60, higher survival rate for TM than for MR, Z(n = 39) = 3.28, p<
p = .05; MR: Z(« = 29) = 3.04,p < .005; NT: Z(« = 25) = 2.50, .001, or NT, Z(n = 41) = 2.54,p< .01 (Fischer exact p = .035),
 TRANSCENDENTAL MEDITATION, MINDFULNESS, AND LONGEVITY
Table 2
Systolic Blood Pressure, Mental Health Improvement Ratings, and Longevity (Survival Rate)
of the Elderly Following Practice of Assigned Treatment
Transcendental
Measure meditation
Systolic blood pressure*
(adjusted means at
3 months posttest) 125.4
Mental health improve-
ment* rating (means
after 18 months) 3.35
Survival rate" (% alive
after 36 months) 100.0
Note. Other refers to remaining population in the same institutions not assigned to any group (n = 478).
*f><.01. **/><.00025.
with a similar trend also compared with MF, Z(n — 35) = 1.52,
p < .10. The rate for MF was also higher than that for MR,
Z(n = 36) = 1.67, p < .05. No other pairwise contrasts were
significant.2 Two of the four groups also differed from the re-
maining untested population in survival rate: TM, Z(n =
497)= ll.05,p<. 00001, and MF,Z(n = 494) = 2.93,p<. 005.
In light of prior research with nonsenile elderly suggesting a
link between mindfulness and longevity (Langer, Beck, Janoff-
Bulman, & Timko, 1984; Rodin & Langer, 1977), an internal
analysis was conducted on the relationship between survival
rates and mindfulness. For this purpose, subjects were identified
as mindful if they were both rated mentally alert (a necessary
condition for mindfulness) by nursing home staff at pretest (n =
25) and scored relatively high on the OUT, taken as a behavioral
indicator of mindfulness. The OUT did not discriminate
among groups at posttest, possibly because of a ceiling effect
resulting from the single prompt of subjects (cf. Langer & Piper,
1987). However, internal analysis did reveal, as expected, that
the alert subjects scoring above the median on the OUT had a
higher subsequent survival rate (100%) than those scoring below
the median (67%), X 2 (l, n = 25) = S.\6,p < .025.
Personality and General Outcome Measures
Adjusted means (posttest scores after covarying for pretest
scores) for trait anxiety (STAI A-Trait scale), depression (SDS),
and internal locus of control (LOC-I scale), together with means
for each significant self-report assessment of general outcome,
are presented for each group in Table 3.
On the overall planned comparison, there were no group
differences on trait anxiety and depression. Groups did differ in
the predicted direction on locus of control, F(l, 46) = 3.39, p <
.05. For the self-report assessment of outcome scales, posttest-
ing subjects were asked how they "generally feel these days" as
compared to 3 months ago (i.e., before assignment to their pro-
gram). Groups differed as predicted in the degree to which they
reported feeling more "able to cope with inconvenience," f\ 1,
38) = 5.99,p<.01;less"old,"/l(l,40) = 3.20,p<.05;andless
"impatient with others," R(1, 39) = 2.19, p < . 10, trend. There
were no differences between groups found on other general out-
come items that concerned quality of activity, appreciation of
self or environment, having new ideas, or feeling bored with life.
957
Mindfulness No
training Relaxation treatment Other
130.3 145.0 135.3
3.32 2.86 2.90
87.5 65.0 77.3 62.6
On the perceived control measure, pairwise comparisons in-
dicate greater change for MF than for each of the other groups,
including TM: TM (t = 2.20,p < .05, two-tailed); MR (t = 2.07,
p < .025); NT (t = 3.00, p < .0025). There was also a trend
toward TM changing more than NT on perceived control (( =
1.36, p < .10). As predicted, pairwise comparisons indicated
that the TM group felt more able to cope with inconvenience
than NT (r = 1.96, p < .05) and MR (t = 2.24, p < .025). Fur-
thermore, the TM group felt less old than did the NT group (t =
1.85, p < .05) and the MF group (t = 1.65, p < .10, statistical
trend); with a trend also toward MF feeling less old than NT
(t = 1.47, p < .10). Finally, the TM group reported feeling less
impatient with others than NT (t = 1.85, p < .05) and MF (t =
1.65, p<. 10, statistical trend). y
Subjective Evaluation of Program Effectiveness
The treatment evaluation form was completed only by those
subjects who were posttested (i.e., excluding most subjects who
dropped out). However, to canvas opinions of as many subjects
as possible, we added responses for those few items on the drop-
out form that overlapped with those on the treatment evalua-
tion form (see Table 4). Group means for significant scale items,
proportion in each group reporting relaxation or boredom dur-
ing and immediately after practicing their program, and pro-
portion of subjects in each group finding their program valu-
able and practicing regularly, are presented in Table 4.
As predicted, the TM subjects reported feeling "better" dur-
ing their program, F(l, 32) = 2.84, p < .05, and more "inter-
ested," f[l, 43) = 11.58, p < .001, than mindfulness and relax-
ation groups, with a similar trend toward the TM group also
feeling more "alert," F{\, 33) = 1.78, p < .10. Also, immedi-
ately after practicing their program, the TM subjects reported
2
The initial no-treatment (NT) subjects (n = 8) underwent extensive
testing at pre- and posttest. This testing could be expected to stimulate
at least some mindfulness (Langer & Newman, 1979). As anticipated,
the not-at-all or minimally tested NT subjects (n= 14) added for this
comparison did have a relatively low survival rate: 71.4% (10 of 14 vs.
7 of 8). Although in the right direction, the difference between MF (« =
16) and the not-at-all or minimally tested NT subjects still did not reach
significance, Z(n = 30)= 1.10,p>.10.
958 ALEXANDER, LANGER, NEWMAN, CHANDLER, DAVIES
100
95
90
O 85
> 80
d 75
^ 70
65
60
TM MF MR
Figure 1. Percentage of institutionalized elderly (M = 80.7 years at pre-
test; n = 77) still alive 36 months after learning their randomly assigned
experimental program (TM = the Transcendental Meditation program,
MF = mindful ness training, MR = mental relaxation, and NT = no
treatment) as compared to the survival rate for the remaining popula-
tion (RP) in the same institutions (n = 478).
feeling "better," F( 1,43) = 6.17, p < .01, and more "relaxed,"
P(l, 34) = 3.92, p < .05. There were no significant differences
between groups for other items concerning anxiety, fatigue, or
mental clarity during or after their practice.
Analysis of subjects' own choice of adjectives to describe their
program yielded similar results. Substantially more TM sub-
jects reported feeling "relaxed" (rested, quiet, calm, etc.) during
their practice than immediately before compared with mindful-
ness and relaxation subjects, Z(n = 39) = 4.11, p < .000025.
They also reported fewer moments of boredom during their
technique, Z(n = 39) = 1.80, p < .05. Furthermore, they de-
scribed themselves as more relaxed, Z(n = 36) = 4.34, p <
.00001, and reported fewer moments of boredom, Z(n = 36) =
2.308,/> < .01, immediately after their practice than did partici-
pants in the other programs. Finally, more TM subjects re-
ported that overall, their technique was "valuable" to them
than did participants in the mindfulness and relaxation groups
Z(w=39) = 2.40,;><.01.
Because no significant differences in degree of regularity be-
tween groups were found among subjects attending the posttest,
as noted earlier, this factor should not have substantially influ-
enced outcomes on other variables. However, a practical consid-
eration independent of performance on outcome measures, is
whether each program is self-maintaining as indicated by de-
gree of regular practice of all subjects. When assessment of reg-
ularity was evaluated categorically (with regularity defined as
practice at least once per day throughout the treatment period),
and all surviving subjects who did not posttest were also in-
cluded, more TM subjects were found to practice regularly (see
Table 4) than were members of mindfulness training and relax-
ation groups, Z(n = 60) = 2.72, p < .01, two-tailed. The overall
percentage of subjects dropping out (i.e., completely discontin-
uing their programs) was 33.5. However, the overall percentage
of treated subjects who failed to retest on the objective measures
after 3 months, was only 24%; this was because a few irregular
practitioners or dropouts in each group also completed the post-
test. Given the frailty of subjects and the fact that they were not
paid, the retest rate was comparatively high for such treatment
studies (cf. Smith, 1976).3
Discussion
Posttest examination of reported experiences during and im-
mediately after practice of the three techniques supports the
proposal that each produces a different mental state or mode of
cognitive functioning.
Differences in Subjective Experience
During Each Program
Specifically, as predicted, subjective reports at posttest indi-
cated enhancement of both restfulness and alertness during
TM. The alertness component is reflected in this group's report
of being more interested and more alert during the program
and less bored during and afterward, compared to the other
groups. The restful component is reflected in the TM group's
3
Descriptive statistics on reasons given for dropping out are summa-
rized below. Twelve subjects, or 57.1 % of the total dropouts, were willing
to complete the dropout form. This included 5 mindful, 5 relaxation,
and 2 TM subjects. Given the small number of available dropouts from
each treatment group, use of inferential statistics to formally evaluate
differences between the groups was not appropriate; however, examina-
tion of group means suggested that the reasons for dropping out tended
to be similar among groups. When responses were averaged across treat-
ments, a clear pattern of reasons for dropping out is revealed in the
means and standard deviations of item scores (when necessary, the di-
rection of item score is reversed, so that 10 always indicates the most
positive response and 1 the least positive).
Although dropouts did not tend to be disturbed by thoughts (M =
8.18, SD = 3.19), physical sensations (M = 9.25, SD = 2.60), or tired-
ness (M = 9.5, SD = 1.00) during their programs, they did tend to feel
somewhat bored (M = 2.42, SD = 2.83). However, the main reason given
for discontinuing programs was lack of perceived benefits. Virtually all
subjects reported that lack of benefits played "a very large role" in their
decision to stop their program (M = 1.50, SD = .92) and that "no bene-
fits" were noticed continuing throughout the day (M = \ .09, SD = .30).
Uniformly, dropping out was not attributed in any way to the quality of
the teachers (M = 10.00, SD = ,00), who were perceived as doing an
excellent job (M = 9.90, SD = .52). Also, no subjects attributed drop-
ping out to feeling that other residents were getting a better program
(M = 10.0, SD = .00) or to negative feedback from nursing home staff
(M = 10.0, SD = .00). It would thus follow that the TM group had a
lower dropout rate because subjects perceived greater benefits from this
practice. This interpretation is also consistent with the objectively mea-
sured outcomes associated with this program.
 TRANSCENDENTAL MEDITATION, MINDFULNESS, AND LONGEVITY 959

report of being less tense and more relaxed both during and Table 4
after the program (Table 4). This finding of heightened values Subjective Evaluation of Program Effectiveness
of both rest and alertness is consistent with the view that they After 3 Months' Practice
are experienced as complementary aspects of a distinctive uni-
Transcendental Mindfulness
fied state of restful alertness during the TM technique. In re-
Measure meditation training Relaxation
sponse to open-ended questions, some TM practitioners explic-
itly reported periods of the content-free state of pure aware- During each practice
ness—the clear experience of "no mantra or thoughts." Such Better(l)/worse(7)** 2.62 3.42 3.20
Bored (ij/interested
experiences were not associated with an absence of alertness,
(7)"*** 5.67 3.53 3.57
but rather with a silent wakeful potential for experience, with More(l)/less(7)
"a clear mind, more energy, a deep state of rest and relief from alert* 3.00 3.33 3.70
fatigue," and "a state of complete readiness for whatever comes More relaxed or quiet
(%)**** 94.4 41.7 55.6
next" (Subject 42). Subject 34 described her experience imme- Moments of boredom
diately after practice of TM as "calmness, and instead of being (%)** 22.2 41.7 55.6
hurried or concerned as to 'what next,' quietly proceeding (to) After each practice
Better (1 (/worse
each next step, ready, but unhurried."
(7)'*** 2.44 3.25 3.64
In contrast to this experience of silent alertness, subjects dur- Relaxed (l)/tense
ing mindfulness training tended to characterize their experi- (7)** 2.00 3.00 2.60
ence as an active state of directed thinking. As Subject 41 stated, More relaxed or
quiet (%)**** 93.3 25.0 55.6
"I feel mentally stimulated. The mind is activated as it seeks
Moments of boredom
words to fit. . .the need of the particular case. All in all it gives (%)«* 20.0 41.7 66.7
the mind a stimulating workout." However, because the mindful Overall evaluation (%)
Felt program
tasks for this experiment were somewhat difficult, several sub-
valuable for selP" 75.0 38.5 40 jO
jects reported experiencing frustration during the practice. Practiced
Nevertheless, in contrast to subjects in the low-mindful relax- regularly'*** 80.0 47.6 47.4
ation program, they also tended to report feeling more alert
" Include responses from subjects not present at posttesting.
during and better immediately after each practice (see Table 4).
*p<.10. **p<.05. ***/)<.01. ****/><.001.
Furthermore, proportionally, 25% fewer mindful subjects re-
ported moments of boredom during their program, and 37%
fewer reported such moments afterward relative to the relax- gram, and more than twice as many reported feeling relaxed
ation subjects. afterward compared with the mindful subjects. Subject 31 de-
On the other hand, as would be anticipated, one-third more scribes successful relaxation primarily in physical terms: "I can
relaxation subjects reported feeling relaxed during their pro- always feel myself sort of going. When I start practicing I kind
of let down. I can sort of feel my arms relaxing. My nerves kind
of let go." The potential drawback of this low-mindful practice
for some subjects was that it was "peaceful but boring" (Subject
Table 3
61). As predicted, it was only when the restful and alert compo-
Personality and Self-Report Scores for the Elderly
nents were experienced simultaneously during the TM pro-
After 3 Months Practice of Assigned Treatment
gram that frustration and boredom (low-mindfulness) were
Trans- Mind- minimized, subjects felt better (during and after), and were
cendental fulness Relax- No more regular in their practice and valued their program more
Measure meditation training ation treatment (Table 4).
Trait Anxiety
These phenomenological outcomes—taken together with the
(adjusted means) 37.59 36.32 36.65 36.26 finding that there were no differences between treatment groups
Depression (adjusted with regard to expectancy of benefit, ratings of instructor com-
means) 34.66 34.03 33.33 35.86 petence and likeability, and regularity of practice among post-
Internal Locus of
Control (adjusted testing subjects—indicate that the experimental manipulations
means)** 21.60 23.81 21.53 19.93 produced qualitatively distinct changes in immediate experi-
Self-report assessment ence, while controlling for potentially confounding external in-
of general
fluences. On this basis, it is possible to examine the objective
outcomes
Feeling less data to assess whether the different experiential states or cogni-
(l)-more(l) tive modes associated with each program produce significant
"old"** 3.65 3.92 4.33 5.20 differential consequences for psychological and biological adap-
Less(\)-more(l)
able to cope with tive efficiency.
inconvenience*** 5.06 4.58 3.89 3.80
Less (It-more (7) Consideration of Objective Outcomes
impatient with in Relation to Hypotheses
others* 2.75 3.58 3.30 4.00
The results are consistent with the general prediction that
*p<.10. **p<.05. ***.?<. 01. longevity may be benefitted by psychological intervention. The
960 ALEXANDER, LANGER, NEWMAN, CHANDLER, DAVIES
Transcendental Meditation program in particular, and also
mindfulness training, appear to be effective in improving psy-
chological and physiological functioning and thus enhancing
longevity in the elderly, in contrast to the relaxation and no-
treatment conditions.
As indicated by the overall planned comparison, this differ-
ential pattern of improvements was apparent on measures of
cognitive flexibility, paired associate learning, mental health ac-
cording to nurses' ratings, blood pressure, and ultimately, lon-
gevity (survival rate after 3 years). There was also a similar pat-
tern of improvement in subjects' reported capacity to cope with
inconvenience and to feel less "old" and less impatient with
others, after 3 months of practice. In virtually all cases, the pair-
wise comparisons that reached significance were in the direc-
tion predicted by the patterned contrasts. Beneficial outcomes
associated with TM tended to be more extreme than those for
the mindfulness program.
Contrary to the general pattern, however, the mindfulness
group did score higher than did the TM group on perceived
control. This scale seems to reflect in a very specific way what
is being enhanced through this particular form of mindfulness
training. The process of actively forming new distinctions ne-
cessitates gaining increased control over cognitive categories.
Indeed, Chanowitz and Langer (1981) suggest that mindful in-
volvement is the most important factor contributing to a sense
of control. Although it was not significantly higher, the mindful-
ness group also had the highest score on word fluency, followed
by the TM group. This task is related to the word-production
component of the MF training procedure, and thus a higher
score for MF on this task was anticipated. The mindfulness pro-
cedure used in this study, however, is not likely to be the optimal
program for active training in mindfulness. A program in active
distinction making that requires conscious engagement with the
environment may be more challenging and, therefore, even
more effective.
Lack of improvement by relaxation subjects on any objective
outcome in comparison to TM or mindfulness subjects is in
conflict with the placebo or expectancy view that the three treat-
ment programs, being matched for time spent sitting with eyes
closed and expectation of benefit, should have yielded similar
results relative to the no-treatment group. No differences
among the groups were found with regard to expectancy of ben-
efit or ratings of instructors, yet a consistent pattern of differ-
ences among treatments was found in actual benefits.
According to the relaxation hypothesis (Holmes, 1984), TM
and relaxation programs should have given rise to similar bene-
fits, but they did not. Furthermore, TM and relaxation should
have been more similar to each other in their consequences than
to the "nonrelaxing" mindfulness training program. In fact, the
mindfulness subjects reported themselves less relaxed during
and after their practice than did TM and relaxation subjects, yet
they experienced greater objective benefits than the relaxation
group. On the other hand, the cognitive and health results for
the TM group were similar to—but more extreme than—those
for the mindfulness group.
A possible confound in comparing TM to the other proce-
dures used in this study might be the extended training and
presumed commitment of the TM teachers. However, the ex-
periment was designed to minimize any consequent advantage
for the TM group by selecting other instructors on the basis of
high motivation to help the elderly, by matching them for rele-
vant background variables and by requiring them to undergo a
thorough training program. Also, all instructors believed theirs
to be the preferred program, followed equivalent patterns of
teaching and contact with subjects during instruction and fol-
low-up periods, and communicated expectation of equivalent
benefits. The effectiveness of these precautions is evident in that
there were no differences among groups with regard to subjects'
expectancy of benefit or to ratings at posttest of instructors'
competence or likeableness.
Except on the dropout form, responses were not obtainable
from those not attending posttesting. When all subjects were
included in the assessment of regularity (including those who
were not posttested), it was apparent that fewer subjects in the
TM group discontinued regular practice than did subjects in
the other groups. However, because dropouts should be less
likely to have experienced positive effects, exclusion of nonpost-
testing subjects—who included a disproportionately high num-
ber of dropouts—should only have biased results against the
prediction of the most positive outcome for TM. It might be
presumed that at least among those who dropped out, instruc-
tors would be perceived as less competent. However, evaluation
of the dropout forms clearly showed that teachers (of all pro-
grams) were uniformly judged as doing an excellent job, even
by the dropouts. Moreover, responses indicated that dropping
out could not be attributed to physical discomfort or negative
thoughts during the practices nor to negative feedback from
other treatment members or nursing home staff. Instead, sub-
jects uniformly attributed dropping out to lack of perceived cu-
mulative benefits from their respective programs (see footnote
3). Thus the differential dropout rate appears to be one more
effect (rather than the cause) of the differential efficacy of the
treatment groups (and not due to such noncontrolled factors as
likeableness of instructors).
It is possible that other forms of relaxation could have been
more effective than the MR program used here. However, MR
was explicitly designed to incorporate elements that have been
suggested to be sufficient to produce effects similar to TM—
including sitting with eyes closed, sustained voluntary regula-
tion of attention, and mental repetition of noncognitively
arousing stimuli. In contrast to his earlier work, Smith's (1986)
more recent model, which proposes that different types of relax-
ation and meditation may produce distinctive effects, appears
more consistent with this pattern of results.
Positive TM outcomes do not emerge only in comparison to
the "generic" relaxation procedure designed for this study. Re-
cent quantitative meta-analyses have indicated similar TM out-
comes (and higher retention rates) in comparison to such "stan-
dard" relaxation techniques as progressive muscle relaxation
(Eppley, Abrams, & Shear, 1989) or other forms of meditation
on psychological and/or physiological measures (Eppley, Ab-
rams, & Shear, 1989;I%rguson, 1981;Kuchera, 1987). Because
enhancing alertness may be particularly important for the insti-
tutionalized elderly, the contrast between TM and relaxation
may have been especially apparent in the present study, which
focused primarily on changes in alertness and flexibility outside
the practice, as opposed to arousal reduction during it (cf.
Holmes, 1984).
 TRANSCENDENTAL MEDITATION, M1NDFULNESS, AND LONGEVITY
The results of this experiment suggest that the state of restful
alertness during TM should be understood and assessed as qual-
itatively distinct from either simple relaxation or somatic
arousal (being "on edge"). The comparative lack of effective-
ness of the kind of relaxation procedure used in this study, par-
ticularly for the institutionalized elderly, was predicted from the
perspective of mindfulness theory. Such relaxation instructions
may induce a low-mindful condition, because attention is di-
rected to the already familiar or overlearned, and thus may be
of little benefit to those for whom mindlessness may already be
Implications for Aging and Longevity
Do these results represent improvement through actual re-
versal of decrements in functioning associated with aging, or
merely relatively smaller declines in performance over time for
TM and mindfulness compared to relaxation or no treatment
groups? Comparisons of unadjusted mean change scores and
posttest-only assessments of change help clarify this issue. On
the four pretest-posttest measures that reached significance
(systolic blood pressure, associate learning, word fluency, and
internal locus of control), both TM and mindfulness tended to
improve, whereas either or both relaxation and no-treatment
groups declined on each measure.4 On posttest-only assessment
of change, nurses reported that both TM and mindfulness
groups improved in mental health over an 18-month period,
whereas relaxation and no-treatment groups declined slightly
(Table 1). After 3 months, TM and mindfulness groups, on aver-
age, reported feeling better able to cope, less old, and less impa-
tient, whereas relaxation and no-treatment groups felt less able
to cope, older, and split on the impatience item (Table 3). Thus,
these findings are consistent with the prediction that both TM
and mindfulness may prevent or even reverse declines in func-
tioning that otherwise tend to occur among the advanced el-
derly.
The physiological correlates and consequences of restful
alertness during TM in relation to rigidity and aging are also
beginning to be understood. Increased cortical blood flow
(Jevning, Wilson, Smith, & Morton, 1978), frontal EEC phase
coherence (Orme-Johnson & Haynes, 1981), hormonal concen-
trations of arginine vasopressin (O'Halloran, Jevning, Wilson,
Skowsky, & Alexander, 1985) and serum dehydroepiandroster-
one sulfate (Glaser, Brind, Eisner, & Wallace, 1986), all associ-
ated with this state, have also been correlated with greater cog-
nitive flexibility, and reflect changes opposite to those typically
associated with the aging process.
The most striking finding of this study is the apparent in-
crease in longevity (survival rate) with TM: All TM subjects
were alive after 3 years, in contrast with other groups initially
equivalent in chronological age and physiological and psycho-
logical health. Hypertension is a major risk factor for cardiovas-
cular disease which, in turn, is the largest cause of death among
the elderly (Harris, Cook, & Kannel, 1985); thus, reduction of
blood pressure, especially among TM subjects, may have con-
tributed to their increased longevity. This interpretation is sup-
ported by the results of Orme-Johnson's (1987) large-scale field
study, which showed substantially lower hospital admission
rates for serious illness among 2,000 TM practitioners—includ-
961
ing heart disease (87% less)—compared with a matched sample
over a 5-year period (with differences being largest among the
older individuals sampled). Furthermore, controlled longitudi-
nal studies show that another major cardiovascular risk factor
that increases with age—high cholesterol—significantly de-
creases in TM practitioners compared with matched controls,
with diet held constant (Cooper & Aygen, 1978,1979).5
Additional evidence for the relationship between cognitive
functioning and longevity may be seen with regard to the mind-
fulness training procedure. Compared to the low-mindful re-
laxation procedure and the baseline, it, too, was apparently
effective in promoting longevity. In contrast, neither the relax-
ation nor no-treatment groups differed from the remaining
population. Consistent with this interpretation, subjects rated
as "alert" at pretest who also scored higher on a behavioral indi-
cator of mindfulness (the OUT), subsequently had a higher sur-
vival rate.
The results of this study taken as a whole suggest that changes
in state of consciousness or cognitive mode through specific
mental techniques can indeed mediate substantive improve-
ments in the health and cognitive functioning of the elderly,
which are not explicable in terms of simple relaxation with eyes
closed or expectation effects. "Empowerment" of the elderly is
a widely held goal among health care practitioners (National
Council on Aging, 1986; cf. Hofland, 1986; Rowe & Kahn,
1987). However, attempts by many professionals to empower
the elderly through external means may undercut the very goal
of personal autonomy. The great advantage of practicing a self-
referential mental technique is that it opens the possibility of
empowerment from within. Such an approach may serve a vital
role in safeguarding the integrity, lucidity, and longevity of the
elderly, hence restoring for society an enormous resource in the
experience and wisdom of its older members.
4
The mean change scores for TM included the following: recall of
1.17 more difficult word pairs; generation of 2.95 more fluency words;
a decrease of 12.36 points in systolic blood pressure (from a relatively
high level of 139.67); and a small decline of .91 points on internal locus
of control compared with larger declines of 1.27 and 3.37 for relaxation
and no-treatment (only the mindfulness group improved on the latter
measure, by .82 points).
5
Also consistent with our results are Ornish et al.'s (1988) recent
findings suggesting that coronary artery blockage (as well as high choles-
terol) actually may be reversed among patients participating in a com-
prehensive lifestyle change program which includes daily practice of a
traditional meditation procedure. Thus far in their studies, however, the
distinctive contribution of meditation has not yet been isolated because
several other substantial lifestyle changes were involved—including a
low-fat vegetarian diet, smoking cessation, and a regular exercise rou-
tine. In our study, no other lifestyle changes were required; therefore,
changes can be directly attributed to TM practice.
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Accepted June 12,1989 •

Correction to Carli (1989)

In the article "Gender Differences in Interaction Style and Influence," by Linda L. Carli (Jour-
nal of Personality and Social Psychology, 1989, Vol. 56, No. 4, pp. 565-576), on page 567, the
third sentence in the Procedure section should read, "Half of the subjects were paired with
same-sex partners and half with opposite-sex partners, resulting in 16 female pairs, 16 male
pairs, and 32 mixed-sex pairs." On page 568, the equation at the bottom of the left-hand
column should read as follows:

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