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Mantra meditation

meditation · Hindu / Yogic · Buddhist

Mantra meditation is a meditation practice rooted in the Hindu/Yogic and Buddhist traditions, with documented practice spanning over three millennia. It is among the oldest systematically documented contemplative methods, with mantras preserved in the Rigveda dated to approximately 1500–1200 BCE. It alters consciousness primarily through sustained attentional anchoring on a repeated sonic formula, with secondary engagement of breath-synchronized respiratory modulation.

The practitioner sits in a stable posture and repeats a chosen mantra — a Sanskrit syllable, word, or short phrase — either aloud, whispered, or silently. Repetition is typically counted on a 108-bead mala or synchronized with the breath. The central instruction is to return attention to the mantra whenever the mind wanders, without self-judgment. Sessions range from 10 minutes in daily practice to multi-hour sittings in retreat.

A typical session lasts 10 to 30 minutes in daily practice, extending to several hours during intensive retreat. At introductory levels, effects include settling of mental chatter, mild calm, and a sense of stable attention. At established levels, practitioners report deeper concentration, reduced self-referential thought, and emotional equanimity. Restlessness, boredom, intrusive thoughts, and surfacing of difficult emotions are common at all levels.

The primary risks are psychological: intensive repetition can surface repressed material, and in vulnerable individuals may intensify dissociation, anxiety, or depressive symptoms. History of psychosis, acute trauma, or active dissociative disorders warrant caution before sustained practice. Mantra meditation is among the most extensively practiced contemplative methods globally, with a clinical evidence base of over fifty randomized trials showing small-to-moderate benefits for anxiety, depression, and post-traumatic stress.[1]

History & Tradition

Origins

The oldest known mantras are preserved in the Rigveda, the earliest of the four Vedas, composed in Vedic Sanskrit and dated by Indologists to approximately 1500–1200 BCE.[2] The Sanskrit term mantra derives from man- (mind) and -tra (instrument), meaning roughly "instrument of the mind." Vedic seers (rishis) regarded mantras not as composed texts but as shruti — "that which is heard" — transmitted directly from a transcendent source and preserved through oral lineage.

In the Rigveda mantras function as liturgical hymns for ritual (yajna) performance; the Yajurveda and Samaveda extend them into precise sonic formulas for sacrificial rites. The Upanishads (c. 800–200 BCE) reorient mantra use inward: the pranava (Om) becomes an object of contemplation, and mantra shifts from external ritual tool to internal vehicle of liberation. The Mandukya Upanishad is devoted entirely to Om and its four states of consciousness.

Japa — from the Sanskrit root jap-, "to mutter, repeat internally" — is the systematic meditative repetition of a mantra. Patanjali's Yoga Sutras (c. 400 CE) codify the practice in sutra 1.28: tajjapas tadartha bhavanam ("repetition of the pranava and contemplation of its meaning").[3] This passage establishes inward mantra repetition as a central limb of classical yoga.

Transmission and secularization

In the Hindu/Yogic tradition a mantra is not selected by the practitioner but conferred by a qualified teacher (guru) in a formal initiation (mantra-diksha). The diksha transmits not merely a word but the teacher's accumulated shakti through an unbroken lineage. The Shaiva, Shakta, and Vaishnava traditions each maintain distinct lineages and initiation protocols. A japa mala — a string of 108 beads — is the traditional counting instrument; one complete round constitutes one mala.

The Buddhist adoption of mantra is largely Tantric (Vajrayana), transmitted from Indian sources into Tibet, China, Japan, and Korea. The Avalokiteshvara mantra Om mani padme hum is attested in the Karandavyuha Sutra (c. 4th–5th century CE). In Japan, Honen (1133–1212) and Shinran (1173–1263) systematized nembutsu (Namu Amida Butsu) as the core practice of Pure Land Buddhism, and Nichiren (13th century) established daimoku (Nam-myoho-renge-kyo) in his eponymous tradition.

The principal vector for mantra meditation in the West was Maharishi Mahesh Yogi (1918–2008), who trained under Swami Brahmananda Saraswati of a Shankaracharya lineage. Maharishi developed Transcendental Meditation® in the 1950s–60s as a technique-oriented adaptation stripped of explicit religious framing, and the practice spread rapidly after celebrity associations in 1968. The Hindu American Foundation has documented that TM® is rooted in Advaita Vedanta and criticized its framing as "non-religious" as a misrepresentation of its origin. Traditional lineage holders have described TM®'s standardized mantra assignment as a departure from the teacher-to-student transmission structure of classical japa.

Contemporary context

Mantra meditation is now practiced in three broadly distinct institutional forms. Traditional lineage practice continues through living Hindu, Buddhist, and Jain teachers, including organizations such as the Himalayan Institute (founded 1971), the Divine Life Society, and ISKCON.[4] Proprietary modern adaptations include Transcendental Meditation®, taught exclusively through Maharishi International University–certified teachers. Secular clinical adaptations include the Mantram Repetition Program, developed at the VA San Diego Healthcare System by Jill Bormann and tested in randomized trials with U.S. veterans.[5]

The Practice

Technique

The practitioner adopts a stable seated posture, typically cross-legged on a cushion with the spine erect, hands resting on the knees or in the lap. Chair sitting is an accepted alternative — the requirement is an upright position that can be maintained without movement for the duration of the session. Eyes are closed or lowered with a soft, unfocused gaze. A japa mala (108-bead rosary) may be held in the right hand, with the thumb advancing one bead per repetition.

The core method is sustained repetition of a single mantra — a Sanskrit syllable, word, or short phrase such as Om, So Ham, or a longer phrase such as the Maha-mantra Hare Krishna Hare Rama — for the duration of the session. The tradition prescribes three modes of repetition by externalization: vaikhari japa (audible, fully voiced), upamshu japa (whispered or with lip movement only), and manasika japa (purely mental).[3] The instruction is to repeat the mantra continuously and, when attention wanders, to note the wandering without self-criticism and return to the mantra. The most common departure from the method is reciting the mantra mechanically while attention drifts onto unrelated thought — the syllables continue but the practitioner is no longer with them.

At the introductory level, sessions last 10–15 minutes with audible or whispered repetition counted on a mala. At the established level, practitioners typically extend sessions to 20–30 minutes with silent (manasika) repetition and may synchronize the mantra to the breath cycle — one repetition per inhalation and exhalation. At intensive levels, practitioners may complete multiple malas in a sitting, with formal anushthana retreats prescribing 125,000 repetitions over a defined period as a completion ritual. The Mantram Repetition Program structures practice as an 8-week course of brief, frequent repetitions integrated into daily life rather than long single sittings.[6]

Major variants differ in mantra source, repetition mode, and lineage framing. The Himalayan tradition (Swami Rama, Pandit Rajmani Tigunait) emphasizes silent mantra synchronized with breath. The Sivananda tradition (Swami Sivananda, Japa Yoga, 1952) emphasizes audible and whispered repetition with mala counting. Vaishnava Bhakti traditions center on the Maha-mantra and extended audible chanting. Transcendental Meditation® uses individually assigned mantras kept confidential by the practitioner and prescribes twice-daily 20-minute sittings with no counting instrument. The Mantram Repetition Program teaches a single self-chosen secular phrase used in brief portable repetitions throughout the day.

Setting & Preparation

A quiet, private space is the standard setting; ambient noise, interruptions, and bright light reduce continuity. The practitioner sits on a cushion, meditation bench, or chair — the choice depending on flexibility and joint comfort — with a blanket or shawl available, since deep relaxation may produce a slight drop in body temperature.

Equipment is minimal:

Posture supportCushion (zafu), meditation bench, or chair
Counting108-bead japa mala (optional)
TimerSilent or gentle-bell timer for fixed sessions
LineagePersonal mantra from a qualified teacher (traditional)

Solo practice is the dominant mode; group chanting (kirtan, nembutsu gatherings) is a complementary practice rather than a substitute. A trained teacher is recommended but not required for secular practice; in traditional contexts the lineage transmission (diksha) is the practice's foundation.

Mantra meditation is a low-equipment, low-risk practice in routine daily use, but setting choices significantly affect both efficacy and safety in higher-intensity practice. A quiet, private space — free from interruption for the duration of the session — is the practical minimum. Ambient noise and frequent interruptions undermine continuity and increase frustration in early practice.

For practitioners new to the practice, beginning with audible or whispered repetition (vaikhari or upamshu japa) makes the practice more sustainable: external feedback keeps attention engaged where silent repetition tends to drift into mind-wandering. A reliable timer — silent or gentle-bell — is preferable to checking the time, which fragments attention. For traditional practice, a 108-bead japa mala provides a tactile anchor and natural session length. Before intensive practice or retreat, consultation with a teacher in a recognized lineage or with a practice-aware mental health clinician is recommended for practitioners with any history of significant psychiatric illness.

Guidelines

  • Do not begin intensive (retreat-level) mantra practice if you have a history of psychosis, an active dissociative disorder, acute trauma within the last several weeks, or active suicidality without first consulting a practice-aware mental health clinician.
  • Start at the introductory tier: 10–15 minutes daily for the first weeks. Extend duration only after the shorter sessions feel stable, not as a way to force a deeper experience.
  • Choose a single mantra and stay with it across sessions. Frequent switching prevents the depth of attentional engagement that produces the practice's documented effects.
  • If practicing in a traditional lineage, seek formal initiation (mantra-diksha) from a recognized teacher rather than self-selecting a mantra from internet sources.
  • If practicing the Mantram Repetition Program clinically, follow the 8-week structured curriculum with a trained facilitator.[5]
  • Maintain integration practices alongside meditation: regular sleep, exercise, social connection, and time outdoors. Practice intensity without integration is among the documented predictors of meditation-related impairment.[7]
  • Stop the session and resume normal activity if you experience persistent dissociative symptoms, intrusive distressing imagery, or a sense of loss of contact with the body or surroundings that does not resolve when you open your eyes.

Mechanism

Attentional engagement and default-mode deactivation

Mantra repetition functions as a focused-attention anchor: continuous engagement of a single internal object competes for the cognitive resources otherwise devoted to spontaneous self-referential thought. Berkovich-Ohana and colleagues conducted a controlled fMRI study in 23 non-meditators who silently repeated a single word compared to resting baseline. Repetitive speech produced a widespread, unidirectional reduction in BOLD signal centered on the default mode network — particularly the posterior cingulate cortex, precuneus, and hippocampus — without significant positive BOLD in other networks.[8] A behavioral follow-up in the same study confirmed reduced intrinsic, self-referential thought during repetition compared to rest. Because the participants were non-meditators, the effect can be attributed to repetition itself rather than to meditation expertise or expectation.

A 2025 systematic review of 24 neuroimaging studies on chanting (including mantra chanting) found a convergent pattern: activation of the prefrontal cortex, insula, and anterior cingulate cortex — regions implicated in attentional control, interoception, and conflict monitoring — alongside deactivation of default-mode regions.[9] EEG studies within the review consistently showed increased theta-band activity during chanting, associated with relaxed alertness and reduced cognitive load.

Respiratory and autonomic effects

Many traditional and clinical mantra protocols synchronize repetition with the breath cycle, producing a secondary respiratory mechanism. Slow, rhythmic breathing at roughly 6 breaths per minute — a rate that many syllable-paced mantra rhythms naturally approach — drives resonance frequency breathing, which increases heart rate variability and parasympathetic tone. Studies of mantra practitioners have documented increases in high-frequency HRV (a proxy for parasympathetic activity) and reductions in heart rate during practice. These respiratory effects are not unique to mantra meditation but are likely contributors to the autonomic relaxation reported across mantra-based protocols.

The autonomic effects in turn intersect with the attentional mechanism: parasympathetic activation reduces sympathetic-driven cognitive arousal, lowering the salience of intrusive thought and supporting sustained attention to the mantra. The combined attentional and respiratory pathways may explain why mantra-based meditation produces effects on anxiety and stress comparable to mindfulness-based interventions without using open-monitoring instructions.[1]

Subjective Effects

Subjective effects develop across intensity tiers and overlap substantially with focused-attention meditation more broadly. At introductory levels, practitioners typically report settling of mental chatter, a sense of stable attention to a single object, and mild somatic relaxation. As practice deepens, reduced self-referential thought — phenomenologically experienced as a "quieting" of internal narrative — becomes more pronounced, paralleling the default-mode deactivation documented in neuroimaging.[8] At established and intensive levels, practitioners describe states of absorbed concentration in which the mantra continues without effort (ajapa japa in the Yogic tradition), accompanied by emotional equanimity and a sense of bodily settledness.

Unsought effects are common at all levels: restlessness, boredom, intrusive thoughts, the urge to abandon the practice, drowsiness, and the surfacing of emotional material previously held outside awareness. Cancer-survivor and PTSD trials report tolerability comparable to active comparators, though systematic adverse-effect data for mantra meditation specifically remain limited.[10]

▸Effect Grid
Intensity Level:
introductory

Silent or whispered repetition of a chosen mantra.

Body(3)intensity
Sedationlikely
Thinking(3)intensity
Feeling(2)intensity
Catharsispossible
Self(1)intensity
Awareness(2)intensity

Safety

Adverse Effects

Documented adverse effects

Adverse-event data specific to mantra meditation are limited; most evidence comes from broad meditation adverse-event literature in which mantra practice is not separately analyzed. A systematic review by Farias and colleagues, covering literature through October 2019, found a pooled adverse-event prevalence of 8.3% across meditation practices, ranging from 3.7% in experimental studies to 33.2% in observational or self-report studies.[11] The most common categories were anxiety (33% of reported adverse events), depression (27%), and cognitive anomalies (25%); serious events including psychosis, dissociation, and mania were documented but infrequent.

A 2025 U.S. population-representative survey of 886 meditators found that 58.4% reported at least one adverse effect, 31.4% endorsed functional impairment, and 9.1% reported significant impairment.[7] Predictors of impairment included pre-existing psychopathology, retreat participation, and high practice intensity. The study did not isolate mantra-specific rates.

Mantra-specific signals

The 2022 meta-analysis of 51 mantra-based meditation RCTs reported no serious adverse events across included trials, though the authors note that adverse effects were rarely systematically assessed in the source studies.[1] Some studies have documented temporary distress emergence — particularly in clinical populations — consistent with the surfacing of suppressed emotional material during sustained attentional practice. No published case series documents adverse events specifically attributable to japa or other traditional mantra practice as an isolated exposure.

Contraindications

Psychiatric contraindications

History of psychosis or current psychotic-spectrum symptoms is a relative contraindication for intensive or retreat-level mantra practice; the repetitive, absorbing quality of the practice can intensify perceptual anomalies in vulnerable practitioners. Active dissociative disorders warrant similar caution: the absorption characteristic of deep mantra practice may potentiate dissociative states. Acute trauma — particularly within the first weeks after a traumatic event — is a relative contraindication for sustained practice without trauma-informed support, as the surfacing of repressed material can outpace the practitioner's capacity to integrate it.[7]

Active suicidality and severe untreated depression warrant clinical consultation before intensive practice; while the Mantram Repetition Program has shown benefit for depression as an adjunctive treatment, intensive solo practice without clinical support is not equivalent and may worsen rumination in some practitioners.

Medical considerations

Mantra meditation has no direct medical contraindications in the manner of practices involving hyperventilation, prolonged fasting, or extreme postures. Practitioners with chronic pain conditions may experience flare-ups from sustained seated postures; chair sitting or supported postures address this. No cardiovascular contraindications are documented for mantra repetition as such, though practitioners with severe untreated hypertension or arrhythmia should consult a clinician before any new practice regimen.

Substance Interactions

No published literature documents adverse outcomes from mantra meditation combined with psychoactive substances. The practice does not involve breath manipulation sufficient to alter blood gas chemistry, and no pharmacokinetic mechanism for interaction with any substance class has been identified.

One general-population study of U.S. meditators found that lifetime classic psychedelic use was not associated with greater likelihood of meditation-related adverse effects, though the study did not isolate mantra practice from other meditation styles.[7] A theoretical concern — speculative and unsupported by published data — is that the absorption quality of mantra repetition may prolong or intensify altered-state experiences in individuals using high-dose psychedelics in ceremonial settings. Substance interaction evidence for this practice is otherwise absent.

Habituation

Mantra meditation does not produce physiological tolerance or withdrawal in the substance-use sense. Compulsive-use patterns are uncommon but not absent: some practitioners develop a rigid attachment to daily practice such that missed sessions produce anxiety or guilt disproportionate to the actual disruption, a pattern that the contemplative literature has described as "spiritual bypassing" when practice is used to avoid rather than process emotional material.

Retreat dependency — repeated intensive retreats pursued to recapture earlier peak experiences — has been documented in the broader meditation literature and may apply to mantra practitioners who escalate retreat frequency without proportionate integration. High practice intensity is among the documented predictors of meditation-related functional impairment.[7] Practitioners who notice escalating session lengths, increasing dependence on practice to regulate baseline mood, or social withdrawal organized around practice should consider reducing intensity and consulting a practice-aware clinician.

If Distress Arises

The practitioner has full agency to stop or modify the practice at any moment. When attention drifts repeatedly — the most common in-session experience — the instruction is to notice the drift without self-criticism and return to the mantra. Self-criticism for wandering attention is the most common cause of practitioners abandoning the practice within the first weeks.

When difficult emotional material surfaces, the standard response is to continue the mantra at lower intensity (slower pace, audible rather than silent) while allowing the emotion to be present without elaborating on it. If the emotional charge becomes overwhelming, stop the session, open the eyes, and orient to the physical environment — naming visible objects, feeling the contact of the body with the chair or cushion. Resume routine activity. Plan to discuss the surfacing material with a therapist or trusted teacher before the next session.

Dissociative symptoms during practice — a sense of being outside the body, of unreality, or of disconnection from the room — warrant stopping the session and grounding through movement, cold water on the face, or contact with a familiar physical object. Persistent symptoms after grounding warrant clinical consultation, not a return to longer or more intensive practice.[7]

Recovery & Support

Most mantra meditation difficulties resolve with reduced intensity, integration support, and time. Practitioners experiencing persistent meditation-related difficulties — anxiety, depression, dissociation, intrusive imagery, or functional impairment lasting beyond the session — should seek practice-aware clinical support rather than continuing to escalate practice.

Cheetah House provides specialized clinical guidance, peer support, and a referral network for meditation-related adverse experiences and is the best-known resource for practitioners and clinicians navigating these difficulties.[12] The Mantram Repetition Program's clinical literature describes trauma-informed protocols that may guide clinicians treating mantra-related distress.[5] For practitioners in traditional lineages, the lineage teacher is the conventional first point of contact for difficulties arising in practice; for those without such access, practice-aware therapists trained in contemplative studies or contemplative psychology programs can fill the role.

If the practice has become compulsive — sessions extending beyond practical bounds, anxiety in their absence, social or occupational impairment organized around them — reducing session length and frequency, restoring routine activities, and consulting a clinician are appropriate steps. Mantra meditation is a portable practice with no dependence physiology; reducing or pausing it carries no physiological withdrawal risk.

Recovery resources, crisis lines, and support pathways → View all

Progression

Traditional progression

The Hindu/Yogic tradition describes a sequential development across four stages of japa. Vaikhari japa — audible, voiced repetition — is the entry mode, recommended for beginners because external sensory feedback keeps the mind engaged. Upamshu japa — whispered, with lip movement only — is the transitional mode, reducing external dependence. Manasika japa — purely mental, silent repetition — is regarded as the most refined and potent form and requires stable concentration to sustain continuity.[3] The fourth and most subtle stage, ajapa japa ("repetition without repeating"), is described in Tantric texts as the spontaneous, effortless continuation of the mantra after deep internalization — an emergence from years of sustained practice, not a target to be forced.

In mala-based practice, beginners typically complete one mala (108 repetitions) per sitting. Established practitioners complete three to eleven malas in a sitting. Intensive anushthana retreats prescribe completion of 125,000 repetitions over a defined period, structured as a formal vow.[4]

Modern clinical progression

The Mantram Repetition Program uses an 8-week structured progression: weeks one to two focus on mantra selection and basic repetition; weeks three to five introduce one-pointed attention and behavioral application; weeks six to eight integrate slow mindful walking with mantram practice. No formal stage progression beyond the 8-week protocol is specified in the published MRP literature.[6]

Teacher guidance

A teacher is traditionally required: in the Hindu/Yogic context, the formal route is mantra-diksha from a qualified guru in an unbroken lineage. There is no secular credential equivalent. For modern teacher certification, the Himalayan Institute offers Vishoka Meditation Teacher Training (70 contact hours) and a 300-Hour Meditation Specialist program.[4] Transcendental Meditation® teachers are certified exclusively through Maharishi International University's Teacher Training Course. The Mantram Repetition Program is taught by licensed mental health clinicians trained in the protocol; no national credentialing board exists.

Evidence Summary

The clinical evidence base for mantra-based meditation has expanded substantially since 2010, with the most comprehensive synthesis to date being a 2022 systematic review and meta-analysis of 51 randomized controlled trials covering general, student, and clinical populations.[1] Across outcomes, the review found small-to-moderate effect sizes: anxiety reduction (g = −0.46 across 25 studies), depression reduction (g = −0.33 across 22 studies), stress reduction (g = −0.45 across 14 studies), PTSD self-report reduction (g = −0.59 across 6 studies), and small quality-of-life improvement (g = 0.32).

The strongest clinical signal is in post-traumatic stress disorder. The Mantram Repetition Program has been tested in two major RCTs in U.S. veterans: an initial trial against treatment-as-usual showed significant PTSD reduction concentrated in the hyperarousal cluster,[6] and a larger trial of 173 veterans compared MRP head-to-head with present-centered therapy and found MRP non-inferior, with strongest effects again on hyperarousal.[5] A 2022 observational study of 113 veterans found a dose-response relationship: higher practice frequency was associated with greater symptom reduction.[13]

Transcendental Meditation® has the deepest evidence base in cardiovascular outcomes: a 2019 meta-analysis of 9 studies in 851 adults with cardiovascular disease found within-group blood pressure reductions (systolic d+ = 0.31, diastolic d+ = 0.53), though between-group differences against active controls did not reach significance.

Limitations

The evidence base has well-documented limitations. The 2022 meta-analysis classified no included study as low risk-of-bias;[1] most trials used small samples (median n < 50), waitlist or no-treatment controls rather than active comparators, and non-blinded outcome assessment.

Heterogeneity of definitions

A practical confound is the breadth of "mantra-based meditation" in the source literature. The 2022 review aggregates studies of Transcendental Meditation®, the Mantram Repetition Program, the Relaxation Response (Benson), and generic mantra repetition — interventions that differ substantially in protocol, instruction set, and proprietary framing. Effect sizes cannot be cleanly attributed to mantra repetition as an isolated mechanism, and benefits reported under the "mantra meditation" label may reflect specific protocols rather than the practice in general.

Allegiance and publication concerns

Much of the published research on TM® has been conducted by investigators affiliated with the TM organization, raising allegiance-bias concerns documented across multiple independent reviews. Active-comparator trials have generally found smaller between-group effects than waitlist-controlled trials, suggesting that non-specific factors (attention, expectation, group support) account for part of the apparent benefit. The breast-cancer-survivor trial by Henneghan and colleagues found mantra meditation and classical music listening produced equivalent neurocognitive improvements at 8 weeks — a finding consistent with non-specific practice effects rather than mantra-specific mechanism.[10]

Gaps

No published RCT has long-term follow-up (>6 months) for non-TM mantra meditation. Adverse-effect assessment has been inconsistent and is rarely systematic in source trials. Neuroimaging data specific to experienced traditional japa practitioners do not exist; available imaging studies use non-meditators or TM® practitioners.[8][9] Neuroendocrine data isolating mantra repetition as an independent variable are absent.

references

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    ^abcdeÁlvarez-Pérez, Y. and García-Expósito, J. and Rivero-Santana, A. and Perestelo-Pérez, L. and Duarte-Díaz, A. and Ramos-García, V. and Toledo-Chávarri, A. and Serrano-Aguilar, P. (2022) Effectiveness of Mantra-Based Meditation on Mental Health: A Systematic Review and Meta-Analysis — International Journal of Environmental Research and Public Health doi:10.3390/ijerph19063380
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    ^Vedic rishis (-1500) Rigveda
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    ^abcdPatanjali (400) Yoga Sutras of Patanjali
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    ^abcHimalayan Institute (2025) Vishoka Meditation Teacher Training and Meditation Specialist Programs
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    ^abcdBormann, J.E. and Oman, D. and Walter, K.H. and Johnson, B.D. (2018) Individual Treatment of Posttraumatic Stress Disorder Using Mantram Repetition: A Randomized Clinical Trial — American Journal of Psychiatry doi:10.1176/appi.ajp.2018.17060611
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    ^abcBormann, J.E. and Thorp, S. and Wetherell, J.L. and Golshan, S. and Lang, A.J. (2013) Meditation-based mantram intervention for veterans with posttraumatic stress disorder: A randomized trial — Psychological Trauma: Theory, Research, Practice, and Policy doi:10.1037/a0027522