Use of Falun Gong to Address Traumatic Stress among Marginalized Clients

Although mental health service providers have focused on the effects of trauma and related interventions for decades, little is known about pervasive and historic trauma, particularly for socially marginalized individuals. Thus, clinical issues associated with sociopolitical oppression have been under-investigated. Coupled with the lack of sufficient cultural competence when working with diverse clients, mainstream clinicians frequently lack adequate case conceptualization skills and culturally sensitive interventions to assist clients from diverse backgrounds. Using traumatic stress as a framework for exploring evidence-based interventions to address long-term, pervasive marginalization and its psychological effects, the authors propose that mindfulness techniques are particularly beneficial to this client population. The authors reviewed culture-centered interventions to address traumatic stress for marginalized client populations, focusing on the mindfulness practice of Falun Gong. Recommendations for practice include the inclusion of traumatic stress theory and techniques in pre-service training, professional development training for practitioners focusing on mindfulness techniques with clients assessed with historical trauma, and Web-based training for clinical faculty to enhance their knowledge about traumatic stress, historical trauma, and associated interventions for clients from marginalized communities. The authors offer recommendations for future research that focuses on studies exploring the usefulness of Falun Gong in working with clients with traumatic stress.


Introduction
Scholars have most recently begun to investigate the impact of pervasive micro aggressions and other forms of systemic oppression on individuals from culturally and socially marginalized groups. Researchers have suggested that trauma affected clients report emotional and psychological impairment, such as depression and anxiety [1]. Other investigators have found that problems interpersonal conflicts and substance abuse problems are evident. Educational researchers have also explored traumatic stress and academic achievement and assert that severe persistent stress due to environmental factors, such as racism, can negatively impact children's academic performance [2,3]. The authors use traumatic stress theory as a framework for exploring effective interventions to decrease symptomology due to systemic oppression.
The purpose of this paper is to outline the benefits of Falun Gong, an ancient Chinese mind-body and spiritual discipline, as a mindfulness intervention when working with culturally marginalized clients. The authors provide an overview of the clinical issues associated with historical trauma and then present Falun Gong as an alternative solution for ameliorating the effects of social marginalization. The authors suggest that Falun Gong is beneficial in addressing the psychological, physical, academic, and financial needs of these particular types of clients. Recommendations for practice include expanded training on Falun Gong as a clinical intervention and an enhancement of the curriculum in various mental health-training programs to include more emphasis on mindfulness and, more particularly, Falun Gong. Suggestions for future research focus on developing a national study exploring the impact of Falun Gong practices on traumatic stress symptoms for culturally marginalized clients.

The effects of historical trauma on marginalized populations
How individuals cope with trauma is dependent upon their social positioning prior to the onset of traumatic experiences. Some groups of people, such as poor people, the elderly, culturally diverse, and mentally/physically impaired, are disproportionately affected by traumatic events and experiences based upon institutionalized and historical biases in society. Lack of access to institutional resources and lack of power to control those institutions creates a cycle of socio-cultural abuse that threatens the psyche of culturally diverse individuals.
Yet, mental health professionals have been slow to acknowledge clinical issues related to pervasive trauma & chronic stress due to cultural hegemony [4]. For culturally diverse clients, for example, this has meant diagnoses based upon models of normalcy for middle-class Whites. Research has shown that systemic oppression has deleterious physical and mental health effects. Traumatic stress and psychological distress have been shown to be evident in several studies. Some of the outcomes of systemic oppression are noted in physical/psychological health [1][2][3] and education disparities [2,5].

Cultural and clinical competence
For the most part, traditional perspectives in the behavioral sciences have focused on the client as a poorly functioning individual. An ecological approach considers the possibility of a malfunctioning system and its impact on the client [6]. In analyzing some hypotheses to explain why clinicians have been slow to incorporate systemic interventions into their roles and responsibilities, one study suggests that clinicians may "underestimate the power of resources other than their values, skills, and personalities" ( [7], p. 33).
An eco-systemic perspective in examining trauma aids in understanding and conceptualizing the needs of culturally diverse communities. Concentrating on the African American experience, researchers have begun investigating the correlates between historical trauma and oppression [1,[8][9][10]. Additional work in this area by Seaton [11] revealed that, in particular, due to racism, African Americans experience more stressful events than European Americans. In summarizing the Differential Exposure Hypothesis (DEH), Seaton suggested that racism, bias, and discrimination are detrimental to African Americans because they are disproportionately placed at higher risk for psychological disorders. Eco-systemic interventions incorporate an understanding of those external influences that impact an individual's functioning [6].
Over the past two decades, mental health practitioners across all disciplines have become increasingly aware of the need for clinicians to involve themselves in the role of advocate for their clients [12][13][14]. Clinicians need to consider their clients within the context of their families and communities, as well as their social, cultural, and religious systems [15]. Additionally, assessment and treatment models are needed to intervene with clients who have been impacted by systemic oppression. Clinicians can explore relevant themes to address the context of systemic oppression and the related traumatic experiences. Intervening for trauma due to systemic oppression is necessary for recovery. Through their expanded awareness of sociocultural oppression, clinicians can become healers as well as advocates for their clients [14].

Traumatic stress theory
Chronic stress/pervasive trauma, related to systemic oppression, is transgenerational in nature: this is contextualized by historical and systemic oppression resulting in discriminatory legislation and racism in the U.S. Current effects of systemic oppression and trauma may be additive to the historical trauma experienced by previous generations [3]. Many of the problems reported by individual trauma survivors also are reported by their partners, including individual stress symptoms, isolation, poor relationship quality, and reduced intimacy. The available literature suggests that trauma and trauma symptoms affect not only the individual but also the people with whom traumatized persons have a significant relationship (e.g., spouses, partners, and children). However, this literature on the systemic effects of trauma is predominantly clinical in nature [16].
Trauma is experienced intergenerationally despite the absence of direct exposure to a traditional traumatic stimulus as evidenced from the study of Jewish Holocaust survivor's children [17]. This study was also extended to the family members of veterans from World War II and the Vietnam War, indigenous peoples, individuals and groups living under repressive regimes, those experiencing domestic violence and crime, and those living with infection and life-threatening diseases. Symptoms may include depression, anxiety, suicidal ideation and behavior, substance abuse, and violence.
Effective interventions with culturally diverse clients: (a) build on existing knowledge within the client's worldviews, (b) maintain client empowerment and agency, (c) demonstrate reciprocity in the transformation process, and (d) honor the historical and contextual forms of healing within the client's familial and community networks. Some examples of these types of interventions include the use of story circle and other forms of narrative storytelling. More recently, clinical research has explored the benefits of meditation and mindfulness is assisting trauma-affected clients. Both of these types of interventions can be useful in working with culturally diverse clients.

Story circle
Story circle is a tool to build equal partnerships that foster better understanding and communication among participants with like interests, thereby creating a stronger sense of community [18]. The story circle is oral and affective in nature. Stories tell individuals about their whole selves. Clients have the opportunity to share their feelings, thoughts and emotions with other people. They free their spirit in a way that is incomprehensible to outsiders. The term outsiders, refers to either observers of the story circle, or other cultures that may not be familiar with storytelling traditions in their society. The story circle tends to create a comfortable environment that encompasses warmth and trust. The facilitator's job is to make sure each person connects the themes and patterns that the stories have created. All stories should connect in some way or another. It is also appropriate for members of the story circle to challenge one another after the storytelling has taken place. When it is time to process, members should discuss where they felt connected and focus on feelings and thought processes. The facilitator should also let everyone share responsibility for keeping track of time because it can last a while. Also, a follow-up activity should be conducted for the group as well.

Mindfulness/meditation and emergent practices
There is plentiful evidence to show that Eastern meditation and mindfulness techniques have beneficial effects on our personal and work life [19][20][21][22]. One study showed that participants reported significant reduction in anxiety, depression, and stress levels after a 10-week mindfulness meditation program [20]. Other studies indicated that meditation could alter brain function and even change the physical structure of the human brain, impacting the concept of lifelong neuroplasticity [23][24][25][26]. Weaver [22] noted some of these studies showed that even novice or inexperienced meditators can rewire their brains and reap the benefits of meditative practices. These modified Eastern meditative and mindfulness techniques have shown to be beneficial effects.
As more people are seeking peace, inner balance, and wellbeing through meditation and mindfulness practices, there is a mushrooming of interest from those in the helping profession to integrate these ancient practices into their work [27][28][29][30][31][32]. A survey by the Psychotherapy Networker revealed 41.4% of about 2600 therapists reported integrating certain mindfulness techniques into their professional practice [29]. An online survey by Counseling Today, a publication of the American Counseling Association (ACA), indicated that 87% of counselors reported adopting an integrated practice with mindfulness approaches into their professional work with clients [28]. Writers, like Meyers [28], regard meditation as a form of mindfulness based technique.
Today, Falun Gong is one of the fastest emergent Chinese spiritual and meditative movement practices that is spreading throughout the world [31][32][33]. Large scale studies conducted in mainland China showed the tremendous health and wellness effects of Falun Gong [32,[34][35][36]. Likewise, various studies outside of mainland China and around the world indicated Falun Gong's beneficial effects [33,[37][38][39]. There were two studies outside of China that stood out. The first was the Australian survey completed by the first author under the auspices of The University of South Australia for partial fulfillment of the Doctor of counseling degree examined the health and wellness effects of Falun Gong from the selfreports of Falun Gong practitioners [38]. It was the first empirical study with a diverse sample outside of mainland China [33,38]. The second one, completed for the partial fulfillment of the Doctor of Philosophy in Psychology at the University of California, Los Angeles, demonstrated that practicing Falun Gong has a beneficial effect and that long-term practice may lead to hemispheric changes in the brain [40,41].
Falun Gong has not been a subject for much research. Besides these two studies conducted under the auspices of an Australian and a US university respectively, a team of medical doctors and researchers in the United States had undertaken a pilot study to examine the effects of Falun Gong on gene expression and the role of neutrophils in Falun Gong practitioners [42]. Findings from their pilot study revealed superior gene expression, enhanced immunity, and longer lifespan of neutrophils in Falun Gong respondents [42]. The researchers' endeavor provided the first evidence to suggest that practicing Falun Gong could influence immunity, metabolic rate, and cell regeneration. Then there were several publications documented many individuals experiencing health and wellness healing effects after they started practicing Falun Gong [43][44][45].

What is Falun Gong?
Also known as Falun Dafa, Falun Gong is a high-level Chinese self-cultivation practice for overall mind, body, and spiritual improvement [33,46,47]. It originated from Northeast China. Over the past two decades since its teacher and founder, Master Li Hongzhi first introduced Falun Gong to the public in 1992, there are numerous terms used to describe Falun Gong [33,38]. Most non-Falun Gong writers concurred that Falun Gong is a form of qigong [46,[48][49][50][51] or a Buddhist qigong system [52]. Other expressions used to describe Falun include traditional Chinese religious practice, or revival of traditional Chinese spiritual practice [49,[53][54][55][56], or as a new religious movement [57][58][59][60]. Gale and Gorman-Yao [61] described Falun Gong as a cultural movement, while Ackerman [62] referred to the practice as a New Age spiritual movement.
Despite the myriad of descriptive terms and expressions, there is a mutual understanding that Falun Gong is a form of qigong, a comprehensive spiritual meditation discipline, a quasi-religious practice, or a new Chinese religious movement. Human Rights Watch Senior Advisor Spiegel [51] offered a comprehensive definition, describing Falun Gong as a synthesis of qualities: "A form of qigong, an ancient Chinese deep-breathing exercise system sometimes combined with meditation that enthusiasts claim promotes physical, mental, and spiritual well-being by enhancing the flow of vital energy through a person's body. It also includes elements of popular Buddhism and Daoism" (Spiegel, 2002, p. 8).
Among practitioners, Falun Gong, an ancient Chinese spiritual discipline, is better known as Falun Dafa. The Chinese word "Fa" ( [63], p. 390) refers to law or principles in the Buddha School teachings but this is not the same as the Buddhism taught by Buddha Shakyamuni or Siddhārtha Gautama. Penny states in his book, The Religion of Falun Gong, that the "falun" in the name Falun Gong "has a different meaning from that in Buddhism" ( [64], p. 5). He describes Falun Gong as "the practice of the Wheel of the Law" (p. 5), and that Falun Dafa refers to "the Great Method of the Wheel of the Law" ([64], p. 5).
In Zhuan Falun, the complete teachings of Falun Gong, "Dafa," which is pronounced as "Dah-fah" simply means the "Great Law" or the "Great Way" ([63], p. 2). While Falun Dafa is more befitting and widely used in Falun Gong literature, for the purpose of this article that comprises the White Paper, many writers have consistently alluded to this Chinese spiritual discipline as Falun Gong. This is partly because Falun Gong has remained more popular and widely used across different media, popular search engines, and literature by non-Falun Gong people [33,38].

Advanced practice with ancient roots
Most Falun Gong literature describes the practice as an ancient Chinese spiritual discipline in the Buddha tradition [31,33,38,47,65,66]. Falun Gong, pronounced "Fah-loon Gong," is a high-level, mind-body spiritual system with its roots in both ancient Buddhist and Taoist traditions [63,67]. The gong in Falun Gong and qigong connotes exercise or practice but Falun Gong is not one at the same as practicing qigong. The gong in Falun Gong actually pertains to a "high-energy substance that manifests in the form of light, and its particles are fine and its density is high" ([63], p. 5). In Falun Gong, it is the cultivation of this gong that facilitates genuine healing, mind-body, and spiritual transformation [63] that many individuals experience. Simply put, Falun Gong, with its moral teachings and fivea meditative exercises, is a popular, tranquil cultivation practice for overall mind-body and spiritual improvement.
At the heart of the practice, Falun Gong teaches three universal principles-Truthfulness, Compassion, Forbearance-or Zhen, Shan, Ren in Chinese ( [63], pp. [13][14][15][16][17]. While some people in the West describe Falun Gong as a "Chinese yoga" ( [47], p. 40), Falun Gong exercises are a lot simpler than yoga and do not imitate animal movements, like Indian yoga does. Falun Gong has only four standing exercises and one sitting meditation [67]. First introduced to the public in mainland China in 1992, the founder of the practice explains that Falun Gong is an advanced spiritual cultivation discipline and hence a high level form of qigong [63]. Within 7 years-from 1992 to 1999-Falun Gong rose from anonymity to become one of the fastest growing spiritual practices. On July 20, 1999, Falun Gong was illegally banned in mainland China and followers of the practice received the most horrendous persecution [33]. At the time, about 100 million people in China were practicing Falun Gong, which means that about one out of 13 Chinese people in mainland China was practicing Falun Gong [68], as a result of the practice's healing benefits.

Cultivating the heart and mind
A unique characteristic of Falun Gong lies in its focus on heart and mind cultivation and on becoming a morally upright person. Falun Gong is based on the ancient tradition of self-cultivation, transcending ordinary existence toward a higher state of being, and liberating one from the illusions of this material world. Thus, cultivation calls for letting go of desires, being virtuous and uprightness, as well as using special practices techniques to refine both the mind and body [33,63].
Falun Gong comprises two distinctive aspects-cultivation and practice. Cultivation or self-cultivation is an Eastern concept for mind, body, and spiritual improvement [69] that is a crucial and vital aspect of traditional Chinese culture. Falun Gong underlines xinxing cultivation, which is, cultivating the heart and mind [63,67]. Cultivating the heart denotes improving one's moral character-guided by the principles of truthfulness, compassion, and forbearance [63].
It must be noted that improving one's mind and heart, or moral character, requires a strong main consciousness. In Falun Gong cultivation, it is important that "the mind must be right" ( [63], p. 245). According to the teachings of Falun Gong, when one's heart and mind or xinxing improves, one's body, mind, and spirit will naturally transform [63] and one will thereby reach optimum health and wellness. So, Falun Gong is more than just a meditation practice; it is a spiritual cultivation discipline for overall body, mind, and spiritual advancement. Of the two-cultivation versus practice-it must be noted that cultivation is far more important than the exercise practice. The latter is merely to strengthen the mechanisms in the body [67].
The practice component of Falun Gong involves a sitting meditation and four standing exercises. Each exercise has specific health-related aims and benefits [67].
Simple, yet beneficial is its health-wellness impact on millions of individuals who turn to Falun Gong for solace. From the integrative counseling perspective, Falun DOI: http://dx.doi.org /10.5772/intechopen.93301 Gong is a mind-body approach embodying the art of self-care as well as serving as an intervention strategy [37]. Hence, there is potential for its integration into the helping profession [32,33,37,[70][71][72][73][74], in particular for addressing traumatic stress among marginalized clients.

Benefits
Practicing Falun Gong has numerous benefits. Many individuals can attest to it that Falun Gong can help to ease anxiety, stress, and traumatic stress; enhance energy and vitality; and improves the mind and body [43,44]. Falun Gong has offered inner joy, peace, and serenity, leading to spiritual growth and enlightenment for many individuals. At the 2018 International Conference on Spirituality and Psychology, the first author, who was invited to speak about the viability of Falun Gong integration, presented three case examples on how Falun Gong was able to help individuals to overcome anxiety, depression, and post-traumatic stress disorder [71,72].
Case story examples illustrate the healing benefits of Falun Gong and its integration feasibility with counseling in helping clients toward self-healing and realizing their varied purpose in life. The ancient art of storytelling helps to provide insight into the healing effects of Falun Gong, allowing individuals who have benefitted from the practice to express their inner world and to create meaning by describing in their own words how Falun Gong has impacted and transformed their lives. For example, voice actor and author Rich Crankshaw is one such individual who has benefited tremendously from the practice. His healing from traumatic stress arising from child hood abuse was empowering: "After three days, my anxiety was lower, my stress level was lower, my depression was not as dominant, and all of a sudden, I understood that I just didn't need to smoke weed or drink beer anymore" ( [75], p. 197) . Falun Gong "has been a major part of my ongoing healing and recovery" ( [75], p. 198), stated Crankshaw who has an English-Mohawk indigenous ancestry.
Academic research exploring the therapeutic effects of Falun Gong is still lacking. The prevailing body of Falun Gong literature exploring its beneficial effects can be classified into two groups. The first wave of enquiry was in mainland China before the persecution of Falun Gong began on July 20, 1999, while the second movement of scholarly enquiry into the beneficial effects of practicing Falun Gong took place outside of China after 1999. This section revisits some of the studies from both categories. Before 1999, a team of researchers in mainland China completed an extensive survey with a sample size of 12,731 participants from five districts in Beijing [34]. Findings from this massive survey indicated Falun Gong's effectiveness was over 99%, with a 59% cure rate. For physical and mental health, the improvement rate was over 80 and 97%, respectively [34].
After the onset of the persecution in 1999, some practitioners in Canada and the United States conducted the North American survey [39]. Findings from this survey supported and reinforced the results from the large-scale Beijing surveys [34]. In 2000, a single-case study for partial fulfillment of a master's degree in social science in counseling showed the beneficial use of Falun Gong in relieving burnout and posttraumatic stress [37]. Additionally, there are two reports worth citing. The first is an independent study conducted in Taiwan, which found that people who practice Falun Gong are physically and mentally healthier than the general Taiwanese population [76]. Respondents reported that practicing Falun Gong helped to eliminate unhealthy and addictive lifestyle habits, such as gambling, cigarette smoking, alcohol addiction, and chewing betel nuts that is a common habit in Asian countries [76]. Lio et al.'s study also highlighted Falun Gong's medical cost-saving potential, showing a 50% decrease in the use of medical health insurance for Falun Gong Psychosomatic Medicine 8 respondents [76,77]. In another study, a group of researchers in Russia reported a 73% improvement rate in the respondents' health and wellness [78].
Researchers from Switzerland, Taiwan, UK, and the US did a meta-analysis based on the self-reports from Chinese cancer patients between 2000 and 2015 and found that practicing Falun Gong could significantly improve survival rate for cancer patients [79]. About 97 percent (n = 147, 96.7%) indicated full symptom recovery, with 60 cases confirmed by their doctors [79].

Discussion
Falun Gong can be a useful alternative to existing interventions for traumatic stress because of its ability to alleviate anxiety and bring about innerpeace [33,73]. Contemporary research that explores traumatic stress as it relates to racial bias suggests that individuals often report unhealthy and addictive lifestyles as a means of coping with the daily microaggressions. Falun Gong could help these clients to become more congruent in their perspectives on mind body connection. Falun Gong is likely to target the psychological and physical issues associated with traumatic stress and provide clients with less cognitive distress leading toward better decision-making and help clear negative thought patterns. Falun Gong can also provide clients with a cost-effective intervention that makes it accessible to clients across the socio-economic spectrum.
Moreover, Falun Gong is an intervention that can be conducted within systems, such as family, work, and organization, in much the same way mindfulness and meditation have been introduced into various workplace [21,[80][81][82][83]. The use of Falun Gong within the family system is likely to impact interpersonal conflicts that may result from ongoing stressors within the social environment. Parent-child, sibling, and couple interactions can be improved when family members engage in Falun Gong practices and activities together. In this manner, families can share in countering the effects of institutional racism and Falun Gong can serve as a coping mechanism for reducing the associated stress.
Using the mindful practice of Falun Gong in the workplace, employees can become much more productive when they are able to reduce the stress related to workloads and any differential treatment that some members from within the working environment may experience. This would allow for opportunities to clearly think through forms of advocacy for themselves and for others who may be victims of microaggressions in the workplace. On the organizational level, Falun Gong can support members in finding harmony, improving collaboration efforts, and thinking clearly about strategic goals and initiatives for the organization. Rather than becoming riddled with interpersonal conflicts due to competing demands, issues of power and control among various factions, or challenges caused by lack of member engagement or financial concerns, organizational leaders are able to stay focused on how to work toward a unified goal.
Although Falun Gong, as a mindfulness and meditative practice, is still new to the mental health professions, it is promising as an effective intervention, particularly when working with marginalized clients who experience traumatic stress in a diverse and multiple settings. In fact, various studies have shown that practicing mindfulness and meditation may be beneficial for both the therapists and their clients. For instance, in Germany, a team of researchers found that therapists' personal training in meditation could have favorable impact on clients [84]. The randomized double blind controlled study conducted by Grepmair et al. [84] revealed that it did not matter whether or not the clients themselves practice meditation or know that their therapist practices meditation. Their findings revealed that the outcome was still favorable for the clients.
In another study, Schure et al. [85] emphasized the relevance of preparing counseling students with mindfulness techniques as self-care skills and intervention strategies that students could later incorporate into their professional work. In an earlier study, Gale and Gorman-Yao [61] discussed the health-wellness potential and cultural implications of integrating Falun Gong into nursing for a "culturally appropriate and sensitive nursing care to all clients" (p. 124), a concept that counseling educators and professionals could consider and implement in teaching programs.

Recommendations for Practice
Suggestions for improving clinical practice include the inclusion of traumatic stress theory and techniques in pre-service training as well as professional development training for practitioners. Additionally, it is recommended that clinical faculty enhance their knowledge about traumatic stress so that it can be integrated into the various curricula in mental health training programs. Pre-service and practitioner training could focus on integrating Falun Gong in to working with clients assessed with historical trauma. For faculty, web-based training would enhance their knowledge about traumatic stress, historical trauma, and associated interventions for clients from marginalized communities, as well as learning about Falun Gong.
The need for proper training in the mindful practice of Falun Gong via counseling programs in tertiary institutions is crucial. It is hoped an integrated approach with Falun Gong will be part of a training program. While other types of mindfulness techniques are widely taught, there are hardly any institutions that currently offer the mindful practice of Falun Gong as part of their curriculum.

Conclusion
The authors offer a recommendation for future research to focus on studies that explore and document the use of Falun Gong to work with clients who have been assessed with traumatic stress. There is a dire need for these studies to provide solid evidence of the positive link between practicing Falun Gong and traumatic stress mainstream and minority communities. For Falun Gong's integration viability, there is thus a need for pioneers in the field to shoulder greater responsibilities, emphasize on-going research, evaluations, and implement proper documentation on the health and wellness effects of Falun Gong, its auxiliary and integrative potential for the health and wellbeing of counseling and health professionals, clients, and the community at large. *Address all correspondence to: sibubooks@gmail.com Note 1. This paper and its topic were initially presented at the 2019 International Conference on Spirituality and Psychology in Bangkok, Thailand, by the co-authors. The first author has included more information about Falun Gong from the original White Paper that focuses on integration and the use of Falun Gong to address traumatic stress among marginalized clients.

Author details
2. For citation purposes in this book chapter, the authors have used the Fair Winds Press publication of Zhuan Falun. However, it is recommended that readers refer to the 2014 hardcover edition of Zhuan Falun for references: [86].
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