Utilizing Meditation Audio in Warrior Mind Training Treat Traumatized Firefighters

. Meditation is a psychological concept that has become a hot topic recently in the field of neuroscience. Based on many fundamental and crucial experiments or research, people discovered that meditation, however, is a stress buster that helps people to alleviate the symptoms of anxiety disorders spectrums with its scientific mechanisms that are studied. When it comes to firefighters frequently exposed to traumatic fire scenes and at risk of being traumatized, chances are high that meditation will be a pragmatic way of improving their resistance when exposed to the trauma without any side effects caused by its medication. This paper examines the effectiveness of meditation in alleviating PTSD or traumatized symptoms for firefighters with the use of two psychological scales, analyzing and categorizing each result in the statistic. By listening to the meditation audio, the symptoms of insomnia and anxiety have been assuaged, shown by the post-intervention group with p=0.099<0.1, χ2 =4.63 in insomnia-scale measurement, as well as p=0.079<0.1, χ2 = 3.086 in traumatized-scale measurement, embodying the effectiveness of meditation in alleviating traumatized symptoms and insomnia severity as prediction (P was set at 0.1).


Introduction
Posttraumatic stress disorder (PTSD), the development of recognizable symptoms after exposure to one or more traumatic experiences, is characterized by a predominance of emotional, behavioral, and fear-based reexperience symptoms, symbolized by anhedonia or dysphoric mood states and negative thoughts. [1] Every year, 6% of the population, or around 6 out of every 100 individuals, will have PTSD at some point in their life. [2] Firefighters, who experienced multiple traumatic events, have a greater risk of developing PTSD at a heightened rate. [3] According to studies, anything between 7% and 37% of firefighters matches the requirements for a current PTSD diagnosis. [4] As a crucial job in saving people's lives, firefighters' mental issues need increased awareness and effective treatment. Treatment such as exposure therapy functions effectively by targeting the acquired behaviors in avoidance that individuals adopt in reaction to circumstances, ideas, and memories that are seen as frightening or anxiety-inducing. [5] Nonetheless, exposure therapy has the highest dropout rate of any PTSD therapy that has been well researched so far, and it has also been linked to increased levels of violence, suicidal thoughts, and depression in certain veterans. [6] The ineffectiveness of half of the people's absent response to therapy and uncomfortable feelings while undergoing treatment stresses the importance of considering a new option for treating PTSD. [7] The practice of meditation may be characterized as a collection of methods designed to promote increased alertness and concentration. [8] Its primary goal is to reduce reactivity to one's unpleasant thoughts and sensations, which, while disturbing and upsetting and stealing one's attention from time to time, are invariably transient. [9] For thousands of years, contemplative practice and self-regulation have benefited greatly from the practice of meditation. Following the end of World War II, an increased interest in meditation and Eastern philosophy began to take root. [10] The Warrior Mind Training program -based on mind-focusing techniques -was created for veterans to stay focused during combat and to reintegrate themselves into society once combat has ended. [11] This training technique reduces trauma reactions --fluctuated mood states or insomnia caused by physical reasons or experienced mental nightmares --and is used at seaside Camp Lejeune, 100 miles inland at the Army's Fort Bragg, and at many facilities in California. [12] [13] Warriors may fortify their brains by fusing these potent mind-focusing techniques with the therapeutic benefits of music. [14] Enhancing resilience and mindfulness skills, warriors, and further prevention will guarantee those veterans like firefighters are less affected by trauma.
With firefighters younger and fewer experiences being more likely to experience PTSD since they experience more types of disasters, professional training may help reduce the likelihood of developing PTSD. [15] This research, in this case, focuses on the younger firefighters with less working experience to determine whether meditation functions well in alleviating their traumatized symptoms by improving their sleeping conditions.

Participants
Participants were firefighters from two classes of Beijing Economic and Technological Development Zone Fire Rescue Detachment. The selection criteria included: 1) At least 15 numbers of Active-Duty firefighters, 2) At the age between 20-30 years old on average, 3) Males, 4) Many times of working experience (20-30 times) on average.

Testing Assessment
In this research, the researcher used the Athens Insomnia Scale (AIS) and PTSD Checklist for DSM-5 (PCL-5) to measure before and after the meditation was performed.

Technical Equipment
Wen Juan Xing, a website for designing the questionnaire, includes two measurement scales sent to the two classes of firefighters before and after.
[18] The data in the questionnaire can also be exported in excel for further statically analysis.
Zen Warrior, a piece of Asian meditation music for Tai Chi yoga practice and oriental songs for martial arts training, [19] is used as the Warrior Training Audio, listened to by those firefighters for seven nights and 15 minutes before sleeping as an intervention.

Procedure
At the beginning of the before-after study, two classes of active-duty firefighters (18-22) who will be randomly picked were involved in the research process. And the hypothesis of Warrior Mind Training is displayed that it can alleviate the firefighter's traumatized symptoms, as well as their insomnia severity.
Before the intervention, firefighters, having undergone the same training and life experience, will be asked to finish both PCL-5 (with 21 of them) and AIS scales (with 22 of them), and the results of both scales will be measured and recorded. Their ages and numbers of fires entered will also be mentioned in both questionnaires. Consequently, the researcher will sum up the numbers on the scales and categorize those results into different levels of insomnia and kind of traumatized symptoms.
During the intervention, two classes of firefighters will be required to listen to the Zen Warrior's audio for seven nights for 15 minutes before sleeping. Every activity they experience during the day is controlled as same as before the intervention.
After the intervention, the 18 firefighters (four of whom did not attend in the later measurement due to going out for business) in the same classes will be asked to complete the same questionnaire again. Subsequently, the researcher calculates the sum of the number of each sample in each scale, categorizing them into a specific level of sleeping condition and traumatized level (E.g., the firefighter whose sum of the answer in AIS is 4 is concluded as the absence of insomnia; the firefighter who chooses 3 in questions 6 or 7 have the traumatized symptoms).
After finishing the data collection and analysis process, the researcher then undergoes statistical analysis.

Statistic Analysis
Baseline characteristics will be compared before and after the intervention in the same groups of firefighters using the Chi-square test, used to compare observed results with expected results. P was set at 0.1 for each outcome by using SPSSAU.   18-22 active firefighters at the age of 24.55 on average, having 27.6 to 28.5 times of working experience, were investigated to complete two scales of measurement before or after the intervention.  According to Figure 2, the level of insomnia before intervention is shown in the left column, in which the mild insomnia level is 59.09%, whereas the absence of insomnia only takes 40.91%. After the intervention of listening to mediation audio, the mild insomnia level was 27.78%, the moderate insomnia level in 5.56%, and the percentage of having insomnia was 33.3%. The symptom of insomnia in percent decreases after listening to the meditation audio for seven nights based on the data. According to Figure 3, the symptom of traumatized reaction takes 61.9% before the intervention. The absent-symptom type solely takes 38.1%; after the intervention, the percentage of absenttraumatized reaction types increases to 66.67%, whereas the type of traumatized symptoms diminishes to 33.3%. The percentage of traumatized-symptom types decreases due to exposure to meditation audio during the intervention for seven nights. Specifically, when focusing on particular questions before and after the intervention, the ALS scale, which measures the sleeping condition of people, discovered an increasing percentage of people chose the "No problem" option (from 31.82% to 72.22%), meaning a significant improvement in sleeping condition. Moreover, the "Slightly delayed" option's percentage, representing mild insomnia, decreases obviously (reduces from 68.18% to 22 PCL-5 scale also demonstrated the increase in the absence of traumatized reactions, shown by the "Not at all" option from 66.67% to 83.33%; the percentage of "A little bit" also decreases, representing decreasing of traumatized symptoms in proportion, regardless the increase in extreme of moderate traumatized symptoms.

Discussion
Measuring firefighters' behaviors before or after intervention on the ALS and PCL-5 scales, the researcher finds the effectiveness of meditation audio in alleviating insomnia and traumatized symptoms. Furthermore, the positive impact of meditation even alters each symptom of insomnia or being traumatized included in both scales' questions per se.
Meditation has the capacity to improve people's sleeping conditions by diminishing insomnia and sleep disturbance. The previous study focuses on evaluating the effectiveness of mindfulness meditation, a mind-body medicine intervention, in improving sleep quality in adults with mild sleep disorders. [20] In the short term, formalized meditation-based therapies may help older persons with their sleep issues, and this impact seems to transfer over into a reduction in sleep-related daytime impairment that has consequences on the quality of life. [21] Moreover, in the evaluation of the efficacy of mindfulness meditation for treating chronic insomnia, the researchers discovered adults with persistent insomnia might benefit from mindfulness meditation as a therapy option, which might replace more conventional insomnia medications. [22] Meditation also plays an indispensable role in mitigating traumatized symptoms. As a time-based symptom, instead of longer-conditioned PTSD, [23] a quintessential anxiety disorder, [24] being traumatized can be alleviated by taking simple meditation. The previous study, which is an openlabel, a randomized clinical trial, looked at the benefits of meditation on anxiety, to which PTSD attributes, fatigue, and quality of life in women following breast cancer radiation therapy. [25] The findings corroborated that meditation is useful in reducing anxiety levels in breast cancer patients. [26] The fatigue level of the control group increased, whereas the fatigue level of the test group who received meditation therapy dropped, indicating that meditation is helpful in reducing fatigue. Aside from that, despite the lack of a direct measurement of exhaustion, a study found that meditation has a good effect on energy and physical function. [27] Customarily, when being traumatized, the amygdala undergoes dysregulation, and dysfunction contributes to the traumatized symptoms. In this way, amygdala down-regulation could enhance clinical efficacy. [28] By taking meditation, through decreased amygdala activation, the training may enhance emotional responsiveness. [29] During the intervention process, the method of the Warrior Mind Training program was used for those active firefighters who experienced traumatized symptoms and insomnia in a large proportion (59.09% of insomnia in Figure 2 and 61.90% of presence of traumatized reaction in Figure 3). Listening to the meditation audio of Zen Warrior audio for seven nights before sleeping, the participants' sleeping conditions and severity of traumatized symptoms were analyzed with two scales (ALS and PCL-5) before and after. When listening to the audio, the participants focused on their breath, emptying their minds, and therefore their sleeping condition improved. This can show the positive effects of the intervention type, as well as the effectiveness of undergoing meditation, which supports theoretical perspectives that meditation has the effect of reducing insomnia levels.
In addition, the results of the one-question PCL-5 scale asking about the feeling of stressful events' reexperience shown in Figure 5 also support the theoretical perspective that undergoing meditation positively influences alleviating traumatized symptoms.

Limitation
In spite of the promising finding in this study which discovered the effectiveness of meditation in assuaging insomnia and traumatized symptoms of firefighters, several limitations must be noted. Firstly, the limited sample size reduces the visibility of the result. Without testing the firefighters BCP Social Sciences & Humanities

ERSS 2022
Volume 20 (2022) from the whole Fire Department, the researcher merely conducted experiments among two classes of firefighters at young ages. Additionally, there are more variables that should be taken into consideration: ages and times of being a fireplace. These factors can also be influential in determining the level of firefighters' severity of insomnia and traumatized reactions. Finally, the time of undergoing meditation and listening to the Zen Warrior audio should be prolonged from seven nights to two months for better accuracy. In the future study, the researcher should include a larger sample size above 200 firefighters of different ages and different working backgrounds, testing the factors like ages or working times related to the symptoms of insomnia and being traumatized by listening to the meditation audio for two months.