Feasibility of a mindfulness-based intervention to address youth issues in Vietnam

Abstract

Youth problems including risky sex, drug use, violence and mental health issues are on the rise in Vietnam. Mindfulness is proposed as one way to address unskillful responses to stress that give rise to these behavioral and psychosocial issues in Vietnam. This study explores the feasibility of a mindfulness program for adolescents and young adults in a central city in Vietnam. The mindfulness-based intervention was comprised 1-h daily session over 3 weeks that was conducted at two different sites, one with handicapped adolescents/young adults at the Vocational School for Handicapped and the other with at-risk youth at a semi-private high school. Forty-two Vietnamese youth participants and five Vietnamese teachers/facilitators who were trained in the mindfulness program provided personal reflections of their experiences. Analyses of the qualitative data suggest that mindfulness was enthusiastically received and accepted by both youth and teachers. There is strong indication that mindfulness is promising as a prevention strategy to help with stress and to build important life skills among Vietnamese youth.

BACKGROUND

Historical and cultural foundation

Mindfulness as a contemplative practice of Buddhism has deep roots in Vietnam extending as far back as to the first century C.E.; Master Tang Hoi was a prominent Zen teacher who first introduced Buddhism to Vietnam, which then later spread to China (Thich Nhat Hanh, 2001). Vietnam and China were first exposed to the ideas and practices of Buddhism as a result of the sea trading routes between India and China/Vietnam; Indian merchants who ventured to distant lands were often Buddhist practitioners who through interactions with the local people exposed them to concepts and teachings of Buddhism (Thich Nhat Hanh, 2001).

Mindfulness is considered the mental function of present moment awareness and acceptance of all phenomena (thoughts, emotions and sensations), and as a form of meditation is the applied dimension of Buddhist philosophy. It is simply the recognition of all phenomena that present themselves as they are, without the usual mental chatter, commentary or discursive thoughts of the mind. Mindfulness is an innate and inherent mental function of all individuals, yet practice and cultivation is needed and necessary to achieve high-level competency.

Over eons, decades and generations, individuals have actually engaged in mindfulness practice without labeling it as ‘mindfulness’ or any conceptual terms. The individual most recognized in history as being the exemplar practitioner, who was able to use mindfulness meditation to achieve awakening—enlightenment is known as the Buddha (Siddhārtha Gautama, Shakyamuni). Realizing the potential of mindfulness meditation techniques to achieve awakening and the universality of this possibility, he then organized the practice in a clear, structured and systematic way. Upon his death, his Buddhist teachings (Dharma) then expanded across the Asian continent and countries including Burma, China, Korea, Japan, Thailand and Vietnam.

This expansion did not necessary mean adoption as it encountered resistance with certain indigenous cultures like in Afghanistan. However, in Vietnam, the Buddhist teachings were easily and widely accepted and adopted by individuals as it resonated harmoniously with the local indigenous culture. In fact, the identity of Vietnamese culture since the beginning of Vietnam civilization is based on key principles and culture of Buddhism (Thich Nhat Hanh, 2001).

Mindfulness played a very important and crucial role in Vietnam history with respect to social structures. Most of the kings in Vietnam were Buddhists. Thirteenth century King Trần Nhân Tông, who was the third emperor of the Tran Dynasty, was quite influential in promulgating the principles and practices of Buddhism throughout his reign including practices of kindness, compassion and tolerance. In fact, Buddhism became deeply steeped in the political, economic and educational system, and along with Confucianism which also provided moral codes and ethical guidance, the thread that wove all social and family life together in Vietnam (Le, 2011). While mindfulness provided navigation in the areas of the Truth, the Good and the Beauty, Confucianism provided navigation within the realm of interpersonal relationships and social interactions. Together, they formed the social and ethical foundation of Vietnam.

The term mindfulness in Vietnamese is Chánh Niệm, coined by Thich Nhat Hanh, which literally means ‘Right Mindfulness’ (Thich Nhat Hanh, 1975). Chánh means right, and Niệm means remembering in the present moment. Because of Vietnam's colonial history with China for more than 1000 years, the Vietnamese language itself of course has had a lot of Chinese influences. Niệm (mindfulness, 念) consists of two parts: the first part (the top portion 今) is now or the current moment. The second part (the bottom portion 心) is ‘heart’, so combined this equates to remembering to recognize what is happening in the present moment.

It is interesting to note that the practice of mindfulness in Vietnam existed for centuries among lay people without formal training in Buddhist philosophy through various rituals. For example, in the cultural practice of ancestral worship—Thờ Cúng Tổ Tiên—while it is not necessarily a form of mindfulness meditation practice, the essence of this practice is to encourage deep reflection through recognizing that in this present moment, we are here because of our ancestors, that our ancestors are with us not only through the biological makeup of the DNA, but also through the values and virtues that are passed on to each child which are based on the foundation of mindfulness practices. Additionally, it is the awareness that this phenomena (our existence) has a dependent origination (our ancestors); that is, we do not possess an inherent independent nature but require certain conditions for our manifestation, and that our physical form, like our ancestors, will also one day go back to the earth. This practice essentially reflects the Buddhist philosophy of interdependence and impermanence that is cultivated in the mindfulness practice (McWilliams, 2014).

Another example is the cultural practice of cây nêu ngày tết. In this practice, at the beginning of the lunar new year, a bamboo tree (cây nêu) is planted with a piece a cloth representing a ceremonial flag attached to the top so that it blows and casts a shadow on the ground. The shadow is meant to symbolize the chasing away of evil spirits, and the practice itself is a symbol of the struggle between good and evil. The deep essence of the practice, however, is a direct reference to remembrance of our Buddha nature; by practicing mindfulness, we are able to discern between the ‘good’ and ‘evil’ mental formations that are within us, and in doing so, recapture our true essence. Thus in some respect, mindfulness is embedded in Vietnamese cultural practices in an implicit sense and encompasses more than the formal definition of meditation practice.

There is arguably two ways of mindfulness as embodied and practiced in Vietnam. One way is through the formal route of monastic training. This involves the scholarly study and deep, formal practice of mindfulness meditation although some Buddhist scholars perceive Buddhism as a doctrine or philosophy and do not necessarily practice mindfulness. The other way is through endorsement of Buddhism as a belief system and practice of ritual ceremonies, and the application of the five mindfulness trainings (e.g. reverence, respect and protection of life) as a precept or a moral code (e.g. refrain from killing, eating meat). Yet without a clear understanding about the role and application of mindfulness in rituals, then such rituals remain reflection of cultural habit patterns and/or as practices of devotion. In some respect, we can use mindfulness to shine the light on the deep meaning of cultural practices. For instance, eating can be done mindfully, with full awareness and engagement of all five senses and mind consciousness, or unmindfully. Praying to ancestors can be done to ask for blessing or a favor rather than as a practice to reflect on the nature of interconnection. Buddhists are not necessarily mindfulness practitioners, but given a country with a large Buddhist presence, it is likely that mindfulness practices may be more easily accepted and embraced. With more than half of the population in Vietnam endorsing Buddhism as a religion and practice (U.S. Department of State, 2013), we suggest that a mindfulness-based intervention may be one potential viable solution to address many of the current social stress and ills of Vietnam, particularly among the youth population.

Youth problem behaviors in Vietnam

Vietnam is currently dealing with a rise in youth problems including risky sex, substance use and mental health issues (Cox, 2012). These social issues were not as apparent 10 years ago, but they are increasingly gaining headlines and attention. Although Vietnam has experienced peace within the last 40 years or so, after enduring centuries of war with China (1000 years), France (100 years), USA (20 years) and Japan (5 years), Vietnam is still in the process of recovery and rebuilding. Since Doi Moi in 1986, Vietnam has increased its economic ranking in terms moving away from being one of the poorest countries in the world to now a lower middle-income country status (Reena et al., 2013). As a one-party Communist state, its goal is to become a developed nation by 2020 (BBC news, http://www.bbc.co.uk/news/world-asia-pacific-16567315). Vietnam is certainly at a key transitional period. Vietnam's growth out of poverty is due in part to global trade relations with US and other Western countries. Yet with the increased interactions and relations with Western countries including the larger forces of globalization, Vietnam youth are being exponentially exposed to many Western ideas, values and behavioral patterns that sometimes stand in vast contrast with the Vietnamese traditional ways, standards and practices (Cox, 2012; Maria, 2002). Along with the economic, social and cultural changes, consumption patterns have also changed resulting in identity and social conflicts (Gao et al., 2012; Lou et al., 2012). Because the younger generation has access to the Internet, albeit restricted somewhat by the government, they have acquired and adopted Western ideals via media, entertainment and telecommunication (Lou et al., 2012).

Sex, for instance, is a very closed topic for Vietnamese. Parents do not talk to their children about sex, peers do not talk to each other about sex and friends do not talk to each other about sex. In fact, sex is considered an impolite topic in social conversations. There is much embarrassment, shame and unwillingness to disclose and share. As such, Vietnam is considered a restrictive culture when it comes to sexuality and issues of sexuality. Yet worldwide, premarital sex is increasingly being accepted by young people (Gao et al., 2012), and youth in Vietnam are of no exception (Gao et al., 2012; Lou et al., 2012; Tu et al., 2012; Zuo et al., 2012). According to an international cross-sectional study conducted in three Asian cities (Hanoi, Shanghai and Tampei) among adolescents and young adults, attitudes toward premarital sex and sexual behaviors are becoming more permissive across both genders (Gao et al., 2012; Lou et al., 2012; Tu et al., 2012; Zuo et al., 2012).

Alongside the increase in sexual permissiveness is the increase in HIV infections in Vietnam. Of particular concern is the youth population ages 14–29, who are at high risk for infection due to a myriad of reasons (Gammeltoff, 2002; Kaljee et al., 2005; Thao et al., 2006; Save the Children, 2009; Ha and Fisher, 2011; Nguyen et al., 2012). Moreover, youth of Vietnam are also becoming increasingly engaged in smoking, alcohol use, drug use, violence and suicide (Tu et al., 2012). According to Tu et al. (Tu et al., 2012), the marginalization of the conservative Confucianist culture in Vietnam has allowed these risky behaviors, in particular, drinking, smoking and violence to increase.

In addition to the rise in youth externalized problems, Vietnam is also seeing a rise in youth internalized problems. According to a longitudinal study conducted in Vietnam (Le et al., 2012), one-third of adolescents self-reported lifetime experiences of low mood and sadness. While self-harm and suicidal behaviors were less prevalent than in other countries, this study revealed that these risky behaviors are becoming more common among adolescents in Vietnam (Le et al., 2012). Significant risk factors of suicidal behaviors include being female, of ethnic minority status, illiterate, exposure to violence, as well as following a religion other than the dominant Buddhist tradition (Le et al., 2012). We contend that mindfulness, with its deep historical roots in Eastern traditions, may be a viable promising prevention intervention approach to address these rising youth problem behavior/issues in Vietnam.

Why mindfulness?

In the USA, while studies of mindfulness intervention with youth and adolescents are currently limited, they do nevertheless suggest that mindfulness is effective at helping youth to develop important life skills to deal with stress and to regulate emotions (Burke, 2010; Meiklejohn et al., 2012; Thurman and Torsney, 2014). Among adult studies, there is evidence suggesting that mindfulness results in significant improvements in basic cognitive and emotional processes such as sustained attention and focus, impulse control and emotional regulation, with observable underlining changes structurally and functionally at the brain level including areas associated with executive functioning (Lutz et al., 2009; Holzel et al., 2011). These findings are similar to those reported in a recent meta-analytical study that found significant effects with respect to improvement on cognitive functioning, and amelioration of stress and emotional problem among children and adolescents in school settings (Zenner et al., 2014).

A major reason for the higher rates of substance use, violence and risky sexual behavior during adolescence is poor attention and impulse control, and difficulties in regulating emotions particularly under periods of intense emotional arousal (Steinberg, 2005). One recent study comparing incarcerated youth vs. non-incarcerated youth revealed that incarcerated youth had more activation in the default network associated with conceptual self-evaluation and mind-wandering and less activation of the control and attention network associated with the prefrontal cortex and functional connectivity (Shannon et al., 2011). Mindfulness is proposed as one strategy to enhance self/emotional regulation and executive functioning (Thurman and Torsney, 2014), thereby reducing risks for unskillful and risky behaviors.

Many of the current youth problems in Southeast Asia including Vietnam stem from the difficulties and stress associated with navigating through the process of globalization and the rapid political, economic and social changes that are occurring (Maria, 2002; Cox, 2012). The ability to bring focus and attention to the present moment, nonjudgmentally, increases the ability to objectively observe one's internal experiences, which can result in more skillful responses. For instance, rather than having ‘anger’ or ‘sadness’ take over, one is able to observe and notice, with curiosity even, the nature and texture of the feeling. In turn, this results in greater spaciousness in which to respond and to choose from alternative options in terms of how to respond, as compared with reacting or reverting to one's habitual mental and behavioral patterns.

Because mindfulness has historical and cultural roots in Vietnam, we contend that a mindfulness-based intervention program would be feasible and well received by youth and teachers in Vietnam. We also assert that mindfulness is not simply associated with Buddhism but is also associated with education in the highest sense as it is about developing and tuning one's faculties in attention and concentration, as well as the ability to engage in deep reflection so that one acts and engages in life with full awareness and compassion. Our study describes the process and implementation of a mindfulness-based youth development intervention in one region in Vietnam. Personal reflections from 5 teachers and 42 students were collected and analyzed using thematic coding.

METHODS

Process of translation and delivery

The curriculum is based on the culturally adapted 10-module mindfulness-based intervention for Native American youth (Le and Gobert, 2015) with influences from the Mind Body Awareness program (Himelstein et al., 2012), John Kabat-Zinn's Mindfulness-Based Stress Reduction (MBSR) program and social–emotional learning. The 10-module curriculum was translated by a Buddhist scholar, trained in Thich Nhat Hanh tradition (second author), and examined and back-translated by a language professional who was fluent in both Vietnamese and English. Discrepancies, inappropriateness of metaphors or stories were examined, revised and added accordingly. Module 3 of the original module (Mindfulness of Nature) was deleted and substituted for a module on interconnection and impermanence, which was considered more pertinent and related to Vietnamese Buddhist culture and Buddhist philosophy. In addition, principles of the three Dharma Seals (Taisho Revised Tripitaka Sutra No. 104), which is the core teaching of the Buddha, were also incorporated and added into the modules.

The framework for delivery remained consistent to the original intervention. That is, the class was conducted with everyone sitting around in a circle. Confidentiality, trust and speaking and listening from the heart were modeled and practiced by the facilitators and then subsequently among the participants. The facilitators were certified teachers recruited from the Department of Education of Vietnam and social workers from various communities serving agencies with 2–30 years of teaching experiences. The teachers were trained in the curriculum over a 3-day period and were provided with opportunities to practice and to deliver the modules in an open-heartedness, guiding relationship style. During the entirety of program implementation, the program developer and Buddhist scholar provided guidance and coaching to the teachers to ensure integrity and fidelity to the curriculum.

It took ∼6 months to obtain the appropriate permissions and approvals from various levels of the Vietnam government to implement the program. Human subject approval was also granted by the Human Studies Program/IRB of the University of Hawaii at Manoa.

Participants

Participants were recruited at two sites. The first site was at the Vocational School for Handicapped with a student population of about 120, aged 10–35 years old. This school offered skills training in embroidery, tailoring, carpentry, household electronics and mechanics to physically and mentally handicapped youth, both males and females. Some students reside at the school, while others live at home and come to the school during the day. The second site was at the Tran Hung Dao High School, which is a semi-private school with a population of ∼1140, aged 15–18 years old. At the High School, students were selected to participate based on their academic record, which included poorest performing and highest performing students. At the Vocational School, students were selected based on the schedule of the class and their availability to participate. At both sites, students were informed about the mindfulness program, and those who were interested were able to sign up and participate in the program. Consent and assent forms were collected from each of the participating students as well as from the Director of the Vocational School, the Director of Tran Hung Dao High School and from the facilitators/teachers. In total, 50 youth from the Vocational School for Handicapped signed up as well as 10 youth from Tran Hung Dao High School. Roughly, 30% could not read and write, so reflections were collected among 42 participants only.

Procedures

The program was delivered over a three-week period that met each day for an hour; in total, there were 15 h of programming as well as a celebratory party for all participants and teachers/facilitators at the end. Each class consisted of two teachers who facilitated the mindfulness curriculum along the ten modules: mindful breathing; mindful listening; mindfulness of the body; mindfulness of thoughts; mindfulness of emotions; balance and choice; compassion and empathy; judgment and acceptance; impermanence and aligning with virtue. There were a minimum of 8 students and a maximum of 15 students per class, and each class consisted of mixed gender. Each class started with a brief mindful breathing using the bell (2–3 min), then the following activities in various order: story, metaphor, song, experiential activity, discussion, lecture, mindfulness practice and then ending with a brief meditation using the bell. At the end of the program, the students and teachers were asked to provide open-ended personal reflections about their experiences in the program based on this one statement: please describe your thoughts, feelings or experiences about the mindfulness class.

Data analysis

Analysis of the personal reflections occurred in several phases. The personal reflections were first translated into English and then reviewed and compared with the Vietnamese version by another bilingual person. In the second phase, the first author and one graduate research assistant read through some of the interviews and engaged in open coding (Strauss and Corbin, 1998). Categories were developed using key words and phrases, and both the first author and graduate research assistant engaged in initial coding of the data using a constant comparison process (Saldana, 2009). In the third phase, the graduate research assistant trained another graduate research assistant in the coding categories, and both read through and coded all the interviews using the qualitative software NVivo. Discrepancies and disagreements were discussed until agreement was reached. Inter-rater reliability was established at kappa = 0.85 during the third phase. Finally, key themes were identified as the axial coding was integrated and merged.

RESULTS

Youth's receptivity

It was evident that youth expressed a high degree of interest, engagement and positive feelings about the program. In fact, the theme that was most salient was that mindfulness is beneficial to my life, with strong sentiments around improving self-confidence, connection, love and focus:

It (mindfulness) also makes my life more beautiful, and love life much more … helped me to understand others, care for another … . love everyone more, learn to share with other … all the students gave me a sense of family. I am very touched … teachers held my hand, walking side by side me each step giving me a sense of belonging to the human race.—19-year-old female.

I learn mindfulness and sewing, but of the two, I learn mindfulness the most because it helped me to focus and reflect a lot and become more aware of myself and those around me. It helped me to have confidence in my life.—15-year-old female.

Before I learned mindfulness, I felt that I was often sad, bored, could not focus on my task. Often I was tired, easy to be sick, lack motivation to do anything. I also felt the ground is unstable under my feet. Ever since learning mindfulness, I've changed a lot. I love life more, and much more happier. I can stand up in times of difficulties … mindfulness empowers me to stand up in life.—20-year-old female.

Before mindfulness class, I could never concentrate on whatever I am doing, and my brain is very chaotic and has conflicts. After class, I am able to concentrate and focus on what I'm doing by allowing myself one minute to calm down.—15-year-old male.

The theme of positive feelings about the program was also apparent, with common conveyance of happiness, fun and wishing that the program continued:

My wish is to have the mindfulness class more often, and go deeper.—20-year-old, female.

After this class, I plan to continue to practice mindfulness. I wish that I could continue mindfulness class, and to have more mindfulness programs.—16-year-old, male.

I thought it (mindfulness class) was a lot of fun when I played the games … I had fun with my peers in class, and I thank you, my teachers, who gave me these moments of joys and beautiful days.—15-year-old female.

The third main theme was around awareness of emotions, with commonly expressed ideas such as mindfulness helping to regulate emotions, helping to reduce inferiority complex, and noticing that feelings improved:

In my life, I was born with a handicap. I don't have much advantages, care and love from parents and my relatives. Often, I experience an inferiority complex. Ever since I came to the Center to learn a skill, I didn't want to interact with anyone even those who extended care and attention to me. As a result, I am who I am today. Ever since I came to mindfulness class, I feel very joyful and full of happiness. I am completely different, much healthier, love life more.—21-year-old female.

Before I took this class, I'm the type of person who could not think and usually get angry and argue easily … before this class, I thought that this life had no meaning, was boring, but ever since I took this mindfulness class, I understand now the meaning of life, and realize to treasure each moment, don't waste it …—18-year-old female.

Less frequently mentioned but also expressed by the youth centered on mindfulness helping to overcome challenges and increasing self-awareness:

I love it (mindfulness class) because it helped me to overcome many difficulties and challenges in my life, and help me to reduce stress … after this class, I will continue to practice and will apply mindfulness throughout my whole life.—16-year-old female.

I learned a lot that is very helpful to myself in this mindfulness class … after this class, I will not just look at the appearance of another to make judgments, but to pay attention within, inside of another.—16-year-old male.

the most meaningful thing was that it helped me to understand more clearly about my past.—18-year-old female.

Indeed, the tune of transformation was clearly echoed in many of the youth's reflections. One reflection, in particular, by a 17-year-old female beautifully captured the essence of her transformation:

When I first stepped into class, the first day, I kept thinking what are we going to learn in this class? After the teacher's lessons, I feel that I've slowly changed, my personality and characteristics. I know how to care and share with others, more. Never before have I listened to what my body is thinking/feeling/telling me—that was a huge challenge for my mind that I was able to accomplish … I begin to really enjoy the class, from the beginning of the sound of the bell, I am able to listen to my thoughts mindfully. And then, I am able to feel my breath, and have more self-awareness. It helped me to concentrate and to listen more accurately. I learned how to care and share the happiness and sadness of me and others. Sometimes we perceive the emotions are normal feelings but when recognize the emotions and become aware of the emotions, that is the moment that mindfulness arrives in our actions and helps us to realize what is true and what is false. Knowing how to care other people emotions, understand, listen, and share with others. That is the lesson that I conclude from this class of mindfulness.

Teachers/facilitators' receptivity

The teachers/facilitators' personal reflections mainly concern how the mindfulness class benefited the students and how conducting the sessions affected them. Several also provided concrete recommendations for program improvement. Along the theme of noticing and observing changes among the students, sentiments of positive changes, greater self-confidence and more love and care among each other were expressed. Illustrative examples of this include the following: ‘I see that the impact of the mindfulness program with all the students is the sharing, openness of their hearts, and especially they are no longer sad or have a complex due to their disadvantages. There is one student who has a condition where she cannot feel any emotion (emotionless), she doesn't speak to anyone but after 3 sessions, she sang a song out loud in front of the….’

The lessons assist the students to regain self-confidence. This is the most important aspect for Vietnamese youth/students…the second is concentration … and the third is the quality of ethics…the lessons contribute to helping students develop love and sympathy. As it occurs slowly, the lessons will permeate into the students, resulting in better students who will become great men and women in society.

I can say that after this program, the students became more mature. The students at the vocational school for handicapped noticed that they had less inferiority complex because this class helped the students to share about their sentiments with others around. The students noticed that they are not lonely anymore and live a more meaningful life. The students at the high school, the changes that I observed make me want to cry. I am a literature teacher. I always struggle how to teach not only the knowledge of literature but also how to become a ‘person’. This mindfulness class has contributed to making the students well behave at home and at school.

This one teacher also noted that the students would frequently contact her after the completion of the mindfulness program, and they shared with her how the class helped them to realize their shallow thinking and to nurture their love for others. The teachers/facilitators also noted changes within themselves as a result of conducting the mindfulness classes including greater awareness of their own thoughts and emotions, less mind-wandering and greater joy and happiness. Similar to several of the students' reflections, the teachers/facilitators also expressed feelings about loving life more and being grateful for their blessings.

In terms of recommendations, teachers reported that using stories, folk tales or proverbs was more favorable and effective than lecturing to convey ideas and concepts. Further, they noted that the stories need to be popular or commonly known, easy to understand and easy to tell. An extension of the use of story-telling is to tell the story without disclosing the ending, and then asking the students how they would resolve the issue, and then bringing mindfulness into it, and asking them again how they would then resolve the issue. Another recommendation that they offered included developing more activities and being creative in terms of linking the activities to the modules, or to accommodate to special needs participants. For instance, some participants because of their handicap situation could not walk, so instead of binding the legs for the balance activity, they had them bind their hands instead. Several of the teachers/facilitators also wanted more detailed materials in the curriculum although it was the intention of the program developer to keep the materials simple and spacious thereby allowing openness and creativity to unfold within the users.

DISCUSSION

We proposed that because mindfulness and the principles of mindfulness have strong historical roots in Vietnamese culture although in a more implicit than explicit sense, that it would be widely and easily accepted by the youth and teachers and that the participants would derive some beneficial outcomes. Indeed, from the personal reflections of the 42 student participants and the 5 teachers/facilitators, it was evident that there was high degree of acceptance and receptivity for the mindfulness program in Vietnam. In fact, throughout the 3 weeks, no one missed a class, and several students asked if the program could continue, wanting to go deeper and further into the practice. Several of the teachers/facilitators described leading the mindfulness group as one of their most rewarding and heart-warming life experiences to date and wished that they could facilitate mindfulness full time. As additional evidence, after completion of this feasibility study, the Directors at both the schools continued the program for another 10 weeks, and a mindfulness club consisting of 500 student members was initiated.

While the original intent of the study was to determine feasibility, at the same time, the program yielded many significant and positive transformations that were unexpected. Students reported not only decreases in the negative affect (sad, boredom) and stress, but also in their inferiority complexes; they also expressed increases in well-being, positive mood (happy, appreciation and gratitude), embracing life, empathy and connection with others. Many students shared how mindfulness techniques and practices, specifically mindful breathing, increased awareness of their own emotions and thoughts, which allowed them to regulate and observe their emotions/thoughts more objectively rather than be controlled and consumed by them. They also conveyed how they felt much closer to their peers, and how the depth of their sharing within the group setting fostered a sense of family and appreciation for their peers and teachers. Indeed, during the closing ceremony, many tears of joy and compassion were shed among the teachers as they revealed observations of changes they noticed among the students.

The high degree of receptivity and acceptance for this mindfulness program including the teaching of core mindfulness practices (mindful breathing, body scan, mindful listening and mindful walking) may in part be due to the resonance between the ideas of mindfulness and Vietnamese traditional and indigenous practices; in other words, mindfulness practices are rooted and linked to the Buddhist and traditional culture/collectivistic values in Vietnam. Among Eastern cultures, mindfulness meditation is considered part of daily life and spiritual functioning with an orientation toward selflessness and compassion whereas among Western cultures, meditation and mindfulness is regarded more as a technique related to self-improvement and stress reduction (Suchday et al., 2014). For example, in mindful breathing as discussed earlier, the individual is building concentration energy, which will allow him/her to see deeply the connection between him/herself and the ancestors during the practice of ancestor worship. Many of the very common, well-known cultural stories, proverbs and parables used by the teachers have core ideas of mindfulness imbedded in these stories. The program allows for these stories and proverbs to be shared again and to make the connection between moral principles/ethics and mindfulness explicit. For example, in the common saying ‘uốn lưỡi bảy lần trước khi nói’ (curl your tongue seven times before speaking), the idea is that one needs to take careful consideration before speaking one's mind (illustrative of mindful speech). Another example is the proverb ‘lời nói chẳng mất tiền mua; lựa lời mà nói cho vừa lòng nhau’ (speech does not cost any money; so choose your speech wisely to bring comfort and ease to others), again illustrative of mindful speech. A repeated sentiment among the youth's and teachers' reflections concerns how mindfulness helps them to develop greater harmony and compassion toward others and helps them to realize the importance of certain ethics and virtues.

The program was intentional in terms of allowing the teachers/facilitators to incorporate culturally relevant and appropriate stories, parables and proverbs. In fact, this was highly encouraged throughout the training, and during the training as well as implementation, we observed that the teachers/facilitators quickly incorporated Vietnamese cultural relevant stories, proverbs and songs in each of the modules.

It should also be noted that only two of the teachers/facilitators had in-depth mindfulness practice. The majority of the teachers/facilitators were new to mindfulness, but they quickly learned, practiced and adopted the mindfulness practices in their daily life and in terms of their relation with the students. Indeed, teachers/facilitators frequently reflected how mindfulness is helping them to become better teachers and to connect with their students in a more meaningful way. Jennings (2015) suggest that mindfulness can help teachers to develop their social and emotional competencies which can contribute to their effectiveness and performance.

Limitations

Despite the positive feedback and wide receptivity for the program, there are several limitations that need to be considered. First, because the program was offered on a voluntarily basis, there is potential for selection bias. Students who were already intrigued or interested in meditation/mindfulness were the ones who signed up and were more motivated to learn and embrace the mindfulness techniques. While the qualitative findings were extremely positive, there is need for an intensive and extensive scientific study of mindfulness among youth in Vietnam. Such a study should include a randomized control clinical trial with three levels of data capture (objective-third person, second person subjective and first person subjective).

The second limitation concerns the fact that this is a feasibility study to explore whether a mindfulness program would be accepted in Vietnam; as such, we cannot make any generalizable conclusions or causal inferences. We can only say that there is strong suggestion that this mindfulness program is feasible for youth and the emerging adult population in Vietnam. There is also discussion of expanding the program to other communities including to other schools including those in rural regions, to women's groups, to orphanages, to the cyclo drivers, to families who live in boathouses, among others.

CONCLUSIONS

Although increasing, the study of mindfulness for youth and adolescent populations still remains limit, and particularly limited to those of European ancestry. Only very few studies to date have included other ethnic groups such as African Americans and Hispanics (Roth and Robbins, 2004; Himelstein et al., 2012; Sibinga et al., 2013), or Native American youth (Le and Gobert, 2015), and only one has included youth outside of the industrialized Western countries (Wongtonkam et al., 2014). This study is thus particularly novel and significant. This feasibility study suggests that a mindfulness-based program for youth and young adults in Vietnam has great potential and promise in terms of facilitating well-being, awareness, connection and decreasing stress. Mindfulness is arguably one viable solution to curb the tide of youth problem behaviors in Vietnam by bringing Vietnamese youth and young adults back to their cultural roots and heritage. Mindfulness becomes the link to realize one's virtues and ethics so that one acts and engages in life with full awareness, understanding and freedom.

Acknowledgements

We extend a deep bow of gratitude to Kim Le and Kinh Thi Nguyen for their tremendous support and assistance in this program. We are also grateful to Nguyen Tan Thanh, Dao Thi Mai and to all the teachers/facilitators and youth who opened their hearts and mind. Special thanks also go to Rebecca Young and Loc Minh Nguyen for their research assistance.

References