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CHAPTER 1
INTRODUCTION
1.1 STRESS
Stress is often termed as a twentieth century syndrome, born out of
man`s race towards modern progress and its ensuing complexities. In other words,
stress is a dynamic process involving both the individual and the environment. There
can be innumerable stress factors since different individuals react differently to the
same stress conditions. Competition and constant changes result in a demanding
environment that often turns stressful. The negative effects of stress on health are
well known [1].
1.2 DEFINITION OF STRESS
Stress can generally be defined as the reaction of individuals to demands
(stressors) imposed upon them, where the well-being of individuals is detrimentally
affected by their failure to cope with the demands of their environment [2]. However
within an academic framework as defined by Selye [3], the stimulus or the ‘stress’ is
referred to as a ‘stressor’ which does not cause us to be ‘stressed out’, but rather is
something which causes a ‘stress response’ within the body. In recent years stress
has been more usefully defined as transactional concept. People are not disturbed by
situations per se but by the ways they appraise and react to situation [4].
1.3 THEORIES OF STRESS
Stress is a multidimensional phenomenon and conceptualized in several
ways. It has been studied from three major perspectives: 1) stress as a response, 2) a
stimulus, and 3) a relation.
a) Stress as a response: According to Hans Selye (1976) [5], stress is
defined as "the non-specific response of the body to any demand made upon it."
Moreover, stress is a state or condition of the body produced by diverse nocuous
agents and manifested by a syndrome of changes. The factors that produce stress are
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called stressors and can be a wide variety of mental, emotional, and other
psychological events. He also identified three components of physiologic stress that
are the stressor, the physiologic or chemical disturbance produced by the stressor,
and the body’s adaptative response to the stressor.
b) Stress as a Stimulus: Stimulus definitions focus on events in the
environment such as natural disasters, noxious conditions, illness, or being laid off
from work. This approach assumes that certain situations are normatively stressful
but a person’s perception of the event as positively toned or negatively toned is
irrelevant; and there is a common threshold beyond which disruption occurs [6].
c) Stress as a transaction: According to Lazarus & Folkman in 1984
[7], stress is best understood in terms of the individual’s cognitive interpretation of
potentially stressful events. How events are perceived is more important than the
objective events themselves. Stress is neither an environmental stimulus nor a
psychological response, but rather a relationship between environmental demands
and the ability to deal with them. Thus, stress is seen as a transaction between
individual and environment.
1.4 TYPES OF STRESS
Figure 1.1 shows the various types of stress based on the effect, duration,
cause and type of stressor.
Figure 1.1 Types of stress
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1.5 STRESS RESPONSE
Organisms however do not passively respond to the effects of stress-
they respond in a more complex way.
1.5.1 GENERAL ADAPTATION SYNDROME (GAS)
Selye in 1956 [3] labelled the universal response to stressors the general
adaptation syndrome or GAS.
Alarm is the first stage. When the threat or stressor is identified or
realized, the body's stress response is a state of alarm. During this stage adrenaline
will be produced in order to bring about the fight-or-flight response. There is also
some activation of the hypothalamic pituitary adrenal (HPA) axis, producing cortisol.
Resistance is the second stage. If the stressor persists, it becomes
necessary to attempt some means of coping with the stress. Although the body begins
to try to adapt to the strains or demands of the environment, the body cannot keep
this up indefinitely, so its resources are gradually depleted
Exhaustion is the third and final stage in the GAS model. At this point,
all of the body's resources are eventually depleted and the body is unable to maintain
normal function. At this point the initial autonomic nervous system (ANS) symptoms
may reappear (sweating, raised heart rate etc.). If stage three is extended, long term
damage may result and can manifest itself in obvious illnesses such as ulcers,
depression, diabetes, trouble with the digestive system or even cardiovascular
problems, along with other mental illnesses.
The stress response incorporates a variety of different physiological
systems all supporting homeostasis. The exact nature of the co-ordination is
complex. Coordination of the stress response however is governed by the nervous
and endocrine systems. However the brain is the central organ of the stress response
[8] which in turn influences other systems such as the cardiovascular system and the
immune system [9].
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1.5.2 Physiological Changes in Response to a Stressor
Three physiological pathways known to demonstrate extraordinary
responsiveness with respect to psychosocial stimuli:
(1) The Neural axis
(2) The Neuroendocrine axis and
(3) The Endocrine axis
1.5.2.1 The Neural Axis
Three neural axes comprise the neural stress response: (1) the
sympathetic nervous system (SNS), (2) the parasympathetic nervous system (PNS),
and, (3) the neuromuscular nervous system. These neural pathways are the first of all
stress response axes to become activated during stress arousal and are quickest.
When a threat is perceived, neural impulses descend to the posterior
hypothalamus (in the case of a sympathetic activation) and the anterior hypothalamus
(in the case of a parasympathetic activation). The specific end-organ effects of the
sympathetic and the parasympathetic nervous systems are summarized in Table 1.1
[10].
Table 1.1 Responses of Effector Organs to Autonomic Nervous System Impulses
SNS PNSFunction Ergotropic; catabolism Trophotropic; anabolismActivity Diffuse DiscreteAnatomy Emerges from spinal cord Thoracolumbar CraniosacralLocation ofganglia
Close to spinal cord Close to target organ
Postganglionicneurotransmitter
Noradrenalin a (adrenergic) Acetylcholine (cholinergic)
Specific actionsPupil of eye Dilates ConstrictsLacrimal gland – Stimulates secretion
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Table 1.1 (Contd.)Salivary glands Scanty, thick secretion Profuse, water secretionHeart Increases heart rate Decreases heart rate
Increases contractility Decreases metabolismIncreases rate of idiopathicpacemakers in ventricles -
Blood vesselsSkin and mucosa Constricts –Skeletal muscles Dilates –Cerebral Constricts DilatesRenal Constricts –Abdominalviscera
Mostly constricts –
Lungs: bronchialtubes
Dilates Constricts
Sweat glands Stimulates a Constricts
Liver Glycogenolysis for release ofglucose
Expels bile
Spleen Contracts to release bloodhigh in erythrocytes –
Adrenal medulla Secretes adrenaline(epinephrine) andnoradrenaline(norepinephrine) a
–
Gastrointestinaltract
Inhibits digestion Increases digestion
Decreases peristalsis andtone
Increases peristalsis and tone
Kidney Decreases output of urine ?Hair follicles Piloerection –Male sex organ Ejaculation Erection
1.5.2.2. The Neuroendocrine Axis
Physiologist Walter Cannon first wrote about a phenomenon that he
termed homeostasis, which is an adaptational effort of the body to stay in balance.
Cannon in 1953 [11] wrote extensively on one particular aspect of the ANS’s role in
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the stress response—the neuroendocrine process. The “fight-or- flight” response is
referred as an “active coping” system. This active coping system has been referred to
as the “sympathoadrenomedullary system” (SAM).
The “fight-or- flight” response can be activated in human beings by
numerous and diverse psychological influences, including varied psychosocial
stimuli and is thought to be a mobilization of the body to prepare for muscular
activity in response to a perceived threat. The response innervates the adrenal gland,
or more specifically, the adrenal medulla which secretes catecholamines:
norepinephrine (noradrenaline) and epinephrine (adrenaline).
The adrenal medullary cells are divided into two types: A cells, which
secrete epinephrine, and N cells, which secrete norepinephrine. About 80% of the
medullary catecholamine activity in humans is accounted for by epinephrine [12] or
observed in humans as a result of activation of this axis in response to psychosocial
stressor exposure. Table 1.2 summarizes the specific somatic effects [19] by adrenal
medullary axis stimulation.
Table 1.2 Effects of Adrenal Medullary Axis Stimulation
Increased arterial blood pressureIncrease blood supply to brain (moderate)Increased heart rate and cardiac outputIncreased stimulation of skeletal musclesIncrease plasma free fatty acids, triglycerides, cholesterolIncreased release of endogenous opioidsDecreased blood flow to kidneysDecreased blood flow to gastrointestinal systemDecreased blood flow to skinIncreased risk of hypertensionIncreased risk of thrombosis formationIncreased risk of angina pectoris attacks in persons so proneIncreased risk of arrhythmiasIncreased risk of sudden death from lethal arrhythmia, myocardialischemia, myocardial fibrillation, myocardial infarction
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1.5.2.3 Endocrine Axis
The most chronic and prolonged somatic responses to stress are the
result of the endocrine axes and reviews [13] demonstrate that these axes can be
activated in humans by numerous and diverse psychological stimuli, including varied
psychosocial stimuli. Figure 1.2 depicts the effect of stress on the endocrine axis.
Fig 1.2. Effect of Stress on Endocrine axis
The neural sensory information processed in the limbic system
(hippocampus and amygdala) activates the paraventricular nucleus (PVN) in the
hypothalamus, which synthesize corticotrophin-releasing hormone (CRH) and
arginine vasopressin (AVP). These substances activate the anterior pituitary, where
proopiomelanocortin (POMC) is produced. CRH and AVP cleave POMC into
adrenocorticotrophic hormone (ACTH) and beta-endorphins which are released into
the systemic circulation. ACTH is transported by the blood to the adrenal glands to
stimulate the synthesis of corticosteroids [14] namely mineralocorticoids
(aldosterone), glucocorticoid (cortisol) and androgens (dehydroepiandrosterone
(DHEA)). Cortisol is the major stress hormone with effective responses to the stress
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stimuli in many body tissues including the brain [15]. The adrenal cortical response
axis has been referred to by various authors as the hypothalamic–pituitary–adrenal
cortical system (HPAC). Activation of this system in the aggregate has been
associated with the helplessness/hopelessness depression syndrome, passivity, the
perception of no control, immunosuppression, and gastrointestinal symptomatology.
Behaviourally, the HPAC system appears to be activated when active coping is not
possible; thus, it has been called the “passive coping” system. The effects of the
glucocorticoids in apparent response to stressful stimuli are summarized in Table 1.3.
Table 1.3 The Effects of the Glucocorticoid Hormones and HPAC Activation
Increased glucose production (Gluconeogenesis)
Exacerbation of gastric irritation
Increased urea production
Increased release of free fatty acids into systemic circulation
Increased susceptibility arteherosclerotic processes
Increased susceptibility to nonthrombotic myocardial necrosis
Thymicolymphatic atrophy (demonstrated in animals only)
Suppression of immune mechanisms
Exacerbation of herpes simplex
Increased ketone body production
Appetite suppression
Associated feeling of depression, hopelessness, helplessness, and loss of control
The Somatotropic Axis activated during stress releases the somatotropin-
releasing factor (SRF) which stimulates the anterior pituitary which thereby releases
the growth hormone (somatotropic hormone) into the systemic circulation which
stimulates the release of the mineralocorticoids. Selye [3], and also produces a
diabetic-like insulin-resistant effect, as well as mobilization of fats stored in the body
which increases the concentration of free fatty acids and glucose in the blood[16].
Stress response in human is also said to affect the thyroid axis [17]. Thyroid
hormones have been shown to increase general metabolism, heart rate, heart
contractility, peripheral vascular resistance (thereby increasing blood pressure), and
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the sensitivity of some tissues to catecholamines. Stimulation of posterior pituitary
results in the release of the hormones vasopressin (antidiuretic hormone, or ADH)
and oxytocin and prolactin into the systemic circulation [18].
1.5.3 Biochemical and Hematological Changes in Response to Stressor
Endocrine changes during stress may cause certain biochemical changes.
� Increase the concentration of circulating lipids and lipoproteins.
� Increase blood glucose level by decreasing glucose uptake and
increased glycolysis and gluconeogeneis.
� In liver, cortisol is anabolic and hence it increase protein synthesis,
increases hepatic uptake of amino acids, increase m-RNA formation
and synthesis of proteins including plasma proteins, enhances urea
synthesis from amino acid.
1.5.4 Immune System Alterations in Response to a Stressor
Stress has long been associated with altered immune function. A
bidirectional communication exists between the central nervous and immune systems
which involves common peptide hormones and receptors that regulate the immune
response via feedback mechanisms [19]. Several molecules induced during the
response to stress have been implicated in immunomodulation, including
catecholamines, neuropeptides, and steroid hormones. Glucocorticoids are said to
have both immunosuppressive [20] and immunoenhancing properties as well [21].
CRH can enhance or diminish immune responses independent of glucocorticoids
[22].
Any psychological or behavioural event such as anger, anxiety, and
especially depression that is capable of affecting the autonomic nervous system's
activity or hormonal activity is also able to influence the immune system, showing
that the brain and the immune system are sufficiently well connected and influenced
by each other [23]. During stress, innate immune mechanisms are preserved while
adaptive responses are clearly compromised. During periods of stress there are likely
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to be important demands on the immune system due to infection, thus stress
regulation of the immune response may have evolved to provide a well-orchestrated
immune defence to ensure survival [24].
The overall effects of chronic stress (Figure 1.3) on immune modulation
are therefore diverse and include decreased NK cell function, down-regulation of T-
and B-cell responses, an imbalance in cytokine production (e.g., Th1 Th2 shift),
Stress may also be linked to the induction of proinflammatory cytokines such as
IL-6.
Fig 1.3 Immune System Alterations in Response to a Stressor
1.5.5 Psychological Changes in Response to a Stressor
Both behavioral and psychological changes occur in response to a
stressor; the impact of which depends on whether the stressor is acute or chronic.
Figure 1.4 clearly depicts the psychological, physiological, emotional and
behavioural changes associated with stress. Psychological changes in response to a
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stressor include, but are not limited to, anxiety, depression, fear, sadness, anger and
confusion. While the concept of fear has been of concern to humanity since ancient
times, the concept of anxiety was not fully recognized as a distinct and pervasive
human condition until the late 1800s. Chronic stress and a lack of coping resources
accessible by an individual can often lead to the development of psychological issues
such as depression and anxiety. Figure 1.4 shows the changes associated with stress.
Figure1.4 Psychological, Physiological, Emotional and Behavioural Changes
Associated with Stress.
1.6 STRESS AS A RISK FACTOR FOR VARIOUS DISEASES
“Stress” is often implicated in the pathogenesis of illnesses; however, its
direct culpability is not easily established. To gain a better understanding of how
stress can lead to illness, it is useful to invoke the concept of allostatic load, first
introduced in 1993 by McEwen and Stellar [25]. In their words, “The (cumulative)
strain on the body produced by repeated ups and downs of physiologic response, as
well as by the changes in metabolism can predispose the organism to disease which
is defined as a state of allostatic load.” There is likely a connection between stress
and illness.
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Chrousos in 2000 [26] has reviewed evidence showing that stress-
induced chronic increase in hormones like cortisol, catecholamines, and interleukin-6
provide a hormonal milieu conducive to the development of visceral obesity (and
the insulin-resistance-dyslipidemia syndrome), hypertension, atherosclerosis,
osteoporosis, and immune dysfunction. Additional stress-related illnesses include
conditions such as depression [27], irritable colon [28], peptic ulcer [29], diabetes
mellitus [30] as well as rheumatoid arthritis [31]. Although the role of stress in
causation of various diseases may have been overestimated by some authors, there is
little doubt that, in many cases, stress plays a critical role in determining clinical
outcome. Mechanism by which activation of the stress system may increase the risk
of diseases is shown in Table 1.4.
Table 1.4 Stress Response and its Clinical Effect
Abbreviation: SNS-Sympathetic Nervous System, GH- Growth
Hormone, IGF-1 – insulin Like Growth factor -1, TSH-Thyroid stimulating hormone,
LH-Luteinizing Hormone, T3-Triiodothyronine
Adapted from: Stress: A Risk Factor for Serious Illness VanItallie.
BT [32]
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Evidence from prospective observational studies provides support for
stress as an important factor in certain diseases. Hence, development of interventions
that can reduce the behavioral and biological sequelae of psychological stress and the
demonstrated efficacy of such interventions would provide clinical data on the
clinical importance of the work.
1.7 STRESS MANAGEMENT:
Stress management refers to a wide spectrum of techniques and
psychotherapies aimed at controlling a person's levels of stress, usually for the
purpose of improving everyday functioning. There are a number of allopathic and
alternative/complementary treatments that are effective in eliminating or reducing
stress and stress-related disorders (Fig 1.5).
• Medications may include drugs to control anxiety and depression as
well as drugs that treat such physical symptoms of stress as indigestion or high blood
pressure.
• Psychotherapy, including insight-oriented and cognitive/behavioral
approaches, is effective in helping them reframe their perceptions and interpretations
of stressful events.
• Therapeutic massage, hydrotherapy, and bodywork are forms of
treatment that are particularly helpful for people who tend to carry stress in their
muscles and joints.
• Aromatherapy, pet therapy, humor therapy, music therapy, and other
approaches that emphasize sensory pleasure are suggested for severely stressed
people who lose their capacity to enjoy life.
• Naturopathic recommendations regarding diet, exercise, and
adequate sleep, and the holistic approach of naturopathic medicine can help persons
with stress-related disorders to recognize and activate the body's own capacities for
self-healing.
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• Relaxation techniques, anxiety reduction techniques, breathing
exercises, yoga, and other physical exercise programs improve the body's relaxation
response.
Fig 1.5 Types of Stress Management Strategies
Among the above said stress management techniques, Yoga a 3,000
year old tradition, is now regarded in the western world as a holistic approach to
health and is classified by the National Institutes of Health as a form of
Complementary and Alternative Medicine (CAM).
1.8 YOGA AND YOGA CONCEPTS
Yoga is an Indian life science philosophy with a rich and varied history
which is a practical discipline incorporating a wide variety of practices the goal of
which is to develop a state of mental and physical health, well-being, inner harmony
and ultimately “a union of the human individual with the universal and transcendent
existence” [33]. Although yoga is historically a systematic process of spiritual
unfolding spiritual discipline, it has also been used clinically as a therapeutic
intervention. Yoga goes to the roots of a poor lifestyle and when presented in a
comprehensive manner, tends to convince the patient that a good lifestyle is not only
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healthier, but also more enjoyable than a poorer lifestyle. It saves money and can be
performed anywhere which is a constructive point of yoga.
1.9 DEFINITION OF YOGA
“Yoga is the control of the fluctuations of the mind.”
- Patanjali’s Yoga Sutra 1.2; c. 150 C.E.
The etymology of yoga is derived from the Sanskrit verb yuj, meaning
“to yoke or join together.” As the opening quotation suggests, yoga as a
psychospiritual technology is focused on controlling the fluctuations of the mind,
with the physical body serving as just one tool toward that end.
1.10 DIFFERENT SCHOOLS OF YOGA
There are different yoga schools and the major schools of yoga are BKS
Iyengar School of Yoga, Bikram Yoga, Ashtanga Yoga, Kripalu Yoga, Integral
Yoga, Kundalini Yoga, Artistic Yoga. Their basic goal is more or less the same and
they all help to achieve mastery over body and mind. It is just the approach that is
different. Apart from these major schools of yoga, various styles of yoga are being
practiced worldwide.
Table 1.5: Types of Yoga Schools and Founders
Year Name of Yoga School Name of the Founder1906 Yoga Sri Tirumalai Krishnamacharya
1920 Agni Yoga Nicholas Roerich and his wife HelenaRoerich (theosophy)
1921 Integral Yoga Sri Aurobindo
1946 Kriya Yoga Paramahansa Yogananda1948 Yoga of Synthesis Swami Sivananda1950s Satyananda Yoga Swami Satyananda Saraswati1955 Ananda Marga Shri Shri Anandamurti
1960s Transcendental Meditation Maharishi Mahesh Yogi
1970 Bikram Yoga Bikram Choudhury
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Table 1.5 Contd.,
1971 Himalayan Institute of YogaScience and Philosophy Swami Rama
1970s Siddha Yoga Swami Muktananda
1970s Surat Shabd Yoga Sant Mat movement, Kirpal Singh
1970s Sahaja Yoga Sri Nirmala Srivastava
1981 Art of Living Sri Sri Ravi Shankar
1984 Yoga for human excellenceand Kayakalpa Yogiyaraj Vethathri Maharishi
1992 Isha Foundation Sadhguru Jaggi Vasudev
1997 Ananda yoga Swami Kriyananda
1.11 LAND OF YOGA -INDIA
India is rightly called the land of yoga. All systems of yoga developed
from this ancient land. Historians and leaders in the yoga community say they
believe that a man named Patanjali was the first to codify yoga, by writing a text in
northern India around the third century B.C.[34]. Patanjali wrote the Yoga-Sutras
that outlined an eight-limbed path for yoga, also known as astanga yoga. These eight
aspects of yoga encompass what yoga gurus consider the five layers of the human
being: the anatomical, physiological, mental, intellectual, and spiritual bodies.
1.12 EIGHT LIMBS OF YOGA
Yoga was originally developed as a method of discipline and attitudes to
help people reach spiritual enlightenment. Yoga is often depicted metaphorically as a
tree and comprises eight aspects, or ‘‘limbs. The eight limbs are comprised of ethical
principles for living a meaningful and purposeful life; serving as a prescription for
moral and ethical conduct and self-discipline, they direct attention towards one's
health while acknowledging the spiritual aspects of one's nature. Traditionally, the
limbs are practiced in succession, culminating in the attainment of enlightenment.
Any of the eight limbs may be used separately, but within yoga philosophy the
physical postures (asanas) and breathing exercises (pranayama) prepare the mind and
body for meditation and spiritual development.
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Fig 1.6. Eight Limbs of Yoga
1.12.1 Asanas (Physical Postures)
In Sanskrit asana, means "staying" or "abiding". Asana, the practice of
physical postures is the most commonly known aspect of yoga and is used as a tool
to calm the mind and move into the inner essence of being. One definition of asana is
that a postural pattern created by deviating the head and trunk from the center of
gravity and having the pattern maintained purposefully for a length of time, and then
released in a smooth and effortless manner [35]. The postural pattern is initiated
slowly and with attention to internal proprioception and maintaining a full
diaphragmatic breath. True asana is described classically as having the qualities of
stability (sthira), ease (sukha) [36], and effortlessness or minimized effort (prayant
shaithilya). An asana is not a braced or artificially sustained “pose” that would create
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or maintain inappropriate or sustained biomechanical stress to soft tissue or articular
surfaces. From the yoga therapeutic perspective, asana is also an attitude that is
psychophysiologic in nature, in which the state of mind or mindfulness is of the
utmost importance, hence linking the physical position with the higher koshas.
Asanas are often practiced as pairs, known as counter poses.
Biomechanically this creates balance by soft tissue lengthening, hyaline cartilage
compression and distraction, and reversing intervertebral disc pressures and dural
stretch. These counter forces are also delivered to the internal organs, composed of
smooth muscle or the glands of the endocrine system. The practitioner experiences
the more subtle effects of the higher koshas through this counterbalance, bringing
about a balance in emotions and the biochemical manifestations of that balance. This
mechanical stimulation coupled with the relaxation response has been cited as one
potential source of many of the nonmusculoskeletal benefits of yoga [37].
1.12.2 Pranayama (Breath Control)
"Improve Your Breathing (Pranayam)
To Reduce Stress and Increase Your Performance"
- Ingrid Bacci
Pranayama is a Sanskrit word composed of the words ‘prana’ meaning
vital lifeforce and “ayama” meaning restraint. An alternative root of the word is
given by Ramamurti Mishra who says that “Expansion of individual energy into
cosmic energy is called pranayama” which gives a deeper insight into the purpose of
pranayama to a yoga practitioner. It goes hand in hand with the asana or pose. In the
Yoga Sutra, the practices of pranayama and asana are considered to be the highest
form of purification and self discipline for the mind and the body, respectively.
Pranayama consists of three phases: ‘‘puraka’’ (inhalation);
‘‘kumbhaka’’ (retention) and ‘‘rechaka’’ (exhalation) that can be either fast or slow
[38]. Although all pranayama has three phases, different forms of pranayama evoke
dissimilar and sometimes opposite responses in the subject depending on variables
such as which nostril is used or the speed of the respiration. Different forms of
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pranayama activate different branches of the ANS effecting oxygen consumption,
metabolism and skin resistance. A calm, peaceful mind is content and non-violent
and more receptive to the sense withdrawal (pratyahara) and deep concentration
(dharana) that bring about states of meditation.
Pranayama channels the prana in the body to calm, rejuvenate and uplift
the mind. It serves as an important bridge between the external, active and highly
physical practice of yoga asana and the subtle internal practices that lead the yogi
into deeper states of meditation.
1.12.3 Meditation (Dhyana)
The word mediation is derived from two Latin words: meditari (to think,
to dwell upon, and to exercise the mind) and the mederi (to heal). It is originally
from Sanskrit word “medha” which means wisdom. “Meditation means being
meditative, silent, peaceful, with no thoughts in the mind and it is consciousness
without content”. When a mirror is not reflecting anything, it is meditation”, said
Gautam Buddha [39].
The term meditation refers to a broad variety of practices (much like the
term sports) that includes techniques designed to promote relaxation, build internal
energy or life force (qi, ki, prana, etc.) and develop compassion [40]. The aim of
meditation is overcoming negative minds and cultivating productive thoughts [41].
The attitudes needed for meditation are non-judging, patience, beginners’ mind, trust,
acceptance, and letting go [42].
1.12.3.1 Types of Meditation
In the present biomedical researches’, Ospina et al [43] broadly divided
meditation into five categories; mantra meditation, mindfulness meditation, yoga, Tai
Chi and Qigong. First, mantra meditation is composed of transcendental meditation
(TM), relaxation response and clinically standardized meditation. They share
common characteristics to develop deep concentration by repeating silently or aloud
the mantra (a word or phrase). This is so-called concentration meditation of Buddhist
meditation. Second, mindfulness meditation is composed of vipassana meditation,
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Zen meditation, mindfulness-based stress reduction (MBSR) and mindfulness-based
cognitive therapy (MBCT). The hallmark of this category is to cultivate mindfulness
and wisdom of oneself. Third, yoga is an ancient Indian system that comprises basic
forms of postural movement, meditation, breathing technique and relaxation [44].
Fourth, Tai Chi is the Chinese art for individual health and well being. It involves
gentle body movement in continuous sequence, breathing patterns and mental
concentration [45]. Fifth, Qigong is quite similar to Tai Chi in terms of body
movement but relates to breathing attention with meditation basis. However, Qigong
emphasizes the concept of Qi flow (flow of internal vital energy) as well [45].
1.13 PURPOSE OF YOGA
Generally put, yoga is a disciplined method utilized for attaining a goal.
In the Yoga Sutras, Patanjali indicates that the ultimate goal of yoga is a state of
permanent peace or Kaivalya. As the power of the mind is properly harnessed and
focused (stable, without fluctuation), the physical outcomes are, enhanced flexibility,
posture, balance, strength, and physical health [36] and thus used as a complete
exercise program and physical therapy routine [35].
1.14 YOGA THERAPY
Yoga therapy is the “process of empowering individuals to progress
toward improved health and well-being through the application of the philosophy and
practice of Yoga” [46]. At the physical level Yoga and its cleansing practices have
proven to be extremely effective for various disorders. The elements of yoga directly
addressing health concerns are known as yoga therapeutics.
A recent summary (2012) indicates that there is relatively strong
evidence to suggest that yoga may have beneficial effects for pain-associated
disability and mental health [47]. A preceding overview (2010) shows unanimously
positive evidence emerged for depression and cardiovascular risk reduction with
yoga, with little supporting evidence to suggest benefit for patients with epilepsy,
asthma or various pain conditions [48]. Another clinical review suggests that
psychological symptoms and disorders (anxiety, depression, sleep), pain syndromes,
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autoimmune conditions (asthma, multiple sclerosis), immune conditions (lymphoma,
breast cancer), pregnancy and weight loss can all be positively affected by yoga [49].
1.15 YOGA THERAPY-SCIENTIFIC EVIDENCES
Recently McCall [50] performed a literature review to synthesize the
current hypotheses and scientific evidence for underlying mechanisms of yoga
intervention. He concluded that major effect of yoga is on the endocrine, nervous
systems as well as on the physical health. Figure 1.7 depicts a summary of evidence
as expressed in empirical and hypothetical findings of their research.
Figure 1.7: Scientific Evidence on the Effect of Yoga
Adapted from: How Might Yoga Work? An Overview of Potential
Underlying Mechanisms Review by Marcy C. Mc. Call (2013).
1.16 SCIENTIFIC YOGA RESEARCH IN INDIA
Yoga research in India began thousands of years ago, with the
experiences of the great sages. Actual studies in the laboratory began in the 1920s by
a sage, Swamy Kuvalayanada founder of a yoga center called Kaivalyadhama (in
west India). Through the 1920s until the 1960s the world over people wanted to
study extraordinary powers of exceptional yogis. Exciting experiments were
conducted at the All India Institute of Medical Sciences, New Delhi and on the late
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Swami Rama (from Rishikesh) at the Menninger Foundation (in the U.S.). However
these experiments seemed to suggest that yoga had little to do with the common man
and the effects required years of practice with extreme sacrifice. This changed when
in the late 1960s Maharishi Mahesh Yogi introduced transcendental meditation to the
world. For the first time changes were seen in University students after a short
duration of practice. This lead to research at Swami Vivekanada Yoga Research
Foundation (South India) which published and is publishing some of the most
rigorously controlled trials on the therapeutic effects of yoga, the National Institute
of Mental Health and Neurosciences (South India) and the Defense Institute of
Physiology and Allied Sciences, which took yoga to the Indian army. At this stage
most of the research and interest in yoga was in India, the place of its' origin.
However the majority of Indians located in villages knew little about yoga, assuming
the practice was for the educated, urbanized Indian. This changed with the mass
movement of Patanjali Yogpeeth, which has taken yoga and ayurveda to Indians in
remote villages. The institution is actively engaged in research. It is encouraging to
note that research on yoga which began almost a century ago in India, continues to
be of great interest in yoga institutions as well as in medical institutions of national
importance. Equally encouraging is the fact that research in this area is being actively
funded by the Government of India.
In order to formulate yoga as an evidence based medicine, further
research are to be conducted to prove the benefits of yoga and make it a daily
practice among the healthy as well as diseased population for improved health and
well being. From an evidence-based healthcare perspective, the hypothetical
underlying mechanisms to explain potential effects of yoga are in the early stages of
investigation. Research in the field of yoga is being carried out extensively in various
parts of the world on different schools of yoga. Among the various types of yoga
which have been researched widely, Sudarshan Kriya of The Art of Living (AOL)
Foundation is one among it that has been scientifically proven to be beneficial on
various health conditions.
23
1.17 SUDARSHAN KRIYA AND PRANAYAM (SK&P)
In Sanskrit Su= right, Darshan= vision, Kriya=purifying action
Sudarshan Kriya, an integral part of Art of Living programmes is a purifying
practice, whereby one receives a proper vision of one’s true self. It is a rhythmic
breathing technique combined with meditation that facilitates physical, mental,
emotional and social well-being.
Nature is replete with various rhythms and cycles - day follows night,
night follows day, seasons come and go. Similarly, there are biological rhythms to
our bodies, minds and emotions. When these rhythms are in sync, we feel a sense of
harmony and well-being. When stress or illness throws them out of order, we
experience discomfort and discontent and feel upset and unhappy. The breath
connects the body and mind. Just as emotions affect our patterns of breathing, we can
bring about changes in our mental and behavioural patterns by altering the rhythms
of our breath. It flushes our anger, anxiety and worry; leaving the mind completely
relaxed and energized.
1.17.1 Founder of Sudarshan Kriya - H. H. Sri Sri Ravi Shankar
His Holiness Sri Sri Ravi Shankar is a renowned spiritual leader and
multi-faceted humanitarian whose mission of uniting the world into a violence-free
family has inspired millions of people worldwide. Born in 1956 in Southern India,
Sri Sri's appeal transcends class, race, religion and nationality. Millions of people
revere him as their spiritual leader, and look up to him for inner peace and promoting
ecumenical values. In 1981, Sri Sri started the Art of Living Foundation, an
international non profit educational and humanitarian organization. The Foundation,
now active in more than 140 countries, offers educational and self-development
programs designed to eliminate stress and foster a sense of well-being. In Europe and
the United States, the Foundation's programs are helping inner city youth to turn
away from gang violence, drugs and alcohol. Sri Sri's Prison Programs have helped
transform the lives of an estimated 150,000 inmates around the world.
24
In 1997, Sri Sri founded the International Association for Human
Values, a humanitarian non profit organization that advances human values in
political, economic, industrial, and social spheres. While his self development
programs have popularized traditionally exclusive ancient techniques, Sri Sri's social
initiatives address an array of issues such as conflict resolution, disaster and trauma
relief, prisoner rehabilitation, youth leadership, women's empowerment, female
foeticide, child labor, and access to education. His teachings of love, practical
wisdom, and service promote harmony among people, and encourage individuals to
follow their chosen spiritual path, while honoring other paths.
1.17.2 Sudarshan Kriya (SK) process
Sudarshan Kriya emphasizes breathing in three different rhythms. The
theory mentions that the Kriya allows a healthy and pleasant mind to produce
chemical messengers, which travel from the nervous system to the immune system,
resulting in the overall betterment of both body and mind.
Sudarshan Kriya (SK) and related practices (SK&P) are derived from the
Yogic Science of Breath derived from Vedic texts. SK&P includes gentle stretches
(yoga postures), specific breathing exercises (the central technique is SK; see below),
and cognitive coping and stressor evaluation strategies. SK&P is traditionally
understood to dissolve emotional distress and create the subjective experience of rest
and well-being. The instructors in SK&P are trained by the International Art of
Living Foundation in two residential courses of two weeks each which included
approximately one year of practical field work in between.
The breathing techniques that are part of SK&P are:
(a) Three-Stage Pranayama with Ujjayi or "Victory Breath",
(b) Three sets of Bhastrika or "Bellow's Breath", and
(c) SK or the "Healing Breath Technique" and are practiced in that order.
The breathing practices are done in a sitting posture, either in a chair or
on the floor. Eyes are kept closed throughout the sessions. Normal breathing is at the
25
rate of 14 to 16 breaths per minute. Ujjayi is a slow and deep breathing technique at
2 to 4 breaths per minute. Three-Stage Pranayama with Ujjayi breath is an advanced
form using a specific ratio of inhalation and exhalation, and breath-holds.
Participants practice this component where specific arm positions are held for
approximately ten minutes in total.
First stage:
In this stage hands are kept on the pelvic bone and participants are
trained to breath in Ujjai for a definite period. Then they are asked to hold the breath
for a definite period and then asked to breathe out in Ujjai for a definite period.
Second stage:
In this stage hands are kept on chest area and breathing in and out in
Ujjai and holding the breath are done in the same fashion as for Stage I.
Third stage:
In this stage hands are kept on the back of the shoulder and breathing is
done in the same fashion as for Stage I.
The second breathing component of SK&P is Bhastrika. Here the
breathing is vigorous and faster, about twenty to thirty respiratory cycles per minute.
Three approximately one-minute rounds of Bhastrika are followed by a few minutes
of normal breathing. Arm movements are used to increase the force and depth of
inhalation and exhalation. Practice of this component lasts for approximately five
minutes. 3 stage Pranayam is followed by Bhastrika Pranayam where hand
movements up and down are coordinated with fast breath In and Out through the
nose. This is followed by Omkar meditation for 3 times followed by Sudarshan Kriya
in Gurujis recorded voice.
The central component of SK&P is SK which is an advanced cyclical
breathing exercise of slow, medium, and fast rates in succession. Slow breaths are
about 20 respiratory cycles per minute, medium breaths are about 40– 50 respiratory
cycles per minute, and the fast breathing is about 60–80 cycles per minute. The
26
participant rotates through these breathing patterns during SK. Kriya involves
regulating ones breath to the sounds of ‘So-hum’ (‘so’ for inhale & ‘hum’ for exhale).
The entire Kriya involves multiple rounds with each round having long, medium and
short inhalation and exhalation with varying rhythms and intensities.
This process continues for 35 minutes which is then followed by Yoga
nidra (tranquil state) for about 10 minutes. Towards the end of the Yoga nidra, the
participants are made to meditate for a few minutes. Once they are aware of the
environment, they are allowed to sit up and open their eyes.
The home SK instruction is given on the last day of the workshop. It
starts with 20 long and slow in and out breaths, 40 medium –length breaths and 40
small, fast ones. This 20-40-40 is done three times and lasts a total of 7-9 min. after
that the practitioners observe silence keeping his/her body for 1 min and pay
attention to their body and then finish with five long , slow so –hums after which the
practitioners lies down in supine position for deep meditation for few min.
1.17.3 The Art of Living Courses
The masterpiece of the Art of Living Course is the powerful breathing-
based technique Sudarshan Kriya. By the side of it, the AOL offers various courses,
to furnish practical knowledge and techniques to unlock their deepest potential and
bring fullness to life. Whether happy and successful or feeling the stress of poor
health, disappointments, or fear, every participant is cared for and comes away
lighter, with effective techniques for releasing mental and physical stress and
increasing his or her health, energy, peace, self-knowledge, awareness, and joy. The
art of living conducts various introductory and postgraduate courses for people of
different age. Table shows the details of some of the main courses of AOL
foundation specially designed for children, adolescent and adults.
27
Tab
le 1
.6
The
Art
of L
ivin
g C
ours
es
S.N
oC
ours
eA
ge(y
rs)
Rem
arka
ble
feat
ures
Tec
hniq
ues
1Th
e A
rt of
Liv
ing
Hap
pine
ss P
rogr
am(P
art 1
cou
rse)
18+
�R
e-di
scov
er th
e pr
esen
t mom
ent —
not
as a
conc
ept b
ut a
s a d
irect
exp
erie
nce.
�Th
e po
wer
to c
reat
e a
joyo
us li
fe th
at is
on-
purp
ose.
�Th
e co
nfid
ence
to s
tretc
h an
d gr
ow b
eyon
dlim
iting
bel
iefs
, an
d th
e ab
ility
to
lead
ade
eply
fulfi
lling
life
.�
Expe
rienc
e un
limite
d po
wer
and
free
dom
�Th
is c
ours
e in
clud
es v
alua
ble
skill
s fo
rm
anag
ing
nega
tive
emot
ions
an
dch
alle
ngin
g sit
uatio
ns,
�Fo
r im
prov
ing
focu
s an
d pr
oduc
tivity
at
wor
k an
d str
engt
heni
ng re
latio
nshi
ps�
Prac
tical
wisd
om a
nd p
roce
sses
to d
iscov
erw
hat i
s wor
king
and
not
wor
king
in li
fe�
Yog
a fo
r im
prov
ed h
ealth
and
inc
reas
edfle
xibi
lity
�Su
dars
han
Kriy
a,
a po
wer
ful
brea
thin
gte
chni
que
and
othe
r anc
ient
pra
ctic
es.
2A
RT
Exc
el C
ours
e –
All
Rou
nd
Trai
ning
in
Exce
llenc
e
8-13
�Pr
ovid
es a
n op
portu
nity
to
disc
over
the
hum
an v
alue
s the
y na
tura
lly p
osse
ss�
Giv
es th
e Si
x G
olde
n K
eys t
o Su
cces
s�
Kno
wle
dge
that
is
kid
-frie
ndly
and
ye
tde
eply
rele
vant
to st
uden
ts�
Incu
lcat
es a
stro
ng lo
ve fo
r lea
rnin
g
�Pr
ovid
ing
tool
s th
at s
timul
ate
child
ren’
sna
tura
l se
nse
of i
nqui
ry a
nd i
mag
inat
ion
whi
le e
xpan
ding
thei
r min
ds
28
(Tab
le 1
.6 C
ontd
.)
3Y
outh
Em
pow
erm
ent
Sem
inar
(YES
!)13
-17
�En
able
s yo
uth
to
succ
essf
ully
na
viga
teth
roug
h th
e ac
adem
ic
and
pers
onal
chal
leng
es o
f hig
h sc
hool
.
�Th
e pr
ogra
m
feat
ures
in
tere
sting
disc
ussio
ns,
fun
and
chal
leng
ing
gam
es,
and
a pr
actic
al
appr
oach
to
pr
oble
mso
lvin
g,
time
man
agem
ent,
hand
ling
rela
tions
hips
an
d de
alin
g w
ith
peer
pres
sure
.
4Y
outh
Lea
ders
hip
Trai
ning
Pro
gram
(YLT
P)18
– 2
7�
The
mis
sion
is
to
re
vive
an
d en
rich
com
mun
ities
thr
ough
the
upl
iftm
ent
and
trans
form
atio
n of
you
th.
�Em
pow
ers
yout
h to
tak
e re
spon
sibili
ty f
orth
eir
own
futu
re
and
that
of
th
eir
com
mun
ity.
�El
imin
ates
str
ess
usin
g in
depe
nden
tlyre
sear
ched
str
ess-
relie
ving
br
eath
ing
tech
niqu
es
5Y
outh
Em
pow
erm
ent
and
Skill
s wor
ksho
p (Y
ES+)
18-3
0�
Incr
ease
effi
cien
cy, s
treng
then
rela
tions
hips
, and
bui
ld u
nsha
kabl
eco
nfid
ence
;�
Prac
tical
kno
wle
dge
on ti
me-
man
agem
ent
and
entre
pren
eurs
hip.
�H
ighl
y fu
n an
d ch
alle
ngin
g lif
e-sk
ills a
ndca
paci
ty b
uild
ing
prog
ram
that
has
reac
hed
thou
sand
s of s
tude
nts a
nd y
oung
prof
essi
onal
s�
Asa
nas a
nd M
edita
tion
�Su
dars
han
Kriy
a &
Pra
naya
m
29
(Tab
le 1
.6 C
ontd
.)
6Li
ving
wel
l cou
rse
�U
nder
stand
ing
of p
erso
nal
curre
nt h
ealth
cond
ition
,�
Som
e sim
ple
yet
prof
ound
yo
ga
asan
asta
ught
uni
tes
and
ties
up e
very
thin
g ne
atly
and
aids
the
body
to h
eal a
nd c
orre
ct it
self.
�Im
prov
e so
cial
rel
atio
nshi
p, a
n ab
ility
to
deve
lop
a de
ep
sens
e of
be
long
ingn
ess
impr
ovin
g th
e ch
ance
s to
bon
d w
ith m
ore
peop
le a
nd t
hus
impa
ctin
g th
e he
alth
in
apo
sitiv
e w
ay.
�Th
ere
is
spec
ial
atte
ntio
n gi
ven
to
get
starte
d w
ith a
hea
lthie
r lif
esty
le f
or p
eopl
ew
ho n
eed
to m
ove
out o
f com
pulsi
ve h
abits
rela
ted
to
smok
ing,
dr
inki
ng
and
drug
abus
e.
Livi
ng
Wel
l pr
ogra
m
empo
wer
sin
divi
dual
s on
str
ateg
ies
to
dela
ypr
ogre
ssio
n of
the
cond
ition
, pre
vent
ion
ofco
mpl
icat
ions
and
man
agem
ent.
�It
also
fo
cuse
s on
th
e ill
-effe
cts
ofps
ycho
soci
al
activ
ity,
stres
s, to
bacc
o,al
coho
l or o
ther
subs
tanc
e ab
use.
�O
ne
expe
rienc
es
the
touc
h of
lif
e an
dle
aves
the
sha
dow
s of
chr
onic
illn
esse
sbe
hind
.
�D
aily
sch
edul
e an
d bu
ilds
in p
ract
ices
that
aid
in b
uild
ing
conf
iden
ce,
joy
and
ease
into
life
that
pre
vent
s com
plic
atio
ns.
�Y
oga
asan
as (P
adam
asad
hana
),�
Sury
a N
amas
kar
�Su
dars
han
Kriy
a &
Pra
naya
m�
Med
itatio
n
30
1.18 SCIENTIFIC RESEARCH ON ART OF LIVING PRACTICES
Research suggests that breathing can be affected by experiences and
circumstances. When faced with a distressing moment, the body can become over
activated and breathing can become more rapid and shallow. Fortunately, breathing
is controllable. Breathing exercises have been used to manage emotions and regulate
stress, as well as increase energy and maintain optimal arousal needed for greater
focus and performance. Because breathing exercises can be quickly learned and
provide immediate feelings of relief, they can be easily incorporated into existing
trainings or treatments. Sudarshan Kriya, a rhythmic breathing technique has been
scientifically proven to have numerous health benefits.
A number of research studies have appeared in independent, peer-
reviewed journals that attest the benefits of Sudarshan Kriya. Table 1.7 shows the
published research studies on SK&P.
31
Tab
le
1.7
: Pub
lishe
d R
esea
rch
stud
ies o
n SK
&P
Tab
le
1.7a
: Inf
luen
ce o
f SK
&P
on S
tres
s, D
epre
ssio
n A
nd A
nxie
ty
S.N
oA
utho
rY
ear
Popu
latio
n (S
ampl
esi
ze (N
)D
urat
ion
of p
ract
ice
Des
ign
Out
com
e
1Jy
otsn
a V
P[5
1]20
12
Dia
betic
pat
ient
s(49
)6
mon
ths
Pros
pect
ive
rand
omiz
edco
ntro
lled
trial
Non
-sig
nific
ant
trend
to
war
dim
prov
emen
t in
gl
ycem
ic
cont
rol,
impr
ovem
ent
in
the
qual
ity
of
life
(QO
L).
2K
atzm
anM
A [5
2]20
12
Gen
eral
ized
Anx
iety
Dis
orde
r (G
AD
) (41
)4
wee
ks
An
open
-labe
l tria
l R
educ
tions
occ
urre
d in
the
pre-
and
pos
t-in
terv
entio
n m
ean
Ham
ilton
an
xiet
ysc
ale
(HA
M-A
) to
tal
scor
e an
d ps
ychi
csu
bsca
le.
3D
esci
lo T
[53]
2010
Su
rviv
ors o
f the
200
4So
uth-
East
Asia
tsuna
mi (
183)
24 w
eeks
N
on-r
ando
miz
edstu
dyR
elie
ve p
sych
olog
ical
dis
tress
fol
low
ing
mas
s dis
aste
rs
4R
ao R
M[5
4]20
08
Early
stag
e br
east
canc
er p
atie
nts
unde
rgoi
ng su
rger
y (6
9)
4 w
eeks
R
ando
miz
edco
ntro
lled
trial
Dec
reas
e in
the
state
and
trai
t of
anx
iety
,de
pres
sion
, s
ympt
om s
ever
ity,
dist
ress
and
impr
ovem
ent
in q
ualit
y of
life
, CD
56%
and
low
er le
vels
of s
erum
IgA
6 K
jellg
ren
A[5
5]20
07
Hea
lthy
volu
ntee
rs(5
5)6
wee
ks
A c
ontro
lled
pilo
ttri
alLo
wer
ed d
egre
e of
anx
iety
, de
pres
sion
and
stres
s, an
d al
so
incr
ease
d th
eir
degr
ee o
f opt
imis
m
32
Tab
le 1
.7a
. Inf
luen
ce o
f SK
&P
on st
ress
, dep
ress
ion,
anx
iety
----
cont
d
S.N
oA
utho
rY
ear
Popu
latio
n
(Sam
ple
size
(N)
Dur
atio
nD
esig
nO
utco
me
7 V
edam
urth
acha
r[5
6]20
06.
Alc
ohol
depe
nden
tin
divi
dual
s (30
)
2 w
eeks
R
ando
miz
ed c
ontro
lled
trial
Red
uctio
ns
in
Bec
k D
epre
ssio
nIn
vent
ory
(BD
I) sc
ores
, co
rtiso
l an
dA
CTH
.
8 B
razi
er A
[57]
20
06
HIV
/AID
S(47
)-
Ran
dom
ized
con
trolle
dtri
alPo
sitiv
e ch
ange
s in
wel
l bei
ng
9 Ja
naki
ram
aiah
N[5
8] 2
000
Mel
anch
olia
(15)
4
wee
ks
Ran
dom
ized
com
paris
on
Alte
rnat
ive
to d
rugs
in m
elan
chol
ia a
s a
first
line
treat
men
t
10
Jana
kira
mai
ah N
[59]
1998
D
ysth
ymic
patie
nts (
46)
3 m
onth
s
-
Rem
issi
on
from
de
pres
sion,
el
evat
edpl
asm
a pr
olac
tin, S
tabl
e co
rtiso
l lev
els
11
Subr
aman
ian
S[6
0]20
12
Hea
lthy
Stud
ents
(43)
6 w
eeks
Ra
ndom
ized
con
trolle
d Re
duct
ion
in
anxi
ety
scor
e ,c
orts
iol,
incr
ease
in p
rola
ctin
, be
ta e
ndor
phin
and
phys
ical
as
wel
l as
men
tal
wel
l be
ing,
impr
ovem
ent i
n im
mun
ity a
nd a
cade
mic
perf
orm
ance
33
Tab
le 1
.7b.
Influ
ence
of S
K&
P o
n Br
ain
Func
tions
S.N
oA
utho
rY
ear
Popu
latio
n(S
ampl
e si
ze (N
)D
urat
ion
of p
ract
ice
Out
com
e
1 B
hatia
M [6
1]20
03
Prac
titio
ners
(19)
2-3
deca
des
Incr
ease
s in
beta
act
ivity
wer
e ob
serv
ed in
the
left
fron
tal,
occi
pita
l, an
d m
idlin
e re
gion
s of t
hebr
ain
2 B
aija
l S [6
2]20
10
Prac
titio
ners
dur
ing
Saha
j Sam
adhi
med
itatio
n (1
0)
3-7
year
sEn
hanc
ed th
eta
band
act
ivity
, inc
reas
ed th
eta
cohe
renc
e
3 Sr
iniv
asan
N [6
3]20
07
Med
itato
rs (1
0)3-
7 ye
ars
Larg
er M
ism
atch
Neg
ativ
ity(M
MN
) am
plitu
des
4 N
aga
Ven
kate
sha
Mur
thy
PJ [
64]
1997
15
dys
thym
ic a
nd 1
5m
elan
chol
icde
pres
sion
pat
ient
s
3 m
onth
sN
orm
al (E
lect
roen
ceph
alog
ram
) EEG
brai
nwav
e, si
gnifi
cant
relie
f fro
m d
epre
ssio
n
34
Tabl
e 1.
7c :
In
fluen
ce o
f SK
&P
on C
ance
r pa
tient
s
S.N
oA
utho
rY
ear
Popu
latio
n(N
)D
urat
ion
ofpr
actic
eD
esig
nO
utco
me
1 K
umar
, N [6
5]
2013
Bre
ast c
ance
r pat
ient
s( 7
8)3
mon
ths
Ran
dom
ized
study
Dec
reas
e in
cor
tisol
and
ver
bal
scor
e of
pai
n
2K
ochu
pilla
i V[6
6]20
05
Can
cer p
atie
nts
24 w
eeks
-In
crea
se in
Nat
ural
Kill
er c
ells
Tabl
e 1.
7d:
Influ
ence
of S
K&
P on
Oxi
dativ
e St
ress
and
Ant
ioxi
dant
Sta
tus
S.N
oA
utho
rY
ear
Popu
latio
n(N
)D
urat
ion
Des
ign
Out
com
e
1 Sh
arm
a [6
7]20
08
SK p
ract
ition
ers (
42)
At l
east
1ye
arO
bser
vatio
nal
Posi
tive
effe
cts o
n im
mun
ity, a
ging
,ce
ll de
ath,
and
stre
ss re
gula
tion.
2 Sh
arm
a H
[68]
20
03
Polic
e tra
iner
s (24
)5
mon
ths
Ran
dom
ised
study
Low
er le
vels
of b
lood
lact
ate
, hig
her
leve
ls o
f ant
ioxi
dant
s
3 A
gte
VV
[69]
20
11
Mild
hype
rtens
ives
(26)
2 m
onth
s O
pen
labe
lin
terv
entio
nstu
dy
Dec
reas
e in
Dia
stol
ic B
lood
Pres
sure
, Ser
um u
rea
and
plas
ma
Mal
ondi
alde
hyde
(MD
A)
35
Tab
le 1
.7 e
: In
fluen
ce o
f SK
&P
on G
ene
Exp
ress
ion
Prof
iles
S.N
oA
utho
rY
ear
Popu
latio
n(N
) D
urat
ion
Des
ign
Out
com
e
1Q
u S
[70]
2013
Hea
lthy
prac
titio
ners
of
SKY
(14)
5 m
onth
sto
5 y
ears
-
97 u
niqu
e ge
nes
2Sh
arm
a [6
7]20
08SK
pra
ctiti
oner
s(4
2)A
t lea
st 1
year
-
Exer
ted
effe
cts
on im
mun
ity, a
ging
, cel
lde
ath,
and
stre
ss re
gula
tion
thro
ugh
trans
crip
tiona
l reg
ulat
ion.
Tab
le 1
.7g
: O
ther
ben
efits
of S
K&
P
S.N
oA
utho
rY
ear
Popu
latio
n(N
) D
urat
ion
Des
ign
Out
com
e1
Jasm
in J
Parm
ar [7
1]20
13
Hel
athy
volu
ntee
rs (3
8)3
mon
ths
Com
para
tive
Stud
yR
educ
tion
in B
lood
pre
ssur
e an
dim
prov
emen
t in
card
io re
spira
tory
para
met
ers
2G
hahr
eman
iD
G [7
2]20
13
Hig
h sc
hool
stude
nts (
327)
1 w
eek
Para
llel c
ontro
l Y
ES! p
rom
ote
men
tal h
ealth
inad
oles
cent
s, po
tent
ially
prot
ectin
g th
em fr
om h
arm
ful c
opin
gbe
havi
ors
3Sa
yyed
A [7
3]
20
10
Hea
lthy
volu
ntee
rs (5
5)8
days
-D
ecre
ase
in T
otal
Cho
leste
rol,
LDL,
incr
ease
in H
DL,
sign
ifica
nt c
hang
es in
pulm
onar
y fu
nctio
ns
36
1.19 PURPOSE OF THE STUDY
Modern living has brought with it, not only innumerable means of
comfort, but also a plethora of demands that tax human body and mind. People of
different ages experience different levels and types of stress. There is no age at
which we are exempt from stress. Stresses begin from nursery children, elementary
aged children and school children. Adolescence and teenage are stressful phase in
life. Though this is the longest stage in human being‘s life which faces conflicts
among various values (morals) counter opinions by parents, monotonous and
cognitive life style can lead to copious amounts of stress on an adolescents.
Teenagers spend their life as in academics as a student in school and college.
Academic environment in India has a very oppressive nature which is
highly mark-oriented, perfectionist and encouraging the tendency to over-achieve
which eventually leads to emotional exhaustion and burnout. The stress which is
experienced by students may adversely affect their academic achievement, personal
well being and long term professional capabilities. It can lead to mental distress and
it can have a negative impact on their cognitive functioning and learning. Thus, it is
extremely crucial that to combat it immediately. Therefore stress management can be
used to help the students filter out some of the stress and enhance their performance,
mental well being and minimizes the adverse behaviour as well.
Middle aged people of age 30-50 tend to have too many responsibilities
about work and family life. Job stress plays a significant role in daily stress. This is
often spurred by office politics, workloads, worries over salary and time-sensitive
deadlines. Due to rapid changes associated with urbanization financial worries for
family expenses and children education also have a major impact on the middle aged
people. As these stresses are faced daily, it becomes a chronic stress which leads to
serious health issues like hypertension, diabetes, obesity among which hypertension
is the major health problem due to chronic stress. Hypertension (HTN) remains the
most common risk factor for cardiovascular morbidity and mortality. The incidence
of HTN is rising the world over because of common environmental factors:
37
excessive dietary sodium, obesity, physical inactivity, excessive alcohol intake,
psychologic stress.
People of different age group acquire stress from different factors and
hence have to learn how to manage their stress in a healthy and productive manner.
Innovative and assorted styles of stress management techniques may be well suitable
for each age group, for a proper outcome.
Art of living (AOL), foundation offers different variety of courses for
different age groups depending upon the type of stress they face. Evidence
supporting SK&P as alternative therapy is accumulating. Until recent times, 25
research papers have been published in scientific journals. With these intriguing
findings, it is imperative to conduct further research on SK&P to formulate it as
evidence based mind body medicine. Up to our knowledge, none of the studies
focused on specific courses of AOL namely, the YES+ an explicit course for college
students and Living well course particular for lifestyle diseases.
1.20 OBJECTIVES
With this context, the study had two objectives.
Objective 1: To find out the effect of short term structured yoga module
(YES! +) on psychological as well as biological changes associated with stress
response in healthy engineering college students during examination stress.
Objective 2: To find out the effect of structured yoga module (Living
well course) as an adjunct to antihypertensive drug therapy on psychological,
biological and molecular changes in recently diagnosed mild essential hypertensive
patients.
Each objective is presented as separate chapters (Chapter 2 and 3). As
the thesis pertains to research work carried out on the effect of yoga on exam stress
and hypertension, it is in order to introduce the reader about exam stress,
hypertension and related aspects separate introduction, materials and methods,
results, discussions and conclusion are provided for each chapters.