Journal of Behavioral Medicine, Vol. 29, No. 4, August 2006 ( C  2006) DOI: 10.1007/s10865-006-9063-6 Effects of Spiritual Mantram Repetition on HIV Outcomes: A Randomized Controlled Trial Jill E. Bormann, 1,2,6 Allen L. Gifford, 3 Martha Shively, 1,2 Tom L. Smith, 1,4 Laura Redwine, 4 Ann Kelly, 1 Sheryl Becker, 1 Madeline Gershwin, 1 Patricia Bone, 5 and Wendy Belding 5 Accepted for publication: June 7, 2006 Published online: July 18, 2006 We examined the efficacy of a psycho-spiritual intervention of mantram repetition—a word or phrase with spiritual associations repeated silently throughout the day–on psychological distress (intrusive thoughts, stress, anxiety, anger, depression), quality of life enjoyment and satisfaction, and existential spiritual well-being in HIV-infected adults. Using a 2-group by 4- time repeated measures design, 93 participants were randomly assigned to mantram (n = 46) or attention control group (n = 47). Over time, the mantram group improved significantly more than the control group in reducing trait-anger and increasing spiritual faith and spiri- tual connectedness. Actual mantram practice measured by wrist counters was inversely as- sociated with non-HIV related intrusive thoughts and positively associated with quality of life, total existential spiritual well-being, meaning/peace, and spiritual faith. Intent-to-treat findings suggest that a mantram group intervention and actual mantram practice each make unique contributions for managing psychological distress and enhancing existential spiritual well-being in adults living with HIV/AIDS. KEY WORDS: HIV/AIDS; randomized controlled trial; spirituality; spiritual therapy; meditation; mind-body and relaxation techniques; intervention study. Growing evidence supports the premise that spirituality is associated with better health outcomes (Seeman et al., 2003) and improved quality of life (Aguirre, 1998; Brady et al., 1999; Paloutzian and Ellison, 1982). Both religious and spiritually-based practices may buffer the effects of stress (Ironson et al., 2002; Koenig et al., 2001; Ozsoy and Ernst, 1999; Pargament et al., 2004; Reed 1986; Tuck et al., 2001; Sowell et al., 2000; Woods et al., 1999) which 1 VA San Diego Healthcare System, 3350 La Jolla Village Drive (118), San Diego, CA 92161, USA. 2 School of Nursing, San Diego State University, San Diego, CA 92182, USA. 3 Bedford VA Medical Center, Bedford, MA 01730, USA. 4 University of California San Diego, San Diego, CA 92161, USA. 5 Veterans Medical Research Foundation, San Diego, CA 92161, USA. 6 Correspondence should be addressed to e-mail: jill.bormann@ va.gov. are known to impair the immune system (Antoni et al., 2002; Baum and Posluszny, 1999; Kiecolt- Glaser et al., 2002a,b). Research has demonstrated that forms of medi- tation like Transcendental Meditation (TM), a tech- nique using a “meaningless” mantra assigned by a teacher and repeated silently while sitting qui- etly with eyes closed for 15–20 min, twice a day, is associated with stress reduction (Alexander et al., 1993). Other health improvements reported in- clude reduced hypertension (Alexander et al., 1996; Alexander et al., 1993; Schneider et al., 2005; Schneider et al., 1995), improved pain management (Mills and Farrow, 1981), improved cerebral blood flow (Jevning et al., 1996) and EEG changes (Taneli and Krahne, 1987). Findings of these TM studies, however, have been challenged by Canter and Ernst (2003, 2004) who found “700 published research pa- pers on TM, many of which have been produced by 359 0160-7715/06/0800-0359/0 C  2006 Springer Science+Business Media, Inc.