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yogatexts/2. Effect of SMET yoga program on Positive and Negative Affectivity of employees_ a randomised controlled study. conv.txt

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+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+Effect of SMET yoga program on Positive and Negative Affectivity of employees; a randomised controlled study.
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+Jyothi Vasu
+Research Scholar, S-VYASA University, Bengaluru, Karnataka, India
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+Towards the partial fulfillment of Doctoral degree in Yoga
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+under the guidance of
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+Sony KumariM.A., PhD
+Professor, S-VYASA University, Bengaluru, Karnataka, India
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+and co-guidance of
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+K. B. AkhileshM.S., PhD
+Professor, Indian Institute of Science, Bengaluru, Karnataka, India
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+H. R. NagendraM.E., PhD
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+Chancellor, S-VYASA University, Bengaluru, Karnataka, India
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+The Division of Yoga & Management
+Swami Vivekananda Yoga AnusandhanaSamsthana (SVYASA- A university established under section 3 of the UGC Act. 1956)
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+Volume XIII Issue III MARCH 2020	Page No: 203
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+Abstract
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+Background :
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+This study seeks to investigate the impact of Self-Management of Excessive Tension (SMET) yoga program on changes in Positive and Negative affectivity of the employees.
+Materials and methods: It is a randomised two group (yoga and control group) intervention study with pre and post assessments. SMET yoga program is used as an intervention.A sample of 240 employees (120-Yoga and 120-Control group) consisting of both male and female, working for a BPO office in Bengaluru, India belonging to an age group of 20-45 years participated in the study. PANAS scale was used to administer the study parameters. Data was analysed by using SPSS software.
+Results:A considerable variation in mean values (difference in pre and post data) were observed after SMET intervention for various dimensions ofPositive Affectivity and Negative Affectivity Schedule (PANAS). The results were found to be significant with p < 0.05.
+Conclusions: Studyshowed that SMET helped to increase Positive affectivity and to reduce the Negative affectivity of the employees.
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+Key words: Cyclic Meditation, Negative Affectivity,Personality Traits, Positive Affectivity, SMET, Yoga
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+Background:
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+The word "personality" originates from the Latin word persona, which means mask (Stevko, 2014). In French, it is equivalent to personalete. Personality also refers to the pattern of thoughts, feelings, social adjustments, and behaviours consistently exhibited over time that strongly influences one's expectations, self-perceptions, values, and attitudes (Srivastava & Mishra, 2016). It also predicts human reactions to other people, problems, and stress.
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+Personality affects all aspects of a person's performance, even how he reacts to situations on the job. Not
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+every personality is suited for every job position, so it's important to recognize personality traits and pair
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+employees with the duties that fit their personalities the best. This can lead to increased productivity and job satisfaction, helping your business function more efficiently.
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+Introduction:
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+Positive Affectivity:
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+Positive  Affectivity  (PA)  is  a  personality  characteristic  that  describes  how  humans  experience positive emotions while interacting with others and with their surroundings. Those with high positive
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+Volume XIII Issue III MARCH 2020	Page No: 204
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+affectivity are typically enthusiastic, energetic, confident, active, and alert. Those having low levels of positive affectivity can be characterized by sadness, lethargy, distress, and un-pleasurable engagement (Watson et al, 1988).
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+Positive affect reflects neither a lack of negative affect, nor the opposite of negative affect, but is a
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+separate,  independent  dimension  of  emotion. Positively  affected  people  are  said  to  be  more  active physically, socially, mentally and emotionally (Watson &Tellegen, 1988a).
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+Positive affectivity is a managerial and organizational behavior tool used to create positive environments
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+in the workplace. Through the use of PA, the manager can induce a positive employee experience and culture. The positive affectivity hypothesis predicts that employees with positive dispositions receive more supervisor support because they are more socially oriented and likable.PA can be measured as both a state and a trait; state affect captures how a person feels at any given time while trait affect is the tendency of a person to experience a particular affective state over time (Watson and Pennebaker, 1989).
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+PA helps individuals to process emotional information accurately and efficiently, to solve problems, to make plans, and to earn achievements. Psychological capital (PsyCap) refers to an individual’s positive psychological  state  of  development  and  is  characterised  by  positive  affectivity,  self-efficacy,  hope, resilience, and optimism.
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+PA may influence to enhance the personal resources which can help to overcome or deal with distressing situations.  These  resources  are  physical  (e.g.,  better  health),  social  (e.g., social  support networks), intellectual and psychological (e.g., resilience, optimism, and creativity). PA provides a psychological break or relief from stress, supporting continued efforts to replenish resources depleted by stress.Its buffering functions provide a useful antidote to the problems associated with negative emotions and ill health due to stress. Likewise, happy people are better at more mature coping efforts than people with negative emotions.
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+Negative Affectivity:
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+Negative Affect (NA) is a dimension of subjective distress that includes a variety of adverse mood states, including anger, contempt, disgust, fear, and nervousness (Watson et al., 1988). NA, like PA, can be measured as both a state and a trait and has been linked to both subjective and objective health indicators. State NA has been linked to increased same-day pain (Gil et al., 2003) and decreases in self-reported health (Benyamini et al., 2000). Evans and Egerton (1992) found that state NA led to a higher incident of
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+Volume XIII Issue III MARCH 2020	Page No: 205
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+colds.  Burnout  is  a  negative  affective  state  caused  by  recurring  distress  (Shirom,  1989).Negative affectivity is a stable and inherited disposition to experience nonspecific distress or unpleasant emotions (Clark et al. 1994). It is considered by some to be synonymous with the personality factor of neuroticism, which corresponds to individuals’ tendency to experience negative affect states (Costa and McCrae 1980; Watson et al. 1988a).
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+It  is  important  to  an  organisation  that  its  employees  must  be  emotionally  balanced.  The  greatest competitive advantage for an organisation’seconomy is a positive workforce. Therefore it is important for organisations to find ways to enhance their employees’ positive psychological states of mind and decrease their negative emotions i.e. their psychological capital, to achieve desired organisational outcomes.
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+Negative affectivity (NA) is a personality variable that involves the experience of negative emotions and poor self-concept. Watson and Clark (1984) proposed that negative affectivity encompasses a range of constructs including trait anxiety, neuroticism, ego strength, and maladjustment, among others. Negative affectivity roughly corresponds to the dominant personality factor of anxiety/neuroticism that is found within the Big Five personality traits as emotional stability. Neuroticism can plague an individual with severe mood swings, frequent sadness, worry, and being easily disturbed, and predicts the development and onset of all common mental disorders.Research shows that negative affectivity relates to different classes of variables such as, self-reported stress and poor coping skills, health complaints, and frequency of unpleasant events. Weight gain and mental health complaints are often experienced as well.
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+Negative affectivity is considered a general risk factor for a range of physical and mental health problems, which frequently co-occur. For example, someone experiencing one negative mood state (e.g., sadness) is likely to report greater levels of other negative mood states such as fear or anger (Watson and Naragon-Gainey 2010). As a trait, negative affectivity is considered a broad predisposition to experience negative emotions  such  as  anxiety,  fear,  and  sadness  (Watson  et  al.  1988b).  Indeed,  negative  affectivity  is associated with a range of psychopathology, including eating disorders (Cook et al. 2014; Stice 2002), substance use disorders (Cook et al. 2014), schizophreniaspectrum disorders (Blanchard et al. 1998), personality disorders (Zeigler-Hill and Abraham 2006), and a variety of health concerns (Watson and Naragon-Gainey  2014).  Additionally,  negative  affectivity  is  theorized  to  play  an  etiological  role accounting for the overlap in negative emotional disorders of anxiety and depression (Clark and Watson 1991).
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+Volume XIII Issue III MARCH 2020	Page No: 206
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+Further,  negative  affect  was  identified  as  one  of  five  “core  elements”  of  personality  along  with detachment, antagonism, disinhibition, and psychoticism (Krueger et al. 2012), emphasizing the role of negative affectivity not only in personality disorders but also personality at a broader level. Notably, negative affectivity is theorized to be a preexisting temperamental disposition, occurring prior to the onset of specific pathology. Prospective studies have found negative affectivity to predict later onset of a range of problems including mental health, hypertension, and substance abuse (Craske et al. 2001; Jonas and Lando 2000; Measelle et al. 2006; Pine et al. 1998). Overall, available works suggest negative affectivity is a consistent marker of distress across a range of presenting problems and plays an etiological role in their onset.
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+Hence employees having more negative affectivity trait cannot use their maximum potential and hence will find it difficult to give their fullest to the organization. Therefore these employees may be assisted to decrease their negative affectivity, so that they would be able to work more efficiently and contribute positively to the growth and success of the organization.
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+Stress   Management   programs   (SMP)   are   conducted   in   organisations   to   help   employees   to overcomephysical and mental imbalances. Though everyone is unique, we all possess certain traits that set us apart from the rest, for many reasons. These traits define who we are and how we respond to situations. We only need to ignite that dormant passion and give a boost to our persona.
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+The Stress  Management  programs assists  individuals  to  effectively manage  the  imbalance in  healthy ways, including - exercising, seeking social support, using pleasant activities and relaxation techniques. The Stress Management training program in the workplace builds on the better Work-Life balance. Studies  on  Stress  Management  programs  suggests  that  these  comprehensive  programs  can  improve mental health, behaviour and well-being of workers.
+Previous research studies have proved that yoga techniques can bring down the imbalances enormously. Self-Management  of  Excessive  Tension(SMET)  is  one  such  holistic  yoga-based  stress  management program  developed  by  Swami  Vivekananda  Yoga  AnusandhanaSamsthana  (S-VYASA)  University, Bengaluru. It is a simple and easy technique to practice which is based on traditional concept of yoga for improving both internal and external well-being of an individual. It is specially suited to the modern day executives, professionals, management experts, housewives and others.
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+Volume XIII Issue III MARCH 2020	Page No: 207
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+YOGA:
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+Yoga is a conscious process of gaining mastery over the mind. It’s a process of elevating oneself through calming of mind.
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+The great sage Patanjali ‘father of yoga’ uses the word ‘Klesha’ in his ‘Yoga Sutras’ for stress and
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+proposes the techniques of yoga for reducing (thinning) stress. It will not be a sudden elimination but gradual systematic process of moving from higher stress levels to lower ones and slowly eliminating.
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+According to ‘Bhagavadgita’ (2 - 62, 63), by using the technique of yoga, we learn to expand our
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+horizons, increase our capacities and manifest our dormant potentialities.
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+Hence yoga is one of the popular ways to reduce physical and mental imbalances to a greater extent. It helps to set right the defects in different koshas. The negative emotions like Negative Affectivity can be minimised which helps to develop confidence, to increase optimism, enthusiasm and other positive characters. An employee with more positivities, tries to improve his performance and in turn strives for the growth of the organisation and also helps to achieve its goals and targets.
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+Benefits of Yoga :
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+Yoga offers man a conscious process to solve menacing problems of unhappiness, restlessness, emotional upset, hyper-activity and so on.
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+It helps to evoke the hidden potentialities of man in a systematic and scientific way by which man becomes a complete individual.   His   physical,   mental, emotional, spiritual and intellectual faculties develop  in  a  harmonious  and  integrated  manner  to  meet  the  all-round  challenges  of  the  modern technological era with its hectic speed.
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+It also helps for muscular relaxation, developing willpower and improving creativity.
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+SMET- Self-Management of Excessive Tension
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+Self-Management of Excessive Tension (SMET) module is a holistic yoga-based stress management program  which  is  developed  by  Swami  Vivekananda  Yoga  AnusandhanaSamsthana  (S-VYASA) University, Bengaluru. It is a simple and easy technique to practice which is based on traditional concept of yoga for improving both internal and external well-being of an individual. It is specially suited to the modern day executives, professionals, management experts, housewives and others. Yoga offers total rehabilitation by integrated module of SMET.
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+Volume XIII Issue III MARCH 2020	Page No: 208
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+SMET is based on MāndukyaUpanishad consisting of Yogic science and Vedic ideology for combating physical and mental imbalances and ensuring all round health of the body and mind combined. It is a series of successive stimulations and relaxations that can solve the complex problems of the mind. It helps to release stress at deeper levels. This technique is interspersed and an aspirant finds it easy in comparison with other practices of yoga.
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+The cardinal principles of Yoga are; “stimulation and relaxation of the body; slow down the breath and calm down the mind”. Crystallizing such principles into practical techniques, S-VYASA has developed highly effective programs of stress management, offered under the following four headings:
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+1. Instant Relaxation Technique (IRT) 2. Quick Relaxation Technique (QRT) 3. Deep Relaxation Technique (DRT)
+4. Self Management of Excessive Tension (SMET)
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+Aim and Objectives of SMET: 1.   Stimulate the mind.
+2.   Calm down the distractions. 3.   Recognize the Stagnations.
+4.   Achieve peace and happiness.
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+5.   Enhancing the efficiency of staff involved in management and other stream 6.   Promoting health and wellbeing through yoga
+7.   Recovering and managing various physical and mental aliments through specific yoga techniques.
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+8.   Improving the skills and equipoise in action by developing concentration and absolute focus towards work through various Yoga techniques.
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+Components of SMET :
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+(a) Theory sessions - namely Lectures, Talks, Counselling, Discourses and
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+(b)  Practice  sessions  -  Cyclic  Meditation  (CM)  which  includesÄsanas,  Relaxation  techniques  and Meditation.
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+Volume XIII Issue III MARCH 2020	Page No: 209
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+Theory sessions - topics:
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+1.   Concept of Stress
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+2.   Growth of Executives 3.   Group Dynamics
+4.   Introduction to SMET
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+5.   Recognition of problem is half solution 6.   S-VYASA movement
+7.   Researches on SMET
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+8.   Benefits and Advantages of going through SMET program
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+Practice session - Cyclic Meditation - CM:
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+Cyclic Meditation is a practice, built on the principle of alternate Stimulation and Relaxation. This technique was developed by Dr. H. R. Nagendra of S-VYASA university, Bengaluru. It is a simple and effective technique to relieve stress and induce deep sleep and relaxation. There are proven results that, CM can reduce the number of hours needed in order to feel rejuvenated.
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+Cyclic Meditation involves the following steps :
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+Step 1.   Lie down in śavāsana and chant Opening Prayer  “Layesambodhayetchittam……….”
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+ललललललललललललललललललललललललललललललललललललललल ललललललललललललललललललललललललललललललललललल३-४४॥
+layesaṃbodhayeccittaṃvikṣiptaṃśamayetpunaḥ | sakaṣāyaṃvijānīyātsamaprāptaṃnacālayet ||māndukyopaniśat kārika|| 3-44 ||
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+Meaning: If the mind becomes inactive in a state of oblivion awaken it again. If it is distracted,, bring it
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+back to the state of tranquility. (In the intermediary state) know the mind containing within it desires in potential form. If the mind has attained the state of equilibrium, then do not disturb it again.
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+Stimulate & awaken the sleeping mind, calm down the distractions, recognize the innate stagnations & stay in steadiness without disturbing it.
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+Step 2	(a) Perform IRT - Instant Relaxation Technique
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+(b) Coming up to Tāḍāsanasthiti (standing position) – Linear awareness (c) Relaxation and centering in Tāḍāsana
+Step 3.  Standing asana - Perform Ardhakaṭicakrāsana (first right and then left )
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+Volume XIII Issue III MARCH 2020	Page No: 210
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+(a)  Coming down tośavāsana from right side Step 4.  Perform QRT - Quick Relaxation Technique
+Step 5.  Sitting āsanas - Sit up and relax in Danḍāsana (sitting with leg stretching) (a)Perform Vajrāsana
+(b)Perform Sasankāsana and return to Vajrāsana (c) Perform Ardha-uśtrāsanaor uśtrāsana
+(d) Relax in leg stretching sitting position (e) Go straight back to śavāsana
+Step 6.  Perform DRT – Deep Relaxation Technique
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+(a) Come up straight and assume any sitting position -preferably Vajrāsana (b) Chant Closing Prayer “ Omsarvebhavantusukhinah…….”
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+ॐललललल लललललल लललललल|ललललल ललललल लललललललल ।
+ललललल ललललललल लललललललल
+|लल लललललललललललललललललललल । ॐललललललल ललललललल ललललललल ॥
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+sarve bhavantu sukhinah, sarve santu nirāmayāh, sarve bhadrāṇi paśyantu, mā kaścit duhkha bhāgbhavet; om ṣāntih ṣāntih ṣāntihi॥
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+Meaning:
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+May	all	become	happy,	May	none	fall	ill;	May	all	see	auspiciousness	everywhere, May none ever feel sorrow, Om peace peacepeace.
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+Need for the study :
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+Physically healthy and mentally sound employees are the assets for an organisation.Improved Positive affectivity and reduced Negative affectivity of employees are considered to be very important factors which are necessary for the growth and success of an organization in achieving its goals.
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+No studies have reported examining the impact of SMET Yoga Program on Positive and Negative
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+affectivity. Hence the need.
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+Study Rationale:
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+There are many reasons for all sorts of physical, mental and emotional imbalances of a person. Hence these imbalances causes hindrances for an employee to work to his maximum potential or to exhibit positive characters.
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+Volume XIII Issue III MARCH 2020	Page No: 211
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+So by reducing theimbalance , one can maximize his potential and work with a healthy and positive state of mind. Keeping this aspect as a rationale, efforts have been made to improve the positive characters of employeesand to minimise theirnegative characters.
+Previous research studies have proved that yoga techniques can bring down the Negative affectivity and improve positivity enormously. Self-Management of Excessive Tension (SMET) is one such holistic yoga-based	stress	management	program	developed	by	Swami	Vivekananda	Yoga AnusandhanaSamsthana (S-VYASA) University, Bengaluru, which has been used as an intervention in our study.
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+Aim:
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+To study the impact of SMET yoga module on positive and negative characteristics of employees.
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+Objective:
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+ To evaluate the impact of SMET yoga module on Positive affectivity of employees.  To evaluate the impact of SMET yoga module on Negative affectivity of employees.
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+Hypothesis:
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+Null Hypothesis: SMET Yoga Module will not improve Positive affectivity and will not reduce Negative affectivity of the employees.
+Research Hypothesis: SMET Yoga Module will improve Positive affectivity and will reduce Negative affectivity of the employees.
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+Research Methodology:-
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+Research Design:
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+It is a randomised two group (yoga and  control group), intervention study with pre and post assessments.
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+SMET program is used as an intervention. Yoga group will undergo SMET yoga program and Control group will be engaged in their routine work and they will undergo SMET program after the study. It will be a waitlist control group.
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+Measures:-
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+Dependant variables– Positive affectivity andNegative affectivity
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+Independent variable –Job stress
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+Volume XIII Issue III MARCH 2020	Page No: 212
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+Control Variables – Age, Gender, Qualification, Designation, Job Tenure
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+Research Instruments used:
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+PANAS scale- developed by Watson, D.,Clark, L. A., &Tellengen, A., (1988) - measures 10 specific positive and 10 specific negative affects each at two different levels. It uses a 5-point scale (1 = very slightly or not at all, 5 = extremely) to indicate the extent of generally feeling the respective mood state. The Authors calculated Cronbach á coefficients in different samples range from 0.90 to 0.96 for PA and from 0.84 to 0.87 for NA.
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+Reliability and Validity:
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+Reliability and Validity reported by Watson (1988) was moderately good. For the Positive Affect Scale, the Cronbach alpha coefficient was 0.86 to 0.90; for the Negative Affect Scale, 0.84 to 0.87. Over a 8-week time period, the test-retest correlations were 0.47-0.68 for the PA and 0.39-0.71 for the NA. The PANAS has strong reported validity with such measures as general distress and dysfunction, depression, and state anxiety.
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+Samples :
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+Source – The sampling technique used in this research is simple random sampling. Employees working
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+for Vee-Technologies private Ltd., a BPO organisation at Bengaluru, India were selected randomly for the study. Subjects of the present study were from different departments of the organization like finance, HRM, production etc. and they belonged to the category of managers, non-managers and official staff of the organization.
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+Criteria - Both male and female employees of 20 to 45 years of age group were selected.
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+Size - Total of 240 employees participated in the study, out of which 120 belonged to ‘experimental Yoga group’ and 120 belonged to ‘waitlisted Control group’.
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+Duration of the study :3 months,  weekly 2 days, one hour session per day. Employees were asked to practice the same at home for the remaining 3 days of the week by listening to the instructions which were recorded by them. They self-reported their home practice.
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+Statistical Analysis: Statistical Package for Social Sciences (SPSS) 22.0 was used to perform the statistical analysis.
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+Volume XIII Issue III MARCH 2020	Page No: 213
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+Results / Findings:
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+The response choices of the scale used, consisted of a Likert type 5 point rating scale.
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+As the data consists of scores given to the response choices, the variables under measurement are not normally distributed. Hence analysis was made using non-parametric tests. The Mann -Whitney U test is used to measure the significance of the data.
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+Table 1 shows the Descriptive Statistics of the PANAS of the employees of Yoga group.
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+In this table we can see that there is a significant change in the mean values of post data compared to pre data of all the variables. This implies that SMET has a positive impact in improving the positive characters and reducing the negative characters of the employees.
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+Table 2 shows median, mode and percentile values for yoga group of employees.
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+Table 3 shows the Descriptive Statistics of the PANAS of the employees of Control group.
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+In this table, there is not much difference in the mean values of the variables of  pre and post data of the employees who have not participated in the SMET Yoga program.
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+Table 4 shows median, mode and percentile values for Control group of employees.
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+Table 5 shows the Mean Ranks and the sum of Ranks for PANAS of the Yoga group - employees.
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+In this table we can see that there is a tremendous change in the mean Ranks and sum of Ranks of post data compared to pre data of all the variables. This proves the positive effect of SMET in improving the positive characters and reducing the negative characters of the employees.
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+Table 6 shows the Mean Ranks and the sum of Ranks for PANAS of the Control group - employees.
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+In this table, there is not much difference in the mean Ranks and sum of Ranks of the variables of  pre and post data of the employees who have not participated in the SMET Yoga program.
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+Table 7 shows the actual significance values of the test for PANAS of employees of Yoga group.
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+This table clearly shows the significance of data of each dimension of PANAS of Yoga group. Since the P value is < 0.05 in each case, it means to say that, Reject Null Hypothesis and Accept Research Hypothesis.
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+The post data of different variables of Control group were not found to be significant for PANAS (p not less than 0.05) as per our observation.
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+SMET has a positive impact on all the variables of PANAS. SMET has helped the employees in improving their Positive (characters) Affectivity and to reduce theirNegative (emotions) Affectivity to a maximum extent.
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+Volume XIII Issue III MARCH 2020	Page No: 214
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+Discussions :
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+Previous studies and research findings aboutSMET :
+
+A study on SMET, reported decrease in occupational stress levels and baseline autonomic arousal in managers, showing significant reduction in sympathetic activity (Vempati, R. P., and Telles, S. (2000)). Effectiveness of Self- Management of Excessive Tension (SMET) programme on emotional well-being of managers was studied.. In this study, Emotional Quotient was used as an indicator for emotional well-being. SMET intervention contributed to the betterment of emotional well- being of the managers (Sony Kumari, N.C.B. Nath, and Nagendra, H. R. (2007)). A study was made to assess the effect of Self-Management of Excessive Tension (SMET), on brain wave coherence. Results of a study showed that participation in a SMET program was associated with improvement in emotional stability and may have implications  for  'Executive  Efficiency'.  On  the  whole,  significant  increase  in  cognitive  flexibility, intelligence and emotional stability were attained by following SMET (Ganpat, T. S., and Nagendra, H. R.  (2011))  .A study examined  the  possibility of enhancing emotional competence  (EC)  along with emotional  Intelligence  (EI)  through  Self  Management  of  Excessive  Tension  (SMET)  program.  The participating executives reported improvement in efficiency at work. In addition they have experienced other benefits like reduction in blood pressure, sleep decreases in the consumption of the tranquilizers, clarity in thinking, and relaxed feeling in action (Kumari, S., Hankey, A., and Nagendra H. R. (2013)). In another study, SMET intervention has again proved to contribute to significant enhancement of emotional competence level of the managers (Sony Kumari, N.C.B. Nath, and Nagendra, H. R. (2007)). A study evaluates the impact of a 5 day stress management programme (SMET) for managers as measured by AcuGraph3  - ‘Digital  Meridian  Imaging’  system.  The  5  days  SMET  intervention  increased  overall ‘Prāṇic’energy in the main acupuncture meridian channels. The program significantly improved overall chi (Chinese term) energy. Chi energy would increase, both in individual meridians and the overall (Meenakshy K. B., Alex Hankey, HongasandraRamarao Nagendra. (2014)). A study was conducted to evaluate the effect of 5 days yoga based Self-Management of Excessive Tension (SMET) on profile of mood states of managers. The negative moods were significantly reduced following SMET program. Whereas positive moods improved. The intense yoga based SMET program enhanced the profile of mood in managers (Rabindra M.A., Pradhan B. and Nagendra H.R, (2014)). SMET intervention with an insight of group dynamics & executive growth along with the practices proved to bring about a significant trend in scores which suggested that SMET as part of Yoga could be an effective tool for managing stress and hence enhancing managerial leadership (PadmavatiMaharana, DrSanjib Patra , Dr. T M Srinivasan, Dr. H R Nagendra,. (2014)). A study was conducted to examine the effect of Stress Management Programme, Self- Management   of excessive Tension (SMET) on the managers. It was observed that significant improvement in health and personality traits were recorded (Rabindra Acharya, BalramPradhan and H. R.
+
+
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+Volume XIII Issue III MARCH 2020	Page No: 215
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+
+Nagendra (2017)). Effect of SMET Programme showed to improve the attention of top line managers in another study (Shatrughan Singh and Nagendra, H. R. (2012)).
+
+
+Findings from the present study:
+
+In this study, 2 sub-scales were studied with the help of PANAS scale.
+
+It was observed that some positive changes happened in the employees who underwent SMET program as mentioned below for each sub-scale or component.
+
+Negative affectivity :Employees complaining about distress, upset, guilty, scare, hostile, irritability,
+
+ashamed,  nervous,  jittery  or  afraid  became  more  confident,  open  minded,  optimistic  and  also  their participation and involvement increased to a greater extent after going through the SMET programme.
+
+
+Positive  Affectivity:  The  interest,  excitement,  strength,  enthusiasm,  pride,  alertness,  inspiration, determination, attentiveness, activeness and self-motivationof the employees improved noticeably who underwent SMET programme.
+
+
+In total, this study has proved that SMET helps in improving the Positive affectivity of employees to a noticeable extent. It has also showed that the SMET has helped to a large extent in reducing the Negative affectivity of the employees to a minimum level which in turn increased their positivities.
+
+
+Advantages of going through SMET Program :
+
+
+This methodology has been formulated after years of in-depth study and research into actual case histories by highly qualified doctors and yoga experts. Professionals need sensitivity, brilliance and creativity. But in the process of career advancement one’s stress levels rise and this ultimately leads to deteriorating health. Also any activity related to computer leads to Musculoskeletal, Emotional and Visual problems. With SMET all these issues can be avoided or managed if they occur.
+
+
+Over  the  last  25  years,  these  programs  have  been  conducted  at  various  business  houses,  factories, industries, and educational institutions, management development institutions and for the common public in general. Course participants have experienced deep relaxation resulting in great calmness of mind and body during the programs. Preliminary investigations have demonstrated the efficacy of this program in handling stress effectively.
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+Volume XIII Issue III MARCH 2020	Page No: 216
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+The program ushers in a new era in that, it brings about a ‘Turn around’ in the participant’s outlook, both official and personal and propels him along the path of progress towards efficiency, physical & mental equipoise. SMET improves the sharpness of the mind which is the decision making machinery, by inculcating techniques that help one to go to deeper and subtler levels of consciousness and gain mastery over the mind. It helps to provide the much needed - but denied unwittingly - relaxation to the body-mind complex and to break the shackles of baser thoughts besides elevating one to unlimited expansiveness of understanding - Dr. H. R. Nagendra of S-VYASA university, Bengaluru ; founder of this module.
+
+
+Importance of Positive and Negative affectivityof an employee for an organisation:
+
+Personality  traits  are  extremely  important  in  today’s  competitive  organisational  setting.  Employees
+
+individually  possess  diverse  personality  traits  that  may  influence  negatively  or  positively  their performance of jobs assigned to them. It is therefore important that managers and organisational members take into account these important individual differences because realising these traits will help managers and colleagues to deal with employees’ job performance.
+
+Personality has received much attention from the research community in many contexts. In recent decades research on personality traits and its exploration in the context of work behavior has been revitalized . Personality trait is relatively stable and enduring individual tendency of reacting emotionally or engaging in a behavior in a certain way. Hence Personality traits reflect people’s characteristic patterns of thoughts, feelings, and behaviors. Here we study about two most important personality traits  namely Positive affectivity and Negative affectivity of employees in an organisation.
+
+Conclusion:
+
+Self-Management of Excessive Tension (SMET) program deals with the employees (human beings as a whole), by approaching them in a holistic way to minimize their problems related to various areas of an organisation. SMET Program is exclusively and extensively developed for those having physical and mental imbalances due to various reasons such as work pressure,job stress and so on in specifically corporate world. The techniques are simple but very much effective if practiced regularly. In a very short span of time, the program helps to acquire the power to perform better, free from stress in a relaxed and balanced way. From this study we can see that SMET program contributes considerably to improve the positive behaviourof the employees and reduce their negativities at the same time. Hence it is suggestive that SMET intervention is a very effective way of enhancing employees’ potential to get the maximum benefit out of them and also to enhance their persona.
+
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+Volume XIII Issue III MARCH 2020	Page No: 217
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+Limitations of the study:
+
+Although the study provided interesting insights, the study also has shortcomings.
+
+Firstly, the measures used in the study are self-report measures, whichtypically suffers the problem of a social desirability effect. Many a times, participants choose an ideal alternative instead of the truth.
+
+Secondly, this study is restricted to a private BPO organisation and the findings are provisional and cannot be generalized to other organizations in the same sector as well as to other sectors. Thus, the external validity of the study is low.
+
+Thirdly, the study has been conducted with a sample size of 120 respondents. More appropriate results could have been obtained if sample size would have been increased.
+
+In this study, three months intervention was given. Intervention period can be increased. Only one company /organization was studied. Studies can be conducted at different organisations. This could give stronger findings.
+
+The study would have brought more good results if the comparative analysis would have been made between males and females and between different variables. Some more demographic variables would have been selected to make the study more detailed one.
+
+Scope for future research :
+
+Some moderator and mediator variables like age, experience or gender variables can be considered to study the parameters and their consequences. Other possible negative consequences can also be studied to enrich this field of research.
+
+Future researchers may also wish to develop their own set of questionnaires. Future research can replicate the methodology adopted in the present study to other sectors.  More studies can be carried out to find out the extent to which personality traits influences other perceptions of the organisation. The development of scientific and practical tools and techniques to implement the above findings can be a future initiative.
+
+Conflict of Interest Statement:
+
+The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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+Volume XIII Issue III MARCH 2020	Page No: 218
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+
+References:
+
+Benyamini, Y., Idler, E. L., Leventhal, H. and Leventhal, E. A. (2000). ‘Positive affect and function as influences on self-assessment of health: expanding our view beyond illness and disability’. Journals of Gerontology, 55B, 107–16.
+
+Blanchard, J. J., Mueser, K. T., &Bellack, A. S. (1998).Anhedonia, positive and negative affect, and social functioning in schizophrenia. Schizophrenia Bulletin, 24(3), 413–424.
+
+Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100(3), 316–336. http://doi.org/10.1037/0021- 843X.100.3.316.
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+Clark, L. A., Watson, D., & Mineka, S. (1994). Temperament, personality, and the mood and anxiety disorders. Journal of Abnormal Psychology, 103(1), 103–116. http://doi.org/10.1037/0021-843X.103.1.103.
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+Cook, B. J., Wonderlich, S. A., & Lavender, J. M. (2014). The role of negative affect in eating disorders and substance use disorders. In T. D. Brewerton & A. B. Dennis (Eds.), Eating disorders, addictions and substance use disorders (pp. 363–378). Berlin: Springer. Retrieved from http://link.springer.com/chapter/10.1007/978-3-642-45378-6_16.
+
+Costa, P. T., & McCrae, R. R. (1980). Influence of extraversion and neuroticism on subjective well-being: Happy and unhappy people. Journal of Personality and Social Psychology, 38(4), 668–678. http://doi.org/ 10.1037/0022-3514.38.4.668.
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+Craske, M. G., Poulton, R., Tsao, J. C., &Plotkin, D. (2001). Paths to panic disorder/agoraphobia: An exploratory analysis from age 3 to 21 in an unselected birth cohort. Journal of the American Academy of Child and Adolescent Psychiatry, 40(5), 556–563. http://doi. org/10.1097/00004583-200105000-00015.
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+Evans, P. D. and Egerton, N. (1992). ‘Mood states and minor illness’. British Journal of Medical Psychology, 65, 177–86.
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+Ganpat, T. S., and Nagendra, H. R., “Effects of yoga on brain wave coherence in executives.”Indian Journal of Physiology and Pharmacology, vol 55(4), (2011), pp. 8-12.
+
+Gil, K. M., Carson, J. W., Porter, L. S., Ready, J., Valrie, C., Redding-Lallinger, R. and Daeschner, C. (2003).‘Daily stress and mood and their association with pain, health-care use, and school activity in adolescents with sickle cell disease’.Journal of Pediatric Psychology, 28, 363–73.
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+Jonas, B. S., &Lando, J. F. (2000).Negative affect as a prospective risk factor for hypertension. Psychosomatic Medicine, 62(2), 188–196. http://doi.org/10. 1097/00006842-200003000-00006.
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+Krueger, R. F., Derringer, J., Markon, K. E., Watson, D., &Skodol, A. E. (2012).Initial construction of amaladaptive personality trait model and inventory for DSM-5. Psychological Medicine, 42(9), 1879– 1890. http://doi.org/10.1017/S0033291711002674.
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+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+Kumari, S., Hankey, A., and Nagendra H. R., “Effect of SMET on Emotional Dynamics of Managers.” Voice of Research, vol 2(1), 2013, pp. 49-52.
+
+Measelle, J. R., Stice, E., & Springer, D. W. (2006). A prospective test of the negative affect model of substance abuse: Moderating effects of social support. Psychology of Addictive Behaviors, 20(3), 225– 233. http://doi.org/10.1037/0893-164X.20.3.225.
+
+Meenakshy,  K.  B.,  Alex  Hankey,	HongasandraRamarao  Nagendra,  “Electrodermal	Assessment  of SMET Program for business executives.” Voice of Researchvol 2 (4), 2014, ISSN 2277-7733.
+
+PadmavatiMaharana , Dr. Sanjib Patra , Dr. T. M. Srinivasan, Dr. H. R. Nagendra, “Role of Yoga based
+
+stress management program towards leadership development in managers.” IOSR Journal of Business and Management (IOSR-JBM) e-ISSN: 2278-487X, p-ISSN: 2319-7668. vol 16(5) ver II, 2014,  pp. 01-05, www.iosrjournals.org.
+
+Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998).The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55(1), 56–64. http://doi.org/10.1001/archpsyc.55.1.56.
+
+Rabindra Acharya, Balram Pradhan and H. R. Nagendra, “Effect of Stress Management Programmes on the Health and Personality Traits of Managers.”Indian Journal of Public Administration, vol 60(2),2017, pp. 350-359.
+
+Rabindra, M.A., Pradhan, B. and Nagendra, H.R., “Effect of short-term yoga based stress management program on mood states of managers.” International Journal of Education & Management Studies, vol 4(2), 2014, pp. 150-152 http://www.iahrw.com/index.php/home/journal_detail/21#list© Indian Asociation of Health, Research and Welfare.
+Shatrughan,  Singh,  and  Nagendra,  H.  R.,  “Effect  of  SMET  Programme  on  attention  of  top  line managers.”Space, vol 3(3), 2012, pp. 20.
+
+Shirom, A. (1989). ‘Burnout in work organizations’.In Cooper, C. L. and Robertson, I. (Eds), International Review of Industrial and Organizational Psychology. New York: John Wiley, 25–48.
+
+Sony Kumari, N. C. B. Nath, and Nagendra, H. R., “Enhancing emotional competence among managers – SMET.”Journal  of  the  National  Academy  of  Psychology  (Psychological  Studies),  vol  52(2):  2007. pp.171-173.
+
+Srivastava1, A. & Mishra, A. (2016).A Study on the Impact of Big Five Personality Traits on Consciousness. The International Journal of Indian Psychology, 3(2), 77 – 83.
+
+Stevko, R. (2014). Neurophysiology.Morrisville:Lulu
+
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+
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+Volume XIII Issue III MARCH 2020	Page No: 220
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+Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128(5), 825–848. http://doi.org/10.1037/0033- 2909.128.5.825.
+
+Stone, A. A., Cox, D. S., Vladimarsdottier, H. and Jandorf, L. (1987). ‘Evidence that secretory IgA antibody is associated with daily mood’. Journal of Personality and Social Psychology, 52, 988–93.
+
+Stone, A. A., Neale, J. M., Cox, D. S. and Napoli, A. (1994). ‘Daily events are associated with a secretory immune response to an oral antigen in men’. Health Psychology, 13, 400–18.
+
+Vempati, R. P., and Telles, S., “Baseline occupational stress levels and physiological responses to a two day stress management program.” Journal of Indian Psychology, vol 18(1 & 2), 2000,  pp. 33-37.
+
+Watson, D., & Clark, L. A. (1984). Negative affectivity: The disposition to experience aversive emotional states. Psychological Bulletin, 96(3), 465–490. http:// doi.org/10.1037/0033-2909.96.3.465.
+
+Watson, D., Clark, L. A., &Tellegen, A. (1988a). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070. http:// doi.org/10.1037/0022-3514.54.6.1063.
+
+Watson, D., Clark, L. A., & Carey, G. (1988b). Positive and negative affectivity and their relation to anxiety and depressive disorders.Journal of Abnormal Psychology, 97(3), 346 .http://doi.org/10.1037/0021-843X.97.3. 346.
+
+Watson, D. and Pennebaker, J. W. (1989). ‘Health complaints, stress and distress: exploring the central role of negative affectivity’. Journal of Personality and Social Psychology, 96, 234–54.
+
+Watson, D., &Naragon-Gainey, K. (2010). On the specificity of positive emotional dysfunction in psychopathology: Evidence from the mood and anxiety disorders and schizophrenia/schizotypy. Clinical Psychology Review, 30(7), 839–848. http://doi.org/10.1016/j.cpr. 2009.11.002.
+
+Watson, D., &Naragon-Gainey, K. (2014).Personality, emotions, and the emotional disorders. Clinical Psychological Science, 2(4), 422–442. http://doi.org/10. 1177/2167702614536162.
+
+Zeigler-Hill, V., & Abraham, J. (2006). Borderline personality features: Instability of self-esteem and affect. Journal of Social and Clinical Psychology, 25(6), 668–687. http://doi.org/10.1521/jscp.2006.25.6.668.
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+TABLES
+
+Table 1 : PANAS – Yoga – Descriptive Statistics
+
+Descriptive Statistics
+
+N	Range
+
+Posit_pre	120	10
+
+Minimum
+
+11
+
+Maximum
+
+21
+
+Mean
+
+15.54	0.162
+
+Std. Deviation 1.777
+
+Variance
+
+3.158
+
+
+
+Posit_post	120	9 Negat_pre	120	9 Negat_post	120	9
+Valid N	120 (listwise)
+
+40                 49                 44.79 40                 49                 44.60
+11	20	15.28
+
+0.168    1.842           3.393 0.162    1.770           3.133
+0.152	1.670	2.789
+
+
+
+*Posit_pre – Positive Affect pre data values,*Posit_post - Positive Affect post data values
+
+*Negat_pre  –Negative Affect pre data values, * Negat_post - Negative Affect post data values
+
+
+
+Table 2 : PANAS – Yoga –Statistics
+
+
+
+
+
+N	Valid
+Missing
+
+
+Posit_pre 120
+0
+
+Statistics Posit_post 120
+0
+
+
+Negat_pre 120
+0
+
+
+Negat_post 120
+0
+
+Std. Error of Mean	0.162	0.168	0.162	0.152 Median	16.00	45.00	44.50	15.00 Mode	16	45	43	16
+
+Percentiles      25 50
+75
+
+14.00             43.00             43.00              14.00 16.00             44.50             44.50              15.00
+17.00	46.00	46.00	16.00
+
+
+
+Table 3 : PANAS –Control – Descriptive Statistics
+
+Descriptive Statistics
+
+N       Rang     Minimu e            m
+Posit_pre	120	10	11
+Posit_post	120	10	11 Negat_pre	120	9	40 Negat_post	120	9	40
+Valid N	120 (listwise)
+
+Maximu	Mean m
+21	15.38	0.166
+21                15.41    0.175 49                44.55    0.162
+49	44.67	0.163
+
+Std. Deviation 1.820
+1.916 1.777
+1.789
+
+Variance
+
+3.312 3.672 3.157
+3.199
+
+
+
+
+
+Volume XIII Issue III MARCH 2020	Page No: 222
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+Table 4 : PANAS –Control –Statistics
+
+Statistics
+
+
+N	Valid
+Missing
+
+Posit_pre 120
+0
+
+Posit_post 120
+0
+
+Negat_pre 120
+0
+
+Negat_post 120
+0
+
+Std. Error of Mean	0.166	0.175	0.162	0.163 Median	15.00	15.00	44.00	45.00 Mode	16	15	43	43a
+
+Percentiles   25 50
+75
+
+14.00           14.00            43.00            43.00 15.00           15.00            44.00            45.00
+16.00	17.00	46.00	46.00
+
+
+
+Mann Whitney U Test  - Independent samples :
+
+
+
+Table 5 : PANAS – Yoga group – Friedman’s Two way Analysis of Variance by Ranks
+
+
+
+Variable
+
+Posit_pre Negat_pre
+
+N	Mean	Sum of rank             Ranks
+120	1.53	183.6 120	3.45	414
+
+Variable	N
+
+Posit_post       120 Negat_post      120
+
+Mean       Sum of rank        Ranks
+3.55	426 1.47	176.4
+
+
+
+Mann Whitney U Test  - Independent samples :
+
+Table 6 : PANAS – Control group – Friedman’s Two way Analysis of Variance by Ranks
+
+
+
+Variable
+
+Posit_pre Negat_pre
+
+N	Mean	Sum of rank           Ranks
+120       1.48            177.6 120       3.49            418.8
+
+Variable	N
+
+Posit_post       120 Negat_post      120
+
+Mean       Sum of rank        Ranks
+1.52            182.4 3.51            421.2
+
+
+
+Table 7 : Hypothesis Test statistics summary
+
+
+N = 120
+Degrees of freedom	= 3
+Exact significance   –  2*(1-tailed sig) = 0.00 Variable
+Posit_post Negat_post
+
+
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+Volume XIII Issue III MARCH 2020
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+Asymptotic  Significance (2 sided Test) = 0.00 0.00
+0.00
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+
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+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+Effect of SMET yoga program on Positive and Negative Affectivity of employees; a randomised controlled study.
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+Jyothi Vasu
+Research Scholar, S-VYASA University, Bengaluru, Karnataka, India
+
+
+
+Towards the partial fulfillment of Doctoral degree in Yoga
+
+
+under the guidance of
+
+Sony KumariM.A., PhD
+Professor, S-VYASA University, Bengaluru, Karnataka, India
+
+
+and co-guidance of
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+K. B. AkhileshM.S., PhD
+Professor, Indian Institute of Science, Bengaluru, Karnataka, India
+
+H. R. NagendraM.E., PhD
+
+Chancellor, S-VYASA University, Bengaluru, Karnataka, India
+
+The Division of Yoga & Management
+Swami Vivekananda Yoga AnusandhanaSamsthana (SVYASA- A university established under section 3 of the UGC Act. 1956)
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+Volume XIII Issue III MARCH 2020	Page No: 203
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
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+Abstract
+
+
+Background :
+
+This study seeks to investigate the impact of Self-Management of Excessive Tension (SMET) yoga program on changes in Positive and Negative affectivity of the employees.
+Materials and methods: It is a randomised two group (yoga and control group) intervention study with pre and post assessments. SMET yoga program is used as an intervention.A sample of 240 employees (120-Yoga and 120-Control group) consisting of both male and female, working for a BPO office in Bengaluru, India belonging to an age group of 20-45 years participated in the study. PANAS scale was used to administer the study parameters. Data was analysed by using SPSS software.
+Results:A considerable variation in mean values (difference in pre and post data) were observed after SMET intervention for various dimensions ofPositive Affectivity and Negative Affectivity Schedule (PANAS). The results were found to be significant with p < 0.05.
+Conclusions: Studyshowed that SMET helped to increase Positive affectivity and to reduce the Negative affectivity of the employees.
+
+Key words: Cyclic Meditation, Negative Affectivity,Personality Traits, Positive Affectivity, SMET, Yoga
+
+
+
+Background:
+
+The word "personality" originates from the Latin word persona, which means mask (Stevko, 2014). In French, it is equivalent to personalete. Personality also refers to the pattern of thoughts, feelings, social adjustments, and behaviours consistently exhibited over time that strongly influences one's expectations, self-perceptions, values, and attitudes (Srivastava & Mishra, 2016). It also predicts human reactions to other people, problems, and stress.
+
+Personality affects all aspects of a person's performance, even how he reacts to situations on the job. Not
+
+every personality is suited for every job position, so it's important to recognize personality traits and pair
+
+employees with the duties that fit their personalities the best. This can lead to increased productivity and job satisfaction, helping your business function more efficiently.
+
+Introduction:
+
+Positive Affectivity:
+
+Positive  Affectivity  (PA)  is  a  personality  characteristic  that  describes  how  humans  experience positive emotions while interacting with others and with their surroundings. Those with high positive
+
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+affectivity are typically enthusiastic, energetic, confident, active, and alert. Those having low levels of positive affectivity can be characterized by sadness, lethargy, distress, and un-pleasurable engagement (Watson et al, 1988).
+
+
+Positive affect reflects neither a lack of negative affect, nor the opposite of negative affect, but is a
+
+separate,  independent  dimension  of  emotion. Positively  affected  people  are  said  to  be  more  active physically, socially, mentally and emotionally (Watson &Tellegen, 1988a).
+
+
+Positive affectivity is a managerial and organizational behavior tool used to create positive environments
+
+in the workplace. Through the use of PA, the manager can induce a positive employee experience and culture. The positive affectivity hypothesis predicts that employees with positive dispositions receive more supervisor support because they are more socially oriented and likable.PA can be measured as both a state and a trait; state affect captures how a person feels at any given time while trait affect is the tendency of a person to experience a particular affective state over time (Watson and Pennebaker, 1989).
+
+
+PA helps individuals to process emotional information accurately and efficiently, to solve problems, to make plans, and to earn achievements. Psychological capital (PsyCap) refers to an individual’s positive psychological  state  of  development  and  is  characterised  by  positive  affectivity,  self-efficacy,  hope, resilience, and optimism.
+
+
+PA may influence to enhance the personal resources which can help to overcome or deal with distressing situations.  These  resources  are  physical  (e.g.,  better  health),  social  (e.g., social  support networks), intellectual and psychological (e.g., resilience, optimism, and creativity). PA provides a psychological break or relief from stress, supporting continued efforts to replenish resources depleted by stress.Its buffering functions provide a useful antidote to the problems associated with negative emotions and ill health due to stress. Likewise, happy people are better at more mature coping efforts than people with negative emotions.
+
+
+Negative Affectivity:
+
+Negative Affect (NA) is a dimension of subjective distress that includes a variety of adverse mood states, including anger, contempt, disgust, fear, and nervousness (Watson et al., 1988). NA, like PA, can be measured as both a state and a trait and has been linked to both subjective and objective health indicators. State NA has been linked to increased same-day pain (Gil et al., 2003) and decreases in self-reported health (Benyamini et al., 2000). Evans and Egerton (1992) found that state NA led to a higher incident of
+
+
+
+Volume XIII Issue III MARCH 2020	Page No: 205
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
+
+
+
+colds.  Burnout  is  a  negative  affective  state  caused  by  recurring  distress  (Shirom,  1989).Negative affectivity is a stable and inherited disposition to experience nonspecific distress or unpleasant emotions (Clark et al. 1994). It is considered by some to be synonymous with the personality factor of neuroticism, which corresponds to individuals’ tendency to experience negative affect states (Costa and McCrae 1980; Watson et al. 1988a).
+
+It  is  important  to  an  organisation  that  its  employees  must  be  emotionally  balanced.  The  greatest competitive advantage for an organisation’seconomy is a positive workforce. Therefore it is important for organisations to find ways to enhance their employees’ positive psychological states of mind and decrease their negative emotions i.e. their psychological capital, to achieve desired organisational outcomes.
+
+Negative affectivity (NA) is a personality variable that involves the experience of negative emotions and poor self-concept. Watson and Clark (1984) proposed that negative affectivity encompasses a range of constructs including trait anxiety, neuroticism, ego strength, and maladjustment, among others. Negative affectivity roughly corresponds to the dominant personality factor of anxiety/neuroticism that is found within the Big Five personality traits as emotional stability. Neuroticism can plague an individual with severe mood swings, frequent sadness, worry, and being easily disturbed, and predicts the development and onset of all common mental disorders.Research shows that negative affectivity relates to different classes of variables such as, self-reported stress and poor coping skills, health complaints, and frequency of unpleasant events. Weight gain and mental health complaints are often experienced as well.
+
+
+Negative affectivity is considered a general risk factor for a range of physical and mental health problems, which frequently co-occur. For example, someone experiencing one negative mood state (e.g., sadness) is likely to report greater levels of other negative mood states such as fear or anger (Watson and Naragon-Gainey 2010). As a trait, negative affectivity is considered a broad predisposition to experience negative emotions  such  as  anxiety,  fear,  and  sadness  (Watson  et  al.  1988b).  Indeed,  negative  affectivity  is associated with a range of psychopathology, including eating disorders (Cook et al. 2014; Stice 2002), substance use disorders (Cook et al. 2014), schizophreniaspectrum disorders (Blanchard et al. 1998), personality disorders (Zeigler-Hill and Abraham 2006), and a variety of health concerns (Watson and Naragon-Gainey  2014).  Additionally,  negative  affectivity  is  theorized  to  play  an  etiological  role accounting for the overlap in negative emotional disorders of anxiety and depression (Clark and Watson 1991).
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+Volume XIII Issue III MARCH 2020	Page No: 206
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+Further,  negative  affect  was  identified  as  one  of  five  “core  elements”  of  personality  along  with detachment, antagonism, disinhibition, and psychoticism (Krueger et al. 2012), emphasizing the role of negative affectivity not only in personality disorders but also personality at a broader level. Notably, negative affectivity is theorized to be a preexisting temperamental disposition, occurring prior to the onset of specific pathology. Prospective studies have found negative affectivity to predict later onset of a range of problems including mental health, hypertension, and substance abuse (Craske et al. 2001; Jonas and Lando 2000; Measelle et al. 2006; Pine et al. 1998). Overall, available works suggest negative affectivity is a consistent marker of distress across a range of presenting problems and plays an etiological role in their onset.
+
+Hence employees having more negative affectivity trait cannot use their maximum potential and hence will find it difficult to give their fullest to the organization. Therefore these employees may be assisted to decrease their negative affectivity, so that they would be able to work more efficiently and contribute positively to the growth and success of the organization.
+
+
+Stress   Management   programs   (SMP)   are   conducted   in   organisations   to   help   employees   to overcomephysical and mental imbalances. Though everyone is unique, we all possess certain traits that set us apart from the rest, for many reasons. These traits define who we are and how we respond to situations. We only need to ignite that dormant passion and give a boost to our persona.
+
+
+The Stress  Management  programs assists  individuals  to  effectively manage  the  imbalance in  healthy ways, including - exercising, seeking social support, using pleasant activities and relaxation techniques. The Stress Management training program in the workplace builds on the better Work-Life balance. Studies  on  Stress  Management  programs  suggests  that  these  comprehensive  programs  can  improve mental health, behaviour and well-being of workers.
+Previous research studies have proved that yoga techniques can bring down the imbalances enormously. Self-Management  of  Excessive  Tension(SMET)  is  one  such  holistic  yoga-based  stress  management program  developed  by  Swami  Vivekananda  Yoga  AnusandhanaSamsthana  (S-VYASA)  University, Bengaluru. It is a simple and easy technique to practice which is based on traditional concept of yoga for improving both internal and external well-being of an individual. It is specially suited to the modern day executives, professionals, management experts, housewives and others.
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+Volume XIII Issue III MARCH 2020	Page No: 207
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
+
+
+
+YOGA:
+
+Yoga is a conscious process of gaining mastery over the mind. It’s a process of elevating oneself through calming of mind.
+
+The great sage Patanjali ‘father of yoga’ uses the word ‘Klesha’ in his ‘Yoga Sutras’ for stress and
+
+proposes the techniques of yoga for reducing (thinning) stress. It will not be a sudden elimination but gradual systematic process of moving from higher stress levels to lower ones and slowly eliminating.
+
+According to ‘Bhagavadgita’ (2 - 62, 63), by using the technique of yoga, we learn to expand our
+
+horizons, increase our capacities and manifest our dormant potentialities.
+
+
+Hence yoga is one of the popular ways to reduce physical and mental imbalances to a greater extent. It helps to set right the defects in different koshas. The negative emotions like Negative Affectivity can be minimised which helps to develop confidence, to increase optimism, enthusiasm and other positive characters. An employee with more positivities, tries to improve his performance and in turn strives for the growth of the organisation and also helps to achieve its goals and targets.
+
+Benefits of Yoga :
+
+Yoga offers man a conscious process to solve menacing problems of unhappiness, restlessness, emotional upset, hyper-activity and so on.
+
+It helps to evoke the hidden potentialities of man in a systematic and scientific way by which man becomes a complete individual.   His   physical,   mental, emotional, spiritual and intellectual faculties develop  in  a  harmonious  and  integrated  manner  to  meet  the  all-round  challenges  of  the  modern technological era with its hectic speed.
+
+It also helps for muscular relaxation, developing willpower and improving creativity.
+
+SMET- Self-Management of Excessive Tension
+
+Self-Management of Excessive Tension (SMET) module is a holistic yoga-based stress management program  which  is  developed  by  Swami  Vivekananda  Yoga  AnusandhanaSamsthana  (S-VYASA) University, Bengaluru. It is a simple and easy technique to practice which is based on traditional concept of yoga for improving both internal and external well-being of an individual. It is specially suited to the modern day executives, professionals, management experts, housewives and others. Yoga offers total rehabilitation by integrated module of SMET.
+
+
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+Volume XIII Issue III MARCH 2020	Page No: 208
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+
+SMET is based on MāndukyaUpanishad consisting of Yogic science and Vedic ideology for combating physical and mental imbalances and ensuring all round health of the body and mind combined. It is a series of successive stimulations and relaxations that can solve the complex problems of the mind. It helps to release stress at deeper levels. This technique is interspersed and an aspirant finds it easy in comparison with other practices of yoga.
+
+
+The cardinal principles of Yoga are; “stimulation and relaxation of the body; slow down the breath and calm down the mind”. Crystallizing such principles into practical techniques, S-VYASA has developed highly effective programs of stress management, offered under the following four headings:
+
+
+1. Instant Relaxation Technique (IRT) 2. Quick Relaxation Technique (QRT) 3. Deep Relaxation Technique (DRT)
+4. Self Management of Excessive Tension (SMET)
+
+
+Aim and Objectives of SMET: 1.   Stimulate the mind.
+2.   Calm down the distractions. 3.   Recognize the Stagnations.
+4.   Achieve peace and happiness.
+
+5.   Enhancing the efficiency of staff involved in management and other stream 6.   Promoting health and wellbeing through yoga
+7.   Recovering and managing various physical and mental aliments through specific yoga techniques.
+
+8.   Improving the skills and equipoise in action by developing concentration and absolute focus towards work through various Yoga techniques.
+
+
+Components of SMET :
+
+(a) Theory sessions - namely Lectures, Talks, Counselling, Discourses and
+
+(b)  Practice  sessions  -  Cyclic  Meditation  (CM)  which  includesÄsanas,  Relaxation  techniques  and Meditation.
+
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+Volume XIII Issue III MARCH 2020	Page No: 209
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+
+Theory sessions - topics:
+
+1.   Concept of Stress
+
+2.   Growth of Executives 3.   Group Dynamics
+4.   Introduction to SMET
+
+5.   Recognition of problem is half solution 6.   S-VYASA movement
+7.   Researches on SMET
+
+8.   Benefits and Advantages of going through SMET program
+
+
+
+Practice session - Cyclic Meditation - CM:
+
+Cyclic Meditation is a practice, built on the principle of alternate Stimulation and Relaxation. This technique was developed by Dr. H. R. Nagendra of S-VYASA university, Bengaluru. It is a simple and effective technique to relieve stress and induce deep sleep and relaxation. There are proven results that, CM can reduce the number of hours needed in order to feel rejuvenated.
+
+Cyclic Meditation involves the following steps :
+
+Step 1.   Lie down in śavāsana and chant Opening Prayer  “Layesambodhayetchittam……….”
+
+ललललललललललललललललललललललललललललललललललललललल ललललललललललललललललललललललललललललललललललल३-४४॥
+layesaṃbodhayeccittaṃvikṣiptaṃśamayetpunaḥ | sakaṣāyaṃvijānīyātsamaprāptaṃnacālayet ||māndukyopaniśat kārika|| 3-44 ||
+
+Meaning: If the mind becomes inactive in a state of oblivion awaken it again. If it is distracted,, bring it
+
+back to the state of tranquility. (In the intermediary state) know the mind containing within it desires in potential form. If the mind has attained the state of equilibrium, then do not disturb it again.
+
+Stimulate & awaken the sleeping mind, calm down the distractions, recognize the innate stagnations & stay in steadiness without disturbing it.
+
+
+Step 2	(a) Perform IRT - Instant Relaxation Technique
+
+(b) Coming up to Tāḍāsanasthiti (standing position) – Linear awareness (c) Relaxation and centering in Tāḍāsana
+Step 3.  Standing asana - Perform Ardhakaṭicakrāsana (first right and then left )
+
+
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+Volume XIII Issue III MARCH 2020	Page No: 210
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+
+(a)  Coming down tośavāsana from right side Step 4.  Perform QRT - Quick Relaxation Technique
+Step 5.  Sitting āsanas - Sit up and relax in Danḍāsana (sitting with leg stretching) (a)Perform Vajrāsana
+(b)Perform Sasankāsana and return to Vajrāsana (c) Perform Ardha-uśtrāsanaor uśtrāsana
+(d) Relax in leg stretching sitting position (e) Go straight back to śavāsana
+Step 6.  Perform DRT – Deep Relaxation Technique
+
+(a) Come up straight and assume any sitting position -preferably Vajrāsana (b) Chant Closing Prayer “ Omsarvebhavantusukhinah…….”
+
+ॐललललल लललललल लललललल|ललललल ललललल लललललललल ।
+ललललल ललललललल लललललललल
+|लल लललललललललललललललललललल । ॐललललललल ललललललल ललललललल ॥
+
+sarve bhavantu sukhinah, sarve santu nirāmayāh, sarve bhadrāṇi paśyantu, mā kaścit duhkha bhāgbhavet; om ṣāntih ṣāntih ṣāntihi॥
+
+Meaning:
+
+
+May	all	become	happy,	May	none	fall	ill;	May	all	see	auspiciousness	everywhere, May none ever feel sorrow, Om peace peacepeace.
+
+
+Need for the study :
+
+Physically healthy and mentally sound employees are the assets for an organisation.Improved Positive affectivity and reduced Negative affectivity of employees are considered to be very important factors which are necessary for the growth and success of an organization in achieving its goals.
+
+No studies have reported examining the impact of SMET Yoga Program on Positive and Negative
+
+affectivity. Hence the need.
+
+Study Rationale:
+
+There are many reasons for all sorts of physical, mental and emotional imbalances of a person. Hence these imbalances causes hindrances for an employee to work to his maximum potential or to exhibit positive characters.
+
+
+
+
+
+
+Volume XIII Issue III MARCH 2020	Page No: 211
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
+
+
+
+So by reducing theimbalance , one can maximize his potential and work with a healthy and positive state of mind. Keeping this aspect as a rationale, efforts have been made to improve the positive characters of employeesand to minimise theirnegative characters.
+Previous research studies have proved that yoga techniques can bring down the Negative affectivity and improve positivity enormously. Self-Management of Excessive Tension (SMET) is one such holistic yoga-based	stress	management	program	developed	by	Swami	Vivekananda	Yoga AnusandhanaSamsthana (S-VYASA) University, Bengaluru, which has been used as an intervention in our study.
+
+
+Aim:
+
+To study the impact of SMET yoga module on positive and negative characteristics of employees.
+
+
+Objective:
+
+ To evaluate the impact of SMET yoga module on Positive affectivity of employees.  To evaluate the impact of SMET yoga module on Negative affectivity of employees.
+
+Hypothesis:
+
+Null Hypothesis: SMET Yoga Module will not improve Positive affectivity and will not reduce Negative affectivity of the employees.
+Research Hypothesis: SMET Yoga Module will improve Positive affectivity and will reduce Negative affectivity of the employees.
+
+
+Research Methodology:-
+
+Research Design:
+
+It is a randomised two group (yoga and  control group), intervention study with pre and post assessments.
+
+SMET program is used as an intervention. Yoga group will undergo SMET yoga program and Control group will be engaged in their routine work and they will undergo SMET program after the study. It will be a waitlist control group.
+
+Measures:-
+
+Dependant variables– Positive affectivity andNegative affectivity
+
+Independent variable –Job stress
+
+
+
+
+
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+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+
+Control Variables – Age, Gender, Qualification, Designation, Job Tenure
+
+Research Instruments used:
+
+PANAS scale- developed by Watson, D.,Clark, L. A., &Tellengen, A., (1988) - measures 10 specific positive and 10 specific negative affects each at two different levels. It uses a 5-point scale (1 = very slightly or not at all, 5 = extremely) to indicate the extent of generally feeling the respective mood state. The Authors calculated Cronbach á coefficients in different samples range from 0.90 to 0.96 for PA and from 0.84 to 0.87 for NA.
+
+Reliability and Validity:
+
+Reliability and Validity reported by Watson (1988) was moderately good. For the Positive Affect Scale, the Cronbach alpha coefficient was 0.86 to 0.90; for the Negative Affect Scale, 0.84 to 0.87. Over a 8-week time period, the test-retest correlations were 0.47-0.68 for the PA and 0.39-0.71 for the NA. The PANAS has strong reported validity with such measures as general distress and dysfunction, depression, and state anxiety.
+
+
+Samples :
+
+Source – The sampling technique used in this research is simple random sampling. Employees working
+
+for Vee-Technologies private Ltd., a BPO organisation at Bengaluru, India were selected randomly for the study. Subjects of the present study were from different departments of the organization like finance, HRM, production etc. and they belonged to the category of managers, non-managers and official staff of the organization.
+
+Criteria - Both male and female employees of 20 to 45 years of age group were selected.
+
+Size - Total of 240 employees participated in the study, out of which 120 belonged to ‘experimental Yoga group’ and 120 belonged to ‘waitlisted Control group’.
+
+Duration of the study :3 months,  weekly 2 days, one hour session per day. Employees were asked to practice the same at home for the remaining 3 days of the week by listening to the instructions which were recorded by them. They self-reported their home practice.
+
+
+Statistical Analysis: Statistical Package for Social Sciences (SPSS) 22.0 was used to perform the statistical analysis.
+
+
+
+
+
+
+Volume XIII Issue III MARCH 2020	Page No: 213
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+
+
+
+Results / Findings:
+
+The response choices of the scale used, consisted of a Likert type 5 point rating scale.
+
+As the data consists of scores given to the response choices, the variables under measurement are not normally distributed. Hence analysis was made using non-parametric tests. The Mann -Whitney U test is used to measure the significance of the data.
+
+Table 1 shows the Descriptive Statistics of the PANAS of the employees of Yoga group.
+
+In this table we can see that there is a significant change in the mean values of post data compared to pre data of all the variables. This implies that SMET has a positive impact in improving the positive characters and reducing the negative characters of the employees.
+
+Table 2 shows median, mode and percentile values for yoga group of employees.
+
+Table 3 shows the Descriptive Statistics of the PANAS of the employees of Control group.
+
+In this table, there is not much difference in the mean values of the variables of  pre and post data of the employees who have not participated in the SMET Yoga program.
+
+Table 4 shows median, mode and percentile values for Control group of employees.
+
+Table 5 shows the Mean Ranks and the sum of Ranks for PANAS of the Yoga group - employees.
+
+In this table we can see that there is a tremendous change in the mean Ranks and sum of Ranks of post data compared to pre data of all the variables. This proves the positive effect of SMET in improving the positive characters and reducing the negative characters of the employees.
+
+Table 6 shows the Mean Ranks and the sum of Ranks for PANAS of the Control group - employees.
+
+In this table, there is not much difference in the mean Ranks and sum of Ranks of the variables of  pre and post data of the employees who have not participated in the SMET Yoga program.
+
+Table 7 shows the actual significance values of the test for PANAS of employees of Yoga group.
+
+This table clearly shows the significance of data of each dimension of PANAS of Yoga group. Since the P value is < 0.05 in each case, it means to say that, Reject Null Hypothesis and Accept Research Hypothesis.
+
+The post data of different variables of Control group were not found to be significant for PANAS (p not less than 0.05) as per our observation.
+
+SMET has a positive impact on all the variables of PANAS. SMET has helped the employees in improving their Positive (characters) Affectivity and to reduce theirNegative (emotions) Affectivity to a maximum extent.
+
+
+
+
+
+Volume XIII Issue III MARCH 2020	Page No: 214
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
+
+
+
+Discussions :
+
+Previous studies and research findings aboutSMET :
+
+A study on SMET, reported decrease in occupational stress levels and baseline autonomic arousal in managers, showing significant reduction in sympathetic activity (Vempati, R. P., and Telles, S. (2000)). Effectiveness of Self- Management of Excessive Tension (SMET) programme on emotional well-being of managers was studied.. In this study, Emotional Quotient was used as an indicator for emotional well-being. SMET intervention contributed to the betterment of emotional well- being of the managers (Sony Kumari, N.C.B. Nath, and Nagendra, H. R. (2007)). A study was made to assess the effect of Self-Management of Excessive Tension (SMET), on brain wave coherence. Results of a study showed that participation in a SMET program was associated with improvement in emotional stability and may have implications  for  'Executive  Efficiency'.  On  the  whole,  significant  increase  in  cognitive  flexibility, intelligence and emotional stability were attained by following SMET (Ganpat, T. S., and Nagendra, H. R.  (2011))  .A study examined  the  possibility of enhancing emotional competence  (EC)  along with emotional  Intelligence  (EI)  through  Self  Management  of  Excessive  Tension  (SMET)  program.  The participating executives reported improvement in efficiency at work. In addition they have experienced other benefits like reduction in blood pressure, sleep decreases in the consumption of the tranquilizers, clarity in thinking, and relaxed feeling in action (Kumari, S., Hankey, A., and Nagendra H. R. (2013)). In another study, SMET intervention has again proved to contribute to significant enhancement of emotional competence level of the managers (Sony Kumari, N.C.B. Nath, and Nagendra, H. R. (2007)). A study evaluates the impact of a 5 day stress management programme (SMET) for managers as measured by AcuGraph3  - ‘Digital  Meridian  Imaging’  system.  The  5  days  SMET  intervention  increased  overall ‘Prāṇic’energy in the main acupuncture meridian channels. The program significantly improved overall chi (Chinese term) energy. Chi energy would increase, both in individual meridians and the overall (Meenakshy K. B., Alex Hankey, HongasandraRamarao Nagendra. (2014)). A study was conducted to evaluate the effect of 5 days yoga based Self-Management of Excessive Tension (SMET) on profile of mood states of managers. The negative moods were significantly reduced following SMET program. Whereas positive moods improved. The intense yoga based SMET program enhanced the profile of mood in managers (Rabindra M.A., Pradhan B. and Nagendra H.R, (2014)). SMET intervention with an insight of group dynamics & executive growth along with the practices proved to bring about a significant trend in scores which suggested that SMET as part of Yoga could be an effective tool for managing stress and hence enhancing managerial leadership (PadmavatiMaharana, DrSanjib Patra , Dr. T M Srinivasan, Dr. H R Nagendra,. (2014)). A study was conducted to examine the effect of Stress Management Programme, Self- Management   of excessive Tension (SMET) on the managers. It was observed that significant improvement in health and personality traits were recorded (Rabindra Acharya, BalramPradhan and H. R.
+
+
+
+Volume XIII Issue III MARCH 2020	Page No: 215
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
+
+
+
+Nagendra (2017)). Effect of SMET Programme showed to improve the attention of top line managers in another study (Shatrughan Singh and Nagendra, H. R. (2012)).
+
+
+Findings from the present study:
+
+In this study, 2 sub-scales were studied with the help of PANAS scale.
+
+It was observed that some positive changes happened in the employees who underwent SMET program as mentioned below for each sub-scale or component.
+
+Negative affectivity :Employees complaining about distress, upset, guilty, scare, hostile, irritability,
+
+ashamed,  nervous,  jittery  or  afraid  became  more  confident,  open  minded,  optimistic  and  also  their participation and involvement increased to a greater extent after going through the SMET programme.
+
+
+Positive  Affectivity:  The  interest,  excitement,  strength,  enthusiasm,  pride,  alertness,  inspiration, determination, attentiveness, activeness and self-motivationof the employees improved noticeably who underwent SMET programme.
+
+
+In total, this study has proved that SMET helps in improving the Positive affectivity of employees to a noticeable extent. It has also showed that the SMET has helped to a large extent in reducing the Negative affectivity of the employees to a minimum level which in turn increased their positivities.
+
+
+Advantages of going through SMET Program :
+
+
+This methodology has been formulated after years of in-depth study and research into actual case histories by highly qualified doctors and yoga experts. Professionals need sensitivity, brilliance and creativity. But in the process of career advancement one’s stress levels rise and this ultimately leads to deteriorating health. Also any activity related to computer leads to Musculoskeletal, Emotional and Visual problems. With SMET all these issues can be avoided or managed if they occur.
+
+
+Over  the  last  25  years,  these  programs  have  been  conducted  at  various  business  houses,  factories, industries, and educational institutions, management development institutions and for the common public in general. Course participants have experienced deep relaxation resulting in great calmness of mind and body during the programs. Preliminary investigations have demonstrated the efficacy of this program in handling stress effectively.
+
+
+
+
+
+Volume XIII Issue III MARCH 2020	Page No: 216
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
+
+
+
+The program ushers in a new era in that, it brings about a ‘Turn around’ in the participant’s outlook, both official and personal and propels him along the path of progress towards efficiency, physical & mental equipoise. SMET improves the sharpness of the mind which is the decision making machinery, by inculcating techniques that help one to go to deeper and subtler levels of consciousness and gain mastery over the mind. It helps to provide the much needed - but denied unwittingly - relaxation to the body-mind complex and to break the shackles of baser thoughts besides elevating one to unlimited expansiveness of understanding - Dr. H. R. Nagendra of S-VYASA university, Bengaluru ; founder of this module.
+
+
+Importance of Positive and Negative affectivityof an employee for an organisation:
+
+Personality  traits  are  extremely  important  in  today’s  competitive  organisational  setting.  Employees
+
+individually  possess  diverse  personality  traits  that  may  influence  negatively  or  positively  their performance of jobs assigned to them. It is therefore important that managers and organisational members take into account these important individual differences because realising these traits will help managers and colleagues to deal with employees’ job performance.
+
+Personality has received much attention from the research community in many contexts. In recent decades research on personality traits and its exploration in the context of work behavior has been revitalized . Personality trait is relatively stable and enduring individual tendency of reacting emotionally or engaging in a behavior in a certain way. Hence Personality traits reflect people’s characteristic patterns of thoughts, feelings, and behaviors. Here we study about two most important personality traits  namely Positive affectivity and Negative affectivity of employees in an organisation.
+
+Conclusion:
+
+Self-Management of Excessive Tension (SMET) program deals with the employees (human beings as a whole), by approaching them in a holistic way to minimize their problems related to various areas of an organisation. SMET Program is exclusively and extensively developed for those having physical and mental imbalances due to various reasons such as work pressure,job stress and so on in specifically corporate world. The techniques are simple but very much effective if practiced regularly. In a very short span of time, the program helps to acquire the power to perform better, free from stress in a relaxed and balanced way. From this study we can see that SMET program contributes considerably to improve the positive behaviourof the employees and reduce their negativities at the same time. Hence it is suggestive that SMET intervention is a very effective way of enhancing employees’ potential to get the maximum benefit out of them and also to enhance their persona.
+
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+
+Volume XIII Issue III MARCH 2020	Page No: 217
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+
+Limitations of the study:
+
+Although the study provided interesting insights, the study also has shortcomings.
+
+Firstly, the measures used in the study are self-report measures, whichtypically suffers the problem of a social desirability effect. Many a times, participants choose an ideal alternative instead of the truth.
+
+Secondly, this study is restricted to a private BPO organisation and the findings are provisional and cannot be generalized to other organizations in the same sector as well as to other sectors. Thus, the external validity of the study is low.
+
+Thirdly, the study has been conducted with a sample size of 120 respondents. More appropriate results could have been obtained if sample size would have been increased.
+
+In this study, three months intervention was given. Intervention period can be increased. Only one company /organization was studied. Studies can be conducted at different organisations. This could give stronger findings.
+
+The study would have brought more good results if the comparative analysis would have been made between males and females and between different variables. Some more demographic variables would have been selected to make the study more detailed one.
+
+Scope for future research :
+
+Some moderator and mediator variables like age, experience or gender variables can be considered to study the parameters and their consequences. Other possible negative consequences can also be studied to enrich this field of research.
+
+Future researchers may also wish to develop their own set of questionnaires. Future research can replicate the methodology adopted in the present study to other sectors.  More studies can be carried out to find out the extent to which personality traits influences other perceptions of the organisation. The development of scientific and practical tools and techniques to implement the above findings can be a future initiative.
+
+Conflict of Interest Statement:
+
+The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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+Volume XIII Issue III MARCH 2020	Page No: 218
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+References:
+
+Benyamini, Y., Idler, E. L., Leventhal, H. and Leventhal, E. A. (2000). ‘Positive affect and function as influences on self-assessment of health: expanding our view beyond illness and disability’. Journals of Gerontology, 55B, 107–16.
+
+Blanchard, J. J., Mueser, K. T., &Bellack, A. S. (1998).Anhedonia, positive and negative affect, and social functioning in schizophrenia. Schizophrenia Bulletin, 24(3), 413–424.
+
+Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100(3), 316–336. http://doi.org/10.1037/0021- 843X.100.3.316.
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+Clark, L. A., Watson, D., & Mineka, S. (1994). Temperament, personality, and the mood and anxiety disorders. Journal of Abnormal Psychology, 103(1), 103–116. http://doi.org/10.1037/0021-843X.103.1.103.
+
+Cook, B. J., Wonderlich, S. A., & Lavender, J. M. (2014). The role of negative affect in eating disorders and substance use disorders. In T. D. Brewerton & A. B. Dennis (Eds.), Eating disorders, addictions and substance use disorders (pp. 363–378). Berlin: Springer. Retrieved from http://link.springer.com/chapter/10.1007/978-3-642-45378-6_16.
+
+Costa, P. T., & McCrae, R. R. (1980). Influence of extraversion and neuroticism on subjective well-being: Happy and unhappy people. Journal of Personality and Social Psychology, 38(4), 668–678. http://doi.org/ 10.1037/0022-3514.38.4.668.
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+Craske, M. G., Poulton, R., Tsao, J. C., &Plotkin, D. (2001). Paths to panic disorder/agoraphobia: An exploratory analysis from age 3 to 21 in an unselected birth cohort. Journal of the American Academy of Child and Adolescent Psychiatry, 40(5), 556–563. http://doi. org/10.1097/00004583-200105000-00015.
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+Evans, P. D. and Egerton, N. (1992). ‘Mood states and minor illness’. British Journal of Medical Psychology, 65, 177–86.
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+Ganpat, T. S., and Nagendra, H. R., “Effects of yoga on brain wave coherence in executives.”Indian Journal of Physiology and Pharmacology, vol 55(4), (2011), pp. 8-12.
+
+Gil, K. M., Carson, J. W., Porter, L. S., Ready, J., Valrie, C., Redding-Lallinger, R. and Daeschner, C. (2003).‘Daily stress and mood and their association with pain, health-care use, and school activity in adolescents with sickle cell disease’.Journal of Pediatric Psychology, 28, 363–73.
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+Jonas, B. S., &Lando, J. F. (2000).Negative affect as a prospective risk factor for hypertension. Psychosomatic Medicine, 62(2), 188–196. http://doi.org/10. 1097/00006842-200003000-00006.
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+Krueger, R. F., Derringer, J., Markon, K. E., Watson, D., &Skodol, A. E. (2012).Initial construction of amaladaptive personality trait model and inventory for DSM-5. Psychological Medicine, 42(9), 1879– 1890. http://doi.org/10.1017/S0033291711002674.
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+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+Kumari, S., Hankey, A., and Nagendra H. R., “Effect of SMET on Emotional Dynamics of Managers.” Voice of Research, vol 2(1), 2013, pp. 49-52.
+
+Measelle, J. R., Stice, E., & Springer, D. W. (2006). A prospective test of the negative affect model of substance abuse: Moderating effects of social support. Psychology of Addictive Behaviors, 20(3), 225– 233. http://doi.org/10.1037/0893-164X.20.3.225.
+
+Meenakshy,  K.  B.,  Alex  Hankey,	HongasandraRamarao  Nagendra,  “Electrodermal	Assessment  of SMET Program for business executives.” Voice of Researchvol 2 (4), 2014, ISSN 2277-7733.
+
+PadmavatiMaharana , Dr. Sanjib Patra , Dr. T. M. Srinivasan, Dr. H. R. Nagendra, “Role of Yoga based
+
+stress management program towards leadership development in managers.” IOSR Journal of Business and Management (IOSR-JBM) e-ISSN: 2278-487X, p-ISSN: 2319-7668. vol 16(5) ver II, 2014,  pp. 01-05, www.iosrjournals.org.
+
+Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998).The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55(1), 56–64. http://doi.org/10.1001/archpsyc.55.1.56.
+
+Rabindra Acharya, Balram Pradhan and H. R. Nagendra, “Effect of Stress Management Programmes on the Health and Personality Traits of Managers.”Indian Journal of Public Administration, vol 60(2),2017, pp. 350-359.
+
+Rabindra, M.A., Pradhan, B. and Nagendra, H.R., “Effect of short-term yoga based stress management program on mood states of managers.” International Journal of Education & Management Studies, vol 4(2), 2014, pp. 150-152 http://www.iahrw.com/index.php/home/journal_detail/21#list© Indian Asociation of Health, Research and Welfare.
+Shatrughan,  Singh,  and  Nagendra,  H.  R.,  “Effect  of  SMET  Programme  on  attention  of  top  line managers.”Space, vol 3(3), 2012, pp. 20.
+
+Shirom, A. (1989). ‘Burnout in work organizations’.In Cooper, C. L. and Robertson, I. (Eds), International Review of Industrial and Organizational Psychology. New York: John Wiley, 25–48.
+
+Sony Kumari, N. C. B. Nath, and Nagendra, H. R., “Enhancing emotional competence among managers – SMET.”Journal  of  the  National  Academy  of  Psychology  (Psychological  Studies),  vol  52(2):  2007. pp.171-173.
+
+Srivastava1, A. & Mishra, A. (2016).A Study on the Impact of Big Five Personality Traits on Consciousness. The International Journal of Indian Psychology, 3(2), 77 – 83.
+
+Stevko, R. (2014). Neurophysiology.Morrisville:Lulu
+
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+
+
+Volume XIII Issue III MARCH 2020	Page No: 220
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+Stice, E. (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128(5), 825–848. http://doi.org/10.1037/0033- 2909.128.5.825.
+
+Stone, A. A., Cox, D. S., Vladimarsdottier, H. and Jandorf, L. (1987). ‘Evidence that secretory IgA antibody is associated with daily mood’. Journal of Personality and Social Psychology, 52, 988–93.
+
+Stone, A. A., Neale, J. M., Cox, D. S. and Napoli, A. (1994). ‘Daily events are associated with a secretory immune response to an oral antigen in men’. Health Psychology, 13, 400–18.
+
+Vempati, R. P., and Telles, S., “Baseline occupational stress levels and physiological responses to a two day stress management program.” Journal of Indian Psychology, vol 18(1 & 2), 2000,  pp. 33-37.
+
+Watson, D., & Clark, L. A. (1984). Negative affectivity: The disposition to experience aversive emotional states. Psychological Bulletin, 96(3), 465–490. http:// doi.org/10.1037/0033-2909.96.3.465.
+
+Watson, D., Clark, L. A., &Tellegen, A. (1988a). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070. http:// doi.org/10.1037/0022-3514.54.6.1063.
+
+Watson, D., Clark, L. A., & Carey, G. (1988b). Positive and negative affectivity and their relation to anxiety and depressive disorders.Journal of Abnormal Psychology, 97(3), 346 .http://doi.org/10.1037/0021-843X.97.3. 346.
+
+Watson, D. and Pennebaker, J. W. (1989). ‘Health complaints, stress and distress: exploring the central role of negative affectivity’. Journal of Personality and Social Psychology, 96, 234–54.
+
+Watson, D., &Naragon-Gainey, K. (2010). On the specificity of positive emotional dysfunction in psychopathology: Evidence from the mood and anxiety disorders and schizophrenia/schizotypy. Clinical Psychology Review, 30(7), 839–848. http://doi.org/10.1016/j.cpr. 2009.11.002.
+
+Watson, D., &Naragon-Gainey, K. (2014).Personality, emotions, and the emotional disorders. Clinical Psychological Science, 2(4), 422–442. http://doi.org/10. 1177/2167702614536162.
+
+Zeigler-Hill, V., & Abraham, J. (2006). Borderline personality features: Instability of self-esteem and affect. Journal of Social and Clinical Psychology, 25(6), 668–687. http://doi.org/10.1521/jscp.2006.25.6.668.
+
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+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
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+
+
+TABLES
+
+Table 1 : PANAS – Yoga – Descriptive Statistics
+
+Descriptive Statistics
+
+N	Range
+
+Posit_pre	120	10
+
+Minimum
+
+11
+
+Maximum
+
+21
+
+Mean
+
+15.54	0.162
+
+Std. Deviation 1.777
+
+Variance
+
+3.158
+
+
+
+Posit_post	120	9 Negat_pre	120	9 Negat_post	120	9
+Valid N	120 (listwise)
+
+40                 49                 44.79 40                 49                 44.60
+11	20	15.28
+
+0.168    1.842           3.393 0.162    1.770           3.133
+0.152	1.670	2.789
+
+
+
+*Posit_pre – Positive Affect pre data values,*Posit_post - Positive Affect post data values
+
+*Negat_pre  –Negative Affect pre data values, * Negat_post - Negative Affect post data values
+
+
+
+Table 2 : PANAS – Yoga –Statistics
+
+
+
+
+
+N	Valid
+Missing
+
+
+Posit_pre 120
+0
+
+Statistics Posit_post 120
+0
+
+
+Negat_pre 120
+0
+
+
+Negat_post 120
+0
+
+Std. Error of Mean	0.162	0.168	0.162	0.152 Median	16.00	45.00	44.50	15.00 Mode	16	45	43	16
+
+Percentiles      25 50
+75
+
+14.00             43.00             43.00              14.00 16.00             44.50             44.50              15.00
+17.00	46.00	46.00	16.00
+
+
+
+Table 3 : PANAS –Control – Descriptive Statistics
+
+Descriptive Statistics
+
+N       Rang     Minimu e            m
+Posit_pre	120	10	11
+Posit_post	120	10	11 Negat_pre	120	9	40 Negat_post	120	9	40
+Valid N	120 (listwise)
+
+Maximu	Mean m
+21	15.38	0.166
+21                15.41    0.175 49                44.55    0.162
+49	44.67	0.163
+
+Std. Deviation 1.820
+1.916 1.777
+1.789
+
+Variance
+
+3.312 3.672 3.157
+3.199
+
+
+
+
+
+Volume XIII Issue III MARCH 2020	Page No: 222
+JAC : A Journal Of Composition Theory	ISSN : 0731-6755
+
+
+
+
+
+Table 4 : PANAS –Control –Statistics
+
+Statistics
+
+
+N	Valid
+Missing
+
+Posit_pre 120
+0
+
+Posit_post 120
+0
+
+Negat_pre 120
+0
+
+Negat_post 120
+0
+
+Std. Error of Mean	0.166	0.175	0.162	0.163 Median	15.00	15.00	44.00	45.00 Mode	16	15	43	43a
+
+Percentiles   25 50
+75
+
+14.00           14.00            43.00            43.00 15.00           15.00            44.00            45.00
+16.00	17.00	46.00	46.00
+
+
+
+Mann Whitney U Test  - Independent samples :
+
+
+
+Table 5 : PANAS – Yoga group – Friedman’s Two way Analysis of Variance by Ranks
+
+
+
+Variable
+
+Posit_pre Negat_pre
+
+N	Mean	Sum of rank             Ranks
+120	1.53	183.6 120	3.45	414
+
+Variable	N
+
+Posit_post       120 Negat_post      120
+
+Mean       Sum of rank        Ranks
+3.55	426 1.47	176.4
+
+
+
+Mann Whitney U Test  - Independent samples :
+
+Table 6 : PANAS – Control group – Friedman’s Two way Analysis of Variance by Ranks
+
+
+
+Variable
+
+Posit_pre Negat_pre
+
+N	Mean	Sum of rank           Ranks
+120       1.48            177.6 120       3.49            418.8
+
+Variable	N
+
+Posit_post       120 Negat_post      120
+
+Mean       Sum of rank        Ranks
+1.52            182.4 3.51            421.2
+
+
+
+Table 7 : Hypothesis Test statistics summary
+
+
+N = 120
+Degrees of freedom	= 3
+Exact significance   –  2*(1-tailed sig) = 0.00 Variable
+Posit_post Negat_post
+
+
+
+
+
+
+Volume XIII Issue III MARCH 2020
+
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+
+
+Asymptotic  Significance (2 sided Test) = 0.00 0.00
+0.00
+
+
+
+
+
+
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+This technique is called cyclic meditation (CM) which 
+consists of a set of postures interspersed with relaxation 
+techniques. Scientific investigations documented that CM 
+showed improvement in physiological,[3] psychological,[4] 
+and neurophysiological variables.[5] School children’s 
+underwent 7 days CM training and found improvement 
+in psychomotor performance.[6,7]
+Stress is associated with homeostasis, which lead to somatic 
+and pathological condition.[8] This has been playing a major 
+role in society and generating difficulties in human’s social, 
+emotional, behavioral, and personal life.[9] All the fields 
+are getting affected by stress, including working place, 
+educational and health institutions.[10] The negative effects 
+have been seen in all occupational and professional areas.
+Impact of stress has an adverse effect on student’s health 
+and academic performance.[11] Independently, either 
+INTRODUCTION
+Meditation is difficult to learn and practice and hence 
+requires guided training. Hence, S‑VYASA developed 
+a technique based on Upanishadic verses taken from 
+Mandukya karika,[1] which say that when mind loses 
+its awareness (laya) and enters into a sleepy state, then 
+it awaken with some stimulation (Sambodhayet). Do it 
+again and again till mind reaches a state of equanimity 
+calmness.[2]
+Background: Meditation brings calmness to the mental activities and develops the internal awareness. It 
+can be helpful in reducing stress and anxiety in student community and academicians. Aims: The aim was 
+to measure the outcomes of cyclic meditation (CM), yogic relaxation technique, when compared to supine 
+rest (SR). We examine reduction in anxiety, using Spielberger’s State‑Trait Anxiety Inventory (STAI). Materials 
+and Methods: A total of 60 high school students (both genders) participated in this study, aged between 13 
+and 16 years (group average age ± standard deviation, 14.78 ± 1.22 years). They were attending 10 days 
+yoga training course during their summer vacation. Those children’s, who had English as the main medium of 
+instructions, were included. They acted as their own controls. They were divided into two groups and tested 
+on the STAI, immediately before and after 22:30 min of practice of CM on 1 day, and immediately before and 
+after an equal period of SR on the other day. For the assessment, the first group performed CM on day 9, 
+and SR on day 10. For the second group, the order was reversed. Results: There was a significant reduction 
+on STAI scores within group (pre and post) of CM (4.27%, P = 0.016) session and no change in SR session. 
+Further, subgroup analysis based on gender revealed that the female group had a significant reduction 
+following both sessions, but male group had nonsignificant reduction in STAI score. The female group found 
+significantly differs from the male group in STAI score on both the sessions. Conclusions: The CM found to 
+be a useful technique to combat the state of anxiety with different magnitude of changes in gender subgroups. 
+The female group was benefitted more by following both CM and SR sessions compared with male group.
+Key words: Anxiety, cyclic meditation, meditation, relaxation
+A comparative study on two yogic relaxation techniques on 
+anxiety in school children
+Natesh Babu, Balaram Pradhana, H R Nagendra
+S-VYASA Yoga University Campus, Prashanti Kutiram, Vivekananda Road, Kallubalu Post, Jigani, Anekal, Bengaluru, India
+Address for Correspondence: Mr. Natesh Babu, 
+Asst. Director, S-VYASA Yoga University Campus, Prashanti Kutiram, 
+ 
+Vivekananda Road, Kallubalu Post, Jigani, Anekal, Bengaluru – 560105, India 
+ 
+E‑mail: [email protected]
+Access this article online
+Website: 
+www.ijoyppp.in
+Quick Response Code
+DOI: 
+10.4103/2347-5633.157887
+Original Article
+ABSTRACT
+65
+International Journal of Yoga - Philosophy, Psychology and Parapsychology  Vol. 1  Jul-Dec-2013
+[Downloaded free from http://www.ijoyppp.org on Friday, July 29, 2016, IP: 14.139.155.82]
+Babu, et al.: Relaxation technique on anxiety in children
+66
+International Journal of Yoga - Philosophy, Psychology and Parapsychology  Vol. 1  Jul-Dec-2013
+single yoga technique or integrated yoga has been found 
+to diminish the stress level. There are several yoga 
+techniques to combat the harmful effects. Scientific 
+investigation showed that students of MBBS,[8,12‑14] dental[15] 
+and nursing,[16] engineering,[17] college,[18] and school[19] 
+have used different yoga practices for their psychological 
+health benefits.
+Most of the above mentioned studies investigated the 
+long‑term effect while CM studies are conducted on Yoga 
+residential university course students. There is a dearth of 
+scientific studies on teenage school students. Hence, the 
+present study is aimed to evaluate immediate effect of CM 
+on teenage students’ anxiety.
+MATERIALS AND METHODS
+Subjects
+The sample size was calculated based on the effect 
+size (0.57) obtained from the previous study,[20] using 
+G* Power software, Version 3.0.10 (Behavior Research 
+Methods),[21] where the  level was 0.05, power  = 
+0.95 and the recommended sample size was 42. In this 
+study, 60 high school students were recruited, who were 
+under‑going a 10  day personality development camp. 
+Since the intervention and measuring tool for the test 
+were in English, the subjects belonged to English medium 
+school with normal health status were included. Similarly, 
+subjects having any history of ill‑health and undergoing 
+any medication were excluded. They were in the age range 
+of 13-16 years (group average age, 14.37 ± 1.22 years) 
+in equal number of both genders [Table 1]. They were 
+explained about the details of the protocol, and the written 
+consent was obtained from their parents.
+Procedure
+The participants were given training for practice of both 
+CM and supine rest (SR) for 8 days. They were assessed 
+before and after equal period of both CM and SR. The 
+assessments were taken on two consecutive days, on day 
+9 and 10. It was self as control design. The subjects were 
+randomly assigned into two groups equally. The first group 
+performed CM on day 9 and SR on day 10, and the second 
+group with the order reversed. Subjects were tested on the 
+State‑Trait Anxiety Inventory (STAI) immediately before 
+and after a session of CM of 22:30 min’s duration on 1 day, 
+and immediately before and after an equal period of SR 
+on the other day.
+Instrument
+Anxiety assessment
+The state anxiety was measured using Spielberger’s STAI 
+consisted of 20 self‑report scales, with each scale running 
+from 1 to 4 for a full score of 80, to evaluate the general 
+tendency to be anxious as a personality trait. The reported 
+concurrent validity ranges from 0.75 to 0.80 with other 
+tests[22] and it was widely used earlier in Indian population.
+Intervention
+Subjects were instructed to keep their eyes closed 
+throughout the practice of both CM and SR. CM used 
+prerecorded instructions, which emphasized the need 
+to carry out the practice slowly, with awareness and 
+relaxation. Practice starts with subjects lying on their back 
+in the supine (Shavasana) and consists of the following 
+sequence:
+Chanting of a verse from the Mandukya Upanishad[1] 
+(0:40 min); isometric contraction of the muscles of the 
+body ending with SR (1:00 min); slowly getting up by 
+shifting the body to the left side and standing at ease 
+(Tadasana), “balancing” the weight on both feet, called 
+centering (2:00 min); The first standing lateral bending 
+posture, toward the right side (Ardhakaticakrasana) 
+(1:20 min); Tadasana (1:10 min) with instructions about 
+relaxation and awareness; Ardhakaticakrasana bending 
+toward the left side (1:20 min); Tadasana as previously 
+(1:10 min); forward bending (Padahastasana) (1:20 min); 
+Tadasana as previously (1:10 min); backward bending 
+(Ardhacakrasana) (1:20 min); slowly coming down into 
+the supine posture (Shavasana) with instructions to 
+relax different parts of the body in sequence (10:00 min). 
+All postures are practiced slowly, with instructions to be 
+aware of all felt sensations. Total duration of practice is 
+22:30 min.[2]
+During the session of SR, subjects were asked to lie on their 
+back in the corpse posture (Shavasana) with eyes closed, 
+legs apart and arms away from the sides of the body. This 
+practice was also given for 22:30 min, the same as for CM, 
+timed on a stopwatch.
+Data analysis
+Statistical analysis was performed using SPSS (Released 
+2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.). 
+The scores of STAI data were normally distributed (P > 0.05, 
+Shapiro–Wilk’s test). Hence, Student’s paired “t”‑test was 
+used for within group comparison for both CM and SR.
+RESULTS
+Mean values and standard deviation for STAI scores tests 
+are given in Table 2.
+Table  1: Age groups mean±SD, of male and female
+Age
+Mean±SD
+n
+Total
+14.37±1.22
+60
+Male
+14.47±1.14
+30
+Female
+14.27±1.31
+30
+SD=Standard deviation
+[Downloaded free from http://www.ijoyppp.org on Friday, July 29, 2016, IP: 14.139.155.82]
+Babu, et al.: Relaxation technique on anxiety in children
+67
+International Journal of Yoga - Philosophy, Psychology and Parapsychology  Vol. 1  Jul-Dec-2013
+Cyclic meditation session showed a significant reduction 
+in the STAI score from 38.90 to 37.24 (P = 0.016, paired 
+sample “t”‑test). The SR session showed a nonsignificant 
+reduction in the STAI score from 38.88 to 37.62 (P = 0.073, 
+paired sample “t”‑test). The two sessions showed no 
+significant difference in their baseline mean (P = 0.981, 
+independent “t”‑test) and also following CM and SR 
+sessions (P = 0.705, independent “t”‑test).
+• Female group: CM sessions showed a significant 
+reduction in the STAI score from 37.71 to 
+34.75 (P = 0.01, paired sample “t”‑test). The SR session 
+showed a significant reduction in the STAI score from 
+37.94 to 35.08 (P = 0.017, paired sample “t”‑test)
+• Male group: CM sessions showed a nonsignificant 
+reduction in the STAI score from 37.71 to 
+34.75 (P = 0.633, paired sample “t”‑test). The SR session 
+SR showed a nonsignificant reduction in the STAI score 
+from 37.94 to 35.08 (P = 0.620, paired sample “t”‑test).
+There was no significant gender difference of the mean 
+before sessions of CM (P = 0.301, Independent “t”‑test) 
+and SR (P = 0.451, Independent “t”‑test). However, there 
+were significant difference in the mean score after session 
+of CM (P = 0.047, Independent “t”‑test) and SR (P = 0.049, 
+Independent “t”‑test).
+The female group had significantly higher reduction 
+in STAI score as compared to male group in CM 
+(P = 0.049, Independent “t”‑test) and SR (P = 0.019, 
+Independent “t”‑test).
+DISCUSSION
+The present study showed a significant reduction in State 
+Anxiety Scores following CM session in the whole group 
+by 4.27% alone. Previous study in adult group with similar 
+design showed higher magnitude of changes. This may be 
+due to participants in the previous study who were highly 
+experienced and well‑trained in meditation, relaxation and 
+different yoga techniques. They were residential students 
+doing undergraduate and postgraduate yoga courses.[23] The 
+gender subgroup analysis found a significant reduction 
+in (CM = 7.85% and SR = 7.54%) compared with their 
+respective prescores.
+The meta‑analysis of efficacy of relaxation training 
+(Jacobson’s progressive relaxation, autogenic training, 
+applied relaxation, and meditation) for anxiety showed 
+medium effect size (Cohen’s d  =  0.57).[20] In another 
+study on natural stress relief, meditation reduced trait 
+anxiety after 1 and 2 weeks of practice (Cohen’s d = 0.46; 
+d = 0.67) respectively.[24] Whereas in the present study 
+found (Cohen’s d = 0.32 for the whole group and d = 0.5 
+for female group) immediately after CM, which showed 
+consistent findings with earlier studies. Hence, this 
+indicates that different relaxation strategies had a different 
+effect on anxiety levels.
+The key components of CM are slow, smooth, effortless 
+body movement with awareness and relaxation. The 
+relaxation component of CM occurs at the end of last 
+7 min, which may lead to lowering the sympathetic arousal 
+and anxiety scores. These characteristics of CM may be 
+contributing toward reducing the state of anxiety.
+Identical study on CM had shown an increase in 
+parasympathetic activity,[25] reduction in oxygen 
+consumption,[3] inhibit the cortical arousal.[5] These are the 
+physiological indicators of reduction of stress and anxiety.
+This is the first comparative study between genders on 
+CM. Until now all the CM study had been evaluated in 
+the adult well experienced male participants except one 
+study that included female subjects alone.[25] Apart from 
+this there were two studies on teenagers that included 
+both genders, but they were not mentioned about gender 
+comparison of their outcome measures.[6,7]
+The study had few limitations; participants were recruited 
+from yoga camp, which could be a confounding variable, 
+as the outcome variable might be influenced because 
+of the adherence toward yoga practices. It was a self as 
+control study design with convenient sampling, low 
+sample size, and short duration of training program 
+7 days. Hence, the result cannot be generalized. CM can 
+be used in educational programs for the school children’s 
+to reduce their anxiety level. Further, studies using CM as 
+an intervention could also be investigated on physiological 
+variable viz., EEG, EMG activity, and cortisol level and 
+hormonal activity.
+ACKNOWLEDGMENT
+Authors acknowledge the support of S‑VYASA Yoga University, 
+Bengaluru in carrying out this study.
+REFERENCES
+1.	
+Chinmayananda S. Mandukya Upanishad. Bombay, India: Sachin Publishers; 
+1984.
+Table  2: State anxiety inventory of CM and SR 
+(values  are group mean±SD)
+Gender n
+CM
+SR
+Pre
+Post
+Pre
+Post
+Total
+60 38.9±8.84 37.24±9.76*** 38.88±9.49
+37.62±10.02
+Male
+30 40.09±9.59
+39.73±9.6
+39.81±9.38
+40.15±9.36
+Female
+30 37.71±8.01 34.75±9.42**† 37.94±9.66 35.08±10.16***
+***P<0.05; **P<0.01 Student’s paired t‑test; postscores compared with 
+respective prescores, †P<0.05; Independent t‑test; postscore compared 
+with postscore between gender (male vs. female). SD=Standard deviation, 
+CM=Cyclic meditation, SR=Supine rest
+[Downloaded free from http://www.ijoyppp.org on Friday, July 29, 2016, IP: 14.139.155.82]
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+Nagendra HR, Nagarathna R. New Perspectives in Stress Management. 
+Bangalore, India: Swami Vivekananda Yoga Prakashan; 1997.
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+Subramanya P, Telles S. Performance on psychomotor tasks following two 
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+Subramanya P, Telles S. Changes in midlatency auditory evoked potentials 
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+Pradhan B, Nagendra H. Immediate effect of two yoga‑based relaxation 
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+Pradhan B, Nagendra HR. Effect of yoga relaxation techniques on performance 
+of digit‑letter substitution task by teenagers. Int J Yoga 2009;2:30‑4.
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+Gopal A, Mondal S, Gandhi A, Arora S, Bhattacharjee J. Effect of integrated 
+yoga practices on immune responses in examination stress‑A preliminary 
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+Mendelson T, Greenberg MT, Dariotis JK, Gould LF, Rhoades BL, Leaf PJ. 
+Feasibility and preliminary outcomes of a school‑based mindfulness 
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+Warnecke E, Quinn S, Ogden K, Towle N, Nelson MR. A randomised 
+controlled trial of the effects of mindfulness practice on medical student 
+stress levels. Med Educ 2011;45:381‑8.
+12.	 Malathi A, Damodaran A, Shah N, Krishnamurthy G, Namjoshi P, Ghodke S. 
+Psychophysiological changes at the time of examination in medical students 
+before and after the practice of yoga and relaxation. Indian J Psychiatry 
+1998;40:35‑40.
+13.	 Malathi A, Damodaran A. Stress due to exams in medical students – role of 
+yoga. Indian J Physiol Pharmacol 1999;43:218‑24.
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+health: A pilot study. Med Teach 2009;31:950‑2.
+15.	 Shankarapillai R, Nair MA, George R. The effect of yoga in stress reduction 
+for dental students performing their first periodontal surgery: A randomized 
+controlled study. Int J Yoga 2012;5:48‑51.
+16.	 Malinski VM, Todaro‑Franceschi V. Exploring co‑meditation as a means 
+of reducing anxiety and facilitating relaxation in a nursing school setting. 
+J Holist Nurs 2011;29:242‑8.
+17.	 Subramanian S, Elango T, Malligarjunan H, Kochupillai V, Dayalan H. 
+Role of sudarshan kriya and pranayam on lipid profile and blood cell 
+parameters during exam stress: A randomized controlled trial. Int J Yoga 
+2012;5:21‑7.
+18.	 Smith JA, Greer T, Sheets T, Watson S. Is there more to yoga than exercise? 
+Altern Ther Health Med 2011;17:22‑9.
+19.	 Kauts A, Sharma N. Effect of yoga on academic performance in relation to 
+stress. Int J Yoga 2009;2:39‑43.
+20.	 Manzoni GM, Pagnini F, Castelnuovo G, Molinari E. Relaxation training for 
+anxiety: A ten‑years systematic review with meta‑analysis. BMC Psychiatry 
+2008;8:41.
+21.	 Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical 
+power analysis program for the social, behavioral, and biomedical sciences. 
+Behav Res Methods 2007;39:175‑91.
+22.	 Spielberger C, Gorsuch R, Lushene R. Manual for the State‑Trait Anxiety 
+Inventory. Palo Alto, CA: Consulting Psychologists Press; 1970.
+23.	 Subramanya P, Telles S. Effect of two yoga‑based relaxation techniques on 
+memory scores and state anxiety. Biopsychosoc Med 2009;3:8.
+24.	 Coppola F. Effects of natural stress relief meditation on trait anxiety: A pilot 
+study. Psychol Rep 2007;101:130‑4.
+25.	 An H, Kulkarni R, Nagarathna R, Nagendra H. Measures of heart rate 
+variability in women following a meditation technique. Int J Yoga 
+2010;3:6‑9.
+How to cite this article: Babu N, Pradhana B, Nagendra HR. A 
+comparative study on two yogic relaxation techniques on anxiety in 
+school children. Int J Yoga - Philosop Psychol Parapsychol 2013;1:65-8.
+Source of Support: Nil, Conflict of Interest: None declared
+Babu, et al.: Relaxation technique on anxiety in children
+68
+International Journal of Yoga - Philosophy, Psychology and Parapsychology  Vol. 1  Jul-Dec-2013
+[Downloaded free from http://www.ijoyppp.org on Friday, July 29, 2016, IP: 14.139.155.82]

yogatexts/A Cross-National Survey on Health Perceptions and Adopted Lifestyle-Related Behavior during the COVID-19 Pandemic.txt

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+Original Paper
+Health Perceptions and Adopted Lifestyle Behaviors During the
+COVID-19 Pandemic: Cross-National Survey
+Nandi Krishnamurthy Manjunath1, PhD; Vijaya Majumdar1, PhD; Antonietta Rozzi2, MA; Wang Huiru3, PhD; Avinash
+Mishra4, PhD; Keishin Kimura5; Raghuram Nagarathna1, MD; Hongasandra Ramarao Nagendra1, PhD
+1Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, India
+2Sarva Yoga International, Sarzana SP, Italy
+3Shanghai Jiao Tong University, Shanghai, China
+4Vivekananda Yoga China, Shanghai, China
+5Japan Yoga Therapy Society, Yonago City, Japan
+Corresponding Author:
+Vijaya Majumdar, PhD
+Swami Vivekananda Yoga Anusandhana Samsthana University
+#19, Eknath Bhavan, Gavipuram Circle
+KG Naga
+Bengaluru, 560019
+India
+Phone: 91 08026995163
+Email: [email protected]
+Abstract
+Background: Social isolation measures are requisites to control viral spread during the COVID-19 pandemic. However, if these
+measures are implemented for a long period of time, they can result in adverse modification of people’s health perceptions and
+lifestyle behaviors.
+Objective: The aim of this cross-national survey was to address the lack of adequate real-time data on the public response to
+changes in lifestyle behavior during the crisis of the COVID-19 pandemic.
+Methods: A cross-national web-based survey was administered using Google Forms during the month of April 2020. The
+settings were China, Japan, Italy, and India. There were two primary outcomes: (1) response to the health scale, defined as
+perceived health status, a combined score of health-related survey items; and (2) adoption of healthy lifestyle choices, defined
+as the engagement of the respondent in any two of three healthy lifestyle choices (healthy eating habits, engagement in physical
+activity or exercise, and reduced substance use). Statistical associations were assessed with linear and logistic regression analyses.
+Results: We received 3371 responses; 1342 were from India (39.8%), 983 from China (29.2%), 669 from Italy (19.8%), and
+377 (11.2%) from Japan. A differential countrywise response was observed toward perceived health status; the highest scores
+were obtained for Indian respondents (9.43, SD 2.43), and the lowest were obtained for Japanese respondents (6.81, SD 3.44).
+Similarly, countrywise differences in the magnitude of the influence of perceptions on health status were observed; perception
+of interpersonal relationships was most pronounced in the comparatively old Italian and Japanese respondents (β=.68 and .60,
+respectively), and the fear response was most pronounced in Chinese respondents (β=.71). Overall, 78.4% of the respondents
+adopted at least two healthy lifestyle choices amid the COVID-19 pandemic. Unlike health status, the influence of perception of
+interpersonal relationships on the adoption of lifestyle choices was not unanimous, and it was absent in the Italian respondents
+(odds ratio 1.93, 95% CI 0.65-5.79). The influence of perceived health status was a significant predictor of lifestyle change across
+all the countries, most prominently by approximately 6-fold in China and Italy.
+Conclusions: The overall consistent positive influence of increased interpersonal relationships on health perceptions and adopted
+lifestyle behaviors during the pandemic is the key real-time finding of the survey. Favorable behavioral changes should be bolstered
+through regular virtual interpersonal interactions, particularly in countries with an overall middle-aged or older population. Further,
+controlling the fear response of the public through counseling could also help improve health perceptions and lifestyle behavior.
+However, the observed human behavior needs to be viewed within the purview of cultural disparities, self-perceptions, demographic
+variances, and the influence of countrywise phase variations of the pandemic. The observations derived from a short lockdown
+period are preliminary, and real insight could only be obtained from a longer follow-up.
+JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 1
+https://formative.jmir.org/2021/6/e23630
+(page number not for citation purposes)
+Manjunath et al
+JMIR FORMATIVE RESEARCH
+XSL•FO
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+(JMIR Form Res 2021;5(6):e23630) doi: 10.2196/23630
+KEYWORDS
+health behavior; self-report; cross-national survey; COVID-19; behavior; perception; lifestyle; nutrition; real-time
+Introduction
+The World Health Organization (WHO) declared the outbreak
+of COVID-19 a pandemic on March 11, 2020 [1]. As of March
+24, 2020, the most affected regions in the world were the
+Western Pacific region (China, the Republic of Korea, Japan,
+etc), with a total of 96,580 reported confirmed cases, and the
+European region (Italy, Spain, Germany, the United Kingdom,
+etc), which accounted for a total of 195,511 positive cases [2].
+There was a global panic due to the shifting of the COVID-19
+epicenters from China to Europe, mainly Italy, which reported
+the worst outcomes up to March 25, 2020 (69,176 reported cases
+and the maximum number of COVID-19 deaths of 6820) [2].
+Global disease outbreaks impact varied aspects of physical and
+mental health, even suicidality [3-5]. As observed in the
+infectious disease epidemic of severe acute respiratory syndrome
+(SARS) in 2003, exposure to new pathogens can manifest as a
+qualitatively distinct mental impact [6]. Social isolation
+measures 
+(large-scale 
+quarantines, 
+long-term 
+home
+confinements, and nationwide lockdowns) [7-11], although
+essential for controlling viral spread, go against the inherent
+human instinct of social relationships [12,13]. If these measures
+are implemented for a long duration, they can be detrimental
+to mental health, as observed in recent reports from China and
+Vietnam [14-17], and they are expected to result in modification
+of people’s lifestyle behaviors, such as increased adoption of
+unhealthy dietary habits and sedentary behavior. These changes
+can exacerbate the burden of the “pandemics” of behavioral and
+cardiovascular diseases that already prevail in modern societies
+[18,19]. The latest trends of re-emergences of such infectious
+disease outbreaks merit timely preparedness involving
+community engagement and focus on healthy lifestyle behaviors
+[20,21]. Although the mental impact of the COVID-19 pandemic
+is being addressed in a timely fashion [22,23], the associated
+real-time influences on people’s health perceptions and lifestyle
+choices remain underresearched [24,25]. Careful consideration
+of the demographic and cultural impact of tailored public health
+intervention strategies on human behavior is also greatly needed
+when designing such strategies. Here, we report the findings of
+a cross-national survey that aimed to generate rapid perspectives
+on the status of health-related perceptions and their influence
+on the likelihood of adoption of healthy lifestyle choices during
+the COVID-19 pandemic. The settings were China and Japan,
+two nations in the Western Pacific region that were greatly
+impacted by COVID-19; Italy, from the European region; and
+India, a highly populous South Asian country that was a
+potential threat region at the time of the survey [2,7-9,11].
+Methods
+Sampling and Data Collection
+Given the restricted mobility restrictions and confinement due
+to 
+the 
+COVID-19 
+lockdown, 
+we 
+conducted 
+a
+cross-sectional survey using a web-based platform. We
+disseminated the survey through the circulation of a Google
+Form via institutional websites and private social media
+networks, such as Facebook and WhatsApp. We also used the
+group email lists of a few social organizations, universities,
+academic institutions, and their interconnections to share the
+questionnaire links, which further facilitated the snowball
+sampling. The respondents were residents of China, Japan, Italy,
+and India who were aged 18 years or older. We anonymized
+the data to preserve and protect confidentiality. The study was
+approved by the institutional review boards and institutional
+ethics committees of the respective nations: Swami Vivekananda
+Yoga Anusandhana Samsthana (SVYASA), India; Sarva Yoga
+International, Italy; Shanghai Jiao Tong University, China; and
+Japan Yoga Therapy Society, Japan. Respondents were informed
+about the objectives of the survey and the anonymity of their
+responses. Informed consent was obtained through a declaration
+of the participants of their voluntary participation, the
+confidentiality of the data, and the use of the collected
+information for research purposes only. The survey period was
+April 3-28, 2020. Once submitted, the responses were directly
+used for the analysis, and revisions of the responses were not
+allowed.
+Questionnaire Structure
+We chose a short format for the questionnaire, with 19 questions
+to facilitate rapid administration. The first set of questions
+(Q1-Q5) were related to the respondents’ demographic details:
+age, gender, country of residence, working status, and the
+presence of any chronic illness or disability diagnosed by a
+physician. The next set (Q6-Q14) contained perception-related
+questions on self-rated physical and mental health, sleep quality,
+coping ability, energy status (a psychological state defined as
+an individual's potential to perform mental and physical activity
+[26,27]), coping flexibility, and perceptions related to
+interpersonal relationships as well as the fear of the pandemic.
+The questions were phrased as statements, with responses
+recorded on 3- or 5-point scales. For example, the respondents
+were requested to self-rate their mental and physical health
+status with the questions “How do you rate your physical health
+at present as” and “How do rate your mental health at present
+as” with answer modalities of (1) excellent, (2) very good, (3)
+good, (4) average, and (5) poor. These single-item self-health
+assessment questions are validated tools used in national surveys
+and epidemiological studies to assess health perceptions among
+individuals, strongly related to various morbidities, and
+mortality, and they have been validated across various ethnicities
+[28-33]. A further set of questions (Q15-Q19) focused on items
+related to the respondents’ recent lifestyle behavior choices:
+eating habits, engagement in physical activity or exercise, and
+substance use. Permitted responses for these behavior-related
+questions were either yes or no. For eating habits, the
+respondents provided self-rated scores for their time of eating;
+nourishment related to intake of vegetables and fibers; and daily
+JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 2
+https://formative.jmir.org/2021/6/e23630
+(page number not for citation purposes)
+Manjunath et al
+JMIR FORMATIVE RESEARCH
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+intake of “junk food” (described as packaged and processed
+sweets or salty snacks); the combined scores were dichotomized
+into “good” (score ≥3) and “poor” (score ≤2).
+Data Analysis
+An exploratory factor analysis using the principal axis factoring
+and varimax rotation suggested that three factors were present
+in the data. Items related to health perceptions were used to
+form a scale for perceived health status (the health scale); the
+scores were represented as mean (SD). For the remaining two
+factors, we could not form scales, as they scored Cronbach α
+values <.6; instead, we used the most relevant single item to
+represent the factor. The two primary outcomes of the study
+were the health scale and the adoption of healthy lifestyle
+choices. The health scale was derived as mentioned above;
+further health scale scores were categorized based on tertile
+distribution into low (poor), middle (average), and high (good)
+scores. Adoption of healthy lifestyle choices was defined as the
+engagement of the respondent in any two of three healthy
+lifestyle choices (eating habits, substance use, and exercise).
+Multivariate linear and logistic regression analyses were used
+to test the influence of the perceptions and the personal variables
+on the primary outcomes. Most of the items in the survey were
+recorded as 3-point responses. Hence, to achieve homogeneity
+in the analyses of the survey items, the 5-point Likert responses
+of the self-rated health items, excellent, very good, good,
+average, and poor, were collapsed into three categories: (1) very
+good/excellent, (2) good, and (3) average/poor. Analysis of
+variance was used to assess comparisons between continuous
+variables, and P<.05 was considered significant. Chi-square
+analysis was used for cross-country comparisons for categorical
+variables.
+Results
+The aim of this survey was to understand the cross-national
+psychosocial and behavioral impact of the lockdowns and social
+isolations imposed due to the COVID-19 pandemic. We received
+3370 responses: 1342 from India (39.8%), 983 from China
+(29.2%), 669 from Italy (19.8%), and 377 from Japan (11.2%).
+The demographic profiles of the respondents are presented in
+Table 1.
+Table 1. Countrywise representation of the personal characteristics of the survey participants.
+P valuea
+Italy (n=669)
+Japan (n=377)
+China (n=983)
+India (n=1342)
+Overall (N=3371)
+Variable
+<.001
+48.43 (13.65)
+53.49 (9.35)
+29.77 (11.98)
+29.42 (12.29)
+36.04 (15.54)
+Age (years), mean (SD)
+<.001
+Age group (years), n (%)
+31 (4.7)
+1 (0.3)
+490 (49.8)
+685 (51.0)
+1200 (35.6)
+18-24
+84 (12.5)
+4 (1.1)
+152 (15.5)
+267 (19.9)
+503 (14.9)
+25-34
+309 (46.2)
+217 (57.5)
+314 (32.0)
+330 (24.6)
+1176 (34.9)
+35-54
+169 (25.2)
+98 (26.0)
+21 (2.1)
+40 (3.0)
+330 (9.8)
+55-64
+76 (11.4)
+57 (15.1)
+6 (0.6)
+20 (1.5)
+162 (4.8)
+>65
+<.001
+506 (75.6)
+348 (92.0)
+802 (81.6)
+880 (65.6)
+2535 (75.2)
+Female gender, n (%)
+<.001
+395 (59.0)
+335 (89.0)
+406 (41.3)
+582 (43.4)
+1709 (50.7)
+Working, n (%)
+<.001
+314 (46.9)
+151 (40.0)
+84 (8.5)
+169 (12.6)
+647 (19.2)
+Has a chronic illness, n (%)
+aCross-country comparisons for categorical variables were conducted using chi-square analysis. Analysis of variance was conducted to assess comparisons
+among the continuous variable of age. A P value <.05 was considered significant.
+The mean age of the respondents was 36.04 years (SD 15.54)
+(Table 1); the average age of the Indian and Chinese respondents
+(29.42 years, SD 12.29, and 29.77 years, SD 11.98, respectively)
+was lower than that of the Japanese and Italian respondents
+(53.49 years, SD 9.35, and 48.43 years, SD 3.65, respectively).
+Overall, there was a higher representation of the female gender
+(2535/3371, 75.2%). Japan had the highest representation of
+women (348/377, 92.0%) and working people (335/377, 89.0%)
+(Table 1). Italy and Japan had the highest representations of
+respondents with a known status of chronic illness (314/669,
+46.9%, and 151/377, 40.0%, respectively).
+Table 2 shows the countrywise status of the perceptions of health
+and psychosocial factors reported in response to the ongoing
+outbreak of COVID-19. The health status score was highest for
+Indian respondents (9.43, SD 2.43) and lowest for Japanese
+respondents (6.81, SD 3.44). Overall, 846/3371 (25.1%) of the
+respondents had good health status; Japanese and Chinese
+respondents had the highest representation of low health status
+(236/377, 62.6%, and 562/983, 57.2%, respectively). Sleep
+quality was perceived well by the majority of Indians (917/1342,
+68.3%), and the majority of Japanese and Chinese respondents
+perceived their sleep quality as average/poor (264/377, 70%,
+and 554/983, 56.3%, respectively). Italian respondents had
+almost equal representations of good and average sleep qualities.
+Coping abilities during social isolation were perceived as good
+by 1264/3371 (37.5%) of the overall population, with the
+countrywise trend of India (672/1342, 50.1%) > Italy (283/669,
+42.3%) > Japan (131/377, 34.8%) > China (178/983, 18.1%).
+Fear response was almost equally distributed in positive or
+intermediate categories for most of the country respondents,
+except for Italians, among whom the intermediate or partial fear
+response was the most evident (469/669, 70.1%). Coping
+flexibility responses were very similar across all the countries
+except Japan, wherein the majority of respondents (317/377,
+84.1%) reported experiencing little challenging response to
+JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 3
+https://formative.jmir.org/2021/6/e23630
+(page number not for citation purposes)
+Manjunath et al
+JMIR FORMATIVE RESEARCH
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+sudden changes in living norms. Responses to interpersonal
+relationships followed the trend of India (733/1342, 54.6%) >
+Japan (183/377, 48.5%) > Italy (287/669, 42.9%) > China
+(337/983, 34.3%). Adopted lifestyle behavior yielded the trend
+of India (1129/1342, 83.9%) > Italy (361/669, 54.0%) > China
+(436/983, 44.4%) > Japan (137/377, 36.2%).
+Based on the regression analysis on the perceived health status,
+female respondents had a 0.14 lower score compared to male
+respondents (Table 3). Participants with a positive history of
+chronic illness and those who were not working also had lower
+health status scores, by 0.11 and 0.04, respectively, compared
+to their counterparts. Increased personal relationships and
+positive fear response were associated with increases in health
+status across all the countries, particularly Japan, which showed
+the highest value of β (.60). For Indian respondents, an increase
+in age was significantly associated with increase in health status
+by a score of 0.12.
+Increased interpersonal relationships was a significant predictor
+of adoption of health lifestyle choices across the respondents
+in all the countries except for Italy (adjusted OR 1.93, 95% CI
+0.65-5.79) (Table 4). Positive perception of fear was
+significantly associated with likelihood of adoption of healthy
+lifestyle choices only in Indian respondents (adjusted OR 2.41,
+95% CI 1.18-4.96). Perceived health status categories were
+significantly associated with the likelihood of adoption of
+healthy lifestyle choices across all the countries; most
+prominently, high health status increased adoption of healthy
+lifestyle choices by approximately 6-fold in China and Italy.
+JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 4
+https://formative.jmir.org/2021/6/e23630
+(page number not for citation purposes)
+Manjunath et al
+JMIR FORMATIVE RESEARCH
+XSL•FO
+RenderX
+Table 2. Countrywise representation of perceptions and behavioral changes among the survey respondents related to the COVID-19 outbreak.
+P valuea
+Italy (n=669)
+Japan (n=377)
+China (n=983)
+India (n=1342)
+Overall
+(N=3371)
+Perception or behavior and response
+First factorb
+.01
+8.43 (2.56)
+6.81 (3.44)
+7.09 ( 2.92)
+9.43 (2.43)
+8.26 (3.36)
+Health status, mean (SD)
+150 (22.4)
+69 (18.3)
+71 (7.2)
+556 (41.4)
+846 (25.1)
+High, n (%)
+Medium, n (%)
+225 (33.6)
+72 (19.1)
+350 (35.6)
+413 (30.8)
+1062 (31.5)
+294 (43.9)
+236 (62.6)
+562 (57.2)
+413 (30.8)
+1463 (43.4)
+Low, n (%)
+<.001
+Self-rated physical health, n (%)
+173 (25.9)
+88 (23.3)
+467 (47.5)
+629 (46.9)
+1357 (40.2)
+Excellent/very good
+375 (56.0)
+135 (35.8)
+200 (20.3)
+573 (42.7)
+1283 (38.1)
+Good
+121 (18.1)
+154 (40.8)
+316 (32.1)
+140 (10.4)
+731 (21.7)
+Poor/average
+<.001
+Self-rated mental health, n (%)
+206 (30.8)
+93 (24.7)
+0 (0)
+645 (48.1)
+944 (28.0)
+Excellent/very good
+371 (55.4)
+122 (32.4)
+642 (65.3)
+535 (39.9)
+1670
+(49.5)
+Good
+92 (13.8)
+162 (43.0)
+341 (34.7)
+162 (12.1)
+757 (22.5)
+Poor/average
+<.001
+Self-rated sleep quality, n (%)
+328 (49.0)
+113 (29.9)
+429 (43.6)
+917 (68.3)
+1787 (53.0)
+Good
+240 (35.9)
+234 (62.1)
+477 (48.5)
+354 (26.4)
+1305
+(38.7)
+Average
+101 (15.1)
+30 (8.0)
+77 (7.8)
+71 (5.3)
+279
+(8.3)
+Poor
+<.001
+Self-rated coping abilities, n (%)
+283 (42.3)
+131 (34.8)
+178 (18.1)
+672 (50.1)
+1264 (37.5)
+Good
+298 (44.5)
+139 (36.8)
+516 (52.5)
+539 (40.1)
+1492 (44.3)
+Average
+88 (13.2)
+107 (28.5)
+289 (29.4)
+131 (9.8)
+615 (18.2)
+Poor
+Second factor , n (%)
+<.001
+Fear/anxiety related to COVID-19c
+125 (18.7)
+157 (41.6)
+470 (47.8)
+628 (46.8)
+1380 (40.9)
+Not at all (positive)
+469 (70.1)
+213 (56.5)
+485 (49.3)
+662 (49.3)
+1829 (54.3)
+Partially (intermediate)
+75 (11.2)
+7 (1.9)
+28 (2.8)
+52 (3.9)
+162 (4.8)
+Extremely (negative)
+<.001
+Self-perception of low energy
+261 (39.0)
+239 (63.4)
+282 (28.7)
+667 (49.7)
+1449 (43.0)
+Never
+390 (58.3)
+132 (35.0)
+672 (68.4)
+641 (47.8)
+1835 (54.5)
+Sometimes
+18 (2.7)
+6 (1.6)
+29 (3.0)
+34 (2.5)
+87 (2.6)
+All the time
+<.001
+Challenging response to sudden changes in living norms (coping flexibility)
+144 (21.5)
+44 (11.7)
+221 (22.5)
+436 (32.5)
+845 (25.1)
+Least/not at all/little
+309 (46.2)
+317 (84.1)
+411 (41.8)
+417 (31.1)
+1454 (43.1)
+Little
+216 (32.3)
+16 (4.2)
+351 (35.7)
+489 (36.4)
+1072 (31.8)
+Extremely/somewhat
+Third factor, n (%)
+<.001
+Interpersonal relationshipsc
+287 (42.9)
+183 (48.5)
+337 (34.3)
+733 (54.6)
+1540 (45.7)
+Increased
+310 (46.3)
+179 (47.5)
+550 (56.0)
+533 (39.7)
+1572 (46.6)
+Not changed
+JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 5
+https://formative.jmir.org/2021/6/e23630
+(page number not for citation purposes)
+Manjunath et al
+JMIR FORMATIVE RESEARCH
+XSL•FO
+RenderX
+P valuea
+Italy (n=669)
+Japan (n=377)
+China (n=983)
+India (n=1342)
+Overall
+(N=3371)
+Perception or behavior and response
+72 (10.8)
+15 (4.0)
+96 (9.8)
+76 (5.7)
+259 (7.7)
+Reduced
+<.001
+Motivating influence of COVID-19 on lifestyle
+221 (33.0)
+132 (35.0)
+217 (22.1)
+605 (45.1)
+1175 (34.8)
+Completely
+360 (53.8)
+223 (59.2)
+695 (70.7)
+641 (47.8)
+1919 (57.0)
+Partially
+88 (13.2)
+22 (5.8)
+71 (7.2)
+96 (7.1)
+277 (8.2)
+Not at all
+<.001
+485 (72.5)
+283 (75.1)
+750 (76.3)
+1126 (83.9)
+2643 (78.4)
+Adoption of ≥2 healthy lifestyle choices
+<.001
+361 (54.0)
+137 (36.3)
+436 (44.4)
+867 (64.6)
+1801 (53.4)
+Adoption of healthy eating behavior
+<.001
+623 (93.1)
+355 (94.1)
+918 (93.4)
+1277 (95.2)
+3173 (94.1)
+Decreased dependency on and use
+of tobacco, alcohol, or any other
+substances
+<.001
+426 (63.7)
+272 (72.1)
+672 (68.4)
+910 (67.8)
+2280 (67.6)
+Increased engagement in exercise
+or similar activities
+aCross-country comparisons for categorical variables were conducted using chi-square analysis; all the P values were significant.
+bAn exploratory factor analysis using principal axis factoring and varimax rotation suggested that there were 3 factors present in the data. The first
+factor consisted of health-related perceptions; composite scores for perceived health were generated as summative scores of the included items.
+cFor the remaining 2 factors, scales could not be formed; rather, the single items that were thought to best summarize the respective factors were
+considered for further association analyses.
+Table 3.  Multivariate linear regression analysis (β coefficients, standard errors, and t and P values) of the association between health status, personal
+variables, and perceptions.
+Italy
+Japan
+China
+India
+Overall
+Predic-
+tors
+P
+t
+SE
+β
+P
+t
+SE
+β
+P
+t
+SE
+β
+P
+t
+SE
+β
+P
+t
+SE
+β
+Demographic variables
+.51
+–0.66
+0.02
+–.07
+0.12
+1.55
+0.02
+.08
+.07
+1.79
+0.01
+.07
+<.001
+3.74
+0.01
+.12
+<.001
+5.12
+0.01
+.14
+Age
+Gender (reference: male)
+.97
+–0.03
+0.52
+<.001
+0.77
+–0.30
+0.64
+.01
+.72
+–0.35
+0.23
+–.01
+<.001
+–3.24
+0.14
+–.09
+<.001
+–7.51
+0.12
+–.14
+Fe-
+male
+Working status (reference: working)
+.72
+–0.36
+0.55
+–.03
+0.48
+–0.71
+0.56
+–.04
+.59
+–0.54
+0.23
+–.02
+.75
+–0.32
+0.15
+–.01
+.04
+–2.04
+0.13
+–.04
+Not
+work-
+ing
+Chronic illness (reference: no)
+.34
+–0.96
+0.47
+–.09
+0.01
+–2.81
+0.35
+–.14
+.04
+–2.04
+0.31
+–.06
+<.001
+–6.12
+0.20
+–.16
+<.001
+–5.63
+0.15
+–.11
+Yes
+Perceptions
+Interpersonal relationships (reference: decreased)
+.03
+2.17
+0.68
+.27
+<.001
+4.86
+0.85
+.60
+<.001
+4.12
+0.31
+.21
+<.001
+6.48
+0.28
+.38
+<.001
+10.76
+0.21
+.37
+In-
+creased
+.12
+1.56
+0.66
+019
+0.01
+2.66
+0.84
+.33
+.28
+1.08
+0.29
+.05
+<.001
+3.71
+0.29
+.21
+<.001
+4.15
+0.21
+.14
+No
+change
+Fear response (reference: poor)
+<.001
+3.03
+1.02
+.50
+0.01
+2.72
+1.38
+.54
+<.001
+8.02
+0.52
+.71
+<.001
+8.69
+0.33
+.59
+<.001
+10.84
+0.30
+.54
+Posi-
+tive
+.08
+1.77
+0.97
+.30
+0.20
+1.30
+1.37
+.26
+<.001
+4.35
+0.51
+.38
+<.001
+5.22
+0.33
+.35
+<.001
+5.82
+0.30
+.29
+Fair
+JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 6
+https://formative.jmir.org/2021/6/e23630
+(page number not for citation purposes)
+Manjunath et al
+JMIR FORMATIVE RESEARCH
+XSL•FO
+RenderX
+Table 4. Role of perceptions in the adoption of healthy lifestyle choices.
+Italy
+Japan
+China
+India
+Overall
+Perception
+Adjusted OR
+(95% CI)
+OR
+(95% CI)
+Adjusted OR
+(95% CI)
+OR
+(95% CI)
+Adjusted OR
+(95% CI)
+OR
+(95% CI)
+Adjusted OR
+(95% CI)
+OR
+(95% CI)
+AdjustedbOR
+(95% CI)
+ORa
+(95% CI)
+Health status (reference: low)
+6.22
+(1.90- 20.40)
+3.33
+(2.01-
+5.51)
+2.83
+(1.18-6.77)
+3.64
+(1.59-
+8.37)
+5.83
+(2.30-4.79)
+6.02
+(2.38-
+15.20)
+2.62
+(1.75-3.92)
+2.98
+(2.07-
+4.28)
+3.42
+(2.51-4.64)
+3.67
+(2.87-
+4.68)
+High
+2.46
+(1.03-5.83)
+2.10
+(1.42-
+3.12)
+1.06
+(0.54-2.08)
+1.33
+(0.72-
+2.45)
+2.43
+(1.72-3.45)
+2.61
+(1.85-
+3.69)
+1.57
+(1.07-2.31)
+1.76
+(1.24-
+2.50)
+2.00
+(1.59-2.50)
+2.09
+(1.72-
+2.54)
+Medium
+Interpersonal relationshipsc (reference: decreased)
+1.93
+(0.65-5.79)
+1.86
+(1.07-
+3.22)
+5.25
+(1.46-8.92)
+4.43
+(1.49-
+13.15)
+1.77
+(1.03-3.05)
+2.01
+(1.18-
+3.41)
+2.16
+(1.15-4.08)
+1.86
+(1.03-
+3.37)
+2.42
+(1.70-3.45)
+2.21
+(1.64-
+2.98)
+In-
+creased
+1.40
+(0.50-3.96)
+1.59
+(0.93-
+2.73)
+1.88
+(0.54-6.52)
+1.87
+(0.65-
+5.42)
+0.99
+(0.61-1.62)
+1.03
+(0.64-
+1.68)
+1.18
+(0.63-2.21)
+1.09
+(0.60-
+1.97)
+1.18
+(0.84-1.66)
+1.25
+(0.94-1.7)
+Not
+changed
+Fear responsec (reference: poor)
+2.20
+(0.41-11.71)
+1.62
+(0.86-
+3.04)
+4.85
+(0.73-32.19)
+1.84
+(0.34-
+9.99)
+2.18
+(0.96-4.94)
+2.38
+(1.06-
+5.33)
+2.41
+(1.18-4.96)
+2.72
+(1.38-
+5.36)
+2.50
+(1.54-4.05)
+2.43
+(1.69-
+3.50)
+Positive
+1.25
+(0.27-5.80)
+1.34
+(0.80-
+2.27)
+1.97
+(0.31-12.55)
+0.93
+(0.18-
+4.93)
+1.32
+(0.59-2.96)
+1.46
+(0.66-
+3.23)
+1.32
+(0.65-2.65)
+1.37
+(0.71-
+2.65)
+1.33
+(0.83-2.14)
+1.36
+(0.95-
+1.93)
+Fair
+aOR: odds ratio.
+bAdjusted for sex, age, work status, and history of chronic illness.
+cFactor represented by a single item that was thought to best represent the underlying notion.
+Discussion
+The aims of this short cross-national behavioral survey study
+were to generate rapid ideas regarding perspectives on health
+and lifestyle behavior and to provide initial insights into
+designing global but culturally tailored public health policies.
+Health Perceptions: Countrywise Status
+A differential countrywise response was observed toward
+perceived health status across the survey participants; Indians
+had a better representation of high health status (41.4%)
+compared to respondents from other countries (China, 7.2%,
+Japan, 18.2%, and Italy, 22.5%). Despite the inconsistencies in
+health perceptions, there was a consistent influence of social
+support measured by perceptions of interpersonal relationships
+and fear of perceived health status. However, there were
+countrywise differences in the magnitude of the impact of
+perceptions on health status; perception of interpersonal
+relationships was most pronounced in the comparatively older
+Italian and Japanese respondents (β=.68 and .60, respectively)
+and that of fear in the Chinese respondents (β=.71). These
+findings favor the implementation of regularized virtual
+interpersonal interactions toward combating the adverse health
+impact of the pandemic, particularly in countries with a higher
+proportion of older people [34]. Controlling the fear response
+through counseling would also aid the improvement of health
+outcomes in populations affected by pandemics. The findings
+of this survey related to the influence of gender on health
+perceptions (the health status score of female respondents was
+lower by 0.14 units compared to that of male respondents) are
+in line with the global trend of poorer health perception in
+women than in their male counterparts [35]. These real-time
+findings observed during the pandemic also relate with reports
+documented before the COVID-19 pandemic, with a generally
+higher prevalence of adverse mental health symptoms in women
+compared to men [36]. Overall, there seemed to be a differential
+influence of demographic variables on health perceptions across
+the global population during the pandemic.
+The comparatively high scores of the perceived health status in
+Indian respondents could be underlined by an early phase of
+the pandemic with slower progression in India during the survey
+period [11]. The younger age of the Indian respondents (mean
+age 29.42 years, SD 12.29) seemed to further facilitate
+interpersonal relationships (54.6%) during the lockdown, which
+also explains their better health status (β=.38) [34,37]. Younger
+age identity has been associated with well-being and better
+perceptions of health [38]. However, in this survey, an
+unexpectedly positive linear relationship was observed between
+increasing age and better perception of health status (β=.12) in
+young Indian respondents. This finding can be attributed to the
+JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 7
+https://formative.jmir.org/2021/6/e23630
+(page number not for citation purposes)
+Manjunath et al
+JMIR FORMATIVE RESEARCH
+XSL•FO
+RenderX
+compounding effect of the COVID-19 pandemic on already
+existing emotional distress among young adults (related to their
+examinations, uncertainties, social relationships, etc) [39].
+Unfortunately, in line with previous reports [14,15], we could
+also observe a continued/posttraumatic impact of the pandemic
+in Chinese respondents, reflected in their comparatively low
+perception of health status (poor health status was reported by
+57.2% of these respondents). We believe the poor health
+perceptions in the Chinese respondents is due to the underlying
+influence of fear perceptions (β=.71). Further, since the country
+had successfully emerged from the first wave of the pandemic
+during the survey, and social norms had also almost returned
+to normal, with fewer imposed lockdowns, the moderate increase
+in interpersonal relationships (34.3%) may not be sufficient to
+facilitate health status.
+The observed low status of perceived health in the Japanese
+respondents (low health status, 62.6%) is in accord with a health
+paradox in that country, which is a tendency to perceive health
+poorly despite the advanced economy [40,41]. Although this
+influence is not direct, an indirect influence of the comparatively
+old, middle-aged demographic profile of the Japanese
+respondents along with the mediatory impact of chronic diseases
+on health status (β=–.14) could also underlie the lower health
+perceptions of the Japanese respondents [42]. The perception
+of poor sleep quality in the Japanese respondents also needs
+attention, as this finding is in line with reports of the suicidal
+tendencies in this country [43].
+On a positive note, amid the aggravated pandemic at the time
+of the survey, the majority of the Italian respondents who were
+middle-aged perceived only partial fear of the pandemic (70.1%
+response), and they reported better health perceptions (health
+status score 8.43, SD 2.56) than Japanese respondents (health
+status score 6.81, SD 3.44) and Chinese respondents (health
+status score 7.09, SD 2.92). Approximately 55% of the responses
+for self-rated physical and mental health were in the
+moderate/fair tier, which is in accord with the reported tendency
+of Italian people toward intermediate categories of health
+perception [44]. The lack of negative influence of middle age
+and chronic illness on health perception can be attributed to the
+highly efficient medical care and adequate access to social
+support provided in Italy during the lockdown (improved
+interpersonal relationships were reported by 42.9% of Italian
+respondents).
+Role of Perceptions in the Adoption of Lifestyle
+Choices: Countrywise Comparisons
+Despite the imposed social isolation and home confinement and
+the prevailing fear during the COVID-19 pandemic, we observed
+a positive behavioral response toward lifestyle. Overall, 78.4%
+of the respondents adopted at least 2 healthy lifestyle choices
+during the COVID-19 pandemic. The majority of the
+respondents (67.6%) reported increased engagement in physical
+activity or exercise as opposed to the expected sedentary
+behavior due to home confinement. This favorable although
+unexpected outcome can be attributed to the timely release of
+the advisory recommendations made by various global and
+government agencies, including the WHO, on home-based or
+other easy‐to‐perform exercises under physical restrictions
+[45,46]. One of the crucial affirmative responses observed in
+this survey was the overwhelming response toward substance
+use (94.1%), which is more justifiable by lack of availability
+[47] than motivational influence. Along similar lines, in a recent
+survey on the immediate response to COVID-19, a 3% reduction
+in smoking was reported in Italians, which was attributed to the
+fear of increased risk of respiratory distress or mortality [48].
+To this end, we suggest the implementation of internet-based
+and cost-effective behavioral therapies, particularly cognitive
+behavioral therapy, which may aid the successful alleviation of
+maladaptive coping tendencies, thereby reducing the risk of
+future health catastrophes in the post–COVID-19 era [49,50].
+Social connectedness is an important dimension that controls
+population health and healthy lifestyle behavior [51]. In this
+cross-national survey, perception of increased social support
+and capital, manifested through enhanced interactions among
+close friends and family members (measured as interpersonal
+relationships in the survey), seemed to fill the void of missing
+social connectedness and encouraged the adoption of healthy
+lifestyle choices (adjusted OR 2.42, 95% CI 1.70-3.45). The
+substantial representation of the adoption of healthy lifestyle
+choices in Chinese and Japanese respondents (~75%),
+irrespective of their overall poor health perceptions, could be
+related to reverse causality. In the Japanese respondents (who
+had an older, middle-aged demographic profile), their working
+status (OR 4.37, 95% CI 1.19-16.02) (Table S1, Multimedia
+Appendix 1) and interpersonal relationships (OR for the
+adoption of healthy lifestyle choices 5.25, 95% CI 1.46-18.92)
+also seemed to contribute significantly to the adoption of healthy
+lifestyle behavior.
+The influence of interpersonal relationships on the adoption of
+healthy lifestyle choices was not consistent across different
+countries and was absent in the Italian respondents. However,
+this finding aligns with the previously reported relationship
+between a healthy lifestyle and self-perceived health in the
+European population [52]. Perception of good health was a
+prominent predictor of adoption of a healthy lifestyle (adjusted
+OR 6.22, 95% CI 1.90-20.40) in the middle-aged Italian
+respondents, with a 36.6% proportion of older individuals (>55
+years). Even intermediate scores of health perceptions (health
+status) also significantly predicted the likelihood of the adoption
+of healthy lifestyle choices (OR 2.43, 95% CI 1.72-3.45) in the
+Chinese respondents compared to the respondents from other
+countries, explained by their demographic characteristic of
+younger age. These countrywise differential cultural influences
+of perceptions on health and health behaviors during pandemics
+indicate that endorsement of the same, such as family support
+and togetherness, should consider existing disparities, especially
+for western countries [13].
+The findings of this report, particularly those regarding varied
+health perceptions and their differential influence on the
+likelihood of adopting healthy lifestyle choices, should be
+considered within the purview of the survey period with
+countrywise phase variations of the pandemic. Chinese
+respondents displayed the continued impact of the pandemic,
+as they had already witnessed one phase of the pandemic [2].
+Younger Indian respondents scored better for their health- and
+behavior-related perceptions due to the stable and early phase
+JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 8
+https://formative.jmir.org/2021/6/e23630
+(page number not for citation purposes)
+Manjunath et al
+JMIR FORMATIVE RESEARCH
+XSL•FO
+RenderX
+of the pandemic (as of April 22, there was a comparatively
+steady expansion of COVID-19 cases in India compared to other
+countries, with 18,985 confirmed cases [11]). However, the
+responses of Japanese and Italian respondents related to their
+older age; these countries were also witnessing rising waves of
+COVID-19 at the time of the survey [7,53]. Japan was under
+an extended state of national emergency, as the number of
+“untraceable” cases was soaring [7]. Italy was also under an
+extended period of lockdown and was one of the hardest-hit
+nations, with an apparent mortality rate of approximately 13%
+[53,54].
+The observed predominantly female participation in the survey
+indicates a lack of stringent sampling but also highlights the
+active involvement of women, who are considered to be at high
+risk of socioeconomic vulnerability toward disease outbreaks
+such as the COVID-19 pandemic. The positive response for
+self-care in women is also a sign of improving gender equity
+toward health awareness. The observed overwhelmingly female
+participation level (75.2%) could not be ascribed to the gender
+representation of countries such as India and China [55] but
+could be ascribed to the high readiness of the female population
+to interactively use the internet, in particular to research
+health-related information and programs, as observed in recent
+reports [56-58].
+The study is limited by the lack of inclusion of perceptions of
+preventive behaviors and did not compare the respondents’
+views on precautionary measures, such as the use of face masks
+[59]. In a recent cross-country comparison between Polish and
+Chinese respondents, higher use of face masks in Chinese
+respondents (Polish respondents, 35.0%; Chinese respondents,
+96.8%; P<.001) was found to be associated with better physical
+and mental impact of the COVID-19 pandemic [59]. Further,
+the observations of the adopted lifestyle choices presented here
+are derived from a short lockdown period during the COVID-19
+pandemic and are preliminary, influenced mostly by
+self-perception; demographic and cultural differences and
+realistic insight could only be obtained from a longer follow-up.
+Due to the self-reported nature of the observations, positive
+behavioral responses toward lifestyle are likely to be inflated.
+Good perceived health was associated with improved
+interpersonal relationships. Older respondents were least likely
+to report a positive relationship change, as observed in the
+responses of Italian and Japanese survey participants. However,
+there was a strong influence of improved interpersonal
+relationships on perceived health as well as adoption of healthy
+lifestyle choices in Japanese respondents. These findings
+indicate the potential of regularized virtual interpersonal
+interactions to attenuate the adverse psychosocial impact of
+such pandemics.
+In conclusion, the key finding of the survey is that the consistent
+positive influence of increased interpersonal relationships and
+good perceptions of health were found to have a significant
+influence on adopted lifestyle behaviors during the adverse time
+course of the COVID-19 pandemic. These favorable behavioral
+perceptions should be bolstered through enhanced health
+awareness, and regularized virtual interpersonal interactions,
+particularly in countries with an overall middle-aged or older
+population. Simultaneously, controlling the fear response
+through counseling would also help improve health outcomes
+in nations affected by pandemics. However, the observed human
+behavior has cultural influences, and it may not be globally
+generalizable.
+Data Availability Statement
+The data that support the findings of this study are available on
+request from the corresponding author.
+Acknowledgments
+The authors gratefully acknowledge the contributions of Dr Ravi Kulkarni and Dr Kousthubha for facilitating the data processing
+and providing technical support for preparing Google Forms, etc. There was no funding source for this study.
+Authors' Contributions
+MNK conceptualized the survey, performed the literature search, collected data from public sources, and contributed to the
+manuscript writing. VM wrote the manuscript and performed the literature search and statistical analyses. NR conceptualized the
+study and revised the manuscript. HR reviewed the manuscript. MNK and VM finalized the manuscript. The corresponding author
+had full access to all the data in the study and had final responsibility for the decision to submit for publication.
+Conflicts of Interest
+None declared.
+Multimedia Appendix 1
+Supplementary table.
+[DOCX File , 20 KB-Multimedia Appendix 1]
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+Abbreviations
+SARS: severe acute respiratory syndrome
+SVYASA: Swami Vivekananda Yoga Anusandhana Samsthana
+WHO: World Health Organization
+Edited by G Eysenbach; submitted 18.08.20; peer-reviewed by P Mathur, R Ho, A Videira-Silva; comments to author 26.10.20; revised
+version received 03.12.20; accepted 11.04.21; published 01.06.21
+Please cite as:
+Manjunath NK, Majumdar V, Rozzi A, Huiru W, Mishra A, Kimura K, Nagarathna R, Nagendra HR
+Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic: Cross-National Survey
+JMIR Form Res 2021;5(6):e23630
+URL: https://formative.jmir.org/2021/6/e23630
+doi: 10.2196/23630
+PMID: 33900928
+©Nandi Krishnamurthy Manjunath, Vijaya Majumdar, Antonietta Rozzi, Wang Huiru, Avinash Mishra, Keishin Kimura, Raghuram
+Nagarathna, Hongasandra Ramarao Nagendra. Originally published in JMIR Formative Research (https://formative.jmir.org),
+01.06.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License
+(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
+provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information,
+a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.
+JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 12
+https://formative.jmir.org/2021/6/e23630
+(page number not for citation purposes)
+Manjunath et al
+JMIR FORMATIVE RESEARCH
+XSL•FO
+RenderX

yogatexts/A Effect of Cyclic Meditation on Consciousness Field as Measured by REG.txt

@@ -0,0 +1,1227 @@
+                 
+16 
+ 
+ 
+A Effect of Cyclic Meditation on Consciousness Field as 
+Measured by REG 
+Ghanshyam Singh Thakur and Nagendra HR*. 
+Department Swami Vivekananda Yoga Research Foundation, Bangalore India. 
+[email protected] 
+ABSTRACT 
+Field REG trials monitoring major events as Millennium change have recorded significant influences on global 
+consciousness fields as measured by "EGGS" installed in different parts of the world. The emotional outburst of persons 
+all over the world on Princess Diana's death showed highly significant changes in the field REG global measures. Earlier 
+studies on Cyclic Meditation (CM) and supine rest performed by individuals have shown no influence on the 
+surrounding consciousness fields. The present study was directed to examine whether CM known to induce very deep 
+rest ( equivalent to about 2 to 3 times more rest than 6 hours of good sleep)  performed together in a group can bring 
+changes in the surrounding consciousness field. Forty healthy volunteers were trained for 3 weeks in performance of CM 
+individually and in a group synchronizing all their bodily movements, breath and awareness examining the changes in 
+the whole body. The field trial consisted of 10 minutes of supine rest on ground followed by 22.5 minutes of 
+performance of CM and 10 minutes of post CM supine rest. The REG tracked the changes at the rate of 60 data points in 
+a minute from start to end. The analysis of REG data showed no significant changes in pre and post sessions while 
+showed highly significant changes during about 89% of the CM performance. The same session was repeated once more, 
+the results of which showed similar results. The part-wise analysis showed the influence of different phases of the CM 
+practice. 
+KEYWORDS: Cyclic Meditation, Random Event Generator, consciousness field  
+          
+INTRODUCTION: 
+  
+The efforts of the Princeton University Anomalies 
+group have taken the investigations a step further 
+into the framework of scientific rigor.  Here we 
+have tried to proceed a little more in this direction.  
+ 
+ 
+ 
+Modern Science is in a turning point1.  
+The 
+paradigm 
+shift 
+from 
+matter-based 
+to 
+consciousness-based 
+approach 
+is 
+becoming 
+inevitable2.  It is now accepted by quantum 
+physicists when dealing with electrons and 
+fundamental particles, that the observer can 
+influence the behavior of the particles3. Influence 
+of mind on matter has been a phenomenon in 
+vogue from times immemorial in India and a 
+systematic methodology was evolved by Patañjali 
+in his yoga sūtras4.  The demonstration of such 
+capacities in the higher states of consciousness 
+were in abundance by masters of any of the four 
+streams of yoga- Rāja (Patañjali) Yoga, Bhakti 
+Yoga, Jñāna Yoga & Karma Yoga5.  
+  
+     
+ 
+This has been the greatest attraction for 
+people at  large  all  over  the  world  to  take to the 
+ 
+ 
+*Corresponding author. 
+ 
+Swami Vivekananda Yoga Research Foundation, 
+Eknath Bhavan, #19 Gavipuram Circle 
+K G Nagar Bangalore 560019, India.  
+path of yoga in all seriousness and with total 
+commitment. These people even go to Himālayan 
+peaks to meet such yoga masters6. 
+ 
+The association between sleep and 
+meditation has been of interest and an early 
+study 
+actually 
+showed 
+that 
+experienced 
+practitioners of Transcendental Meditation 
+(TM) spent appreciable parts of meditation 
+sessions in sleep stages 2, 3, and 47. However, 
+this did not further the understanding about 
+whether practicing meditation can actually alter 
+the sleep structure. A more recent study on TM 
+practitioners using standard polysomnography 
+did attempt to answer this question8. There 
+were eleven long-term practitioners, nine short-
+term practitioners, and eleven non-practi-
+tioners. While there were no significant 
+differences among the groups in standard sleep 
+measures, visual inspection of slow-wave EEG 
+records did show specific differences among 
+the groups for the first three cycles of stages 3 
+and 4 of slow wave sleep. The long-term 
+practitioners had significantly greater theta 2-
+alpha 1 relative power than the other two 
+groups. In this report the increased theta-alpha 
+activity coexisting with delta activity of deep 
+sleep was interpreted as suggestive of the 
+practitioners 
+having 
+reached 
+periods 
+of 
+transcendental consciousness.  
+Meditation is actually the seventh stage 
+Journal of Scientific Speculations and Research 
+        Vol. 1, No. 2, pg  16 –27, 2010 
+ 
+ISSN 2229 - 3523  
+ 
+Journal of Scientific Speculations and Research 
+ 
+ 
+ 
+        Nagendra et al., 2010 
+ 
+ 
+ 
+17 
+in the classical eight stages to reach a stage of 
+final mental liberation described in traditional 
+yoga texts9. Some people find it easier to 
+practice the earlier stages, such as yoga 
+postures (asanas). Based on this, a technique 
+was evolved called cyclic meditation which 
+combines yoga postures interspersed with pe-
+riods of supine rest, when the person is given 
+instructions to help reach a meditative state10. 
+In 
+normal 
+volunteers, 
+practicing 
+cyclic 
+meditation 
+reduced 
+psychophysiological 
+arousal based on a decrease in oxygen 
+consumption11,12 and changes in heart rate 
+variability suggestive of a shifttowardsvagal 
+dominance13. Despite these changes suggestive 
+of reduced physiological arousal, practitioners 
+performed better in a cancellation task 
+requiring selective attention14 and showed an 
+increase in the P300 event related potential 
+amplitude 
+following 
+the 
+practice15, 
+also 
+suggestive of enhanced sustained and selective 
+attention. More directly, a two-day yoga 
+program which involved cyclic meditation 
+decreased 
+occupational 
+stress 
+levels 
+and 
+baseline autonomic arousal16. Specifically, 
+when participants were categorized based on 
+the occupational stress index (OSI) at baseline, 
+those with high OSI levels showed a decrease 
+in breath rate and a change in heart rate 
+variability suggestive of vagal dominance, 
+while those with low OSI levels to begin with 
+showed no change.   
+ 
+One study has showed that persons who 
+were already experienced in yoga practice, 
+including meditation, practicing a technique 
+called cyclic meditation (CM) increased the 
+percentage of time spent in slow-wave sleep 
+(SWS), decreased the time spent in rapid-eye-
+movement (REM) sleep, and reduced the 
+number 
+of 
+awakenings 
+per 
+hour. 
+The 
+participants' subjective rating of sleep was also 
+better following CM compared with the other 
+recording day, after SR16.  
+ 
+ 
+ 
+ 
+ 
+A research project was undertaken by 
+Swami Vivekananda Yoga Research Foundation on 
+measuring consciousness field using REG from 
+August 
+2001 
+to 
+September 
+200317. 
+The 
+investigators carried on a study on following five 
+sections: (i) Standardization (ii) The effect of an 
+individual alone on the unit (iii) The effect of 
+groups, collectively on the unit (iv) A study of 
+„collective consciousness‟ where groups of people 
+gathered for a common purpose; and (v) A study of 
+pairs of empathic individuals and whether they 
+were able to detect how the other individual was 
+attempting to alter the unit. With this background, a 
+study had been designed to evaluate how a 
+particular state of consciousness induced during the 
+Deep Relaxation Technique (DRT) can have an 
+influence on REG? the study on REG changes 
+induced by a group of 80 healthy volunteers 
+practicing DRT or lying down with Random 
+thinking showed no significant change in REG; this 
+study shows that relaxation technique DRT done in 
+a group has no capacity to induce changes in the 
+consciousness field by the combined Psycho-kinetic 
+power of the big group18. Similar manner we found 
+that 10 days practice of CM can improve the 
+performance on digit letter cancellation task19. 
+ 
+This has already been demonstrated. The 
+Agnihotra, has been shown to have the effect of 
+significantly 
+increasing 
+the 
+growth 
+of 
+rice 
+seedlings20. Other studies, one on the effects of 
+Agnihotra on the bioenergetics systems of 
+individual microorganisms, and another on the 
+antiseptic and antibiotic effects of smoke during 
+Puja and Agnihotra ash revealed that water could 
+be cleansed and purified, and made it fit for 
+drinking21 Puja appears to be a promising, 
+scientific, cost effective, eco-friendly method of 
+countering the increasingly deadly pollution, 
+purifying the environment, and enriching it with 
+healthy substances.  
+ 
+The possibility of psycho-kinesis is still 
+controversial, but quite well established. Uri 
+Geller‟s claims to bend metal objects by power of 
+the 
+mind 
+are 
+well 
+known, 
+and 
+scientific 
+observations of his paranormal powers have been 
+published22. With regard to the possibility of a Puja 
+affecting REG, previous experiments suggest that 
+each individual has a certain possibility of 
+influencing the instrument, and this is usually 
+interpreted as a form of psycho-kinesis23. Indian 
+studies of effects on REG‟s, include one showing 
+that Gāyatri mantra produces significant results24 
+That suggests that Puja or Yajñas  should also have 
+observable effects on REG.  
+ 
+ 
+ 
+ 
+ 
+Similarly, field trials have shown that 
+major events involving emotional responses from 
+large numbers of people can influence REG‟s23. But 
+deep relaxation technique had shown no effect on 
+REG individually in earlier study18 
+ 
+ 
+ 
+ 
+ 
+The results of many experiments using 
+REGs provide clear statistical evidence that the 
+behavior of these devices deviates from chance 
+expectation in correlation with the pre-defined 
+Journal of Scientific Speculations and Research 
+ 
+ 
+ 
+        Nagendra et al., 2010 
+ 
+ 
+ 
+18 
+intentions of participants in the experiments. In 
+1979, 
+the 
+Princeton 
+Engineering 
+Anomalies 
+Research Laboratory (PEAR) began collecting large 
+databases in an REG experiment with particularly 
+rigorous controls and a variety of optional 
+parameters to assess the reliability and the nature of 
+the apparent mind/machine interaction. Over a 12 
+year period of primary investigation, ten physical 
+and psychological conditions were examined as 
+possible mediating variables in the experimental 
+results. A number of extensions and variations on 
+the basic protocol have been explored, using several 
+random sources as well as a selection of different 
+physical systems whose performance is dependent in 
+a fundamental way on some form of random 
+process. A brief summary of the REG results based 
+on an analysis of variance is available25. 
+ 
+The present study was designed to assess 
+whether a group practicing CM with total 
+synchronization influence the consciousness field.. 
+ 
+MATERIALS AND METHODS: 
+ 
+Sample: Forty healthy volunteers out of 80 came for 
+attending residential yoga instructors course (YIC) 
+who gave their informed consent were selected for 
+the study. Their age range was 18 to 50 years 
+(mean age = 28.98, SD = 5.12).  
+ 
+ 
+ 
+ 
+ 
+ 
+Fig. 1: Design of the study 
+ 
+Pre and post reading were taken before and ending 
+the session of CM for five minutes. During the 
+practice of CM reading were taken for 22.5 minutes  
+ 
+Intervention: The entire group was trained to do the 
+CM regularly for 25 days before the experiment 
+was conducted. There were theory sessions to 
+explain the dimensions of CM one hour per day for 
+the first 10 days consisting of the following topics: 
+Introduction to CM; Concept of stress according to 
+modern medical science and according to Yoga; 
+Recognitions half solution; stress release by CM; 
+Concept of growth 1- Depth of perception; Concept 
+of growth 2- Expansion of awareness; Group 
+Dynamics; All pervasive awareness and CM; 
+Research finding on CM; VYASA Movement. 
+Each day there was a practice session after the 
+theory everyday for about 30 minutes during which 
+corrections of practices were done. After ten days 
+the participants practiced the CM for the Next 15 
+days listening to a pre recorded audio tape of 22.5 
+minutes. Their practices were checked regularly by 
+the trainers for its best effectiveness. Emphasis was 
+made to synchronies their movements meticulously 
+in time with the instructions.   
+ 
+Cyclic Meditation (CM): Subjects were instructed 
+to keep their eyes closed throughout the time 
+periods of practice of CM. CM used prerecorded 
+instructions, which emphasized the need to carry 
+out the practice slowly, with awareness and 
+relaxation. The practice started with subjects lying 
+on their back in shavasana (2 minutes) and consists 
+of the following sequence after the Repetition of a 
+verse from the Mandukya Upanishad (30) (0:40 
+minutes): 
+ 
+1. Isometric contraction of the muscles of the 
+body ending with supine rest (1:00 minutes). 
+Called IRT 
+ 
+Fig. 2a: IRT (Instant relaxation technique) 
+2. Slowly coming up from the left side and 
+standing at ease ( tadasana ), 'balancing' the 
+weight on both feet, called centering (2:00 
+minutes).    
+                                      
+ 
+Fig. 2b: Tadāsana 
+1. Bending to the left (ardhakatichakrasana ).by 
+raising the right hand slowly upward, stretching 
+upward in the vertical position and bending to 
+the left. Maintaining and slowly returning the 
+vertical position. Slowly bringing down the right 
+05 minutes 
+pre recording 
+ 
+  22.5 minutes of CM  
+05 minutes 
+post recording 
+Journal of Scientific Speculations and Research 
+ 
+ 
+ 
+        Nagendra et al., 2010 
+ 
+ 
+ 
+19 
+hand to stand in vertical position Tadasana (1:20 
+minutes). 
+ 
+Fig. 2c: Ardhakatichakrāsana 
+2. Tadasana with instructions about relaxation and 
+awareness (1:10 minutes).  
+ 
+Fig. 2d: Tadāsana 
+3. Ardhakatichakrasana bending to the right (1:20 
+minutes).  
+ 
+Fig. 2e: Ardhakatichakrāsana 
+4. Tadasana as previously (1:10 minutes).  
+5. Forward 
+bending 
+(padahastasana) 
+(1:20 
+minutes).  
+ 
+Fig. 2f: Padahastāsana 
+6. Tadasana as previously (1:10 minutes).  
+7. Backward bending (ardhachakrasana) (1:20 
+minutes).  
+                      
+ 
+Fig. 2e: Ardhachakrāsana 
+8. Slowly coming down into the supine posture ( 
+shavasana ).  
+ 
+ 
+ 
+ 
+ 
+ 
+9. DRT- Instructions to relax different parts of the 
+body in sequence (10:00 minutes) in 6 phases. 
+ 
+Fig. 2f: DRT (Deep relaxation technique) 
+Journal of Scientific Speculations and Research 
+ 
+ 
+ 
+        Nagendra et al., 2010 
+ 
+ 
+ 
+20 
+Phase I: Bring your awareness to the tip of the toes, 
+gently move your toes and relax.  Sensitize the 
+soles of your feet; loosen the ankle joints; relax the 
+calf muscles; gently pull up the knee caps release 
+and relax; relax your thigh muscles, buttock 
+muscles; loosen the hip joints, relax the pelvic 
+region and the waist region. Totally relax your 
+lower part of the body.R..e..l..a..x ..  Chant A-kára 
+and feel the vibration in your lower parts of the 
+body. 
+ 
+Phase II: Gently bring your awareness to the 
+abdominal region and observe the abdominal 
+movement for a while, relax your abdominal 
+muscles and relax the chest muscles. Gently bring 
+your awareness to your lower back, relax your 
+lower back, and loosen all the vertebral joints one 
+by one. Relax the muscles and nerves around the 
+back bones. Relax your middle back, shoulder 
+blades and upper back muscles, totally relax. Shift 
+your awareness to the tip of the fingers, gently 
+move them a little and sensitize. Relax your fingers 
+one by one. Relax your palms, loosen the wrist 
+joints, relax the forearms, loosen the elbow joints, 
+relax the hind arms-triceps, biceps and relax your 
+shoulders. Shift your awareness to your neck, 
+slowly turn your head to the right and left, again 
+bring back to the center. Relax the muscles and 
+nerves of the neck. Relax your middle part of the 
+body, totally relax. R..e..l..a..x .. . Chant U-kára 
+and feel the vibration in the middle part of your 
+body. 
+ 
+Phase III: Gently bring your awareness to your 
+head region. Relax your chin, lower jaw and upper 
+jaw, lower and upper gums, lower and upper teeth 
+and relax your tongue. Relax your palates hard and 
+soft; relax your throat and vocal chords. Gently 
+shift your awareness to your lips, relax your lower 
+and upper lips. Shift your awareness to your nose, 
+observe your nostrils, and feel the warm air 
+touching the walls of the nostrils as you exhale and 
+feel the cool air touching the walls of the nostrils as 
+you inhale. Observe for a few seconds and relax 
+your nostrils. Relax your cheek muscles, feel the 
+heaviness of the cheeks and have a beautiful smile 
+on your cheeks. Relax your eye balls muscles, feel 
+the heaviness of eye balls, relax your eye lids, eye 
+brows and in between the eye brows. Relax your 
+forehead, temple muscles, ears, the sides of the 
+head, back of the head and crown of the head. 
+Relax your head region, totally relax. R..e..l..a..x .. 
+and chant M-kára feel the vibration in your head 
+region. 
+ 
+Phase-IV: Observe your whole body from toes to 
+head and relax, chant an AUM in a single breath. 
+Feel the resonance throughout the body. 
+Phase-V: 
+Slowly 
+come 
+out 
+of 
+the 
+body 
+consciousness and visualize your body lying on the 
+ground completely collapsed. 
+ 
+Phase-VI: Imagine the vast beautiful blue sky. The 
+limitless blue sky. Expand your awareness as vast 
+as the blue sky. Merge yourself into the blue sky. 
+You are becoming the blue sky. You are the blue 
+sky. Enjoy the infinite bliss. E..N..J..O..Y.. the 
+blissful state of silence and all pervasive awareness. 
+ 
+Phase-VII: 
+Slowly 
+come 
+back 
+to 
+body 
+consciousness. Inhale deeply.Chant an “AUM-
+kára”. Feel the resonance throughout the body. The 
+soothing and massaging effect from toes to head. 
+ 
+Phase-VIII: Gently move your whole body a little. 
+Feel the lightness, alertness and movement of 
+energy throughout the body. Slowly bring your legs 
+together and the hands by the side of the body. 
+Turn over to the left or the right side and come up 
+when you are ready.                   
+All postures are practiced slowly, with instructions 
+to be aware of all sensations. Total duration of 
+practice was 21.14 minutes10. 
+ 
+Assessment: REG is Random Event Generator is a 
+device that is connected to a computer to generate 
+random numbers which are converted into a plot. 
+The question as to whether the will or intent or the 
+very presence of a group performing CM with 
+synchronization can break the random number 
+generation process of REG is being observed.  If 
+the curve (Fig 1) goes on fluctuating within the 
+parabola, it is an indication that the changes are all 
+non-significant (p > .05). If the group activity 
+influences the consciousness field by psycho-
+kinesis, the curve would move beyond the parabola 
+(p<0.05). 
+ 
+What does it measure? It measures the extent to 
+which the performance of CM synchronized group 
+can influence the REG. it is assumed that the field 
+surrounding the group will get a capacity (psycho-
+kinetic power) to influence REG and bring a 
+significant change in random number generation.  
+ 
+If the mean value is <101.00 or greater than 
+99.00, then it is non-significant (p>0.05).  That 
+means that group performance of CM have no 
+significant influence on REG.  
+ 
+ 
+Journal of Scientific Speculations and Research 
+ 
+ 
+ 
+        Nagendra et al., 2010 
+ 
+ 
+ 
+21 
+Global consciousness during the millennium change 
+ 
+ 
+Fig. 3a: The following figure incorporates data from all time zones and all 27 eggs that had reported data as of 11 
+January. The cumulative deviation averaged across all time zones and all eggs yields a Chisquare of 88.33 on 60 df, 
+with a probability against chance of 0.010. Below the figure is a table documenting the 36 time zones used in the 
+analysis, expressed in the time zone offset and the actual GMT times of the Just a Minute event. 
+ 
+Global consciousness during the funeral services for princes Diana 
+ 
+Fig. 3b: During the public ceremonies for Princess Diana, results compounded across twelve independent 
+recordings at various locations in Europe and the United States showed an anomalous effect that would occur by 
+chance only about once in 100 repetitions of this experiment (p = 0.013), as displayed in a graph of the deviation 
+accumulated across all the datasets 
+ 
+Journal of Scientific Speculations and Research 
+ 
+ 
+ 
+        Nagendra et al., 2010 
+ 
+ 
+ 
+22 
+ 
+ 
+ 
+Fig. 3c: Global consciusnesss during the funeral services for Mother Teresa 
+ 
+Eleven datasets for Mother Teresa's funeral show 
+little indication of an anomalous effect, with a 
+composite outcome indistinguishable from chance 
+(p = 0.654), as displayed in figure 1c. We speculate 
+that the difference derives from the nature of the 
+global attention, which was very different in the 
+two cases. The significant result for Diana's funeral 
+confirmed our prediction based on the obvious 
+potential of this tragic and unexpected occasion to 
+produce emotional engagement and resonance. The 
+outcome is consonant with results obtained in 
+previous Field REG studies and supports tentative 
+interpretations suggesting that groups of people, 
+especially when they are attuned and engaged by a 
+common theme, may produce something like a 
+"consciousness field" that can induce a small but 
+statistically identifiable bias in a nominally random 
+sequence. Similar influences on an REG were 
+found during the Apthoryama organized in the 
+Trichur district of Kerala in 200626. Studies of the 
+effect of Bhajans on an REG23, and Japa on Gāyatri 
+Mantra by individuals24 have seen significant 
+changes. Field-REG trials during Princess Diana‟s 
+death, the Millennium changes etc. have found 
+similar results (ref). Results at SVYASA on Bhajan 
+sessions23 have also produced similar findings. In 
+short, significant changes in REG have been seen in 
+situations of deep agony, pain or excitement, as 
+well as spiritual activity. It would appear that 
+extreme 
+distress-eustress 
+in 
+the 
+emotional 
+dimension may be necessary to produce significant 
+changes in REG. 
+ 
+Details of REG: The researcher Micro REG s/n 
+0128, US Patent5, 830, 064 is supplied by Mind-
+Song Co. Inc. was used. A typical micro electric 
+REG consists of an analog section based on a solid 
+diode, and a Johnson noise source, or field-effect 
+transistor (FET), with its output processed through 
+a multi-stage amplification and clipping circuit. 
+Components are selected to produce a white noise 
+spectrum that is flat over the range of 500 to 
+30,000Hz. Analog portions of such an REG system 
+are very sensitive to variations in design. Their 
+construction includes sophisticated shielding from 
+environmental fields 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+The analog signal is compared with a DC 
+reference level, yielding a digital (CMOS or TTL 
+logic) output that unambiguously defines analog 
+inputs as binary, above and below the reference 
+voltage. This digital signal is periodically sampled 
+by an edge triggered flip flop, which locks in a bit 
+of 1or 2 until the next clocking period. These 
+devices typically have an adjustable sampling rate 
+(for example 1000per second).The sampling 
+process yields a continuous sequence of bits which 
+are further processed to mitigate residual biases. 
+The sequence of bits then is shifted into an 8-bit 
+shift register, the content of which is transferred at 
+Journal of Scientific Speculations and Research 
+ 
+ 
+ 
+        Nagendra et al., 2010 
+ 
+ 
+ 
+23 
+18-millisecond to a UART chip for asynchronous 
+transmissions as a data byte. These bytes are 
+transmitted to the serial port of the computer at 
+9600 baud, where they are read and converted to 
+REG data by dedicated software.  
+ 
+ 
+ 
+ 
+ 
+The digital and analog circuits of the REG 
+are electrically isolated from each other and they 
+are active asynchronously. A separate external 
+power has been used to minimize electromagnetic 
+field interactions within the device. Further, the 
+REG are protected by design against most internal 
+and 
+external 
+sources 
+of 
+electromagnetic 
+interference, mu-metal or other shielding around 
+the sensitive early stages of the analog circuit. 
+ 
+Data Collection: The REG was kept at a distance 
+of 1.5 meter from the stage from where the 
+instructions were given. Studies have shown that 
+1.5 meter‟s distance from the computer screen has 
+an optimum effect in bringing highest influence on 
+the REG3.  
+ 
+We have chosen this study to see whether a 
+field induced by a group of healthy volunteers 
+practicing CM with synchronizing can influence 
+REG even without their intent. The REG recorded 
+data at a speed of 60 data points per minute from 
+start. Pre data of supine rest (SR)  300 sec., CM 
+performance  21.10 minutes (1270 sec.) followed 
+by 300 sec. of post data.  
+ 
+Data Analysis: Each data point of sample was 
+converted into z score as,  
+Npq
+x
+z
+/
+)
+100
+(
+, 
+ 
+Where: x is the data point of sample value,  
+N is the sample size per second (200), 
+p = chance expected hit rate (0.5) and  
+q = 1-p.  
+Each z values were squared and in further step 
+cumulative sum of z squared scored were obtained.  
+ 
+These values are cumulative chi-squared values.   
+They are evaluated as 
+1
+2
+2
+2
+df
+z
+,  
+ 
+Where:   
+2 is the chi-square value,  
+df is the number of samples, and  
+z is distributed as a standard normal 
+deviate.   
+ 
+The probability of this z score was 
+determined by using the Excel function p = 
+normsdist (z). 
+ 
+ 
+ 
+These 
+records 
+were 
+analysed 
+systematically by calculating p values as described 
+above. Durations for which REG was influenced 
+during pre-during-post phases of interventions at an 
+interval of one minute was calculated and are 
+depicted in table 1.  
+ 
+ 
+ 
+ 
+Fig. 4: Shows the raw data values as recorded by REG in Pre, During and Post sessions. Each data points 
+represent an average of 200 data points scanned by the REG in 1 second 
+ 
+ 
+Journal of Scientific Speculations and Research 
+ 
+ 
+ 
+        Nagendra et al., 2010 
+ 
+ 
+ 
+24 
+Table 1: Gives the full picture of the event with the data recorded and depicted once. 
+ 
+Sl.No
+. 
+Event 
+Durations 
+(in second) 
+Mean ±  Std. deviation 
+Maximum 
+value 
+Minimum 
+value 
+1 
+Pre CM 
+300 
+99.81 ± 6.74 
+117 
+82 
+2 
+Prayer 
+70 
+99.4 ± 6.25 
+117 
+84 
+3 
+I.R.T 
+60 
+102.56 ± 8.09** 
+124 
+84 
+4 
+Centering 
+60 
+98.51 ± 7.59 
+115 
+83 
+5 
+Ardhakatichakrasana 
+from right side 
+60 
+100.75 ± 7.57 
+117 
+80 
+6 
+Tadasana relaxation with 
+instructions 
+60 
+100.51 ± 6.89 
+113 
+82 
+7 
+Ardhakatichakrasana 
+from left side 
+60 
+100.31 ± 6.19 
+116 
+88 
+8 
+Tadasana relaxation with 
+instructions 
+60 
+98.15 ± 6.00 
+108 
+83 
+9 
+Padahastasana, forward 
+bending 
+60 
+101.18 ± 7.31 
+118 
+84 
+10 
+Tadasana relaxation with 
+instructions 
+60 
+99.83 ± 6.98* 
+114 
+79 
+11 
+Ardhachakrasana, 
+backward bending 
+60 
+100.73 ± 7.95 
+116 
+81 
+12 
+Tadasana relaxation with 
+instructions 
+60 
+100.65 ± 6.09 
+118 
+91 
+13 
+Deep relaxation 
+technique 
+540 
+99.79 ± 7.58* 
+124 
+79 
+14 
+Closing Prayer 
+60 
+99.80 ± 7.64 
+113 
+75 
+15 
+Post CM 
+300 
+100.59 ± 7.26 
+120 
+80 
+ 
+*p<0.05, **p<0.01 
+Colum 2 shows the activities of the events which include Pre and Post sessions also.  
+Colum 3 showed the total duration of the each activity in second.  
+Colum 4, 5 and 6 are showing the mean values with SD, maximum value and minimum value respectively. 
+   
+Graphical representation of data in table 1, indicating clearly that the REG was influenced during I.R.T (P<0.01), Tadasana 
+with instructions (p<0.05) and Deep relaxation technique (p<0.05). 
+ 
+ 
+ 
+ 
+Fig. 5: 1: Pre CM, 2: Prayer, 3: I.R.T, 4: Centering, 5: Ardhakatichakrasana from right side, 6: Tadasana 
+relaxation with instructions, 7: Ardhakatichakrasana from left side, 8: Tadasana relaxation with instructions, 9: 
+Padahastasana forward bending, 10: Tadasana relaxation with instructions 11: Ardhachakrasana, backward 
+bending, 12: Tadasana relaxation with instructions, 13: Deep relaxation technique, 14: Closing Prayer, 15: Post CM 
+Journal of Scientific Speculations and Research 
+ 
+ 
+ 
+        Nagendra et al., 2010 
+ 
+ 
+ 
+25 
+ 
+Figures 2, 3 and 4 show the records from REG out 
+put shoeing the responses from start to end (pre-
+during-pos). 
+ 
+ 
+ 
+Fig. 6: Presents the standard presentation of 
+REG results as cumulative sum of (z²-1) values 
+with degree of freedom (figure 1a, b, c). And 
+table 2 shows the overall effect of CM group 
+performance on REG. 
+ 
+Table 2: Over all effect of CM group 
+performance on REG. 
+ 
+Days 
+Total 
+duration 
+(in sec.) 
+Duration 
+(┼) 
+% 
+change 
+ 
+P 
+value 
+Pre 
+300 
+NS 
+0 
+NS 
+During 
+1270 
+660 
+51.96 
+0.01* 
+Post 
+300 
+NS 
+0 
+NS 
+Duration (┼) represents the time in seconds during 
+which REG was significantly influenced.  
+ 
+Table 3: Changes in consciousness fields in 
+different events as measured by REG. 
+ 
+No. 
+Events 
+Degree of 
+Freedom 
+Duration 
+(┼) 
+P 
+valve 
+Z² 
+Value 
+1 
+Millennium 
+changes 
+60 
+60 
+0.01 
+88.33 
+2 
+Princes 
+Diana‟s 
+funeral 
+60 
+50 
+0.05 
+NA# 
+3 
+Mother 
+Teresa's 
+funeral 
+25 
+0 
+0.65 
+NA# 
+4 
+Navratri 
+Festival 
+1450 
+1450 
+0.05 
+79.18 
+5 
+Agnihotra 
+600 
+580 
+0.01 
+86.66 
+ 
+#NA- Not Available 
+ 
+Duration (┼) represents the time in seconds during 
+which REG was significantly influenced.  
+ 
+RESULTS: 
+ 
+Glancing through fig. 3 to 6 and table 1 and 2, it 
+can be seen that the supine rest before the start of 
+the intervention showed no significant influence on 
+the REG. However, as the intervention started, the 
+REG started showing alternate phases of significant 
+and non-significant changes during performance of 
+different phases of CM (table 1).  
+After the intervention (post data) again in Supine 
+rest position there was no influence in REG (table 
+1). 
+Table 2 shows the overall effect of pre-during and 
+post phases. It can be seen that the REG was 
+influenced for a total of 660 sec. out of 1270 sec 
+ 
+DISCUSSION: 
+ 
+Comparing figures 3a, b and c with that of 
+figure 6 it is evident that REG has responded to 
+these events similarly. The Z2 values for 
+millennium change is 88.33 in degree of freedom of 
+60 while in our cases there are 99.60 and degree of 
+freedom 1270 (table 3).  
+Extreme agony, great excitement or awe are 
+evident in these cases mentioned in table 3. At 
+these points of time Dharanā and Dhyāna occurs 
+leading to Samādhi like experience through 
+compassion in extreme agony and great bliss in 
+excitements. When Dharanā –Dhyāna- Samādhi 
+occur together it is called Samyama (trayam ekatra 
+samyamah pys 3.4, 4). Samyama is the tool 
+suggested by Patanjali to reach higher and subtler 
+levels of consciousness, in which state ESP, PK and 
+other powers emerge4. An individual has to raise to 
+great heights of higher layers of consciousness at 
+which level the effect of the same becomes wide 
+spread in the whole of its surrounding (ahimsa 
+satya pratisthayaam tatsannidhau vairatyagah pya 
+2.35, 4). The nonviolence spreads so effectively in 
+their vicinity that even enemy animals live together 
+in harmony. The ashrams of great sages were 
+models of such phenomena. 
+In CM, the group brings out similar effect is 
+evident from this study. The CM performed by a 
+group of 40 persons with synchronization will 
+significantly influence the REG evidencing the 
+arousal of PK power. This is in tune with the claims 
+of the yoga text (Māndukya kārika) that we move 
+towards subtler levels of mind acquiring different 
+varieties of siddhis including PK power.  
+This study adds new dimensions about the 
+effect of CM which is distinctly different from 
+earlier studies in which CM has shown significant 
+Journal of Scientific Speculations and Research 
+ 
+ 
+ 
+        Nagendra et al., 2010 
+ 
+ 
+ 
+26 
+effect a metabolic rate reduction, power of 
+concentration, memory, processing of information 
+in brain, etc13,14,15,16. 
+Finally the study for the first time has 
+unraveled the effectiveness of different components 
+of CM- IRT, PH to Tadasana and DRT showing 
+significant changes during these components than 
+others. 
+Looking at fig. 5, it is obvious that REG has 
+responded to a transition from supine rest position 
+to IRT (stretch and relax), from front bending PH to 
+standing rest position Tadasana and from standing 
+position to DRT position. There are possibilities 
+that the physical aspect of stretch and relax, 
+powerful front bending to tadasana which involves 
+maximum changes in blood flow to head and a 
+similar change from standing to lying down 
+position. 
+The other part of CM namely DRT significant 
+changes are related to changes at mental and 
+emotional levels representing the 5th and 6th phases 
+of DRT. 
+Stimulation – relaxation combine is the very 
+special dimension of CM. stimulation meant to 
+break the Tamas (lethargy, laziness etc) which have 
+brought significant change in the REG responses. 
+Even at emotional and mental level is 5th and 6t 
+phases of DRT where is there are stimulations to 
+move out of the body- out of the body experience 
+and a feeling of expansion taking to the infinite 
+blue sky. 
+Looking at the events in table 3, it is obvious 
+that REG responds to situation of one, emotional 
+agony or excitements felt by large number of 
+people globally. In CM group performance also 
+these aspects have come out vividly when there is a 
+sudden change in physical level blood flows or one 
+at emotional level.  
+This study can be a breakthrough in PK power 
+studies where group effectiveness of CM can be 
+used to bring positive change in the surrounding 
+atmosphere. 
+The possibilities of the use of such influences 
+induced by a group of CM practitioners in 
+treatment of different chronic and severe patients. 
+.  
+CONCLUSIONS: 
+ 
+This study “effect of cyclic meditation on 
+consciousness field” using REG has shown that 
+1. CM practices done synchronizing by a group of 
+people well trained in its performance can 
+influence the REG significantly for sizeable 
+duration (51.96 %) of its performance. 
+2. The duration and quantum of influence are 
+comparable to global events as princes Diana‟s 
+funeral, Millennium change event (z² value – 
+88.93). 
+3. The stimulation-relaxation combines which 
+shatters stagnations, laziness, and lethargy and 
+channelizes the energies so produced towards 
+calmness and deep rest. These states of deep 
+rest the mind jumps into higher states of 
+consciousness in which there arises higher 
+power as PK power evidenced in this study. 
+4. While DRT performed individually had shown 
+no effect on REG in earlier studies18 this 
+investigation shows that individual practice of 
+DRT has no capacity to influence the REG but 
+in this study DRT has showed the capacity to 
+influence the REG because of the group effect..
+ 
+ 
+REFERENCES: 
+   
+1. Capra, F (1984):  Turning Point: Bantam Books, New York. 
+2. Goswami, A (1993): The Self Aware Universe: Putnam Book, New York. 
+3. Jahn, R.G., Dunne B.J (1987): Margins of Reality-The role of consciousness in the physical 
+world: Harcourt Brace, New York. 
+4. Taimini, I.K (2001): The Science of Yoga: The Theosophical Publishing House, Chennai.   
+5. Brunton, Paul (1970): A search in secret India: B.I.Publications, Delhi. 
+6. Paramhamsa Yogananda (1970): Autobiography of a Yogi: Jaico Publishing House, Bombay. 
+7. Pagano RR, Rose RM, Stivers RM, Warrenburg S (1976): Sleep during transcendental 
+meditation. Science, 191 (4224), 308-10.  
+8. Mason LI, Alexandar ON, Travis IT (1997): Electrophysiological correlates of higher 
+states of consciousness during sleep in long-term practitioners of the Transcendental 
+Meditation. Sleep, 20 (2), 102-10.  
+Journal of Scientific Speculations and Research 
+ 
+ 
+ 
+        Nagendra et al., 2010 
+ 
+ 
+ 
+27 
+9. Taimini IK (1986): The Science of Yoga. 4,h ed. Madrash: The Theosophical Publishing 
+House,  
+10. Nagendra HR, Nagarathna R (1997): New perspectives in stress management. Swami 
+Vivekananda Yoga Prakashan, Bangalore. 
+11. Telles S, Reddy SK, Nagendra HR (2000): Oxygen consumption and respiratory 
+following two yoga relaxation techniques, Applied Psychophysiology Biofeedback, 25 
+(4), 221-27. 
+12. Sarang PS, Telles S (2006): Oxygen consumption and respiration during and after two 
+yoga relaxation techniques, Applied Psychophysiology Biofeedback, 31(2), 143-51.  
+13. Sarang P, Telles S (2006): Effects of two yoga based relaxation techniques on heart rate 
+variability (HRV), Int Stress Manag, 13 (4), 1-16.  
+14. Sarang SP, Telles S (2007): Immediate effect of two yoga-based relaxation techniques 
+on performance in a letter-cancellation task, Percept Mot Skills, 105 (2), 379-85.  
+15. Sarang SP, Telles S (2006): Changes in P300 following two yoga-based relaxation 
+techniques, Int Neurosci, 116, 1419-30.  
+16. Vempati RP, Telles S (2000): Baseline occupational stress levels and physiological 
+responses to a two day stress management program, Indian Psychol, 18(1-2), 33-37.  
+17. Nagendra HR., Telles Shirley, Manjunath NK, Naveen KV (2003): Measuring consciousness 
+fields using a Random Event Generator, A study submitted to the Defense Research and 
+Development Organization (DRDO), Ministry of Defense, Government of India, New Delhi. 
+18. Thakur GS, Nagendra HR, Nagarathna R (2009): Effect of deep relaxation technique on the 
+capacity to influence REG-a randomized control trail, , Indian Journal Of Traditional 
+Knowledge, 8 (3): 459-463. 
+19. Balaram P, Nagendra HR (2009): Effect of yoga relaxations techniques on performance of 
+digit letter cancellation task by teenagers, International journal of yoga, 2 (2): 30-34. 
+20. Heisnam JD (2004): Effect of agnihotra on the germination of rice seeds, Indian Journal of 
+Traditional Knowledge, 231-239. 
+21. Gaikwad MP (1995):  Agnihotra- The message of time,  Akhand Jyoti Sansthan, Mumbai.  
+22. Panati C (1976): The Geller Papers. Scientific Observations on the Paranormal Powers of Uri 
+Geller,  Houghton Miffin, Houghton.   
+23. Mohan T, Nagendra HR, Nagarathna R (2003): Effect of emotional culture session on the 
+capacity to influence the REG, Indian Journal Of Traditional Knowledge, 405-409. 
+24. Neha R (2004): Role of Gāyatri Mantra in Optimizing the Random Event Generator 
+[dissertation].Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bangalore, 
+India.  
+25. Nelson R, Retrieved from http://noosphere.princeton.edu/measurement. html.     
+26. Surendra R (2007): Effect of Navratri Festival on people and environment, Indian Journal of 
+Traditional Knowledge, 412-416.  
+ 

yogatexts/A FMRI Study of Stages of Yoga Meditation Described in Traditional Text.txt

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+Volume 5 • Issue 3 • 1000185
+J Psychol Psychother
+ISSN: 2161-0487 JPPT, an open access journal 
+Research Article
+Open Access
+Telles et al., J Psychol Psychother 2014, 5:3
+http://dx.doi.org/10.4172/2161-0487.1000185
+Research Article
+Open Access
+Psychology & Psychotherapy
+J
+o
+u
+r
+n
+a
+l
+ 
+o
+f
+ 
+P
+s
+y
+c
+h
+o
+l
+o
+g
+y
+ 
+&
+ 
+P
+s
+y
+c
+h
+o
+t
+h
+e
+r
+a
+p
+y
+ISSN: 2161-0487
+A FMRI Study of Stages of Yoga Meditation Described in Traditional Text
+Shirley Telles1,2*, Nilkamal Singh1, K.V. Naveen2, Singh Deepeshwar2, Subramanya Pailoor2, N.K. Manjunath2, Lija George 2,3, Rose Dawn3 
+and Acharya Balkrishna1
+1PatanjaliResearch Foundation, Haridwar, India
+2ICMR Center for Advanced Research in Yoga and Neurophysiology, S-VYASA, Bengaluru, India
+3Department of Neuro-imaging and Interventional Radiology, NIMHANS, Bengaluru, India
+Abstract
+Objectives: .Meditation is described in traditional yoga texts as three stages, which follow each other in 
+sequence: (i) Focused attention (FA), (ii) Focused attention on the object of meditation (MF), and (iii) Meditation with 
+one-pointed focused attention without effort (ME). When not in meditation the mind is considered to be in a state of 
+normal consciousness characterized by random thinking (RT). The objective of the present study was to determine 
+the brain areas activated during the three stages of meditation compared to the control state using fMRI.
+Methods: Functional magnetic resonance images were acquired from twenty-six right handed meditators during 
+MF, ME and random thinking (RT) for comparison. Ten of them were experienced (average age ± SD, 37.7 ± 13.4 
+years; 9 males) with 6048 hours of meditation, whereas 16 (group average age ± SD, 23.5 ± 2.3 years; all males) 
+were less experienced, with 288 hours of meditation. During the fMRI recordings the participants practiced RT, 
+non-meditative focused thinking (FA), MF and ME, each lasting for 2 minutes. Brain areas activated during the 
+intervention were scanned using a 3.0-Tesla Philips-MRI scanner. 
+Results: During the third phase of meditation (ME) the experienced meditators alone showed significant 
+activation in the right middle temporal cortex (rMTC), right inferior frontal cortex (rIFC) and left lateral orbital gyrus 
+(LOG) (p < 0.05), Bonferroni adjusted t-tests for unpaired data, comparing ME and random thinking. 
+Conclusions: These changes suggest that ME is associated with sustained attention, memory, semantic 
+cognition, creativity and an increased ability to detach mentally.
+Keywords: Meditation; Yoga; Traditional texts; Random thinking; 
+fMRI; Focused attention; Effortless focused attention
+Introduction
+Meditation can be considered to be a training in awareness which 
+produces definite changes in perception, attention, and cognition [1]. 
+Meditation is also recognized as a specific consciousness state in which 
+deep relaxation and increased internalized attention co-exist [2]. Perhaps 
+related to this is the concept that directing and regulating attention are 
+considered an inherent part of different meditation techniques [3].
+Multiple neuroimaging studies on meditation have attempted to 
+describe the cognitive processes involved. The most common examples 
+are of focused attention and open monitoring meditation [4,5]. There 
+appears to be no neuroimaging study which has categorized the process 
+of meditation based on traditional texts whether Buddhist, Yoga, Chinese 
+or any others. The present study aimed to compare three stages of yoga 
+meditation described in Indian yoga texts with the mental state that is 
+described to exist when not in meditation. This non-meditative state is 
+characterized by both mind-wandering and switching of attention at 
+random. It has been described in traditional texts as the characteristic 
+mental state when the mind is not directed or instructed (Cancalata in 
+Sanskrit; Bhagavad Gita, Circa 500 B.C.; Chapter 6, Verse 34; simplified 
+here as random thinking or RT) [6]. This was considered as the control 
+state against which the stages of meditation were compared. In an 
+attempt to describe this mental state with contemporary descriptions it 
+can be considered as normal consciousness [7]. 
+Traditionally it is mentioned that in order to reach a meditative 
+state attention should be focused and maintained. In order to do this 
+different meditation techniques use varied objects, mantras as well as 
+interoception [8].
+As a practitioner attempts to meditate there are three successive 
+*Corresponding author: Shirley Telles, Patanjali Research Foundation, 
+PatanjaliYogpeeth, Haridwar, Uttarakhand 249405, India. Tel: +91 01334 244805; 
+Telefax: +91-1334-24008, E-mail: [email protected]
+Received April 07, 2014; Accepted May 26, 2015; Published June 02, 2015
+Citation: Telles S, Singh N, Naveen KV, Deepeshwar S, Pailoor S, et al. (2015) A 
+FMRI Study of Stages of Yoga Meditation Described in Traditional Text. J Psychol 
+Psychother 5: 185. doi: 10.4172/2161-0487.1000185
+Copyright: © 2015 Telles S, et al. This is an open-access article distributed under 
+the terms of the Creative Commons Attribution License, which permits unrestricted 
+use, distribution, and reproduction in any medium, provided the original author and 
+source are credited.
+stages, these are: (i) Focused attention (FA), (ii) Meditative focusing 
+(MF) and (iii) Pure meditation (ME). In FA the practitioner attempts 
+to return to focus when the mind wanders and attention is directed 
+to several thoughts about the same subject (in the present study the 
+thoughts were on the concepts of meditation). During Meditative 
+focusing (MF) focusing of attention is directed to a single thought 
+(in the present case the Sanskrit syllable ‘Om’), with the exclusion of 
+all distractions, which requires effort. Pure meditation (ME) occurs 
+as the practitioner continues with the second stage the stage of pure 
+meditation is spontaneously reached, where attention is on a single 
+thought (in this case the syllable ‘Om) but there is no effort involved.
+The descriptions of each stage of meditation in the traditional texts 
+give greater clarity about the processes involved. The first stage (FA) 
+is called ekagrata in Sanskrit (Bhagavad Gita, Chapter 6, Verse 12), 
+during which attention is directed to a series of associated thoughts. 
+As mentioned above if the thoughts are related to meditation, 
+the person would then be able to progress to the next two stages, 
+dharana (MF) and dhyana (ME). Dharana (or focusing with effort), is 
+described as ‘confining the mind within a limited mental area’ (‘desha-
+bandhashchittasya dharana’, Patanjali’s Yoga Sutras, the sage Patanjali 
+Citation: Telles S, Singh N, Naveen KV, Deepeshwar S, Pailoor S, et al. (2015) A FMRI Study of Stages of Yoga Meditation Described in 
+Traditional Text. J Psychol Psychother 5: 185. doi: 10.4172/2161-0487.1000185
+Page 2 of 6
+Volume 5 • Issue 3 • 1000185
+J Psychol Psychother
+ISSN: 2161-0487 JPPT, an open access journal 
+Circa 900 B.C.; Chapter 3, Verse 1) [9]. The next state is dhyana or 
+effortless expansion called pure meditation This state is described as 
+‘the uninterrupted flow of the mind towards the object chosen for 
+meditation’(‘tatra pratyayaikatanata dhyanam’, Patanjali’s Yoga Sutras, 
+the sage Patanjali Circa 900 B.C.; Chapter 3, Verse 2).
+The difference between dharana and dhyana in using effort to 
+direct attention is supported by data which show a shift towards vagal 
+dominance during dhyana [10]. Apart from the autonomic variables 
+there have been electrophysiological recordings of short [11], middle 
+[12] and long latency [13] auditory evoked potentials during FA, MF, 
+ME as well as during the control state (RT) of random thinking. The 
+changes were both in the time taken for information transmission (i.e., 
+the latency) as well as in the number of neurons recruited (indicated by 
+the amplitude). However auditory evoked potentials were specific for 
+the auditory pathway and the neural generators were correspondingly 
+specific to that pathway. Also evoked potential recordings do not 
+give spatial and temporal resolution which fMRI provides to localize 
+changes in brain functions. 
+Hence the present study was designed to compare the parts of the 
+brain involved in three successive stages of traditionally described yoga 
+meditation (i.e., FA, MF and ME) each with the mind wandering state 
+(RT) using fMRI.
+Methods
+Participants
+The participants were twenty-six right handed trained meditators. 
+Ten of them (9 males; group average age ± SD; 37.7 ± 13.4 years) 
+had 7 years of experience of meditation {(7 years × 12 months × 24 
+days × 180 minutes)/60} = 6048 hours), practiced as the two stages, 
+meditative focusing (ME) leading to pure meditation (ME). The other 
+sixteen meditators had 18 months experience of the same meditation. 
+They were all males and had an average age of 23.5 ± 2.3 years with 
+experience of 288 hours {(18 month × 24 days × 40 minutes)/60} = 288 
+hours). The two groups significantly differed with respect to age (t = 
+4.11 ; df = 24 ; p = 0.0003). Baseline characteristics of the experienced 
+and less experienced meditators are given in Table 1. Participants were 
+recruited for the trial by notices on the notice boards of the institution, 
+the Indian Council of Medical Research Center for Advanced Research 
+(ICMR-CAR), located in Bangalore, south India. This center is attached 
+to a residential yoga training center where meditators receive training 
+in meditation and come for advanced retreats. There was no incentive 
+to take part in the study and while the study design was explained to 
+the participants, the research question was not. To be included in the 
+trial participants had to meet the following criteria (i) normal health 
+based on a routine physical and mental health examination, (ii) right 
+hand dominance based on a routine hand dominance inventory [14], 
+and (iii) regularity in their practice of meditation, where regularity 
+meant practicing for at least 40 minutes a day for six days in a week. 
+The experienced meditators practiced for 180 minutes in a day while 
+the inexperienced meditators practiced for 40 minutes each day. 
+Pre-determined exclusion criteria were: (i) if they were not able to 
+be scanned due to claustrophobia, metal implants, a pacemaker, or 
+pregnancy, and (ii) inability to meditate in the scanner environment. 
+None of the participants had to be excluded for these reasons. The 
+study was approved by the Institutions’ ethics committees of the (i) 
+Indian Council of Medical Research Center for Advanced Research 
+(ICMR-CAR), and (ii) the National Institute of Mental Health and 
+Neurosciences (NIMHANS), both located in Bangalore in south 
+India. Signed informed consent was obtained from all the participants 
+following the guidelines of the Indian Council of Medical Research.
+Intervention
+During the fMRI recordings, the participants were asked to practice 
+the control and the three meditation sessions in the following order 
+i.e., random thinking, non-meditative focused thinking, meditative 
+focusing, and effortless meditation or pure meditation, each lasting for 
+2 min. The oral instructions were given from the control room through 
+noise-canceling electrostatic headphones.
+Random thinking
+Participants were asked to keep their eyes closed and allow 
+their thoughts to wander freely as they listened to a compiled audio 
+CD consisting of brief periods of conversation, announcements, 
+advertisements and talks on diverse topics recorded from a local radio 
+station transmission. These conversations were not connected and 
+hence it was thought that listening to them could induce a state of 
+random thinking.
+Non-meditative focused thinking (FT)
+Participants were asked to keep their eyes closed and listened to a 
+pre-recorded lecture on concepts of meditation. This was intended to 
+induce a state of non-meditative focusing.
+Meditative focusing (MF)
+During training participants were asked to open their eyes and 
+gaze at the Sanskrit syllable ‘Om’ as it is written in Sanskrit. However 
+in the scanner they were asked to keep their eyes closed. During this 
+time guided instructions through a pre-recorded audio tape required 
+them to direct their thoughts to physical attributes of the syllable, i.e., 
+the shape, the size and the color. The main emphasis during meditative 
+focusing was that thoughts are consciously brought back if they wander 
+to the single thought of ‘Om’.
+Effortless meditation or pure meditation (ME)
+During this session participants were instructed to keep their eyes 
+closed and dwell on thoughts of ‘Om’
+, particularly on the subtle (rather 
+than physical) attributes and connotations of the syllable. This would 
+gradually allow the participants to experience brief periods of silence, 
+which they reported after the session.
+Variables
+Experienced meditators (n = 10)
+Less experienced meditators (n = 16)
+Education 
+A minimum of 17 years
+A minimum of 17 years
+Age (mean ± S.D)
+37.7 ± 13.4 years
+23.5 ± 2.3 years
+Gender (M/F)
+9 /1 
+16/0
+Meditation practice (minutes/day)
+180 
+40 
+Meditation practice (total number of months)
+84 
+18 
+Hours of meditation (total hours)
+6084 
+288 
+Table 1:  Baseline Characteristics of the Experienced and Less Experienced Meditators.  Values are Group Mean.
+Citation: Telles S, Singh N, Naveen KV, Deepeshwar S, Pailoor S, et al. (2015) A FMRI Study of Stages of Yoga Meditation Described in 
+Traditional Text. J Psychol Psychother 5: 185. doi: 10.4172/2161-0487.1000185
+Page 3 of 6
+Volume 5 • Issue 3 • 1000185
+J Psychol Psychother
+ISSN: 2161-0487 JPPT, an open access journal 
+Design
+A block design was used. The paradigm consisted of two repeat 
+sessions of 8 minutes duration. The session was repeated on another day 
+at the same time of the day. Each session had 4 blocks corresponding to 
+Random Thinking (RT), Focusing (FC), Meditative Focusing (MF) and 
+‘pure’ Meditation (ME) in a fixed sequence, for 120 seconds per block, 
+20 dynamic scans per block (20 × 4 = 80 dynamic scans in one session); 
+hence in total 160 dynamic scans from the 2 sessions were used for 
+analysis. Participants had been informed that a simple instruction to 
+change their mental state would be given using the intercom to avoid 
+their getting startled.
+The sequence (i.e., RT-FC-MF-ME) was fixed. The fact that it 
+was not randomized is a disadvantage of the study. However (i) this 
+sequence is pre-determined in the traditional descriptions [9], and 
+(ii) participants had been trained to follow a fixed sequence during 
+familiarization sessions in the scanner environment.
+For one month prior to the experiment the participants were trained 
+to meditate in a fabricated ‘simulated scanner’ which was a cylinder 
+of comparable dimensions. During this time the participants were 
+required to listen to pre-recorded ‘scanner noise’ which was recorded 
+during actual acquisition. These familiarization sessions were of the 
+same duration as the actual recording sessions. The practice session 
+included two trials : that is 2 minute sessions for each of the 4 states, 
+practiced in 16 minute sessions, 5 days a week during the month.
+Assessments
+Functional image data acquisition and reduction
+MRI scanning was conducted using a 3.0-Tesla Phillips-MRI head 
+scanner with an 8 channel head frequency coil. To minimize motion 
+artifact the participants’ head was padded with foam coil. Functional 
+images were acquired in 160 slices rotated about 30o above the anterior-
+posterior commissure (AC-PC) using a T2*-weighted EPI pulse 
+sequence (repetition time, TR=3000; echo time, TE=35;flip angle, 
+FA=90°;field of view, FOV=230×230×128 mm; slice thickness = 8mm, 
+with 0mm slice gap). The 30oline offset was intended to reduce signal 
+loss due to susceptibility artifact in the orbito-frontal cortex [15]. Scan 
+acquisition was time-locked to the onset of each trial. Before functional 
+scanning, a T1-weighted MP-RAGE high resolution 3D anatomical 
+image was acquired. There were 160 slices, 1 mm thick; TR=8.1 ms; 
+TE=3.7 ms; FA=90°; FOV=240×240×160 mm. The purpose was to 
+evaluate structural abnormalities (there were none) and to allow for 
+transformation of functional data into standard reporting space for 
+spatial normalization [16]. With the block design paradigm used, 
+which is detailed above and in Figure 1,160 dynamic scans from the 2 
+sessions were obtained.
+Imaging data were processed using Brain Voyager (BVQX 2.1; 
+Brain Innovation, Maastricht, The Netherlands). Preprocessing 
+included (i) 3-D motion correction using trilinear interpolation, (ii) 
+Figure 1: Experienced meditators (n = 10): Areas showing supra threshold activation in right middle temporal cortex, right inferior frontal cortex and left orbital gyrus in 
+meditation  (p < 0.05, t-tests for unpaired data Bonferroni adjusted following one-way ANOVA).
+Citation: Telles S, Singh N, Naveen KV, Deepeshwar S, Pailoor S, et al. (2015) A FMRI Study of Stages of Yoga Meditation Described in 
+Traditional Text. J Psychol Psychother 5: 185. doi: 10.4172/2161-0487.1000185
+Page 4 of 6
+Volume 5 • Issue 3 • 1000185
+J Psychol Psychother
+ISSN: 2161-0487 JPPT, an open access journal 
+slice-scan time correction to temporally realign the slices, (iii) spatial 
+smoothing using a 3D 6mm full width at half maximum (FWHM) 
+Gaussian filter, (iv) voxel-wise linear detrending, and (v) temporal 
+filtering of frequencies below 3 cycles per time course to remove low 
+frequency non-linear drifts. Registration of the functional images to 
+anatomical volumes was completed with standard BVQX methods. 
+For group-wise analysis, spatial normalization of functional images 
+was carried out by scaling the functional images into standard 
+Talairach space.
+Self–Report of Meditation on Visual Analog Scales (VAS)
+At the end of each session participants were asked to rate the extent 
+that they felt they were able to follow instructions on a liner continuous 
+scale from 0 to 10, where 0 meant ‘not being able to at all’ and 10 meant 
+‘being able to do so perfectly’
+.
+Data Analysis
+Imaging data were analyzed using whole brain voxel-wise statistical 
+tests (Brain Innovation Version 2.1, The Netherlands). The Talairach 
+Client (Version 2.4.3) was used to assign Talairach atlas 3D co-
+ordinates and overlay statistical maps onto the reference anatomical 
+image, transformed as standard reporting co-ordinates.
+A General Linear Model was applied for group whole-brain 
+analysis. Following separate one-factor ANOVAs for each of the two 
+groups, separate t-tests were carried out to compare overlay values 
+of (i) Focused attention (FA), (ii) Meditative Focusing (MF), and 
+(iii) Pure Meditation (ME), where each of them were compared with 
+Random Thinking (RT) for comparison, and for any change. The level 
+of significance was p < 0.01 with a cluster threshold of 10. Comparisons 
+were made with t-tests which were Bonferroni adjusted or FDR 
+corrected to reduce Type I errors
+Results
+(i)	 Self-rated ability to switch between states on the VAS: All 
+participants rated their ability to switch between states as 7 or 
+more on the 10 point scale, where 0 meant ‘not able to switch at 
+all’ and 10 meant ‘able to switch perfectly without any difficulty 
+at all’ [17]. There was no further analysis performed on the self-
+reports,
+(ii)	The imaging data of the two sets of participants, (a) experienced 
+meditators with 6048 hours of meditation practice, and (b) the 
+less experienced meditators with 288 hours of experience of 
+meditation practice:
+Experienced meditators
+	 The 10 experienced meditators showed a significant change in the 
+comparison between pure meditation (ME) and random thinking (RT) 
+(p = 0.049, one tailed); One Factor ANOVA followed by Bonferroni 
+adjusted t tests). Areas showing supra-threshold activation are 
+mentioned in Table 2 and shown in Figure 1. 
+Less experienced meditators
+There were no significant areas of activation for the three 
+comparisons, which is (i) RT with FA, and (ii) RT with MF and (iii) 
+RT with ME (p > 0.05); One Factor ANOVA after Bonferroni adjusted 
+t tests. 
+Discussion
+Meditators with a total of 6048 (7 years) of experience of meditation 
+on the Sanskrit syllable “Om’ showed significant activation in the right 
+medial temporal cortex (rMTG), right inferior frontal cortex (rIFG), 
+and left orbital gyrus (LOG) during the stage of effortless or “pure” 
+meditation. The comparison was with a period of random thinking. 
+There were no changes during meditation with focusing or during 
+focusing alone compared to random thinking.
+In the present study the activation was observed in the right middle 
+temporal cortex and right inferior frontal cortex which has been 
+observed in earlier studies on meditation [18]. The medial temporal 
+cortex is known to be involved in cognition and specifically in memory 
+processing [19,20]. Other aspects of cognition required for memory such 
+as attentional control are regulated by the inferior frontal gyrus [21,22]. 
+Multichannel EEG of an advanced meditator during four different 
+meditations using Low Resolution Electromagnetic Tomography 
+(LORETA) was carried out. Functional images showed activation 
+in the right fronto-temporal region along with other areas. The right 
+fronto-temporal areas are considered to be involved in self-induced 
+meditational dissolution and reconstitution of the experience of the self. 
+Hence the results of the present and the earlier study [18] suggest that 
+meditation activates brain areas concerned with self-representation. 
+While the LORETA study [18] demonstrated activity in the right 
+fronto-temporal region, the present study showed activity specifically 
+in the right inferior frontal cortex. These results are comparable with 
+an eLORETA study. Here eLORETA was used to compare differences in 
+cortical source activity in intermediate (average experience 4 years) and 
+advanced (average experience 30 years) Australian meditators of the 
+Satyananda Yoga tradition [23]. Assessments were made during a body 
+steadiness meditation, mantra meditation and non meditation mental 
+calculation. Across all conditions differences were greatest in the same 
+regions as the present study which included the right inferior frontal 
+gyrus, and right anterior temporal lobe.
+The above studies [18,23] demonstrated changes in the right inferior 
+frontal gyrus and temporal region. The activation of the rMTG reported 
+in the present study is in contrast to the findings of a report [24] which 
+measured the performance of participants during an fMRI adapted 
+Stroop word-color task. The comparison was between meditators and 
+non-meditators. The Stroop task performance was comparable for the 
+two groups. The MTG among other regions showed greater activity 
+in the non-meditators than meditators during the incongruent task 
+condition. The absence of activity during meditation in these areas 
+was considered to suggest that meditation improves efficiency possibly 
+through sustained attention and impulse control. The fact that the 
+Sl. No.
+Activation Area
+Brodmann Area
+L/Ra
+Talaraich Coordinatesb (mm)
+t-test
+X
+Y
+Z
+p - valueb (uncorrected)
+Bonferroni corrected
+Right middle temporal cortex (rMTC)
+37
+R
+66
+-54
+0
+p < 0.000002
+p < 0.049
+Right inferior frontal cortex (rIFC)
+44, 45 and 47
+R
+-48
+14
+18
+p < 0.000002
+p < 0.049
+Left lateral orbital gyrus (LOG)
+11
+L
+6
+42
+-21
+p < 0.000002
+p < 0.049
+aLeft or Right Hemisphere
+bFrom the atlas of Talairach and Tournoux (1988)
+Table 2: Areas of Activation and Talairach Coordinates in the Comparison Between Random Thinking and Pure Meditation
+Citation: Telles S, Singh N, Naveen KV, Deepeshwar S, Pailoor S, et al. (2015) A FMRI Study of Stages of Yoga Meditation Described in 
+Traditional Text. J Psychol Psychother 5: 185. doi: 10.4172/2161-0487.1000185
+Page 5 of 6
+Volume 5 • Issue 3 • 1000185
+J Psychol Psychother
+ISSN: 2161-0487 JPPT, an open access journal 
+middle temporal gyrus was activated during pure meditation (ME) in 
+the present study could be related to the fact that in this state attention 
+was maintained on the object of focus without effort. The findings of the 
+present fMRI study may be correlated with a morphometry assessment 
+of cortical thickness in Brain Wave Vibration (BWV) meditation [25], 
+a practice intended to increase awareness. Among other areas the 
+meditators showed greater cortical thickness in the temporal cortex 
+[25]. The regions with greater thickness were considered to be involved 
+in internal mentation or attention that is detached from the external 
+world [26]. While the present study demonstrated significantly greater 
+activation in the right middle temporal cortex based on functional 
+neuroimaging, structural cortical thickness mapping and diffusion 
+tensor imaging showed greater cortical thickness in 46 experienced 
+meditators compared with 46 matched meditation naïve volunteers in 
+several brain areas including the middle temporal cortex [25].
+The increased activation in the inferior frontal cortex in the present 
+study has been reported in another neuroimaging study on meditation 
+[27]. When two meditation techniques, a ‘focused based’ practice and 
+a ‘breath based’ practice were studied, a strong correlation was found 
+between the depth of meditation and activation in several areas of the 
+brain including the inferior frontal cortex and temporal pole [28]. 
+In the present study the increased activation of the lateral orbital 
+gyrus during meditation may be associated with certain changes in 
+mental attitude. The LOG is associated with specific personality traits 
+including Machiavellian scores [29,30]. The Machiavelli personality 
+is described as unemotional and detached from social morality for 
+personal benefits. During meditation there is a possibility of attaining 
+a mental state detached from all thoughts unrelated to meditation 
+[31]. The activation of the LOG during ME suggests detachment 
+which is ideal in meditation provided it co-exists with empathy, social 
+consciousness and compassion. Also the orbital gyrus is considered 
+to have a role in processing changes in reward related information 
+[32]. Meditation could possibly influence factors involved in reward 
+gratification with a detached attitude. 
+In meditation the ability to voluntarily shift from normal 
+consciousness to meditation is enhanced. Thirty one meditators with 
+meditation experience between 1.5 and 25 years were assessed using 
+a block on-off design with 45 seconds alternating epochs. During the 
+onset of meditation and normal relaxation SPM and ICA analysis 
+showed activation in multiple regions in the frontal, temporal, parietal 
+and limbic areas which was presumed to constitute a combination 
+of fronto-parietal and cingulo-oppicular activation [33]. The block 
+design in the present study which required practitioners to switch 
+between random thinking and the three stages of meditation within a 
+short period suggests that experienced meditators were able to change 
+from non-meditation to meditation even though this was assessed 
+subjectively without any biological marker.
+ It was also found by the study of Thomas et al. [23] that the networks 
+greatly expanded during meditation practice to include homologous 
+regions of the left hemisphere. It may be speculated that this may be 
+true for the present study as well. Hence the apparent restriction of 
+activation to the right hemisphere may be a partial result with the actual 
+activation involving an extended network within the brain. 
+The absence of changes in the less experienced meditators is 
+possibly related to their shorter duration of meditation experience, 
+rather than to other differences between the groups such as the age. 
+This is supported partly by a single study [34] which did not find any 
+difference in self-focused attention between two groups whose mean 
+age differed by 10 years. However the contribution of the difference in 
+ages cannot be entirely ruled out. 
+The present study has certain unique features, particularly the 
+attempt to study changes in the brain during meditation as described 
+in traditional texts. This description does not specify a particular 
+object or mantra, but describes a process to direct attention which 
+can be used across different meditation techniques. The findings are 
+limited by factors such as (i) the fixed sequence in the block design 
+even though the stages of meditation are sequential, (ii) the absence of 
+a group of non-meditators, (iii) the experienced meditators’ ages varied 
+considerably, though their experience and intensity of meditation 
+experience was comparable and (iv) the self-reports of efficacy to shift 
+from state to state could have been influenced by subjectivity and the 
+short time intervals of each block (2 minutes) made it all the more 
+necessary to check this.
+Conclusion
+In conclusion, the present results showed that there are differences 
+during effortless or ‘pure’ meditation as described by traditional yoga 
+texts compared to random thinking, involving activation of areas 
+involved in semantic cognition, memory, sustained attention, creativity 
+and the ability to detach mentally.
+Acknowledgement
+The authors gratefully acknowledge the funding from the Indian Council of 
+Medical Research (ICMR), Government of India, as part of a grant for a Center 
+for Advanced Research in Yoga and Neurophysiology (CAR-Y&N), (Project No. 
+2001-05010).
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+A FMRI Study of Stages of Yoga Meditation Described in Traditional Text. J 
+Psychol Psychother 5: 185. doi: 10.4172/2161-0487.1000185
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yogatexts/A Holistic Antenatal Model Based on Yoga, Ayurveda, and Vedic Guidelines.txt

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+Health Care for Women International, 36:256–275, 2015
+Copyright © Taylor & Francis Group, LLC
+ISSN: 0739-9332 print / 1096-4665 online
+DOI: 10.1080/07399332.2014.942900
+A Holistic Antenatal Model Based on Yoga,
+Ayurveda, and Vedic Guidelines
+ABBAS RAKHSHANI and RAGHURAM NAGARATHNA
+Department of Life Sciences, Svyasa University, Bengaluru, India
+AHALYA SHARMA
+Shalya Tantra (Ayurveda Surgery), Government Ayurvedic Medical College, Mysore, India
+AMIT SINGH and HONGASANDRA RAMARAO NAGENDRA
+Department of Life Sciences, Svyasa University, Bengaluru, India
+The prevalence of pregnancy complications are on the rise globally
+with severe consequences. According to the World Health Organi-
+zation (WHO, 2009), every minute, at least one woman dies and
+20 are affected by the complications related to pregnancy or child-
+birth. While the root cause of pregnancy complications is unclear, it
+likely has physical, psychological, social, and spiritual aspects. The
+Vedas are a rich source of antenatal health care guidelines in all
+these aspects. The primary objective of the authors was to compile
+the scriptural and scientific evidence for a holistic antenatal model
+of yoga with emphasis on sociocultural Indian practices.
+Millions of women globally suffer from some form of pregnancy complica-
+tion each year (World Health Organization [WHO], 2009). While scientific
+advances in antenatal health care have saved many lives with reduced ma-
+ternal and infant mortality (Seibel, Kiessling, Bernstein, Bernstein, & Seibel,
+1993), they have not been able to explain the root cause of pregnancy
+complications and, as a result, the prevalence of these disorders is on the
+rise (Narendran, Nagarathna, & Nagendra, 2008). Maternal stress has been
+implicated as a contributing factor to the etiology of many complications
+of pregnancy (Zamorski & Green, 1996). Yoga has been shown to reduce
+maternal stress and improve pregnancy outcomes (Rakhshani et al., 2012).
+Received 20 September 2012; accepted 2 July 2014.
+Address correspondence to Abbas Rakhshani, Department of Life Sciences, Svyasa Uni-
+versity, #19, Eknath Bhavan, Gavipuram Circle, Kempe Gowda Nagar, Bengaluru 560018,
+India. E-mail: [email protected]
+256
+Holistic Antenatal Model
+257
+Based on previous studies, the authors believe that a holistic model based
+on the yogic and Ayurvedic guidelines can be effective in the management
+of low-risk and high-risk pregnancies.
+A pregnancy complication is defined as a problem that arises during
+pregnancy and can potentially put the health of the mother, fetus, or both
+at risk (Beers, Fletcher, Jones, & Porter, 2003). According to the WHO, more
+than 20 million pregnant women worldwide annually suffer from at least
+one obstetric complication of pregnancy (WHO, 2009), excluding Caesarean
+section; with miscarriage, preterm deliveries, low birth weight, and fetal de-
+formities being the most prevalent (Porter, 2009). While the root causes of
+these disorders are not clear, maternal stress has been shown to play a
+major role in their development (Roy-Matton, Moutquin, Brown, Carrier, &
+Bell, 2011). Maternal stress has been shown to adversely affect pregnancy
+outcomes (Zamorski & Green, 1996). In fact, several studies have reported
+that events in the maternal environment will filter through the placental
+barrier and can affect the development of the placenta (Grammatopoulos,
+2008; Hecht et al., 2008). Furthermore, there is now mounting evidence that
+maternal stress can not only increase the risk of morbidity and premature
+mortality (Pinar & Carpenter, 2010) but it can also predispose the affected
+individuals to diseases over the course of their lives (Li & Wi, 1999). In
+addition to maternal psychological stress, poor diet and sedentary lifestyle
+of the mother has been linked to increased risk of complications during
+pregnancy (Krishna & Harigopal, 1979; Saraswati, 2008). Additionally, ma-
+ternal diet has been shown to influence fetal growth (Drake et al., 2012).
+Therefore, maintaining a good regime of diet, exercise, and a lifestyle that
+promotes minimum psychological stress for the mother can be a prelude to
+a successful pregnancy.
+Yoga, a 5,000-year-old Indian practice, is a holistic approach that pro-
+motes physical, mental, and spiritual well-being in practitioners (Bijlani,
+2008). A recent review has enlisted the potential positive effects of yoga
+during pregnancy (Babbar, Parks-Savage, & Chauhan, 2012). Yoga has been
+shown to reduce perceived pain (Reis, 2012), improve sleep efficiency (Bed-
+doe, Lee, Weiss, Kennedy, & Yang, 2010), promote shorter duration of
+labor (Chuntharapat, Petpichetchian, & Hatthakit, 2008), and improve ma-
+ternal quality of life (Rakhshani, Maharana, Raghuram, Nagendra, & Venka-
+tram, 2010). The Integrative Approach of Yoga Therapy (IAYT) is a set of
+yoga modules to address many lifestyle-related health conditions. In low-
+risk pregnancy, IAYT has been shown to improve pregnancy outcomes
+(birthweight and APGAR scores) and reduce the frequency of occurrence of
+pregnancy complications, including pregnancy-induced hypertension (PIH),
+intra-uterine growth restriction (IUGR), and small for gestational age (SGA;
+Narendran, Nagarathna, Narendran, Gunasheela, & Nagendra, 2005b). In
+high-risk pregnancy, yoga has been shown to dramatically reduce incidence
+of hypertension-related complications, improve pregnancy outcomes, and
+258
+A. Rakhshani et al.
+promote the health of the fetus (Rakhshani et al., 2012). An important
+observation in the latter study was that participants were inclined to go
+to their hometowns at the first sign of any complication, and more so at the
+time of delivery. Further inquiry revealed that these tendencies were woven
+into the fabric of the Indian culture and perhaps into many other cultures
+around the globe. The importance of local traditions to modern clinical trials
+is another reason for the development of this model.
+Sociocultural factors play an important role in increasing maternal stress
+during pregnancy. Through millenniums, Indian traditions have evolved to
+reduce such stress and promote well-being in the mother and her fetus
+(Pandey, 2002). The focus continues after the child is born and throughout
+his or her life (Pandey, 2002). In fact, Indian beliefs are based on the ide-
+ology that life is a precious gift from God and it should be celebrated, at
+every stage, from conception to death (Tull, 2008). From this social point of
+view, a baby is the product of that sacred union, and, therefore, it is con-
+sidered a divine gift. It is not then surprising that there are numerous rituals
+centered around marriage and pregnancy in the Indian traditions. These rit-
+uals, often referred to as Samsk¯
+aras (a word which literally means “making
+complete”) in the Vedic literature, are meant to infuse divinity at every step
+of the reproductive process (Tull, 2008). Such rituals are not exclusive to the
+Indian traditions though. Nearly every culture around the globe has strong
+established rituals for marriage, pregnancy, and birth (Hamon & Ingoldsby,
+2003).
+The primary objective of the authors was to formulate a potential com-
+prehensive and holistic antenatal health care model that can provide guide-
+lines: (a) for design of future studies in this important area, and (b) for
+providing sustainable and effective health care to pregnant women. The
+model takes into account previous studies involving yoga and nutrition dur-
+ing pregnancy, as well as the related Vedic scriptures and the Indian ritu-
+als, Samsk¯
+aras, that may be of value for timing the interventions. Although
+the social and spiritual aspects of the model are geared toward the Indian
+traditions and philosophies, practices from other traditions could easily be
+incorporated into the model without affecting the other elements of it.
+Health From the Modern Medicine Point of View
+The WHO defines health as “a state of physical, mental, social and spiritual
+well-being, and not merely the absence of disease or infirmity” (Larson, 2006,
+p. 181). We chose this definition as the framework to develop this holistic
+antenatal model.
+Health From the Vedic Point of View
+From the Vedic point of view, the physical body is the grossest part of
+the human existence. There are also other metaphorical bodies, sometimes
+Holistic Antenatal Model
+259
+FIGURE 1 Effects of lifestyle stress versus yoga on health.
+Note: The yogic practices and lifestyle stress have opposing effects on the different ko´
+sas. The
+negative impact of the lifestyle stress has been illustrated in this figure by uneven arrows.
+called ko´
+sa (
+) or sheaths, that are more subtle than the physical body
+but play equally important roles in our emotional, mental, and spiritual well-
+being (Rakhshani, 2013). Including the physical body, there are a total of
+five ko´
+sas that are collectively referred to as pancha ko´
+sas (
+). Yoga
+seeks the root causes of illnesses within the four subtle bodies, believing
+that the diseases of the physical body are manifestations of disturbances in
+those metaphorical layers (Rakhshani, 2013). Table 1 outlines the different
+bodies and their primary functions.
+Manomaya ko´
+sa is of particular importance in maintaining optimum
+health. Disturbances in this ko´
+sa, due to lifestyle stress or past traumas,
+interfere with the flow of prana in pranamaya ko´
+sa, which ultimately result in
+failure of a particular weak organ in the annamaya ko´
+sa. Such disturbances
+can also affect the vijnanamaya ko´
+sa and distort viveka (discrimination),
+which in turn blocks proper contacts with the anandamaya ko´
+sa (blissful
+state). Figure 1 shows this interaction graphically.
+Embryology From the Vedic and Modern Standpoints
+The classic Ayurvedic literature describes the fertilization process, under the
+heading of “S¯
+ar¯
+ira Sth¯
+ana.” These texts also give details on the composition of
+the matter based on the following five elements that constitute the universe
+outside and inside of the body: (a) earth (prthvi = solid), (b) fire (agni =
+heat), (c) water (ap = fluid), (d) air (vayu = movement), and (e) space
+(aakasa). The Vedic literature gives a particular emphasis on the role of vayu
+in the conception and development of an embryo since vayu controls the
+mind. For that reason, anxiety, stress, and other emotions could potentially
+interfere with conception (Bhishagratna, 1991). Of all the factors stated for
+260
+A. Rakhshani et al.
+TABLE 1 Ko´
+sas and Their Primary Characteristics
+Ko´
+sa1,2
+Description
+Annamaya ko´
+sa
+“Anna” means food. This physical body needs food as its
+nourishment “annadhyeva khalvimani bhut¯
+ani jayante”
+(everything is born out of physical matter); “annena jat¯
+ani
+jivanti” (they live because of anna); “annam prayanti
+abhisa ˙
+mvisanti” (they merge into anna); and “j¯
+atanyannena
+vardhante” (they grow because of anna).3 If this ko´
+sa is
+neglected, improvement in other ko´
+sa become difficult if not
+impossible.
+Pranamaya ko´
+sa
+“Pr¯
+ana” means vital energy. It refers to the energy that is
+responsible for the physiological activities of all living cells. Five
+sections of the main pr¨
+a¨
+ea manage the functions in five zones:
+pr¯
+ana (respiration and special senses), ap¯
+ana (defecation,
+micturition, menstruation, etc), sam¯
+an¯
+a (digestion), vy¯
+an¯
+a (touch
+sense, circulation of fluids all over etc), and ud¯
+ana (thinking,
+belching, vomiting, etc).4 pr¯
+ana circulates through an intricate
+and invisible system of pathways called nadis. The main three
+nadis are ida, pi`
+ıgal¯
+a, and c
+¸uc
+¸uman¨
+a in the spine. They branch
+out to about 72,000 nadis throughout the body. The ida and
+pi ˙
+ngal¨
+a channels correlate with the left and right nostrils, making
+it possible to manipulate pr¯
+ana through controlled breathing.
+Manomaya ko´
+sa
+“Manah” means mind. This ko´
+sa is the seat of perception and
+emotions. Using the five senses, information is acquired to create
+a perception of the world outside and then used to prepare
+appropriate emotional responses to those perceptions.
+Vijnanamaya ko´
+sa
+“Vji˜
+n¯
+ana” means knowledge. This is the seat of wisdom that
+facilitates the thinking process of the mind. Utilizing this faculty,
+we are able to discriminate right from wrong and make
+appropriate judgments (viveka) for a healthy lifestyle. More
+significantly, this is the place of intuition that is used when
+analytical process fails to guide us.
+Anandamaya ko´
+sa
+“¯
+ananda” means bliss. This forms the unchanging template of
+(existence, consciousness, and bliss) of our being on which the
+other ko´
+sas carry on their activities. This is also the basic stuff of
+this entire creation. ¨
+anandamaya ko´
+sa is experienced as a
+blissful ecstatic state of pure awareness when all mental activity
+ceases. The main approach of yoga therapy as a mind-body
+medicine is to maintain the practitioner in this state that is
+regarded as a state of perfect health.
+1The bodies are listed from the grossest, the physical body, to the subtlest, the bliss body.
+2‘Maya’ means illusion. Therefore, all these five bodies must be conquered by the spiritual practitioner of
+yoga in order for he or she to realize the nature of his soul, which sits beyond these illusions.
+3Taittiriya upanis
+.ada 3.2.
+4Reference to the pancha pranas appears in several scriptures; including Mahabharata and Shikshavalli
+Upanishad.
+conception, therefore, Saumanasya (happiness/tranquility of mind) of the
+mother is considered to be the most important factor (Sharma & Bhagwan,
+1992). The unborn child is also said to emulate the nature of the maternal
+mindset during fertilization (Sharma & Bhagwan, 1992).
+Holistic Antenatal Model
+261
+The Garbha or embryo is described in the Vedic literature as the union of
+the sperm, the ovum, and the soul in the womb. First, the conscious element
+(i.e., the soul) endowed with mental faculty, unites with the mahabhutas
+(maha means great and bhutas means elements; the term refers to the five
+great elements: ether, air, fire, water, and earth) in a fraction of a second.
+This would be a Vedic explanation for the reason why in-vitro fertilization
+fails so often. The embryo also requires the maternal and paternal factors:
+saatmya (wholesomeness), rasa (digestive product of mother’s food), and
+mind (Bhishagratna, 1991). The mind is said to propel the jeeva (soul) into
+the uterus impelled by the deeds of previous lives.
+The Bh¯
+agavata Pur¯
+ana states the concept of conception in canto 3, chap-
+ter 31, verse 1, as, “The living entity, the soul, is made to enter into the womb
+of a woman through the particle of male semen to assume a particular type
+of body (
+)”
+(Gupta & Valpey, 2013). This concept parallels science’s view that the sper-
+matozoon joins the oocyte in the uterine tube to form a zygote. In the
+following verse, the next development of the embryo is explained:
+The sperm and the ovum mix on the first night and by the fifth night,
+the union looks more like a bubble, which gradually turns into a lump
+like a plum by the tenth night and later into an egg. (
+)
+Once again, an unprecedented description of mitosis is put forward. The
+zygote becomes a morula (of 12 to 16 cells) after 5 nights and then develops
+into a blastocyst with a fluid-filled center (just like a bubble) in 10 days (The
+Endowment for Human Development, 2010). The accuracy of this develop-
+ment is uncanny and clearly shows the ability of the seers to visualize the
+process through meditation since there were no other means to do so at that
+time. The next verse further explains the organ development of the embryo
+in the first trimester:
+By the end of the first month, the head is formed and by the end of
+the first three months, the hands and the feet are formed along with
+the nails, fingers, toes, body hair, and the bones. By this time, the
+skin appears, as do the organ of generation and the other apertures
+in the body, namely the eyes, nostrils, ears, mouth and anus. (
+)
+Once again, this passage mirrors discoveries of modern science with amazing
+accuracy. Indeed, the formation of the brain starts at the very early stages
+of embryo development. Between the fourth and fifth weeks of pregnancy,
+the head has developed to a much larger size compared with the rest of
+262
+A. Rakhshani et al.
+the body, giving the embryo the look of a tadpole (The Endowment for
+Human Development, 2010). In the same line, the next few verses describe
+the growth of the organs formed in the first trimester.
+The Sixteen Samsk¯
+aras
+It is important to point out that the role of women in Hindu society is
+complex due to its dual nature. On one hand, they are viewed as fertile and
+compassionate caregivers, but, on the other hand, they can be viewed as
+hostile and overprotective (Wadley, 1977). A woman’s overemphasized role
+as a caregiver may be the primary cause of her aggressiveness toward people
+whom she suspects may want to hurt her family physically, financially, or
+socially. A point of particular concern to her is an “evil eye” (or evil spirit)
+that envies her life and wants to damage it through negative energy. Part
+of the childbearing rituals are concerned with repelling such external forces
+(Jacobson & Wadley, 1992) through mantras and divine offerings, which are
+believed to ensure normal progression of the different stages of pregnancy
+and provide the mother with the necessary social acceptance. Table 2 lists
+the 16 most frequently practiced Samsk¯
+aras in India. Here, we shall very
+briefly describe only the first four, which are relevant from the point of
+conception through delivery of the newborn.
+First
+Samsk¯
+ara:
+Garbh¯
+adh¯
+ana
+(
+)—The
+conception
+ritual.
+“Garbha” means womb, and “adaana” means donation (Dasji, 2010). There-
+fore, the term “Garbhadana” literally means donation to the womb (Alter,
+1997). In India, the procreation of offspring is regarded as necessary for
+paying off debt to the forefathers (Dasji, 2010).
+Second Samsk¯
+ara: Pu ˙
+msavana (
+)—The ritual for seeking a male
+offspring.
+Pumsavana literally means engendering a male offspring. Tradi-
+tionally, male offsprings have been preferred since they maintain the conti-
+nuity of the family lineage (Pandey, 2003). Also, sons are required to perform
+the necessary cremation rituals that guarantee a safe passage for the father
+and the mother after they leave this world (Pandey, 2003). Some authors,
+however, have distanced themselves from the gender connotation of this
+Samsk¯
+ara and have interpreted it as a ritual to secure a child full of vi-
+tality (Tambe, 2011). After Garbhadhan Samsk¯
+ara, and when symptoms of
+pregnancy have manifested, the Pumsavana Samsk¯
+ara is performed, usu-
+ally during the second month of pregnancy when the moon is in a male
+constellation. Pumsavana and Simantonyana (the third Samsk¯
+ara) are only
+performed during a woman’s first pregnancy (Dasji, 2010). During the cer-
+emony, the pregnant woman consumes one bead of barley and two beads
+of black grain, along with a little curd (Dasji, 2010). This is accompanied by
+a Homa (a fire ritual, where offerings are given to the deities through fire)
+and chanting of the following by the acharya (the priest; Dasji, 2010): “The
+Holistic Antenatal Model
+263
+TABLE 2 The 16 Samsk¯
+aras
+Samsk¯
+ar¯
+a (
+)
+Pregnancy stage
+Description
+1
+˙
+garbh¯
+adh¯
+ana
+Prior to conception
+The ritual of conception
+2
+pu ˙
+ms¯
+avana
+During pregnancy
+The ritual of seeking a male child
+3
+s¯
+imantonnayana
+During pregnancy
+The ritual for safe delivery
+4
+jat¯
+akarma
+At birth
+The ritual to purify the newborn
+5
+n¯
+amakara¨
+eam
+After birth
+The naming ceremony
+6
+niskrama¨
+eam
+After birth
+The first outing ceremony
+7
+annaparasana
+After birth
+The first solid food feeding ceremony
+8
+c¯
+ud
+. ¯
+akaran
+. am
+After birth
+The tonsure ceremony
+9
+karnabhedhah
+.
+After birth
+The ear piercing ceremony
+10
+vidy¯
+arambhah
+.
+Childhood
+The education ceremony
+11
+upanayanam
+Childhood
+The sacred thread wearing ceremony
+12
+ved¯
+arambhah
+.
+Youth
+The initiation into the Vedic studies
+13
+ke´
+s¯
+antah
+Youth
+The first shaving ceremony
+14
+sam¯
+avartanam
+Adult
+The school graduation ceremony
+15
+viv¯
+ahah
+Adult
+The marriage ceremony
+16
+anty¯
+esti
+Adult
+The funeral rites
+Pumsavana Samsk¯
+ara is performed with a view that a healthy and bright
+child may born” (Dasji, 2010, p. 15).
+Third Samsk¯
+ara: S¯
+imant¯
+onnayana (
+) —A ritual for safe deliv-
+ery.
+The objective of this Samsk¯
+ara is to ensure a complication-free preg-
+nancy and a safe delivery of the child. It is usually performed in the fourth
+month of pregnancy (Pandey, 2003). First, a prayer is offered to the deities
+and, then, while combing the hair of his wife from front to back, the husband
+chants the following to protect the fetus: “I perform this Simantonnayanam
+Samsk¯
+ara to please God and for the development of the fetus of my wife
+and to remove any obstacles caused by evil spirits and to bring all things of
+prosperity [to the fetus]” (Dasji, 2010, p. 17). Finally, “other old and young
+ladies of the noble families bless the pregnant woman” (Dasji, 2010, p. 17).
+264
+A. Rakhshani et al.
+Fourth Samsk¯
+ara: J¯
+atakarma (
+) —The ritual to purify the newborn.
+Jatakarman literally means natal rites and it is similar in concept to that
+of baptizing the newborn in Christianity. This Samsk¯
+ara is performed right
+before severing the umbilical cord. Its purpose is to ensure proper intellectual
+development, adequate strength, and a long life for the newborn (Dasji,
+2010). The father places a mixture of honey and ghee on the tongue of the
+child and blesses him with the following prayer: “You [the fetus] may become
+strong like a stone. Brave against the enemies like the great sage Parshuram
+and you may remain pious forever like the gold” (Dasji, 2010, p. 18). Then
+the father cuts the umbilical cord and the child is bathed with milk to bless
+him with physical, mental, and spiritual progress. Finally, the acharya chants
+the following prayer to seal the ritual: “I perform this jatakarma Samsk¯
+ara for
+pleasing the God and to remove all kinds of obstacles produced by this child
+staying in the womb and getting nourishments from the mother through the
+placenta” (Dasji, 2010, p. 18).
+The Integrative Approach of Yoga Therapy (IAYT)
+Yoga is a holistic approach to well-being that originated in India (Bijlani,
+2008). It involves a combination of stretching, breathing, posture, and med-
+itation that promotes health and spiritual growth in the practitioners (Chan-
+dler, 2001). These techniques are lowimpact, noninvasive, and have few
+side-effects (Benson & McCallie, 1979). A growing body of research data now
+supports the use of yoga for prevention and management of chronic lifestyle-
+related ailments (Bijlani, 2008; Hanser, 2009; McCall, 2007; Taylor, 2003). The
+IAYT is a holistic approach of health management that uses kriyas, asanas,
+pranayamas, meditation, devotional chanting, and self-analysis (Narendran
+et al., 2008).
+METHODS
+An antenatal model was planned based on WHO’s definition of health and
+the Vedic perspective of well-being with a focus on Indian sociocultural
+practices (Samsk¯
+aras). The model can easily be adapted to other cultures
+and incorporate their traditions. We have adopted a systematic approach for
+the development of the model, which consists of three phases that are ex-
+plained below. Through this process, we research, collect, and put together
+guidelines from the Vedic literature, the yogic sciences, and Ayurvedic
+medicine to formulate a holistic model that addresses the well-being of
+the women physically, psychologically, emotionally, socially, and spiritually.
+Figure 2 illustrates the three developmental phases for this model.
+Procedure
+Phase 1: Compilation of the data from the literature.
+A Vedic literature
+search for the ancient pregnancy practices, which are relevant to modern
+Holistic Antenatal Model
+265
+FIGURE 2 Phases of the antenatal model development.
+medicine, was conducted and was summarized in the first section of this
+article. In this phase, the results were compiled into a table based on their
+potential applications to modern antenatal care.
+Phase 2: Compilation of the data from the field.
+The present model was
+developed by incorporating the recommendations of health practices for the
+well-being of pregnant women gathered in Phase I.
+Phase 3: Development of the antenatal model.
+The main aim of this
+phase was to collect all available evidences for the effects of these health
+practices. While there are some published data indicating the potential ben-
+efits of yoga in pregnancy, we found that the literature lacks evidence on
+the effects of another school of Indian medicine, particularly Ayurveda, that
+is widely practiced in India. Hence, Ayurvedic physicians who have adopted
+these Samsk¯
+aras in their routine practices were interviewed and the relevant
+collected data was compiled and has been presented below.
+RESULTS
+Phase 1
+Table 2 summarizes the data collected from the Vedic literature regarding
+the applicable Samsk¯
+aras.
+Phase 2
+The results of the second phase of this work are presented in Tables 3 and 4.
+The model has four domains, with the recommended practices highlighted
+under each heading. Detailed accounts of the physical, psychological, social,
+and spiritual domains are provided here.
+Physical domain.
+At the physical level, a healthy lifestyle (dinacharya)
+is recommended, which includes proper diet, cleansing techniques, and yoga
+266
+A. Rakhshani et al.
+TABLE 3 Diet During Pregnancy Based on the Yogic and Ayurvedic Principles
+Gestational age
+Diet recommendations
+First trimester
+0–4 weeks
+Non-medicated milk repeatedly, generally sweet, cold and
+liquid diet
+5–8 weeks
+Milk medicated with herbs belonging to the group of
+Madhura-aushadhi, such as kakoli (Roscaea procera), draksha
+(grapes), and yashti madhu (Glycyrrhiza glabra)
+9–12 weeks
+Milk with honey and ghee
+Second trimester
+13–16 weeks
+Butter mixed with milk (Ch.Sh.8/32), cooked Shasti rice (rice
+grown for 60 days) with curd
+17–20 weeks
+Ghee and milk
+21–24 weeks
+Milk prepared with madhura guna dravyas with ghee plus ghee
+and rice gruel medicated with Gokshura (Small caltrops)
+Third trimester
+25–28 weeks
+Ghee medicated with the drugs of pr˚
+athak parny¨
+adi (Uraria
+picta etc) group
+29–32 weeks
+Medicated oil enemas: (a) Asthapana Basti using a decoction of
+badara (jujube fruit), bal¨
+a (Country mallow), atibal¨
+a (Indian
+mallow), ´
+satapusp¯
+a (fennel), palala (pestled sesame seeds),
+milk, curd, mastu (whey/supernatant liquid of butter milk),
+oil, salt, madanaphala (emetic nut), honey and ghee, and (b)
+followed by Anuvasana Basti with ghee medicated with
+Madhura guna Dravyas mentioned above
+33 weeks to delivery
+Thick rice gruel, mixed with ghee (Yav¨
+agu)
+postures. Vedic literature emphasizes the effects of diet on the internal milieu
+of subtle energy systems (vata, pitta, kapha as described by Ayurveda or
+prana according to yoga) and the mind (Frawley, 1999).
+Rice, milk, and clarified butter (ghee) medicated with various herbs play
+a major role in the diet of a pregnant woman according to the yogic and
+Ayurvedic teachings as outlined in Table 3 (Sharma & Bhagwan, 1992). These
+medicinal herbs include those belonging to the group of Madhura-aushadhi,
+such as roscaea procera (a genus of 22 species belonging to the ginger
+family, such as kakoli, known in English as Fritillary), wild grapes (also
+known as draksha, a plant that pacifies vata and pitta; it is often used to treat
+ulcers, inflammations, fracture, dysentery, diarrhea, fever, poisonous bites,
+and respiratory infections), and licorice (also known in English as Tribulus
+terrestris Linn, is the root of glycyrrhiza glabra and belongs to the legume
+family) during the second month (Sharma & Bhagwan, 1992). No medicinal
+herbs are recommended during the third, fourth, and fifth months of preg-
+nancy (Bhishagratna, 1991). During the sixth month, ghee prepared with
+“small caltrops” (also known as Gokshura or Tribulus Terrestris, is believed
+to contain steroidal saponins, alkaloids, and flavanoids, and has been shown
+to improve fetal development in sheep [Walker, Bird, Flora, & O’Sullivan,
+1992] and reduce oxidative stress in rats [Kamboj, Aggarwal, Puri, & Singla,
+2011]) must be given and in the seventh month ghee made with the prithak
+Holistic Antenatal Model
+267
+TABLE 4 Antenatal Holistic Model
+Domain
+Description
+Psychological domain
+Pranayama and breathing
+practices
+Sectional breathing, nadishuddhi, Sheetali,
+bhramari, Nadanusandhana
+Kriyas
+Jala neti throughout pregnancy.
+Meditation
+Visualization, guided imagery, trataka, sectional
+breathing, nadishuddhi, Sheetali, bhramari,
+Nadanu-sandhana, Om meditation
+Social domain
+Interventions beginning prior to
+conception
+Garbhaadhaana Samsk¯
+ara for the Indian population
+and local conception traditions for the global
+population.
+Interventions during pregnancy
+Pumsavana and Simanatonnayana Samsk¯
+aras for
+the Indian population and local pregnancy
+traditions for the global population.
+Interventions after delivery
+Jatakarma Samsk¯
+ara for the Indian population and
+local birth traditions (such as baptizing) for the
+global population.
+Spiritual domain
+Jnana yoga, bhakti yoga, karma yoga, raja yoga:
+dharana, bhavana, pathana, satsanga, japa, seva,
+viveka, vairagya, and bhakti.
+parny¯
+adi group of herbs (which is said to help the fetal development accord-
+ing to the Su´
+sruta Sa ˙
+mhit¯
+a, the ancient text of Hindu system of medicine) are
+recommended (Bhishagratna, 1991). During the eighth month, the expectant
+mother is recommended to take a medicated enema (¯
+asth¯
+apana basti) of the
+decoction of jujube fruit (known in India as badara and scientifically as Zizi-
+phus zizyphus, is commonly known as red date, Chinese date, Korean date,
+or Indian date, belonging to the buckthorn family Rhamnaceae) mixed with
+country mallow (bal¯
+a), Indian mallow (atibal¯
+a), fennel (´
+satapusp¯
+a), pestled
+sesame seeds (palala), milk, curd, whey/buttermilk (mastu), oil, salt, emetic
+nut (madanaphala), honey, and ghee (Bhishagratna, 1991). This should be
+followed by a medicated oil enema (anuv¯
+asana basti), with oil prepared with
+milk and madhura gana dravyas described above (Bhishagratna, 1991). The
+pregnant woman is advised to consume rice cooked with milk and added
+ghee for the additional protein needed for the proper development of the
+fetus (Sharma & Bhagwan, 1992). Such a diet will provide proper nourish-
+ment for the annamaya kosha, enriches the pranamaya kosha, and provides
+calmness of the mind in the manomaya kosha (see Figure 1).
+Several cleansing techniques, kriyas, that are safe and useful for healthy
+progression of pregnancy and prevention of complications are incorporated
+in the model. Vamana dhouti is recommended for prevention and treatment
+of pregnancy-induced nausea and vomiting (Rao et al., 2009). Mild Kapal-
+abhati (done at a rate of 27 breaths/minute) helps in normalizing breathing
+patterns and promoting calmness of the mind during the first trimester of
+268
+A. Rakhshani et al.
+low-risk pregnancies. Jalaneti is useful to cleanse the nasal passage and may
+be safely practiced throughout high- and low-risk pregnancies.
+Yogic postures aim to achieve mastery over the fluctuations of
+the mind (
+: y¯
+oga´
+scittavrtti nir¯
+odhah; Woods, 2003). This
+is achieved by maintaining the final posture with ease and effortless-
+ness (
+prayatna ´
+saithily¯
+ananan tasam¯
+a pattibhy¯
+am;
+Woods, 2003). Yogic postures help in providing deep rest to the organs.
+The following exercises and asanas were used in high-risk pregnancies
+without any reported difficulties or safety issues (Rakhshani et al., 2012):
+p¯
+adasa˜
+nc¯
+alanam (cycling in supine pose), gulphag¯
+uranam (ankle rotation),
+j¯
+anuphalak¯
+akarsanam (kneecap contraction), ardh¯
+atitali¯
+asana (half-butterfly
+exercise), poorn¯
+atitali¯
+asana (full-butterfly exercise), jyotitr¯
+ataka (eye exer-
+cises), and matsyakr¯
+id¯
+asana (lateral shavasana). Other asanas have been
+shown to be safe in low-risk pregnancies (Rakhshani et al., 2010): tadasana
+(mountain pose), ardhakati-chakrasana (lateral arc pose), trikonasana (tri-
+angle pose), vajrasana (the ankle posture), vakrasana (spine twist pose),
+siddhasana (sage pose), Baddhakonasana (bound ankle pose), upavista
+konasana (sit with legs apart), malasana (garland pose), viparita karani (half
+shoulder stand), and ardha-pavanamuktasana (folded leg lumbar stretch).
+Breathing practices aim at reducing the breathing rate, which in
+turn calm the mind (
+´
+sv¯
+asa pra´
+sv¯
+asay¯
+orgati
+vicch¯
+edah pr¯
+an¯
+ay¯
+amah; Woods, 2003). The following breathing exercises
+were used in both high- and low-risk pregnancies (Rakhshani et al., 2010,
+2012): hasta ¯
+ayama ´
+svasanam (hands in and out breathing), hastavist¯
+ara
+´
+svasanam (hands stretch breathing), gulphavist¯
+ara ´
+svasanam (ankles stretch
+breathing with wall support), katiparivartana ´
+svsanam (side twist breathing),
+utt¯
+anap¯
+ad¯
+asana ´
+svasanam (leg raise breathing), setubandh¯
+asana ´
+svasanam
+(hip raise breathing), supta udar¯
+akarsanasana ´
+svasanam (supine abdominal
+stretch breathing), and vy¯
+aghr¯
+asana ´
+svasanam (tiger stretch breathing).
+The asanas and the breathing exercises are intended to strengthen
+the musculoskeletal system, stretch ligaments, massage organs, and bring
+oxygen-rich circulation to the various parts of the body in the annamaya
+kosha. In the pranamaya kosha, they move the prana, remove blockages in
+the nadis, and open the chakras. Finally, and most importantly, they gradu-
+ally make the mind one-pointed in the manomaya kosha (Rakhshani, 2013).
+Daily care also plays an important role in the wellness of the expect-
+ing mother. For example, after the thirty-sixthweek of gestation, Ayurvedic
+physicians recommend the following: (a) daily bathing with water boiled
+with leaves, such as those of castor bean (Eranda-Ricinus communis) and
+five-leaved chaste tree (Nirgundi-Vitex negundo), which reduce the v¨
+ata
+dosha; (b) daily massage with medicated oils (Tripathi, 2009); (c) applica-
+tion of enema (sth¯
+apan¯
+a basti) from twenty-eighth to thirty-second weeks
+followed by unctuous enema (anuvasana basti) of medicated oil with milk
+and decoction of drugs of sweet group, like madhuka (Shastri, 2009); and
+Holistic Antenatal Model
+269
+(d) insertion of vaginal tampons soaked with oil can be performed from
+thirty-sixth week onward to lubricate the cervix, the vaginal canal, and the
+perineum (Tripathi, 2009).
+Psychological domain.
+This forms the core of all practices recom-
+mended at all levels because, from the Vedic point of view, stress be-
+gins in the mind as suppressed emotions. The scriptures provide the log-
+ical steps of arriving at an understanding of the nature of any emotion
+(suppressed or expressed) and define it as “uncontrolled fast rewinding
+of thoughts in the mind” (
+k¯
+amakr¯
+odh¯
+odbhavam v¯
+egam;
+Ranganathananda, 2000). All recommended practices are meant to reduce
+stress by slowing down the mind (
+: Manah pra´
+saman¯
+op¯
+ayah).
+These include meditation of various types. Many of the recommended prac-
+tices have been used successfully as interventions in past studies (Rakhshani
+et al., 2010; Satyapriya, Nagendra, Nagarathna, & Padmalatha, 2009). The
+following pranayamas that have been used in several published studies have
+been incorporated in the model: sectional breathing, nadishiddhi, Sheetali,
+bharamari, Nadanusandhana (Satyapriya et al., 2009).
+Social domain.
+Trials targeting the Indian population should take into
+account the Samsk¯
+aras to reduce dropouts and attrition. Interventions be-
+ginning prior to conception should include marital status as part of their
+selection criteria and, in the event that unmarried couples are included,
+the Garbhadana ceremony. Astrology is the cornerstone of the Indian cul-
+ture. It would behoove the investigators, therefore, to consult with a reliable
+astrologer to find the auspicious days during the duration of the study execu-
+tion and incorporate them into the design. For example, if the interventions
+are administered during the second month of pregnancy, knowing when the
+moon is in its male constellation would allow women to anticipate the Pum-
+savana Samsk¯
+ara. Auspicious days during the fourth month of pregnancy
+would also be the time that Simanatonayan Samsk¯
+ara could be performed.
+Studies targeting other populations of the world would need to incorporate
+their own regional customs and rituals into the model.
+Spiritual domain.
+Responsibility (prabhutvam), tolerance (titiksha),
+contentment (santosha), and self-confidence (aatma vishwasah) are some of
+the essential qualities necessary for moving toward a healthy motherhood.
+Yoga is defined as “freedom” or “personal autonomy”; to be able to shift
+from established patterns of psychological responses to a desired response
+at will. To do, not to do, or to do differently is the freedom we all pos-
+sess (
+kartumakartumanyath¯
+a v¯
+a kartum ´
+sakyam;
+Badarayana, 1960). This freedom evolves by dwelling in the inner silent
+state marked by blissful awareness during yoga practices. There are numer-
+ous such practices that could be incorporated in the design of trials based
+on the teachings of the four paths of yoga, which are jnana yoga (yoga of
+knowledge), bhakti yoga (yoga of devotion), karma yoga (yoga of service),
+and raja yoga (yoga of controlling the mind): (a) dharana (concentration),
+270
+A. Rakhshani et al.
+(b) bhavana (contemplation on a deity), (c) pathana (study of the scriptures),
+(d) satsanga (being in the company of wise people), (e) japaya (chanting of
+the holy names), (f) seva (selfless service), (g) viveka (developing discrimi-
+nation between right and wrong), (h) viragia (developing dispassion toward
+the objects of the senses), and (i) bhakta (transforming hard emotions into
+soft, divine emotions, as it is said in the Narada Bhakti sutra: the purest form
+of love is devotion
+parama pr¯
+ema r¯
+upa bhaktih). Practices of
+bhakti yoga are deeply embedded in the Indian traditions starting with reg-
+ular daily worship of the personal God (ishtadevata) to special celebrations
+(Samsk¯
+aras) with intense practices (vrat¯
+as) for different phases of pregnancy.
+The abode of the mother should be well fumigated, worshiped, and have
+sound of the Vedic hymns (or other spiritual songs from other faiths) being
+recited by br¯
+ahman¯
+as (holy priests). The pregnant woman after getting up in
+the morning and performing her regular chores should be busy in worship
+of god and should do selfless service (seva; Bhishagratna, 1991). By using
+different religious icons from other faiths, these spiritual practices could be
+utilized by other studies that use yoga and Ayurveda as interventions but are
+targeting other world populations.
+DISCUSSION
+The authors’ aim was to compile the scriptural and scientific evidence for a
+holistic antenatal model of yoga with emphasis on sociocultural Indian prac-
+tices (Samsk¯
+aras). We believe that the model provides practices that promote
+positive well-being at physical, psychological, social, and spiritual levels as
+recommended by the WHO in its definition of heath and by the yogic scrip-
+tures. Except for the social elements, most of the other components of the
+model are replicable in different cultures. While many other studies have
+used various components of this model in trials conducted at different parts
+of the globe, the mechanism of action of yoga in pregnancy is not clear.
+Some speculations have been offered in the next section.
+MECHANISMS
+According to the studies we have reviewed, yoga-based therapies seem to be
+promising interventions during pregnancy. None of these studies, however,
+explain the underlying mechanisms of the physiologic and psychological
+effects of yoga during pregnancy. The collective results suggest that the
+reported improvements likely occur through a number of pathways.
+Yoga by directly activating the vagus nerve may improve parasympa-
+thetic output, leading to enhanced cardiac-vagal function, mood, energy
+state, and related neuroendocrine, metabolic, and inflammatory responses
+(Taylor, Goehler, Galper, Innes, & Bourguignon, 2010). Yoga may pro-
+mote a feeling of well-being by reducing the activation and reactivity of the
+Holistic Antenatal Model
+271
+sympathoadrenal system through increased vagal activity (Bowman et al.,
+1997) and better autonomic reactivity after yoga as pregnancy advances
+(Satyapriya et al., 2009). Improved stability of the hypothalamic pituitary
+adrenal (HPA) axis may also contribute as evidenced by decreased corti-
+sol levels in normal adults (Kamei et al., 2000; West, Otte, Geher, Johnson,
+& Mohr, 2004) and increased early morning cortisol in pregnancy (Beddoe
+et al., 2010; Kabat-Zinn, 1990) after yoga. Field attributes this to the “stimula-
+tion of dermal and/or sub-dermal pressure receptors that are innervated by
+vagal afferent fibers, which ultimately project to the limbic system including
+hypothalamic structures involved in cortisol secretion” (Field, 2011, p. 6).
+Another explanation could be that stress reduction, through mind manage-
+ment, could have an impact on reduction of oxidative stress, which in turn
+reduces pregnancy complications (Hsieh et al., 2012).
+It is also possible that a yogic lifestyle has a positive impact on proper
+placentation (particularly if practiced early in pregnancy), although research
+data are needed to substantiate this. Improved blood volume and hemodilu-
+tion with better blood supply to the placenta may be a major contribution of
+the restful relaxation techniques used in yoga (Jayashree, Malini, Rakhshani,
+Nagendra, & Nagarathna, 2013).
+These speculations would not be complete without a reference to the
+yogic vantage on the mechanism of action of yoga on the body given in the
+yogic text by Patanjali (Woods, 2003) and others (Nagarathna & Nagendra,
+2001). These scriptures tell us that all of these practices produce calmness of
+the mind in the manomaya kosha, which results in proper prana flow in the
+pranamaya kosha and better functioning of the organs in the annamaya
+kosha (Venkatesananda, 1984; Rakhshani, 2013):
+(changing the lifestyle by good abiding to good coun-
+seling, the samanya adhija vyadhi is destroyed (Gupta, 2013).
+LIMITATIONS OF THE STUDY
+The study is a retrospective presentation of the steps that were followed
+over the years and not a prospective planned study to assess the valid-
+ity and reliability of the model. Statistically acceptable checklists and scor-
+ing were not used during the literature search. Not all authors of the arti-
+cle met in groups before finalizing the model. No statistical calculations of
+split half reliability or validity were planned because this was a preliminary
+study.
+STRENGTHS OF THE STUDY
+The aim was to highlight the conceptual basis for the holistic practices
+that were prevalent in ancient India that have been carried on (modified
+272
+A. Rakhshani et al.
+suitably) even today. This model formed the basis of the interventions used in
+several control trials (Narendran, Nagarathna, & Nagendra, 2005a; Rakhshani
+et al., 2010, 2012).
+SUGGESTIONS FOR FUTURE WORK
+Yoga is now widely recognized and practiced throughout the world. Ante-
+natal yogic practices recommended in this model can be adapted and imple-
+mented in different cultures. Future studies may cull out some of the mean-
+ingful evidence-based cultural and spiritual practices from different cultures
+that may be incorporated or reinstated for healthy progression of pregnancy
+and promotion of well-being of the mother and the offspring.
+CONCLUSION
+Complications of pregnancy are serious life-threatening disorders with se-
+vere economical and social consequences globally. Clearly there is a need
+to identify a noninvasive and cost-effective solutions for the management of
+these disorders. Several studies have shown yoga to be useful in management
+of low-risk and high-risk pregnancies. The yoga and Ayurvedic guidelines
+incorporated in this model are holistic treatments (both physical and psycho-
+logical), which intend to define normal health as harmony and balance and
+not just a fight for survival. They can be practiced in any country or culture
+and offer a solution to restore normalcy and balance using soft techniques
+that correct the stress pathology. We believe that this model opens up a new
+holistic approach to antenatal care for women internationally.
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+Copyright of Health Care for Women International is the property of Routledge and its
+content may not be copied or emailed to multiple sites or posted to a listserv without the
+copyright holder's express written permission. However, users may print, download, or email
+articles for individual use.

yogatexts/A Perspective on Yoga as a Preventive Strategy for Coronavirus Disease 2019.txt

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+Int J Yoga. 2020 May-Aug; 13(2): 89–98.
+Published online 2020 May 1. doi: 10.4103/ijoy.IJOY_22_20
+PMCID: PMC7336943
+PMID: 32669762
+A Perspective on Yoga as a Preventive Strategy for Coronavirus
+Disease 2019
+R Nagarathna,  HR Nagendra,  and Vijaya Majumdar
+Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
+Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru,
+Karnataka, India
+Address for correspondence: Dr. Vijaya Majumdar, Division of Life Sciences, Svyasa University, Bengaluru -
+560 105, Karnataka, India. E-mail: [email protected]
+Received 2020 Mar 24; Revised 2020 Mar 29; Accepted 2020 Apr 1.
+Copyright : © 2020 International Journal of Yoga
+This is an open access journal, and articles are distributed under the terms of the Creative Commons
+Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the
+work non-commercially, as long as appropriate credit is given and the new creations are licensed under the
+identical terms.
+Abstract
+The pandemic outbreak of coronavirus disease 2019 (COVID-19) infection caused by severe acute
+respiratory syndrome-coronavirus 2 has led to profound public health crisis. In particular, individuals
+with preexisting conditions of heart disease, diabetes, cerebrovascular diseases and the elderly are most
+vulnerable to succumb to this infection. The current COVID-19 emergency calls for rapid development
+of potential prevention and management strategies against this virus-mediated disease. There is a
+plethora of evidence that supports the add-on benefits of yoga in stress management, as well as
+prevention and management of chronic noncommunicable diseases. There are some studies on the
+effect of yoga in communicable diseases as well but very few for acute conditions and almost none for
+the rapidly spreading infections resulting in pandemics. Based on the available scientific evidences on
+yoga in improving respiratory and immune functions, we have formulated very simple doable
+integrated yoga modules in the form of videos to be practiced for prevention of the disease by children,
+adults, and the elderly.
+Keywords: Coronavirus disease 2019, immune function, yoga
+Introduction
+The current outbreak of coronavirus disease 2019 (COVID-19) is an infection caused by severe acute
+respiratory syndrome-coronavirus 2 (SARS-CoV-2)[1,2,3,4,5,6,7,8,9,10] with the recently analyzed
+mortality of 5·7% (95% CI 5·5–5·9)[5] The initial reports of disease outbreak were reported in Wuhan,
+Hubei Province of China, COVID-19 followed by its worldwide expansion[3,6,7] owing to the highly
+contagious nature of the virus. In a meeting on January 30, 2020, as per the International Health
+Regulations (2005), the WHO declared the outbreak as a Public Health Emergency of International
+Concern as it has spread across 18 countries across the globe with four countries reporting human-to-
+human transmission.[8]
+1
+2
+2
+1
+2
+Phylogenetic analysis has indicated a zoonotic origin of SARS-CoV-2,[6] with person-to-person
+transmissibility.[10] SARS-CoV-2 is a β-CoV with highly identical genome to bat CoV, pointing to bat
+as the natural host.[9,11] CoVs belong to a large family of single-stranded RNA viruses (+) with a
+broad distribution across humans, other mammals, and birds and cause respiratory, enteric, hepatic, and
+neurologic infections.[7] These RNA viruses derive their name due to the crown-like or coronal
+appearance (coronam is the Latin term for crown) given by the club-shaped glycoprotein spikes in the
+envelope. Importantly, the past two decades have witnessed the emergence of three highly pathogenic,
+novel zoonotic CoVs – SARS-CoV (SARS-CoV now named SARS-CoV-1) discovered in November
+2002, Middle East respiratory syndrome (MERS)-CoV (MERS-CoV) in June 2012, and SARS-CoV-2,
+identified in December 2019 – and have been of global public health concerns.[2,7] These periodic
+emergencies occur due to frequent cross-species infections and increasing interfaces between humans
+and other animal interface.[7,12] These frequent emergences also derive from the high prevalence and
+wide distribution of CoVs, their large genetic diversity, and frequent recombination of their genomes.
+[12]
+SARS-CoV-2 causes a respiratory viral infection that represents the most prevalent and pathogenic
+forms of communicable infectious diseases.[6,13] In severe cases, wherein there is a delay or absence
+of early and effective antiviral treatment, the infection could manifest in a compromised systemic and
+local respiratory defense mechanisms leading to bacterial coinfection culminating into severe acute
+respiratory illness and occasionally into acute respiratory distress syndrome (ARDS).[7,8,9] The
+current estimates indicate a basic reproduction number (R ) of 2.2, implying that on an average, each
+infected person spreads the infection to an additional two persons.[14]
+The latest updates suggest that the pandemic of COVID-19 has entered a new stage with rapid spread
+in countries outside China indicating the need of practicing the measures for self-protection toward the
+prevention of transmission of the infection to others.[4] As of March 16, 2020, a drastic escalation in
+the number of cases of COVID-19 was observed outside China with a number of 143 affected
+countries, states, or territories reporting infections to the WHO.[15] The COVID-19 outbreak is an
+indication of the prevailing challenge of the recurrent surfacing of the unprecedented pathogenic
+infections that demand regular monitoring and preparedness.[14] There is an urgent need of basic and
+clinical research efforts to aid in the understanding of the disease biology and development of robust
+combat measures.[14]
+Clinical Course of Coronavirus Disease 2019
+SARS-CoV-2 primarily spreads by droplets, and is postulated to have higher transmissibility as
+compared to seasonal influenza. A major concern arises due to its likely spread via even asymptomatic
+or minimally symptomatic individuals who may not seek any clinical evaluation.[16] As reported by
+Huang et al., patients with COVID-19 primarily present with fever, fatigue, and dry cough.[17] Most of
+the patients exhibit favorable prognosis, however, older patients and those with chronic underlying
+conditions may present with worse outcomes.[17,18] In the early stages of infection, patients could be
+afebrile represented with only chills and respiratory symptoms.[19] The clinical spectrum varies from
+asymptomatic or mild symptomatic forms to severe forms characterized by respiratory failure that
+necessitates mechanical ventilation and support in an intensive care unit (ICU) or multi-organ and
+systemic manifestations in terms of sepsis, septic shock, and multiple organ dysfunction syndromes.[8]
+Challenges toward the Combat of Coronavirus Disease 2019
+Effective prevention or treatment of COVID-19 remains a top priority toward the curtailing of this
+pandemic. Implementation of several infection control measures (e.g., social isolation, distancing, or
+quarantine of entire communities) have been posited for control and prevention of the COVID-19
+outbreak.[4,20] The most important and effective challenge seems to establish preventive intervening
+strategies before the human–pathogen interface. Vaccination is the one of the most radical
+countermeasures to combat an infectious disease epidemic. Although substantial progress has been
+made toward characterization of the causative virus for COVID-19, a time period of probably a least 1
+year to 18 months has been speculated for substantial vaccine production.[21] In the early stage of the
+pandemic, antiviral treatment is the most effective method. Very recently hydroxychloroquine has been
+0
+reported to be apparently effective against the treatment of COVID-19-associated pneumonia in clinical
+studies.[22,23] However, implementation of antiviral treatment and prophylaxis has several
+requirements, in particular an adequate stockpile of drugs along with the safety of the treatment and
+cost-effectiveness.[24] Most importantly, the preventive/controlling measures should be implemented
+in a judicious and cost-effective manner.[24]
+Integrated Yoga for the Management of Noncommunicable Clinical Conditions
+Yoga, an ancient mind–body technique, is defined as samatvam (balance/equipoise/homeostasis) at
+both mind and body levels to be achieved through mastery over the modifications of the mind
+(chittavrittinirodhah). The available evidence indicates that yoga/meditation facilitates the coordination
+among the set of homeostatic responses involving the interaction among the nervous, endocrine, and
+immune systems.[25] Hence, the recent definition of yoga states it as a comprehensive skill set of
+synergistic process tools that aids in bidirectional feedback and modulation of autonomic nervous
+system outputs through integration between central nervous system (CNS) and afferent and re-afferent
+inputs from interoceptive processes such as the somatosensory, viscerosensory, and chemosensory.[25]
+Postures (Sanskrit: asana), breath regulation (Sanskrit: pranayama), and meditation along with the
+conceptual corrections comprise the integrative system of yoga techniques that could promote physical
+as well as mental well-being. The postures or asanas are purported to have different effects. Some are
+stimulatory to the nervous and circulatory systems, some develop coordination and concentration,
+while others have a calming effect on the body. Some postures such as the corpse pose are used for
+elongated periods of relaxation.
+Clinically, these therapeutic techniques of yoga have been reported to be beneficial against the
+management of acute stress as in posttraumatic stress disorder after tsunami[26] or in chronically
+stressed people with depression or anxiety[26,27,28] and in many noncommunicable diseases such as
+asthma,[29,30] hypertension,[31,32] heart disease,[33] and diabetes.[34,35,36,37,38] In particular,
+yoga has been repeatedly reported to facilitate the attainment of glycemic control and mitigate the
+influence of other risk factors associated with the complications in patients with diabetes as compared
+to control conditions. It has been proposed that the abdominal pressure created during exhalation in
+Kapalabhati improves the efficiency of β-cells of the pancreas.[35] It can be further viewed as
+modulated interoception or sensory modulation evoked by the vigorous practice of Kapalabhati aids in
+the increased interoception of the abnormal glycemic control that is signaled through the sensory inputs
+of the CNS that in turn modulates the autonomic outputs to the pancreas and other organs related to
+disease pathophysiology.
+Insights from Clinical Evidence on Efficacy of Yoga/Meditation against
+Communicable Disease Settings
+There is evidence for the beneficial effects of yoga as an add-on strategy for the management of
+communicable diseases including influenza,[39,40] tuberculosis (TB),[41] and human
+immunodeficiency virus (HIV) infection,[42,43,44] wherein status of immune system is an important
+factor that determines the progression of the disease. The results from the Meditation or Exercise for
+Preventing Acute Respiratory Illness Trial (MEPARI) trial indicated that training in meditation evoked
+a larger reduction in global acute respiratory infection (ARI) severity as compared to exercise or the
+wait-list control participants.[39,40] The findings of the study were found to be in concordance with
+prior literature on beneficial effects of moderate-intensity exercise against immune system and
+reduction in the incidence of ARI illness.[39]
+Similarly, a prospective, randomized trial compared the efficacy of two programs (yoga and breath
+awareness) as an add-on to anti-TB treatment in sputum-positive cases in a sanatorium in Bangalore.
+[41] A total of 1009 pulmonary TB patients were screened and 73 were alternately allocated to yoga (n
+= 36) or breath awareness (n = 37) groups. At the end of 2 months, the yoga group showed a
+significantly better reduction in symptom score and an increase in weight and lung capacity with an
+improved level of infection control and radiographic image as compared to the nonyoga group.
+Effect of 1 month of integrated yoga (IY) intervention has reported to significant improvement in the
+psychological states as well as in the viral loads in patients suffering from HIV-1 infection.[42] Further,
+yoga has also been reported to be an effective intervention for stress management and improvement in
+psychological health among HIV/AIDS patients.[42,43,44] These findings indicate toward a potential
+complementary role for yoga in the management of communicable diseases.
+Yoga for the alleviation of stress induced immune deregulation and strengthening
+of innate immune response-Paradigm for Viral Infections
+Immunity of the host is an essential requisite to facilitate the eradication of infections. Impaired
+immunity characterized by lymphopenia and elevated CRP levels is an essential clinical feature of
+COVID-19.[19] Frequent representation of elderly individuals in the COVID-19-infected cases
+indicates the plausible role of immunosenescence underlying their vulnerability to the infection. The
+severity and outcome of the viral infection could be either an outcome of an effective cellular/innate
+immune response that combats SARS-CoV-2 as observed in the patients with mild clinical signs of
+infection or a state of immunosuppression that debilitates and sometimes overwhelms the host's
+defense.[2] Available evidence indicates that stress modulates immune competence through
+immunosuppression[45] (latency of herpesvirus as represented by the antibody titers), upper respiratory
+tract infection, and wound healing time, indicating that stress causes a significant immune response
+dysfunction. Both acute and chronic stressors can mediate their effects on sympathetic nervous system
+and the hypothalamic–pituitary–adrenal (HPA) axis, thereby impairing antiviral immune responses and
+innate immunity and deregulation of different immune parameters, primarily the inflammatory
+pathways.[46,47] Fear, uncertainty, and stigmatization are psychological stress factors during public
+health emergencies such as COVID-19.[48] These factors hinder appropriate medical and mental health
+interventions and could serve as psychological risk factors and alter the immune function of subjects in
+quarantine or health-care workers. In the context of pandemics with individuals experiencing high
+levels of psychological stress, the modulation of HPA axis through practice of yoga could alleviate
+stress and could aid in the strengthening of the antiviral immune responses.
+Innate immunity is needed for precise regulation to eliminate the virus, otherwise will result in
+immunopathology. A randomized controlled study in nonstressed young healthy students showed a
+significant increase in interferon-gamma (IFN-γ) levels (a central regulator of cell-mediated immunity,
+having antiviral, immune-regulatory functions) in the yoga group as compared to students who did not
+do yoga.[49] On the contrary, a study by Gopal et al.[50] on students with examination stress showed a
+significant reduction in the levels of IFN-γ levels after yoga as compared to the nonyoga control group.
+(Academic stress, the stressful condition of students taking examination, has been proposed to be
+considered as a more appropriate model of naturalistic stress in human beings as compared with
+laboratory-induced stress situations). These physiological aspects of yoga-based mechanisms indicate
+toward the buffering effect of the yoga that aids in restoring the imbalance characterized by either
+suboptimum or excessive expression of immune responses. Based on its ability to induce and precisely
+regulate the IFN-γ levels, yoga could boost innate immune responses during the incubation and
+nonsevere stages to eliminate the virus.[51] Interestingly, these preliminary observations point to the
+phenomenon of samatvam or shift toward homeostasis by the holistic approach of IY on the human
+immune system and all other physiological functions. Further, practice of yoga has been associated
+with increased immune surveillance in terms of the modulation of the frequency of blood lymphocytes.
+[46] Infante et al. reported that in transcendental meditation (TM) practitioners, count of
+CD3+CD4−CD8+ lymphocytes (P < 0.05), B-lymphocytes (P < 0.01), and natural killer (NK) cells (P
+< 0.01) was higher as compared to the control group.[52] Kamei et al. reported a significant correlation
+between the frontal alpha wave activation and the increase in NK activity during yoga exercises.[53]
+NK cells are innate lymphocytes that serve as the first line of defense against invading viruses limiting
+their spread and subsequent tissue damage. Further, Tooley et al. reported significantly higher plasma
+melatonin levels in mediators practicing TM-Sidhi.[54] Melatonin is known to regulate cellular as well
+as humoral immunity and stimulates the production of NK cells. A study on 96 women with breast
+cancer, who participated in a MBSR program for 8 weeks, showed restoration of their NK cell activity
+and IFN-γ levels as compared to continued deregulation in the non-MBSR group.[55] In addition,
+postyoga increases in IgA (an antibody isotype central to mediating mucosal immunity) in pregnant
+women support the protective potential of yoga against invading pathogens.[56] As mentioned above,
+the immunity scores (CD4 counts) of HIV patients have been reported to improve with yoga practice.
+[42] Overall, these studies indicate that practice of yoga might strengthen cell-mediated or mucosal
+immunity and could be used as a preventive measure against virus or other pathogen-mediated
+infections.
+Yoga for alleviation of erratic immune responses
+The available evidence supports the potential of yoga as a complementary intervention for populations
+at risk or already suffering from diseases with an inflammatory component.[46] Several evidences
+indicate that yoga might influence chronic inflammatory state and might optimize impaired immune
+function in stress-induced conditions.[46] The available evidence also uniformly supports that yoga
+practice could downregulate pro-inflammatory markers. Among its influence on pro-inflammatory
+markers, significant decreases in interleukin-1 (IL-1) beta, as well as indications for reductions in IL-6
+and tumor necrosis factor (TNF)-alpha, have been indicated.[46] Cytokine storm represented by
+increased cytokine levels (IL-6, IL-10, and TNF-α), lymphopenia (in CD4  and CD8  T-cells), and
+decreased IFN-γ expression in CD4  T-cells is associated with severe COVID-19.[57] These findings
+support the utility of yoga as a complementary intervention for populations at risk or already suffering
+from COVID-19. Duration of the yoga intervention could significantly influence the effects of yoga
+practice on inflammatory markers. Based on the findings of Pullen et al.,[33] in populations with a high
+risk of increased inflammation such as heart failure, shorter course of interventions of only 8 weeks has
+been suggested to be sufficient to reduce inflammatory processes. The authors have indicated that a
+reciprocal influence of duration of intervention required depends on the severity or deviation from
+normal physiology.[33]
+Integrated Yoga for the Management of Coronavirus Disease 2019 with
+Comorbidities
+Respiratory tract infections are highly prevalent in patients with diabetes as compared to those without
+diabetes.[58] Extending on the same note, prevalence of diabetes has also been reported to be one of
+the most distinctive comorbidities in patients with COVID-19; in the study by Xiaobo Yang et al. 22%
+of the non-survivor critically ill COVID-19 patients were reported to have diabetes.[59] This highly
+prevalent association between diabetes and COVID-19 could be attributed to the compromised immune
+function, reduced T-cell response, reduced neutrophil function, and disorders of humoral immunity.[58]
+Further, the hyperglycemic environment in these patients could also increase the virulence of
+pathogens, lower the production of interleukins in response to infection, with reduced chemotaxis and
+phagocytic activity, and immobilization of polymorphonuclear leukocytes.[58] As mentioned above,
+fear, uncertainty, and stigmatization are psychological stress factors during public health emergencies
+such as COVID-19.[48] The stress-induced activation of the HPA axis could also significantly
+contribute to poor glycemic control (hyperglycemia),[35] thereby exacerbating the clinical symptoms.
+The stress-reducing aspects of yoga through modulation of HPA axis in patients with aberrant glycemic
+control (diabetes and prediabetes) could aid in the attainment of glycemic control as has been
+frequently reported.[34,35,36,37,38] The practice of yoga might aid in reducing the exacerbations and
+clearance of virus infection in COVID-19 patients with diabetes through reducing the influence of
+systemic hyperglycemic and inflammatory milieu.
+Similarly, hypertension is also a distinct comorbidity of COVID-19 infection.[60] A study by Guan et
+al. on 1099 patients with confirmed COVID-19 reported the high prevalence of comorbidities of
+hypertension (23·7%) and diabetes mellitus (16·2%) in 173 severe cases.[60] Hypertension is typically
+treated with drug inhibitors that target the renin–angiotensin system (RAS).[18,61] These drugs are
+mainly the angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs).
+These RAS inhibitors have been well established against the effective management of blood pressure
+(BP) as well as protection from disease-associated inflammation. However, RAS inhibitors have been
+postulated to affect the expression of ACE2 mRNA and the activity of ACE2 in tissues.[18,61] ACE2
+is a key counterregulatory enzyme of ACE that degrades angiotensin II to angiotensin-(1–7), thereby
+attenuating the effects on vasoconstriction, sodium retention, and fibrosis,[62] although there have been
+no definitive conclusions regarding the association of COVID-19 with RAS inhibitors. ACE2 has been
++
++
++
+proposed to be a likely cellular receptor of COVID-19,[62] and in vitro findings have been reported
+that the receptor mediates the entry of COVID-19 virus into HeLa cells.[63] Further long-term use of
+ACEIs might suppress the adaptive immune response, which is a key defense against viral infection.
+[61]
+Yoga and meditation, in particular slow deep breathing, have been reported to decrease sympathetic
+nervous system activity, and increase the baroreflex sensitivity in hypertensive patients, thereby
+reducing their blood pressure values.[64] Modulation of HPA axis and autonomic outputs including BP
+has also been reported to underlie its physiological effects of yoga.[64] However, there has been a lack
+of evidence on specific targeting of RAS or its effector components through yoga. Inflammatory
+systematic milieu in hypertensive patients with already altered autonomic regulations could exacerbate
+disease outcomes. Based on the anti-inflammatory potential of yoga in hyperinflammatory settings
+such as hypertension, we further extend that yoga could reduce the clinical nonfavorable outcomes in
+hypertensive patients. Further, a Class II-A level of Evidence B recommendation for BP-lowering
+efficacy has been conferred on slow breathing.[65] Hence, yoga/slow breathing techniques could
+provide a safe adjunct/complementary approach for the management of hypertension in COVID-19
+patients with hypertension.
+Yoga for Better Respiratory Capacity
+There is a plethora of evidence that breathing exercises have beneficial effects on the respiratory
+system.[66] Pranayama, a yoga-based respiratory exercise, is a simple and cost-effective intervention
+that could be easily integrated in daily routine and has been proven beneficial in subjects across
+different age groups including the elderly.[67] Yoga training has been reported to improve strength of
+expiratory as well as inspiratory muscles.[68] Joshi et al. reported beneficial effects of a 6-week course
+of pranayama on ventilatory lung functions.[69] The authors reported improved ventilatory functions
+with respect to lowered respiratory rate (RR) and increased forced vital capacity (FVC), forced
+expiratory volume at the end of 1  s (FEV1%), maximum voluntary ventilation (MVV), peak
+expiratory flow rate (PEFR), and prolongation of breath-holding time.[69] Repeated practice of
+pranayama has been shown to strengthen cardiorespiratory coupling and increases in the
+parasympathetic activity in healthy individuals.[64] The breathing practice called Kapalabhati is
+comprised of powerful strokes of exhalations accompanied with the contraction of abdominal and
+diaphragmatic muscles followed by passive inhalations.[70] Kapalabhati aids in appropriate training
+and toning of diaphragm and abdominal muscles. It also helps in removal of secretions from bronchial
+tree, cleansing up respiratory passages and the alveoli.[70] A combination of yogic breathing
+techniques improved the pulmonary functions in competitive swimmers.[71]
+Yoga Practice and Chronic and Acute Respiratory Distress
+There have been several reports of clinical trials that suggest an overall effect of yoga training toward
+improved pulmonary function in patients with chronic obstructive pulmonary disease (COPD),
+[72,73,74,75,76,77] an important cause of morbidity and mortality, and poses a major public health
+problem. When meta-analyzed, a significant clinical effect of yoga in COPD patients with respect to
+FEV1 was observed.[72] In addition, the studies reported training effects of yoga on improved exercise
+capacity, lung function decline, quality of life, and dyspnea in patients with COPD.[72] Several
+mechanistic factors have proposed to underlie the beneficial effects seen in the patients undergoing
+yoga such as increasing respiratory stamina, relaxing chest muscles, expanding the lungs, raising
+energy levels, and calming the body.[72] However, due to the lack of adequate data and insufficient
+clinical evidence provided by these studies, the clinical relevance of these findings needs further
+thorough robust experimental evaluations.[72]
+Findings of Meditation or Exercise for Preventing Acute Respiratory Illness Trial –
+Paradigm for viral-mediated respiratory infections
+There has been a dearth of clinical evidence on influence of yoga against acute respiratory distress.
+However, there have been two major relevant successive reports of MEPARI trials that tested the effect
+of training in mindfulness-based stress reduction (MBSR) or sustained moderate-intensity exercise on
+st
+incidence, duration, severity, and impact of all-cause mortality of ARI.[39,40] MEPARI-1 reported
+statistically and clinically significant reductions in ARI illness for participants randomly assigned to 8
+weeks of MBSR training, compared to the observational controls. The MEPARI-2 trial was designed to
+replicate and extend findings from the first MEPARI trial.[40] The authors reported a consistent pattern
+of benefits across the two trials suggestive of preventive effects ranging from 14% to 33% proportional
+reductions in ARI illness.[40] Very importantly, the authors presented a comparative perspective of the
+findings of MEPARI trials against vaccinations against influenza.[40] Flu shots or vaccines are known
+to reduce influenza, with published estimates of proportional reductions in symptomatic illness,
+medical visits, and absenteeism ranging from 13% to 70%.[78,79,80,81,82] The authors Vaccinations
+are disease specific; in other words, these are specific to virus strains, so the protection provided is also
+specific and restrictive. However, mindfulness and exercise trainings have more generic mechanisms,
+regardless of etiological agent. A recent study has reported beneficial effect of meditation on adaptation
+to the hypoxic high altitude conditions that requires synergistic functioning of respiratory, cardiac, and
+hematological system.[83] The authors reported increase in the partial pressure of oxygen, (PO2) a
+marker of bio-availability of oxygen at the cellular levels.[83]
+Pilot study on yoga module in coronavirus disease 2019
+Breathing exercises using the concepts of yoga could also be adopted to help during states of acute
+respiratory distress. We have previously taught an eight-stepped yoga breathing procedure consisting of
+very simple neck muscle relaxation movements and asanas with breathing exercises using the support
+of a chair during 110 episodes of acute airway obstruction in 86 bronchial asthma patients. There was a
+significant improvement in their PEFR by >20% within 30 min of the practice with successful relief
+from the episode. The patients reported reduction in panic and anxiety element, cutting the vicious
+cycle of aggravating bronchial obstruction. Based on the above discussed several beneficial aspects of
+yoga on the immune and respiratory systems against varied clinical settings including that of infectious
+diseases, we postulate a therapeutic potential of yoga towards COVID-19 prevention and management
+[Figure 1]. We have evolved age-specific sets of yoga modules [Tables 1 and 2] based on our extensive
+experience of over past 35 years on clinical research on yoga. The modules have been made available
+for public use on our website https://svyasa.edu.in. To this end, a pilot study was conducted on request
+providing a 4-min video of very simple practices as a voluntary clinical aid to the hospitalized COVID-
+19 patients in Milano, Italy, visited by 1000 people between March 17 and 20, 2020. The report by a
+cardiac surgeon who was also admitted in the intensive care unit of the Italy based hospital due to
+severe COVID-19 infection stated “We have reached scientific evidence that this simplified protocol
+sent by you is effective and we intend to disseminate to the overall Scientific Community”.
+Figure 1
+Potential beneficial effects of Yoga against COVID-19 infection
+Table 1
+Yoga modules for management of coronavirus disease 2019 9 patients with mild symptoms
+Open in a separate window
+Serial
+number
+Category
+Name of the yoga practice
+Children 6-18
+years
+Adults, 18-60 years
+Elderly > 60
+years
+Prayer
+Vinayaka
+Remover of
+all obstacles
+Maha Mrityunjaya
+Remover of fear of
+death
+Dhanvantari
+Lord of health
+1
+Loosening
+Exercises
+(Shithilikarana
+Vyayama)
+Forward and
+backward
+bending(1
+min)
+Spinal twisting (1
+minute)
+Forward and
+backward bending
+(1 min)
+Spinal twisting
+on chair (1 min)
+Spinal twisting
+(1 min)
+Forward and
+backward bending
+(1 min)
+Spinal twisting (1
+min)
+Mukha Dhouti
+(1/2 min)
+Mukha Dhouti
+(1/2 min)
+Surya
+Namaskar (2
+rounds - 2
+min)
+2
+Breathing
+exercises and
+asana
+Hands stretch
+breathing (1
+min)
+Hands in and out
+breathing (1 min)
+Hands in and out
+breathing (1 min)
+Hands in and out
+breathing (1
+min)
+Tiger
+breathing (1
+min)
+Hands stretch
+breathing (1 min
+each variation)
+Hands stretch
+breathing (1 min
+each variation)
+Hands stretch
+breathing (1
+min)
+Matsyasana/Sulabha
+ 
+Matsyasana (1 min)
+Chair Vakrasana
+(1 min)
+Sulabha
+Matsyasana (1
+min)
+3
+Kriya (cleansing
+techniques) and
+pranayama
+Kapalabhati
+Kriya (30
+strokes - 1
+min)
+Kapalabhati Kriya
+(30 strokes - 1 min)
+Kapalabhati Kriya
+(30 strokes - 1
+min)
+Kapalabhati
+Kriya (15
+strokes - 1 min)
+Nadishuddhi
+Pranayama (2
+min)
+Abdominal
+breathing (1 min)
+Abdominal
+breathing (1 min)
+Nadishuddhi
+Pranayama (2
+min)
+Table 2
+Script of the prayers and figures of the yoga practices
+Open in a separate window
+Financial support and sponsorship
+Nil.
+Conflicts of interest
+There are no conflicts of interest.
+Vinayaka mantra
+Mahamrityunjaya mantra
+Dhanvantari mantra
+OM HAM SAM bhagavate
+Nityayoga yuktaya
+ 
+Sacchidananda murtaye
+ 
+Vihayakaaya namah
+ 
+(I offer my salutation to lord
+ 
+Vinayaka who is established in
+yoga state and is the manifestation
+of the universal existence,
+consciousness, and bliss through
+these syllables OM, HAM, and
+SAM)
+Trayambakam yajamahe
+ 
+Sugandhim
+pushtivardhanam
+ 
+Urvarukamiva Bandhnaat
+ 
+Mrityormuksheeyamamritaat
+ 
+Om shaantih Shaantih
+shantih
+ 
+(I offer my salutation to the
+three-eyed lord who is full of
+fragrance and gives energy
+and strength
+ 
+Drop off the fear of death
+just like a ripe cucumber
+drops from its stalk)
+Om namami dhanvantarim aadi devam
+ 
+Suraasurairvandita paadapadmam
+ 
+Loke jara rugbhaya mrityunaasham
+ 
+Dataarameesham vividhoushadheenaam
+ 
+Om shaantih Shaantih shantih (I offer
+my salutation to the lotus feet of that
+original lord Dhanvantari who has given
+many medicines to remove fear of
+diseases and overcome aging and death
+to the world and saluted by all other
+gods)
+Loosening practices
+Forward and backward bending
+Spinal twist
+Spinal twist on chair
+Surya Namaskar
+Breathing practices
+Hands in and out breathing
+Hands stretch breathing
+Tiger breathing
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yogatexts/A Pilot Study on Evaluating Cardiovascular Functions during the Practice of Bahir Kumbhaka (External Breath Retention).txt

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+Original Research Paper
+A pilot study on evaluating cardiovascular functions during the practice
+of Bahir Kumbhaka (external breath retention)
+L. Nivethitha*, A. Mooventhan, N.K. Manjunath
+Department of Research and Development, S-VYASA University, Bengaluru, Karnataka, India
+A R T I C L E 
+I N F O
+Article history:
+Received 21 October 2016
+Received in revised form 16 January 2017
+Accepted 17 January 2017
+Available online xxx
+Keywords:
+Cardiovascular functions
+Kumbhaka
+Pranayama
+A B S T R A C T
+Background: Breath is the dynamic bridge between body and mind and Pranayama (breathing techniques)
+is one of the most important yogic practices. There is a lack of scientific evidence on cardiovascular
+functions during the practice of pranayama techniques, especially Kumbhaka. Hence, this present study
+aims at evaluating the cardiovascular functions of healthy volunteers during the practice of Bahir
+Kumbhaka (BK) (external breath retention).
+Materials and methods: Nineteen healthy volunteers with the mean (standard deviation) age of 23.53
+(3.08) were recruited. All the subjects were asked to perform BK for the duration of 30 s (1 round) and
+repeat the same for 3-rounds with the rest period of 1 min between each round. Baseline, during and post
+assessments were taken before, during and immediately after the practice. Statistical analysis was
+performed using repeated measures of analysis of variance with the use of statistical package for the
+social sciences, version 16.
+Results: Result of this study showed a significant increase in systolic blood pressure (SBP) and rate
+pressure product (RPP) during the practice of BK which was revert back to normal after the practice; and a
+significant increase in diastolic blood pressure (DBP), mean arterial pressure (MAP) and double product
+(Do-P) during the practice of BK which did not revert back to normal even after the practice.
+Conclusion: The result of this pilot study suggests that the practice of BK increases the SBP, DBP, MAP, RPP
+and Do-P during the practice.
+© 2017 Elsevier Ltd. All rights reserved.
+1. Background
+Yoga is an ancient Indian science and the way of life, which
+includes the practice of specific posture (asana), regulated
+breathing (Pranayama) and meditation. Breath is the dynamic
+bridge between body and mind and Pranayama is an art of
+prolongation and control of breath which is one the most
+important yogic practices [1]. It consists of 4-important aspects
+like 1) Pooraka (inhalation), 2) Rechaka (exhalation), 3) Antar
+kumbhaka (internal breath retention), and 4) Bahir Kumbhaka
+(external breath retention) [2].
+Previous studies reported the effect of various pranayamas such
+as breath awareness, right nostril breathing, left nostril breathing
+[3], 
+alternate 
+nostril 
+breathing [3,4], 
+Kapalabhati, 
+Bhastrika,
+Kukkuriya, Savitri, Pranav [4] and Bhramari Pranayama [5] on
+cardiovascular variables before and after the practice. Only very
+few studies have reported the cardiovascular effect of particular
+pranayama technique during the practice [6].
+Though Kumbhaka (breath retention) is one of the important
+aspects of pranayama, it should only be practiced for as long as is
+comfortable and is not recommended for people with cardiovas-
+cular diseases (CVD) and high blood pressure (BP) [2]. The scientific
+reason for not recommending it to such people is less known and to
+the best of our knowledge there is no known study reported the
+cardiovascular 
+effect 
+of 
+Kumbhaka 
+practice 
+especially 
+Bahir
+(External) Kumbhaka (BK) either in healthy or people with CVD.
+Hence, this present pilot study aims at evaluating the cardiovas-
+cular effect of BK in healthy volunteers.
+2. Materials and methods
+2.1. Subjects
+Nineteen healthy volunteers with the mean (standard devia-
+tion) age of 23.53 (3.08) were recruited from a university, South
+India based on the following inclusion and exclusion criteria.
+Inclusion criteria: age = 18 years and above; gender = both male and
+female; subjects who are willing to participate in the study.
+Exclusion criteria: subject with the history of any systemic and
+* Corresponding author.
+E-mail address: [email protected] (L. Nivethitha).
+http://dx.doi.org/10.1016/j.aimed.2017.01.001
+2212-9588/© 2017 Elsevier Ltd. All rights reserved.
+Advances in Integrative Medicine xxx (2016) xxx–xxx
+G Model
+AIMED 105 No. of Pages 3
+Please cite this article in press as: L. Nivethitha, et al., A pilot study on evaluating cardiovascular functions during the practice of Bahir
+Kumbhaka (external breath retention), Adv Integr Med (2017), http://dx.doi.org/10.1016/j.aimed.2017.01.001
+Contents lists available at ScienceDirect
+Advances in Integrative Medicine
+journal homepage: www.elsevier.com/locate/aimed
+mental illness; regular use of medication for any diseases; chronic
+smoking or alcoholism; subject who is unable to perform BK. The
+study protocol was approved by the institutional ethical commit-
+tee and a written informed consent was obtained from each
+participant.
+2.2. Design of the study
+This is a single group repeated measure study, in which all the
+subjects were asked to perform BK. The baseline, during and post
+assessments were taken before, during and after the practice.
+2.3. Assessment
+Height: By using a standard measuring tape, height in cm of
+each subject was measured.
+Weight: By using a standard weighing machine, the weight in kg
+of each subject was measured.
+Body mass index (BMI): It has been derived by using height and
+weight in the formula of weight in kg divided by height in meter
+square [1].
+Cardiovascular variables:
+A beat to beat changes in the cardiovascular variables such as
+systolic blood pressure (SBP), diastolic blood pressure (DBP), mean
+arterial pressure (MAP), heart rate (HR), stroke volume (SV), left
+ventricular ejection time (LVET), cardiac output (CO), pulse interval
+(PI), and total peripheral resistant (TPR) were assessed in sitting
+position using non-invasive blood pressure monitoring system
+(Finapres 
+Continuous 
+Non-Invasive 
+Blood 
+Pressure 
+Systems,
+Netherlands). A finger cuff of suitable size was placed on the left
+middle finger, in between the interphalangeal joints. A Non-
+invasive blood pressure cuff was placed on the upper arm of the
+same hand at the level of the heart and the marker on the cuff was
+directly above the brachial artery. The hand was placed at the knee
+and flexed at the elbow. A brachial correction was also made for
+each subject before assessment. Assessments were taken at rest
+before starting of the pranayama (baseline), during and after each
+pranayama practice. Data were extracted in off-line and exported
+to Microsoft excel 2007.
+Assessments such as pulse pressure (PP), rate pressure product
+(RPP), and double product (Do-P) were derived by using following
+formulas. PP was calculated as (SP 
 DP); RPP as (HR  SP/100); and
+Do-P as (HR  MP/100) [7].
+2.4. Intervention
+Bahir Kumbhaka (BK) (External breath retention): Subjects were
+asked to perform breath holding/retention after exhalation [2] for
+the duration of 30-s. This is one round and it was repeated for 3-
+rounds with a rest (normal breath) period of 1-min between each
+round.
+2.5. Data analysis
+Statistical analysis was performed using repeated measures of
+analysis of variance and post hoc analysis with Bonferroni
+adjustment for multiple comparisons with the use of Statistical
+Package for the Social Sciences (SPSS) for Windows, Version 16.0.
+Chicago, SPSS Inc. p-value <0.05 was considered as significant.
+3. Results
+Demographic variables of the study group have been provided
+in Table 1. Results of this present study showed a significant
+increase in SBP and RPP during the practice of BK that revert back
+to normal after the practice; and a significant increase in DBP, MAP
+and Do-P during the practice of BK that did not revert back to
+normal even after the practice; and no such significant changes
+were observed in rest of the variables (Table 2).
+4. Discussion
+SBP, DBP, PP, and MAP are known as the best predictors of CVD
+risks [8]. Results of this present study showed a significant increase
+in SBP during the practice of BK and revert back to normal after the
+practice. It might attribute to the combined effect of increased level
+of CO due to increased level of HR and increased level of TPR during
+the practice of BK because SBP = CO  peripheral resistance (PR)
+[7].
+A significant increase in DBP, MAP during the practice of BK
+might attribute to the increase in TPR during the practice but these
+changes did not revert back to normal even after the practice and
+even though there was a reduction in TPR after the practice of BK.
+Hence, the mechanism behind the sustained effect of increased
+level of DBP and MAP even after the practice is unclear.
+The increase in RPP and Do-P might attribute to the increase in
+HR and BP. RPP and Do-P are the important indirect indicators of
+myocardial oxygen consumption and load on the heart [7]. A
+significant increase of these variables in this study indicates strain
+increasing effects of BK on the heart during the practice and
+relieved after the practice.
+Since Yoga is becoming popular throughout the world, people
+are 
+very 
+much 
+interested 
+in practicing 
+various 
+techniques
+especially the advanced techniques which include Kumbhaka
+practice within a short span of period. According to a Yogic text, the
+practice of advanced techniques should begin only after we
+become master over the basic techniques. And these advanced
+techniques has to be practiced gradually in order to get adopt the
+body and mind with the practice, to reach the final stage. If, it is not
+followed then that might lead to certain adverse effects [2]. This
+Table 1
+Demographic variables of the study group (n = 19).
+Variables 
+Study group (n = 19)
+Age (years) 
+23.53  3.08
+Gender 
+Males (n = 18) and female (n = 1)
+Height (m) 
+1.70  0.09
+Weight (kg) 
+60.42  8.60
+Body mass index (kg/m2) 
+20.90  2.30
+Table 2
+Cardiovascular changes while practicing Bahir Kumbhaka (n = 19) (RMANOVA).
+Variables 
+Baseline 
+During 
+Post
+SBP (mmHg) 
+115.93  14.35 
+129.22  18.53*
+119.53  12.75
+DBP (mmHg) 
+71.54  8.87 
+80.84  11.12*
+74.05  8.77*
+MAP (mmHg) 
+88.74  10.24 
+100.07  13.75*
+92.01  9.81*
+PP (mmHg) 
+44.39  8.23 
+48.38  9.86 
+45.48  7.30
+RPP (Units) 
+97.91  16.71 
+113.31  23.21*
+103.35  15.65
+Do P (Units) 
+74.97  12.29 
+87.72  17.27*
+79.67  12.69*
+HR (beats/mint) 
+84.61  10.82 
+87.94  13.68 
+86.82  11.92
+SV (l) 
+70.42  13.35 
+69.95  12.36 
+70.20  13.03
+LVET (ms) 
+267.86  17.03 
+259.49  20.82 
+261.90  18.86
+Cardiac output (l/mint) 
+5.89  1.24 
+6.07  1.40 
+6.00  1.15
+Pulse interval (ms) 
+730.50  98.08 
+712.26  133.55 
+716.63  116.19
+TPR (mmHg min/l) 
+1.04  0.29 
+1.11  0.31 
+1.02  0.27
+Note: All values are in mean  standard deviation. SBP = systolic blood pressure;
+DBP = diastolic blood pressure; MAP = mean arterial pressure; PP = pulse pressure;
+RPP = rate pressure product; Do-P: double product; HR = heart rate; SV = stroke
+volume; LVFT = left ventricular ejection time; TPR = total peripheral resistant.
+* p < 0.05.
+2 
+L. Nivethitha et al. / Advances in Integrative Medicine xxx (2016) xxx–xxx
+G Model
+AIMED 105 No. of Pages 3
+Please cite this article in press as: L. Nivethitha, et al., A pilot study on evaluating cardiovascular functions during the practice of Bahir
+Kumbhaka (external breath retention), Adv Integr Med (2017), http://dx.doi.org/10.1016/j.aimed.2017.01.001
+present study results also supporting the above mentioned
+concept by showing the increased level of SBP, DBP, MAP, RPP
+and Do-P during the practice of BK (one of the advanced aspects of
+pranayama) even in healthy volunteers. Hence, in order to avoid
+complications of high-BP, this kind of practices should not be
+recommended suddenly to the people with hypertension and other
+CVD. Care must be taken in administrating this breathing
+technique by mastering over the basic practices (slow/yogic
+breathing techniques) and then a gradual increase in the duration
+of practice to get adopt with the practice. Because, regular practice
+of slow inspiration and expiration for longer duration would help
+in training the stretch receptors of respiratory muscles, chest wall
+and walls of the alveoli to support the breath holding along with
+acclimatizing the central and peripheral chemoreceptors for both
+hypercapnoea and hypoxia.
+Breath holding time is one of the most important variables used
+to measure the respiratory function [9]. Longer the breath holding
+time, better the pulmonary function. Since, BK is one of the breath
+holding techniques that was shown to increase BP as well as RPP
+and Do-P (indirect measure of cardiac workload), regular practice
+of BK alone or along with other pranayama practices might be
+considered in cardio-respiratory training of healthy individuals to
+strengthen the system and to prevent the various cardio-
+respiratory problems.
+Strengths of this present study: First study evaluating the
+cardiovascular effect of BK during the practice itself; Beat to beat
+changes in the blood pressure was measured using standard
+advanced non-invasive blood pressure monitoring systems.
+Limitations of this study: Small sample size; subjects were
+healthy volunteers which is limiting the scope of this study in
+people with pathological conditions; autonomic function assess-
+ments such as heart rate variability, galvanic skin resistance, pulse
+plethesmogram; baroreflex sensitivity would have provided more
+information. Hence, further studies are required with larger
+sample size using all the above mentioned objective variables in
+both healthy and people with pathological conditions for the better
+understanding.
+5. Conclusion
+The result of this study suggests that the practice of BK
+increases the SBP, DBP, MAP, RPP and Do-P during the practice.
+Source of funding
+Nil.
+Conflict of interest
+None declared.
+References
+[1] A. Mooventhan, V. Khode, Effect of Bhramari pranayama and OM chanting on
+pulmonary function in healthy individuals: a prospective randomized control
+trial, Int. J. Yoga 7 (2014) 104–110.
+[2] S. Saraswati, Asana Pranayama Mudra Bandha, 4th rev. edition, Yoga
+Publications Trust, Munger, Bihar, India, 2008.
+[3] P. Raghuraj, S. Telles, Immediate effect of specific nostril manipulating yoga
+breathing practices on autonomic and respiratory variables, Appl.
+Psychophysiol. Biofeedback 33 (2008) 65–75.
+[4] V.K. Sharma, M. Trakroo, V. Subramaniam, M. Rajajeyakumar, A.B. Bhavanani, A.
+Sahai, Effect of fast and slow pranayama on perceived stress and cardiovascular
+parameters in young health-care students, Int. J. Yoga 6 (2013) 104–110.
+[5] T. Pramanik, B. Pudasaini, R. Prajapati, Immediate effect of a slow pace breathing
+exercise Bhramari Pranayama on blood pressure and heart rate, Nepal Med. Coll.
+J. 12 (2010) 154–157.
+[6] S. Telles, S.K. Sharma, A. Balkrishna, Blood pressure and heart rate variability
+during yoga-based alternate nostril breathing practice and breath awareness,
+Med. Sci. Monit. Basic Res. 20 (2014) 184–193.
+[7] A. Mooventhan, Immediate effect of ice bag application to head and spine on
+cardiovascular changes in healthy volunteers, Int. J. Health Allied Sci. 5 (2016)
+53–56.
+[8] H.D. Sesso, M.J. Stampfer, B. Rosner, C.H. Hennekens, J.M. Gaziano, J.E. Manson,
+et al., Systolic and diastolic blood pressure, pulse pressure, and mean arterial
+pressure as predictors of cardiovascular disease risk in men, Hypertension 36
+(2000) 801–807.
+[9] P.S. Karthik, M. Chandrasekhar, K. Ambareesha, C. Nikhil, Effect of pranayama
+and suryanamaskar on pulmonary functions in medical students, J. Clin. Diagn.
+Res. 8 (2014) BC04–BC06.
+L. Nivethitha et al. / Advances in Integrative Medicine xxx (2016) xxx–xxx 
+3
+G Model
+AIMED 105 No. of Pages 3
+Please cite this article in press as: L. Nivethitha, et al., A pilot study on evaluating cardiovascular functions during the practice of Bahir
+Kumbhaka (external breath retention), Adv Integr Med (2017), http://dx.doi.org/10.1016/j.aimed.2017.01.001

yogatexts/A Psycho-Oncological Model of Cancer according to Ancient Texts of Yoga.txt

@@ -0,0 +1,663 @@
+Volume 3 • Issue 1 • 1000129
+J Yoga Phys Ther
+ISSN: 2157-7595 JYPT, an open access journal 
+Research Article
+Open Access
+Amritanshuram, J Yoga Phys Ther 2013, 3:1
+http://dx.doi.org/10.4172/2157-7595.1000129
+Research Article
+Open Access
+Yoga & Physical Therapy
+A Psycho-Oncological Model of Cancer according to Ancient Texts of 
+Yoga
+Amritanshuram R*, Nagendra HR, Shastry ASN, Raghuram NV and Nagarathna R 
+ S-VYASA University, Bengaluru, India 
+*Corresponding author: Amritanshuram, Division of Life Sciences, Swami 
+Vivekananda Yoga Anusandhana Samsthana, Bangalore, India, E-mail: 
+[email protected]
+Received December 17, 2012; Accepted January 28, 2013; Published January 
+31, 2013
+Citation: Amritanshuram R, Nagendra HR, Shastry ASN, Raghuram NV, Nagarathna R 
+(2013) A Psycho-Oncological Model of Cancer according to Ancient Texts of Yoga. J 
+Yoga Phys Ther 3:129. doi:10.4172/2157-7595.1000129
+Copyright: © 2013 Amritanshuram R. This is an open-access article distributed 
+under the terms of the Creative Commons Attribution License, which permits 
+unrestricted use, distribution, and reproduction in any medium, provided the 
+original author and source are credited.
+Keywords: Yoga; Psycho-neuro-immunological studies; Etiology of 
+cancer
+Introduction
+Cancer is a leading cause of death worldwide accounting for 7.4 
+million deaths (13% of all deaths worldwide) in 2008 [1]. Research 
+to understand the etiology and eradicate the tumor burden without 
+harming the host has progressed greatly and has resulted in successful 
+cure (in a few cancers), improved longevity and quality life. But the 
+world statistics indicates that the prevalence of the disease has not 
+reduced which is intriguing. In India alone, 22.2% of women presently 
+suffer from cancer which is expected to increase to almost 30% in the 
+next five years [2]. This is one of the reasons that have led patients to 
+resort to complementary and alternative medicine (CAM). According to 
+a previous survey, approximately 21% of cancer survivors in the United 
+States had engaged in CAM practices [3]. In India, approximately 
+56% of the cancer patients took recourse to alternative therapies [3]. 
+Among these, yoga was the third most commonly accepted therapy 
+[3]. These surveys have also compiled the reasons for resorting to 
+CAM. They were: management of side effects, reduction of costs 
+involved, avoiding poor quality of life, minimizing psychological ill-
+health and reducing recurrences in spite of undergoing such traumatic 
+treatments [3]. The reason appears to stem from a more fundamental 
+cause than these. As treating professionals and researchers we seem to 
+have missed a major factor, namely the mind, in our entire search for 
+a solution. Conventional treatment has concentrated on dealing with 
+pathophysiology at physical, physiological and molecular levels, but in 
+reality the human system is governed by a more powerful subtle entity 
+called the mind [4].
+Life style and psychosocial stresses were recognized to be 
+contributory to sickness, by a few researchers, as early as nineteen 
+seventies [4,5], but it is only recently that enough data has been 
+accumulated to propose a psycho-neuro-immunological model for 
+Abstract
+Background: Several psycho-oncological models of cancer have been published. Integrated module of yoga 
+has been found to be effective as an add-on to conventional management of cancer through randomized control 
+studies.
+Objectives: To develop a model of the aetiopathogenesis of cancer according to ancient yoga texts. 
+Methods: This process had four phases: 1) Review of modern scientific and original texts dating back to 5000 
+years, 2) Focused Group Discussions (8 members) to develop the model, 3) preparation of the module based on the 
+proposed model and 4) field testing of yoga modules for patients with cancer.
+Results: Yoga texts propose that cancer is disturbed homeostasis (an imbalance) based in the mind. Persistent, 
+uncontrolled, fast recycling of thoughts in the mind due to wrong knowledge about the source of happiness is the 
+origin. This activates wasteful release of vital energy, (prana), which in due course, expresses onto the physical body 
+as habituated imbalance resulting in uncontrolled molecular (gene) level activity. This ‘local violence’, progresses 
+by activating the chemical reactions, resulting in inflammation or uncontrolled mitosis. The goal of yoga therapy 
+is ‘mastery over inner chemical processes through mindfulness and alertful rest to reduce the inner violence’. 
+Yoga modules were developed based on this understanding of the etiology of cancer. Review of literature and 
+group discussions which also contributed to these modules, aided to keep the focus on scriptural relevance and 
+clinical feasibility. These modules were used in patients with stage 2 and 3 breast cancer in randomized control 
+studies between 2003 till 2008. The results of these studies pointed to the beneficial effects of yoga as compared 
+to conventional management. During surgery, IAYT reduced hospital stay, faster wound healing and lower drain 
+retention; during chemotherapy, practice of yoga demonstrated lower nausea intensity and frequency, anxiety, 
+depression, better immunological status and quality of life; yoga practice during radiation therapy brought about 
+lesser side effects, less stress levels, better cortisol rhythm, sleep. During and after the treatment period patients 
+indicated better quality of life. Controlled studies on breast cancer patients provided the scientific evidence that these 
+modules are effective in clinical settings.
+Conclusion: This yoga based, workable model has incorporated the subtle aspects of mind (prana, mind and 
+the self) into the psycho-neuro-immunological model of cancer. Evidence suggests that yoga techniques that are 
+based on the models are effective in the management of breast cancer. Mechanism studies and intense dialogue are 
+necessary to consolidate these concepts.
+Citation: Amritanshuram R, Nagendra HR, Shastry ASN, Raghuram NV, Nagarathna R (2013) A Psycho-Oncological Model of Cancer according 
+to Ancient Texts of Yoga. J Yoga Phys Ther 3:130. doi:10.4172/2157-7595.1000129
+Page 2 of 6
+Volume 3 • Issue 1 • 1000129
+J Yoga Phys Ther
+ISSN: 2157-7595 JYPT, an open access journal 
+cancer [6]. This has helped to create an awareness of the role of mind 
+body relationship in the etiology and progression of cancer. Anderson 
+et al. [7] proposed a model in 1994 that pointed to a relationship 
+between mind and cancer. By 2006 they moved on to create a model 
+that portrayed a linear progressive casual relationship between 
+psychological stress, immune disturbance and cancer [8]. Further, in 
+2010 Ao P et al. [9] proposed a dynamic non linear mathematical model 
+of the etiology and progression of cancer based on the interaction of 
+the caspase-3 molecules to indicate the states of normalcy, disease and 
+stress. 
+Among the various CAM treatments available, yoga offers a holistic 
+model using an entirely different concept of understanding human 
+body in health and disease states; it also offers self corrective techniques 
+to restore normalcy. Ancient texts dating back to about 5000 years (Rig 
+Veda, Patanjali Yoga Sutra and ayurveda] provide a highly evolved 
+conceptual basis of aetiopathogenesis of disease and its management. 
+The ‘Integrated Approach of Yoga Therapy (IAYT) for Cancer’
+, used 
+as complimentary to conventional medicine in all studies conducted 
+by Swami Vivekananda Yoga Anusandana Samsthana (S-VYASA) 
+consisted of practices that were based on this model. The aim of the 
+present study is to present a holistic model of etiopathogenesis of 
+cancer using both the ancient and present knowledge.
+Methods
+This retrospective scientific narrative has been classified under four 
+phases (Table 1).
+Content generation
+Research scholars reviewed traditional yoga and ayurveda texts 
+for references to disease etiology and cancer specific pathology and 
+progression [10–13]. A comprehensive list of all the attributes and 
+treatment modalities were compiled for further discussion.
+Scientific literature including empirical evidence and review 
+articles were also scrutinized and hypothesized cancer etiology models 
+[9] were noted apart from accumulating information regarding latest 
+trials that had been done in the field of mind body medicine as a disease 
+management strategy [14–18].
+Model development
+Focused Group Discussions (FGD): The literature thus compiled 
+was presented to a group of experts for deliberations. The participants 
+of the focused group discussion (FGD) included eight members 
+consisting of 3 yoga experts with in-depth scriptural knowledge who 
+were practitioners of these techniques, one post graduate physician, two 
+oncologists who work with cancer patients and understand their major 
+concerns and needs at physical, mental and emotional levels during the 
+conventional therapies, and two research fellows.
+For each item on the list, the experts were asked to mark ‘useful’
+, 
+or ‘not relevant’ for understanding cancer etiology. The group was also 
+asked to suggest more references regarding cancer and its etiopathology. 
+In addition to this, in-depth discussions ensued which formed a major 
+method for data generation. These discussions and suggestions thereof 
+were noted and were added to the pre-existing list. Inputs by the experts 
+were used to finalize the model for cancer etiopathogenesis. 
+The flexibility of the FGD structure facilitated exploratory 
+discussions which made the outcome more humanized rather than 
+a score based questionnaire method. Despite its time consuming 
+characteristic, it helped the researchers to interact as contributors 
+to the model. The probing questions and discussions facilitated the 
+development of the model by sharing each others’ experiences also. The 
+entire process involved several small group meetings, correspondences, 
+sitting together for meditation and visiting the experts in the field apart 
+from the FGDs. 
+All the suggestions offered by the group of experts were deemed 
+equally important and taken into consideration for designing the 
+model. This was done by the research scholars under the guidance of 
+the yoga experts.
+Module preparation
+The FGD resulted in the formation of a etiopathological model of 
+cancer. A check list of yoga practices which was developed based on this 
+model were provided to the same team of experts for their opinion. This 
+process followed a semi-structured format, using open-ended questions 
+in a face-to-face conversational style and the focus was to document the 
+interviews and discussions that were based on the literature review and 
+experiential knowledge. Inputs regarding feasibility, need, relevance of 
+several yoga techniques were used to develop the modules of integrated 
+approach of yoga that formed the material for another publication [19].
+Field testing
+The modules that evolved were initially administered to patients 
+with different cancers as part of the pilot study. These subjects were 
+recruited from the residential health home of the institution, admitted 
+for two to three weeks to undergo integrated approach of yoga therapy. 
+These modules were administered to them for the period of their stay 
+by trained experts (two of the senior faculty who were involved in the 
+FGD). Feedback from these patients was recorded immediately after 
+each session. Based on this, further changes were made to the modules. 
+Further we conducted two randomized controlled studies that 
+used the modules of IAYT for cancer as an add-on to conventional 
+management of breast cancer (stages 2 and 3) results of which formed 
+the material for the eight publications on the complimentary role of 
+IAYT in breast cancer [20–27].
+Results
+Contents of the model: Panchakoshva viveka (the five components 
+of human being).
+According to yoga texts (Taittereya Upanishad), the human system 
+consists of five components [pancha kosha]: Physical body (Annamaya 
+Kosha), Subtle Energy or Prana (Pranamaya kosha), Instinctual mind 
+(Manomaya kosha), Intellectual or discriminative mind (Vignanamaya 
+kosha) and bliss-full silent state (Anandamaya kosha) (Figure 1). 
+Content Generation
+o	
+Review of traditional texts
+o	
+Review of scientific literature on cancer pathology
+o	
+Interactions and discussions with experienced yoga 
+gurus
+Model 
+Development
+o	
+Focused Group Discussions and semi structured 
+interviews
+o	
+8 experts from yoga or oncology field
+o	
+preparation of yogic model for cancer management
+Yoga Module 
+Preparation
+o	
+List of practices based on etiopathology and need
+o	
+Validation of yoga modules
+Field Testing
+o	
+Pilot studies on patients with cancer in stages 2-4 in 
+sites such as breast, cervix, stomach, colon cancers 
+included
+o	
+Randomized controlled studies on patients with 
+breast cancer( stage 2-3)
+Table 1:  Stages in the development of yogic model for the aetiopathogenesis of 
+cancer.
+Citation: Amritanshuram R, Nagendra HR, Shastry ASN, Raghuram NV, Nagarathna R (2013) A Psycho-Oncological Model of Cancer according 
+to Ancient Texts of Yoga. J Yoga Phys Ther 3:130. doi:10.4172/2157-7595.1000129
+Page 3 of 6
+Volume 3 • Issue 1 • 1000129
+J Yoga Phys Ther
+ISSN: 2157-7595 JYPT, an open access journal 
+Shvetashvatara Upanishad [10] describes that a human being is 
+in perfect harmony with nature and healthy when he is established in 
+Anandamaya kosha which is the unchanging state of being, the self 
+(called Brahman) and the causal state of beings from where all other 
+(ever changing) Koshas emerge [28]. Analogies to explain that Ananda/
+perfect health is the unchanging core of one’s personality include ‘this 
+kosha is like the string in a necklace of beads’ (Bhagavad Gita 7.7), like 
+the gold in all jewels (Chandogya Upanishad, 6.1.6) [12] or the clay in 
+different shaped pots (Chandogya Upanishad, 6.1.3) [12]. This state is 
+experienced as a state wherein one reaches a state of inner quietitude 
+with awareness and the knowledge that ‘I am made of the same 
+universal consciousness and bliss that forms the base material of the 
+entire creation’
+.
+ (Mandukya Upanishad 2) [29]; e.g. a salt doll dives into the ocean 
+to understand the depth of the ocean but gets the joy of becoming the 
+ocean itself by losing its individual entity [30]. 
+Waves begin in this ocean of blissful quietitude and become grosser 
+and grosser to form the other four components of the body (Ch3v3-6) 
+[28]. The first wave (spandana) that appears is the ‘I’ (self awareness) 
+followed by several varieties of waves that form a template of right 
+knowledge, the Vignanamaya kosha. In this state man is in perfect 
+health as he is in tune with nature [28] and leads a healthy life style with 
+complete mastery over his mind (Ch1v3) [31]. As these waves gather 
+momentum with higher amplitude and rewinding speed (ch5v26) 
+[11], (ch8v88) [13] it gathers energy to become the Manomaya kosha 
+in which likes and dislikes begin (Tattva Bodha v49) [32]. As the 
+process of grossification continues it goes on to become the vital energy 
+(pranamaya kosha) and the physical molecules (Annamaya kosha) 
+(Ch3 v5) [28]. Yoga techniques offer techniques of mastering the gross 
+[13] to reach the subtle layers of one’s existence by introspective slowing 
+down of thoughts. The subtle controls the gross e.g. if one masters prana 
+he can manipulate the functions of physical body; mind can manipulate 
+prana; vignana can master the mind and prana (Ch1v40) [31]. The goal 
+of life is to establish in a state of complete mastery by remaining in a 
+state of vignana , a state of complete freedom and contentment, freedom 
+from all distress and disease (shvetashvatara Upanishad ch2v12) [10]. 
+This is a state in which one develops the ability to manipulate the laws 
+of nature within the body and outside the body (ch1v4) [31]. 
+The model proposes the ability to master the law that governs 
+programmed cell cycle. Mind is the most highly evolved and the 
+most powerful entity in the manifest universe. A living human body 
+is a flux of continuous changes that is programmed to live a full life 
+span of about a century in perfect heath if it is not disturbed by major 
+calamities. As man goes through the ups and downs of life (be it 
+exposure to external onslaughts like injury or infection, or emotionally 
+challenging situations), it sets off an imbalance. The scriptures are 
+very emphatic when they say that this imbalance occurs due to lack 
+of mastery over mind which is the starting point of any mind body 
+disease. Sage Vasistha describes the progression of this imbalance that 
+results in cancer (and/or other lifestyle related disorder) in the text yoga 
+Vasistha (ch9 v82-117) [13]. The search for happiness in outside objects 
+continues with unresolved conflicts due to wrong notion about the 
+meaning of life and nature of happiness. The nature of this conflict or 
+distress is described as ‘uncontrolled recycling of sentences in the mind’ 
+(yogic definition of stress) (ch5v23) [11], the Manomaya kosha. This 
+imbalance due to uncontrolled speed (udvega) of suppressed emotions 
+when unchecked results in an imbalance and percolates into pranamaya 
+kosha. This is detectable as disturbed pattern of breathing (increased 
+rate and irregular rhythm) and poor digestion. As this imbalance and 
+loss of mastery goes on for some time it becomes an involuntary habit, 
+a reflex. Chronic constipation or irritable bowel (alternate constipation 
+and diarrhea), fatigue and generalized body aches are the other 
+general (non-specific) manifestations at this level. When unattended 
+by correcting the imbalance at the root cause (the Manomaya and 
+Vignanamaya koshas) the process continues and localizes to a specific 
+zone in the physical body (Annamaya kosha). Thus, the uncontrolled 
+rush of prana (vital energy) results in uncontrolled electro-chemical 
+processes in the physical body, the annamaya kosha. This appears to 
+mean that the physical fight (tissue inflammation) is a reflection of 
+the violence or fight in the mind. We know today that inflammation 
+is a feature of cancer. Thus, the uncontrolled excessive prana (subtle 
+energy) flow seems to cause the changes in the molecular level that 
+goes on to alter the apoptotic programming resulting in immortal 
+cells and perpetuation of cancer cells (Figure 2). Further, the texts go 
+on to describe that the localization of the disease (cancer) depends on 
+external (insult by carcinogenic agents, trauma, toxins, and infections) 
+or internal (genetic) factors.
+Thus, the yogic model proposes that the entire problem is due to 
+repetitive on slaught by uncontrolled thoughts (suppressed emotions) 
+at the mind level (Manomaya kosha) which causes excessive prana 
+activity and manifests as violence (inflammation) at annamaya kosha 
+to show up as cancer.
+Figure 1:  showing etiopathogenesis of cancer, combining knowledge from yoga 
+texts and modern literature.
+Figure 2: Five Layers of the Human system.
+Citation: Amritanshuram R, Nagendra HR, Shastry ASN, Raghuram NV, Nagarathna R (2013) A Psycho-Oncological Model of Cancer according 
+to Ancient Texts of Yoga. J Yoga Phys Ther 3:130. doi:10.4172/2157-7595.1000129
+Page 4 of 6
+Volume 3 • Issue 1 • 1000129
+J Yoga Phys Ther
+ISSN: 2157-7595 JYPT, an open access journal 
+Integrated approach of yoga therapy for cancer
+The integrated approach of yoga offers a comprehensive means 
+to overcome the damage by achieving mastery at all levels through 
+deep cellular rest (reducing the speed, violence and inflammation). At 
+the physical level (Annamaya kosha) there are practices that include: 
+cleansing the body (yogic kriyas) of the endotoxins (Aama as portrayed 
+in ayurveda) both at the gross (fecal matter) and subtle (molecular 
+toxins e.g. free radicals) levels [33]; correcting the life style through 
+yogic diet and injunctions for healthy behavior (sleep, activity, speech, 
+righteousness); and providing deep rest (reduce the speed) to the 
+damaged/sick tissues through physical postures (asanas). Pranayama 
+or breathing techniques corrects the imbalances in pranamaya kosha 
+through voluntary reduction in the rate of breathing (Ch2 v49) [34]. 
+Meditation (Dharana, Dhyana, Samadhi and Sanyama), the Manomaya 
+kosha practice is the most important as it aims at direct mastery over the 
+mind, the root cause of the problem by establishing in an introspective 
+state of blissful awareness (dhyana=effortless flow of a single thought) 
+(Ch2 v2) [31] (Ch3 v2) [34]. Devotion (bhakti yoga or emotional 
+culture) is another important component that helps in harnessing the 
+uncontrolled surge of violent suppressed emotions through using ‘pure 
+love’
+. At the vignanamaya kosha level (intellectual) correction of the 
+false notion is achieved through understanding that ‘I am made of the 
+universal consciousness and bliss (Ananda) which is independent of 
+the mind’
+. At anandamaya kosha level, karma yoga helps in achieving 
+blissful awareness free from all fears (including fear of death). Thus 
+the highlight of this model is the possibility of the practitioner to de-
+identify and dissolve oneself in the universal consciousness that is 
+described as existence (sat), consciousness (chit) and bliss (ananda), 
+through right knowledge and awareness. All practices including 
+yogic diet, kriyas (cleansing), asanas, pranayama, dharana, dhyana, 
+devotion and self analysis prepare the system to stop the turbulent 
+fluctuations (superficial and deep seated subconscious activities) and 
+allow the mind to rest in a state of inner quietitude(wakeful sleep) . 
+A single positive thought (a resolve) dropped in the ocean of blissful 
+quietitude (sanyamah) has the ability to reverse the imbalances at all 
+levels [31]. Thus the process of reversing the structural and functional 
+abnormalities at the tissue level is described through this model.
+Field testing
+The major changes suggested by the patients, after having 
+undergone sessions of the yoga module, as part of the pilot study, were: 
+(a) the duration of each module of the practice had to be reduced from 
+60 to 30 minutes, (b) there was a need for recorded audio CDs/cassettes 
+to help them continue the practice and (c) some of the imageries used 
+during the practice had to be replaced. E.g.: the ‘death experience’ had 
+to be replaced by ‘surrender to the divine lord’ which gave much more 
+confidence to face the disease.
+The results of randomized control trials on stage 2 and 3 breast 
+cancer patients have shown beneficial effects of IAYT, throughout the 
+entire treatment phase, as an add-on to conventional treatment. 
+Stage 2 and 3 breast cancer patients undergoing surgery showed 
+shorter hospital stay, suture removal and lower drain retention in 
+the group that were administered IAYT. Patients receiving IAYT 
+along with radiotherapy showed significantly lower levels of anxiety, 
+depression distress, fatigue, insomnia, and appetite loss, negative effect 
+and stress and improved activity levels, positive effect, emotional and 
+functional quality of life while the amount of change in DNA damage 
+was significantly lower as compared to controls. Cortisol rhythms 
+also showed restorative changes in yoga group. Breast cancer patients 
+receiving chemotherapy and IAYT reported lower nausea intensity 
+and frequency apart from lower state and trait anxiety, depression, 
+symptom severity, distress and better quality of life. Higher immune 
+parameters like NK cells, CD8+ and CD56+ counts were also observed 
+for this group. 
+Discussion
+This narrative summary of a pre-clinical process, presents a model 
+of the aetiopathogenesis of cancer that has evolved over 5000 years of 
+research in the east by yoga masters as an introspective science. This 
+model of origin and progression of cancer takes into account the 
+existence of subtle aspects of the personality such as prana, mind, and 
+the self (the soul). The holistic model proposes that the root cause of 
+the disease is the wrong mindset or incorrect notion viz. ‘the source of 
+happiness is the external agents of enjoyment’
+. The life’s ambitions and 
+plans are all based on this notion. Frustrations occur when these are 
+not fulfilled. Emotional suppressions become mandatory to carry on 
+with life. This results in chronic imbalance that disturbs homeostasis 
+and culminates to cancer. This analysis provides the logical basis for 
+using corrective techniques that are used in yoga practices. 
+Our studies that used intervention modules called IAYTC 
+(integrated approach of yoga therapy for cancer) based on this model 
+as an add-on during the entire course of conventional management of 
+breast cancer (stages 2 and 3) have shown the beneficial effects [20–27]. 
+The results of these studies indicate that the IAYT modules complement 
+conventional treatment and are clinically relevant to cancer patients. 
+However, they do not provide direct evidence for the etiopathological 
+model that is proposed in this article and is a working hypothesis that 
+has been suggested.
+Comparisons with other psyco-oncological models
+Anderson et al. [7] proposed a bio-behavioral model of the 
+relationship between stresses of cancer based on several publications 
+up until 1994. 
+Her study highlighted the mechanisms by which psychological and 
+behavioral responses may influence biological processes and the health 
+outcomes and gave insights into the role of mind in compliance to 
+standard therapies. Further, based on a decade long (between 1995 and 
+2005) explosive discoveries on the relationship between psyche and the 
+immune modulation the same researchers Thornton and Anderson [8] 
+presented a psycho-neuro-immunological model of cancer. This model, 
+for the first time, hypothesized a causal linear relationship between the 
+chain of events starting from stressors, psychological stress response 
+that may lead to physiological stress response going on to immune 
+changes and the disease processes. They could also incorporate many 
+molecular mediators and moderators in the model. There has been 
+continuing debate on this psycho-neuro-immunological model of the 
+genesis and progression of cancer. A robust study by Surtees et al. [35] 
+investigated the associations between lifetime social adversity measures 
+that included stressful life events in childhood and adult life, stress 
+adaptive capacity, and perceived stress over a 10-year period. Looking 
+at the Incidence through the cancer registry data showed no evidence 
+that social stress exposure or individual differences in its experience are 
+associated with the development of breast cancer [35].
+Research in the last decade identified several mediators involved in 
+the genetics of cancer that has led to successful drug discoveries. Based 
+on these, Ao et al. [9] proposed a non linear mathematical physical 
+(stochastic dynamic) model. According to this model, the oncogenes 
+and other molecular and cellular agents form pathways and modules 
+Citation: Amritanshuram R, Nagendra HR, Shastry ASN, Raghuram NV, Nagarathna R (2013) A Psycho-Oncological Model of Cancer according 
+to Ancient Texts of Yoga. J Yoga Phys Ther 3:130. doi:10.4172/2157-7595.1000129
+Page 5 of 6
+Volume 3 • Issue 1 • 1000129
+J Yoga Phys Ther
+ISSN: 2157-7595 JYPT, an open access journal 
+that cross talk to each other to form endogenous networks. The 
+nonlinear dynamical interactions among these generate many locally 
+stable states of which some states may be normal such as cell growth, 
+apoptosis, arresting, etc,; others may be abnormal, such as growth 
+with elevated immune response and high energy consumption, likely 
+the signature of cancer; some may be useful to deal with rare stressful 
+situations. 
+Similar to basic discoveries at molecular levels that led to safer 
+drugs to scavenge for cancer cells, the eastern yoga model offers a 
+sound conceptual basis for psycho-oncological processes that leads to 
+techniques of yoga with the potential of returning to normalcy.
+Since the first published research article evaluating the benefits of 
+a support group therapy [36] in 1981, several researchers have used 
+techniques like mindfulness-based stress reduction (MBSR), progressive 
+muscle relaxation, Tibetan yoga as alternative forms of mindful and 
+proactive non-pharmacological methodologies in combination with 
+conventional treatment and seen a plethora of benefits in cancer care. 
+To date there are three metaanalyses [37–39] of all published papers on 
+yoga in cancer, that provide consistent evidence to the strong beneficial 
+effects on distress, anxiety and depression, moderate effects on fatigue, 
+general HRQoL, emotional function and social function, small effects 
+on functional well-being, and no significant effects on physical function 
+and sleep disturbances. Looking at the results of all these studies, it 
+raises a question as to how all these studies could show similar results 
+although they had used different practices ranging from only physical 
+practices to meditative practices. The answer lies in the understanding 
+that all these (asanas, pranayama, meditation etc) are only techniques to 
+help the patient arrive at an internal mastery over the mind and prana 
+that helps in correcting the imbalances. As the premise for calling any 
+practice ‘yoga’ is clarified in ancient Indian literature, researchers had 
+the freedom to modify the intervention to suit the desired objectives.
+Summary
+The scriptural basis of the IAYTC has been discussed. The model 
+incorporates all aspects of the personality with mind as the starting 
+point with cancer as the end point of the process. 
+Limitations of the study
+This work refers a retrospective presentation of the steps that were 
+followed over the years and not a prospective planned study to assess 
+the validity and reliability of the model. Statistically acceptable check 
+lists and scoring were not used during all group discussions and the 
+format was semi structured. Not all members of the focused group met 
+during all discussions and there were several meetings that were not 
+documented. Statistical calculations of split half reliability were not 
+planned. 
+The clinical trials performed using yoga techniques developed 
+based on the proposed model cannot directly validate the model but 
+indicate that yoga is an effective tool for the management of cancer. 
+Although cancer patients and yoga teachers would greatly benefit from 
+the knowledge of this model, it is not a necessity that this model be the 
+only mechanisms of action.
+Strengths
+This is the first proposed model that explains the role of imbalances 
+at several levels of existence (physical body, prana and mind). It 
+forms the basis for self corrective techniques. RCTs that led to eight 
+publications [20–27] provide the evidence. This offers new direction to 
+research on cancer at subtler levels. 
+Conclusion
+This study offers a model for holistic approach to cancer research 
+as it incorporates the subtle components into the psycho-neuro-
+immunological model of cancer. More robust studies to understand the 
+mechanism are to be designed, in the future, in order to find evidence 
+for each process in the hypothesized model.
+Acknowledgements
+We acknowledge the support and the funding provided by the librarian and the 
+staff of S-VYASA University.
+References
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+to Ancient Texts of Yoga. J Yoga Phys Ther 3:130. doi:10.4172/2157-7595.1000129
+Page 6 of 6
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+J Yoga Phys Ther
+ISSN: 2157-7595 JYPT, an open access journal 
+al. (2007) Effects of an integrated yoga programme on chemotherapy- induced 
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+Influence of yoga on mood states, distress, quality of life and immune outcomes 
+in early stage breast cancer patients undergoing surgery. Int J Yoga 1: 11–20. 
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+Effects of yoga on symptom management in breast cancer patients: A 
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+induced genotoxic stress in breast cancer patients undergoing radiotherapy. 
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+S 
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+Radical Mediated Disorders in Ayurveda with Special Referance to Bhutagni 
+Vyapara and Ama at molecular Level. Anc Sci Life. 19: 17–20. 
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+S 
+(1999) 
+Raja Yoga. 
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+Raja Yoga. 
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+Physical and psychosocial benefits of yoga in cancer patients and survivors, 
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+patients and survivors: a systematic review and meta-analysis. BMC cancer 
+12: 412. 
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+Yoga. J Yoga Phys Ther 3:130. doi:10.4172/2157-7595.1000129

yogatexts/A Questionnaire designed to measure tridosha values in adolescents changes in score pre-post an IAYT yoga module.txt

@@ -0,0 +1,1063 @@
+Kaur et al.                                                                       European Journal of Biomedical and Pharmaceutical Sciences 
+ 
+ 
+www.ejbps.com 
+ 
+205 
+ 
+ 
+ 
+A QUESTIONNAIRE DESIGNED TO MEASURE TRIDOSHA VALUES IN 
+ADOLESCENTS: CHANGES IN SCORE PRE-POST AN IAYT YOGA MODULE 
+ 
+ 
+Devika Kaur1, Alex Hankey2* and HR Nagendra3 
+ 
+1S-VYASA, Prashanthi Kutiram Campus, Manchenahalli, Kalluballu Post, Jigani, Anekal Taluk, Bengaluru District, 
+Karnataka 560105. 
+2Distinguished Professor of Yoga and Physical Science S-VYASA, Prashanthi Kutiram Campus, Manchenahalli, 
+Kalluballu Post, Jigani, Anekal Taluk, Bengaluru District, Karnataka 560105. 
+3Chancellor, S-VYASA, Prashanthi Kutiram Campus, Manchenahalli, Kalluballu Post, Jigani, Anekal Taluk, 
+Bengaluru District, Karnataka 560105. 
+ 
+ 
+ 
+ 
+ 
+Article Received on 30/07/2019                               Article Revised on 19/08/2019                                    Article Accepted on 09/09/2019 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+INTRODUCTION 
+India‟s ancient science of life, Ayurveda[1,2] lays great 
+emphasis on the concept of Prakriti[3], because that 
+concept provides a preliminary assessment of patients‟ 
+physiological tendencies when faced by stressors[4], 
+continuing exposure to which will inevitably lead to 
+pathogenesis.[5] In the historical system, many Vaidyas 
+were trained to use Nadi Vigyan.[6,7] Ayurveda‟s system 
+of pulse diagnosis, in addition to Dashavidha Pariksha, 
+for the all-important evaluation of Prakriti and Vikriti in 
+those who came to consult them.[8] 
+ 
+The drift away from traditional systems of healthcare 
+under British influence[9,10], led to neglect of Ayurveda 
+and its systems of diagnosis and treatment. Medical 
+training colleges did not cover them, though Vaidyas 
+trained by traditional Guru-Shishya principles continued 
+to learn them. More recently, this been remedied with 
+present Ayurveda training institutions teaching them as 
+part of their curriculum.[1]* The present need is to 
+develop equivalent ways to obtain the same patient 
+information. 
+A 
+previous 
+paper[11] 
+described 
+the 
+development and testing of a questionnaire for children. 
+We ourselves have developed a separate questionnaire, 
+the Kashyapa Prakriti Inventory (KPI), aiming to 
+evaluate Prakriti in adolescents. This paper describes its 
+administration to adolescents before and after training in 
+a 90-minute Yoga module, designed in accordance with 
+the principles of the Integrated Approach to Yoga 
+Therapy[12] (IAYT).  
+ 
+Historically, Yoga originated in India as the ancient 
+Vedic civilization‟s system of personal development for 
+the children of Rishis, Kings and other leaders of 
+society.[13] The discipline is informally described in the 
+first Upanishads[14], and slowly acquired a formal status 
+as the path to union (Yuj) with the Divine[15], and 
+consequent release from the cycle of birth and death.[16] 
+ 
+Yoga focuses on gaining mastery over body and mind[17] 
+and consequent acceleration to gaining life‟s true goal of 
+self-realization and enlightenment.[18] It integrates body, 
+mind and spirit using a comprehensive, holistic approach 
+in practices emphasizing breathing and stretching, 
+postures and pranayama, chanting and meditation, as 
+detailed below. Yoga practices for the individual may 
+SJIF Impact Factor 6.044 
+ 
+Research Article 
+ejbps, 2019, Volume 6, Issue 11, 205-211. 
+European Journal of Biomedical 
+AND Pharmaceutical sciences 
+ 
+http://www.ejbps.com 
+ 
+ 
+ISSN 2349-8870 
+Volume: 6 
+Issue: 11 
+205-211 
+Year: 2019 
+*Corresponding Author: Alex Hankey 
+Distinguished Professor of Yoga and Physical Science S-VYASA, Prashanthi Kutiram Campus, Manchenahalli, Kalluballu Post, Jigani, Anekal 
+Taluk, Bengaluru District, Karnataka 560105.  
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ABSTRACT  
+Background: Ayurveda emphases the prakriti concept as fundamental to assessing patients‟ physiologies. Recent 
+decades have proposed new ways to evaluate it. Previous papers describe formulation and testing of new 
+inventories to evaluate physiological and psychological aspects of prakriti in children and adolescents. Here, we 
+report changes in adolescents pre-post a Yoga intervention. Methodology: The study was conducted at a high 
+school and PU-college level on 82 adolescents, aged 15.29±1.65 years. The Yoga module was given thrice per 
+week for four weeks. It included Yoga breathing/stretching practices, postures, Mind Sound Resonance 
+Technique, mantra recitation and relaxation techniques. The Inventory was administered pre-and-post the 
+intervention. Statistical analysis used SPSS-21.0 Wilcoxon Signed-Ranks-Test. Results: Vata decreased, p<0.05; 
+Pitta and Kapha increased, p<0.05. Discussion: Participant‟s initial states were Vata dominant. Results indicate 
+that their tridosha became more balanced; psychologies calmer, personalities steadier, causing fewer problems. 
+Changes are attributable to alteration of underlying Tridoshas; epigenetics may provide an explanation.  
+ 
+KEYWORDS: Prakriti, Psychology, Vata, Pitta, Kapha, Yoga.  
+ 
+Kaur et al.                                                                       European Journal of Biomedical and Pharmaceutical Sciences 
+ 
+ 
+www.ejbps.com 
+ 
+206 
+also include consideration of bodily compositions. The 
+texts hold that nature and body are directly related to 
+each other as described in the phrase „Avinabhaava 
+Sambandha‟[19], inseparable connection.  
+ 
+Today, many top Yoga research institutions like 
+NIMHANS 
+and 
+Kaivalyadhama[20,21], 
+and 
+other 
+academic organizations like Harvard University[22] and 
+Patanjali Yoga Peeth[23], have worked with great 
+dedication to observe benefits of Yoga practices and 
+validate them. Studies have been done on all age groups: 
+children[24]; adolescents[25]; adults[26] and the elderly.[27] 
+In adolescents (the concern of this study), effects of yoga 
+have been seen in such fields as: increased academic 
+motivation and persistence[28]; social behavior[25]; coping 
+with stress[29], dealing with anxiety[30], and similarly yoga 
+as a complementary treatment for the quality of life of 
+adolescents suffering from IBS[31], etc. However, there 
+seems to be no study of possible effects of yoga on 
+Prakriti in adolescents; hence the present study.  
+ 
+Allied to yoga is the ancient Vedic system of medicine, 
+Ayurveda.[1-3] According to Ayurveda, the human body is 
+organized by three fundamental physiological principles 
+called Doshas that govern all bodily functions[32], Vata 
+dosha, Pitta dosha & Kapha dosha.[33] Strictly speaking, 
+the word „Dosha‟ means impurity, because Doshas may 
+express imbalances in the composition of important 
+aspects of the physiology.[34] However, the Ashtanga 
+Sangraha by Vaghbata, related to the third of Ayurveda’s 
+main three texts[1-3], states that when functioning in 
+balance, Doshas are „Dhatus‟, i.e. they nourish & 
+support the system.[35] A fundamental idea in Ayurveda 
+is that each well-functioning Dosha possesses an 
+intrinsic strength, Bala[36], that may vary from person to 
+person, e.g. the strength of a person‟s digestion is 
+proportional to the strength of their Jataragni, an aspect 
+of their Pitta Dosha. If Jataragni and hence Pitta Bala is 
+strong, then digestion is good[37], but if it is low, then 
+weak digestion may give rise to toxicity, known as 
+Ama[38], and so to disease.  
+ 
+The relative strengths of the three doshas are 
+summarized in Ayurveda‟s theory of Prakriti, or 
+„physiological types‟.[39] The dominant Dosha is used to 
+name the corresponding Prakriti: a Vata Prakriti type 
+has Vata Dosha dominant in their system; a Pitta 
+Prakriti type has Pitta Dosha dominant, while a Kapha 
+Prakriti type possesses dominant Kapha Dosha. If a 
+person has the strongest two Dosha Balas close to each 
+other, then they belong to a combination of types, Vata-
+Pitta, Pitta-Kapha or Kapha-Vata.[40] 
+ 
+When such matters are considered in further depth, 
+imbalances between a person‟s Doshas are recognized to 
+increase susceptibility to disease. Dosha imbalances are 
+thus seen as precursors to all diseases, both physical and 
+mental.[41] Disease in Ayurveda is seen as driven by both 
+general and specific considerations. Dosha imbalances 
+tell the general class of pathology, while more detailed 
+considerations 
+tell 
+the 
+specific 
+disease. 
+If 
+one 
+subcomponent of Vata is driven out of balance by 
+another subcomponent of Vata, the result is a Vata-vyadi, 
+a neurological disorder.[42] For example, Pranavruta-
+samana vatavyadhi[43], where the Vata subdosha, prana, 
+drives another Vata subdosha, samana, out of balance 
+corresponds to Alzheimers disease. Charaka Samhita[1] 
+also mentions several related Vata-vyadhis which 
+correspond to other neurological disorders, such as MS, 
+Parkinson‟s disease, Hemiplegia and Paraplegia.[42] 
+  
+Common understanding of Ayurveda propagates the 
+view that an individual‟s Prakriti is fixed from birth – or 
+rather from the time of conception and zygote formation. 
+In reality, the process of Prakriti selection is more 
+complex. Sushruta Samhita states[44]: the seven prakriti 
+types have contributions from conception & birth, 
+family, place, time, age, balas and factors acquired by 
+the individual. However, Gangadhar Tika‟s celebrated 
+commentary[45] on Charaka Samhita interprets the 
+concept of Prakriti as a state of „equilibrium of doshas‟, 
+so that other types with dominance of single, or pairs of, 
+Doshas, are states of Arogya, i.e. pathophysiology – 
+Vikriti.  
+ 
+In studies of human psychophysiology, it is natural to 
+connect strengths of various organ systems to properties 
+of the personality. A strong digestion, high Pitta Dosha, 
+may be connected to a „fiery personality‟, showing anger 
+more easily (Choleric)[46]; a person with dominant Vata 
+Dosha may be more subject to attacks of anxiety, and 
+neurotic disorders.[47] People with dominant Kapha 
+Dosha may be more relaxed, happier and easy-going 
+than their peers, but will be more susceptible to 
+overweight, and thus to the metabolic syndrome 
+spectrum of disorders.[48] 
+ 
+In this way, ancient Indian Psychology associates 
+Doshas with different facades of the human personality. 
+The Ayurveda classics propose seven types of Prakriti: 
+Vataja, Pittaja, Kaphaja, Vata-Pittaja, Vata-Kaphaja, 
+Pitta-Kaphaja and Sama, with each of which a different 
+style of personality may be associated.[49] 
+ 
+In addition to these seven physiological types, the 
+Ayurveda 
+texts 
+introduce 
+sixteen 
+mental 
+types, 
+categorized 
+according 
+to 
+three 
+different 
+basic 
+dimensions, known as Gunas or qualities. The first, 
+Sattvoguna, has seven types associated with it; the 
+second, Rajoguna, has six related types, and the third, 
+Tamoguna has three associated types.[50] Thus, besides 
+its personality types connected to the physiology, 
+Ayurveda texts also utilize these three, more spiritually-
+oriented, personality concepts. Sattva – luminous with 
+wisdom and self-knowledge; Rajas – more focused on 
+enjoyment and pleasures in the external world, and 
+driven by impulsiveness, aggression etc.; and Tamas – 
+dragged down with inertia from failure to adhere to high 
+moral precepts, past disasters in life etc.[51] 
+ 
+Kaur et al.                                                                       European Journal of Biomedical and Pharmaceutical Sciences 
+ 
+ 
+www.ejbps.com 
+ 
+207 
+These last three qualities (Gunas) of personality, 
+Triguna, are often associated with Yoga, due to their use 
+to assess an individual‟s personal capacity for spiritual 
+growth: a soul is thought to evolve from Tamas 
+dominance to Rajas dominance, and on to Sattva 
+dominance, which is transcended in the final stages of 
+spiritual liberation. Such a process may take many 
+lifetimes.[52] 
+ 
+Many studies of these concepts from Yoga and Ayurveda 
+have been carried out. Those on adolescents are clearly 
+more relevant to the study reported here. For example, in 
+a study in a public school, Yoga practice was seen to 
+improve 
+adolescent‟s 
+mood 
+and 
+affect.[53] 
+An 
+uncontrolled pilot study of a module based on Patanjali‟s 
+ashtanga Yoga for children and adolescents has observed 
+benefits for weight management and psychological well-
+being.[54] A paper offering guidance to clinicians on 
+prescription of Yoga as a complementary therapy for 
+children and adolescents has proved very beneficial.[55] 
+In these various fields, studies of adolescents have 
+broadened scientific understanding gained from studies 
+on adults.  
+ 
+Previous 
+papers 
+on 
+young 
+people 
+include 
+the 
+development and assessment of a self-rating scale to 
+measure Tridoṣhas in children aged 6 to 12 years.[56] One 
+study assessed changes in Triguna in children observed 
+in a 10-day Personality Development Camp.[57] Another 
+found that yoga / meditation training improved abilities 
+to learn self-control and self-care in adolescent sex 
+offenders.[58] A further study observed that exercise, 
+Yoga and meditation improved adolescents‟ depressive 
+and anxiety disorders.[59] Management through yoga of 
+academic anxiety was also considered, while effects of a 
+youth empowerment seminar on adolescents‟ impulsive 
+behavior has been reported.[25] A feasibility study has 
+validated a Yoga module for emotional and behavioral 
+disorders in adolescents and younger children.[60] 
+ 
+Medically, a study has measured effects of yoga practice 
+on stress, depression, and health-related quality of life in 
+a non-clinical sample of adolescents, finding it very 
+useful.[61] Similarly yoga as a complementary treatment 
+for the quality of life of adolescents suffering from IBS, 
+hemophilia, cancer, and emotional and behavioral 
+disorders was found highly beneficial, as was a study of 
+the subjective experience of yoga as a management 
+strategy for stress and depression in pregnant, urban, 
+African-American adolescents.[62] Finally, a literature 
+review has evaluated the effects of yoga practice on 
+pulmonary function in healthy adolescents, including 
+perspectives on barriers to, and facilitators of, physical 
+activity.[63] 
+ 
+AIMS AND OBJECTIVES 
+The aim of this study was to evaluate the use of the new 
+KPI for adolescents. The objective was to administer the 
+inventory pre and post a Yoga program and assess any 
+changes. To this end, the study assessed the effects on 
+adolescents of an IAYT Yoga module designed for that 
+purpose. The research hypotheses were that the module 
+would have significant observable changes on each 
+variable being assessed. The null hypotheses were either 
+that such changes would not occur, or that they would 
+not attain p < 0.05 significance.  
+ 
+MATERIALS AND METHODS 
+Study Protocol (see Figure 1): The study was conducted 
+in Vivekananda Education Centre, Jayanagar and MES 
+Pre-University college, Maleshwaram, Bengaluru. It was 
+a Pre-Post design on 82 randomly selected adolescents 
+aged 13-18 years. For the mean ages for each gender and 
+both together, see Table 1.  
+ 
+Table 1: Age Distribution by Gender. 
+AGE 
+13 YRS 
+14 YRS 
+15 YRS 
+16 YRS 
+17 YRS 
+18 YRS 
+TOTAL 
+Mean±SD 
+BOYS 
+8 
+9 
+8 
+9 
+7 
+6 
+47 
+15.34±1.66 
+GIRLS 
+7 
+6 
+7 
+6 
+5 
+4 
+35 
+15.23±1.66 
+TOTAL 
+15 
+15 
+15 
+15 
+12 
+10 
+82 
+15.29±1.65 
+Caption: Table 1 shows numbers of students in each year of age according to gender and in total. 
+ 
+Inclusion Criteria: Physically and Mentally Healthy, 
+Either Gender, Aged 13 to 18 years.  
+ 
+Exclusion Criteria: Attention Deficit Hyperactive 
+Disorder, Psychosis, Autism / Mentally Challenged.  
+ 
+Intervention: 90-minute Integrated Yoga Module (see 
+Table 2) with seven different sections- Breathing 
+Exercises, 
+Dynamic 
+Exercises 
+including 
+Suryanamaskara, Asanas, Pranayamas, Chanting, Yogic 
+Games, and Relaxation Techniques; given 3 times per 
+week for four weeks. Also, participants were instructed 
+to practice at home daily for the other days of each week, 
+and given a printed sheet of the module to use to direct 
+their practices.  
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+Kaur et al.                                                                       European Journal of Biomedical and Pharmaceutical Sciences 
+ 
+ 
+www.ejbps.com 
+ 
+208 
+Table 2: Integrated Yoga Module. 
+SECTION 
+PRACTICE 
+TIME (mins) 
+1. Breathing Exercises 
+Hands In & Out Breathing 
+2min 
+ 
+Vertical Hand Stretch 
+1min 
+ 
+Ankle Stretch 
+1min 
+ 
+Tiger Breathing 
+1min 
+ 
+Dog Breathing 
+1min 
+ 
+Rabbit Breathing 
+1min 
+ 
+Sectional Breathing 
+2min 
+2. Dynamic Exercise 
+Hand Swing 
+2min 
+ 
+Twisting 
+1min 
+ 
+Alternate Side Bending 
+1min 
+ 
+Forward & Backward Bending 
+1min 
+ 
+Jogging 
+3min 
+ 
+Pavanamuktasana Kriya 
+4min 
+Suryanamaskara 
+Suryanamaskara 
+5 min 
+3. Asana 
+Ardhakati chakrasana 
+1min 
+ 
+Padahastasana 
+2min 
+ 
+Ardhachakrasana 
+1min 
+ 
+Ushtrasana 
+2min 
+ 
+Paschimottanasana 
+2min 
+ 
+Suptavajrasana 
+1min 
+ 
+Makarasana 
+1min 
+4. Pranayama 
+Nadishuddhi 
+3min 
+ 
+Kapalabhati (a Yoga Kriya) 
+2min 
+ 
+Bhramari 
+1min 
+ 
+Sheetali 
+1min 
+5. Chanting 
+Vedic Chanting (Choice of 10 Sections) 
+6min 
+Different on Different Days 
+Bhagavad Gita 
+8min 
+ 
+Nadanusandhana / Omkara Meditation 
+4min/5min 
+6. Yogic Games: Choice of - 
+Find Ram-Shyam 
+5min 
+Different on Different Days 
+Accepting Criticism 
+2min 
+ 
+Find-a-Leader 
+1min 
+ 
+Search Engine 
+5min 
+7. Relaxation Technique 
+IRT, QRT & DRT (from SMET Program) 
+1min,3min,7min 
+ 
+Assessment: The KPI was administered before and after 
+the four-week intervention.  
+ 
+Statistical Analysis: Employed SPSS version 21.0. First, 
+the Kolmogorov-Smirnov test was used to check whether 
+the data were normally distributed; since it was not, the 
+Wilcoxon Signed Ranks Test was applied to assess the 
+significance of within-group changes in the data.  
+ 
+RESULTS  
+Results are displayed in Table 3 below, which shows that 
+Dosha Prakriti measured according to the KPI changed 
+highly significantly for each Dosha. Changes generally 
+indicate improved health, since, once imbalances have 
+set in, excess Vata Dosha tends to drive other doshas 
+further out of balance. The decreases in Vata Dosha seen 
+over the course of the four-week period indicate more 
+steadiness of mind suggesting reductions in a. Chitta-
+Vritti activity[64], and b. generally unnerving speed of 
+thought, which lead to speedier actions on a physical 
+level. This result also suggests slowing of the breath and 
+/ or breathing. In contrast, the other two Doshas, Pitta 
+Dosha and Kapha Dosha were both strikingly much 
+stronger than Vata Dosha at the end of the month.  
+ 
+Table 3a: Pre and Post Dosha Values of Present Study. 
+VATA 
+PITTA 
+KAPHA 
+Pre 
+Post 
+Pre 
+Post 
+Pre 
+Post 
+11.28±3.12 
+8.09±2.60 
+12.91±3.24 
+15.86±3.32 
+16.37±3.34 
+19.59±3.25 
+Table 3b: Pre and Post Dosha Values of Patil Study. 
+10.74±3.42 
+7.98±2.11† 
+12.80±3.57 
+13.96±1.85† 
+11.80±4.42 
+13.72±2.04 
+Caption: Tables 3as & 3b display Pre and Post Values of Dosha Prakritis for Adolescents (3a) & Children (3b) 
+ 
+ 
+ 
+Kaur et al.                                                                       European Journal of Biomedical and Pharmaceutical Sciences 
+ 
+ 
+www.ejbps.com 
+ 
+209 
+DISCUSSION 
+The last statement requires comment: high Kapha levels 
+can precipitate Kapha Rogas, of which obesity and 
+related disorders like metabolic syndrome are all too 
+common among today‟s population. However, the 
+participants‟ ages must be taken into consideration: ages 
+5 to 13 are dominated by anabolism related to physical 
+growth and thus naturally exhibit high levels of Kapha 
+Dosha; similarly, ages 13 to 18 are dominated by Pitta 
+Dosha, as the physicality of youth comes into play. 
+Observing higher levels of Pitta and Kapha Doshas, 
+when assessing youth in the age range addressed in this 
+study is quite acceptable. The final Dosha Prakriti scores 
+therefore reflect processes taking place all during the 4-
+week module practice. They can be interpreted as 
+indicating restoration of Dosha Prakriti values towards 
+their usual ranges for this age group.  
+ 
+Comparison with Patil‟s study[11] is instructive. Pre-post 
+percentage changes obtained in Patil‟s study and this 
+study are as follows: (Vata: -25.6, -28.2) (Pitta: +8.90, 
++22.8) and (Kapha: +16.2, +19.7). The two studies 
+therefore show similar changes in Dosha scores after a 
+one month Yoga module intervention; the only major 
+difference being in percent change in Pitta score, with 
+adolescents, in a naturally Pitta stage of life, showing 
+greater increase. This observed difference was almost to 
+be expected. 
+ 
+Generally, in recent times, because of modern Ahara-
+Vihara habits common in this stage of life, we see Dosha 
+Balas opposite to those said to characterize the age group 
+in question. The data therefore indicate that inculcating 
+the module‟s Yoga practices at an early age will help 
+restore desired Dosha balances, and, as Vata Dosha 
+reduces and Pitta Dosha increases, the memory, 
+intelligence and basic learning skills characteristic of 
+youth.  
+ 
+Practising dynamic exercises like those in the module 
+will tend to induce or increase sweating, sweda. 
+According to Ayurveda classics, swedana is a treatment 
+that reduces Vata Dosha, and that will benefit the three 
+gunas by reducing Rajas and Tamas.  
+ 
+Strengths: The strengths of the study are: a. it is the first 
+to assess the effect of Yoga on Tridosha in adolescents; 
+b. being a pre-post design, the first to observe significant 
+changes in state in all three Doshas, Vata, Pitta and 
+Kapha; c. the intervention can bring changes in Tridosha 
+large enough to significantly alter adolescents‟ physical 
+and psychophysiological states – and possibly reshape 
+their personalities. 
+ 
+Limitations: No control group was included in the 
+study.  
+ 
+Future Research: Any future study should include a 
+control group along with the Yoga group. A randomized 
+controlled trial would then be the best study design, but 
+with the following caveat: here, the same Yoga module 
+was used for all the participants, despite their having 
+different Dosha Prakritis; future studies should use 
+several Yoga modules, each adapted to a particular 
+Dosha Prakriti. Then we may anticipate improved 
+progress towards Sama Prakriti being achieved in all 
+cases.  
+ 
+CONCLUSIONS  
+The study suggests that the four-week IAYT Yoga 
+module employed in the intervention brings significant 
+balancing benefits for Tridoshas in adolescents. It may 
+also benefit levels of the three Gunas. Practiced regularly 
+over a sufficient period of time, breathing techniques like 
+sectional breathing, Nadi Shuddhi, and Sitali, named in 
+the yoga module help to reduce Vata at the physical 
+level, and simultaneously overcome Tamas. Adopting 
+dynamic practices like Suryanamaskara, Asanas & 
+Kapalabhati, Pitta increases so that the individual 
+him/herself transforms inertia (Tamas) into Rajas, thus 
+bringing lightness and flexibility to the body and 
+dynamism to brain activity (Rajas). In yogic lore, this is 
+considered an advance on the path to transcending the 
+influence of Gunas. Along with these practices, addition 
+of meditation, Japa, breath retention in Pranayama and 
+increasing time of maintaining each Asana helps to 
+increase stability of body and mind (Sattva).[57] 
+ 
+ACKNOWLEDGEMENT  
+We would like to thank all the students from the school 
+and college for their active participation, also the 
+management for their kind support. I would like to thank 
+Dr. Suchitra for the timely discussions regarding the 
+study. All the experts involved in the study.  
+ 
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+regular yoga practice on pulmonary function in 
+healthy individuals: a literature review. The Journal 
+of Alternative and Complementary Medicine, 2013 
+Mar 1; 19(3): 185-90. 
+65. Shearer A. The Yoga Sutras of Patanjali. I(2): 2 
+Crown Publishing, London, 2010.  
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yogatexts/A Review on Hydrotherapy Practices in Ancient India.txt

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+_____________________________________________________________________________________________________ 
+ 
+# Dean; 
+*Corresponding author: E-mail: [email protected]; 
+ 
+ 
+ 
+Journal of Complementary and Alternative Medical 
+Research 
+ 
+17(1): 22-29, 2022; Article no.JOCAMR.79409 
+ISSN: 2456-6276 
+ 
+                                 
+ 
+ 
+A Review on Hydrotherapy Practices in Ancient 
+India 
+ 
+K. J. Sujatha a*# and N. K. Manjunath b 
+ 
+a Division of Natural Therapeutics, Shri Dharmasthala Manjunatheshwara College of Naturopathy and 
+Yogic Sciences, Ujire, 574240, India. 
+b Director of Research and International affairs, S-VYASA University, India. 
+ 
+Authors’ contributions 
+ 
+This work was carried out in collaboration between both authors. Both authors read and approved the 
+final manuscript. 
+ 
+Article Information 
+ 
+DOI: 10.9734/JOCAMR/2022/v17i130323 
+ 
+Open Peer Review History: 
+This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers,  
+peer review comments, different versions of the manuscript, comments of the editors, etc are available here: 
+https://www.sdiarticle5.com/review-history/79409 
+ 
+ 
+Received 07 November 2021 
+Accepted 10 January 2022 
+Published 12 January 2022 
+ 
+ 
+ABSTRACT 
+ 
+Background: Water being one of the five great elements (pañcamahābhūta), is considered to be 
+the medium of creation and maintenance of life. Hydrotherapy is the application of water in various 
+forms, temperature on the body either internally or externally for the treatment of the diseases and 
+maintenance of health. It has been observed that many of the practices are considered as a part of 
+daily routine before it was developed into a separate treatment modality. Application of water was 
+given utmost importance in Indian traditional texts like Rigveda, yajurveda, atharva veda, as well 
+as caraka samhitä, çuçruta samhitä and añöäìgasangraha of äyurveda. The practice of 
+hydrotherapy was a part of the all performances or rituals like yäga and yajïa. In this study we aim 
+to elaborate the ancient Indian techniques for improving the body immunity through hydrotherapy 
+as mentioned in traditional texts. The traditional references for hydrotherapy technique like bath, 
+affusion, immersion, packs, irrigations, compresses, poultices, etc, in Indian tradition are searched 
+and compiled. The key changes which can happen in the body due to these practices, which 
+confirm the healthy condition is studied and the proper methodology for these procedures are listed 
+as per the Indian texts with upgrading methods.  We observed in this research that, although 
+having a firm foundation of these behaviours listed in all classic books, they are not mandatory in 
+our day-to-day actions.The modern life style has given more liberty to the people about these 
+Review Article 
+ 
+ 
+ 
+ 
+ 
+Sujatha and Manjunath; JOCAMR, 17(1): 22-29, 2022; Article no.JOCAMR.79409 
+ 
+ 
+ 
+23 
+ 
+practices.  Many historical methods have been seen to be unappealing or to fail to persuade 
+others. In this regard we found many of the ready/ easy practices which can reach wider range of 
+people, as an essential method to propagate and train for better living and protection of health to 
+entire humankind. 
+ 
+ 
+Keywords: Water; hydrotherapy; Indian tradition; vedas; naturopathy. 
+ 
+ABBREVATIONS 
+ 
+RV  :  Rigveda  
+YV  
+:  Yajurveda  
+BAU  :  Bruhadäraëyakopanisad  
+TU  
+:  Taittaréya upaniñad  
+CS  : Caraka Samhita 
+AS  
+: Añöäìgasangraha  
+AV  
+: Atherva Veda  
+SS  
+: Sütra Stäna 
+ 
+1. INTRODUCTION 
+ 
+Hydrotherapy is the application of water in 
+various forms and temperature on the body 
+either internally or externally for the treatment of 
+the diseases and maintenance of health [1]. It 
+has been observed that many of the practices 
+are considered as a part of daily routine before it 
+was developed into a separate treatment 
+modality like Hydrotherapy. The practices like 
+washing hands, gargling (throat irrigation), 
+Bathing, water drinking is considered to be the 
+protective measures, then evolved and modified 
+into different procedures [2]. The concept of 
+usage of water for prevention and treatment of 
+disease and promotion of health was well 
+developed in philosophy and medicine of eastern 
+civilization based on river Sindhu [3]. Water or 
+“äpa” was worshipped in reality and symbolically 
+in ancient Indian culture as nature was kept 
+above man [4]. Ancient religious thought is 
+progression from physical to spiritual, from a 
+purely naturalistic to an increasingly ethical and 
+psychological view of nature [5]. Worshipping of 
+water resources has the intention of protection 
+and maintenance of health through water. 
+ 
+Water is one of the five great elements 
+(pañcamahābhūta) namely ether (ākāśa), air 
+(vāyu), fire (teja or agni), water (āpa), and Earth 
+(pṛthivī) [6]. In Vedas and Upanishads, the 
+traditional text books of Indian culture, the 
+process of evolution of five great elements 
+(pañcamahābhūta) 
+is 
+explained 
+very 
+systematically.  The Air is said to have been 
+generated from space, fire from air, water from 
+fire, and earth from water. Fire and water, which 
+are claimed to pervade the whole cosmos, have 
+a tight relationship and are said to be procreative 
+[7]. The five elements constitute the physical 
+universe; Water is regarded as the primordial 
+substance from which the universe came into 
+being as it is mentioned in Rigveda (RV), 
+SBXIV,3,2.13. It is mentioned that water is the 
+source of our lives, i.e, janayathä [8]. In 
+Yajurveda (YV) hymn no-17/36 states that life in 
+universe, by receiving the cosmic water will have 
+the 
+ability 
+to 
+partake 
+it 
+fully 
+[9]. 
+Bruhadäraëyakopanisad 
+(BAU)t 
+in 
+its 
+verse,6.4.1, mentions that the element earth 
+sustains all creatures and the earth is sustained 
+by water. The water gets transformed into herbs 
+and vegetations, they in turn become flowers and 
+then fruits and fruits support the creatures [10]. 
+The respect was shown by taking utmost care of 
+the water sources. There was a warning in 
+Atherva Veda (AV) about maintaining of water 
+and its sources clean. Pollution was mentioned 
+as poisoning and considered as responsible for 
+spreading of diseases.  One who dirties or spoils 
+ponds, lakes, rivers, etc., or cause smell near 
+residential areas was liable to chastisement [11] 
+Waters and herbs should have no poison’ is 
+mentioned in RV saàhitä vi –39-5. ‘Waters are to 
+be freed from defilement’ is according to Atharva 
+Veda Samhita x-5-24. Taittaréya upaniñad (TU) 
+in the verse 5.101 prescribes certain norms for 
+human beings to keep the environment clean. 
+“One should not cause urine and stool in water, 
+should not spit in water; and should not take bath 
+[12]. Yajurveda also cautions against polluting 
+water as well as destroying trees or plants which 
+are the sources of medicine. It is mentioned in 
+padmapuräëa in the verse from 8-13of chapter 
+8of Kriya Yoga Sar that dirtying of water or 
+surroundings of rivers as a sinful act.  This is an 
+excellent mode of preventing the disease. The 
+God who exists in the universe, lives in air, 
+water, in fire and also in trees and herbs, men 
+should have reverence for them”. BAU (3.9.28) 
+[13] in the same manner the subject of water has 
+been 
+related 
+spiritually, 
+philosophically, 
+cosmologically, medically, and poetically in the 
+ancient Indian literature comprising the veda, 
+upaniñad, puräëä and småti. 
+ 
+2. NEED FOR THE STUDY 
+ 
+The knowledge of medicinal property of water 
+was inherited among ancient Indian people and 
+ 
+ 
+ 
+ 
+Sujatha and Manjunath; JOCAMR, 17(1): 22-29, 2022; Article no.JOCAMR.79409 
+ 
+ 
+ 
+24 
+ 
+texts. The use of water as a medicine was not 
+investigated and it remained unearthed. This 
+study referred the ancient Indian literature such 
+as veda and upaniñad, äyurveda and traditional 
+treatment methods, exploring the knowledge of 
+hydrotherapy. It has become a need, especially 
+because hydrotherapy now occupies the majority 
+of treatment modalities as an independent or 
+adjuvant therapy in the present day. We have 
+conducted a study to revive hydrotherapy of 
+ancient India which will be a contribution towards 
+the better understanding in diagnosis, and 
+treatment of the disease. 
+ 
+3. CONCEPT OF MEDICINAL PROPERTY 
+IN WATER  
+ 
+Atharva veda (AV) mentions about beneficial 
+effects of water irrespective of the place where it 
+had been obtained. In verse 11/4, it is said that 
+“In those deserts where water is present, it is 
+available from ponds, the water we fill in 
+pitchers/pots, water available through rains, may 
+all this water be beneficial to us”. The benefit 
+which is mentioned here is health itself to every 
+individual human being [14]. Caraka Samhita 
+(CS) defines health as a condition which is the 
+best source of virtue, wealth, gratification and 
+emancipation while diseases are destroyers of 
+this source of welfare and life itself (CS.Sū.1.15-
+17) [15]. According to çuçruta samhitä, a healthy 
+person is one who has a perfect balance of all 
+body functions in equilibrium with the mind and 
+soul, any deviation from which results in 
+diseases (SS.Sū.15,41) [16]. Añöäìgasangraha 
+(AS) a traditional text on Ayurveda describes that 
+there can be no life without water and world is 
+predominantly watery both in health or in ill 
+health [17]. Kathopanishad refers to this custom 
+stating ‘A learned guest who visits our dwellings 
+is gleaming similar to fire and to appease him get 
+water132’; in other words, guests must be first 
+treated with water to cleanse themselves.[17]. 
+So, providing water to wash hands, legs and 
+giving water to sip is the first line of treatment 
+recommended for the guests especially in Hindu 
+culture. AV in several other hymns like 6.23; 24 & 
+57 specifically mention the medicinal value of 
+waters and as a dispeller of diseases, as a curer 
+of incurable diseases. In the verse-1.161.9., RV 
+recognizes these qualities and state – ‘there 
+exists no better element other than water”. In the 
+verse - 10.9.5. of RV, it is stated that “Water is 
+sovereign 
+of 
+precious 
+treasures, 
+hence 
+requested to act as a healer and remove all ill 
+health”  [18]. The water is considered to be a 
+preservable, precious panacea for the disease 
+condition. 
+4. WATER AS UNIVERSAL REMEDIAL 
+AGENT  
+ 
+The medicinal property of water, uplifts it as a 
+universal remedial agent i. e vishwa bheSaja. 
+Water was known to give strength and vigor as it 
+is mentioned in RV. It is known to relive the 
+weakness or degeneration (kñaya). Water is 
+abundantly filled with Medicinal Herbs; helps to 
+protect body, so that one can live long according 
+to RV [19]. “Water is present in all Medicinal 
+Herbs of the World, as TU explains the same in 
+verse 1.7.1. Thus, water was considered to be 
+the main ingredient of herbs and plants, also all 
+living beings, in particular human beings. In AV 
+water gets first place as a curative medicine, 
+Water gives strength, it is remedial, it expels 
+diseases [20]. AV tells indirectly that water 
+contains nectar, the mythological divine drink 
+which makes Gods (Deva) unageing and 
+immortal. AV feels that water is, as skilled as a 
+physician, even the herbs are medicinal because 
+they are the products of water. The early 
+beginnings of the art of healing and of the 
+knowledge of healing herbs are found in the 
+“kauçika sütra “of the AV [21]. Yajurveda in the 
+verse15.20 elaborates the application of water 
+differently. “Water is the light, the essence, the 
+nectar and the God, the Brahman”. Yajurveda 
+described water is good for eye problems and is 
+energetic. Up till now in day-to-day practices 
+most of the eye problems are removed by rinsing 
+eye with water [22]. Inherent properties of water 
+both Physical and chemical are responsible for 
+the different functions which are carried out by 
+water in both human beings and plants. Water 
+moves from root of the plant till the tip by 
+capillary action.  Capillary action is the ability of a 
+liquid to flow in narrow spaces without the 
+assistance of, and in opposition to external 
+forces like gravity. Water is capable of capillary 
+action due to its properties of adhesion & 
+cohesion [23].  
+ 
+An example of capillary action in human biology 
+is the drainage of constantly produced tear fluid 
+from the eye. This is essential in many parts of 
+the 
+body, 
+especially: 
+(low 
+viscosity 
+and 
+lubricating 
+property) 
+in 
+the 
+thoracic 
+and 
+abdominal cavities where internal organs (e.g., 
+the heart and lungs, and the organs of the 
+digestive system) are located next to each other 
+and slide over one another as the body moves 
+[24]. At synovial joints, structures such as bones, 
+ligaments, and tendons must move smoothly 
+relative to one another without being hampered 
+by friction between the various structures/ 
+ 
+ 
+ 
+ 
+Sujatha and Manjunath; JOCAMR, 17(1): 22-29, 2022; Article no.JOCAMR.79409 
+ 
+ 
+ 
+25 
+ 
+surfaces. Lubrication is required when internal 
+organs/cells come into contact with one another 
+and glide over one another. Organisms Depend 
+on 
+Cohesion. 
+Hydrogen 
+bonds 
+hold 
+the 
+substance 
+together, 
+a 
+phenomenon 
+called 
+cohesion. Cohesion is responsible for the 
+transport of the water column in plants. The 
+existence of hydrogen bond will help water to 
+consider a unique media to treat all the ailment 
+[25]. The physical properties are recognized in 
+rain water as stated in Sütra Stäna (SS) 45.3.   It 
+was stated that water dropping down from sky, 
+has no taste, no odour. It is absolutely pure and 
+beneficial like nectar. it gives and sustains life, 
+quenches thirst, cures wounds by weapons etc. 
+and revives the consciousness of those who faint 
+due to fatigue, gives clear knowledge, removes 
+drowsiness, burning sensation in the body. The 
+concept of water in Rigveda also recognizes 
+these properties of water as divine values. “The 
+water which is created in the universe, the water 
+which flows in the form of river etc, the water 
+which comes from the digging of the wells, 
+canals etc., the water which is self-created in the 
+form of waterfalls etc, who enters into the ocean 
+and who is pure and full of light, who is full of 
+divine characteristics, help me in this world. 
+Thus, Water is being mentioned as the great 
+purifier and help when received [26]. The 
+rejuvenation therapy (rasäyana) originally based 
+on ‘Rasa’ means water only. The rasa or sap of 
+water is known to care like mother. Water is 
+considered as mother who can know to care in 
+the disease process and correct the system. 
+Vedic texts consistently use ‘rasa’ in the sense of 
+water.  “äpam rasaù” is a frequently appearing 
+phrase in the AV. Similarly, in the AV there was 
+frequent praise of water and its virtues such as 
+conferring luster, putting away old age, resisting 
+of diseases and bringing of immortality are 
+emphasized [27]. Thus, in the Vedic age water 
+was regarded as rasäyana and it is said to fulfil 
+all the functions and dispeller of diseases.  
+ 
+5. HEALING PROCESS IN WATER 
+ 
+Healing process in water is categorized into three 
+remedial 
+properties 
+like 
+Absorbing 
+and 
+communicating property, change of state and 
+solvent property [28]. 
+ 
+5.1 Absorbing 
+and 
+Communicating 
+Property 
+ 
+According to the concept of Indian philosophy as 
+explained in Vedic age, water gets divided into 
+minute particles due to the effect of sun rays and 
+wind. Then it ascends to the atmosphere by the 
+capillary of air. It gets condensed there and 
+subsequently falls as rainfall. So, absorption of 
+water by the atmosphere was recognized here. 
+The verse RV,83.4 Rishi Atri prays parjanya in 
+the following words: - “When parjanya (Sun of 
+Heaven) protects the earth with his waters i.e. 
+irrigates the earth, then winds (for rains) are 
+blown, lightning strikes, vegetation sprouts and 
+grows, sky downpours the drops of water and the 
+earth becomes capable for the welfare of the 
+whole 
+world”. This verse mentions about 
+absorption of water by earth helping the 
+vegetation and energy will be gained through this 
+vegetation [29]. Compared with other materials 
+water can absorb or release a relatively large 
+amount of heat energy while only adjusting its 
+own temperature by a relatively small amount. 
+Therefore, the fact that water accounts for a 
+significant proportion of body mass helps the 
+body to cope with environmental temperature 
+variations and maintain the body's temperature 
+within a safe and comfortable range. The specific 
+heat of the body and water help in the amount of 
+heat that must be absorbed or communicated 
+between water and body to be same. SS 
+mentions that Aqua is a major chemical required 
+for digestion of food taken in. It is advisable to sip 
+little water during meals. The water is also said to 
+give nutrition in the verse VII.49.2 of RV. 
+Nutrition of the body is by two processes mainly, 
+absorption of food and communication of heat 
+produced in cellular activity. So, absorption and 
+communication can be very effective through 
+watery medium when it is used internally. 
+ 
+5.2 Change of State 
+ 
+In Linga purana of 1.36.38 and 1.36.39 say that 
+water is never destroyed nor lost, only its state is 
+changed. Verses 1.36.66-67 of the Linga purana 
+says that it changes one state to the other, water 
+(liquid) to Vapour (gas) by sun heat.  Vapour 
+ascends to the sky with the air   and gets 
+converted into cloud. The cloud will be converted 
+into rain fall. These verses indicate that he 
+interchanging of solid, liquid and vapour state of 
+water was known [30]. The tripartite nature of 
+agni has been connected with the three forms of 
+water – celestial, atmospheric, and terrestrial, 
+called by different synonyms in RV. In Verse 
+XII362.4 of Mahabharata, it is explained that sun 
+rays will rain for 4 months and same water will be 
+extracted by the sunrays [31]. The circulation of 
+water in different forms. The change of state of 
+water from solid to liquid and liquid to gas of vice 
+versa provides a wide range of application each 
+state exhibiting unique effect on the body [32]. 
+ 
+ 
+ 
+ 
+Sujatha and Manjunath; JOCAMR, 17(1): 22-29, 2022; Article no.JOCAMR.79409 
+ 
+ 
+ 
+26 
+ 
+5.3 Solvent Property 
+ 
+In 
+cändogya 
+upaniñad 
+verse 
+6.13.1, 
+the 
+dissolving property of water where the son 
+çvetaketu gets the knowledge of Brahman. Water 
+is an excellent solvent that transports many 
+essential molecules and other particles around 
+the body. These include nutrients and waste 
+products from the body's metabolic processes. 
+Ionization, Electronegativity and osmosis in 
+water, helps to flush out toxins and waste 
+products from tissues and ultimately from the 
+body [33]. Elimination by water is mentioned in 
+Veda both from body and mind. Water is said to 
+wash away the wicked tendencies in a person 
+the treacheries burning within and any falsehood 
+of the mind.8.1. RV offers oblations to deities 
+presiding over the flowing waters- “O Water, 
+which we have drunk, becomes refreshing in our 
+body. May you be pleasant to us by driving away 
+diseases and pains – O divine immortal waters” 
+(RV 63). Water is seen as the reservoir of all 
+curative medicines. ‘varuëa’ is a cosmic ruler as 
+well as the deity that dwells in waters, presides 
+over them and is, therefore, prayed to for 
+granting strength and virility to people’. Water is 
+considered to be a purifier, life-giver, and 
+destroyer of evil [34]. 
+ 
+6. TECHNIQUES OF HYDROTHERAPY  
+ 
+Baths, Packs, Compresses and irrigations are 
+the main treatment modalities of hydrotherapy 
+which were practised in ancient India. All these 
+treatments have different action and reaction 
+according to the ability of response in the person, 
+temperature, duration, area of application and 
+mode of application used. The cold receptors will 
+get stimulated gradually but hot receptors 
+suddenly [35]. The series changes can occur in 
+three phases as action, reaction and remote 
+effect. So, hydrotherapy prescription making 
+should be very much subjective. The modalities 
+like cold bath and immersions were practiced by 
+appreciating the beneficial effects. Verse 9.1 of 
+RV mentions about deeply entering to water 
+which will produce shining of skin in person. In 
+RV ponds of varying depths for bathing was 
+mentioned in hymn no10/71/7 [36]. All major 
+religions of India place an emphasis on 
+ceremonial purity, and bathing is one of the 
+primaries means of attaining outward purity. 
+Ancient Indians used elaborate practices for 
+personal hygiene with three daily baths and 
+washing. In Hindu households, any acts of 
+defilement are countered by undergoing a bath 
+and Hindus also immerse in Sarovar as part of 
+religious rites. These are recorded in the works 
+called gruhya sütra and are in practice today in 
+some communities. The gruhya sütra or Vedic 
+domestic rites and rituals for the householders 
+mentions about washing hands, taking bath, 
+wearing wet cloth as in pack and sipping water 
+as part of many rituals [37]. Steam bath and Sun 
+bath, are mentioned in äyurveda as svedana, 
+snehana. They are the pre procedures for 
+Panchakarma [38]. An herbal combination is 
+added sometimes to the steam for medicinal 
+effect. Sea bathing and river bathing were also 
+advised as a hygienic measure in Hinduism.  
+Local baths like ‘Foot bath’ improves eyesight 
+and pacifies the mind. This rejuvenates the 
+circulatory 
+system. 
+The 
+foot 
+bath 
+is 
+recommended 
+for 
+curing 
+acute 
+headache, 
+insomnia, disorders related to blood pressure, 
+etc [39]. 
+ 
+There is clear instruction on drinking water based 
+on a person's nature. When water is consumed, 
+it bestows fortunate divinity on the individual who 
+drinks it.4.1 of RV.  Consuming water about 1.5 
+liters each morning on an empty stomach, as 
+well as throughout the day is called uña käla 
+cikistä. Water therapy is considered to be a 
+material way of taking an "internal bath" [40]. The 
+attributes of rainwater gathered prior to the 
+contact with land are listed by çuçruta in the 45th 
+branch of SS. ‘It beats the disparities caused by 
+vätä, pitta, kapha offers vigor, augments the 
+seven building materials of the body known as 
+saptadhätu which enhances the brain activity’. 
+Once it touches the land its quality changes 
+according to the quality of the terrain. cäëakya 
+néti in the verse 41 mentions that during 
+indigestion the right and suitable food is water 
+only, preferably hot water. CS mentions that 
+Water taken at dawn works like the heavenly 
+nectar, and in the process of assimilation, it 
+bestows strength; water works like poison when 
+taken immediately after food and as a medicine 
+when 
+properly 
+employed 
+during 
+disease 
+condition.  SS talks about the quantity of water to 
+be taken. The food doesn’t get digested and 
+assimilated if water is consumed in very high 
+quantities. The same problem occurs when water 
+is consumed in too low quantities. It is important 
+to drink more water on a regular basis if you want 
+to have a decent appetite. A person suffering 
+from loss of taste, heartburn, oedema, any of the 
+wasting illnesses, poor digestion, abdominal 
+dropsy, skin disorders, fever, diseases affecting 
+the eyes, ulcer, and diabetes mellitus should 
+drink as little water as possible.AS in the verse 5 
+states that water consumed in the middle, at the 
+ 
+ 
+ 
+ 
+Sujatha and Manjunath; JOCAMR, 17(1): 22-29, 2022; Article no.JOCAMR.79409 
+ 
+ 
+ 
+27 
+ 
+end and in the beginning results in a balanced 
+structure, obese structure and a lean structure, 
+respectively. SS warns that water taken before 
+meals 
+will 
+dampen 
+the 
+digestive 
+power 
+(jaöharägni) and dilute the digestive juices, and 
+in the long run, it results in malassimilation 
+(ineffective assimilation). Water, when taken 
+immediately after meal, causes obesity, and 
+hence, it is advisable to take little water in the 
+course of meals.  
+ 
+SS explains about the thirteen types of 
+fomentation as well as their indications and 
+contra indications. At the time of fomentation, it is 
+necessary to protect the body like eyes, heart 
+and testicle. Because these are most delicate 
+parts of the body. Fomentation is to be 
+administered until there is complete recovery 
+from cold, colic pain, stiffness and heaviness of 
+body, or until tenderness and sweating appear 
+there. 
+ 
+SS in the verse 45 explains the use of describes 
+the therapeutic benefits of cold water. Cold water 
+is known to be helpful in treating epilepsy, in 
+summer, in the condition of excessive body heat, 
+the imbalance of pitta, treating blood poisoning, 
+problem associated with excessive consumption 
+of 
+wine, 
+the 
+state 
+of 
+unconsciousness, 
+exhaustion, vertigo or dizziness and nausea. 
+Although 
+cold 
+water 
+is 
+good 
+and 
+is 
+recommended to be used as medicine, its use is 
+not advised under conditions, such as pain at the 
+sides  of the chest,  catarrh, rheumatism, 
+diseases of  the larynx, distention of the stomach 
+by gas or air, cases of undigested faeces, acute 
+stage of fever, just after the exhibition of any 
+emetic or purgative remedy, severe cough and 
+soon after consuming fatty or oily drinks 
+(snehapäna) acute cold, vätä diseases, sore 
+throat, gastritis, constipation, fever immediately 
+after dysentery and nausea, during hiccups and 
+on consuming more of oily food. 
+ 
+7. CONCLUSION 
+ 
+Water is an essential component in the medical 
+field. It is unquestionably a component of treating 
+symptoms and eradicating the underlying cause 
+of the sickness. The word ‘jévanaà ’ is derived 
+from the root verb ‘jéva’ meaning embracing life 
+or ‘präëadhäraëe’. Water is given the word 
+jévanaà jévanaà to show its importance in life. 
+Water is broadly found in scriptures as an utter 
+necessity in bathing, (snaana), drinking (päna), 
+cleansing (çauca), relieving treatment (cikitsä), 
+hospitality (upacära), farming (kruñi), and offering 
+(tarpaëaà). Mahatma Gandhi employed water 
+therapy to effectively heal many people's 
+diseases. Water is consequently understood as 
+the elixir of life. Water is used both in the 
+preparation 
+of 
+medications 
+and 
+in 
+their 
+consumption. 
+Prevention, 
+treatment 
+and 
+maintenance of health through is a divine 
+responsibility of every person. In this regard, the 
+knowledge of ancient scholars on usage of water 
+as medicine water is thought to bring peace, 
+happiness wealth, long life and good health. 
+ 
+NOTE 
+ 
+The study highlights the efficacy of "ayurveda" 
+which is an ancient tradition, used in some parts 
+of India. This ancient concept should be carefully 
+evaluated in the light of modern medical science 
+and can be utilized partially if found suitable. 
+ 
+CONSENT 
+ 
+It is not applicable. 
+ 
+ETHICAL APPROVAL 
+ 
+It is not applicable. 
+ 
+COMPETING INTERESTS 
+ 
+Authors have declared that no competing 
+interests exist. 
+ 
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+_________________________________________________________________________________ 
+© 2022 Sujatha and Manjunath; This is an Open Access article distributed under the terms of the Creative Commons Attribution 
+License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any 
+medium, provided the original work is properly cited. 
+ 
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+Peer-review history: 
+The peer review history for this paper can be accessed here: 
+https://www.sdiarticle5.com/review-history/79409 

yogatexts/A SURVEY ON THE NEED FOR DEVELOPING AN AYURVEDA BASED.txt

@@ -0,0 +1,845 @@
+Jour. of Ayurveda & Holistic Medicine 
+Volume-II, Issue-VII 
+8 
+ 
+ 
+A SURVEY ON THE NEED FOR DEVELOPING AN AYURVEDA BASED 
+PERSONALITY (TRIDOSHAPRAKRTI) INVENTORY 
+ Ramakrishna B R 1 Kishore K R2  Vaidya V 3 Nagaratna R4 Nagendra H R5 
+ 
+INTRODUCTION: 
+Background 
+With increasing prevalence of life style related diseases/non 
+communicable diseases and failure of the conventional 
+medical system to tackle them holistically, a division of CAM 
+(complementary and alternative medicine) came into 
+existence to carry out research on the potential benefits of 
+many of these traditional systems of medical practice [1]. Of 
+these, TCM (Traditional Chinese Medicine) and Ayurveda 
+have been classified under whole medical systems [2]. 
+Ayurveda defined as the science of life [3], aims at maintaining 
+health of the healthy and cure of the sick through life style 
+management and therapeutic measures with natural 
+resources [4]. The assessment of personality type (prakrti) is 
+one of the basic steps in Ayurvedic diagnosis, prevention and 
+therapeutics. 
+Personality 
+Personality (Prakrti) is defined as the characteristic behaviour 
+of Physical, Physiological and Psychological features, that 
+emerges out of an intense interaction between the human 
+system and his environment. Prakrti is a Sanskrit word 
+meaning “nature” that refers to the natural constitution of an 
+individual.  Prakrti gets ingrained genetically in an organism 
+at the time of conception based on the predominant 
+dosha/doshas 
+and 
+gets 
+modified 
+by 
+environmental 
+influences.Prakrti constitute the basic substratum of a living 
+organism which is used to classify different types of 
+personalities. The nature of each doshaprakari has been well 
+defined among Ayurvedic classics. Predominance of one or 
+two of these doshas decides the physical, physiological and 
+psychological features of an individual that is determined at 
+the time of conception itself [5].  Accordingly, seven types of 
+Prakriti are manifested, three formed by the predominance 
+of a single dosha (Vatala, Pittala, Kaphala) , three by a 
+combination of two doshas (VataPittala, VataKaphala, 
+PittaKaphla)and one by a balance of all the threedoshas 
+(SamaPrakrti)[6]. This classification helps an Ayurveda 
+physician to determine the diagnosis and prognosis of a 
+disease, select suitable therapies, fix appropriate dose of the 
+pharmacological agents and advise right type of lifestyle 
+ABSTRACT: 
+Prakrti is a Sanskrit word that means “nature” or natural form of constitution of an individual. It is one of the bases of 
+classifying human population in general and in the diagnosis and prognosis of diseases,selection of drugs, dosage 
+fixation and therapeutic management according to Ayurveda. Prakrti gets ingrained in an organism at the time of 
+conception and gets modified according to one’s habitat, habit,age, environmental influences,  lifestyle and etc. 
+Ayurvedic physicians invariably use Prakrti concept to understand specific Prakrti of a patient in their practice out of 
+their experience. Till date Prakrti assessment has remained subjective. Although there are Prakrti assessment tools in 
+the form of Questionnaires, Checklists and Inventories they are either arbitrary or falling short of key standardization 
+parameters. In this study it was planned to establish whether there is a necessity to develop a standardized tool in the 
+evaluation of Prakrti. A standardized self-rating questionnaire was developed and administered to 34 qualified 
+Ayurvedic physicians (M: F=12:22) with mean age 30.29 ± 6.15 yrs (mean ± SD) and clinical experience [5.53 ± 4.57 
+(mean years ±SD)], belonging to different areas of Bangalore to assure proper representation of the cohort.  
+The study revealed that Ayurvedic physicians invariably use Prakrti in their clinical practice. They also agreed that their 
+assessment of Prakrti differed from another physician and accepted that they were not convinced about the reliability 
+of available tools and unanimously agreed on the need to develop a research based standardized tool for Prakrti 
+assessment. 
+Key Words: Prakrti, Ayurveda, Ayurveda Physician, Tridosha. 
+1PhD (Yoga) scholar, 5Chancellor, Swami Vivekananda Yoga 
+Anusandhana Samsthana (SVYASA) University, Bengaluru (India) 
+2Research officer, National Ayurveda Dietetics Research Institute, 
+Bengaluru (India) 
+3Deputy Medical Superintendent, Sushrutha Ayurveda Medical 
+College and Hospital, Bengaluru (India) 
+4Medical Director, Arogyadhama, SVYASA university, Bengaluru 
+(India) 
+Corresponding author email:  [email protected] 
+Access this article online: www.jahm.in 
+Published by Atreya Ayurveda Publications, Ilkal-587125 (India) 
+all rights reserved. 
+Received on: 29/07/14, Revised on: 12/08/14, Accepted on: 
+20/08/14 
+ 
+Jour. of Ayurveda & Holistic Medicine 
+Volume-II, Issue-VII 
+9 
+ 
+modifications. It is widely used for career counselling, 
+lifestyle counselling, marital counselling and etc. by 
+traditional Ayurvedic community which is being significantly 
+followed by the western Ayurvedic followers too. 
+Assessment of personlaity 
+Detailed descriptions of assessment of prakritibased on 
+subjective and objective methods of examination are 
+available in all major texts of Ayurveda. A major component 
+of the theoretical and practical training of an Ayurveda 
+physician is dedicated to recognize the prakriti and its 
+imbalances. With Ayurveda becoming one of the accepted 
+medical educational systems that trains many young 
+practitioners who may not have yet developed the capacity 
+to detect the prakriti that comes through long experience, 
+there seems to be an urgent need for an objective and 
+standardized paper pencil Inventory to help them fix the 
+basic personality and then go on to recognize the imbalances. 
+To date, there are a few such paper pencil audits and 
+software based tools available and none of them have gone 
+through the process of validation using the standard 
+statistical methods. Hence, we plan to develop a validated 
+prakriti assessment tool. As a preparatory step, the present 
+study was aimed at eliciting the need among practicing 
+Ayurveda physicians for developing a standardized tool to 
+assess Prakriti.  
+Methodology  
+Step 1: A focused group discussion (FGD) was carried out to 
+develop a check list to be administered to the physicians. The 
+group 
+consisted 
+of 
+five 
+Ayurveda 
+physicians 
+with 
+postgraduate qualification. Likert scale of check list was 
+developed comprising of 15 questions (table 1) intending to 
+cover the following objectives - Awareness, Utility, 
+Employability, Access, Acceptance and Need for research 
+based standardized tool to assess Prakrti.  
+Table 1 - Check-list of questions to elicit opinions from Ayurvedic physicians on the utility of prakriti assessment tool. 
+Please answer all questions. Mark your choice in the columns provided. 
+(MA : Mildly agree; A : Agree; SA : Strongly agree; NS : Not sure; MD : Mildly disagree; 
+D: Disagree; SD: Strongly disagree) 
+ No. 
+Questions 
+MA 
+A 
+SA 
+NS 
+MD 
+D 
+SD 
+1 
+Assessment of prakriti is an essential and integral part of 
+diagnosis 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+2 
+Prakriti forms an important basis of my disease management 
+plan 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+3 
+I carry out Prakriti assessment of all my patients 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+4 
+Prakriti assessment helps me to assess severity of the disease, 
+decide the dosage of the medicines, and predict response to 
+treatment and prognosis. 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+5 
+Prakriti evaluation is not a must in my clinical practice 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+6 
+I rarely carry out prakriti assessment of all my patients 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+7 
+I get expected treatment response irrespective of prakriti 
+assessment 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+8 
+Ayurveda approach is incomplete without prakriti assessment 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+9 
+My assessment of prakriti might differ significantly from 
+another Ayurveda physician 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+10 
+I use a standardized tool to assess prakriti of my patients 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+11 
+ I disagree with question number 10 because  there is no 
+standardized tool available to assess prakriti (if you have any 
+other reason please explain  in the space provided for ‘other 
+comments’ ) 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+12 
+I would not have reservations to use a standardized tool to 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+Jour. of Ayurveda & Holistic Medicine 
+Volume-II, Issue-VII 
+10 
+ 
+ 
+Step 2:  The researcher approached 125 Ayurveda 
+practitioners who satisfied the selection criteria for the 
+survey. The inclusion criteria were:  
+a) Ayurveda practitioners with > 5 years of practice,  
+b) Both genders,  
+c) Age between 30 to 70 years, and  
+d) Those who are working in Private clinics and Govt 
+hospitals.  
+A representative sample of 125 that included physicians 
+practicing Ayurveda in the East, West, North, and South parts 
+of Bengaluru who satisfied the selection criteria were 
+approached.  After seeking the consent by telephone calls to 
+participate in the survey, the researcher visited the 
+physicians at a mutually convenient time (with prior 
+appointment) to complete the check list that took about ten 
+minutes of their time.  
+Statistical Analysis  
+The answer sheets were collected and data entry was carried 
+out in excel sheets. The data was analysed using multiple 
+responses analysis and Non-parametric Chi-squared test. 
+RESULT 
+Table 2 shows the results of the validation scores by the FGD 
+comprising four subject experts and a Statistician. We 
+retained all the questions as all participants of the FGD 
+agreed that the questions were appropriate. We reworded 
+the questions 13 and 14 to make them more explicit as only 
+20% said ‘most appropriate’ and 80% said ‘appropriate’.  
+  
+Table 2:  Validation of the contents of the questionnaire by the FGD. 
+assess prakriti of my patients. 
+13 
+A standardized tool to assess prakriti will help Ayurveda 
+practitioners in their practice 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+14 
+Are you aware of paper pencil tools in English language to 
+assess prakriti (mention the reasons)? 
+Yes 
+No 
+Reasons 
+ 
+ 
+ 
+15 
+If your answer to qn. No. 14 is ‘yes’ , do you use them in your 
+clinical practice (mention with reasons) 
+ 
+ 
+ 
+ 
+If your answer  to qn. no 14 is ‘no’,   mention the reasons 
+ 
+Comments or suggestions: -------------------------------------------------------------------------------------------------------------------------------------------
+Name:....................................age:....................................gender: male/ female  
+Qualifications:.......................................... Affiliation : self-employed/ employee  
+Signature : .................................... date: ............................ 
+Key : 1 = Most appropriate, 2 = Appropriate, 3 = Less appropriate, 4 = Not appropriate 
+Question no. 
+Expert 1 
+Expert 2 
+Expert 3 
+Expert 4 
+Expert 5 
+% Agreement 
+Most-Appropriate 
+Appropriate 
+1 
+1 
+2 
+1 
+2 
+1 
+60 
+40 
+2 
+2 
+1 
+1 
+2 
+1 
+60 
+40 
+3 
+1 
+2 
+1 
+2 
+1 
+60 
+40 
+4 
+1 
+1 
+1 
+1 
+2 
+80 
+20 
+5 
+2 
+1 
+2 
+2 
+1 
+40 
+60 
+6 
+2 
+1 
+1 
+2 
+2 
+40 
+60 
+7 
+1 
+1 
+2 
+2 
+2 
+40 
+60 
+8 
+2 
+2 
+1 
+1 
+1 
+60 
+40 
+9 
+1 
+1 
+1 
+1 
+1 
+100 
+0 
+11 
+1 
+2 
+1 
+1 
+1 
+80 
+20 
+Jour. of Ayurveda & Holistic Medicine 
+Volume-II, Issue-VII 
+11 
+ 
+ 
+Table 3: Showing the details of the participants of the Survey. 
+ 
+Out of 125 physicians approached, 34 participated in the 
+study, 12 male and 22 female doctors. Of these, 14 were in 
+the age range of 30 to 40 years, 11in 40 to 50 range, 6  in 50 
+to 60 range and 3 in the range of 60 to 70 years .  
+Although the answer sheets had 7 options, after going 
+through an initial analysis, the FGD agreed to regroup the 
+answers under four categories to make it a meaningful 
+analysis . Questions 14 and 15 which had binary answers 
+were not included in this table 
+Table 4 :  Analysis of answers by 34 physician participants 
+Question No. 
+Total Agreement 
+Not sure 
+Total Disagreement 
+Not Answered 
+χ2 value 
+ 
+Sig p value 
+1 
+33 (97.06%) 
+1(2.94%) 
+0 
+0 
+30.118 
+<0.001 
+2 
+31 (91.18) 
+1(2.94%) 
+1(2.94%) 
+1(2.94%) 
+79.412 
+<0.001 
+3 
+30 (88.24) 
+4 (11.76) 
+0 
+0 
+19.882 
+<0.001 
+4 
+34 (100%) 
+0 
+0 
+0 
+No comparison 
+5 
+8 (23.53%) 
+0 
+24 (70.59%) 
+2 (5.88%) 
+22.824 
+<0.001 
+6 
+11 (32.35%) 
+1(2.94%) 
+21 (61.76%) 
+1(2.94%) 
+32.353 
+<0.001 
+7 
+14 (41.18%) 
+3 (8.82%) 
+16 (47.06%) 
+1(2.94%) 
+20.353 
+<0.001 
+8 
+31 (91.18) 
+0 
+2 (5.88%) 
+1(2.94%) 
+51.235 
+<0.001 
+9 
+23 (67.65%) 
+2 (5.88%) 
+7 (20.59%) 
+2 (5.88%) 
+34.941 
+<0.001 
+10 
+18 (52.94%) 
+2 (5.88%) 
+11 (32.35%) 
+3 (8.82%) 
+19.882 
+<0.001 
+11 
+7 (20.59%) 
+0 
+1(2.94%) 
+26 (76.47%) 
+20.059 
+<0.001 
+12 
+12 (35.29%) 
+2 (5.88%) 
+8 (23.53%) 
+12 (35.29%) 
+0.882 
+0.049 
+13 
+30 (88.24) 
+3 (8.82%) 
+1(2.94%) 
+3 (8.82%) 
+46.294 
+<0.001 
+ 
+Q no 1,2,3,4: 33 out of 34Doctors (97%) agreed that 
+Assessment of prakriti is an essential and integral part of 
+diagnosis(Q1)  and all of them (100%) agreed that Prakriti 
+assessment helps  in assessing the severity of the disease, 
+decide the dosage of the medicines, and predict response to 
+treatment and prognosis. 33 out of 34Doctors (97%) agreed 
+that  it forms an important basis of their disease 
+management plan(Q2) and 30 out of 34Doctors (88%)  carry 
+out  Prakriti assessment of all their patients(Q3)   and 8 out of 
+12 
+1 
+2 
+2 
+2 
+1 
+40 
+60 
+13 
+2 
+1 
+2 
+2 
+2 
+20 
+80 
+14 
+2 
+2 
+2 
+1 
+2 
+20 
+80 
+15 
+1 
+2 
+1 
+1 
+1 
+80 
+20 
+16 
+1 
+1 
+1 
+1 
+2 
+80 
+20 
+Variable 
+Number 
+Gender  
+Males  
+12 
+Females 
+22 
+Age 
+Mean± SD 
+30.29± 6.15 yrs 
+Duration of Clinical Experience 
+Mean± SD 
+5.53 ±  4.57 yrs 
+Location in Bengaluru city 
+North  
+09 
+South  
+13 
+East 
+07 
+West 
+05 
+Type of practice  
+Private clinics  
+19 
+Govt. Hospital faculty 
+15 
+Jour. of Ayurveda & Holistic Medicine 
+Volume-II, Issue-VII 
+12 
+ 
+34Doctors (23%)  did not agree that  Prakriti evaluation is  a 
+must in his/ her clinical practice.(Q5). 
+Q 6,7, 8:   31Doctors(91%) agreed that  Ayurveda approach is 
+incomplete without prakriti assessment (Q 8) , 11 
+Doctors(32%) rarely carried out prakriti assessment of all 
+their patients (Q 6), and 14 Doctors(41%) expressed that  
+they get expected treatment response irrespective of prakriti 
+assessment.  
+Q9: 23 Doctors (68%) agreed that their assessment of prakriti 
+might differ significantly from another Ayurveda physician’s 
+assessment and 7 Doctors (21%) disagreed which may point 
+to the confidence in these Doctors had about the clarity with 
+which the tradition would have laid down the objective ways 
+of assessing the prakriti.    
+Q 10,11,14:18 Doctors (53%)opined that they are actually 
+using one of the available tools (Qn. no.10); 18 Doctors(53%) 
+said that they are aware of existence of a tool (Qn. no. 14) ;  
+of the 11 Doctors(32%) who opined that they are not using 
+any tool , 7 Doctors(32%)said that they are not using because  
+there is no such standardized tool  available(Q.11)  . It 
+appears that many doctors did not know the difference 
+between a standardized tool from a non-standardized tool. 
+Q 12, 13: Although 30 Doctors (89%) agreed that   a 
+standardized questionnaire   would help Ayurveda 
+practitioners in their practice (Q.13).Only 12 Doctors (35%) 
+were willing to use them (Q.12)  while 8 Doctors (23%) of 
+them were not willing to use, 2 Doctors (6%) were not sure 
+and 12 Doctors (35%) did not respond. 
+DISCUSSION:  
+The study revealed that there is a need for a standardized 
+tool for assessment of Prakriti based on Ayurvedic concepts 
+for clinical usage among the Ayurvedic Doctors. Majority of 
+the Ayurvedic Doctors   confirmed that prakriti assessment is 
+a part and parcel of Ayurvedic methods of clinical diagnosis 
+and management 
+This was a pilot survey on Ayurveda clinicians in different 
+zones of Bengaluru to assess the need for developing a 
+standardized tool. A   questionnaire for the survey was 
+developed by the researcher and validated by a focussed 
+group (FGD) of 5 experts. After making minor corrections in 
+the questions for statistical analysis, the survey was carried 
+out amongst 34 physicians who satisfied the selection 
+criteria. 
+There was complete agreement that assessment of prakriti is 
+an integral part of Ayurveda practice and it helps in diagnosis, 
+prognosis and therapeutic management .Most of them did 
+carry out prakriti assessment. Looking at the questions that 
+asked about the awareness and need for developing a 
+standardized tool, 53% were aware of existence of a tool 
+prepared in English language.  It was interesting to note that 
+53% are already using the existing tools.  Although 35 % felt 
+that developing a standardized tool would be useful, 88.24%  
+agreed to use them in their practice and 24 % were silent . 
+ The question no 1to 4, Assessment of prakruti is an essential 
+and integral part of diagnosis ,Prakruti forms an important 
+basis of my disease management plan ,I carry out Prakruti 
+assessment of all my patients and Prakruti assessment helps 
+me to predict response to treatment/deciding dosage/ assess 
+severity of the disease/predicting prognosis/have drawn the 
+attention of all the participants(97%,91% ,88% and 100% 
+respectively) of the survey and have affirmed that prakrti 
+analysis is an integral part of Ayurvedic clinical practice. 
+The question no 5 to 7, Prakruti evaluation is not a must in 
+clinical practice, I rarely carry out prakruti assessment of all 
+my patients and I get expected treatment response 
+irrespective of prakruti have drawn attention of very less 
+participants (23.53%, 41.18% and 32.35%) and indirectly it 
+shows that Ayurvedic clinical Practice is incomplete without 
+prakriti assessment. 
+The question no 9, My assessment of prakruti might differ 
+significantly from another Ayurvedic physician has drawn the 
+attentionofmajorityof 
+practitioners(67.65%) 
+and 
+have 
+affirmed that in order to attain uniform results with varied 
+investigators ,a standardized tool of prakriti assessment is 
+required. 
+The question no 10, I use a standardized tool to assess 
+prakruti of my patients has drawn the attention of 52.94% of 
+participants. 
+It 
+affirms 
+that 
+majority 
+of 
+Ayurvedic 
+practitioners want to use a scientifically developed tool. 
+The question no 12,I would not have reservations to use a 
+standardized tool to assess prakruti of my patients has drawn 
+the attention of 35.29% with total agreement,5.88%not sure 
+,23.53%  not answered and 35.29% dis-agreement. It affirms 
+that if there is a scientific tool majority of the clinicians would 
+prefer to use it in their clinical practice. 
+The question no 13, A standardized tool to assess prakruti 
+will help Ayurvedic practitioners in their practice hasdrawn 
+the attention of 88.24% of participants. It further affirms that 
+majority of Ayurvedic practitioners want to use a scientifically 
+developed tool. 
+The question no 14 and 15, Are you aware of tools to assess 
+prakrutianddo you use them in your clinical practice have 
+drawn the attention of 41.18% and 52.94%with total 
+agreement respectively.It affirms that majority of Ayurvedic 
+practitioners prefer to use scientific tool it in their clinical 
+practice. 
+To address the above requirements of the Ayurvedic 
+physicians indeed it is necessary to develop a scientific tool of 
+assessment of prakriti. 
+In the direction of a survey study in relation to CAM a few 
+studies have been published. Characteristics of yoga users: 
+Results of a National survey byGurjeet S Birdee, et.al has 
+used the methodology of utilizing cross sectional survey on 
+31044 samples by using a questionnaire with leading 
+questions. The study concluded that Yoga Users are more 
+likely to be white female, young and college educated. Yoga 
+users report benefit for musculoskeletal conditions and 
+mental health. 
+Use of complementary and alternative medicine in 
+cancerpatients: a European survey by 
+A. Molassiotis1, et.al was carried out based on a descriptive 
+survey design spread over 14 countries on 956 samples. The 
+questionnaire used was based on one developed by 
+Swisha,et.al. There were 27 items including demographic 
+Jour. of Ayurveda & Holistic Medicine 
+Volume-II, Issue-VII 
+13 
+ 
+data and questions about CAM.Thestudy concluded that it is 
+imperative that health professionals explore the use of CAM 
+with their Cancer patients. 
+Use of complementary or alternative medicine in a general 
+population in Great Britain. 
+Results from the National Omnibus survey by Kate Thomas 
+and Pat Coleman,et. Al has followed multipurpose survey 
+methods which included interviews and advance letters 
+methods on 2761 samples with checklist comprising 8 
+questions module.The study concluded that there was a 
+strong correlation between the uses of CAMand gross 
+socioeconomicindicators. 
+Utilization of Complementary and Alternative Medicine by 
+UnitedStates Adults: Results From the 1999 National Health 
+Interview 
+Survey 
+by 
+Ni, 
+Hanyu,et.al 
+has 
+followed 
+NHIS(National Health Interview Survey) which covers the 
+non-Institutionalized 
+civilian 
+of 
+US 
+population 
+on 
+30801samples.The survey revealed that The sample size were 
+considerably lower than the reports of previous surveys. 
+Most CAM therapies are based by US adults in conjunction 
+with conventional medical services. 
+CONCLUSION: 
+Prakrtiassessment being one of the important aspects of 
+Ayurvedic clinical medicine is useful in medical and related 
+activities. It helps to classify human population in general to 
+advocate ideal lifestyle for prevention of diseases and 
+improve quality of life.it also helps in selection of therapeutic 
+measures, assessment of drug response & dosage fixation. 
+Ayurvedic physicians invariably use Prakrti in diagnosis and 
+therapeutic management. In order to explicit the need of a 
+scientifically 
+developed& 
+standardised 
+tool 
+for 
+the 
+assessment of prakrti a questionnaire based survey was 
+under taken. The survey reveals that a significant percentage 
+of physicians agreed that Prakrti forms an important basis of 
+disease management and majority of the physicians agreed 
+employment of Prakrti evaluation in their clinical practice. 
+Significant percentage of physicians agreed that their 
+assessment of Prakrtidiffered from another physician. Many 
+expressed thatthey were not sure of any such standardized 
+tool by research and shown their interest to use a 
+standardized prakrti assessment tool in their clinical practice. 
+This demonstrates the need for a standardized tool for 
+Prakrti assessment among Ayurvedic physicians.  
+REFERENCES: 
+1. 
+Complement Med. 2005 Apr; 11(2):221-5. 
+2. 
+Available from NCCAM Website 
+http://nccam.nih.gov/health/Ayurveda/introduction.htm 
+3. 
+Manyam BV, Kumar A. Ayurvedic constitution (prakrti) 
+identifies risk factor of developing Parkinson's disease. J Altern 
+Complement Med. 2013 Jul; 19(7):644-9. 
+4. 
+Website of Central Council for Research in Ayurvedic Sciences, 
+Departmenty of AYUSH, Ministry of Health and Family Welfare, 
+Government 
+of 
+India, 
+New 
+Delhi. 
+Available 
+from  
+http://www.ccras.nic.in/Ayurveda/Ayurveda_origin_01.htm 
+5. 
+Murthy AR, Singh RH.The concept of psychotherapy in 
+Ayurveda with special reference to satvavajaya. ASL. 1987 Apr; 
+6(4):255-61. 
+6. 
+Patwardhan Bhushan, Joshi Kalpana, PhD. And Chopra Arvind. 
+Classification of Human Population Based on HLA Gene 
+Polymorphism and the Concept of Prakriti in Ayurveda the 
+Journal of Alternative and Complementary Medicine. Volume 
+11, Number 2, 2005;349–353 
+7. 
+Sushruta. ShareeraSthana, Chapter 4, Verse 62-63. Dalhana 
+Commentary In: Yadavaji Trikamji (eds.) Sushruta Samhita. 1st 
+ed. Varanasi: ChaukhambhaOrientalia; 1997;360-1 
+8. 
+Joshi RR.A bio statistical approach to Ayurveda: quantifying the 
+tridosha. J Altern Complement Med. 2005 Apr; 11(2):221-5. 
+Cite this article as: Cite this article as: Ramakrishna B R, 
+Kishore K R, Vaidya V, Nagaratna R, Nagendra H R. A survey 
+on the need for developing an Ayurveda based personality 
+(Tridoshaprakrti) Inventory. J of Ayurveda and Hol Med 
+(JAHM); 2014;2(7):8-13. 
+Source of support: Nil, Conflict of interest: None Declared 
+ 
+ 

yogatexts/A Study on effect of Yoga based practices on Job anxiety in Information technology professionals conv.txt

@@ -0,0 +1,523 @@
+
+Paper Received:  30th June, 2015
+Paper Accepted: 05th July, 2015
+Paper Published: 15th July, 2015
+
+ạ
+Human Resource Reflection
+
+A STUDY ON EFFECT OF YOGA BASED PRACTICES ON JOB ANXIETY IN INFORMATION TECHNOLOGY
+PROFESSIONALS
+
+
+ISSN(ONLINE):2348-7518
+
+
+Human Resource Reflection 2(4) 01-09
+July 2015 Impact factor 0.641
+Avanseaza.in
+
+
+
+Pammi Sesha Srinivas SVYASA University, Bangalore
+
+
+Sony Kumari
+SVYASA University, Bangalore
+
+
+Abstract
+Information Technology sector is subjected to large number of job fluctuations as it needs to deal  with  global  market  trends  and  technology  advancements.	Due  to  increasingly adaptation of “short term contracting” by organisations, IT professionals are continuously subjected to regular displacements, layoffs and exceeding job demands.  These uncertainties at workplace are introducing Job anxieties for the professionals. With prolonged periods of Job anxieties, IT professionals are becoming victims of work related stress and depression disorders.  Yoga is the ancient Indian science, said to bring mind fluctuations under control. There is a need to study whether Yoga based practices can help IT professionals on reducing Job anxiety.	Here a  quantitative  study  is  done on  IT professionals from one  of  Multi National company office situated in Bangalore, India to check the impact of Yoga based cyclic meditation practice on Job anxiety levels. It was found in this empirical study that yoga based practices can help to bring down the Job Anxiety levels of IT Professionals. Though findings are done for Indian context, authors strongly feel that, these results may also be applicable to international IT professionals equally. Authors suggest IT professionals and  IT  organisations  to  make  Cyclic  Meditation  as  part  of  health  routines  which  can potentially help reduce job anxiety levels and help increase on-job productivity.
+
+Keywords
+Job Anxiety, Yoga, stress, IT professionals, India.
+
+
+
+
+
+Corresponding author
+Pammi Sesha Srinivas, Research Scholar, SVYASA University, Bengaluru, Karnataka Email: [email protected]
+1
+
+
+Background
+In the present ―age of anxiety‖ one‘s path to success has been rendered extremely difficult owing  to  both  environmental  variables  and psychological characteristics of the individual ( AK Srivatsava, 1977). Researchers working in the field are in agreement that anxiety is a mental	state	primarily	driven	by apprehensions and vague fear.   Anxiety can either be stimulus related, referred as state anxiety or general in nature referred as trait anxiety    (B.    Muschalla.    et    al,    2013). Grinker(1966)  also pointed out that methods of  producing  anxiety  also  depends  on  the personality  traits  of  the  individual.  For  the woman/man  of  modern  age,  being  in  paid working  positions  is  becoming  increasingly important. People prefer to engage in some job  where  they  generally  end  up  spending more  number  hours  in  day.  Anxiety  which pertains to job life of an employee who gets unnecessarily fearful, apprehensive, pessimistic and   emotional   regarding   components   of his/her own work  may be referred to as ‗job anxiety‘(H.N.Prasad,1994).   Job anxiety could also be understood as general feeling of vague fear   and   apprehensive   mind   set   of   the employee  regarding  various  job-components in relation to his /her frame of reference or his/her psychological make-up (AK Srivastava, 1977).     Job anxiety is also a form of state anxiety, driven by job related stimulus.   The relationship  between  characteristics  of  the workplace   and   health   has   been   primary subject  of  research  interest,  and  it  is  also observed  that  both  work  related  stressors and non-work related stressors effect mental health of the individual independently (Clark C  et  al,  2102).  Workplace  effect  on  the individual can either be positive by helping to provide necessary social support, confidence and  self-esteem,  or  be  negative  with  its excessive demands which in turn can induce anxiety.       Job   anxiety   of   employees   is influenced   by   the   market   trends,   fit   to organisation	culture,           supervisor management/leadership          style,          self-expectations  from  job  and  social  support available  at  work/out-side  work  place.  Job Anxiety   may   effect   the   individual   work relations with supervisor and peers. In turn, job  anxiety  for  employees  may  result  in reduced    productivity	for    organisations. Realizing  this  fact,  Organizations  with  long
+
+term   vision   plan   their   management   and leadership  hierarchy  in  such  a  way  that employees	do	get	time	of	their managers/leaders at regular intervals, to know about  company  current  status  and  future prospects.  This helps employees to be aware of their company future plans.
+Review of Literature
+It is observed that job anxiety may influence perceived stress at workplace. There are few studies done about association of job anxiety with   depression,   perceived   stress,   work phobia   and   job   satisfaction.   It   was   also observed  that  personality  characteristics  of individuals  influence  anxiety  traits  in  the individuals.  Below  is  the  literature  survey done	to	understand	existing	studies performed related to Job Anxiety.
+	AK Srivastava (1977) did a detailed study on  components  influencing  ‗Job-Anxiety‘ and came to an understanding that Job-Anxiety is influenced by both work life and  personal  life.	He  concluded  that components   like   Security,   Recognition, Human   relations   at   work,   Reward   and Punishment,  Self-Esteem,  Future  Prospects and capacity to work are essential ones to assess ‗Job-Anxiety‘.
+	During   a   study   performed   on   pre-registration	house	officers,	it	was observed    that	stress,	anxiety    and depression    scores    were    significantly correlated with neuroticism score in both men  and  women.  It  was also  observed that	personality     characteristics     of neuroticism  were  a  predisposing  factor for stress and anxiety in junior doctors (D Newbury-Birch et al., 2015).
+	 A	study	performed	on	Library employees, revealed that degrees of job anxiety are related to job satisfaction in different  ways.  This  study  also  further confirms  the  theory  that  interpersonal relations are major determinants of job anxiety ( H N Prasad, 1994).
+	A  study  done  on  self-  perceived  Job insecurity,  based  on  representative  data from 17 European countries, reveals that job insecurity is also driven by not only by social	structural	or	institutional differences	,	but    also    by	cultural characteristics (Marcel Erlinghagen, 2007).
+    It is also noticed that Job anxiety can also lead  to  work  related  phobia,  which  is
+2
+a STUDY ON EFFECT OF YOGA BASED PRACTICES ON JOB ANXIETY IN INFORMATION TECHNOLOGY PROFESSIONALS
+
+
+
+panic when approaching or thinking about work.	It  was  observed,  from  a  study performed on primary care patients with chronic   mental   disorders,   that   work-related anxiety may play significant role on work related phobia (Beate Muschalla et al.,2014).
+   A  study  performed  on  Male  Assembly Automotive workers in Malaysia revealed that  depression,  anxiety  and  stress  are important  mental  outcomes  in  stressful working settings.  It was further suggested that  reduced  psychological  job-demand, Job  –  insecurity  and  hazards  conditions factors	may	improve	self-perceived depression, anxiety and stress (Bin Abdin EDIMANSYAH et al., 2007).
+	 A study performed on employees from different professional settings of Germany, revealed that Job anxiety is different from trait anxiety and Job anxiety could lead to work avoidance and sickness absence (B. Muschalla,  2013).  A  quantitative  study performed  on  automotive  workers  in Malaysia, revealed that depression, anxiety and  stress  due  to  work  conditions  has mediating role on perceived quality of life (Bin Nordin Rusli, 2008).
+
+Rational for this Study
+Today‘s  world  economy  fluctuations  have caused a lot of disturbances to organisations offering  both services and products , resulting in  downsizing  the  staff,	displacement  of production   units  to   cheaper   geographical places,  mergers	and  in  some  cases  filing bankruptcies. This is particularly applicable to organisations	pertaining    to	Information technology    based	services/products.	IT organisations	are	increasingly    adopting ―short-term  contracting‖  polices  to  reduce impact of exceeding employees expenses on their  financial  figures.  This  means  regular displacement, facing possible lay off, necessity to accept exceeding job demands, are to be named a few for IT professionals of today‘s world.   This   is   not   coming   free   for   IT professionals  in  their  both  professional  life and  personal  lives.  Though  study  done  by Otago University may not have been done on IT  professionals in  particular,  the  university study has shown that 45 per cent of newly diagnosed cases of depression or generalised
+
+anxiety  disorder  were  directly  related  to workplace stress. (Kumar et al., 2009).
+Job  Anxiety  of  IT  professionals  is  much required topic to be understood, where very little	studies	were	performed.	Sub components of Job anxiety described by A.K. Srivastava  (1977)  do  help  to  understand current Job anxiety levels of IT professionals. As jobs for IT  professionals,  are  bound  to move around geographical locations, it would impact   both   personal   and   job   security. Recognition  at  work  is  essential  for  these professionals as they deal with dynamic job and market conditions, failing which it would be difficult to be innovative in problem solving strategies.  IT  professionals  on  an  average spend more numbers at work place/thinking of Job and hence human relations at work, play significant role for them. Any long term disturbances in human relations at work, may cause sleep disorders and may cause mental health illness.     Rewards in terms of sizable monetary   benefits   are   essential   for   IT professionals   due   to   their   uncertain   job profiles. Any anxiety coming due to possible punishment  by  supervisor  has  far  reaching consequences   on   mental   health   for   the employees.   Any delay in Future prospects at work in terms of promotion/ advancements also  plays  a  role  on  Job  anxiety  of  IT professionals. IT professionals as they put up more service need to continuously work for increasing   their   aptitude   to   solve   bigger problems	of   organisations/market,    failing which   organisations do question the need to issue pay checks to these IT professionals.  All in  all,  all  the  components  of  Job  anxiety described A.K. Srivastava help to understand Job Anxiety of IT professionals.
+As it is increasingly visible in today‘s social media,   Yoga   based   practices   are   gaining popularity  for  improvement  of  self  both  in professional life and personal life. Job anxiety is an important symptom that needs to be understood in IT professionals as it may also possibly end up in aiding work related stress and  depression.  Any  Impact  of  Yoga  based practices  on  Job  anxiety  measured  through scientific  study  would  help  IT  professional community to increase its awareness about yoga based practices. This is a unique scientific study performed to date, on measuring impact of Yoga based practices on job anxiety modification.
+
+
+3
+Pammi Sesha Srinivas & Sony kumari
+
+
+
+Details about Job Anxiety Scale (JAS) used:-Job	Anxiety	Scale	(JAS)	questionnaire developed  by     A.K.Srivatsava  is  used  to measure  the  Job  Anxiety  in  this  study.  It measures   seven   sub   components   of   Job Anxiety as shown in Table1. It is an inventory of 80 items out of which 63 were True-keyed and the remaining 17 has been False-keyed with an a priori weight of one score each. The questionnaire items were designed in such a way that they could be used for measuring the extent  of  job  anxiety  of  all  the  employees irrespective  of  the  nature  of  their  jobs, organizations,  and  machines  or  tools  they used. The score on Sinha W-A Self Analysis Form (Anxiety Scale) was used as one of the validation criteria for the Job Anxiety Scale. The  coefficient  of  correlation  between  the scores on the two tests was found to be 0.54 on a representative sample of 100 semi-skilled personnel.	The	obtained    validity	index indicates  that  the  two  tests  measure  the extent of anxiety, although the JAS basically measures the degree of anxiety manifested in
+
+a particular dimension of life of a specified social  group.  To  ascertain  the  extent  of consistency of the results obtained by the Job Anxiety	Scale,	the	split-half	reliability coefficient by odd-even methods, on a sample of   414   employees,   and   the   test-retest reliability  coefficient  on  the  sample  of  110 employees  were  computed.  The  obtained reliability coefficients indicate that the scale is free from internal defects and possesses a fair amount of accuracy in assessing the extent of Job Anxiety. All Validated and reliability tests were  performed  by  AK  Srivatsava  before releasing to public for usage, and his works were published in Indian journal of Industrial Relations   (IJIR).   Based   on   validity   and reliability of this scale, this scale was chosen as a measurement tool for measuring degrees of Job	anxiety	in    IT	professionals.	Due permission was also obtained from editor of IJIR   to   use   this   scale   for   purpose   of conducting this study.
+
+Table1 :-  Components of Job Anxiety Scale
+
+S.No
+
+1
+
+
+2
+
+
+
+3
+
+
+4
+
+
+5
+
+Component
+
+Security concerns
+
+
+Recognition concerns
+
+
+Human relations at work concerns
+
+Reward and Punishment concerns
+
+Self-esteem concerns
+
+Component details
+
+Job security, personal security
+
+
+Fair evaluation, participation, praise, approval, freedom to show proficiency
+
+
+Interpersonal (intra-cadre and inter-cadre) relationship, cooperation, communication
+
+Financial gains, treatment of supervisors, unjust criticism, blame
+
+Self-image, self-respect, social status of the job
+
+
+
+
+
+6
+
+Future concerns
+
+Prospects   Opportunities	of	promotion	and	advancement, opportunity to learn and increase efficiency
+
+
+
+
+
+7
+
+Capacity	to concerns
+
+work   Shoulder  responsibilities,  Self-confidence,  aptitude  and interest for the job-activities
+
+
+
+
+Details about Cyclic Meditation
+Cyclic meditation was developed by SVYASA (Swami Vivekananda Yoga Anusandhana
+
+Samstahana)   University,   Bangalore,   India. Cyclic Meditation could be shortly referred as C.M here after.   C.M is inspired by a verse
+4
+a STUDY ON EFFECT OF YOGA BASED PRACTICES ON JOB ANXIETY IN INFORMATION TECHNOLOGY PROFESSIONALS
+
+
+
+from   Mandukya   Upanishad   (Sanjib   Patra, Shirley Tells.2009). C.M. is a set of stimulation and  relaxation  combine  involving  cycles  of body postures followed by supine rest relax poses.  Body postures are  yoga based  body postures like ardha kati chakrasana, Taadasana , Vajrasana and Ardha vustrasana. Supine rest relax posture followed is shavasana i.e dead corpse pose. Participants going through this intervention   need   to   make   their   body movements very slow  and  continuous. Idea here is by controlling the speed of the body movements, participants can feel the energy impulses flowing throughout the body. While in supine rest position, participants are made aware of their body parts and asked to relax the  tension  if  any.  There  is  a  conscious attempt about breath awareness and slowing down of the thought process in this practice. This is over all 35 minute practice.
+Details of Empirical study performed Sample	chosen	consists	of	―96‖	IT professionals.  All  the  IT  professionals  were selected  from  Bangalore  office  of  a  Multi-National  Information  Technology  company named  Infineon technology  Pvt  Ltd  which  has presence   in   India,   Germany,   Singapore, Austria, UK and U.S.A.   Employees‘ position within   organisation   ranged   from   junior
+
+engineers,  senior  technical  leads  to  people managers. All participants came voluntarily to participate in the study.  Study was performed from 15th  September 2014 to 28th  November 2014.  Total sample size was divided into two groups   namely   Yoga   group   and   Control group.   Yoga group has both men and women employees with an average age of 31.04 years and  with  standard  deviation  of  4.57  years. Control  group  has  both  men  and  women employees with an average age of 32.02 years with a standard deviation of 4.582 years. A, 35 minute ―Cyclic meditation‖ was administered as an intervention for Yoga group. Control group  was  administered  with  walking  or equivalent  physical  exercise  for  35  minute duration   daily   and   maintaining   dairy   as intervention.	The	intervention	was administered  for  2  months  for  both  the groups.   Job Anxiety scale was administered before the intervention period and after the intervention period.
+Inclusion and Exclusion criteria: -	Both Men and women employees, with normal health as declared  by  subjects  were  included  in  the study.  Subjects volunteered for the study do not have any previous experience of any Yoga program as declared by subjects.
+
+
+Table 2 :- Age and Job Experience of Subjects
+
+Control Group	Yoga Group
+
+
+
+
+Age
+
+I.T. Industry Experience
+
+
+Age	I.T. Industry Experience
+
+
+
+
+Mean   32.021   8.208
+S.D	4.307	4.307
+
+31.041   7.395
+4.547	4.281
+
+
+
+
+Procedure
+JAS  questionnaire  were  administered  to  all members participating in the study from both control and yoga groups.   The intervention given  to  Yoga  group  is  a  35  minute,  cyclic meditation	practice,	whose	details	are mentioned   earlier.	Control   group   was administered   with   walking   or   equivalent exercise for 35 minutes and was told to write
+
+a dairy to observe changes taking place. This is a  pre-post  study.	Participants  from  both groups filled up the questionnaires voluntarily before the beginning of the study period and at the end of study period.
+
+Results and Discussion
+Table3 shows Mean and S.D values of various components  of  Job  anxiety  scale  in  Yoga group
+
+
+
+
+5
+
+
+
+Table3 :- Yoga Group
+
+
+Pre
+
+
+
+JAS Component	Mean	S.D Job Security concerns	7.71	1.27 Self-Esteem concerns	7.52	1.32
+Recognition concerns	7.73	1.26 Human   Relations   at   work
+concerns	10.27	1.56 Rewards     &     Punishments
+concerns	10.58	1.44
+Future Prospects concerns	7.56	1.21
+Capacity to work concerns	7.46	1.25 Job Anxiety (overall)	58.85	3.798
+
+
+
+
+
+Mean	S.D 6.04	1.129 5.70	1.57 6.21	1.15
+
+7.77	1.52
+
+8.87       1.52 6.35       1.02
+6.42       1.48 47.37     2.77
+
+Post
+
+
+%	change  in Mean
+21.61 24.11 19.68
+
+24.34
+
+16.13 15.98
+13.96 19.51
+
+
+p	value (Wilcoxon signed      rank test)
+.000 .000 .000
+
+.000
+
+.000 .000
+.000 .000
+
+
+
+As  shown  in  Table3,  mean  value  of  Job security concerns component decreased from 7.71 to 6.04	(21.61% decrease) between pre and   post.   Similarly,   self-esteem   concerns component mean value decreased from 7.52 to 132.4 (24.11% decrease), Human Relations at work concerns mean value decreased from 10.27 to 7.77 (24.34 % decrease). Overall job
+
+anxiety mean value decreased from 58.85 to 47.37   (19.51%)   decrease.   To   see   the significance of change, Wilcoxon signed rank test was used.  It was observed that change is very  significant  in  all  components  of  Job Anxiety Scale (p < .001).
+Table4 shows Mean and S.D values of various components of Job anxiety scale in Control group.
+
+
+Table4 :- Control Group
+
+
+Pre
+
+
+JAS Component	Mean
+
+Job Security concerns	7.79
+
+Self – esteem concerns	7.39
+Recognition concerns	7.81 Human	Relations    at    work concerns                                      10.81 Rewards       &	Punishments concerns                                      10.79 Future Prospects concerns	7.47
+Capacity to work concerns	7.85
+
+
+
+
+S.D   Mean
+
+1.23   7.31
+
+1.25   7.10 1.12   7.27
+
+1.46   10.08
+
+1.67   10.27 1.32   7.17
+1.28   7.46
+
+Post
+
+%   change S.D   in  Mean
+
+1.13   6.18
+
+1.17   4 1.14   6.95
+
+1.38   6.78
+
+1.66   4.84 1.09   4.13
+1.22   5.02
+
+
+p	value (Wilcoxon signed rank test)
+
+.001
+
+.002 .000
+
+.000
+
+.000 .004
+.000
+
+
+
+Job Anxiety (overall)	59.94	3.41
+
+As  shown  in  Table4,  mean  value  of  Job security concerns component decreased from 7.79 to 7.31%	(6.18% decrease) between
+
+56.67	3.35   5.45	.000
+pre and post. Similarly, self-esteem concerns component mean value decreased from 7.39 to 7.10 (4% decrease), Human Relations at work  concerns mean value decreased  from
+6
+a STUDY ON EFFECT OF YOGA BASED PRACTICES ON JOB ANXIETY IN INFORMATION TECHNOLOGY PROFESSIONALS
+
+
+
+10.81 to 10.08 (6.78 % decrease). Overall job anxiety mean value decreased from 59.94 to 56.67 (5.45%) decrease. To see the
+
+significance of change, Wilcoxon signed rank test was used.  It was observed that change is very  significant  in  all  components  of  Job Anxiety Scale (p < .001).
+
+Between groups,	to observe the difference between  pre  post  changes,  Mann  Whitney test was used (Table 5).  There is a significant change in all components of Job Anxiety ( p< .01).
+
+
+Table5 :- Between the Groups (Mann Whitney test)
+
+
+Job Security Recognition
+Human Relations at work Rewards and Punishment Self Esteem
+Future Prospects Capacity to work
+Job Anxiety
+
+Pre	Post .749	.000 .912	.000 .076	.000 .418	.000 .546	.000 .847	.000 0.062	.000
+0.184	.000
+
+
+
+
+Conclusion
+Based on the empirical study performed, it could  be  observed	that  Yoga  group  has performed  well  in  decreasing	Job  Anxiety compared to control group. With the study performed, authors came to conclusion that Yoga	based	practices	can    potentially modify/decrease degrees of Job Anxiety for I.T  professionals.  This  would  be  interesting observation for both IT professionals and IT organisations  as  reduction  in  Job  anxiety would directly help to increase productivity and innovation at work.   I.T organisations can consider	employing    yoga    based	cyclic meditation as part of health programmes for the employees which may aid in reducing Job Anxiety levels.
+
+Limitations of the current study
+This   study   is   done   specific   to   one   I.T organisation,   but   however   extending   this study to multiple organisations and to more number  of  participants  would  give  more generalised   results.   It   also   needs   to   be observed that Job Anxiety for IT Professionals also   depends   on   project   schedule   peak periods   and   performance   review   periods during  the  year.  So  authors  feel  that  to generalize the results observed more number of studies have to be performed on the same number of participants during different time
+
+periods   of   a   year.   Indian   I.T   sector   is witnessing	more	and	more	female professionals year on year, which is healthy for  organisations  as  it  brings  diversity  in organisations thinking. In the current study, not much specific study concerning female and male  professionals  could  be  done.  A  more specific study concerning Female professionals as well as Male professionals could also be carried out in future research studies.
+
+References
+
+A.   K.   Srivastava(1977).   Construction   and Standardization of a Job Anxiety scale. Indian Journal of Industrial Relations.Vol. 13, No. 1 (Jul., 1977), pp. 73-84
+
+Beate Muschalla, DPhil, and Michael Linden, MD  (2014).  Workplace  Phobia,  Workplace Problems, and Work Ability among Primary Care Patients with Chronic Mental Disorders. J Am Board Fam Med 2014;27: 486–494.)
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+B. Muschalla, M. Heldmann and D. Fay(2013). The significance of job-anxiety in a working population. Occupational Medicine ;63:415–421
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+Bin	Abdin	EDIMANSYAH,	Bin	Nordin RUSLI1,	Lin	NAING,     Bin     Abdullah MOHAMED RUSLI, Than WINN and Bin Raja Hussin TENGKU MOHAMED ARIFF (2007).
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+Clark C, Pike C, McManus S et al (2102). The contribution of work and non-work stressors to  common  mental  disorders  in  the  2007 Adult  Psychiatric  Morbidity  Survey.  Psychol Med 2012;42:829–842.
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+D	Newbury-Birch,	F	Kamali	(2001) Psychological stress, anxiety, depression, job satisfaction, and personality characteristics in preregistration house officers ; published in Postgrad Med J. 2001 Feb; 77(904): 109–111
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+Erlinghagen, Marcel (2007) : Self-Perceived Job Insecurity  and  Social  Context:  Are  there Different   European   Cultures   of   Anxiety?, DIW-Diskussionspapiere, No. 688
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+
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+Anthony   D   LaMontagne.,   Tessa   Keegel., Amber   M   Louie.,	Aleck   Ostry&   Paul A.LandSBergis. (2007).  ` A Systematic Review of	Job-stress	Intervention	Evaluation Literature,   1990-2005`.   INT   J   OCCUP ENVIRON HELATH 2007: 13:268-280
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+
+Cary L. cooper   (2010)― Mental Capital and Well-Being‖, stress and health; 2010.
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+Ciarrochi,  J.,  Deane,  F.  P.,  &  Anderson,  S. (2002). Emotional intelligence moderates the relationship between stress and mental health. Personality  and  Individual  Differences,  32, 197-209.
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+Gohm, C. L., Corser, G. C., & Dalsky, D. J. (2005).  Emotional  intelligence  under  stress: Useful, unnecessary, or irrelevant? Personality and Individual Differences, 39, 1017-1028.
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+Goleman, Daniel (1996). Emotional intelligence: Why it can more matter than I.Q., New York: Bantam Books.
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+Jorfi, H., Jorfi, S., Moghadam, K., (2010) Impact of Emotional Intelligence on Performance of Employees in Postmodern Openings, Year 1, No.4, Vol 4, December, 2010
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+Mayer,   J.   D.,   Salovey,   P.   (1993)   The intelligence	of	emotional	intelligence. Intelligence, 17,
+433–442.(chapter2)
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+Nagendra.H.R,  &  Nagarathn.R  (1986).  New Prospective  in  Stress  Management,  SVYASA
+8
+a STUDY ON EFFECT OF YOGA BASED PRACTICES ON JOB ANXIETY IN INFORMATION TECHNOLOGY PROFESSIONALS
+
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+(Swami	Vivekananda	yoga	Anusandhana Samsthana) Publication.
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+Sibia,G.Misra,G.	&	Srivastava,K.A.(2004) Towards	Understanding	Emotional Intelliegnce in Indian context (perspectives of parents,  teachers  and  childrens  )  journal  of National academy of Psychology,vol-49,114-123
+
+Singh, Dalip. (2001) Emotional Intelligence at work (1st ed.). New Delhi: Response Books.
+
+Singh, S. (2004) Development of a Measure of Emotional   intelligence,   Journal   of   National Academy of Psychology, vol-49,136-141
+
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+Sony  Kumari,  Alex  Hanky,  H.R.  Nagendra (2013) Effect of SMET on Emotional dynamics of Managers , voice of research, Vol2, issue 1, June 2013
+
+Tiwari.,P.S.N.&Srivastava,.N.(2004)   Schooling and Development of Emotional Intelligence , Journal of National Academy of psychology,vol-49,151-154
+
+Vempati R.P. & Telles, Shirley (2000). Baseline occupational  stress  levels  and  physiological responses to a two day stress management program. Journal of Indian Psychology, 18, no 1& 2.
+
+Wall, B. (2008) Working Relationships Using Emotional Intelligence to Enhance your Effectiveness with ther (1st Ed.) USA: Davies Black Publishing.
+
+Yvonne Birks, Jean McKendree and Ian Watt (2009)  Emotional  intelligence  and  perceived stress   in   healthcare   students   :   a   multi-institutional, multi- professional survey. BMC medical Education.
+
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+Srivastava,K.B.L.&   Bharamamaikar,S.R.,(2004) Emotional	Intelligence	and	Effective Leadership   Behavior   ,   Journal   of   National Academy of Psychology,vol- 49,107-113
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yogatexts/A comparative study between Vedic and contemporary education systems using bio-energy markers..txt

@@ -0,0 +1,287 @@
+1/27/2021
+A Comparative Study between Vedic and Contemporary Education Systems using Bio-Energy Markers
+https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336939/?report=printable
+1/7
+Int J Yoga. 2020 May-Aug; 13(2): 152–155.
+Published online 2020 May 1.
+doi: 10.4103/ijoy.IJOY_61_19: 10.4103/ijoy.IJOY_61_19
+PMCID: PMC7336939
+PMID: 32669770
+A Comparative Study between Vedic and Contemporary Education
+Systems using Bio-Energy Markers
+Rajesha Halekote Karisetty, Sushrutha Shivanna,  Balaram Pradhan,  TM Srinivasan, and Ramachandra G Bhat
+Division of Yoga Spirituality, Swami Vivekananda Yoga Anusandhana Samsthana S-VYASA Yoga University,
+Bengaluru, Karnataka, India
+Department of Humanities and Social Sciences, MIT School of Vedic Science, Loni Kalbhor, Maharashtra, India
+Division of Humanities, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka,
+India
+Address for correspondence: Prof. Ramachandra G Bhat, Division of Yoga Spirituality, Swami Vivekananda
+Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India. E-mail: [email protected]
+Received 2019 Aug 10; Revised 2019 Aug 20; Accepted 2019 Aug 26.
+Copyright : © 2020 International Journal of Yoga
+This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-
+NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-
+commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
+Abstract
+Background/Aim:
+“The destiny of the whole world depends on the children. If you want to see the silver lining on the
+horizon it is not you and me, but the children who have to be spiritualized” says Swami Satyananda
+Saraswati. Sri Aurobindo states “Education to be complete must have five principal aspects corresponding
+to the five principal activities of the human being: the physical, the vital, the mental, the psychic and the
+spiritual.” Vedic education system (VES) focuses on inculcating all facets for overall development of
+personality. This study is an attempt to understand the lore of Vedic education followed by yoga as a way
+of lifestyle for physiological well-being and for successful unfoldment of children's personality.
+Materials and Methods:
+The sample size was 378 (108 VES and 270 contemporary education system [CES]). We have excluded
+volunteers who had minor health problems from the study. The ethical clearance was taken from SVYASA
+University Ethics Committee, and informed consent was obtained for each individual undergoing the
+study. As it was aimed to collect one-time data, the yoga as a lifestyle in VES itself considered as an
+intervention. Thus, the two systems of educations are compared. The variables are measured using the
+Electro-photonic Image Bio-Well instrument.
+Results:
+1
+2
+1
+2
+1/27/2021
+A Comparative Study between Vedic and Contemporary Education Systems using Bio-Energy Markers
+https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336939/?report=printable
+2/7
+Bio-Well variables for VES and CES were compared. There was a significant difference in VES and CES
+energy level scores, left–right symmetry scores, organ balance, and entropy coefficient scores.
+Conclusions:
+Results suggest that Vedic Education System to be better in the measured parameters compared to
+Contemporary Education System.
+Keywords: Ancient lifestyle, biological well-being, education
+Introduction
+Indian system of education has been known for centuries for its unique nature of imparting knowledge.
+Basic objective of education is to explore the inner potentials through different modules, such as personal
+tutoring system, family vocational training, and self-learning method.[1] Among all the different education
+methods, Vedic education system (VES) was very popular for different reasons; community living for
+mutual emotional understanding, ethical values for humanitarian approach, exploring the inner potentials
+through individual mentoring in the chosen area of knowledge, to name a few.[2] Education in ancient
+India was to nurture all the tools of expression by every available resource: physical, vital, mental, social
+and spiritual as described by Sri Aurobindo.[3] As the physical body is an instrument to achieve the
+desired goals of life, the health and fitness of the body and mind were maintained well in accordance with
+nature.[4]
+Characteristics of physical well-being
+Yoga, as a lifestyle, was an inherent practice of VES which ensured the expected outcome of teaching and
+learning processes.[5] The essential components of yoga way of life are moderation in food, recreations,
+activities, and sleep–wake cycle proclaims Bhagavad-Gita.[6] As a part of yoga lifestyle, the physical
+well-being is meant to be a perfect balance of Dhatus/body tissues in the body as described in Ayurveda; it
+conveys that the three Dosha/humors, namely, Vata – air, Pitta – fire, and Kapha – water, should be in
+balance; the appetite and digestive fire are in a balanced state with cellular metabolism comprising
+complete digestion, absorption, and assimilation; the functions of seven Dhatus (body tissues) are normal
+in quality and quantity; whose metabolic wastes and toxins are properly and timely excreted; the sensory
+and motor organs with an efficiency of right perception and strength; an undisturbed mind, the Atma (soul)
+also in a pleasant/blissful state. Such a person is named as having overall well-being or Swasthah.[7]
+Further, Shvetashvatara Upanishad defines the physical well-being as lightness, health, steady mind,
+complexion, melodious voice, pleasant odor, and scantiness of excretions.[8]
+Routine of Vedic education system: A yoga lifestyle
+Food – Pleasing to body and mind, seasonally available, least processed, measured quantity
+Recreation – Doing things in ideal time, bed and wake up time are fixed in accordance with nature
+Actions – According to one's nature, within the limits of one's own capacity
+Psychological attitude – Practice of ethics and values, universal brotherhood, focused on continuous
+self-improvement.
+Sedentary lifestyle and its consequences on physiological health
+The acceptable differences between the education systems (prior and postmodern education) in India
+should be analyzed in terms of its influence on health and well-being of the human. Because of the modern
+industrialization and capitalistic economic policies, the education system and lifestyle were altered to a
+1/27/2021
+A Comparative Study between Vedic and Contemporary Education Systems using Bio-Energy Markers
+https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336939/?report=printable
+3/7
+Bio-Well
+What does the Bio-Well instrument measure in physical terms?
+great extent which consequently influenced the overall well-being of humans and other living creatures
+across the globe.
+The ancient Indian texts have highlighted that the concept of sedentary lifestyle or wrong lifestyle is the
+root cause of all diseases. Eating unhealthy food which is raajasik and taamasik, occupation at
+inappropriate places, the conduct of activities at unsuitable times and association with wrong people, and
+overfilling the stomach cause diseases by directly influencing the energy channels by blocking the bio-
+energy flow.[9] The bio-physical well-being is disturbed by overeating which in turn leads to sluggishness
+and dullness. In additon, over a period of time, toxins will be accumulated in the body which causes
+constipation and other complications. One feels drowsy and sleepy when the body is full of toxins.[10]
+Modern scientific evidence also proves the consequences of sedentary lifestyle with number of health
+issues. A study reported that students aged 14–17 years who have the routine of only eating junk food,
+overeating, and lack of physical activity are found to be obese and thereby suffer from diabetes, stroke,
+liver diseases, infertility, hypertension, arthritis, and cancer. Obese children also have a high risk of
+development of early heart diseases.[11]
+The value and practice of yoga are recognized globally. Regular practice of yoga in children and young
+people make them face disorders of life with fitness of physical body and steadiness of mind. Adoption of
+yoga as a significant tool minimizes stress and develops resilience. A study focused on the need of yoga
+for stress management, self-regulation, and healthy development reaches similar conclusions.[12]
+With this brief survey, the present study focuses on the physiological well-being where yoga is practiced as
+a way of lifestyle (regular, long time and determined) followed by healthy food, suitable recreations,
+optimal activities, and balanced sleep to avoid consequences of ill health.
+Materials and Methods
+The sample size was 378 (108 Vedic education setup and 270 contemporary education system [CES]). We
+excluded volunteers from the study who had minor health problem at the time of the experiment as it was
+more focused on physiological well-being. The ethical clearance was taken from SVYASA University
+Ethics Committee, and informed consent was obtained for each individual undergoing the study. As it was
+aimed to collect one-time data, yoga as a lifestyle in VES itself is considered as an intervention. The
+sample size was not calculated before the test. However, the G * Power (Dusseldorf, Germany), an overall
+power analysis program software, was used to calculate the power of the test as a post hoc analysis.[13]
+The power was found to be adequate, i.e., >0.80 for energy, left–right (L_R) symmetry, and entropy
+coefficient in Bio-Well parameters.
+Assessment tool
+The Bio-Well which works on the mechanism of Electro Photonic Image (EPI) was developed by
+Russian Scientist, Dr. Konstantin Korotkov in 1996 to capture, map, and analyze the electromagnetic field
+emanating from the human body in response to pulsed electrical field excitation and is used to assess the
+biological well-being.[14] Traditional Chinese medicine recognizes that representations of the whole body
+are found in each organ or region of the body. The phenomenon of fingertip diagnosis in EPI is an example
+of reflexological diagnosis applied to the fingertips, using Pranic energy fields, which are the media
+through which reflexological maps could arise. Hence, the instrument is of acceptable quality for research
+and has been used in various research investigations.[15]
+The Bio-Well instrument is based on
+the stimulation of photon and electron emissions called “photo-electron emissions,” and it has been
+thoroughly studied with physical electronic methods. The emitted particles accelerate in the
+electromagnetic field, generating electronic avalanches on the surface of the dielectric (glass) plate. This
+1/27/2021
+A Comparative Study between Vedic and Contemporary Education Systems using Bio-Energy Markers
+https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336939/?report=printable
+4/7
+Parameters measured for bio-psychological well-being
+process is called “sliding gas discharge.” The discharge causes glow from the excitement of molecules in
+the surrounding gas (which is air), and the parameters of this glow are measured by the Bio-Well
+instrument. Voltage pulses stimulate optoelectronic emission, while intensifying this emission in the gas
+discharge, amplified by the electric field created.
+Bio-well is capable of producing various
+detailed numerical data for multi-varied levels of analysis. In this study, only selected parameters are
+focused for analysis, as listed below.
+Emotional stress – Stress is a complex factor that has both an emotional component (anxiety) and a
+somatic component that results from prolonged exposure to permanent anxiety. Stress has a very
+strong impact on the bio-energy field. Images look very specific
+Energy – Energy (from the Greek enérgeia – action, activity) is a general quantitative measure of
+any type of movement, activity, and the interaction of all types of matter
+L_R symmetry – A measure of how symmetrical the distribution of energy is on the left and right
+sides of the body
+Organs balance – Characteristics of L_R balance of the body. This is an important characteristic in
+the evaluation of physical and mental conditions
+Entropy – This is an indicator of the level of chaos and disharmony in the energy in the system
+Form coefficient – It is one of the EPI parameters to analyze the level of a person's involvement in
+stress–adaptation and adjustability. This also provides the level of stress and balance of activity of
+sympathetic nervous system (SNS) and para-SNS work.
+Method used to collect the data
+The subjects of the present study were requested to come with empty stomach as a standard procedure of
+Bio-Well data acquiring norms to avoid postmeal influence on the subtle energy pattern, ideally in the
+early morning before the subjects get into their normal routine. Data are collected for all 10 fingers using
+Electro Photonic Imaging equipment from both VES and CES groups. Data are retrieved from the
+equipment using Bio-Well software and exported to excel sheet in the form of numerical values. Results
+are analyzed and compared using R-Studio (Boston, MA).
+Data analysis and results
+An independent-samples t-test was conducted to compare Bio-Well parameters for VES and CES. There
+was a significant difference in VES and CES energy level scores; t (376) = 10.579, P = 0.00, L_R
+symmetry scores; t (376) = 3.234, P = 0.001, organ balance; t (376) = 2.130, P = 0.03, entropy coefficient
+scores; t (376) = 11.029, P = 0.0001, as shown in Table 1.
+Discussion
+These results suggest that VES and CES have different Bio-Well scores. Specifically, our results suggest
+that when students undergo different styles of educational systems, different aspects of well-being are
+influenced by the VES having component of yoga lifestyle compared to normal routine. The study showed
+a significant difference in energy, L_R symmetry, entropy coefficient, and organ balance, as for as physical
+well-being is considered.
+Compared to VES, emotional stress values were found less in CES. Form coefficient values which are
+indicative of adaptability also are found more in VES, perhaps because of their yoga practices. It is
+intended that EPI measurement technique could provide finer details of physiological states in yoga
+1/27/2021
+A Comparative Study between Vedic and Contemporary Education Systems using Bio-Energy Markers
+https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336939/?report=printable
+5/7
+lifestyle practitioners. The influence of yoga lifestyle helps to maintain health and well-being of the
+physical body and mind which form basic tools for one's own successful achievement. It is assumed that
+the balanced health status is the outcome of purification of the body through different practices and also
+the bio-energy level is always optimum by the evacuation of mental stressors and accumulated morbid
+matters from the physical body.
+As the entire physical body is maintained by normal secretions of hormones by the endocrine and exocrine
+glands, yoga lifestyle helps in the regulation of hypothalamic–pituitary–adrenal axis and the SNS in
+reducing cortisol. Hence, it is reported that yoga may reduce high energy levels in hypothalamus to both
+bring balance and maintain optimal energy.[16] Hence, it is very much evident that when different
+practices of yoga lifestyle are practiced regularly, the different aspects of physical health are established.
+Entropy indicates the functional state of cells, organs, and the entire human body. The study also shows
+less chaos and disorderliness within the system in the subtle energy of mediators.[14]
+Conclusions
+Through regular practice of yoga as a way of lifestyle, one can maintain optimal level of energy at physical
+level for better performance of any activity. As equal importance is given to develop both intellectual and
+emotional development in VES, the practices of postures followed by pranayama help to maintain the
+balance of SNS and para-SNS, thereby left and right symmetry is achieved. Coordination between the
+motor organs with awareness is highly enhanced by avoiding chaos/haphazardness, thereby establishing
+harmony in the entire physiology. Hence, yoga as lifestyle in ancient/Vedic system of education greatly
+helps to achieve physiological well-being by avoiding further consequences of disorders to achieve better
+working efficiency, academic performance, and behavioral changes in adolescents.
+Suggestions for the future study
+Based on the results achieved, one can propose to carry on research further for more evidence base with
+clinical trial by collecting bio-markers in different zones of the country in both VES and CES to establish
+yoga as lifestyle pertaining to the role of melatonin: its health consequences in both systems of education.
+The limitations of the study are having no subjective variables and biochemical markers.
+Financial support and sponsorship
+Nil.
+Conflicts of interest
+There are no conflicts of interest.
+Acknowledgment
+We acknowledge the contributions of the students, staff, and management of Prabodhini Gurukula,
+Maitreyi Gurukula and Satya Sai Institute, at last, the guidance given by Thaiyar M. Srinivasan of S-
+VYASA, India, for supporting the research.
+References
+1. Mukherjee K. Indian Educational System : An Overview of the Ancient Indian Education. Inflibnet,
+Gandhinagar, Gujrat: p. 143.
+2. Kapur R. Education in the Ancient Period. University of Delhi Research Gate; 2018. p. 25.
+3. Mother T. The Mother on Education Pondicherry. Sri Aurobindo Ashram Publication; 2002. pp. 9–11.
+1/27/2021
+A Comparative Study between Vedic and Contemporary Education Systems using Bio-Energy Markers
+https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336939/?report=printable
+6/7
+4. Nadkarni MV. Handbook of Hinduism. New Delhi: Ane Books Pvt Ltd; 2013. p. 38.
+5. Rangan R, Nagendra H, Bhat GR. Effect of yogic education system and modern education system on
+memory. Int J Yoga. 2009;2:55–61. [PMCID: PMC2934577] [PubMed: 20842265]
+6. Shastri AM. The Bhagavad Gita Madras. Samata Books; 2017. pp. 192–3.
+7. Wright J. The concept of public health. Br J Sch Nurs. 2014;5:206.
+8. Tyagishananda S. Shvetashvataropanishat. Mylapur, Madras: Ramakrishna Math; 1949. p. 53.
+9. Saraswati SJ. Essence of Yoga Vasishtha_Swami Jnanananda Saraswati Pdf. 1985
+10. Muktibodhananda S. Hatha Yoga Pradipika. Munger, Bihar: Light on Hatha Yoga; 2006. p. 654.
+11. Sharma M, Majumdar PK. Occupational lifestyle diseases: An emerging issue. Indian J Occup Environ
+Med. 2009;13:109–12. [PMCID: PMC2862441] [PubMed: 20442827]
+12. Hagen I, Nayar US. Yoga for children and young people's mental health and well-being: Research
+review and reflections on the mental health potentials of yoga. Front Psychiatry. 2014;5:35.
+[PMCID: PMC3980104] [PubMed: 24765080]
+13. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for
+correlation and regression analyses. Behav Res Methods. 2009;41:1149–60. [PubMed: 19897823]
+14. Deo G, Itagi RK, Thaiyar MS, Kuldeep KK. Effect of anapanasati meditation technique through
+electrophotonic imaging parameters: A pilot study. Int J Yoga. 2015;8:117–21. [PMCID: PMC4479888]
+[PubMed: 26170590]
+15. Korotkov K, Williams B, Wisneski LA. Assessing biophysical energy transfer mechanisms in living
+systems: The basis of life processes. J Altern Complement Med. 2004;10:49–57. [PubMed: 15025878]
+16. Gayathri V, AlakaMani TL, Shivakumar K. Effect of Yoga on Endocrine and Nervous System in
+Adolescent children: Assessment Using EPI parameters. Journal of Ayurvedic and Herbal Medicine.
+2018;4:18–21.
+Figures and Tables
+1/27/2021
+A Comparative Study between Vedic and Contemporary Education Systems using Bio-Energy Markers
+https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336939/?report=printable
+7/7
+Table 1
+Descriptive statistics of Bio-Well variables of Vedic education system contemporary education
+system
+Variables
+VES
+CES
+Emotional stress
+3.68±1.10
+3.43±0.94
+Energy
+62.04±6.93*
+54.54±7.51
+L_R symmetry
+93.97±6.74*
+93.31±9.18
+Organ balance
+85.98±8.77*
+85.84±9.23
+Entropy coefficient
+2.81±0.48*
+2.32±0.27
+Form coefficient
+3.36±1.09
+3.15±1.06
+*P<0.001, independent t-test. VES=Vedic education system, CES=Contemporary education system, L_R=Left–right
+Articles from International Journal of Yoga are provided here courtesy of Wolters Kluwer -- Medknow
+Publications

yogatexts/A comparative study of minimum muscular fitness in students with visual impairment and normal vision..txt

@@ -0,0 +1,70 @@
+3/3/2017
+A Comparative Study of Minimum Muscular Fitness in Students with Visual Impairment and Normal Vision | Mohanty | Indian Journal of Health and W…
+http://www.i­scholar.in/index.php/ijhw/article/view/122507
+1/1
+All
+Search
+Home
+Current
+Archives
+Authors
+Institutions
+Vol 7, No 1 (2016)
+Pages: 97­100
+Published: 2016­01­01
+   Subscribe/Renew Journal
+The protective effects of fitness on several health related outcomes have clearly been shown among normal
+sighted  students.  However,  currently  there  is  a  dearth  of  data  pertaining  to  children  with  visual  impairment
+regarding their fitness. The purpose of the study was to examine differences in minimum muscular fitness among
+students with visual impairment and normal vision. Two hundred thirty six students; visually impaired (n=125)
+and  sighted  (n  =111);  of  South  India  matched  on  age,  height,  weight,  and  gender  participated  in  this  study.
+Participants were evaluated for minimum muscular fitness through Kraus­Weber test. Chi ­ square test was used
+to calculate the frequency and percentage of failure and success in both the groups. The results demonstrated
+that sighted students had significantly greater levels of muscle fitness than students with visual impairment. It
+appears that students with visual impairment are deficient in muscle strength as compared to sighted students.
+Inclusion  of  physical  activities  such  as  yoga  in  the  regular  curriculum  of  the  school  is  suggested  for  the
+improvement of the failures status. 
+Keywords
+Visual Impairment, Minimum Muscles Fitness, Kraus­Weber Test.
+ 
+A Comparative Study of Minimum Muscular Fitness in Students with Visual
+Impairment and Normal Vision
+Soubhagyalaxmi Mohanty  , Satyaprakash Purohit  , Rima Mayanglanbam  , Rajashree Ranjita  , Balaram Pradhan  ,
+Alex Hankey 
+ 
+Affiliations
+1 Division of Yoga and Humanities, SVYASA Yoga University, Bangalore, India
+2 Division of Yoga and Humanities, SVYASA Yoga University, Bangalore, Karnataka, India
+ 
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yogatexts/A composite of BMI and waist circumference may be a better obesity metric in Indians with high risk for type 2 diabetes An analysis of NMB-2017, a.txt

@@ -0,0 +1,865 @@
+A composite of BMI and waist circumference may
+be a better obesity metric in Indians with high risk
+for type 2 diabetes: An analysis of NMB-2017, a
+nationwide cross-sectional study
+Murali Venkatrao, Raghuram Nagarathna, Suchitra S. Patil, Amit Singh, S.K. Rajesh,
+Hongasandra Nagendra *
+Division of Yoga and Life Sciences, SVYASA University, Prashanti Kutiram, Vivekananda Road, Kalluballu Post, Jigani, Bengaluru 560015,
+India
+A R T I C L E
+I N F O
+Article history:
+Received 13 October 2019
+Received in revised form
+26 December 2019
+Accepted 27 January 2020
+Available online 29 January 2020
+Keywords:
+Type 2 diabetes
+BMI
+Central fat
+Obesity
+Anthropometric
+A B S T R A C T
+Aims: Obesity measurement is a vital component of most type 2 diabetes screening tests;
+while studies had shown that waist circumference (WC) is a better predictor in South
+Asians, there is evidence that BMI is also effective. Our objective was to evaluate the effi-
+cacy of BMIWC, a composite measure, against BMI and WC.
+Methods: Using data from a nationwide randomized cluster sample survey (NMB-2017), we
+analyzed 7496 adults at high risk for type 2 diabetes. WC, BMI, and BMIWC were evaluated
+using Odds Ratio (OR), and Classification scores (Sensitivity, Specificity, and Accuracy).
+These were validated using Indian Diabetes Risk Score (IDRS) by replacing WC with BMI
+and BMIWC, and calculating Sensitivity, Specificity, and Accuracy.
+Results: BMIWC had higher OR (2
300) compared to WC (1
87) and BMI (2
26). WC, BMI, and
+BMIWC were all highly Sensitive (0
75, 0
81, 0
70 resp.). But BMIWC had significantly higher
+Specificity (0.36) when compared to WC and BMI (0.27 each). IDRSWC, IDRSBMI, and
+IDRSBMIWC were all highly Sensitive (0
87, 0
88, 0
82 resp.). But IDRSBMIWC had significantly
+higher Specificity (0
39) compared to IDRSWC and IDRSBMI (0
30, 0
31 resp.).
+Conclusions: Both WC and BMI are good predictors of risk for T2DM, but BMIWC is a better
+predictor, with higher Specificity; this may indicate that Indians with high values of both
+central (high WC) and general (BMI > 23) obesity carry higher risk for type 2 diabetes than
+either one in isolation. Using BMIWC in IDRS improves its performance on Accuracy and
+Specificity.
+
 2020 Elsevier B.V. All rights reserved.
+1.
+Introduction
+Diabetes is a serious and escalating health burden in India,
+with an age-adjusted comparative prevalence of 10.4%. Over
+77 million people have been diagnosed with the disease. Of
+equal concern is that an additional estimated 43 million peo-
+ple have type 2 diabetes but are undiagnosed [1]. Obesity is a
+well-known risk factor for Diabetes. In India, more than 135
+https://doi.org/10.1016/j.diabres.2020.108037
+0168-8227/
 2020 Elsevier B.V. All rights reserved.
+* Corresponding author.
+E-mail address: [email protected] (H. Nagendra).
+d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7
+Contents available at ScienceDirect
+Diabetes Research
+and Clinical Practice
+journal homepage: www.elsevier.com/locate/diabres
+million individuals were affected by obesity [2]. There is thus
+an urgent need to screen the general population for diabetes
+risk and implement preventive lifestyle change interventions.
+Many screening models have been developed to assess
+diabetes risk [3]. All of these models include an obesity com-
+ponent. The most commonly used model in India, the Indian
+Diabetes Risk Score (IDRS) [4], uses Waist Circumference (WC)
+for obesity; so does the German Diabetes Risk Score [5]. Other
+models (Cambridge Risk Score [6] and Framingham Offspring
+Diabetes Risk Score [7],) use Body Mass Index (BMI), while Fin-
+nish Diabetes Risk Score [8] uses both WC and BMI.
+However, it is not clear whether WC or BMI is better for
+determining type 2 diabetes risk. Various studies [14–23] have
+been done in this area and have drawn conflicting conclu-
+sions. Some studies have found that WC is a better measure
+of risk [17,18,21,22]. Other studies have drawn the opposite
+conclusion [15,19]. At least one study has found both mea-
+sures to be equally good [23]. Given the great breadth and
+depth of these studies, these conflicting conclusions probably
+point to the fact that each metric only partially captures the
+etiological association between obesity and type 2 diabetes.
+We postulated that a composite metric which combines
+central and general obesity would be a better indicator than
+either one in isolation. We defined a composite metric called
+BMIWC and analyzed its performance as a risk factor.
+2.
+Subjects, materials and methods
+2.1.
+Study design
+Niyantrita Madhumeha Bharata (‘‘Control of Diabetes in India”)
+2017, or NMB 2017, was a two-phased study undertaken
+across 29 most populous states/union territories in India.
+The twin objectives of the study were:
+- (Phase 1) To estimate the prevalence of diabetes and predi-
+abetes in 2017 simultaneously in all zones of India
+- (Phase 2) To conduct an RCT using a validated yoga life-
+style protocol
+Phase 1 [9] was a nationwide cross-sectional survey using
+a multi-level stratified cluster sampling technique with ran-
+dom selection among urban and rural populations covering
+29 states and union territories of the country. In a door to door
+survey, researchers used a questionnaire to collect data on
+diabetes status and diabetes risk.
+Phase 2 [9] involved a sub-sample of the phase-I partici-
+pants, from which were selected high-risk individuals (those
+with self-reported diabetes or for whom IDRS was 60) for
+further assessment through blood tests and a more detailed
+questionnaire; and to determine the efficacy of intervention.
+The intervention was a 3-month practice of a standard Yoga
+protocol [10].
+2.2.
+Phase 1 sampling strategy
+Sampling was done at 4 levels: Zones, States, Districts, and
+Villages (rural) or Towns (urban). We chose 24 (of 29) states
+and 4 (of 7) Union Territories. These states were grouped into
+seven zones based on cultural homogeneity [9]. To ensure dis-
+tricts samples within a state were not clustered, we grouped
+the state into geographical regions and chose a district from
+each region (e.g., if a state needed 3 districts, it was grouped
+into north, south, and central).
+Each district was also grouped into geographical regions,
+and we chose:
+1. (Rural) up to four villages with population between 500 and
+1000.
+2. (Urban) up to four Census Enumeration Blocks (CEBs), such
+that total population was around 2000.
+All households within the selected village or CEB were
+surveyed.
+2.3.
+Phase 2 sampling strategy
+From the Phase 1 sample, we selected adults of both genders
+who had the ability to do yoga (and consented to doing it), and
+satisfied one of the following criteria:
+1. Self-reported and newly diagnosed diabetes with or with-
+out glycemic control, using/not using oral hypoglycemic
+agents or insulin
+2. IDRS score was 60
+2.4.
+Procedure for biochemical measures
+All biochemical assays were carried out by the same method
+by the same nationally accredited laboratory. HbA1c, the pri-
+mary glycemic measure, was estimated by high-pressure liq-
+uid
+chromatography
+using
+VariantTM
+II
+Turbo
+(Bio
+Rad,
+Hercules, CA) method [9].
+2.5.
+Participants and outcomes
+We included all individuals in Phase 2 for whom all the fol-
+lowing data were available: WC, Weight, Height, Family his-
+tory of diabetes, Age, Physical Activity, HbA1c, and Diabetes
+Self Declaration (Yes or No). The sole outcome was whether
+the individual had diabetes or not, as determined by the value
+of HbA1c or self-declaration.
+2.6.
+Definitions of obesity metrics
+Values of WC and BMI were bucketed into five risk categories
+(Table 1). The 5 categories for BMI were picked from the stan-
+dardized ranges established for Asian populations [11]. For
+WC, we added two more categories at the bottom and top of
+the three categories established for the Asian Indian popula-
+tion [4].
+We created a composite obesity metric, BMIWC, which
+combines BMI and WC according to the following algorithm:
+If WC was <3, then BMI was scored as BMI – 1; if WC was
+3, the value of BMI remained unchanged. Thus, BMIWC rec-
+ognizes that individuals with both low WC and high BMI are
+at lower risk while individuals with high WC or high BMI
+2
+d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7
+are at higher risk. This adds an additional risk category at the
+lower end, with a score of zero, designated ‘‘Ultra Low”
+(Table 1).
+Below are some examples of obesity risk scores, calculated
+using data from NMB 2017:
+
+Male with WC 85 cm, BMI 27
6 kg/m2 has: WC = 2, BMI = 4,
+and BMIWC = 3
+
+Male with WC 108 cm, BMI 26.3 kg/m2 has: WC = 4, BMI = 3,
+and BMIWC = 3
+2.7.
+Definitions of IDRS and its variants
+The second part of the study sought to validate the efficacy of
+BMIWC by replacing the obesity component of IDRS (WC) with
+BMIWC. We also studied the efficacy of IDRS when the obesity
+component is replaced by BMI. The modified risk scores were
+called IDRSBMIWC and IDRSBMI resp. The definitions of IDRS [3],
+IDRSBMI and IDRSBMIWC are shown in Table 2.
+2.8.
+Analysis
+Contingency table methods (for risk assessment) and confu-
+sion matrix methods (for assessing classification efficacy)
+were used to evaluate each obesity metric. Validation was
+done by replacing WC with BMIWC as the obesity component
+of IDRS and determining classification efficiency of the mod-
+ified IDRS.
+WC, BMI, and BMIWC were compared for their association
+to type 2 diabetes risk. A contingency table of risk categories
+and outcome was created for each metric, and v2 statistic was
+calculated to measure risk association. Using the lowest risk
+category as a reference, Odd Ratio (OR) calculated for each
+risk category. They were also compared for their ability to
+classify the population into two groups: people with type 2
+diabetes and people without. An ROC curve was drawn for
+each measure to determine the threshold score for classifica-
+tion. Based on this threshold, a confusion matrix was created
+for each measure. Efficacy of classification was determined by
+calculating Sensitivity, Specificity, and Accuracy [12]. McNe-
+mar’s statistic was calculated to determine the statistical sig-
+nificance of the difference in Specificities, as discussed by
+Hawass [13].
+IDRS, IDRSBMI and IDRSBMIWC were compared for efficacy of
+classification. An ROC curve was drawn for IDRSBMI and
+IDRSBMIWC to determine classification thresholds. The thresh-
+old for IDRS has already been determined to be 60 [4]. Using
+these threshold values, Sensitivity, Specificity and Accuracy
+were calculated. McNemar’s statistic was calculated to as
+before to determine statistical significance. All analyses were
+done using Python v.3
7. Pandas v.0
23 was used to import
+data, calculate obesity metrics and risk levels. Contingency
+table creation and calculation of risk measures were done
+using Statsmodels v.0
10
1. Confusion matrix creation and
+calculation
+of
+classification
+measures
+were
+done
+using
+Scikit-learn v.0
21
3. v2 and McNemar’s statistics were calcu-
+lated using Scipy v.1
3
0.
+Ethical clearance was obtained by the EC of Indian yoga
+association.
+The
+study
+was
+registered
+in
+CTRI
+CTRI/2018/03/012804.
+3.
+Results
+3.1.
+Description of data
+A total of 7496 individuals at high risk (60 on IDRS) for type 2
+diabetes (3935 females, 3561 males) were analyzed. They var-
+ied in age from 20 to 85 years (m = 48
39, r = 11
86). Waist cir-
+Table 1 – Definitions of Obesity Metrics.
+Metric
+Risk Score
+WC Value (in cm)
+69
99* (female), 79
99* (male)
+1 = Very Low (VL)
+70–79
99 (female), 80–89
99 (male)
+2 = Low (L)
+80–89
99 (female), 90–99
99 (male)
+3 = Moderate (M)
+90–99
99 (female), 100–109
99 (male)
+4 = High (H)
+ 100 * (female), 110* (male)
+5 = Very High (VH)
+BMI Value (in kg/m2)
+ 18
49
+1 = Very Low (VL)
+18
5–22
99
+2 = Low (L)
+23–27
49
+3 = Moderate (M)
+27
5–32
49
+4 = High (H)
+32
5
+5 = Very High (VH)
+BMIWC (dimensionless), values of BMI and WC below refer to risk scores
+BMI = 1 & WC < 3
+0 = Ultra Low (UL)
+BMI = 2 & WC < 3 OR BMI = 1 & WC  3
+1 = Very Low (VL)
+BMI = 3 & WC < 3 OR BMI = 2 & WC  3
+2 = Low (L)
+BMI = 4 & WC < 3 OR BMI = 3 & WC  3
+3 = Moderate (M)
+BMI = 5 & WC < 3 OR BMI = 4 & WC  3
+4 = High (H)
+BMI = 5 & WC  3
+5 = Very High (VH)
+* Two additional categories added at the top and bottom of the three categories established for Asian Indian
+populations.
+d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7
+3
+cumference varied from 60 to 150 cm (m = 91.21, r = 10.91) and
+BMI varied from 12.2 to 66.2 kg/m2 (m = 28.13, r = 4.60). Fig. 1
+shows the distribution of each of these characteristics across
+relevant categories.
+Total number with type 2 diabetes was 3079, of which 1093
+individuals were
+newly
+diagnosed
+and
+1986
+were
+self-
+reported.
+3.2.
+Risk analysis of obesity metrics
+The v2 test of association showed statistically significant
+association between obesity metrics and type 2 diabetes risk:
+WC: v2(4, N = 7496) = 29
10, p < 0
001; BMI: v2(4, N = 7496)
+= 66.58, p < 0
001; BMIWC: v2(5, N = 7496) = 59.06, p < 0
001.
+Odds that a person in the lowest obesity category (VL for
+WC and BMI, UL for BMIWC) had diabetes was calculated for
+each obesity metric, which was used as the reference odds.
+Odds were also calculated at each of the higher obesity
+categories, and the odds ratio was determined by taking the
+ratio of this with the reference odds.
+The following OR values were seen at the highest risk cat-
+egory (VH) for each obesity metric:
+
+For WC: 1
87 (95% CI 1.47–2.37)
+
+For BMI: 2
26 (95% CI 1.58–3.24)
+
+For BMIWC: 2
30 (95% CI 1.51–3.51)
+We can see that WC, BMI and BMIWC each higher odds in
+the VH category compared to the reference (lowest) category.
+But BMIWC outperformed WC and BMI by having a higher OR.
+We also observed that the OR for BMIWC was higher at
+every risk category than the corresponding scores for WC
+and BMI, as seen in Fig. 2.
+WC showed an actual decrease in OR between Moderate
+(M) and High (H) risk levels but showed a dramatically
+increased odds between High (H) and Very High (VH). This
+non-monotonic behavior is an indication that the risk cate-
+gories of WC don’t adequately capture increasing diabetes
+risk. BMI encapsulates diabetes risk better by showing a
+monotonically increasing OR. But BMIWC clearly outperforms
+the WC and BMI: OR is monotonically increasing, and the
+value of OR is higher at every risk category – as can be seen
+by the blue line (representing BMIWC) lying above the orange
+(WC) and green (BMI) lines.
+3.3.
+Classification analysis of obesity metrics
+We plotted ROC curves for WC, BMI, and BMIWC to determine
+the classification thresholds for each measure. These curves
+are shown in Fig. 3. We can see that a risk level of three
+(Moderate) is the optimum threshold. Using this value, we
+calculated Sensitivity, Specificity, and Accuracy. Table 3 shows
+the results.
+BMI had better Sensitivity (6
89%) when compared to WC
+but showed the same Specificity. BMIWC showed slightly
+decreased Sensitivity (7
00%) but vastly improved Specificity
+(34
01%) when compared to WC. In terms of Accuracy, BMI
+was slightly better than WC (4
41%), and BMIWC was better
+still (6
69%).
+Matched sample tables for Specificity were created using
+True Negative (TN) and False Positive (FP) counts, one for
+BMIWC and WC, and another for BMIWC and BMI. Table 4
+shows the counts of tied (FP-FP, TN-TN) and untied (TN-
+FP, FP-TN) pairs. McNemar’s statistic calculated on the val-
+ues untied pairs in these tables as described by Hawass
+[12]. The results were: BMIWC and WC: v2 (1, N = 695)
+= 234
84, p < 0
001; BMIWC and BMI: v2 (1, N = 410) = 408
00,
+p < 0
001. This shows that the increase the Specificity of
+BMIWC
+as
+compared
+to
+WC
+and
+BMI
+is
+statistically
+significant.
+3.4.
+Classification analysis of IDRS variants
+We plotted ROC curves for IDRSBMI, and IDRSBMIWC to deter-
+mine the classification thresholds for each score. These
+curves are shown in Fig. 4. We can see that 60 is the optimum
+threshold for IDRSBMI, and 70 is the threshold for IDRSBMIWC.
+The threshold for IDRS has already determined to be 60 [3].
+Table 2 – Definitions IDRS, IDRSBMI, and IDRSBMIWC.
+Metric
+Score
+IDRS
+Age
+<35 years
+0
+35–49 years
+20
+50
+30
+Physical Activity
+Exercise [regular] + strenuous work
+0
+Exercise [regular] or strenuous work
+20
+No exercise and sedentary work
+30
+Family History
+No family history
+0
+Either parent
+10
+Both parents
+20
+Obesity (WC)
+WC Risk Score  2
+0
+WC Risk Score = 3
+10
+WC Risk Score  4
+20
+Range of the Score
+0–100
+IDRSBMI
+Age, Physical Activity, Family History
+are same as IDRS
+0–80
+Obesity (BMI)
+BMI Risk Score  2
+0
+BMI Risk Score = 3
+10
+BMI Risk Score  4
+20
+Range of the score
+0–100
+IDRSBMIWC
+Age, Physical Activity, Family History are
+same as IDRS
+0–80
+Obesity (Composite)
+If WC Risk Score  2
+0
+BMI Risk Score  2
+0
+BMI Risk Score = 3
+10
+BMI Risk Score  4
+20
+If Waist Risk Score > 2
+BMI Risk Score  2
+10
+BMI Risk Score = 3
+20
+BMI Risk Score  4
+30
+Range of the score
+0–110
+4
+d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7
+These values were used to calculate Sensitivity, Specificity,
+and Accuracy. Table 3 shows the results.
+IDRSBMI showed marginally better Sensitivity (1
27%) and
+Specificity
+(1
85%)
+when
+compared
+to
+IDRS.
+IDRSBMIWC
+showed slightly decreased Sensitivity (6
14%) but vastly
+improved Specificity (26
61%) when compared to IDRS. In
+terms of Accuracy, IDRSBMI was slightly better than IDRS
+(1
46%), and IDRSBMIWC was better still (4
79%).
+Matched
+sample
+tables
+for
+Specificity
+were
+created
+using True Negative (TN) and False Positive (FP) counts,
+Fig. 1 – Respondent Characteristics, n = 7496.
+d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7
+5
+one for IDRSBMIWC and IDRS, and another for IDRSBMIWC
+and IDRSBMI. Table 4 shows the counts of tied (FP-FP,
+TN-TN)
+and
+untied
+(TN-FP,
+FP-TN)
+pairs.
+McNemar’s
+statistic calculated on the values untied pairs in these
+tables
+as
+described
+by
+Hawass
+[12].
+The
+results were:
+IDRSBMIWC
+and
+IDRS:
+v2
+(1,
+N = 567) = 226
04,
+p < 0
001;
+IDRSBMIWC and IDRSBMI: v2 (1, N = 334) = 332
00, p < 0
001.
+This shows that the increase the Specificity of IDRSBMIWC
+as
+compared
+to
+IDRS
+and
+IDRSBMI
+is
+statistically
+significant.
+1
+1.2
+1.4
+1.6
+1.8
+2
+2.2
+2.4
+UL
+VL
+L
+M
+H
+VH
+Odds Rao
+Risk Categories
+WC
+BMI
+BMIWC
+Fig. 2 – Odds Ratio for WC, BMI, and BMIWC.
+Fig. 3 – ROC Curves for WC, BMI, and BMIWC.
+6
+d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7
+4.
+Discussion and conclusions
+Although obesity is an established risk factor for type 2 dia-
+betes, it is unclear what the best anthropometric measure
+for this is. Current studies in this area have focused on two
+metrics – WC (for central fat), and BMI (for general adiposity).
+While there are many studies that have investigated the link
+between WC, BMI, and Diabetes, the result of these studies
+paints a confusing picture.
+Some studies have found that WC is a better predictor of
+Diabetes than BMI. A 2016 [17] study of Chinese, Malays, Asian
+Indians found that ‘‘Abdominal adiposity measures generally
+performed better than BMI in identifying undiagnosed dia-
+betes.”.
+A
+2016
+[18]
+pooled
+analysis
+of
+four
+German
+population-based cohort studies found that ‘‘there were
+stronger associations between anthropometric markers that
+reflect abdominal obesity (WC and WHR) and incident type-
+2 diabetes than for BMI and weight.” A 1991 [21] study of
+South Asians settled in London found that ‘‘Insulin resistance
+syndrome, prevalent in South Asian populations is associated
+with a pronounced tendency to central obesity.” A 2008 [22]
+collaborative analysis of cross-sectional data from 16 cohorts
+from the DECODA study, which involved multiple Asian eth-
+nicities, found that ‘‘WSR (Waist to Stature Ratio, a measure
+of central fat) was stronger than BMI in association with
+diabetes.”
+Other studies have found BMI to be a better predictor of
+Diabetes than WC. A 2018 [23] five-year prospective study of
+elderly Chinese found that ‘‘BMI was the strongest predictor
+of diabetes among both men and women.” A 2015 [16] study
+of Asian Indian, Chinese, and Japanese found that ‘‘Popula-
+tion Attributable Risk (PAR) for BMI was high among Indians.”
+Still other studies have concluded that neither WC nor BMI
+are reliable predictors of Diabetes. A 2000 [15] study of White,
+Black, Hispanic Americans found that ‘‘the positive predictive
+value (PPV) of WC for diabetes was low.” A 2018 [14] study of
+Asian Americans found that ‘‘one in seventeen Asian Ameri-
+Table 3 – Classification analysis.
+Metric
+Sensitivity
+Specificity
+Accuracy
+WC
+0
75
+0
27
+0
47
+BMI
+0
81
+0
27
+0
49
+BMIWC
+0
70
+0
36
+0
50
+IDRS
+0
87
+0
30
+0
53
+IDRSBMI
+0
88
+0
31
+0
54
+IDRSBMIWC
+0
82
+0
39
+0
56
+Table 4 – Matched Samples tables for Specificity.
+WC
+BMIWC
+IDRS
+IDRSBMIWC
+FP
+TN
+FP
+TN
+FP
+2676
+145
+FP
+2605
+104
+TN
+550
+1046
+TN
+463
+1245
+BMI
+BMIWC
+IDRSBMI
+IDRSBMIWC
+FP
+TN
+FP
+TN
+FP
+2821
+0
+FP
+2709
+0
+TN
+410
+1186
+TN
+334
+1374
+Fig. 4 – ROC Curves for IDRS, IDRSBMI, and IDRSBMIWC.
+d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7
+7
+cans with BMI less than 17 has diabetes.” The authors con-
+cluded that regular screening for diabetes was required
+within this group.
+It is clear that neither metric adequately measures obesity
+as it is related to diabetes risk. One reason could be confound-
+ing factors that are inherent to each metric: a tall individual is
+likely to have a higher WC and a muscular individual will
+have a higher BMI, without being more obese. There could
+be deeper, yet to be understood reasons as well.
+Our approach was to study if a composite metric, which
+combines both WC and BMI, would perform better as a risk
+factor for type 2 diabetes. Following the suggestion of the
+WHO expert consultation [11], our metric uses BMI as the
+base metric and gives ‘‘credit” to individuals who had low
+WC – i.e. reduce their risk level.
+We have shown, through v2 analysis, that there is a statis-
+tically significant association BMIWC and the outcome (type 2
+diabetes). We have also shown that BMIWC is superior to WC
+or BMI in predicting type 2 diabetes risk, as demonstrated
+by higher values of OR at every risk category. We can thus
+conclude that BMIWC is a better risk factor for type 2 diabetes
+either central or general fat.
+We also found WC, BMI, and BMIWC are similar in their
+ability to pick individuals with type 2 diabetes from a popula-
+tion (this is measured by Sensitivity): 81% of people with mod-
+erate or higher BMI, 75% of people with moderate or higher
+WC, and 70% of the people with moderate or higher BMIWC
+had type 2 diabetes. Thus, individuals with type 2 diabetes
+are likely to be higher on the obesity scale, regardless of
+which metric is used.
+But, to be useful as a risk factor, WC, BMI, and BMIWC
+should be lower in individuals without type 2 diabetes (this
+is measured by Specificity). We found that WC and BMI have
+low Specificity: among people who did not have type 2 dia-
+betes, only 27% had lower than moderate WC or BMI. How-
+ever, BMIWC was significantly more specific, as 36% of
+people without type 2 diabetes had lower than moderate
+BMIWC. Thus, individuals who have either high central fat or
+general adiposity are at higher risk of diabetes, while individ-
+uals with both low central fat and low general adiposity are at
+lower risk of diabetes. It follows that BMIWC is a better risk
+factor for type 2 diabetes than just WC or BMI.
+It is to be noted a viable screening score considers not just
+obesity, but also other risk factors such as age, family history,
+and physical activity. As mentioned in Section 1, IDRS is an
+effective screening technique used in India which considers
+all of these risk factors. We validated our conclusion that
+BMIWC is a better measure of obesity by modifying IDRS to
+replace
+WC
+with
+BMI
+(IDRSBMI)
+and
+then
+with
+BMIWC
+(IDRSBMIWC). All three variants were highly sensitive: among
+people with type 2 diabetes, 88% had IDRSBMI of 60 or more;
+87% had IDRS of 60 or more, while 82% had IDRSBMIWC of 70
+or more. However, when selecting ONLY people with type 2
+diabetes from within a high-risk population (Specificity),
+IDRSBMIWC significantly outperformed IDRS by 26
61% and
+IDRSBMI by 24
31%.
+This is an important result from both public health and clin-
+ical perspectives. Height, weight, and WC are typically avail-
+able for a patient (or are easily measured). Thus, there is no
+added cost to calculating BMIWC, and IDRSBMIWC. Given the
+significantly better Specificity of IDRSBMIWC, it should be used
+as a screening test in both public health and clinical situations.
+4.1.
+Limitations of this study
+We studied high-risk individuals (41
08% of the study popula-
+tion had type 2 diabetes). We would expect the risk measures
+and Specificity to be different in a sample reflective of the
+general population.
+Our study of IDRSBMIWC has established a classification
+threshold of 70. This threshold may change when future anal-
+ysis will be done using data on individuals in all risk
+categories.
+4.2.
+Suggestions for future work
+We postulated that a proper anthropometric measure of obe-
+sity should take into account both central fat and general adi-
+posity and have established that this is true among high-risk
+Indians. Future work should expand this work by: (a) verifying
+our conclusion within a population sample which includes
+both high- and low-risk individuals, and (b) study BMIWC
+among other ethnic groups.
+Funding
+Ministry of AYUSH, Govt. of India, routed through Central
+Council for Research in Yoga and Naturopathy.
+Role of the funding source
+The study funder had no role in study design, collection, anal-
+ysis, and interpretation of data. The authors had full access to
+the data and the final responsibility to submit their results for
+publication.
+Declaration of Competing Interest
+None.
+Acknowledgements
+We are thankful to (a) funding by the Ministry of AYUSH, Govt.
+of India, routed through Central Council for Research in Yoga
+and Naturopathy (b) the executive committee of Indian yoga
+Association for conducting NMB (c) Art of Living Institute,
+Vethathiri Maharishi College of Yoga, Patanjali Yogpeeth, PGI
+Chandigarh, and SVYASA for providing more than 1200 vol-
+unteers and (d) the members of the research advisory board
+of NMB for their inputs at all stages of the study.
+R E F E R E N C E S
+[1] https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-
+figures.html. Date accessed: Dec 19, 2019.
+[2] Ahirwar R, Mondal PR. Prevalence of obesity in India: a
+systematic review. Diabetes Matab Syndr 2019;13(1):318–21.
+Available from: https://doi.org/10.1016/j.dsx.2018.08.032.
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+doi.org/10.1002/oby.21609.
+[18] Hartwig S, Kluttig A, Tiller D, et al. Anthropometric markers
+and their association with incident type 2 diabetes mellitus:
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+German population-based cohort studies and comparison
+with a nationwide cohort study. BMJ Open 2016;6(1). https://
+doi.org/10.1136/bmjopen-2015-009266 e009266.
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+[20] Wannamethee SG, Papacosta O, Whincup PH, et al. Assessing
+prediction of diabetes in older adults using different
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+men and women. Diabetologia 2010;53(5):890–8. https://doi.
+org/10.1007/s00125-010-1670-7.
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+9

yogatexts/A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain.txt

@@ -0,0 +1,6318 @@
+Complementary
+ Therapies
+ in
+ Medicine
+ (2012)
+ 20,  107—118
+Available
+ online
+ at
+ www.sciencedirect.com
+jou
+ rnal
+ h
+ om
+ epa
+ ge:
+ www.elsevierhealth.com/journals/ctim
+A
+ comprehensive
+ yoga
+ programs
+ improves
+ pain,
+anxiety
+ and
+ depression
+ in
+ chronic
+ low
+ back
+ pain
+patients
+ more
+ than
+ exercise:
+ An
+ RCT
+P.
+ Tekur a,∗,  R.
+ Nagarathna a,  S.
+ Chametcha a,  Alex
+ Hankey a,
+ H.R.
+ Nagendra b
+a Division
+ of
+ Yoga
+ &
+ Life
+ Sciences,
+ Swami
+ Vivekananda
+ Yoga
+ Research
+ Foundation
+ (SVYASA),
+ Bengaluru,
+ India
+b SVYASA,
+ Bengaluru,
+ India
+Available
+ online
+ 28
+ January
+ 2012
+KEYWORDS
+Yoga;
+Chronic
+ low
+ back
+pain;
+Anxiety;
+Depression;
+Mobility
+Summary
+Introduction:
+ Previously,
+ outpatient
+ Yoga
+ programs
+ for
+ patients
+ with
+ chronic
+ low
+ back
+ pain
+(CLBP)
+ lasting
+ several
+ months
+ have
+ been
+ found
+ to
+ reduce
+ pain,
+ analgesic
+ requirement
+ and
+disability,
+ and
+ improve
+ spinal
+ mobility.
+ This
+ study
+ evaluated
+ changes
+ in
+ pain,
+ anxiety,
+ depression
+and
+ spinal
+ mobility
+ for
+ CLBP
+ patients
+ on
+ short-term,
+ residential
+ Yoga
+ and
+ physical
+ exercise
+programs,
+ including
+ comprehensive
+ yoga
+ lifestyle
+ modifications.
+Methods:
+ A
+ seven
+ day
+ randomized
+ control
+ single
+ blind
+ active
+ study
+ in
+ an
+ residential
+ Holistic
+Health
+ Centre
+ in
+ Bangalore,
+ India,
+ assigned
+ 80
+ patients
+ (37
+ female,
+ 43
+ male)
+ with
+ CLBP
+ to
+ yoga
+and
+ physical
+ exercise
+ groups.
+ The
+ Yoga
+ program
+ consisted
+ of
+ specific
+ asanas
+ and
+ pranayamas
+for
+ back
+ pain,
+ meditation,
+ yogic
+ counselling,
+ and
+ lectures
+ on
+ yoga
+ philosophy.
+ The
+ control
+group
+ program
+ included
+ physical
+ therapy
+ exercises
+ for
+ back
+ pain,
+ and
+ matching
+ counselling
+ and
+education
+ sessions.
+Results:
+ Group
+ ×
+ time
+ interactions
+ (p
+ <
+ 0.05)
+ and
+ between
+ group
+ differences
+ (p
+ <
+ 0.05)
+ were
+significant
+ in
+ all
+ variables.
+ Both
+ groups’
+ scores
+ on
+ the
+ numerical
+ rating
+ scale
+ for
+ pain
+ reduced
+significantly,
+ 49%
+ in
+ Yoga
+ (p
+ <
+ 0.001,
+ ES
+ =  1.62),
+ 17.5%
+ in
+ controls
+ (p
+ =
+ 0.005,
+ ES
+ =  0.67).
+ State
+anxiety
+ (STAI)
+ reduced
+ 20.4%
+ (p
+ <  0.001,
+ ES
+ =
+ 0.72)
+ and
+ trait
+ anxiety
+ 16%
+ (p
+ <  0.001,
+ ES
+ =
+ 1.09)
+ in
+the
+ yoga
+ group.
+ Depression
+ (BDI)
+ decreased
+ in
+ both
+ groups,
+ 47%
+ in
+ yoga
+ (p
+ <
+ 0.001,
+ ES
+ =  0.96,)
+ and
+19.9%
+ in
+ controls
+ (p
+ <
+ 0.001,
+ ES
+ =  0.59).
+ Spinal
+ mobility
+ (‘Sit
+ and
+ Reach’
+ instrument)
+ improved
+in
+ both
+ groups,
+ 50%,
+ in
+ yoga
+ (p
+ <  0.001,
+ ES
+ =
+ 2.99)
+ and
+ 34.6%
+ in
+ controls
+ (p
+ <
+ 0.001,
+ ES
+ =  0.81).
+Conclusion:
+ Seven
+ days
+ intensive
+ residential
+ Yoga
+ program
+ reduces
+ pain,
+ anxiety,
+ and
+ depres-
+sion,
+ and
+ improves
+ spinal
+ mobility
+ in
+ patients
+ with
+ CLBP
+ more
+ effectively
+ than
+ physiotherapy
+exercises.
+©
+ 2012
+ Elsevier
+ Ltd.
+ All
+ rights
+ reserved.
+∗Corresponding
+ author
+ at:
+ Division
+ of
+ Yoga
+ and
+ Life
+ Sciences,
+ Swami
+ Vivekananda
+ Yoga
+ Research
+ Foundation
+ (a
+ Yoga
+ University),
+#
+ 19,
+ Eknath
+ Bhavan,
+ Gavipuram
+ Circle,
+ K.G.
+ Nagar,
+ Bengaluru.
+ 560019.
+ Tel.:
+ +91
+ 80
+ 22639963.
+E-mail
+ addresses:
+ [email protected],  p
+ [email protected]
+ (P
+.
+ Tekur),
+ [email protected]
+ (R.
+ Nagarathna).
+0965-2299/$
+ —
+ see
+ front
+ matter
+ ©
+ 2012
+ Elsevier
+ Ltd.
+ All
+ rights
+ reserved.
+doi:10.1016/j.ctim.2011.12.009
+108
+ 
+P
+.
+ Tekur
+ et
+ al.
+Introduction
+Back
+ pain
+ is
+ a  common
+ problem
+ affecting
+ around
+ 1  in
+ 5  adults
+during
+ their
+ lifetime
+ with
+ it’s
+ prevalence
+ rising
+ to
+ 40%
+ when
+asked
+ if  they
+ have
+ experienced
+ symptoms
+ during
+ the
+ previ-
+ous
+ month.1 Its
+ prevalence
+ is
+ well
+ studied:
+ worldwide,
+ 37%
+of
+ CLBP
+ is
+ attributable
+ to
+ occupational
+ ergonomic
+ stressors,
+both
+ physical
+ and
+ psychosocial.
+ In
+ South
+ East
+ Asia,
+ including
+India
+ and
+ China,
+ the
+ figure
+ is
+ 39%.2
+A
+ comparative
+ study3 surveyed
+ back
+ pain
+ in
+ 3  groups
+ of
+manual
+ workers
+ (MW)
+ and
+ 3  groups
+ of
+ office
+ workers
+ (OW)
+in
+ India
+ and
+ the
+ UK
+ totalling
+ 814
+ subjects.
+ They
+ found
+ MWs
+in
+ India
+ to
+ have
+ least
+ prevalence
+ at
+ 15%.
+ In
+ the
+ UK,
+ they
+found
+ 33%
+ for
+ MWs
+ of
+ Indian
+ origin,
+ and
+ 37%
+ for
+ white
+ MWs.
+Similarly,
+ in
+ three
+ groups
+ of
+ OWs,
+ the
+ figures
+ were
+ 25%
+ in
+India,
+ and
+ in
+ the
+ UK,
+ 24%
+ for
+ NRI’s,
+ and
+ 28%
+ for
+ whites.
+ In
+India
+ itself,
+ Sharma
+ et
+ al.4 reported
+ a  23%
+ prevalence
+ of
+CLBP
+ in
+ a  north
+ India
+ outpatient
+ orthopaedic
+ unit.
+Psychological
+ disturbances
+ may
+ cause
+ CLBP
+,
+ or
+ result
+from
+ it:
+ they
+ have
+ predictive
+ value5—7 and
+ greater
+ impact
+than
+ biomechanical
+ factors
+ 8.
+ Most
+ frequently
+ reported
+disturbances
+ are
+ depression,9 anxiety,8 fear10 and
+ anger.11
+Functional
+ disability
+ of
+ any
+ kind
+ has
+ a  high
+ psychological
+impact.
+ CLBP
+ is
+ strongly
+ correlated
+ with
+ state
+ anxiety.12
+In
+ patients
+ with
+ lumbar
+ disc
+ herniation,
+ pain
+ and
+ func-
+tional
+ disability
+ correlate
+ with
+ scores
+ on
+ both
+ anxiety
+ and
+depression.13
+Non
+ pharmacological
+ CAM
+ studies
+ are
+ being
+ tried
+ of
+which
+ yoga
+ with
+ its
+ holistic
+ approach
+ has
+ emerged
+ as
+ an
+important
+ modality
+ in
+ the
+ management
+ of
+ chronic
+ medi-
+cal
+ conditions
+ recently.
+ Many
+ studies
+ of  various
+ kinds
+ of
+Yoga
+ therapy
+ have
+ shown
+ significant
+ benefits
+ to
+ CLBP
+ and
+related
+ chronic
+ conditions
+ like
+ osteoarthritis,14 rheumatoid
+arthritis,15 hypertension16 and
+ asthma.17 Also,
+ mindfulness
+based
+ stress
+ reduction
+ (MBSR)
+ has
+ produced
+ increased
+ well-
+being,
+ and
+ decreased
+ stress
+ and
+ pain-related
+ symptoms
+ in
+patients
+ with
+ both
+ anxiety
+ and
+ chronic
+ pain.18
+There
+ are
+ several
+ schools
+ of
+ yoga
+ that
+ use
+ different
+ com-
+ponents
+ of
+ the
+ 8  limbs
+ of
+ yoga
+ as  propounded
+ by
+ Sage
+Patanjali.19 Amongst
+ different
+ studies
+ conducted
+ on
+ yoga
+therapy
+ specifically
+ designed
+ for
+ CLBP
+,
+ two
+ RCTs
+ on
+ out-
+patients
+ have
+ demonstrated
+ its
+ efficacy
+ in
+ reducing
+ pain,
+analgesic
+ usage,
+ and
+ functional
+ disability:
+ Sherman
+ et
+ al.20
+applied
+ 3  months
+ Vini
+ yoga,
+ and
+ Williams
+ et
+ al.21 4  months
+Iyengar
+ Yoga.
+ Vini
+ yoga
+ has
+ used
+ asanas,
+ pranayama,
+ med-
+itation,
+ and
+ lectures
+ on
+ yoga
+ philosophy.
+ Iyengar
+ yoga
+ has
+used
+ all
+ the
+ above
+ components
+ with
+ greater
+ emphasis
+ on
+the
+ physical
+ postures.
+ Short
+ term,
+ 9—10
+ day,
+ outpatient
+programs
+ have
+ also
+ been
+ studied:
+ Bijlani
+ et
+ al.22 found
+improvement
+ in
+ health
+ status,
+ while
+ Gupta
+ et
+ al.23 addi-
+tionally
+ found
+ benefits
+ to
+ state/trait
+ anxiety.
+ The
+ fast
+ pace
+of
+ contemporary
+ life
+ means
+ that
+ such
+ intensive,
+ short-term
+programs
+ are
+ preferred:
+ patients
+ need
+ to
+ return
+ to
+ normalcy
+quickly.
+In
+ response,
+ SVYASA
+ used
+ its
+ 25
+ years
+ experience
+ of
+ ‘Inte-
+grated
+ Approach
+ of
+ Yoga
+ Therapy’
+ (IAYT)
+ treating
+ similar
+chronic
+ conditions
+ to
+ design
+ a  special
+ back
+ pain
+ mod-
+ule
+ for
+ CLBP
+,
+ including:
+ asanas
+ for
+ back
+ pain;
+ pranayama;
+relaxation
+ techniques;
+ meditation;
+ Yogic
+ counselling
+ for
+stress
+ management;
+ chanting;
+ and
+ lectures
+ on
+ yogic
+ lifestyle
+and
+ philosophy,
+ for
+ application
+ in
+ week-long,
+ intensive
+treatments
+ (Table
+ 1).
+ It  was
+ developed
+ from
+ traditional
+Table
+ 1a
+ 
+Back
+ pain
+ special
+ techniques
+ for
+ yoga
+ group.
+I.
+ Supine
+ postures
+1.
+ Pavanamuktasana
+ (Wind
+ releasing
+ pose)
+ series
+•
+ Supta
+ Pawanamuktasana
+ (leg
+ lock
+ pose)
+•
+ Jhulana
+ Lurkhanasana
+ (rocking
+ and
+ rolling)
+2.
+ Ardha
+ Navasana
+ (half
+ boat
+ pose)
+3.
+ Uttanapadasana
+ (straight
+ leg
+ raise
+ pose)
+4.
+ Sethubandhasana
+ breathing
+ (bridge
+ pose
+ lumbar
+stretch)
+5.
+ Supta
+ Udarakarshanasana
+ (folded
+ leg
+ lumbar
+ stretch)
+6.
+ Shavaudarakarshanasana
+ (crossed
+ leg
+ lumbar
+ stretch)
+II.
+ Prone
+ postures
+1.
+ Bhujangasana
+ (serpent
+ pose)
+2.
+ Shalabhasana
+ breathing
+ (locust
+ pose)
+III.
+ Quick
+ relaxation
+ technique
+ in
+ Shavasana
+ (corpse
+ pose)
+IV.
+ Sitting
+ postures
+1.
+ Vyaghra
+ Svasa
+ (tiger
+ breathing)
+2.
+ Shashankasana
+ breathing
+ (moon
+ pose)
+V.
+ Standing
+ postures
+1.
+ Ardha
+ Chakrasana
+ (half
+ wheel
+ pose)
+2.
+ Prasarita
+ Pada
+ Hastasana
+ (forward
+ bend
+ with
+legs
+ apart)
+3.
+ Ardha
+ kati
+ Chakrasana
+ (lateral
+ arc
+ pose)
+VI.
+ Deep
+ relaxation
+ technique,
+ in
+ Shavasana
+ with
+ folded
+legs.
+Table
+ 1b
+ 
+Control
+ group
+ practices.
+(1)
+ Standing
+ hamstring
+ stretch
+(2)
+ Cat
+ and
+ camel
+(3)
+ Pelvic
+ tilt
+(4)
+ Partial
+ curl
+(5)
+ Piriformis
+ stretch
+(6)
+ Extension
+ exercise
+(7)
+ Quadriceps
+ leg
+ raising
+(8)
+ Trunk
+ rotation
+(9)
+ Double
+ knee
+ to
+ chest
+(10)
+ Bridging
+(11)
+ Hook
+ lying
+ march
+(12)
+ Single
+ knee
+ to
+ chest
+ stretch
+(13)
+ Lumbar
+ rotation
+(14)
+ Press
+ up
+(15)
+ Curl
+ ups
+yoga
+ literature
+ (Patanjali
+ Yogasutras,
+ Upanishads,
+ and
+ Yoga
+Vasishtha).
+ The
+ module
+ was
+ evaluated
+ in
+ unpublished
+ pilot
+studies,
+ for
+ severity
+ of
+ pain,
+ functional
+ disability,
+ and
+ spinal
+flexibility.
+ The
+ first
+ full
+ study
+ demonstrated
+ improvements
+on
+ all
+ 3  variables.24 This
+ led
+ to
+ the
+ present
+ study,
+ which
+includes
+ associated
+ changes
+ in
+ anxiety
+ and
+ depression,
+ as
+the
+ most
+ important
+ causative
+ factors.
+ We
+ hypothesized
+ that
+the
+ yoga
+ group
+ would
+ show
+ greater
+ reductions
+ on
+ all
+ mea-
+sures
+ than
+ controls.
+Methods
+Sample
+ size:
+ a  required
+ n  =  35
+ was
+ obtained
+ by
+ applying
+Cohen’s
+ formula
+ for
+ an
+ expected
+ Effect
+ Size
+ (ES)
+ of
+ 0.89
+and
+ an
+ alpha
+ of
+ 0.05,
+ powered
+ at
+ 0.95,
+ using
+ the
+ G*Power
+A  comprehensive
+ yoga
+ programs
+ 
+109
+program.25 The
+ ES
+ was
+ calculated
+ from
+ the
+ mean
+ and
+ SD
+ of
+the
+ pilot
+ study
+ on
+ 120
+ subjects.26 A  study
+ size
+ of
+ 80
+ subjects
+was
+ decided
+ on,
+ considerably
+ more
+ than
+ the
+ 35
+ required.
+Subjects:
+ comprised
+ the
+ first
+ 80
+ of
+ 160
+ CLBP
+ patients
+admitted
+ between
+ April
+ 2005
+ and
+ June
+ 2006,
+ who
+ satisfied
+the
+ selection
+ criteria.
+Inclusion
+ criteria:  History
+ of
+ CLBP
+ of
+ more
+ than
+ 3  months;
+pain
+ in
+ lumbar
+ spine
+ with
+ or
+ without
+ radiation
+ to
+ legs27;  age,
+18—60
+ years.
+Exclusion
+ criteria:  Confirmed
+ organic
+ spinal
+ pathology
+such
+ as
+ malignancy
+ (primary
+ or
+ secondary),
+ or
+ chronic
+ infec-
+tion
+ such
+ as
+ Tuberculosis;
+ severe
+ obesity
+ (BMI
+ >  39.9)
+ and
+critically
+ ill.
+Medical
+ assessment:
+ was
+ conducted
+ by
+ a  rheumatol-
+ogist.
+ Two
+ experts
+ (radiologist
+ and
+ orthopaedic
+ surgeon)
+gave
+ opinions
+ on
+ whether
+ anteroposterior
+ and
+ lateral
+lumbar
+ spine
+ X-rays
+ satisfied
+ the
+ selection
+ criteria.
+ A  semi-
+structured
+ interview
+ was
+ used
+ to
+ obtain
+ demographic
+ and
+vital
+ clinical
+ data,
+ including
+ personal,
+ family
+ and
+ stress
+ his-
+tory.
+Study
+ approval:
+ was
+ obtained
+ from
+ SVYASA’s
+ review
+ board
+and
+ ethical
+ committee.
+Signed
+ informed
+ consent:
+ It  was
+ obtained
+ from
+ all
+ sub-
+jects.
+ The
+ consent
+ form
+ clearly
+ stated
+ that
+ subjects
+ would
+be
+ randomly
+ allocated
+ to
+ one
+ of
+ two
+ active
+ intervention
+groups.
+Study
+ design: was
+ a  seven
+ day
+ randomized
+ single
+ blind
+active
+ control
+ trial
+ comparing
+ two
+ interventions,
+ yoga
+ ther-
+apy
+ and
+ physical
+ therapy,
+ both
+ designed
+ for
+ lower
+ back
+ pain.
+Randomization:
+ used
+ two
+ sets
+ of
+ 40
+ numbers
+ spanning
+integers
+ 1—80
+ created
+ by
+ a  random
+ number
+ table
+ from
+www.randomizer.org.  CLBP
+ patients
+ admitted
+ week
+ by
+ week
+were
+ sequentially
+ assigned
+ to
+ each
+ group.
+ Numbered
+ con-
+tainers
+ were
+ used
+ to
+ conceal
+ the
+ random
+ allocation
+ before
+implementation.
+Blinding
+ and
+ masking:  the
+ statistician
+ who
+ generated
+the
+ randomization
+ sequence,
+ and
+ subsequently
+ analysed
+ the
+data,
+ the
+ clinical
+ psychologist
+ who
+ administered
+ and
+ scored
+psychological
+ questionnaires,
+ and
+ the
+ researcher
+ who
+ car-
+ried
+ out
+ allocation
+ and
+ assessments,
+ were
+ blind
+ to
+ subjects’
+intervention
+ groups.
+ Coded
+ answer
+ sheets
+ were
+ analysed
+only
+ after
+ the
+ study’s
+ completion.
+ In
+ intervention
+ studies
+of
+ this
+ kind,
+ subjects
+ clearly
+ identify
+ their
+ own
+ treatment:
+double
+ blinding
+ is
+ not
+ possible.
+Setting:
+ SVYASA’s
+ Holistic
+ Health
+ Centre
+ (Arogyadhama)
+is
+ situated
+ at
+ Prashanti
+ Kutiram
+ in
+ quiet
+ countryside,
+ 35
+ km
+south
+ of
+ Bangalore,
+ India.
+Yoga
+ intervention
+ (Table
+ 1a)
+The
+ IAYT
+ back
+ pain
+ module
+ described
+ above
+ is
+ holistic
+ at
+physical,
+ mental,
+ emotional
+ and
+ intellectual
+ levels.28 Spe-
+cial
+ asana
+ techniques
+ for
+ back
+ pain
+ progress
+ slowly
+ over
+ the
+intervention’s
+ first
+ three
+ days
+ from
+ initial
+ safe
+ movements
+to
+ full
+ asanas
+ aiming
+ to:
+(a)
+ relax
+ 
+the
+ 
+spinal
+ 
+muscles,
+ 
+achieved
+ 
+through
+ 
+safe
+stretches
+ of
+ para
+ spinal
+ muscles
+ during
+ folded
+ leg
+ and
+crossed
+ leg
+ lumbar
+ stretch
+ practices,
+ followed
+ by
+ guided
+deep
+ relaxation
+ in
+ supine
+ position29;
+(b)
+ provide
+ a  traction
+ effect
+ (pavanamuktasana);
+ and
+(c)
+ strengthen
+ lumbar
+ (sethubandhasana)
+ and
+ abdominal
+(ekapadasana)
+ muscles.
+Subjects
+ avoid
+ acute
+ forward
+ or
+ backward
+ bends
+ and
+jerky
+ spinal
+ movements.30
+IAYT’s
+ CLBP
+ Pranayama
+ practices
+ reduce
+ breath
+ fre-
+quency
+ to
+ master
+ emotional
+ surges,31 and
+ increase
+ deep
+internal
+ awareness
+ in
+ preparation
+ for
+ meditation,
+ antaranga
+yoga,  its
+ method
+ of
+ stress
+ management.
+ Lectures
+ help
+ sub-
+jects
+ understand
+ corrective
+ yoga
+ healing
+ techniques.
+Physical
+ exercise
+ therapy
+ intervention
+ (Table
+ 1b)
+An
+ independent
+ consultant
+ physiatrist
+ specializing
+ in
+back
+ 
+pain
+ 
+developed
+ 
+the
+ 
+module’s
+ 
+physical
+ 
+therapy
+movements,
+ non-yogic
+ breathing
+ exercises,
+ and
+ scientific
+lectures.
+ The
+ latter
+ included:
+ (a)
+ causes
+ of
+ back
+ pain,
+ (b)
+stress
+ and
+ CLBP
+ and
+ (c)
+ the
+ benefits
+ of
+ physical
+ exercises.
+Nature
+ video
+ programs
+ to
+ relax
+ and
+ engage
+ subjects
+ corre-
+sponded
+ to
+ yoga
+ group
+ chanting.
+Daily
+ routines:
+ were
+ matched
+ hour
+ by
+ hour
+ (Table
+ 2).
+ The
+two
+ groups
+ received
+ identical
+ diets.
+Final
+ interview:
+ included
+ qualitative
+ impressions
+ on
+global
+ improvement,
+ treatment
+ satisfaction,
+ and
+ adverse
+events.
+Outcome
+ variables:
+ were
+ recorded
+ for
+ each
+ subject
+ on
+the
+ first
+ and
+ final
+ days,
+ at
+ the
+ same
+ times.
+State
+ — trait
+ anxiety
+ inventory
+ (STAI) 32:  has
+ 2  forms,
+Y1/Y2,
+ evaluating
+ state
+ anxiety,
+ how
+ subjects
+ feel
+ ‘at
+ this
+moment’;
+ and
+ trait
+ anxiety,
+ how
+ they
+ feel
+ ‘most
+ of
+ the
+ time’
+respective.
+ It
+ has
+ been
+ extensively
+ used
+ in
+ India.
+Beck’s
+ depression
+ inventory
+ (BDI) 33:  measures
+ cognitive,
+affective
+ and
+ vegetative
+ depression
+ symptoms.
+ Scores
+ for
+each
+ items
+ are
+ 0—3,
+ total
+ 0—63.
+ Total
+ scores
+ signify:
+ 0—9,
+ no
+depression;
+ 10—19,
+ mild
+ depression
+ (21
+ in
+ CLBP
+ patients33;
+20—25,
+ moderate
+ depression;
+ 26+,
+ severe
+ depression.
+Numerical
+ rating
+ scale
+ (NRS)
+ for
+ pain:
+ a  horizontal
+ 10
+ cm
+straight
+ line
+ on
+ a
+ white
+ sheet
+ from
+ ‘0’
+ (No
+ pain)
+ by
+ cm
+ up
+to
+ ‘10’
+ (Worst
+ possible
+ pain).
+ Subjects
+ indicate
+ day’s
+ pain
+intensity
+ by
+ a  dot
+ on
+ the
+ line.
+Sit
+ and
+ reach
+ (SAR)34:  measures
+ hamstring
+ and
+ lower
+ back
+flexibility.
+ Subjects
+ sit
+ on
+ floor
+ with
+ legs
+ extended,
+ feet
+resting
+ against
+ apparatus,
+ bend
+ maximum
+ forward,
+ fingers
+pushing
+ the
+ indicator
+ without
+ bending
+ their
+ elbows;
+ distance
+measured
+ in
+ centimetres;
+ correlation
+ with
+ hamstring
+ flexi-
+bility
+ r  =  0.64.
+Statistical
+ analysis:
+ used
+ SPSS
+ 10.0:
+ normal
+ distribution
+of
+ pre
+ values
+ checked
+ using
+ Shapiro—Wilk
+ test.
+ All
+ between
+groups
+ comparisons
+ used
+ post
+ hoc
+ analysis
+ with
+ Bon
+ Ferroni
+correction.
+Results
+Fig.
+ 1  shows
+ the
+ study
+ profile.
+ There
+ were
+ no
+ drop
+ outs.
+ The
+two
+ groups
+ were
+ similar
+ with
+ respect
+ to
+ socio-demographic
+and
+ medical
+ characteristics
+ (Table
+ 3).
+ Baseline
+ data
+ for
+ all
+variables
+ matched
+ between
+ groups
+ (p
+ >
+ 0.05).
+ Baseline
+ val-
+ues
+ of
+ SAR,
+ BDI
+ and
+ NRS
+ only
+ had
+ minor
+ deviations
+ from
+normality.
+ Because
+ the
+ two
+ groups
+ had
+ equal
+ sample
+ sizes35
+and
+ the
+ repeated
+ measures
+ ANOVA
+ test
+ is
+ robust
+ for
+ small
+deviations
+ from
+ normality,
+ it
+ was
+ used
+ to
+ analyse
+ results
+on
+ all
+ variables:
+ group
+ ×  time
+ interaction,
+ within
+ group
+ pre-
+post
+ comparisons,
+ and
+ between
+ groups
+ comparisons.
+ Table
+ 4
+shows
+ results
+ after
+ the
+ intervention.
+ All
+ patients
+ reported
+improvements
+ in
+ sleep,
+ sense
+ of
+ well
+ being,
+ and
+ confidence
+110
+ 
+P
+.
+ Tekur
+ et
+ al.
+Table
+ 2
+ 
+Time
+ table
+ for
+ the
+ two
+ groups
+ for
+ the
+ week
+ long
+ residential
+ program.
+ Daily
+ schedule
+ of
+ practices
+ for
+ yoga
+ and
+ control
+group.
+S.
+ no.
+ 
+Time
+ 
+Yoga
+ group
+ 
+Control
+ Group
+1
+ 
+05.00—05.30
+ am
+ 
+OM
+ meditation
+ —
+ 30
+ min
+ 
+Walking
+ —
+ 30
+ min
+2
+ 
+05.30—06.30
+ am
+ 
+Yoga
+ based
+ special
+ technique
+ —
+ 60
+ min
+ 
+Exercise
+ based
+ special
+ technique
+ —
+ 60
+ min
+3
+ 
+06.30—07.30
+ am
+ 
+Bath
+ &
+ wash
+ 
+Bath
+ &
+ wash
+4
+ 
+07.30—08.15
+ am
+ 
+Chanting
+ of
+ yogic
+ hymns
+ —
+ 45
+ min
+ 
+Video
+ show
+ (on
+ nature)
+ —
+ 45
+ min
+5
+08.15—08.45
+ am
+ 
+Breakfast
+ 
+Breakfast
+6
+08.45—10.00
+ am
+ 
+Rest
+ 
+Rest
+7
+10.00—11.00
+ am
+Lecture
+ (on
+ yogic
+ lifestyle)
+ — 60
+ min
+ 
+Lecture
+ (on
+ healthy
+ lifestyle)
+ —
+ 60
+ min
+8
+11.00—12.00
+ noon
+Pranayama
+ (yogic
+ breathing)
+ — 60
+ min
+ 
+Non
+ yogic
+ breathing
+ practice
+ — 60
+ min
+9
+12.00—01.00
+ pm
+Yoga
+ based
+ special
+ technique
+ — 60
+ min
+ 
+Exercise
+ based
+ special
+ technique
+ — 60
+ min
+10
+ 
+01.00—02.00
+ pm
+ 
+Lunch(vegetarian
+ diet)
+ 
+Lunch
+ (vegetarian
+ diet)
+11
+ 
+02.00—02.30
+ pm
+ 
+Deep
+ relaxation
+ technique
+ —
+ 30
+ min
+ 
+Rest
+ at
+ room
+ —
+ 30
+ min
+12
+ 
+02.30—04.00
+ pm
+ 
+Assessments
+ and
+ counselling
+ 
+Assessments
+ and
+ counselling
+13
+ 
+04.00—05.00
+ pm
+ 
+Cyclic
+ meditation
+ —
+ 60
+ min
+ 
+Listening
+ to
+ music
+14
+ 
+06.15—06.45
+ pm
+ 
+Divine
+ hymns
+ session
+ (Bhajan)
+ —
+ 30
+ min
+ 
+Video
+ show
+ (on
+ nature)
+ —
+ 30
+ min
+15
+ 
+06.45—07.45
+ pm
+ 
+Meditation
+ with
+ yogic
+ chants
+ (mind
+sound
+ resonance
+ technique)
+ —
+ 45
+ min
+Walking
+ —
+ 45
+ min
+16
+ 
+07.45—08.30
+ pm
+ 
+Dinner
+ (vegetarian
+ diet)
+ 
+Dinner
+ (vegetarian
+ diet)
+17
+ 
+08.30—10.00
+ pm
+ 
+Self
+ study
+ 
+Self
+ study
+Hour
+ to
+ hour
+ matching
+ for
+ the
+ type
+ of
+ practices
+ for
+ the
+ two
+ groups
+ was
+ ensured.
+Figure
+ 1
+ 
+Trial
+ Profile.
+A  comprehensive
+ yoga
+ programs
+ 
+111
+Table
+ 3
+ 
+Demographic
+ data.
+Variables
+ 
+YOGA
+ 
+CONTROL
+Number
+ of
+ participants
+ 
+40
+ 
+40
+Males
+ (M)
+ 
+19
+ 
+25
+Females
+ (F)
+ 
+21
+ 
+15
+Age
+ (mean
+ ±
+ SD)
+ 
+49
+ ±
+ 3.6
+ 
+48
+ ±
+ 4
+Education:
+ 
+(a)
+ High
+ school
+ 
+M-3,
+ F-11
+ 
+M-5,
+ F-3.
+(b)
+ College
+M-10,
+ F-8
+ 
+M-13,
+ F-10
+(c)
+ Post
+ graduate
+M-6,
+ F-2
+M-7,
+ F-2
+Males
+Working-sedentary
+14
+16
+Working-non
+ sedentary
+5
+8
+Females
+Working
+6
+7
+Housewives
+ 
+15
+ 
+8
+CLBP
+ 
+<1
+ year
+ 
+10
+ 
+11
+1—5
+ years
+ 
+9
+ 
+11
+5—10
+ years
+ 
+11
+ 
+10
+>10
+ years
+ 
+10
+ 
+8
+Cause
+ 
+Lumbar
+ spondylosis(LS)
+ 
+6
+ 
+5
+Prolapsed
+ intervertebral
+ Disc(PID)
+ 
+6
+ 
+7
+LS
+ with
+ PID
+ 
+19
+ 
+15
+Muscle
+ spasm
+ 
+9
+ 
+13
+after
+ the
+ program.
+ Neither
+ group
+ reported
+ adverse
+ side
+effects.
+STAI:
+ State
+ anxiety
+ scores:
+ Group
+ ×
+ time
+ interactions
+were
+ significant
+ (Table
+ 4)
+ [F(1,78)
+ =  12.96,
+ p  <
+ 0.001],
+ as
+ was
+difference
+ between
+ groups
+ (p
+ <  0.001).
+ Yoga
+ group
+ scores
+decreased
+ 20.4%
+ (p
+ <  0.001,
+ ES
+ =  0.72).
+ The
+ control
+ group
+showed
+ no
+ significant
+ change.
+Trait
+ anxiety
+ scores:
+ Again,
+ group
+ ×  time
+ interactions
+were
+ significant
+ [F(1,78)
+ =  14.90,
+ p  <  0.001]
+ with
+ significant
+difference
+ between
+ groups
+ (p
+ <  0.001).
+ Yoga
+ group
+ scores
+reduced
+ 16%
+ (p
+ =
+ 0.001,
+ ES
+ =
+ 1.09).
+BDI:
+ In
+ both
+ groups,
+ BDI
+ baseline
+ scores
+ were
+ less
+ than
+21
+ (the
+ cut
+ off
+ for
+ moderate
+ depression
+ in
+ CLBP
+ patients.33
+Group
+ × time
+ interaction
+ was
+ significant
+ [F(1,78)
+ =
+ 5.85,
+p
+ =  0.018],
+ 
+with
+ 
+significant
+ 
+difference
+ 
+between
+ 
+groups
+(p
+ <
+ 0.001).
+ Yoga
+ group
+ scores
+ reduced
+ 47%
+ (p
+ =  0.001,
+ES
+ =  0.96).
+ Controls
+ reduced
+ 19.9%
+ (p
+ <  0.001,
+ ES
+ =  0.59).
+NRS:
+ 
+Group
+ × time
+ 
+interaction
+ 
+was
+ 
+significant
+[F(1,78)
+ =
+ 20.52,
+ 
+p  =  0.001].
+ 
+Between
+ 
+groups
+ 
+difference
+was
+ significant
+ (p
+ <  0.001).
+ Yoga
+ group
+ NRS
+ score
+ decreased
+49%
+ 
+(p
+ <  0.001,
+ 
+ES
+ =
+ 1.62).
+ 
+Controls
+ 
+decreased
+ 
+17.5%
+(p
+ =
+ 0.005,
+ ES
+ =
+ 0.67).
+SAR:
+ 
+Group
+ ×
+ time
+ 
+interaction
+ 
+was
+ 
+significant
+[F(1,78)
+ =
+ 4.16,
+ p  =
+ 0.045].
+ Yoga
+ group
+ SAR
+ scores
+ increased
+49.5%
+ (p
+ <
+ 0.001,
+ ES
+ 2.99),
+ controls
+ 34.6%
+ (p
+ <  0.001,
+ ES
+0.81),
+ difference
+ between
+ groups
+ not
+ significant.
+Discussion
+This
+ study
+ has
+ shown
+ better
+ improvement
+ in  STAI,
+ BDI,
+ NRS
+and
+ SAR
+ with
+ significant
+ group
+ ×  time
+ interactions
+ in
+ the
+Yoga
+ group
+ than
+ the
+ control
+ group.
+ Within
+ groups
+ improve-
+ments
+ were
+ significant
+ on
+ all
+ variables
+ in
+ both
+ groups,
+ except
+STAI
+ in
+ controls.
+Strengths
+ of  the
+ study
+(i)
+ Its
+ crossover
+ RCT
+ design
+ in
+ an
+ residential
+ setting
+with
+ active
+ control
+ intervention,
+ consisting
+ of
+ standard
+physical
+ therapy
+ and
+ other
+ practices
+ matched
+ hour
+ by
+hour
+ with
+ the
+ yoga
+ intervention,
+(ii)
+ Acceptability
+ of
+ short-term,
+ intensive
+ residential
+ pro-
+grams
+ in
+ today’s
+ fast
+ pace
+ of
+ life.
+(iii)
+ The
+ number
+ of
+ subjects
+ (80)
+ yielded
+ good
+ p  values
+ and
+statistical
+ power.
+Its
+ weakness
+ is
+ that,
+ despite
+ special
+ care
+ being
+ taken
+ to
+keep
+ the
+ two
+ groups
+ engaged
+ independently,
+ the
+ possibility
+of
+ interactions
+ between
+ them
+ cannot
+ be
+ discounted.
+Strength
+ and
+ weaknesses
+ in
+ relation
+ to
+ other
+ studies
+Two
+ earlier
+ RCTs
+ of
+ yoga
+ for
+ back
+ pain,20,21 also
+ found
+both
+ pain
+ reduction
+ and
+ increased
+ spinal
+ mobility.
+ No
+ pre-
+vious
+ yoga
+ study
+ has
+ observed
+ significant
+ improvements
+ on
+CLBP’s
+ psychological
+ components,36 A
+ review
+ by
+ Chou37 of
+17
+ nonpharmacologic
+ therapies
+ for
+ low
+ back
+ pain
+ found
+that
+ psychological
+ interventions
+ (cognitive-behavioral
+ ther-
+apy
+ and
+ progressive
+ relax
+ ation),
+ exercise,
+ interdisciplinary
+rehabilitation,
+ functional
+ restoration,
+ and
+ spinal
+ manip-
+ulation
+ were
+ effective
+ for
+ CLBP
+.
+ The
+ exercise
+ therapy,
+was
+ associated
+ with
+ small
+ to
+ moderate
+ effects
+ on
+ pain;
+acupuncture
+ was
+ more
+ effective
+ than
+ sham
+ acupuncture;
+massage
+ was
+ similar
+ to
+ other
+ noninvasive
+ interventions
+ and
+Viniyoga
+ was
+ slightly
+ superior
+ to
+ traditional
+ exercises.
+ Seri-
+ous
+ adverse
+ events
+ for
+ all
+ of
+ the
+ noninvasive
+ therapies
+ were
+rare.
+ Some
+ studies
+ of
+ non-yoga
+ interventions
+ (CBT
+,
+ phar-
+macotherapy,
+ aerobics,
+ physical
+ therapies)
+ have
+ observed
+improvements
+ in
+ CLBP
+ pain
+ and
+ disability
+ accompanied
+ by
+reduction
+ in
+ anxiety
+ and
+ depression.38 Reductions
+ in
+ both
+STAI
+ and
+ depression
+ scores
+ after
+ short
+ intensive
+ residential
+112
+ 
+P
+.
+ Tekur
+ et
+ al.
+Table
+ 4
+ 
+Results
+ of
+ all
+ variables
+ post
+ intervention
+ (RMANOVA)
+ 1st
+ day
+ to
+ 7th
+ day.
+Within
+ groups
+ 
+Between
+ groups
+Variable
+ 
+Yoga
+ 
+Control
+ 
+ES
+ 
+p
+ Value
+Mean
+ ±
+ SD
+ 
+95%
+ CI
+ LB
+ UB
+ 
+ES
+ 
+%
+ 
+p
+ Values
+ 
+Mean
+ ±
+ SD
+ 
+95%
+ CI
+ LB
+ UB
+ 
+ES
+ 
+%
+ 
+p
+ Values
+State
+anxiety
+Pre
+42.02
+ ±
+ 9.80
+ 
+38.89
+0.72
+ 
+20.44
+ 
+<0.001
+44.20
+ ±
+ 8.83
+ 
+41.38
+0.07
+1.17
+NS
+1.14
+<0.001
+45.16
+ 
+47.02
+Post 33.43
+ ±
+ 8.08
+ 
+30.84
+ 
+43.68
+ ±
+ 9.89
+ 
+40.51
+36.01
+ 
+46.84
+Trait
+anxiety
+Pre
+43.18
+ ±
+ 8.48
+ 
+40.46
+1.09
+15.88
+ 
+<0.001
+44.25
+ ±
+ 8.25
+ 
+41.61
+0.15
+ 
+2.25
+NS
+ 
+0.94
+<0.001
+45.89
+ 
+46.89
+Post 36.32
+ ±
+ 7.15
+ 
+34.05
+ 
+43.25
+ ±
+ 7.57
+ 
+40.83
+38.60
+ 
+45.67
+BDI
+ 
+Pre
+12.13
+ ±
+ 8.82
+ 
+9.30
+0.96
+ 
+46.99
+<0.001
+13.05
+ ±
+ 6.53
+ 
+10.96
+0.48
+19.92 <0.001
+0.59
+0.001
+14.95
+ 
+15.14
+Post
+6.43
+ ±
+ 7.73
+ 
+3.95
+ 
+10.45
+ ±
+ 5.55
+ 
+8.68
+8.90
+ 
+12.22
+VAS
+ 
+Pre
+6.68
+ ±
+ 1.82
+ 
+6.09
+1.62
+ 
+49.10
+<0.001
+5.88
+ ±
+ 2.15
+ 
+5.19
+0.67
+17.51 0.005
+0.76
+<0.001
+7.26
+ 
+6.56
+Post
+3.40
+ ±
+ 1.88
+ 
+2.79
+ 
+4.85
+ ±
+ 1.96
+ 
+4.22
+4.01
+ 
+5.48
+SAR
+ 
+Pre
+11.62
+ ±
+ 10.11
+ 
+8.39
+1.189
+ 
+49.48
+<0.001
+10.45
+ ±
+ 8.03
+ 
+7.88
+13.02
+11.25
+16.9
+0.81
+34.69 <0.001
+ 
+0.34
+NS
+14.86
+Post 17.37
+ ±
+ 10.77
+ 
+13.93
+ 
+10.07
+ ±
+ 8.84
+20.82
+BDI
+ —
+ beck
+ depression
+ inventory,
+ VAS
+ —
+ visual
+ analogue
+ scale
+ for
+ pain,
+ SAR
+ —
+ sit
+ and
+ reach,
+ CI
+ —
+ confidence
+ interval,
+ LB
+ —
+ lower
+ bound,
+ UB
+ —
+ upper
+ bound,
+ ES
+ —
+ effect
+ size,
+ %
+ —
+ percentage.
+Change,
+ NS
+ —
+ non
+ significant.
+A  comprehensive
+ yoga
+ programs
+ 
+113
+yoga
+ programs
+ are
+ unique
+ to
+ this
+ study,
+ probably
+ a  result
+of
+ the
+ IAYT
+ module’s
+ stress-management
+ components.
+ In
+ 2
+of
+ our
+ earlier
+ publications
+ we
+ have
+ shown
+ significantly
+ bet-
+ter
+ improvement
+ in
+ spinal
+ flexibility
+ — functional
+ disability
+(Oswestry
+ disability
+ index)
+ scores
+ and
+ quality
+ of
+ life
+ (WHO
+QOL)
+ in
+ the
+ yoga
+ group
+ compared
+ to
+ exercise
+ group.39,40 A
+study
+ compared
+ graded
+ exercise
+ therapy
+ with
+ graded
+ behav-
+ioral
+ exposure
+ program
+ for
+ CLBP
+ (a
+ 7
+ h  day
+ rehabilitation-9
+am—4
+ pm,
+ 5
+ days
+ a  week
+ for
+ 3—5
+ weeks)
+ comparable
+ to
+ our
+study
+ (8
+ h  per
+ day
+ for
+ 1  week).
+ They
+ observed
+ 33.3%
+ and
+43.5%
+ reduction
+ in
+ pain
+ intensity
+ in
+ exercise
+ and
+ behavioral
+therapy
+ groups
+ where
+ as
+ the
+ changes
+ were
+ 17.5%
+ and
+ 49%
+in
+ the
+ exercise
+ and
+ IAYT
+ intervention
+ groups
+ respectively
+ in
+our
+ study.
+ Similarly
+ the
+ depression
+ scores
+ reduced
+ by
+ 72%
+(exercise)
+ and
+ 57.6%
+ (behavioral
+ therapy)41 as
+ compared
+ to
+20%
+ (exercise)
+ and
+ 47%
+ (IAYT).
+A study
+ of
+ BDI42 observed
+ correlations
+ between
+ somatic
+and
+ physical
+ function
+ subscales
+ with
+ dysfunctional
+ cogni-
+tions
+ related
+ to  their
+ CLBP
+,
+ reflecting
+ how
+ it
+ was
+ interfering
+with
+ their
+ daily
+ life.
+Meaning
+ of
+ the
+ study
+The
+ detailed
+ design
+ of
+ the
+ Yoga
+ module
+ and
+ its
+ specific
+ new
+features
+ therefore
+ merit
+ consideration.
+ There
+ are
+ different
+yoga
+ therapy
+ schools
+ which
+ incorporate
+ various
+ limbs
+ of
+ yoga
+like
+ asanas,
+ pranayama,
+ meditation,
+ lectures
+ on
+ yoga
+ philos-
+ophy
+ including
+ codes
+ of
+ conduct.
+ For
+ eg,
+ Iyengar
+ yoga
+ uses
+more
+ of
+ the
+ physical
+ practices
+ combined
+ with
+ breathing.
+Vini
+ yoga
+ uses
+ a  smooth
+ flow
+ of
+ postures
+ followed
+ by
+ relax-
+ation
+ and
+ meditation.
+ IAYT
+ incorporates
+ all
+ the
+ components
+to
+ offer
+ a  holistic
+ therapeutic
+ module.
+A
+ first
+ observation
+ is  that
+ simultaneous
+ muscle
+ strength-
+ening
+ and
+ relaxation
+ may
+ be
+ involved.
+ Careful
+ body
+movement
+ together
+ with
+ active
+ mindfulness
+ both
+ strength-
+ens
+ spinal
+ and
+ abdominal
+ muscles,
+ and
+ promotes
+ deeper
+relaxation.
+ This
+ may
+ explain
+ observed
+ improvements
+ in
+ both
+spinal
+ mobility
+ and
+ pain
+ levels,
+ agreeing
+ with
+ findings
+ in
+previous
+ studies
+ of
+ IAYT
+ in
+ healthy
+ volunteers:
+ improved
+stamina
+ and
+ strength,43 and
+ decreased
+ metabolism.44
+Observed
+ stress
+ reduction
+ is
+ consistent
+ with
+ previous
+studies,
+ in
+ which
+ yoga
+ was
+ observed
+ to
+ correct
+ disturbed
+moods
+ in
+ psychiatric
+ patients
+ with
+ anxiety
+ disorders45,46
+and
+ major
+ depressive
+ illness,47 showing
+ that
+ it
+ can
+ bene-
+fit
+ even
+ pathological
+ levels
+ of
+ stress.
+ It
+ suggests
+ that
+ yoga
+has
+ the
+ ability
+ to
+ reverse
+ the
+ interlinked
+ downward
+ spiral,
+whereby
+ CLBP
+ causes
+ depression,
+ which
+ gives
+ rise
+ to
+ fur-
+ther
+ back
+ pain,
+ resulting
+ in  increased
+ depression,
+ and
+ so
+ on.
+This
+ conclusion
+ is
+ corroborated
+ by
+ several
+ studies,
+ in
+ which
+physical
+ well-being,
+ fatigue,
+ stress
+ (PSS)
+ and
+ anxiety
+ (on
+STAI)
+ after
+ yoga
+ practice29,48—50 have
+ been
+ observed.
+ Telles
+et
+ al.51 found
+ reduced
+ physiological
+ arousal
+ and
+ improved
+autonomic
+ stability.
+ Together,
+ these
+ studies
+ provide
+ strong
+evidence
+ for
+ yoga’s
+ stress
+ reducing
+ effects,
+ indicating
+ that
+it
+ can
+ neutralize
+ CLBP’s
+ psychological
+ impact
+ as
+ well
+ as
+ its
+physical
+ symptoms.
+Participants
+ often
+ report
+ that
+ Yoga
+ courses
+ give
+ them
+‘space’
+ to  recognize
+ causes
+ of
+ suppressed
+ negative
+ emo-
+tions.
+ Although,
+ as
+ yet,
+ we
+ have
+ no
+ hard
+ data
+ supporting
+this,
+ medical
+ records
+ indicate
+ that
+ counselling
+ helps
+ IAYT
+residential
+ learn
+ to
+ be
+ more
+ objective
+ about
+ previously
+ dis-
+tressing
+ situations.
+ This
+ seems
+ closely
+ allied
+ to
+ the
+ CBT
+perspective,
+ which
+ sees
+ chronic
+ pain
+ not
+ simply
+ as
+ a
+ neu-
+rophysiologic
+ state,
+ but
+ one
+ including
+ sensory,
+ affective,
+behavioral,
+ and
+ cognitive
+ factors
+ influencing
+ the
+ way
+ the
+patient
+ cognizes
+ the
+ world
+ and
+ assigns
+ meaning
+ to
+ events.52
+Indeed,
+ yoga
+ texts
+ highlight
+ a  major
+ change
+ in  per-
+spective:
+ ‘happiness
+ is
+ an
+ inner
+ state,
+ not
+ depending
+ on
+external
+ situations’.53 Since
+ anxiety
+ and
+ depression
+ are
+significant
+ causes
+ of
+ CLBP
+,
+ The
+ three
+ meditations
+ OM
+meditation,51 cyclic
+ meditation,54,55 mind
+ sound
+ resonance
+technique56 and
+ yogic
+ counselling
+ helped
+ in
+ stress
+ manage-
+ment.
+ Yogic
+ counselling,
+ and
+ lectures
+ similar
+ to
+ modern
+ CBT
+.
+The
+ ‘happiness
+ analysis’
+ derived
+ from
+ Upanishadic
+ texts53
+to
+ encourage
+ participants
+ to
+ recognize
+ sources
+ of
+ their
+emotional
+ surges,
+ restore
+ freedom
+ to
+ remain
+ unaffected,
+and
+ change
+ habituated
+ patterns
+ of
+ response
+ to
+ chronic
+pain.
+This
+ new
+ perspective
+ makes
+ previously
+ difficult
+ situa-
+tions
+ easier
+ to
+ handle.
+ Its
+ occurrence,
+ in
+ an
+ Indian
+ context,
+may
+ explain
+ some
+ of
+ the
+ anxiety
+ reduction.
+ More
+ generally,
+reduction
+ in
+ scores
+ on
+ anxiety
+ and
+ depression
+ indicate
+ that
+subjects
+ were
+ given
+ a
+ margin
+ of
+ safety
+ from
+ subsequently
+redeveloping
+ pathological
+ levels
+ of
+ these
+ conditions,
+ a  point
+of
+ significance,
+ since
+ Yoga
+ medicine
+ is
+ as
+ much
+ preventive
+as
+ curative.
+Next
+ let
+ us
+ consider
+ possible
+ mechanisms
+ for
+ the
+observed
+ degrees
+ of
+ pain
+ reduction.
+ Part
+ may
+ have
+ been
+produced
+ by
+ neural
+ impulses
+ from
+ stretch
+ proprioceptors
+interfering
+ with,
+ and
+ blocking,
+ impulses
+ on
+ the
+ ascend-
+ing
+ pain
+ pathway,
+ as
+ hypothesized
+ in
+ gate
+ control
+ theory.57
+A
+ second
+ level
+ of
+ explanation
+ for
+ Yoga’s
+ efficacy
+ in
+ pain
+reduction
+ may
+ lie
+ in
+ endorphin
+ production
+ at
+ a  cortical
+level,
+ which
+ is
+ known
+ to
+ result
+ from
+ alternate
+ stretch-and-
+relax
+ procedures
+ of
+ Yoga
+ asana
+ practice.58 Anxiety
+ reduction
+requires
+ special
+ consideration.
+ Consistency
+ of
+ observed
+reduction
+ in
+ state
+ anxiety
+ during
+ yoga
+ interventions45,46,48
+with
+ non-significant
+ changes
+ during
+ the
+ physical
+ exercise
+intervention,
+ corroborates
+ earlier
+ studies
+ on
+ yoga
+ in
+ other
+chronic
+ stress-related
+ conditions.59 A
+ previous
+ short
+ term
+out-patient
+ yoga
+ study
+ (3—4
+ h/day
+ for
+ 9
+ days)
+ observed23
+reductions
+ in
+ trait
+ anxiety
+ in
+ patients
+ with
+ chronic
+ disease.
+Thus,
+ the
+ present
+ study’s
+ improvement
+ in
+ trait
+ anxiety
+ (16%)
+by
+ the
+ Yoga
+ group
+ with
+ significant
+ group
+ ×
+ time
+ interac-
+tion,
+ and
+ between
+ groups
+ differences,
+ may
+ be
+ considered
+evidence
+ for
+ the
+ power
+ of
+ yoga
+ interventions
+ to
+ reduce
+deep-rooted
+ stress.
+The
+ transformation
+ may
+ be
+ compared
+ to
+ well
+ sub-
+stantiated
+ changes
+ in
+ emotionality
+ as
+ a  result
+ of
+ regular
+Trancendental
+ Meditation
+ practice,
+ something
+ in
+ which
+ EPI
+author
+ HA
+ Eysenck,
+ himself
+ took
+ great
+ interest
+ when
+ it
+ was
+discovered.60 Both
+ emotionality
+ and
+ trait
+ anxiety
+ are
+ con-
+sidered
+ long
+ term,
+ stable
+ properties
+ of
+ the
+ personality.
+ In
+both
+ the
+ cases,
+ deep,
+ Yoga-oriented
+ programs
+ indicate
+ that
+they
+ may
+ not
+ be
+ as
+ permanent
+ as
+ originally
+ supposed.
+The
+ observed
+ improvements
+ apparently
+ continued
+ after
+the
+ completion
+ of
+ the
+ program:
+ subjects
+ were
+ routinely
+asked
+ to
+ continue
+ one
+ hour
+ daily
+ yoga
+ practice
+ at
+ home
+aided
+ by
+ a  video.
+ At
+ the
+ present
+ time,
+ over
+ 3
+ years
+ after
+the
+ study
+ terminated,
+ many
+ of
+ the
+ previously
+ most
+ incapac-
+itated
+ subjects
+ i.e.
+ those
+ who
+ had
+ made
+ the
+ most
+ progress,
+are
+ still
+ doing
+ their
+ home
+ program,
+ in
+ contact
+ with
+ SVYASA,
+and
+ expressing
+ appreciation
+ for
+ having
+ participated
+ in
+ the
+study.
+114
+ 
+P
+.
+ Tekur
+ et
+ al.
+Possible
+ mechanisms
+ and
+ implications
+ for
+ clinicians
+ or
+policy
+ makers.
+ We
+ recommend
+ that
+ this
+ safe
+ yoga
+ therapy
+for
+ backpain
+ program
+ may
+ be
+ included
+ in  conventional
+ Low
+backpain
+ management
+ protocols
+1.
+ As
+ it
+ has
+ been
+ shown
+ that
+ it
+ is
+ better
+ than
+ physical
+ ther-
+apy
+ in
+ alleviating
+ pain,
+ anxiety
+ and
+ depression
+2.
+ It  is
+ applicable
+ in
+ all
+ age
+ groups
+ since
+ our
+ study
+ included
+adolescents
+ to
+ the
+ elderly
+ (18—65
+ years)
+ and
+ both
+ gen-
+ders.
+3. Cost
+ effectiveness
+ of
+ this
+ self
+ corrective
+ techniques
+which
+ can
+ be
+ practiced
+ at
+ home
+ once
+ learnt
+ is
+ notewor-
+thy.
+Unanswered
+ question
+With
+ increasing
+ popularity
+ of
+ yoga
+ round
+ the
+ globe,
+ gener-
+alisability
+ of
+ this
+ module
+ to
+ different
+ ethnic
+ groups
+ should
+be
+ studied.
+Suggestions
+ for
+ future
+ research
+(i)
+ Long-term
+ follow-up
+ including
+ measures
+ of
+ cognitive
+changes
+ should
+ be
+ studied.
+(ii)
+ EMG
+ studies
+ should
+ be
+ included.
+Short
+ term,
+ intensive
+ residential
+ Yoga
+ programs
+ for
+ back
+pain,
+ designed
+ according
+ to
+ the
+ Integrated
+ Approach
+ of
+Yoga
+ Therapy
+ (IAYT),
+ significantly
+ reduce
+ scores
+ on
+ state
+and
+ trait
+ anxiety,
+ and
+ depression
+ scales
+ as
+ well
+ as
+ reducing
+pain,
+ and
+ improving
+ lower
+ back
+ and
+ hamstring
+ flexibility
+and
+ QoL
+ scores
+ in
+ CLBP
+ patients.
+ The
+ Yoga
+ intervention
+significantly
+ outperformed
+ the
+ control
+ intervention
+ on
+ all
+measures
+ except
+ SAR
+ which
+ did
+ well
+ in
+ both
+ groups.
+Conflict
+ of
+ interest
+ statement
+None
+ declared.
+Source
+ of funding
+SVYASA
+ (Institutional).
+Acknowledgements
+We
+ acknowledge
+ assistance
+ from
+ Ravi
+ Kulkarni
+ PhD
+ —
+ Bio
+Statistician
+ and
+ Balram
+ Pradhan
+ PhD
+ in
+ statistical
+ analysis.
+We
+ thank:
+ Mrs.
+ Ritu
+ Mishra
+ (clinical
+ psychologist)
+ and
+ Dr
+ Usha
+Rani
+ for
+ administering
+ and
+ scoring
+ psychological
+ question-
+naires;
+ SVYASA
+ for
+ co-operation
+ in
+ conducting
+ the
+ program;
+and
+ consultant
+ orthopaedic
+ surgeon
+ Dr
+ John
+ Ebnezer,
+ for
+opinions
+ on
+ X-ray
+ images.
+ We
+ acknowledge
+ the
+ director
+ of
+Jubilee
+ Camdarc
+ radiological
+ institute
+ for
+ assistance
+ with
+x-rays.
+Appendix
+ A.
+ Line
+ diagrams
+ of
+ back
+ pain
+special
+ techniques
+ for  yoga
+ group
+I.
+ Supine
+ postures
+1.Pavanamuktasana
+ (Wind
+ releasing
+ pose)
+•
+ Supta
+ Pawanamuktasana
+ (leg
+ lock
+ pose)
+•
+ Jhulana
+ Lurkhanasana
+ (rocking
+ and
+rolling)
+2.
+ Ardha
+ Navasana
+ (half
+ boat
+ pose)
+3.
+ Uttanapadasana
+ (straight
+ leg
+ raise
+ pose)
+A  comprehensive
+ yoga
+ programs
+ 
+115
+Appendix
+ A  (Continued
+ )
+4.
+ Sethubandhasana
+ breathing
+ (bridge
+ pose
+lumbar
+ stretch)
+5.
+ Supta
+ Udarakarshanasana
+ (folded
+ leg
+lumbar
+ stretch)
+6.
+ Shavaudarakarshanasana
+ (Crossed
+ leg
+lumbar
+ stretch)
+[10pt]
+ II.
+ Prone
+ postures
+1.
+ Bhujangasana
+ (serpent
+ pose)
+2.
+ Shalabhasana
+ breathing
+ (locust
+ pose)
+3.
+ Quick
+ relaxation
+ Technique
+ in
+ Shavasana
+(corpse
+ pose)
+III.
+ Sitting
+ postures
+116
+ 
+P
+.
+ Tekur
+ et
+ al.
+Appendix
+ A  (Continued
+ )
+1.
+ Vyaghra
+ Svasa
+ (Tiger
+ breathing)
+2.
+ Shashankasana
+ breathing
+ (moon
+ pose)
+IV.
+ Standing
+ postures
+1.
+ Ardha
+ Chakrasana
+ (half
+ wheel
+ pose)
+2.
+ Prasarita
+ Pada
+ Hastasana
+ (forward
+ bend
+with
+ legs
+ apart)
+A  comprehensive
+ yoga
+ programs
+ 
+117
+Appendix
+ A  (Continued
+ )
+3.
+ Ardha
+ kati
+ Chakrasana
+ (lateral
+ arc
+ pose)
+V.
+ Deep
+ relaxation
+ technique,
+ in
+ Shavasana
+with
+ folded
+ legs
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+© 2022 Yoga Mīmāṃsā | Published by Wolters Kluwer - Medknow
+Original Article
+A cross-sectional study on impulsiveness, mindfulness, 
+and World Health Organization quality of life in 
+heartfulness meditators
+Dwivedi Krishna1, Deepeshwar Singh1, Krishna Prasanna2
+1Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samasthana, Bengaluru, Karnataka, India, 
+ 
+2Welfare Harvesters, Bengaluru, Karnataka, India
+INTRODUCTION
+Meditation is a self-regulated contemplative practice that helps 
+to improve mental functioning and well-being. Patanjali yoga 
+sutra, the ancient yogic text compiled by sage Patanjali defines 
+“meditation as a balanced, continuous and natural flow of attention 
+directed towards the one point or region of meditation” (Chapter 
+III verses 2; PSY[1]). Later, meditation has categorized into 
+different types of meditative practices as described elsewhere.[2,3] 
+However, in any meditation technique, the practitioner tends to 
+continuously focus on the chosen object for a considerable amount 
+of time and that leads to a focused attentive state of mind. Once 
+the practitioner becomes experienced enough to avoid mind 
+wandering and maintain sustained attention for a considerable 
+amount of time, the practitioner gradually enters the state of deep 
+meditation. Last two decades, researchers have been observed that 
+meditation is capable of promoting mental health and wellbeing. 
+Context: Heartfulness meditation (HM) is a heart-based meditation with its unique feature of transmitting energy 
+which may have an impact on mental health and well-being. The present study intends to compare the mental health-
+related outcomes in long-term HM meditators (LTM), short-term HM meditators (STM), and control groups (CTL).
+Materials and Methods: The self-reported measures of mental health and well-being are reported by using 
+State Trait Anxiety Inventory-II, Barratt Impulsive Scale-11, Mindfulness Attention Awareness Scale, Meditation 
+Depth Questionnaire, and World Health Organization Quality of life-BREF. A total of 79 participants (29 females) 
+participated in LTM (n = 28), STM (n = 26), and CTL (n = 25) with age range 30.09 ± 6.3 years.
+Results: The LTM and STM groups showed higher mindfulness along with the depth of meditation, quality of 
+life, and lower anxiety and impulsivity than to CTL group. Our findings suggest that the HM practice enhances 
+mindfulness, reduces anxiety, and regulates impulsivity. The LTM and STM groups showed significant positive 
+trends of mindfulness as compared to CTL. 
+Conclusion: The results indicated that HM practice could be an effective intervention for reducing anxious and 
+impulsive behavior by subsequently improving mindfulness-related mental health and well-being.
+Key Words:  Anxiety, heartfulness meditation, impulsivity, mental well-being, mindfulness, quality of life
+Address for correspondence: 
+Dr. Deepeshwar Singh, Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, No. 19, Eknath 
+Bhavan, Gavipuram Circle, K.G. Nagar, Bengaluru, Karnataka, India.  
+E-mail: [email protected]
+Submitted: 31-Jan-2022  Revised: 03-Apr-2022  Accepted: 11-Apr-2022  Published: ***
+How to cite this article: Krishna D, Singh D, Prasanna K. A cross-
+sectional study on impulsiveness, mindfulness, and World Health 
+Organization quality of life in heartfulness meditators. Yoga Mimamsa 
+2022;XX:XX-XX.
+This is an open access journal, and articles are distributed under the terms of the 
+Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which 
+allows others to remix, tweak, and build upon the work non-commercially, as long as 
+appropriate credit is given and the new creations are licensed under the identical terms.
+For reprints contact: [email protected]
+ym_15_22_R2
+Access this article online
+Quick Response Code:
+Website:
+www.ym-kdham.in
+DOI:
+10.4103/ym.ym_15_22
+Abstract
+[Downloaded free from http://www.ym-kdham.in on Saturday, July 16, 2022, IP: 136.232.192.146]
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+Krishna, et al.: Heartfulness meditation promotes mental health and well-being
+Yoga Mīmāṃsā | Volume 54 | Issue 1 | January-June 2022	
+25
+Scientific investigations reported that the meditation practice helps 
+to reduce anxiety, depression, and emotional dysregulation.[4-8]
+In recent years, meditation has emerged as a preventive and 
+potential therapeutic tool for psychiatric and psychosomatic 
+problems due to the resultant outcome of meditation techniques 
+for reducing stress, anxiety, and depression.[9-11] A disturbed 
+mental state is associated with an inability to regulate an 
+emotional response to perceived threats, and meditation practice 
+strengthens a person’s mental ability to control emotions when 
+anxious.[12] The scientific investigations on meditation have 
+focused on outcome measures such as cognitive functions, health 
+behaviors, psychological effects, and synchronicities.[13] Previous 
+studies have reported that the mindfulness meditation improves 
+behavior control, quality of life, and reduced impulsivity.[14,15] 
+There is a vast literature on mindfulness meditation concerning 
+mental health issues such as impulsive behavior or distress, 
+and emphasis on protective capacities for distress tolerance 
+and resilience.[14,16] Today, meditation is acceptable and readily 
+adaptable to daily lives to promote mental health and well-
+being.[17,18] However, more research is needed to understand the 
+relationship between various mental health with duration and 
+quality of meditation practice.
+The practice of heart-based meditation has been tested as a 
+potential preventive intervention for a wide range of clinical 
+and psychological issues.[19,20] HM, practice is a modified form 
+of Raja Yoga meditation consisted of meditation, cleaning, and 
+prayer. Empirical evidence suggests that Raja yoga has a positive 
+influence on physiological,[19] emotional, and psychological 
+wellbeing.[20] Further, it has a beneficial effect on emotional 
+regulation, pro-social behavior, positive health, and quality of 
+life.[20-23] However, there is no study, to our knowledge, that 
+examined the different duration of HM experience on mental 
+health-related outcomes and quality of life. Hence, we aimed to 
+check the effect of HM on mindfulness, anxiety, impulsiveness, 
+depth of meditation, and quality of life in long-term and short-term 
+meditators with reference to nonmeditators.
+MATERIALS AND METHODS
+Participants
+In the cross-sectional study, 79 participants (29 females) with 
+age ranged between 25 and 45 years were recruited from 
+heartfulness meditation (HM) centers (long-term HM meditators 
+[LTM]: n = 28, short-term HM meditators [STM]: n = 26) and 
+nearby areas (control [CTL]: n = 25). The inclusion criteria 
+were (a) in the LTM group, the participant should have had 
+more than 3 years of HM experience, (b) in the STM group, 
+the participant should have had at least 6–36 months of HM 
+experience, (c) control participants never had the experience 
+of HM in their total life span. The exclusion criteria were (a) 
+presence of any illness, particularly psychiatric disorders, (b) 
+person on any medication, and (c) history of smoking or alcohol. 
+None of the participants were involved in any other ongoing 
+research activity.
+Demographic information
+All participants were asked to provide their demographic 
+information such as age, gender, occupation, education attainment, 
+meditation experience (in years), frequency of meditation 
+practices (every day, 2–4 times a week, once or twice every week, 
+once every week, or rarely), years of meditation, and the average 
+duration of each meditation session in minutes. The characteristics 
+of the participants are given in Table 1.
+This study was approved by the Ethics Committee of the 
+Institution (RES/IEC-SVYASA/164/1/2020). Written informed 
+consent was obtained from each participant after explaining the 
+design and assessment tools of the study.
+Assessment tools
+The trait anxiety of the participants was assessed using the 
+State-Trait Anxiety Inventory (STAI-II).[24] The trait anxiety 
+STAI-II (how individual generally feels-Trait). It consists of 20 
+items emphasizing the intensity of anxiety symptoms. These 
+questionnaires contain excellent psychometric properties. Each 
+question is rated on a 4-point scale (i) almost never, (ii) sometimes, 
+(iii) often, and (iv) almost always. Reversed scoring items are: 1, 
+2, 5, 8, 10, 11, 15, 16, 19, and 20. Scores range from 20 to 90, and 
+the cutoff for high anxiety is 48.[25] The median alpha reliability 
+coefficient for the trait scale is 0.81.
+The dispositional mindfulness was assessed using the Mindful 
+Attention Awareness Scale (MAAS).[26] This tool measures 
+the general tendency to be attentive and aware of present 
+moment experiences in daily life. It measures a unique quality 
+of consciousness related to a variety of well-being constructs, 
+differentiates mindfulness practitioners from others, and is 
+associated with enhanced self-awareness. MAAS has been used 
+for several studies and reported mental health indicators positively 
+associated with mental and physical health. It contains a 15-item 
+self-reported single-factor scale to assess a core characteristic of 
+mindfulness. It is collected on a 6-point Likert scale; (i) Almost 
+always, (ii) Very frequently, (iii) Somewhat infrequently, (iv) Very 
+infrequently, and (v) Almost never. To score the scale, simply 
+compute a mean of the 15 items. Higher scores reflect higher 
+levels of dispositional mindfulness. The internal consistency 
+reliability is 0.74.
+The quality of life of recruited participants was assessed 
+using the World Health Organization Quality of Life-BREF 
+(WHOQOL-BREF).[27] It is a self-assessment tool to measure 
+the individual’s perceptions in the context of their culture 
+and value systems and their personal goals, standards, and 
+concerns. The WHOQOL-BREF instrument comprises 26 
+items; first, two questions contain overall all quality of life 
+and General Health, 24 items are divided into four domains: 
+(i) physical health with 7 items-explaining about pain and 
+discomfort, energy and fatigue, sleep and relaxation, mobility, 
+and daily life activity; (ii) psychological health with 6 items-
+focusing on positive and negative feelings, thinking, learning, 
+memory and concentration, self-esteem, personal beliefs, and 
+[Downloaded free from http://www.ym-kdham.in on Saturday, July 16, 2022, IP: 136.232.192.146]
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+Krishna, et al.: Heartfulness meditation promotes mental health and well-being
+26 	
+Yoga Mīmāṃsā | Volume 54 | Issue 1 | January-June 2022
+spirituality; (iii) social domain-with 3 items-addressing personal 
+relationships, support, social and sexual activity; and (iv) the 
+environment with eight items detecting the physical safety and 
+protection, home environment, financial resources, health, and 
+social care, seeking for wisdom and skill. Each item is rated on 
+a 5-point Likert scale scored from 1 to 5 on a response scale. 
+Each item of the WHOQO-BREF is scored from 0 (worse) and 
+156 (best) on a response scale.[28] Its good internal consistency 
+is α = 0.63.
+Barratt Impulsiveness Scale-11 (BIS-11) was used to assess the 
+personality/behavioral construct of impulsiveness. There are 
+30-items self-reported scales divided into three primary factors of 
+scale: (1) attentional impulsivity (BIS-A) with 8 items; (2) Motor 
+impulsivity (BIS-M) with 11 items; (3) nonplanning (BIS-NP) 
+with 11 items. Participants respond to each item using a 4-point 
+Likert scale: 1 (rarely/never), 2 (occasionally), 3 (often), and 4 
+(almost always/always). Reversed scoring items are: 1, 7, 8, 9, 
+10, 12 13, 15, 20, 29, and 30. The total score ranges from 30 to 
+120 and higher scores indicate greater impulsivity. BIS-11 internal 
+consistency coefficient is 0.74.
+The depth of meditative experiences was assessed using 
+Meditation Depth Questionnaire (MEDEQ). It contains 30 
+items in five different subdomains; (a) hindrance (MEDEQ-H)-
+assesses the boredom, impatience, and problem with motivation 
+and concentration, (b) Relaxation (MEDEQ-R)-emphasizing 
+comfortable feeling, inner peace, and calmness, (c) personal-self 
+(MEDEQ-PS)-explains the experience of being detached from 
+thoughts, having a deep understanding or insight and feeling 
+centred, (d) Transpersonal qualities (MEDEQ-TPQ)-include 
+emotion such as love, devotion, thankfulness, and connectedness, 
+and (e) Transpersonal-self (MEDEQ-TPS)-interprets the 
+disappearance of cognitive process and the experience of the 
+unity of everything.[29] Each item is rated with the scale ranging 
+from 0 (not at all) to 4 (very much). Responses are summed up to 
+a total score for the dimension of meditation depth. The internal 
+consistency of MEDEQ is = 0.81.
+Heartfulness meditation practice
+It is a unique heart-based practice consisting of cleaning, prayer, 
+and meditation is aided by yogic transmission. Meditation is 
+done preferably in the morning on the source of light within the 
+heart. Cleaning is performed in the evening to rejuvenate oneself 
+from the effects of impressions created by the activities during 
+the day. Prayer is silently offered before going to bed connecting 
+ourselves with our inner-self to reinforce the goal of our life. The 
+entire system becomes pure and more capable of receiving yogic 
+transmission which improves the effectiveness of meditation. The 
+process of transmission is facilitated by meditating with the global 
+guide or certified HM trainer.[19]
+Control group participants who had no experience of any form 
+of meditation were asked to complete the same questionnaires.
+Data analysis
+Statistical analysis was done using the SPSS software version, 20 
+Inc. (Chicago, IL, USA) in Windows. The data were checked for 
+normal distribution and homogeneity of variance by applying the 
+Shapiro‑Wilk test and Levene test. One-way analysis of variance 
+(ANOVA) was performed between group analysis for each 
+psychological assessment. This was followed by post hoc analysis 
+with Bonferroni adjustment for multiple comparisons. Statistical 
+significance was considered at p < 0.05. The descriptive statistics 
+included mean values, standard deviations (SDs), significant 
+values, F-value, partial eta square is given in Tables 2 and 3. The 
+relationship between the scores of trait anxiety (STAI-II) and trait 
+mindfulness (MAAS) with other outcomes was analyzed using 
+Pearson’s correlation, as shown in Table 4.
+RESULTS
+The Shapiro–Wilk test showed that data were homogeneous and 
+normally distributed (p > 0.05). The results of one-way ANOVA 
+for all the variables are reported in Table 2.
+The mean and SD values of self-reported questionnaires are given 
+in Table 3. The post hoc analysis with Bonferroni adjustment 
+Table 1: Characteristics of participants
+Characteristics
+LTM (n=28), n (%)
+STM (n=26), n (%)
+CTL (n=25), n (%)
+Gender
+Male
+17
+18
+16
+Female
+11
+8
+9
+Age (years)
+Male
+32.54±6.2
+30±7.5
+28.43±3.3
+Female
+32±6
+29.45±7.5
+28.12±3.2
+Meditation experience (months)
+137.46±27.54
+12.80±6.48
+‑
+Duration of practice/day (min)
+76.07±15.24
+47.5±20.36
+‑
+Education
+Undergraduate
+9 (32)
+10 (38)
+7 (28)
+Postgraduate
+19 (68)
+16 (61)
+17 (68)
+Higher education
+‑
+1 (4)
+Socioeconomic status
+Lower
+8 (29)
+5 (19)
+7 (28)
+Middle
+18 (64)
+20 (77)
+16 (64)
+Higher
+2 (7)
+1 (4)
+2 (8)
+HM, Heartfulness meditation; LTM, Long‑term HM meditators; STM, Short‑term HM meditators; CTL, Control groups
+[Downloaded free from http://www.ym-kdham.in on Saturday, July 16, 2022, IP: 136.232.192.146]
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+Krishna, et al.: Heartfulness meditation promotes mental health and well-being
+Yoga Mīmāṃsā | Volume 54 | Issue 1 | January-June 2022	
+27
+showed a significant higher scores of MAAS (p < 0.001; 
+p < 0.001), MEDEQ-R (p < 0.05; p < 0.001), MEDEQ-PS (p < 
+0.01; p < 0.001), MEDEQ-TPQ (p < 0.001; p < 0.001), MEDEQ-
+TPS (p < 0.001; p < 0.001), WHOQOL-Physical (p < 0.05), 
+WHOQOL-psychological (p < 0.01) and lower score of STAI-
+II (p < 0.001; p < 0.001), BIS-A (p < 0.05; p < 0.001), BIS-M 
+(p > 0.05; p < 0.001), BIS-NP (p < 0.05; p < 0.001), BIS-T 
+(p < 0.001; p < 0.001) and hindrances of meditation depth scale 
+(p < 0.01; p < 0.001) in the LTM as compared to STM and CTL, 
+respectively. Moreover, the STM group has shown significant 
+higher scores in MAAS (p < 0.01), MEDEQ-PS (p < 0.05), 
+MEDEQ-TPQ (p < 0.05), MEDEQ-TPS (p < 0.05) and lower 
+cores in STAI-II (p < 0.05), BIS-A p < 0.05), BIS-M (p < 0.05), 
+BIS-T (p < 0.01), and MEDEQ-H (p < 0.05) compared to CTL.
+Pearson’s correlation [Table 4] shows a significant negative 
+correlation of MAAS with trait anxiety (LTM [r = −0.38, p < 0.05] 
+and STM [r = −0.47, p < 0.05]); BIS-A (r = −39, p < 0.05), BIS-M 
+(r = −0.51, p < 0.01), BIS-NP (r = −0.54, p < 0.01), BIS-T (r 
+= −0.64, p < 0.001), hindrance (LTM [r = −41, p < 0.05], and 
+STM [r = −0.41, p < 0.05]). Moreover, MAAS showed positive 
+correlation with relaxation (r = 0.48, p < 0.01), transpersonal 
+qualities (r = 0.38, p < 0.05), QOL-Physical (r = 0.44, p < 0.05), 
+QOL-Psychological (r = 0.46, p < 0.05), and meditation experience 
+(r = 0.37, p < 0.05) in LTM group. Whereas, STAI-II has shown 
+negative correlation with meditation experience (r = −0.41, p < 
+0.05), relaxation (r = −0.5, p < 0.01), and positive correlation 
+with hindrance (r = 0.45, p < 0.05) in LTM group and positive 
+correlation with hindrance (r = 0.42, p < 0.05) in STM group. A 
+heatmap of Person’s correlation between mindfulness and other 
+outcome measures of LTM group is presented in Figure 1.
+DISCUSSION
+The primary aim of the study was to compare the mindfulness 
+and anxiety among HM meditators and nonmeditators. Moreover, 
+we also assessed other mental health-related outcomes such 
+as impulsivity, trait anxiety, meditation depth, and quality of 
+life. As expected, we found trait mindfulness was higher and 
+anxiety was lower in the LTM group as compared to the CTL 
+group. Similarly, other mental health-related outcomes showed 
+lower impulsive behavior and higher depth of meditation and 
+Table 2: Analysis of variance results of mental 
+outcomes among three different groups
+Variables
+F
+df 
+p
+pη2
+T‑MAAS 
+42.88
+2,76
+<0.001
+0.53
+STAI‑II
+23.38
+2,76
+<0.001
+0.38
+BIS‑A
+14.55
+2,76
+<0.001
+0.27
+BIS‑M
+9.93
+2,76
+<0.001
+0.21
+BIS‑NP
+8.96
+2,76
+<0.001
+0.19
+BIS‑T
+21.09
+2,76
+<0.001
+0.36
+MEDEQ‑H
+34.73
+2,76
+<0.001
+0.48
+MEDEQ‑R
+13.62
+2,76
+0.013
+0.26
+MEDEQ‑PS
+40.44
+2,76
+<0.001
+0.52
+MEDEQ‑TPQ
+69.31
+2,76
+<0.001
+0.65
+MEDEQ‑TPS
+25.85
+2,76
+<0.001
+0.41
+WHOQoL‑Physical
+3.16
+2,76
+0.04
+0.08
+WHOQoL‑Psychological
+8.53
+2,76
+<0.001
+0.18
+WHOQoL‑SR
+2.90
+2,76
+0.061
+0.07
+WHOQoL‑E
+2.72
+2,76
+0.072
+0.07
+T-MAAS, Triat Mindfulness Attention Awareness Scale; BIS, Barratt Impulsive 
+Scale, BIS‑A, Attentional Impulsivity; BIS‑M, Motor impulsivity; BIS‑NP, 
+Nonplanning; BIS-T, Total impulsivity; STAI‑II, State‑Trait Anxiety Inventory; 
+MEDEQ, Meditation Depth Questionnaire; MEDEQ‑H, MEDEQ‑Hindrance; 
+MEDEQ‑R, MEDEQ‑Relaxation; MEDEQ‑PS, MEDEQ‑Personal‑Self; MEDEQ‑TPQ, 
+MEDEQ‑Transpersonal Qualities; MEDEQ‑TPS, MEDEQ‑Transpersonal‑Self; 
+WHOQoL‑BREF
+, World Health Organization Quality of Life; WHOQoL‑SR, Social 
+relationship; WHOQoL‑E, Environmental; df, degree of freedom
+Table 3: Mean and standard deviation of mental health‑related outcome measures of participants in 
+three groups
+Groups/
+variables
+LTM
+STM
+CTL
+CI (95%) 
+Effect size 
+(Cohen’s d)
+T1
+T2
+T3
+T1
+T2
+T3
+MAAS
+63.29±5.18***,$$$ 55.04±6.43$$ 49.04±3.63
+2.07–10.85
+8.00–16.88
+1.46–10.5
+0.88
+1.88
+0.96
+STAI‑II
+31±5.07***,$$$
+37.31±5.52$ 41.64±6.52 −9.98–(−2.97)
+−13.98–(−6.9)
+−7.57–(−0.36) −1.21 −2.05 −0.69
+BIS‑A
+15.78±2.85*,$$$
+18.85±4.33$ 21.64±4.55 −5.63–(−0.48)
+−8.45–(3.25)
+−5.44–(−0.15) −0.84 −1.56 −0.63
+BIS‑M
+19.71±3.92$$$
+21.50±3.13$ 24.16±4.25
+−4.26–0.68
+−6.94–(−1.95)
+−5.2–(0.12)
+−0.5 −1.08 −0.71
+BIS‑NP
+20±3.15*,$$$
+22.85±2.96 24.04±4.25 −5.11–(−0.58)
+−6.33–(−1.75)
+−3.52–1.14
+−0.93 −1.09 −0.33
+BIS‑T
+55.50±6.85***,$$$ 63.19±5.48$$ 69.84±8.78 −12.51–(−2.87) −19.21–(−9.47) −11.61–(−1.69) −1.15 −1.75 −0.91
+MEDEQ‑H
+3.89±2.11**,$$$
+6.19±1.85$
+8.08±2.98
+−3.9–(−0.87)
+−5.57–(2.51)
+−3.21–(−0.09) −1.23 −1.59 −0.68
+MEDEQ‑R
+10.61±1.19*,$$$
+9.38±1.41
+8.44±1.89
+0.35–2.24
+1.32–3.23
+0.01–1.95
+1.08
+1.48
+0.61
+MEDEQ‑PS
+22.39±3.05**,$$$
+17.35±3.19$ 15.12±2.83
+3.37–7.37
+5.57–9.61
+0.17–4.28
+1.69
+2.53
+0.74
+MEDEQ‑TPQ
+26.18±3.93***,$$$
+18.31±3.45$ 15.52±2.78
+5.74–10.21
+8.51–13.02
+0.49–5.09
+2.16
+3.14
+0.88
+MEDEQ‑TPS
+18.79±1.57***,$$$
+15.38±3.43$ 12.92±3.93
+1.45–5.49
+3.89–7.97
+0.38–4.54
+1.32
+2.03
+0.67
+WHOQoL‑ 
+Physical
+55.78±4.99$
+53.31±5.03 52.16±6.13
+−0.47–6.36
+0.64–7.54
+−2.36–4.66
+0.61
+0.76
+0.20
+WHOQoL‑ 
+Psychological
+61.04±5.28$$
+58.15±6.35 55.12±7.18
+−1.21–6.97
+1.78–10.05
+−1.17–7.24
+0.49
+0.95
+0.45
+WHOQoL‑SR
+59.53±7.71
+56.54±6.21 55.76±3.14
+−0.96–6.96
+1.17–9.18
+−1.89–6.25
+0.43
+0.86
+0.44
+WHOQoL‑E
+56.17±5.27
+55±3.17
+53.56±3.29
+−1.47–3.83
+1.26–6.62
+0.03–5.48
+0.27
+0.89
+0.86
+*Compare with STM; $Compare with CTL; * or $p<0.05; ** or $$p<0.01; *** or $$$p<0.001. HM, Heartfulness meditation; LTM, Long‑term HM Meditators; STM, 
+Short‑term HM Meditators; CTL, Control groups; CI, Confidence interval; MAAS, Mindfulness Attention Awareness Scale; BIS, Barratt Impulsive Scale; BIS‑A, Attentional 
+Impulsivity; BIS‑M, Motor Impulsivity; BIS‑NP, Nonplanning; BIS-T, Total impulsivity, STAI‑II, State‑Trait Anxiety Inventory; MEDEQ, Meditation Depth Questionnaire; 
+MEDEQ‑H, MEDEQ‑Hindrance; MEDEQ‑R, MEDEQ‑Relaxation; MEDEQ‑PS, MEDEQ‑Personal‑Self; MEDEQ‑TPQ, MEDEQ‑Transpersonal Qualities; MEDEQ‑TPS, 
+MEDEQ‑Transpersonal‑Self; WHOQoL‑BREF
+, World Health Organization Quality of Life; WHOQoL-SR, Social relationship; WHOQoL-E, Environmental
+[Downloaded free from http://www.ym-kdham.in on Saturday, July 16, 2022, IP: 136.232.192.146]
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+Krishna, et al.: Heartfulness meditation promotes mental health and well-being
+28 	
+Yoga Mīmāṃsā | Volume 54 | Issue 1 | January-June 2022
+quality of life in HM practitioners. It indicates that the frequency 
+of meditation is associated with improvement in alertness, 
+attentiveness, mindful state, and also enhance the ability to cope 
+with anxiety efficiently.[30,31] These outcomes are inferred from 
+the potential differences in LTM when compared to STM and 
+CTL groups. Moreover, significant associations were observed 
+between meditation experience, mindfulness, anxiety, impulsive 
+behavior, and quality of life in LTM and STM groups. The 
+meditation experience is positively associated with mindfulness 
+and meditation depth and negatively correlated with anxiety 
+and impulsiveness. These results support the previous studies 
+on HM and enhance the evidence of HM practice’s effect on 
+mental health and well-being. The experienced HM practitioners 
+showed lower impulsiveness in attention, motor, and nonplanning 
+behavior. It indicates that HM practice may have preventive and 
+therapeutic potentials to reduce impulsivity among individuals. 
+The trait anxiety also showed a lower score in experienced HM 
+practitioners which indicate that HM controls not only impulsive 
+behavior but also anxiety. The previous study supports our findings 
+that meditation increases subjects’ ability to improve motor 
+responses.[32] It was found that lower BIS-11 motor impulsivity and 
+nonplanning impulsivity subscale scores were associated with the 
+medial orbitofrontal cortex and paracingulate gyrus.[14] These brain 
+areas are associated with a mindfulness practice that is negatively 
+correlated with impulsiveness and anxiety in meditators.[14] HM 
+could be a useful therapeutic technique to treat conditions having 
+features of impulsiveness such as attention deficit hyperactive 
+disorders, obsessive-compulsive disorder, and substance abuse.[6,12] 
+Moreover, the depth of meditation was assessed, and meditators 
+reported higher scores for relaxation, personal self, transpersonal 
+qualities, and transpersonal-self with lower hindrances which 
+suggests that the intense meditation may reduce mental fluctuations 
+and improve self-perception.[33] A previous study reported that 
+cognitive function, attention, and self-awareness are enhanced 
+by mindfulness meditation that showed greater cortical thickness 
+in anterior insular cortex.[34] This study is the first to examine the 
+effect of HM on self-reported dispositional mindfulness and other 
+psychological health outcomes. The quality of life particularly, 
+the physical and psychological domain of life, was higher in the 
+meditators group. Moreover, other studies reported that higher 
+Figure 1: Graphical representation of correlation between mindfulness with anxiety, impulsivity, depth of meditation, and quality of life in 
+LTM group. The Pearson’s correlation showed a significant positive relation of mindfulness with relaxation, meditation depth, and quality of 
+life, whereas the negative relation of mindfulness with anxiety and impulsivity. MAAS, Mindful Attention Awareness Scale;  STAI-II, State-
+Trait Anxiety Inventory; BIS, Barratt Impulsive Scale; BIS-A, BIS-Attentional impulsivity; BIS-M, BIS-Motor impulsivity; BIS-NP, BIS-
+Nonplanning; MEDEQ, Meditation Depth Questionnaire; MEDEQ-H, MEDEQ-Hindrance; MEDEQ-R, MEDEQ-Relaxation; MEDEQ-PS, 
+MEDEQ-Personal-Self; MEDEQ-TPQ, MEDEQ-Transpersonal Qualities; MEDEQ-TPS, MEDEQ-Transpersonal-Self; QOL, Quality of life
+[Downloaded free from http://www.ym-kdham.in on Saturday, July 16, 2022, IP: 136.232.192.146]
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+Krishna, et al.: Heartfulness meditation promotes mental health and well-being
+Yoga Mīmāṃsā | Volume 54 | Issue 1 | January-June 2022	
+29
+self-reported mindfulness was positively correlated with better 
+quality of life and psychological well-being.[26,35] The lower trait 
+anxiety of experienced meditators may be due to reduction in 
+hindrances and enhanced relaxation and personal self, as reported 
+in the MEDEQ. Previous mindfulness meditation studies also 
+found significantly lower STAI-II scores.[36,37] Reduced STAI-
+II scores are principally attributed to the anterior cingulate 
+cortex, a brain region that controls thinking and emotion and 
+is functionally tied with the amygdala reactivity to explicit and 
+implicit emotional processing, which could reduce anxiety.[38] 
+The current finding suggests that HM meditation helped to reduce 
+anxiety by regulating self-referential thoughts. Further, higher trait 
+mindfulness is related to lower neuroticism, depression, anxiety, 
+and higher life satisfaction, optimism, and self-esteem.[39] In line 
+with this, we also observed a negative correlation between trait 
+mindfulness with lower anxiety among meditators. The HM 
+practice has potential to influence breathing rhythm and suppress 
+global vagal modulation and enhance sympathetic and baroreflex 
+activity during deep meditation.[40] These outcomes indicated that 
+HM could be considered a therapeutic tool for healthcare providers 
+to ameliorate health-related issues, and enhance wellness.[30]
+Although HM showed significant change among the practitioners, 
+there are limitations to the study. The limitations of the study 
+are (i) the broad age range of the participants, (ii) the data 
+is a self-reported subjective assessment, (iii) the duration of 
+heartfulness practice was self-reported by meditators, and lack of 
+supervision may have its repercussions, and (iv) there is a need 
+to study a more heterogeneous meditation groups with diverse 
+cultures and societies. Finally, the present study paves a path 
+for future exploration with neuroimaging techniques such as 
+electroencephalogram, electrocardiogram, functional magnetic 
+resonance imaging (fMRI), or positron emission tomography to 
+study the structure or functional and cognitive domains of the brain 
+among long-term, novice, and naïve heartfulness practitioners.
+CONCLUSION
+The results indicated that HM practice could be an effective 
+and promising intervention to enhance mindfulness, depth of 
+meditation, and quality of life with reduction of impulsivity and 
+anxiety. The regular practice of this meditation technique may 
+improve the personal self and transpersonal qualities that promote 
+positive emotions and quality of life. Finally, the outcome of the 
+study highlights the preventive and therapeutic potentials of HM 
+for regulating anxiety and impulsiveness in behavioral disorders.
+Financial support and sponsorship
+Nil.
+Conflicts of interest
+There are no conflicts of interest.
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+Table 4: Relation of mindfulness with anxiety, 
+impulsivity, depth of meditation, and quality of 
+life
+Variables
+LTM
+STM
+Pearson’s (r)
+p
+Pearson’s (r)
+p
+MAAS
+STAI‑II
+−0.38
+0.043
+−0.47
+0.014
+BIS‑A
+−0.39
+0.035
+0.3
+>0.05
+BIS‑M
+−0.51
+0.005
+0.02
+>0.05
+BIS‑NP
+−0.54
+0.003
+−0.13
+>0.05
+BIS‑T
+−0.64
+<0.001
+−0.11
+>0.05
+Hindrance
+−0.43
+0.022
+−0.41
+0.037
+Relaxation
+0.48
+0.008
+0.25
+>0.05
+TPQ
+0.38
+0.045
+0.2
+>0.05
+QOL‑physical
+0.44
+0.020
+−0.28
+>0.05
+QOL‑psychological
+0.46
+0.013
+0.26
+>0.05
+Med‑experience
+0.37
+0.048
+0.17
+>0.05
+STAI‑II
+Med‑experience
+−0.41
+0.032
+−0.25
+>0.05
+Hindrance
+0.45
+0.015
+0.42
+0.029
+Relaxation
+−0.5
+0.007
+0.12
+>0.05
+The Pearson’s correlation showed a significant positive relation of mindfulness 
+with relaxation, meditation depth, and QOL whereas the negative relation of 
+mindfulness with anxiety and impulsivity. HM, Heartfulness meditation; LTM, 
+Long‑term HM meditators; STM, Short‑term HM meditators; MAAS, Mindfulness 
+Attention Awareness Scale; BIS, Barratt Impulsive Scale; BIS‑A, BIS‑Attentional 
+impulsivity; BIS‑M, BIS‑Motor impulsivity; BIS‑NP, BIS‑Nonplanning; BIS-T, Total 
+impulsivity, STAI‑II, State‑Trait Anxiety Inventory; TPQ, Transpersonal qualities; 
+QOL, Quality of life
+[Downloaded free from http://www.ym-kdham.in on Saturday, July 16, 2022, IP: 136.232.192.146]
+1
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+23
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+26
+27
+28
+29
+30
+31
+32
+33
+34
+35
+36
+37
+38
+39
+40
+41
+42
+43
+44
+45
+46
+47
+48
+49
+50
+51
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+54
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+56
+57
+58
+59
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+10
+11
+12
+13
+14
+15
+16
+17
+18
+19
+20
+21
+22
+23
+24
+25
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+27
+28
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+30
+31
+32
+33
+34
+35
+36
+37
+38
+39
+40
+41
+42
+43
+44
+45
+46
+47
+48
+49
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+52
+53
+54
+55
+56
+57
+58
+59
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yogatexts/A narrative review on yoga a potential intervention for augmenting immunomodulation and mental health in COVID-19.txt

@@ -0,0 +1,1921 @@
+Basu‑Ray et al. 
+BMC Complementary Medicine and Therapies          (2022) 22:191  
+https://doi.org/10.1186/s12906-022-03666-2
+REVIEW
+A narrative review on yoga: 
+a potential intervention for augmenting 
+immunomodulation and mental health 
+in COVID‑19
+Indranill Basu‑Ray1,2,3*   
+, Kashinath Metri4, Dibbendhu Khanra5, Rishab Revankar6, Kavitha M. Chinnaiyan7, 
+Nagaratna Raghuram8, Mahesh Chandra Mishra9, Bhushan Patwardhan10, Manjunath Sharma11, 
+Ishwar V. Basavaraddi12, Akshay Anand13, Shrinath Reddy14, K. K. Deepak15, Marian Levy2, Sue Theus1, 
+Glenn N. Levine16, Holger Cramer17, Gregory L. Fricchione18 and Nagendra R. Hongasandra7 
+Abstract 
+Background:  The ongoing novel coronavirus disease 2019 (COVID-19) pandemic has a significant mortality rate 
+of 3–5%. The principal causes of multiorgan failure and death are cytokine release syndrome and immune dysfunc‑
+tion. Stress, anxiety, and depression has been aggravated by the pandemic and its resultant restrictions in day-to-day 
+life which may contribute to immune dysregulation. Thus, immunity strengthening and the prevention of cytokine 
+release syndrome are important for preventing and minimizing mortality in COVID-19 patients. However, despite a 
+few specific remedies that now exist for the SARS-CoV-2virus, the principal modes of prevention include vaccina‑
+tion, masking, and holistic healing methods, such as yoga. Currently, extensive research is being conducted to better 
+understand the neuroendocrinoimmunological mechanisms by which yoga alleviates stress and inflammation. This 
+review article explores the anti-inflammatory and immune-modulating potentials of yoga, along with its role in reduc‑
+ing risk for immune dysfunction and impaired mental health.
+Methods:  We conducted this narrative review from published literature in MEDLINE, EMBASE, COCHRANE databases. 
+Screening was performed for titles and abstracts by two independent review authors; potentially eligible citations 
+were retrieved for full-text review. References of included articles and articles of major non-indexed peer reviewed 
+journals were searched for relevance by two independent review authors. A third review author checked the excluded 
+records. All disagreements were resolved through discussion amongst review authors or through adjudication by a 
+fourth review author. Abstracts, editorials, conference proceedings and clinical trial registrations were excluded.
+Observations:  Yoga is a nonpharmacological, cost-effective, and safe intervention associated with several health 
+benefits. Originating in ancient India, this vast discipline consists of postures (asanas), breathing techniques (pranay‑
+ama), meditation (dhyana/dharana), and relaxation. Studies have demonstrated yoga’s ability to bolster innate immu‑
+nity and to inhibit cytokine release syndrome. As an intervention, yoga has been shown to improve mental health, as 
+© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which 
+permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the 
+original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or 
+other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line 
+to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory 
+regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this 
+licence, visit http://​
+creat​
+iveco​
+mmons.​
+org/​
+licen​
+ses/​
+by/4.​
+0/. The Creative Commons Public Domain Dedication waiver (http://​
+creat​
+iveco​
+mmons.​
+org/​
+publi​
+cdoma​
+in/​
+zero/1.​
+0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
+Open Access
+BMC Complementary
+Medicine and Therapies
+*Correspondence:  [email protected]
+1 Cardiologist & Cardiac Electrophysiologist, Memphis VA Medical Center, 
+1030 Johnson Ave, Memphis, TN 38104, USA
+Full list of author information is available at the end of the article
+Page 2 of 13
+Basu‑Ray et al. BMC Complementary Medicine and Therapies          (2022) 22:191 
+Introduction
+Coronavirus disease (COVID-19) is a highly contagious 
+viral disease that has affected 238,349,712 people world-
+wide as of October 9, 2021. Its outbreak was initially 
+reported in 2019 in Wuhan, Hubei Province, China. 
+Nearly 5 million deaths had been reported worldwide 
+as of the first week of October 2021. Many countries are 
+still “locked down” to prevent extensive spread of infec-
+tion, whereas others have relaxed these measures; even 
+so, social isolation measures are still generally recom-
+mended, at least to some extent. Many argue that easing 
+social restrictions has contributed to spikes in the num-
+ber of cases nationwide [1–5].
+Given the limited treatment options and the emer-
+gence of multiple strains with variable susceptibility to 
+vaccines, clinicians are searching for other interventions 
+to aid in the prevention and treatment of COVID-19. 
+In the context of integrative medicine, yoga is a mind-
+body discipline that promotes healthy living through 
+various components, such as the practice of postures 
+(asana), breathing techniques (pranayama), concentra-
+tion (dharana), and meditation (dhyana) [2, 6]. A grow-
+ing body of evidence suggests that yoga practice leads to 
+better integrative management of a number of non-com-
+municable diseases that share the same pathophysiology, 
+including cardiovascular diseases, stroke, and diabetes 
+mellitus type II. The underlying reasoning is that these 
+diseases, like COVID-19, express rogue immunologi-
+cal aberration, resulting in many of their manifestations, 
+which are often triggered or exacerbated by stress [2, 
+7]. A meta-analysis of ten randomized controlled trials 
+including 431 individuals suggested that yoga programs 
+improved exercise capacity (mean change 2.69, 95% con-
+fidence interval 1.39- 3.99) and health related quality of 
+life (mean change 1.24, 95% confidence interval − 0.37- 
+2.85) among patients with chronic ailments namely heart 
+disease, chronic obstructive pulmonary disease and 
+stroke when compared with normal care [8]. Consistent 
+practice of yoga strengthens innate and adaptive immu-
+nity and helps to enhance physiological functions, such 
+as respiration, digestion, circulation, and hormone pro-
+duction [2, 9–11].
+In this review article, we discuss inflammatory, infec-
+tious, and psychosocial aspects of COVID-19 and 
+explore the anti-inflammatory and immune-modulating 
+potentials of yoga, along with its role in reducing risk fac-
+tors for immune dysfunction and impaired mental health. 
+We propose yoga as an intervention for expediting recov-
+ery in patients with COVID-19 and for enhancing innate 
+immunity and mental health to bolster resistance to the 
+virus [2].
+Methods
+We conducted this narrative review from published lit-
+erature in MEDLINE, EMBASE, and COCHRANE data-
+bases. Articles were retrieved from database searches 
+using keywords related to complementary therapy, 
+COVID-19, immunomodulation, psychological stress, 
+and yoga. Observational and experimental studies and 
+discussing the role of yoga in anxiety, immunomodula-
+tion, and COVID-19 were considered relevant for this 
+narrative review. Screening was performed for titles and 
+abstracts by two independent review authors; poten-
+tially eligible citations were retrieved for full-text review. 
+References of included articles and articles of major 
+non-indexed peer reviewed journals were searched for 
+relevance by two independent review authors. A third 
+review author checked the excluded records. All disa-
+greements were resolved through discussion amongst 
+review authors or through adjudication by a fourth 
+review author. Abstracts, editorials, conference proceed-
+ings and clinical trial registrations were excluded. Only 
+articles in English language were included.
+SARS‑COV‑2 infection
+SARS-CoV-2, the coronavirus that causes COVID-19, is 
+an acute infectious agent that enters the body through 
+the respiratory system. Droplet transmission is under-
+stood to be the primary mode of transmission. Mounting 
+evidence also suggests airborne transmission, although 
+the World Health Organization has yet to confirm this. 
+A person can become infected when his or her mucus 
+membrane (within the nose, eyes, or mouth) comes into 
+contact with the respiratory secretions of an actively 
+infected person discharging virus particles. Having 
+entered the body, the SARS-CoV-2 virus uses its S-spike 
+to bind angiotensin-converting enzyme (ACE)-2 recep-
+tors as an entry point into the cell. The ACE2 receptor is 
+it alleviates anxiety, depression, and stress and enhances mindfulness, self-control, and self-regulation. Yoga has been 
+correlated with numerous cardioprotective effects, which also may play a role in COVID-19 by preventing lung and 
+cardiac injury.
+Conclusion and relevance:  This review paves the path for further research on yoga as a potential intervention for 
+enhancing innate immunity and mental health and thus its role in prevention and adjunctive treatment in COVID-19.
+Keywords:  Catastrophization, Complementary therapies, Covid-19, Immunomodulation, Psychological stress, Yoga
+Page 3 of 13
+Basu‑Ray et al. BMC Complementary Medicine and Therapies          (2022) 22:191 
+	
+expressed primarily in both type I and type II pneumo-
+cytes but also in other types of cells, including endothe-
+lial cells. Thus, it plays a vital role in vascular integrity 
+and hemodynamic regulation [12–14].
+Evidence indicates that cardiac involvement is ubiqui-
+tous in patients with COVID-19, particularly in hospi-
+talized patients [14]. Patients with cardiac risk factors or 
+established cardiovascular disease have heightened vul-
+nerability, along with worse mortality and morbidity pro-
+files. In various studies, nearly 30% of afflicted patients 
+had hypertension and 15% had preexisting cardiovascular 
+disease [15, 16].
+Role of immunity in COVID‑19
+The human immune system comprises multiple organs, 
+such as the spleen, thymus, lymph nodes, tonsils, and 
+bones. Immune cells and their products destroy the 
+intruding infective organisms and neutralize them. The 
+immune system includes both innate immunity and 
+adaptive immunity. Innate immunity is the rapid-act-
+ing first line of defense that effectively inhibits infec-
+tive agents from entering the body. However, if this line 
+of defense fails, the immune system activates adaptive 
+immunity, which is important to control most viral infec-
+tions. The emerging picture reveals that CD4+ T cells, 
+CD8+ T cells and neutralizing antibodies has important 
+role in COVID-19 and thus its prevention and manage-
+ment [17].
+Innate immunity is garnered to restrict infections by 
+novel pathogens, such as SARS-CoV-2. This elaborate 
+immunological cascade appropriately arrests the disease 
+and helps to initiate the repair mechanism, thus ensur-
+ing satisfactory resolution of the infection and generating 
+targeted resistance to defend the body against reinfection 
+by the same organism [18]. The adaptive immune system 
+involves T lymphocytes, B lymphocytes, and pathogen-
+specific antibodies in addition to the proinflammatory 
+cytokines and chemokines that help to eliminate the 
+pathogen [19]. Although these processes are very potent 
+and effective, they can render bystander damage to the 
+body’s own cells and organs.
+Infection with COVID-19 presents with three dif-
+ferent clinical scenarios: (1) asymptomatic carriers 
+who have adequately functioning innate immunity; 
+(2) symptomatic carriers with mild symptoms who 
+achieve spontaneous recovery as their innate immu-
+nity detects infection and restricts it, while generating 
+adaptive immunity that optimally gets rid of the virus; 
+and (3) patients who develop moderate to severe illness 
+and either recover or die from the infection [20]. In this 
+third category of patients, the body’s immune system, 
+in both its innate and adaptive expressions, is activated. 
+In those who die, the immune system is overwhelmed, 
+leading to cytokine release syndrome (CRS), a massive, 
+cascading release of cytokines that initiates widespread 
+destruction and multiorgan failure, ultimately leading to 
+death [13]. In essence, the virus does not directly kill but 
+instead initiates an immunological reaction that is mor-
+bid and occasionally fatal (Fig. 1). It is therefore unfortu-
+nate that the resources harnessed by the body to kill the 
+virus largely outweigh the appropriate levels needed and 
+instead produce tissue destruction, organ failure, and 
+eventually death. Interleukin (IL)-6 is the primary can-
+didate cytokine suspected of perpetrating this fatal reac-
+tion [14, 15]. This knowledge has spawned initiatives to 
+block IL-6 using receptor inhibitors, including biologics 
+like tocilizumab, which are undergoing trials in moder-
+ately to severely ill patients with COVID-19 [19].
+An optimal innate immune response may thus play 
+a vital role in the prevention and early disposal of most 
+COVID-19 infections. A response of this nature is 
+believed to occur in 80% or more of those infected, who 
+either are asymptomatic or develop mild symptoms that 
+defervesce and culminate in an uneventful recovery. The 
+precise cause of immune dysfunction and CRS led by the 
+overproduction of IL-6 is unknown. Nonetheless, con-
+siderable evidence points to the fact that the severity of 
+the disease is based on the immune response to the virus, 
+among other factors [22].
+Pandemics, immunity, and mental health
+Remdesivir, the antiviral agent effective against COVID-
+19, only shortens the illness timetable by around 33% 
+[23]. The antiviral treatments recently approved by the 
+FDA would lead to resistance if randomly used. Moreo-
+ver, their efficacy is not absolute and is only effective if 
+started early in the course of the infection. These limita-
+tions render preventive measures—including vaccina-
+tion, hygiene, social distancing, and personal protective 
+equipment—to be the primary means of managing the 
+COVID-19 pandemic. Social distancing through par-
+tial or complete lockdowns often leads to psychological 
+issues such as anxiety, depression, and panic attacks—all 
+of which are known to downregulate the immune system 
+[2, 24]. Associated economic downturns, featuring job 
+losses and financial hardships, have accentuated mental 
+health issues during the pandemic [25]; suicides, opioid 
+overdoses, and domestic violence also have increased. 
+When vulnerable persons such as children, pregnant 
+women, or elderly relatives are part of the household, 
+stress and anxiety levels appear to worsen, given the 
+higher disease severity and mortality rates in these 
+groups. The conglomeration of stress states is associated 
+with downregulation of immunity and, consequently, 
+with worsened disease manifestations.
+Page 4 of 13
+Basu‑Ray et al. BMC Complementary Medicine and Therapies          (2022) 22:191 
+Stress
+Both chronic and sub-acute stress have a significant 
+negative impact on the immune system [26]: on the 
+one hand, the ability to cope with stress helps preserve 
+immune function; on the other hand, individuals with 
+higher stress levels and poor coping mechanisms have 
+subpar immunity. Lower resilience to stress is associated 
+with poor antibody response and decreased natural-killer 
+cell activity [27, 28].
+Stress affects immune function by increasing glucocor-
+ticoid and catecholamine secretion. Stress also induces 
+chronic sympathetic overdrive as it simultaneously 
+attenuates the parasympathetic system [29]. Escalated 
+sympathetic drive with its attendant hormonal milieu 
+(including cortisol excess and a robust catecholaminergic 
+drive) attenuates the efficacy of the immune system [30]. 
+The aberrant pathophysiology at play under such condi-
+tions is increased inflammation and decreased protection 
+against invading microorganisms [30]. Increased gluco-
+corticoid levels significantly affect the immune function 
+by dysregulating cytokine production, affecting natural-
+killer cell activity and reducing immunoglobulin A (IgA) 
+production [30]. Elevated cortisol potentiates glucose 
+intolerance and diabetes and thus further increases the 
+risk for infection [31]. Moreover, evidence suggests that 
+people who have stressful life events have greater risk for 
+Fig. 1  Pathological changes in lungs in early and severe stages of COVID-19 [From “SARS-CoV-2 and viral sepsis: observations and hypotheses” by Li 
+H, Liu L, Zhang D, et al.; accessed 10 April 2021] [Permission for re-use granted by Elsevier COVID-19 resource center guidelines] [21]
+Page 5 of 13
+Basu‑Ray et al. BMC Complementary Medicine and Therapies          (2022) 22:191 
+	
+respiratory infections [32]. The higher stress levels asso-
+ciated with extended lockdowns and the concomitant 
+fear, anxiety, and depression lead to weakened immunity, 
+opening the floodgates of infection [33].
+The paradoxical response of augmented inflammation 
+that is elicited during stress despite increased corticos-
+teroid levels in the blood is not clearly delineated. After 
+all, chronic stressors should ameliorate the symptoms 
+of inflammation-related diseases, but this conclusion is 
+at odds with the excess morbidity and mortality docu-
+mented in chronically stressed individuals. Miller and 
+colleagues [34] have put forth an alternative hypothesis 
+that posits the development of macrophage resistance to 
+cortisol negative feedback under conditions of chronic 
+stress, due to compensatory downregulation at the 
+immune cell (glucocorticoid) receptor. Early life stress 
+can give rise to blunted cortisol negative feedback of the 
+innate inflammatory response [35]. This may set the stage 
+for the stress-related chronic inflammation thought to 
+lower the threshold for stress-related noncommunicable 
+disease [36]. However, the research establishing cell sur-
+face receptor compensatory changes under conditions of 
+stress has thus far been unimpressive. Further research 
+is needed to discern the probable mechanism for this 
+phenomenon.
+Depression
+During lockdowns, social isolation and lack of physical 
+activity are two prominent risk factors for depression. 
+Depression increases the risk ofCOVID-19 infection sig-
+nificantly. There was increased mortality and hospitali-
+zation rates among COVID-19 infected patients having 
+recently diagnosed depression [37].
+Compared with nondepressed cohorts, individu-
+als with recently diagnosed depression were found to 
+have a significantly higher risk for COVID-19 infec-
+tion (Adjusted Odds Ratio 7.64, 95% confidence interval 
+7.45- 7.83) [35, 36]. Depression is correlated with altera-
+tion in immune markers, including decreases in mitogen 
+proliferation, natural-killer cell activity, and the types 
+and respective quantities of antibodies produced [38]. 
+Depression also dysregulates the neuroendocrine system 
+[39] and consequently increases inflammation, altering 
+the immune system’s effectiveness while simultaneously 
+increasing bystander damage [40]. Patients with depres-
+sion have disrupted T-cell function and elevated levels of 
+cytokines, such as tumor necrosis factor (TNF)-α, IL-1, 
+and IL-6 [40].
+Anxiety
+Pandemics are associated with heightened anxiety, on 
+both the collective and individual levels. The highly con-
+tagious nature of COVID-19 and the lack of treatment 
+options add to the increased threat to survival and may 
+trigger or aggravate existing anxiety and panic disorders.
+Anxiety contributes to significant dysfunction in 
+immune function by dysregulating the hypothalamic-
+pituitary-adrenal (HPA) axis [41, 42]. In a study of 42 
+patients with panic disorder and 42 healthy individuals, 
+Koh and Lee observed significantly lower IL-2 produc-
+tion and lymphocyte proliferation levels in patients with 
+anxiety disorder than in those without [43]. Complex 
+changes in the inflammation milieu related to aberrant 
+cytokines, particularly IL-1β, IL-6, TNF-α, and interferon 
+(IFN)-γ, have been documented in anxiety-based disor-
+ders [44]. Furthermore, patients with anxiety disorder 
+exhibit lower CD4+ cell counts, compared with healthy 
+controls. Studies have also documented the elevation of 
+suppressor CD8+ cells in these conditions, along with 
+a potentiated cytokine response [45]. This abnormal 
+response of the body’s immunological system in anxiety 
+and depression may contribute to heightened infection 
+and mishandling of severe infection, leading to a magni-
+fied, self-damaging cytokine response [46].
+Yoga and immunity
+Yoga is noted to have a positive impact on the immune 
+system [47–49] and inflammation pathways (Table  1). 
+It reduces inflammation and increases the number and 
+activity of natural-killer cells [50–52], thus enhancing 
+cell-mediated cytotoxicity of invading infective agents. 
+Evidence shows that yoga practice is associated with 
+improvement in CD3+ and CD4+ cell counts, salivary 
+cortisol levels, and IgA [53], a dominant player in innate 
+immunity that is present on body linings, such as those of 
+the lungs and the gastrointestinal tract [54]. With yogic 
+intervention, IgA levels increase at the exposed lung bor-
+der, where type II pneumocytes are prevalent. Addition-
+ally, cortisol, which dampens the body’s ability to fight 
+infection, is decreased by practicing yoga.
+Yoga has been found to be effective in immunocompro-
+mised conditions such as HIV. It helps to improve CD4+ 
+count and anxiety, depression, and stress among patients 
+with HIV [47, 56]. It has found to be equally effective in 
+improving CD56+ cell count, anxiety, and depression in 
+chronic disorders such as cancer [51].
+The cytokine storm unleashed by the body’s unregu-
+lated response to SARS-CoV-2 induces multiorgan 
+damage, resulting in high morbidity and mortality. 
+Myocarditis with severe refractory acute heart failure 
+has been noted [57]. As myocarditis is a clear signal for 
+cytokine-mediated damage, direct damage by the SARS-
+CoV-2 virus cannot be discounted, as both the heart and 
+vascular endothelium express the ACE2 receptors that 
+are entry gates for COVID-19 [13]. Cytokine profiles 
+in patients diagnosed with COVID-19 showed marked 
+Page 6 of 13
+Basu‑Ray et al. BMC Complementary Medicine and Therapies          (2022) 22:191 
+Table 1  Studies on Yoga and Immunity
+IgA denotes immunoglobulin A, IL interleukin, TNF tumor necrosis factor
+Author/Year
+Sample size
+Participant 
+characteristics
+Location/ Setting of 
+study
+Study design
+Intervention
+Results
+Conclusion
+Agnihotri et al., 2014 
+[40]
+276
+patients of mild to 
+moderate asthma (FEV 
+1 > 60%) aged between 
+12 to 60 years
+Department of 
+Pulmonary Medicine, 
+King George’s Medical 
+University, U.P., Lucknow, 
+India
+Randomized controlled 
+trial
+6-week yoga interven‑
+tion (30 minutes/day, 
+5 days/week of asana 
+and pranayama)
+Decreased eosinophil 
+and neutrophil counts 
+among patients with 
+asthma in yoga group
+Asana and pranay‑
+ama help to improve 
+hemoglobin counts and 
+to decrease bronchial 
+inflammation
+Chen et al., 2017 [50]
+94
+94 healthy pregnant 
+women at 16 weeks’ 
+gestation
+a prenatal clinic in Taipei
+longitudinal, prospec‑
+tive, randomized 
+controlled trial
+20-week yoga interven‑
+tion (60 minutes/day, 
+twice a week of asana 
+and pranayama)
+Significantly lower 
+cortisol levels; high IgA; 
+improvement in CD3+ 
+and CD4+ cell counts in 
+yoga group
+Asana and pranayama 
+bolster immune response 
+by reducing cortisol levels 
+and increasing IgA and 
+CD3/4+ counts
+Naoroibam et al., 2016 
+[45]
+44
+HIV-1 infected individu‑
+als
+Two HIV rehabilitation 
+centers of Manipur State 
+of India
+A randomized con‑
+trolled pilot study
+1-month yoga interven‑
+tion (60 minutes/day, 
+6 days/week of asana 
+and pranayama)
+Significantly higher 
+CD4+ cell counts in 
+yoga group
+Asana and pranayama 
+improve immunity in 
+HIV-1–infected adults
+Kuloor et al., 2019 [53]
+60
+HIV-positive (aged 
+30-50 years)
+Rehabilitation centres 
+across Bangalore
+A randomized con‑
+trolled study
+8-week yoga interven‑
+tion (60 minutes/day, 
+5 days/week of asana 
+and pranayama)
+Significantly lower rates 
+of anxiety, stress, and 
+depression in yoga 
+group
+Asana and pranayama 
+help lower stress, anxiety, 
+and depression levels of 
+HIV-positive patients
+Yadav et al., 2012 [55]
+86
+Patients with chronic 
+inflammatory diseases 
+and overweight/obese 
+subjects
+Integral Health Clinic, 
+Department of Physiol‑
+ogy, All India Institute of 
+Medical Sciences, New 
+Delhi, India.
+Preliminary results from 
+a nonrandomized pro‑
+spective ongoing study 
+with pre-post design.
+10-day yoga inter‑
+vention (asana and 
+pranayama)
+Decreased levels of 
+cortisol, IL-6, and TNF-α; 
+increased β-endorphin 
+levels
+Asana and pranayama 
+reduce inflammation and 
+stress levels over a short 
+span of intervention
+Rao et al., 2008 [39]
+98
+Recently diagnosed 
+stage II and III breast 
+cancer patients
+Comprehensive cancer 
+care center in Bangalore, 
+India
+Randomized controlled 
+trial
+1-month yoga interven‑
+tion (pranayama)
+Increased CD56+ cell 
+counts in yoga group
+Pranayama bolsters innate 
+immunity after surgery
+Page 7 of 13
+Basu‑Ray et al. BMC Complementary Medicine and Therapies          (2022) 22:191 
+	
+Table 2  Studies on Yoga and Inflammation
+IL denotes interleukin, TNF tumor necrosis factor
+Author/Year
+Sample size
+Participant 
+characteristics
+Location/ Setting of 
+study
+Study design
+Intervention
+Results
+Conclusion
+Kiecolt-Glaser et al., 
+2014 [63]  
+200
+Breast cancer survivors
+The Ohio State Univer‑
+sity, Columbus, OH.
+A randomized con‑
+trolled trial
+12-week yoga interven‑
+tion (twice weekly) 
+among breast cancer 
+survivors
+Significant decrease in 
+IL-6, TNF-α, and IL-1β
+Yoga practice helps 
+reduce inflammation
+Chen et al., 2016 [61]
+30
+Healthy, female Chinese 
+subjects
+School of Public Health, 
+Soochow University, 
+Jiangsu Province, China
+A Randomized Clinical 
+Trial
+8-week Hatha yoga 
+intervention (twice 
+weekly) among healthy 
+females
+Significant decrease 
+in IL-6, IL-8, IL-1β, and 
+TNF-α
+Yoga intervention 
+improves risk for 
+metabolic disorder and 
+inflammatory cytokine 
+dysregulation
+Rajbhoj et al., 2016 [64]
+48
+Male industrial workers
+Scientific Research 
+Department, Kaivaly‑
+adhama, Lonavla, Pune, 
+Maharashtra, India.
+A Randomized Clinical 
+Trial
+12-week yoga interven‑
+tion among healthy 
+male participants
+Significant decrease in 
+IL-10 and IL-1β
+Yoga practices could 
+reduce pro- and anti-
+inflammatory cytokines
+Page 8 of 13
+Basu‑Ray et al. BMC Complementary Medicine and Therapies          (2022) 22:191 
+elevation of T-helper lymphocyte type 1, IFN-γ, and 
+inflammatory cytokines IL-1β, IL-6, and IL-12 for at least 
+2 weeks after disease onset [58]. Among these, IL-6 is a 
+predictor of mortality in COVID-19 patients, which may 
+explain why primary evidence suggests that IL-6 inhibi-
+tors have shown promise as treatments [2, 59].
+Nagarathna et al. have documented the downregulation 
+of pro-inflammatory markers by yoga in their review arti-
+cle, hence supporting the utility of yoga as a complemen-
+tary intervention for subjects at risk or already infected 
+by SARS-CoV-2 virus [60]. Evidence indicates that yoga 
+practice helps to reduce inflammation by downregulating 
+a vast array of initiators and modulators that perpetuate 
+chronic inflammation, including IL-6, TNF-α, and IL-1β 
+[59, 60].
+Multiple randomized controlled trials have docu-
+mented a significant reduction in IL-6 levels in yoga 
+groups as compared with controls [61]. In one study, 
+researchers observed a significant reduction in IL-6 at 
+the 3-month follow-up in breast cancer patients who 
+practiced yoga, compared with a non-yoga control group 
+[62]. Moreover, increasing the amount of yoga practice 
+led to a more pronounced decrease in IL-6, pointing 
+towards a potential dose-response effect. Another rand-
+omized trial showed significantly reduced IL-6 secretion 
+after yoga practice in healthy individuals and significantly 
+reduced secretion of IL-6 when cultured blood was chal-
+lenged with a toll-like receptor agonist [62]. Multiple 
+studies have substantiated the beneficial effect of yoga on 
+inflammation and how it leads to CRS reduction, if not 
+inhibition (Table 2).
+Yoga during stressful events
+Various clinical trials have suggested a significant role for 
+yoga in reducing depression and its associated variables 
+(Table  3). In one study, 16 distressed women received 
+3 months of Iyengar yoga intervention, and a group of 
+8 women served as a control. After 3 months, women 
+in the yoga group showed a significant decrease in per-
+ceived stress, depression, and anxiety and in salivary cor-
+tisol; well-being improved significantly in the yoga group, 
+compared with controls [65].
+Yoga practice helps adherents to develop a positive 
+attitude during stress and to enhance self-awareness and 
+coping ability (Fig. 2). Yoga (asana, pranayama, and medi-
+tation) improves calmness and mindfulness and increases 
+an individual’s awareness and self-control [52]. Hatha 
+yoga (a variation in which only yoga postures are prac-
+ticed, with little or no meditation) improves HPA axis 
+dysregulation, corrects autonomic balance, and enhances 
+homeostasis by hastening recovery from stress [66]. 
+In a study among 131 participants with mild to moder-
+ate stress levels, 10 weeks of a Hatha yoga intervention 
+resulted in significant decreases in stress and anxiety, 
+along with enhanced relaxation [70]. In another study, 
+90-minute Hatha yoga sessions led to a significant reduc-
+tion in titers, negative affect, and cortisol levels [2, 72].
+Yoga helps to reduce the allostatic load of the stress 
+response [73]. It reduces sympathetic overactivity and 
+improves parasympathetic tone during a stressful situ-
+ation, as indicated by oxygen consumption level, heart 
+rate, and the high-frequency component of heart rate 
+variability [69].
+In a meta-analysis by Cramer et  al., yoga was found 
+to be an effective intervention for improving depression 
+[68]. Multiple studies have confirmed that yoga prac-
+tice reduced depression and improved mood and cog-
+nitive function among patients with mild to moderate 
+depression. This is achieved by enhancing the HPA axis 
+function, increasing brain-derived neurotrophic factor 
+(BDNF) levels and serotonin levels, and decreasing cor-
+tisol and inflammatory markers [68, 74, 75]. Autonomic 
+dysfunction is a hallmark of both anxiety and depres-
+sion [76]; regular yoga practice of pranayama can help 
+improve autonomic balance by decreasing sympathetic 
+overactivity and improving parasympathetic activity 
+[69]. Yoga also enhances the γ-aminobutyric acid system, 
+which is implicated in anxiety and depression [69].
+Yoga also improves various cognitive facets, such as 
+attention, concentration, memory, and executive func-
+tioning [71]. By improving body awareness, feelings, and 
+thoughts, yoga facilitates the experience of body sensa-
+tions in a nonjudgmental way [77]. It also enables the 
+practitioner to focus on present experience instead of 
+ruminating over future or past worries [78]. Self-aware-
+ness aids in avoiding addictive or overindulgent behav-
+iors, including overeating and excess sleeping. Yoga helps 
+people remain active and fosters a positive attitude dur-
+ing a lockdown.
+Cardio‑respiratory protective effects of yoga
+Given the severe cardiorespiratory illness manifested 
+in COVID-19 [1], consistent training in yoga may play 
+a protective role. Yoga has numerous positive effects 
+on the cardiovascular and respiratory systems. It has 
+been proven to improve various forms of cardiac 
+arrhythmia, congestive cardiac failure, ischemic heart 
+disease, and hypertension [79–83]. Regular yoga prac-
+tice attenuates systolic and diastolic blood pressure 
+and mean arterial pressure; it has also been credited 
+with maintaining appropriate blood pressure with less 
+medication [84]. Simply lying down in the Savasana 
+yogic posture for 20 minutes daily was found to be 
+effective in reducing systolic and diastolic blood pres-
+sure and the need for antihypertensive medication 
+[85]. Yoga has been shown to improve cardiac function 
+Page 9 of 13
+Basu‑Ray et al. BMC Complementary Medicine and Therapies          (2022) 22:191 
+	
+Table 3  Studies on Yoga and Stress, Anxiety and Depression
+BDNF denotes brain-derived neurotrophic factor, GABA γ-aminobutyric-acid
+Author/Year
+Sample size
+Participant 
+characteristics
+Location/ Setting of 
+study
+Study design
+Intervention
+Results
+Conclusion
+West et al., 2004 [66]
+69
+Healthy college stu‑
+dents
+Reed College, USA
+Longitudinal cohort 
+study
+90-minute Hatha yoga 
+session
+Significant reduction in 
+titers, negative affect, 
+and cortisol
+Hatha yoga reduces both 
+cortisol and perceived 
+stress level
+Michalsen et al., 2005 
+[67]
+24
+24 self-referred female 
+subjects who perceived 
+themselves as emotion‑
+ally distressed
+Germany
+Controlled prospective 
+non-randomized study
+3-month Iyengar yoga 
+intervention among 
+mental distressed 
+women
+Compared to the con‑
+trol groups significant 
+reduction in perceived 
+stress was observed
+Yoga helps to improve 
+perceived stress among 
+distressed women
+Janakiramaiah et al., 
+2000 [68]
+45
+Untreated melancholic 
+depressive patients
+Department of Psychia‑
+try, National Institute 
+of Mental Health and 
+Neurosciences, Banga‑
+lore, India.
+Randomized compara‑
+tive trial
+Sudarshan Kriya for 
+4 weeks among patients 
+with melancholic 
+depression
+Significant reduction in 
+depression score
+Sudarshan Kriya demon‑
+strated its antidepressant 
+effects in depression
+Smith et al., 2007 [65]
+131
+Subjects with mild to 
+moderate levels of stress
+Community in South 
+Australia
+A randomised compara‑
+tive trial
+10-week Hatha yoga 
+intervention
+Significant improve‑
+ment in SF-36 scores 
+was observed in yoga 
+group
+Hatha yoga intervention 
+helps to improve stress, 
+anxiety and health status 
+compared to relaxation
+Naveen et al., 2016 [69]
+54
+Adult outpatients with 
+Major Depression
+Out-patient services of 
+NIMHANS, Bangalore, 
+India
+Prospective cohort 
+study
+3-month yoga interven‑
+tion among patients 
+with depression
+Significant improve‑
+ment in depression, 
+BDNF, and serum corti‑
+sol was observed
+3 month yoga interven‑
+tion helped improve 
+BDNF, cortisol, and 
+depression in depressive 
+patients
+Streeter et al., 2012 [70]
+34
+Normal subjects with no 
+prior yoga experience
+Community in USA
+Randomized compara‑
+tive trial
+60-minute yoga inter‑
+vention
+27% increase in GABA 
+levels in yoga group
+Yoga could help a treat 
+disorders with low GABA 
+levels like depression, 
+anxiety
+Shelov et al., 2009 [71]
+46
+Normal staff and 
+students
+Ferkauf Graduate School 
+of Psychology (FGS) 
+and the Albert Einstein 
+College of Medicine 
+(AECOM) in Bronx, New 
+York
+Randomized controlled 
+trial
+8-week yoga interven‑
+tion
+Elevated levels of mind‑
+fulness, per Freiburg 
+Mindfulness Inventory
+Yoga increases mindful‑
+ness and potentially pre‑
+vents later development 
+of negative emotional 
+mood states
+Page 10 of 13
+Basu‑Ray et al. BMC Complementary Medicine and Therapies          (2022) 22:191 
+in patients with congestive cardiac failure [86] and 
+to improve baroreflex sensitivity, peripheral vascu-
+lar resistance, and heart rate variability [87]. It also 
+helps to attenuate catecholamine secretion, which has 
+been implicated in the etiology of severe cardiomyo-
+pathy and heart failure [88]. In one study, 8 weeks of 
+yoga intervention led to significant decrease in IL-6, 
+C-reactive protein, and extracellular superoxide dis-
+mutase, compared with non-yoga controls in patients 
+with heart failure [89]. Thus, evidence indicates that 
+yoga offers multi-faceted protection from cardiac 
+damage mitigated by aberrant cytokine release, such as 
+that seen with COVID-19.
+Limitations
+Our review is up-to-date, and the findings are of sig-
+nificant relevance but the important limitations must 
+be considered. The literature was searched and sum-
+marized thoroughly but our review was not system-
+atic, thus increasing the possibilities of selection and 
+publication bias. Our study included only articles in 
+English thus introducing a language bias. The associa-
+tions and characteristics identified in this review await 
+clearly proven causative mechanisms. Important con-
+founders exist in the cross-sectional studies reviewed 
+in the form of age, medications, and immune strength. 
+Larger randomized controlled trials will provide nec-
+essary insight on the role of yoga in immunomodula-
+tion and mental health during the present pandemic.
+Conclusions
+The aggregation of pathophysiological aberrations, 
+both psychological and somatic, secondary to COVID-
+19 pandemic and its resultant restrictions, may increase 
+the severity of the infection. Accumulated evidence 
+leads us to hypothesize that, for many, yoga practice 
+may attenuate the ill effects of COVID-19–induced 
+immune dysfunction at different stages.
+From a public health perspective, yoga represents a 
+low-cost, noninvasive strategy for alleviating the physi-
+cal and emotional toll of the COVID-19 pandemic. 
+The aforementioned yoga practices can be performed 
+at home, in adherence to social distancing guidelines. 
+Outcomes from an 8-week yoga intervention (asanas, 
+pranayama, and meditation) indicated that medical 
+treatment plus yoga is more effective than medical 
+treatment alone in reducing anxiety [90]. Relaxation 
+techniques like yoga and meditation helps in managing 
+chronic or long term stress by regulating the cytokines, 
+thus assisting people to overcome co-morbidities asso-
+ciated with diseases and improving the quality of life; 
+which is important in COVID-19 and post-COVID 
+illness [2, 21]. Notwithstanding, appropriate clini-
+cal trials are required to document the efficacy of this 
+strategy.
+Abbreviations
+ACE: Angiotensin-converting enzyme; BDNF: Brain-derived neurotrophic 
+factor; COVID-19: Coronavirus disease; CRS: Cytokine release syndrome; HIV: 
+Human immunodeficiency virus; HPA: Hypothalamic-pituitary-adrenal; IFN: 
+Interferon; IgA: Immunoglobulin A; IL: Interleukin; TNF: Tumor necrosis factor.
+Acknowledgements
+Jeanie F. Woodruff, BS, ELS, contributed to the editing of this manuscript.
+Authors’ contributions
+IBR: Hypothesis and concept, KM, DK, RR, KC: Research and Manuscript 
+preparation: KC, AA, IBR, KM, DK, RR, KC, NR, MCM, BP, MS, IVB, AA, SR, DKK, 
+ML, ST, GNL, HC, GF, and NRH: Manuscript review and contribution of critical 
+intellectual content, including figures and tables. The author(s) read approved 
+the final manuscript.
+Funding
+None.
+Availability of data and materials
+The datasets used and/or analyzed during the current study are available from 
+the corresponding author on reasonable request.
+Declarations
+Ethics approval and consent to participate
+Not applicable.
+Consent for publication
+Not applicable.
+Competing interests
+The authors declare that they have no competing interests.
+Fig. 2  Yoga helps to improve various health parameters related to 
+immunity. [Contribution by Mohammad A. Salem, MD; used with 
+written permission]
+Page 11 of 13
+Basu‑Ray et al. BMC Complementary Medicine and Therapies          (2022) 22:191 
+	
+Author details
+1 
+Cardiologist & Cardiac Electrophysiologist, Memphis VA Medical Center, 
+1030 Johnson Ave, Memphis, TN 38104, USA. 2 
+The University of Memphis, 
+Memphis, TN, USA. 3 
+All India Institute of Medical Sciences, Rishikesh, Uttara‑
+khand, India. 4 
+Department of Yoga, Central University of Rajasthan, Bandar 
+Seendri, Rajasthan, India. 5 
+New Cross Hospital, Heart and Lung Centre, Royal 
+Wolverhampton NHS Trust, Wolverhampton, UK. 6 
+Icahn School of Medi‑
+cine at Mount Sinai, New York, NY, USA. 7 
+Department of Internal Medicine, 
+Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA. 
+8 
+Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karnataka, 
+India. 9 
+Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, 
+Rajasthan, India. 10 
+University Grants Commission, New Delhi, India. 11 
+Anve‑
+shana Research Laboratories, Swami Vivekananda Anusandhana Samsthana 
+(SVYASA University), Bangalore, Karnataka, India. 12 
+Morarji Desai National Insti‑
+tute of Yoga, Ministry of AYUSH, Govt. of India, New Delhi, India. 13 
+Department 
+of Neurology, Post Graduate Institute of Medical Education and Research, 
+Chandigarh, India. 14 
+Public Health Foundation of India, New Delhi, India. 
+15 
+Department of Physiology, All India Institute of Medical Sciences, New Delhi, 
+India. 16 
+Cardiology Section, Baylor College of Medicine, Michael E. DeBakey 
+VA Medical Center, Houston, TX, USA. 17 
+Department of Internal and Integra‑
+tive Medicine, University of Duisburg-Essen, Essen, Germany. 18 
+Department 
+of Psychiatry, Benson-Henry Institute for Mind-Body Medicine, Massachusetts 
+General Hospital, Boston, MA, USA. 
+Received: 23 December 2020   Accepted: 5 July 2022
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+lished maps and institutional affiliations.

yogatexts/A nonrandomized non-naïve, comparative study of the effects of kapalabhati and breath awareness on event- related potentials in trained yoga practitioners.txt

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+THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
+Volume 15, Number 3, 2009, pp. 281–285
+© Mary Ann Liebert, Inc.
+DOI: 10.1089/acm.2008.0250
+A Nonrandomized Non-Naive Comparative Study 
+of the Effects of Kapalabhati and Breath Awareness 
+on Event-Related Potentials in Trained Yoga Practitioners
+Meesha Joshi, M.Sc., and Shirley Telles, Ph.D.
+Abstract
+Objectives: The study was conducted to compare the P300 event-related potentials recorded before and after
+(1) high-frequency yoga breathing (HFYB) and (2) breath awareness.
+Design: The P300 was recorded in participants of two groups before and after the intervention session (1 minute
+in duration).
+Settings and location: All participants were receiving yoga training in a residential yoga center, Swami
+Vivekanada Yoga Research Foundation in Bangalore, India.
+Subjects: Thirty (30) male participants formed two groups (n  15 each) with comparable ages (within an age
+range of 20–35 years) and comparable experience of the two techniques, the minimum experience being 3
+months.
+Interventions: The two groups were each given a separate intervention. One group practiced a HFYB at a fre-
+quency of approximately 2.0 Hz, called kapalabhati. The other group practiced breath awareness during which
+participants were aware of their breath while seated, relaxed.
+Outcome measures: The P300 event-related potential, which is generated when attending to and discriminat-
+ing between auditory stimuli, was recorded before and after both techniques.
+Results: The P300 peak latency decreased after HFYB and the P300 peak amplitude increased after breath aware-
+ness.
+Conclusions: Both practices (HFYB and Breath awareness), though very different, influenced the P300. HFYB
+reduced the peak latency, suggesting a decrease in time needed for this task, which requires selective atten-
+tion. Breath awareness increased the P300 peak amplitude, suggesting an increase in the neural resources avail-
+able for the task.
+281
+Introduction
+B
+reath regulation is an important part of Hatha yoga prac-
+tice, and there are several practices that involve chang-
+ing the rate, depth, and other aspects of breathing.1,2 One of
+the techniques involves high-frequency breathing (i.e., ap-
+proximately at 2.0 Hz) with forceful exhalation. This tech-
+nique is called kapalabhati in Sanskrit (kapala  forehead,
+bhati  shining), which suggests that the practice stimulates
+the brain.3 Kapalabhati is hence a high-frequency yoga breath-
+ing (HFYB) technique.
+In 11 advanced practitioners, the  and -1 activity in the
+electroencephalogram (EEG) increased during the first 5
+minutes of a 15-minute HFYB (kapalabhati) session.4 -1 ac-
+tivity remained high in the next 5 minutes, though  activ-
+ity increased in the later part in the practice. This trend of
+increased  activity continued after the 15-minute practice
+session, which was characterized by a relative increase of
+slower EEG frequencies and subjective relaxation.
+HFYB practice was associated with autonomic changes,
+based on the heart rate variability, suggestive of increased
+sympathetic and reduced vagal activity.5 Increased sympa-
+Swami Vivekananda Yoga Research Foundation, Bangalore, India.
+thetic tone is associated with better vigilance.6 Hence the
+shift in the autonomic balance toward sympathetic domi-
+nance following HFYB may have some bearing on the fact
+that HFYB practice improved performance in a task for at-
+tention and was reported as a Letter to the Editor.7
+The effect of HFYB on attention was studied in medical
+students, middle-aged adults, and people over the age of 60
+years.7 All of them were given a cancellation task before and
+after a 1-minute session of HFYB on one day and before and
+after a breath awareness session (as an alternate intervention)
+on another day. All three categories of volunteers showed im-
+proved performance in the cancellation task, which requires
+selective and sustained attention, as well as the ability to shift
+attention, after HFYB. The study did not attempt to under-
+stand the mechanisms underlying the improvement.
+The present study was designed to assess the effects of
+HFYB (i.e., kapalabhati) and breath awareness on an event-re-
+lated potential generated and associated with the ability to
+pay attention to a given stimulus and discriminate between
+stimuli. The P300 component of event-related potentials is
+considered a neuro-electric phenomenon, since it is gener-
+ated when participants attend to and discriminate between
+stimuli that differ on a single aspect.8 In auditory stimuli, the
+difference is in their frequency. The P300 reflects cognitive
+events requiring attentional and immediate memory pro-
+cesses. In the present study, the P300 was recorded before
+and after (1) high-frequency yoga breathing (i.e., HFYB or
+kapalabhati) and (2) breath awareness.
+Materials and Methods
+Participants
+The participants were 30 male volunteers with ages be-
+tween 20 and 35 years. The 30 participants actually com-
+prised two groups (n  15 each). One (1) was asked to prac-
+tice HFYB group average and the other group was asked to
+practice breath awareness. The mean age  standard devia-
+tion (SD) of the group who practiced kapalabhati was 26.0 
+4.6 years, and for the breath awareness group it was 27.6 
+3.7 years. The two groups’ ages did not differ significantly
+(p  0.05, t-test for unpaired data). The immediate effects of
+these practices were assessed as described below, under “De-
+sign of the Study.” They were all residing at a yoga center
+(i.e., Swami Vivekanada Yoga Research Foundation, in Ban-
+galore, India). These two groups were drawn from a larger
+sample, based on (1) their willingness to participate in the
+trial, (2) their having normal health and not being on med-
+ication, and (3) all of them having a minimum of 3 months
+experience of both HFYB (kapalabhati) and breath awareness.
+Males alone were studied as the P300 (evoked by visual stim-
+uli) varied with gender.9 The study was approved by the in-
+stitution’s Ethics Committee, and all participants gave their
+signed consent to participate.
+Design of the Study
+All 30 participants were assessed before and after 1-minute
+practice sessions. For half of the participants, the practice ses-
+sion was HFYB, and for the remaining 15 participants the
+practice was breath awareness. For both groups, the dura-
+tion of a practice session was 1 minute. While all participants
+were drawn from a comparable larger sample (i.e., persons
+receiving training in yoga at a residential training center),
+they were not randomly assigned to the two groups. On the
+other hand, participants did not self-select to which group
+they would be assigned. Hence, they can be considered as
+two comparable, though nonrandomized groups. The ab-
+sence of a standard method to assign persons to the two
+groups is a methodological limitation of the study.
+Also, the participants were all yoga practitioners, residing
+at a yoga center. While being given training, participants are
+taught that the practice of HFYB (kapalabhati) could increase
+alertness and the ability to be attentive. Participants are also
+taught that breath awareness is practiced to increase the abil-
+ity to be aware of internal sensations. Given this background,
+even though they were not especially told that the P300 task
+is a task to assess attention, participants can be considered
+non-naïve and may have been aware of the hypothesis of the
+study, which is another limitation of the study and arises
+from the participants’ knowledge about the yoga practices.
+Recording Conditions
+P300 auditory event-related potentials were recorded using
+a Nicolet Bravo System (Nicolet Biomedical, Madison, WI).
+The P300 component is generated by giving a simple task re-
+quiring discrimination between two stimuli that are presented
+in a random sequence known as the “oddball” paradigm (i.e.,
+with the infrequent stimulus being considered the oddball).8
+During assessments, subjects were seated in a sound-attenu-
+ated and dimly lit cabin and were monitored on a closed cir-
+cuit television, receiving instructions through an intercom.
+Electrode Positions
+Ag/AgCl disk electrodes were affixed with electrode gel
+(10–20 conductive paste, D.O. Weaver & Co., Aurora, CO) at
+Cz referred to linked earlobes with the ground electrode at
+FPz, based on the International 10–20 system for electrode
+placement.10 Eye movements were recorded with an electro-
+oculogram (EOG) as a bipolar derivation with electrodes
+placed 1 cm above and 1 cm below the outer canthus of the
+right eye. All electrode impedances were kept below 5 k.
+Amplifier Settings
+The EEG activity was amplified with a sensitivity of 100
+V. The prestimulus delay was set at 75 ms and the P300
+event-related potentials were computer averaged in 300 trial
+sweeps, with a range between 75 and 750 ms. The rejection
+level for artifacts was kept at 90%. The low-pass filter was
+set at 0.01 Hz and the high-pass filter was set at 30 Hz.
+Stimulus Characteristics
+Binaural tone stimuli of alternating polarity delivered at
+0.9 ms with a frequency of 1 KHz for standard stimuli and
+2 KHz for target stimuli were used to trigger online averag-
+ing of the EEG.8 The percentage of standard stimuli was set
+at 80 and for the target stimuli was set at 20. The stimulus
+intensity was kept at 70 db sound pressure level (SPL).
+Recording Procedure
+Assessments were recorded immediately before and after
+the intervention. Participants were asked to keep their eyes
+JOSHI AND TELLES
+282
+closed during a recording. They were asked to avoid sub-
+stances that would influence their cognitive functions (e.g.,
+tea and coffee for the caffeine content) on the day prior to
+and on the day of the assessments. The standard and target
+stimuli were delivered through close-fitting earphones
+(TDH-39, Amplivox, Oxford, UK). Participants were asked
+to distinguish between tones and mentally count target stim-
+uli.
+Interventions
+HFYB or kapalabhati practice involves rapid breathing with
+a frequency of approximately 2.0 Hz, during which only ex-
+halation is an active process. Participants were asked to start
+the practice and after approximately 10 seconds they would
+reach the final rate (in this case, approximately 2.0 Hz). This
+would be the actual beginning of the 1-minute session. The
+subjects were timed by the experimenter and after a minute
+they were asked to stop. Hence their actual breathing ses-
+sion was for 70 seconds, out of which they would have been
+breathing at the expected rate for approximately 60 seconds
+and taking 10 seconds to attain the final rate. The fact that
+approximately 10 seconds is required to reach the expected
+rate of approximately 2.0 Hz is based on previous unpub-
+lished observations. Throughout the practice the practition-
+ers sit upright, close their eyes, and breathe in and out
+through their nose. At the end of each session participants
+were asked whether they experienced dizziness, tingling, or
+numbness of the fingers or lightheadedness, as possible signs
+of hyperventilation. None of them reported any of these
+symptoms. However, attempting to assess hyperventilation
+based on these symptoms rather than measured carbon diox-
+ide levels is recognized as inadequate and is a limitation of
+the study.
+Breath awareness was the “alternate” intervention. Dur-
+ing this practice the participants were asked to sit quietly,
+being aware of their breath without manipulating their
+breathing. They were asked to be aware of the flow of air as
+it enters and passes through the nasal passage. Hence,
+throughout the practice the attention is directed toward the
+breath.
+Data Extraction
+The peak amplitude (in V) was defined as the voltage
+difference between a prestimulus baseline and the largest
+positive peak of the P300 within a 250–450-ms latency win-
+dow. The peak latency (ms) was defined as the time from
+stimulus onset to the point of maximum positive amplitude
+within the latency window. The peak latency and peak am-
+plitude were measured for potentials recorded at Cz referred
+to linked earlobes.
+Data Analysis
+The peak amplitudes and peak latencies obtained before
+and after HFYB practice and after breath awareness were
+compared using a repeated-measures analysis of variance,
+with one between-subjects factor (i.e., groups, with two lev-
+els, HFYB group and Breath awareness group), and one
+Within-subjects factor (i.e., States, with two levels, Pre and
+Post).
+Post-hoc analysis with multiple comparisons and Bonfer-
+roni adjustment was carried out to compare values recorded
+before and after HFYB, as well as before and after breath
+awareness.
+Results
+Repeated measures analysis of variance
+The peak latency of the P300 potential showed a signifi-
+cant difference between States [i.e., Pre and Post, with F 
+7.829, df  1,14, p  0.05]. For the P300 peak amplitude, there
+was a significant interaction between Groups (i.e., HFYB and
+Breath awareness groups) and States (i.e., Pre and Post) [F 
+4.746, df  1,14, p  0.05]. In both cases the Hyunh-Feldt ep-
+silon was equal to 1.
+Post-hoc comparisons
+Multiple post-hoc comparisons were carried out with Bon-
+ferroni adjustment. There was a significant reduction in the
+P300 peak latency following HFYB compared to before (p 
+0.05, one tailed). Following breath awareness, on the other
+hand, the P300 peak amplitude increased significantly com-
+pared to before (p  0.05, two-tailed).
+The group mean values  SD of the P300 peak latencies
+and peak amplitudes recorded from Cz are given in Table 1.
+Discussion
+One minute of HFYB at approximately 2.0 Hz decreased
+the P300 peak latency, while a 1-minute session of breath
+awareness increased the P300 peak amplitude.
+In earlier studies the P300 has been recorded before and
+after meditation techniques and after another yoga breath-
+ing practice. For example, definite changes were recorded in
+YOGA BREATHING AND ERPs
+283
+TABLE 1.
+PEAK LATENCIES AND PEAK AMPLITUDES OF P300 
+PRE- AND POST-KAPALABHATI SESSIONS
+HFYB
+Breath Awareness
+(n  15)
+(n  15)
+Latency (ms)
+Pre
+358.20  32.53
+362.80  25.32
+Post
+339.20*  29.99
+340.40  45.57
+Amplitude (V)
+Pre
+8.25  4.90
+5.23  4.04
+Post
+6.79  2.79
+6.55**  3.96
+Values are group means  standard deviation.
+*p  0.05 (one-tailed), **p  0.05 (two-tailed), post-hoc tests with Bonferroni adjustment, comparing
+“post” with respective “pre” values.
+the P300 following transcendental meditation (TM).11 The
+P300 was recorded using a passive auditory listening trial
+paradigm with variable interstimulus intervals between
+identical tone stimuli. There were three groups (viz., expe-
+rienced TM meditators, novices to TM and nonmeditator
+controls). The two groups of meditators had shorter laten-
+cies despite differences in ages (e.g., an average age of 41
+years in experienced mediators and an average age of 20
+years in novices). In another study, the P300 was assessed in
+experienced TM practitioners at pretest baseline, after 10
+minutes of rest, or after 10 minutes of TM practice with con-
+ditions counterbalanced across meditators.12 After TM, the
+P300 latency decreased relative to no change after the rest
+condition.
+The P300 was also studied before and after practicing an-
+other meditation technique, called cyclic mediation (CM).13
+CM consists of cycles of ‘stimulating’ and of ‘calming’ prac-
+tices. Comparisons were made with P300 recordings taken
+before and after an equal duration of supine rest. A greater
+magnitude of decrease in latency was noted after CM com-
+pared to supine rest.
+There is a single report of the effect of practicing a volun-
+tarily regulated breathing technique (or pranayama) on the
+P300.14 The participants were patients with depression and
+the comparison was with people with normal health. P300
+amplitudes were lower in depressives to begin with, but the
+amplitudes increased after practicing the yoga breathing tech-
+nique (Sudarshan Kriya Yoga), for three months, so that the am-
+plitudes were comparable with those of unaffected persons.
+The P300 latency reflects the speed of stimulus classifica-
+tion, is generally not related to the overt response, and is in-
+dependent of the behavioral reaction time.15 Hence, the P300
+latency is an index of stimulus processing rather than re-
+sponse generation and is used as a motor-free measure of cog-
+nitive function. The P300 peak latency is negatively correlated
+with mental functions in normal persons; shorter latencies are
+associated with superior cognitive performance in tasks for
+attention and immediate memory. The P300 amplitude is be-
+lieved to indicate the level of activity related to processing
+incoming information and is sensitive to the resources avail-
+able for attention engaged in completing the task.16
+The neuroelectric events that underlie the generation of
+the P300 arise from interaction between the frontal lobe, the
+hippocampus, and the temporoparietal lobe.17 The primary
+neural generators for the P300 are in the anterior cingulate
+when new stimuli are processed into working memory. Sub-
+sequent activation of the hippocampal formation occurs
+when interconnections between the frontal lobe and the tem-
+poral or parietal lobe are active.18
+The decreased P300 peak latency following HFYB suggests
+that the practice may have reduced the time required for this
+task, which requires selective attention. Based on the change
+in the P300 peak amplitude, breath awareness appeared to
+increase the neural resources available for the attentional task.
+The decrease in P300 latency after different yoga practices
+such as HFYB in the present study and following meditation
+techniques such as TM11,12 and cyclic meditation (CM)13 in
+earlier studies, could be related to two factors. These two fac-
+tors, which are mentioned below, may also apply to the in-
+creased P300 amplitude following breath awareness (in the
+present study) and following Sudarshan Kriya yoga, in an
+earlier study.14 However, the contribution of these factors to
+the changes in P300 is entirely speculative and is not backed
+by any additional recordings.
+The first factor is that all yoga practices, including yoga
+postures (yogasanas), voluntarily regulated breathing (prana-
+yama), and meditation, emphasize the importance of relax-
+ation and awareness of internal sensations.19
+In connection with this, an objective assessment was made
+of the ability of experienced meditators to detect their heart-
+beat, which is a standard, noninvasive measure of resting in-
+teroceptive awareness.20 While no objectively recorded dif-
+ference was found between meditators and nonmeditators,
+meditators consistently self-rated their interoceptive perfor-
+mance as superior and the difficulty of the task as easier.
+Hence, a feeling of being able to be aware of internal sensa-
+tions could facilitate overall awareness and the ability to be
+attentive. However, this again is speculation. This factor may
+be particularly relevant for the increased P300 peak ampli-
+tude following breath awareness.
+The second factor is that a substantial percentage of yoga
+practices are recognized to involve a certain amount of strain.
+In contrast, some of the changes associated with practicing
+yoga techniques, which includes postures (asanas), regulated
+breathing (pranayama), and meditation, reflect reduced strain.
+The most often quoted and early documented changes were
+a decrease in heart and breath rates and in oxygen consump-
+tion following TM.21 These changes suggested that medita-
+tion was a state of parasympathetic dominance. However,
+subsequent studies have shown that most yoga techniques
+do show increased activity in some subdivisions of the sym-
+pathetic nervous system (this may be cardiosympathetic, va-
+somotor, or sudomotor sympathetic nervous system activity)
+that often occur along with other changes suggestive of re-
+duced arousal, hence giving rise to the description of these
+practices as producing a state of “alertful rest.”
+This has been shown for meditation,22,24 HFYB or kapal-
+abhati,5,25 and even for yoga postures (asanas).26 Since in-
+creased sympathetic activity is associated with better vigi-
+lance,5 the fact that yoga practice may increase activity in
+some subdivisions of the sympathetic nervous system may
+also explain the improved performance in the P300 oddball
+task after HFYB. However, though autonomic changes have
+been studied during breath awareness, there were no signs
+of increased sympathetic nervous system activity during
+breath awareness.27 Hence, this explanation (i.e., of increased
+sympathetic activity and of better vigilance) may more
+clearly explain the improved P300 performance after HFYB,
+while the improved interoception may better explain the im-
+provement after breath awareness.
+Hence, both interventions (i.e., HFYB and breath aware-
+ness) influenced the performance in the P300 task. HFYB re-
+duced the time required for the task, whereas breath aware-
+ness appeared to increase the available neural resources
+required for the task. Further studies with simultaneous
+monitoring of autonomic variables would be helpful for un-
+derstanding whether autonomic changes did contribute to
+the changes in the P300 component following these practices.
+In the absence of such recordings, all the ideas presented
+here about the possible mechanisms involved are mere spec-
+ulations, which is a limitation of the study. Other limitations
+of the study include the fact that the subjects were non-naive
+to the intervention, and hence there was no way of knowing
+whether the brain effects were influenced by their expecta-
+JOSHI AND TELLES
+284
+tions. Finally, since both interventions were given for a very
+brief duration (i.e., 1 minute each), this limits interpreting
+the findings and future studies would use longer-duration
+interventions.
+Conclusions
+Both practices (i.e., HFYB and breath awareness), though
+very different, influenced the P300. HFYB (at approximately
+2.0 Hz) reduced the P300 peak latency, suggesting a decrease
+in the time needed for this task, which requires selective at-
+tention. Breath awareness increased the P300 peak ampli-
+tude, suggesting an increase in the neural resources avail-
+able for the task.
+Acknowledgments
+The study formed part of a project funded by the Central
+Council for Research in Yoga and Naturopathy, under the
+Ministry of Health and Family Welfare, Government of In-
+dia, and is gratefully acknowledged. Also, the authors would
+like to mention that the study was inspired by the ideas of
+the late T. Desiraju, who was a professor at the National In-
+stitute of Mental Health and Neurosciences, Bangalore, In-
+dia.
+Disclosure Statement
+The authors state that no competing financial interests ex-
+ist.
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+Maharishi Dayanand Gram
+Bahadrabad, Haridwar, Uttarakhand 249408
+India
+E-mail: [email protected]
+YOGA BREATHING AND ERPs
+285

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+© 2022 Journal of Family Medicine and Primary Care | Published by Wolters Kluwer ‑ Medknow	
+2284
+Introduction
+Technology is becoming ubiquitous. The evolution of 
+smartphones has transformed usage dynamics regardless of 
+age, gender, and economic status. The functions may vary from 
+placing a phone call to checking email, online transactions, 
+texting, surfing the web, playing online games, and listening to 
+music.[1] This problematic overuse has led to addiction in the form 
+of frequent checking of the smartphone.[2,3] Although addiction 
+has been defined as “a pathological condition that one cannot 
+tolerate without continuous administration of substances,” it 
+is now applied to behavioral addictions, such as gaming and 
+internet use.[4] A growing literature has confirmed that usage of 
+smartphones is more evident among emerging adulthood, with 
+an age range of 18–29 years.[5]
+Although smartphone addiction is not recognized as a 
+clinical disorder in the Diagnostic and Statistical Manual of 
+Mental Disorders (DSM‑V) or International Classification of 
+Diseases (ICD‑10), the estimated prevalence of smartphone 
+addiction is in the range of  10% to 20%.[6] Studies have 
+reported a prevalence of problematic smartphone use among 
+children and adolescents as high as 10% in countries such as the 
+United Kingdom,[7] 16.7% in Taiwan,[8]16.9% in Switzerland,[2] 
+30.9% in Korea,[9] and 31% in India.[10] Further, a survey among 
+the six Asian countries showed the highest prevalence of 
+internet addiction through smartphone ownership is 62%.[11] 
+Studies reported many aspects of problematic smartphone 
+behavior are similar to other recognized behavioral addictions 
+A perspective of yoga on smartphone addiction: 
+A narrative review
+Chaitanya K. Putchavayala1, Deepeshwar Singh2, Rajesh K. Sashidharan1
+1Division of Yoga and Physical Science, 2Division of Yoga and Life Science, Swami Vivekananda Yoga 
+AnusandhanaSamsthana (S‑VYASA), Bangalore, Karnataka, India
+Abstract
+Evolution in technology is drastically becoming automatic and making life easier. Among those technologies, smartphones are 
+fast‑changing technology that is equipping humans to work from anywhere. Frequent usage and dependency on smartphones have 
+increased, which in turn contributes to changes in psychosocial behavioral aspects. Addiction plays an important role in modifying 
+the healthy habits of individuals. Problematic usage of smartphones affects both physical and psychosocial health and emerges as a 
+cornerstone of psychosocial disorder. However, there is a dearth of data to understand the core concepts of smartphone addiction 
+and there is a need to understand from the broader perspective. Yoga is considered one of the viable protocols to provide the way 
+for digital detoxification from technology and smartphone addiction by promoting self‑regulation. Yoga brings back a healthy 
+living style, which allows individuals to have enough physical activity through asanas, emotional stability, and awareness through 
+meditation and breathing practices. We hypothesize that a holistic approach to yoga can regulate the symptoms associated with 
+smartphone addiction by increasing the stability of the body and mind and promoting emotional detachment and self‑regulation, 
+which play an important role in the de‑addiction process.
+Keywords: Biopsychosocial model, digital‑detoxification, review, smartphone addiction, yoga
+Review Article
+Access this article online
+Quick Response Code:
+Website: 
+www.jfmpc.com
+DOI: 
+10.4103/jfmpc.jfmpc_1765_21
+Address for correspondence: Dr. Deepeshwar Singh,
+Division of Yoga and Life Science, Swami Vivekananda Yoga 
+Anusandhana Samsthana (S‑VYASA), Bangalore ‑ 560 105, 
+Karnataka, India.
+E‑mail: [email protected]
+How to cite this article: Putchavayala CK, Singh D, Sashidharan RK. 
+A  perspective of yoga on smartphone addiction: A  narrative review. 
+J Family Med Prim Care 2022;11:2284-91.
+This is an open access journal, and articles are distributed under the terms of the Creative 
+Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to 
+remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is 
+given and the new creations are licensed under the identical terms.
+For reprints contact: [email protected]
+Received: 03-09-2021	
+	
+Revised: 15-12-2021
+Accepted: 16-12-2021	
+	
+Published: 30-06-2022
+Putchavayala, et al.: A perspective of yoga on smartphone addiction: A narrative review
+Journal of Family Medicine and Primary Care	
+2285	
+Volume 11  :  Issue 6  :  June 2022
+such as gambling disorder and other traditional addictions 
+(e.g., substance use, smoking, and alcohol). The pathological 
+use of smartphones has created a new kind of maladaptive 
+behavior and emerging as a cornerstone of  psychosocial 
+disorders. Subsequently, researchers have shown greater interest 
+in studying smartphone addiction.[2,12,13] The symptoms associated 
+with problematic smartphone usage negatively influence 
+physiological and psychosocial behavior[14] with low psychological 
+well‑being,[15] depression, loneliness,[14] social anxiety,[16] and 
+cognitive disorders.[17]
+Given the current literature, researchers are actively exploring the 
+significance of yoga and meditation as a viable tool for addressing 
+psychological problems and addictive behaviors. Yoga is a 
+communion of mind and body. Problematic smartphone usage is 
+slowly and steadily gaining influence in manipulating psychosocial 
+behavior. There is a dearth of data in this area to understand 
+the core characteristics. Therefore, we hypothesize that there is 
+a need to understand the problem in a much broader spectrum 
+from the purview of yogic texts that can be recommended as 
+primary care intervention.
+Understanding Smartphone Addiction from a 
+Biopsychosocial Perspective
+The biopsychosocial model of  addiction posits that 
+biological/genetic, psychological, and sociocultural factors 
+contribute to substance use and all must be taken into 
+consideration in prevention and treatment efforts.[18]
+As explained in [Figure 1], smartphone addiction is a complex 
+and heterogeneous problem,[6]and there is a need to understand 
+it from a biopsychosocial perspective. Griffith has proposed 
+the components model of addiction, which proposes that all 
+addictions comprise a set of criteria that rewards physiological 
+and psychosocial behaviors. He proposed six core components 
+for understanding the biopsychosocial process of smartphone 
+addiction. These are salience, mood modification, tolerance, 
+withdrawal, conflict, and relapse.[19]
+Salience
+Predominant smartphone usage over other activities of 
+life influences feelings (craving), cognitive distortions, and 
+deterioration of  social behavior. A study on university 
+students has shown high cognitive absorption levels among 
+the smartphone‑addicted group.[20] Cognitive absorption is 
+characterized by temporal dissociation, focused immersion, 
+heightened enjoyment, control, and curiosity.[21] Further, an 
+functional magnetic resonance imaging (fMRI) study reported 
+that smartphone addiction inhibits cognitive control during 
+emotional processing and influences social interaction.[22] 
+Similarly, a neuroimaging study on adolescents with mobile phone 
+addiction correlates higher impulsive scores with altered gray 
+matter volume and white matter integrity.[23] Similarly, subjects 
+with gaming addiction have shown enhanced craving and brain 
+activity in the lateral and prefrontal cortex for gaming stimuli.[24]
+Mood modification
+The subjective experiences reported using smartphones as a 
+coping strategy to avoid loneliness and dysphoric mood.[25] A 
+study observed that students utilizing their mobile phones as a 
+coping mechanism might get trivial appeasement for loneliness, 
+boredom, and anxiety‑induced situations. However, long‑term 
+utilization might negatively influence mental health.[26] A study 
+reported that dysfunctional cognitive and emotional processes 
+mediate anxiety, depression, and problematic smartphone 
+usage.[27] Furthermore, smartphone addiction and childhood 
+psychological maltreatment.[28] In a recent study with Indian 
+university students, 43% agreed the mobile phone provides an 
+escape from problems, and 70% agreed that the mobile phone 
+helped them overcome bad moods such as feelings of inferiority, 
+helplessness, guilt, anxiety, and depression.[29]
+Tolerance
+The prolonged time spent or frequent checking on smartphones 
+to achieve the former mood modifying effects. Earlier studies 
+claim that the frequent checking of smartphones is because of 
+instant access to rewards. Further, social media has reportedly 
+become the source of perceived social support.[30] Currently, 
+people ascribe perceived social support by likes and shares on 
+social networking sites (e.g., Facebook, Instagram, and Twitter) 
+and communicating through icons.[31] A study has shown that 
+Facebook connectedness is related to greater life satisfaction, 
+lower anxiety, and depression levels, and enhanced social 
+capital.[32] In contrast, extroverts and neurotics with a high 
+Facebook usage negatively influence life satisfaction and social 
+relationships.[33]
+Withdrawal
+Recent studies coined a new word Nomophobia (No mobile 
+phone phobia), and FOMO, “fearing of  being without a 
+mobile phone,” which is the condition of feeling anxiety when 
+Figure 1: Bio psychosocial perspective of smartphone addiction
+Putchavayala, et al.: A perspective of yoga on smartphone addiction: A narrative review
+Journal of Family Medicine and Primary Care	
+2286	
+Volume 11  :  Issue 6  :  June 2022
+missing their smartphones. This condition is widely visible in 
+youngsters with low self‑esteem, anxiety, impulsiveness, and 
+high extroversion/introversion levels.[34] Another study reported 
+interpersonal sensitivity, obsession‑compulsion, and strong 
+predictors for nomophobia.[35]
+Conflict
+Spending prolonged time on smartphones leads to intrapersonal 
+and interpersonal conflicts, influencing their social relations with 
+family and friends.[25] In addition, texting is a potential distractor 
+among school and college students impacting classroom 
+performance.[36] A study reported that the average time for 
+distraction in class is less than 6 minutes.[37]Furthermore, there 
+has been a decline in face‑to‑face interactions among teens and 
+making them less talkative to adults.[38]
+Relapse
+There is not sufficient literature to support the relapse condition 
+in smartphone addiction. This condition tends to check the 
+smartphone to recur the previous hedonic experience after a 
+long period of abstinence. Checking smartphones after waking 
+up and before sleeping to get updated is associated with low 
+self‑control.[39]
+Understanding the Nature of Smartphone 
+Addiction ThroughYoga
+Addiction is defined as a behavior, over which an individual 
+has impaired control with harmful consequences.[40] It can 
+also be viewed as a result of  “mindless” states involving 
+escapist attitudes, automatic thinking, emotional reactivity, 
+social isolation, and low self‑regulation.[41] Research has 
+pointed out that yoga helps control addictive symptoms by 
+promoting self‑regulation.[42,43] According to the World Health 
+Organization (WHO), psychological health is one of the key 
+components in defining health. The core concepts of yoga 
+emphasize the nature of the mind and its afflictions (Kleshas). 
+Traditional texts such as Patanjali Yoga Sutras (PYS), Bhagavad 
+Gita (BG), Hatha Yoga Pradipika (HYP), and Yoga Vasistha (YV) 
+have highlighted the mind (Chitta) and the interplay of qualities 
+of  a person (Gunas) on mental health, and the afflictions 
+caused in the absence of  self‑control and self‑regulation. 
+Sage Patanjali defines yoga as, when the perplexities of the 
+thoughts are controlled by self‑regulation, the mind will reach 
+its pristine (PSY1:2). The afflictions in the mind caused by 
+these perplexing thoughts stem out from ignorance of the 
+truth (Avidya), egoism or identity (Asmita), attachment (raga), 
+aversion (Dwesha), and fear of losing (Abhinivesha) (PSY 2:3). 
+Ayurveda says, “asatmyaindriyarthasannikarsha,” the unhealthy 
+sensory perception causes disharmony in the body either as an 
+increase or decrease of humor (doshas).
+Sankhya’s philosophy postulates that qualities (Gunas) play a 
+vital role in defining a person’s temperament (Swabhava). The 
+Guans are classified into three types. Tamas is characterized by 
+dullness, inactive, illusion, depression, laziness, impulsiveness, 
+and excessive sleep. When Rajas is dominant, it symbolizes 
+passion and desire, egoism, self‑centeredness, greed, restlessness, 
+ambition, and a sense of  self‑gratification. Finally, Sattva 
+is associated with stability, self‑control, clarity of thought, 
+discipline, self‑regulation, one‑pointedness, meditative mind, 
+and detachment.[44]
+The constant use of smartphones has caused sensory overload 
+invigorating the mind for repeated subjective experiences, 
+and the propensity of these experiences is causing ill effects. 
+According to BG, the pleasures from these sensual indulgences 
+develop an attachment that ignites the desire to have more. 
+When not fulfilled, it leads to anger. From anger comes the 
+delusion, followed by loss of memory, and from that comes 
+the destruction of  intellect, leading to the perished mind 
+(BG 2:62‑63). Patanjali further explained how these obstacles 
+manifest into afflictions (PSY 1:30 & 31).
+The above picture [Figure 2] illustrates how these disturbances 
+of the mind (Chittavikshepas) lead to mental agitation (Adhi) 
+and further as a disease in the body (Vyadhi).
+Researchers have found that personality with openness to 
+experience, neuroticism, and extroversion correlates with 
+the smartphone’s problematic  usage.[45,46] Afflictions of 
+the mind explain the symptomatic nature of  smartphone 
+addiction such as mental laziness  (Styana), idleness, and 
+dullness; indecisiveness, doubtful  (Samsaya); carelessness, 
+negligence, and procrastination (Pramada); laziness (Alasya); 
+craving for enjoyment, sensuality  (Avirati); erroneous 
+perception, false views (Brantidarsana); failing to attain desired 
+results  (Alabdhabumikatva); instability  (Anavasthitatva). The 
+ramifications of these are transmuted as a disease (Vyadhi) in the 
+body as sorrow (Dukha), depression (Daurmanasya), shaking off 
+the body (Aangamejayatva); unrhythmic breathing (Svasaprasvasa 
+Vikshepa). According to yoga, disease (vyadhi) is of two types, 
+disease born out of mind, stress born psychosomatic ailments, 
+and neurotic problems (Adhija Vyadhi). The second category 
+is external causes such as accidents, infections, injury, and 
+non‑stress (AnadhijaVyadhi). According to the Yoga Vasistha, 
+mind (Adhi) and disease (vyadhi) are the sources of suffering. 
+Sometimes they follow each other, and at times they cause each 
+other. At the outset, they both root from ignorance and lack of 
+self‑control.[44]
+Yoga for digital detoxification
+Addiction is in opposition to the idea of autonomy.[47,48] Yoga 
+helps develop the ability to connect with life, detox our mind, 
+body, and emotions, and live a harmonious and meaningful 
+life. Current literature has shown that yoga can be a viable tool 
+to manage the afflictions of the body and mind by instigating 
+self‑regulation with the combined practices of asana, pranayama, 
+pratyahara, relaxation, and meditation.[41] These are better 
+explained in detail as:
+Putchavayala, et al.: A perspective of yoga on smartphone addiction: A narrative review
+Journal of Family Medicine and Primary Care	
+2287	
+Volume 11  :  Issue 6  :  June 2022
+Asanas
+Asana is the Sanskrit word for physical posture that helps 
+develop physical and mental stamina and strengthen willpower. 
+In his yoga sutras (PSY), Patanjali expounds that the primary 
+objective of asana is to develop steadiness with ease in the 
+sitting posture and maintain an erect spine for the free flow of 
+energy during meditation (PSY 2.46). The benefits of asana 
+(Asana siddhi) can be reaped with dedication, uninterrupted 
+practice, and a sense of reverence (PSY 1.14). Effects of asana 
+are in the order of somatopsychic, which includes the release 
+of endorphins that induce a sense of relaxation, ease, and 
+well‑being in the practitioner.[49] A study reported that after 1 h 
+of a yoga asana session, there had been an increase of 27% in 
+GABA (gamma‑aminobutyric acid) levels.[50,51] Further, induced 
+stress levels were rescinded with Shavasana compared to supine 
+postures and resting in a chair.[52] Another study reported that 
+techniques using a combination of stimulation followed by 
+relaxation had reduced oxygen consumption, energy expenditure, 
+and physiological arousal compared to other relaxation 
+techniques.[53]
+Pranayama
+Pranayama is the process of  controlling the life force. 
+”Pran”’ means breath, life force; ”Ayama” is lengthening or 
+extension through control. Patanjali expounds pranayama 
+is much more than inhalation and exhalation of  breath. It 
+is the process of  slow and extended inhalation  (puraka) 
+followed by (kumbhaka) retention of  breath and (rechaka) 
+the slow exhalation PYS (2:49). Regular practice improves the 
+functioning of  vital systems of  the body. Mind is a complex 
+structure and highly volatile. Controlling it is a daunting task. 
+The breathing process is connected with the brain and the 
+central nervous system, which is the gateway for emotional 
+responses. Pranayama controls the erratic impulses in the 
+brain by regulating the rhythms of  breath. Recent evidence 
+suggests that rapid breathing  (Bhastrika) pranayama has 
+significantly reduced anxiety and stress levels and affects the 
+brain’s areas involved in processing emotions, attention, and 
+awareness.[54] It has also shown a reduction in craving with 
+smoking addiction,[55] anxiety, and depression.[56] Further, 
+bhramari pranayama enhanced response inhibition and 
+cognitive abilities.[57]
+Pratyahara
+Pratyahara is the fifth limb of Astanga yoga. Pratyahara has a 
+pivotal role in the process of de‑addiction. Pratyahara refers 
+to the conscious withdrawal of the mind from the sensual 
+gratifications (PSY 2:54). Controlling the mind that is conditioned 
+to seek sensual gratifications is challenging. The highest form 
+of pratyahara is not about suppressing the senses; however, 
+sublimating them inward to get into the depths of the mind 
+(PSY 2.55). The other way of doing it is focusing on the space 
+between the two eyebrows with a steady breath; one can gain 
+control over the senses (BG 5.27‑28). Addiction is primarily 
+because of craving and lack of self‑control.[58] Sensory indulgence 
+is the main form of entertainment prevailing with smartphone 
+addiction. Indriya (senses) Pratyahara helps understand the nature 
+of craving and restrain the senses from external gratification by 
+abstaining from these devices to rejuvenate the mind through 
+awareness and self‑control.
+Meditation
+The outset of meditation transpires through Abhyasa (practice) 
+and Vairagya  (detachment)  (PSY 1. 13&16). The practice 
+of pratyahara promotes detachment towards the objects of 
+sensuality. Meditation is referred to as dhyana in yoga. The 
+mind with an uninterrupted flow of consciousness is called 
+dhyana (PSY 3.2). Over time, various techniques of mediation 
+have been evolved from different schools of thought. West 
+has shown greater interest in mindfulness and transcendental 
+meditation. They are extensively studied for their therapeutical 
+benefits in physiological and psychosocial disorders. Studies 
+have reported mindfulness meditation increases somatosensory 
+processing,[59] sleep,[60] quality of life,[61] and reduced emotional 
+reactivity.[62] Further, it effectively controls stress,[63] anxiety,[64] 
+and depression levels.[65] Studies on addiction have reported 
+meditation increases prefrontal activation, which might help in 
+the de‑automatization of addictive responses[66] and improved 
+cognitive functions,[67] response inhibition,[68]self‑control,[69] 
+psychological well‑being,[70] and abstinence from craving.[71,72]
+Figure 2: Illustration of mental agitation by Maharshi Patanjali
+Putchavayala, et al.: A perspective of yoga on smartphone addiction: A narrative review
+Journal of Family Medicine and Primary Care	
+2288	
+Volume 11  :  Issue 6  :  June 2022
+Discussion
+Addiction is defined by the American Society of Addiction 
+Medicine (ASAM) as a primary, chronic disease of the brain’s 
+reward, motivation, memory, and related circuitry. Dysfunction 
+in these circuits results in distinct biological, psychological, 
+social, and spiritual manifestations.[73] According to one study, 
+internet addiction causes an increase in dopamine in the brain, 
+just like any other substance addiction.[74] Excessive use of 
+the internet through smartphones is a relatively new type of 
+addiction. The condition is not officially recognized by the 
+American Psychiatric Association. Nonetheless, many medical 
+professionals and researchers around the world recognize it as a 
+behavioral addiction. According to several studies, excessive use 
+of smartphones, such as gambling, can change and negatively 
+impact an individual over time. Further, issues arising from 
+excessive smartphone use are a growing social issue that is being 
+debated globally. Many studies have found that the prevalence 
+is high among young adults. Mental illness during the critical 
+period of emerging adulthood can result in lifelong disability by 
+impairing an individual’s ability to develop socially, occupationally, 
+and educationally.[75] Currently, individuals visiting the clinics 
+of primary care and psychologists with complaints of anxiety, 
+loneliness, depression, and sleep related problems.[76] Reports 
+suggest that incidence of musculoskeletal pain, pain in the lower 
+back, neck and shoulders are also on the rise.[77]
+Further, research has shown that family environment is one of the 
+strong predictors of adolescent internet addiction. Furthermore, 
+studies reported there is a relationship between communication, 
+attitude, and cohesiveness in the family and adolescent internet 
+addiction.[78] This highlights the care that should be taken by 
+family members and primary care physicians to prevent the 
+spread of this maladaptive behavior. Recent evidence shows that 
+the Cognitive Behavioral Model, exercise therapy, and art therapy 
+are effective in reducing anxiety, depression, impulsiveness, and 
+with drawl symptoms for smartphone and internet addiction.[79,80] 
+However, there is a dearth of data and further investigations are 
+required to address this problem in a holistic way.
+In contrast, yoga is proven to be a viable tool to address 
+physiological, psychosocial, and addictive behaviors by promoting 
+self‑regulation and self‑control. Yoga is a holistic process of 
+bringing body, mind, and spirit into communion. It has a lineage 
+of more than 5000 years. It has shown a positive effect on 
+perceived stress and quality of life with regular practice among 
+young adults by cultivating subjective well‑being.[81] Empirical 
+evidence report that regular practice of yoga in a school has 
+a positive influence on dysphoric moods, emotion regulation, 
+and self‑esteem.[82] A review postulated that regular practice of 
+yoga and meditation has enhanced attention and their functional 
+anatomical relationships along with an increase in the gray matter 
+volume enabling individuals to control movement, memory, and 
+emotions.[83] Including yoga as an adjunct treatment modality by 
+the primary care centers and doctors would help in upholding 
+the biopsychosocial dimensions of health in society.
+Conclusion
+According to recent evidence, researchers are paying more 
+attention to studies on behavioral addictions. Because of its 
+problematic and maladaptive behavior, studies on smartphone 
+addiction have recently increased. Despite this, some studies 
+claim that the prevalence is only 10% to 20%. Because of its 
+market penetration and presence in modern life, there is a need 
+for a broader understanding of the problems associated with it 
+from a biopsychosocial perspective.
+Yoga, in contrast, appears to be a promising treatment for 
+addiction and other psychiatric disorders. Its ability to connect 
+with life aids in the detoxification of our minds and bodies, 
+as well as the regulation of emotions, thereby improving our 
+well‑being. This is an important aspect of addressing addiction’s 
+craving, compulsive behavior, tolerance, and relapse conditions. 
+As a result, incorporating yoga and meditation into daily life will 
+aid in the regulation of the symptoms of maladaptive behavior 
+associated with smartphone addiction.
+Key message
+The excessive use of smartphones is negatively influencing 
+people's behavior. Looking at the problem from a bio-psychosocial 
+standpoint would help us understand its complexities. Yoga is 
+a mind-body medicine, allows us to understand the nature of 
+behaviour in a holistic way, as well as a possible solution to 
+this maladaptive behavior, by promoting self-regulation and by 
+cultivating subjective well-being.
+Highlight
+•	
+Understanding smartphone addiction from the viewpoint of 
+modern psychology and yoga
+•	
+Giving the perspective of yoga as a viable solution to control 
+the symptoms of smartphone addiction.
+•	
+Including yoga as an adjunct treatment modality would be 
+beneficial for the family and primary care doctors.
+Financial support and sponsorship
+Nil.
+Conflicts of interest
+There are no conflicts of interest.
+References
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yogatexts/A practical approach for total well-being based on ancient yogic knowledge.txt

@@ -0,0 +1,591 @@
+34
+© 2019 International Journal of Yoga - Philosophy, Psychology and Parapsychology | Published by Wolters Kluwer - Medknow
+Yoga is becoming very popular across the globe. We need to understand the holistic 
+approach of Yoga in the light of ancient scriptures to explore one’s own nature. 
+Yoga is not mere physical exercises and postures; rather it is a lifestyle. If we 
+examine the current trend, starting from childhood to old age, all are undergoing a 
+drastic change in lifestyle due to rapid technological advancement which is leading 
+to pain, misery, and diseases. We have to examine and understand the perfect way 
+of life in real sense as discussed in various ancient scriptures, where emphasis is 
+given on following a systematic routine in accordance with nature. The concept of 
+total health and well‑being is the real Vedantic insight which has been originally 
+stated in many of ancient scriptures of India. There are hundreds of efforts being 
+made all over the globe with different ideologies in interpreting Yoga based on 
+their own understanding. This study is aimed at the conceptual understanding of 
+Yoga as lifestyle in day‑to‑day living as propounded in our ancient scriptures.
+Keywords: Ancient scriptures, health, right understanding, well‑being, 
+yoga life‑style
+Submission:  28-06-2019, 
+Revision:  26-08-2019, 
+Acceptance:  16-09-2019, 
+Publication:  17-10-2019
+A Practical Approach for Total Well‑being Based on Ancient Yogic 
+Knowledge
+Rajesha Halekote Karisetty, Ramachandra Ganapati Bhat
+Access this article online
+Quick Response Code:
+Website: www.ijoyppp.org
+DOI: 10.4103/ijny.ijoyppp_10_19
+Address for correspondence: Prof. Rajesha Halekote Karisetty, 
+ 
+Division of Yoga‑Spirituality, S‑VYASA Yoga 
+University, Vivekananada Road, Kallubalu Post, Anekal 
+Taluk, Bengaluru ‑ 560 083, Karnataka, India. 
+E‑mail: [email protected]
+of living, we are failing to maintain health due to 
+imbalance in need and greed. With this background, 
+we need to understand the concept of Yoga lifestyle as 
+guided by ancient scriptures and great yoga masters with 
+their natural and eco‑friendly living.
+Insight for right understanding
+As far as the right understanding is concerned, we have 
+to follow some guidelines and methodology where it 
+will not lead to any bias or misunderstanding. For valid 
+apprehension, an ancient text TarkaSaìgraha which 
+gives a comprehensive understanding of nyäya  (logic/
+methodical reasoning) and vaiçeñika  (material science) 
+states;
+Review Article
+Introduction
+A
+ncient concepts and realistic understanding of 
+the ideal yoga lifestyle for total well‑being are 
+well expounded by ancient scriptures with practical 
+and holistic approach. The insight portrayed in 
+traditional sources such as Kaöhopaniñat, Bhagavad 
+Gitä, Haöhayoga Pradépikä, Pataïjali Yogasütra, and 
+Yoga Väsiñöha, which are considered as authentic 
+yoga texts. Meanwhile, we have äyurvedik texts such 
+as Suçåtasaàhitä and carakasaàhitä as ancient roots 
+for yoga way of life and well‑being along the lines of 
+modern scientific understanding. The insight of ideal 
+lifestyle is cemented with the daily routine by great 
+seers of ancient times.
+There is a need to understand and implement a holistic 
+approach of Yoga lifestyle to maintain health and 
+well‑being as the whole globe is in alarming condition 
+as far as noncommunicable disorders are concerned. 
+Although science and technology are growing day 
+by day with new innovations to increase the standard 
+Division of Yoga‑Spirituality, 
+S‑VYASA, Bengaluru, 
+Karnataka, India
+Abstract
+This is an open access journal, and articles are distributed under the terms of the 
+Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows 
+others to remix, tweak, and build upon the work non‑commercially, as long as 
+appropriate credit is given and the new creations are licensed under the identical 
+terms.
+For reprints contact: [email protected]
+How to cite this article: Karisetty RH, Bhat RG. A practical approach for 
+total well-being based on ancient yogic knowledge. Int J Yoga - Philosop 
+Psychol Parapsychol 2019;7:34-8.
+[Downloaded free from http://www.ijoyppp.org on Wednesday, January 27, 2021, IP: 136.232.192.146]
+Karisetty and Bhat: Yoga as a lifestyle for health and well‑being
+35
+35
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 7  ¦  Issue 2  ¦  July‑December 2019
+ywawRnuÉvítuivRx>àTy]anuimTyupimitzaBdÉedat!,
+yathärthanubhavaçcaturvidhaùpratyakñänumityup
+amitiçäbdabhedät| (Ta. Sa.Section 3‑21)
+The 
+methodology 
+for 
+valid 
+apprehension 
+is 
+four‑fold: 
+perception, 
+inference, 
+analytical 
+knowledge, and testimony.[1] Any concept which is 
+examined under these four means is accepted to be 
+valid statement for executing in a day‑to‑day life. 
+With this background, ancient scriptures speak about 
+the yoga way of life with practical approach guided 
+by vedantic insight.
+Understanding from Upaniñats
+Kaöhopaniñat, one of the major upaniñats has very well 
+portrayed the concept of yoga as Adhyätma yoga  (the 
+journey within). It is very easy to implement a natural 
+and yogic lifestyle if one understands the underlying 
+factor of this concept.
+AXyaTmyaegaixgmen dev<mTvaxIraeh;RzaekaEjhait. 12.
+adhyätmayogädhigamenadevaàmatv
+ädhéroharñaçokaujahäti || 1.2.11||
+The objective of practicing Adhyätma yoga is very well 
+summed up here. A  wise by experiencing the blissful 
+nature within, which is attained through meditation on 
+the self, abandons both pleasure and sorrow. Meditation 
+on self is possible when one is able to maintain the 
+equilibrium of mind by withdrawing all sense organs.[2] 
+A further statement supports the intended outcome of 
+yoga;
+ta<yaegimitmNyNteiSwraimiNÔyxar[am!,
+täàyogamitimanyantesthirämindriyadhäraëäm | 
+Ka. Up. 2.3.11|
+That alone is understood to be yoga which reduces 
+the intensity of sensual energies and brings them to a 
+state of steadiness. As a result, one will be free from 
+committing blunders by being aware of all activities for 
+a successful life journey.[3]
+A 
+practical 
+Insight 
+for 
+Yoga 
+lifestyle 
+from 
+Bhagavad Gita
+The real concept of yoga lies in bringing a moderation in 
+various aspects in our lifestyle such as food, recreation, 
+activities, and sleep. This is nothing but an eco‑friendly 
+life.
+yu´aharivharSy yu´ceòSy kmRsu, yu´SvßavbaexSy yaegae 
+Évit Ê>oha. 6‑17.
+yuktähäravihärasya yuktaceñöasya karmasu |
+yuktasvapnävabodhasya yogo bhavati duùkhahä || 
+6‑17||
+He who is temperate in his habits of eating, sleeping, 
+working, and recreation can mitigate all material 
+pains by practicing the yoga system. Food: When 
+pure food is consumed, our understanding becomes 
+absolutely discriminative in the right path. Due to higher 
+understanding, mental reflections will be pure. The memory 
+will be very strong when one has a proper understanding; 
+due to the strong memory, one is released from all worldly 
+bondages.  (Ch. Up.  7.26.2) Recreation: Those additional 
+activities apart from our daily activities that are meant to 
+rejuvenate our inner self should be moderate in nature. 
+Recreational activities are the one that the mind tends to 
+involve in excess indiscriminately. Activities: Our daily 
+activities from dawn to dusk should also be moderate. 
+By all means, it should avoid bad actions. Good deeds 
+constructively strengthen a person. Sleep: Sleep should 
+also be moderate both in quantity and quality. Not 
+sleeping enough and excessively sleeping, both harm our 
+system, and also quality of sleep should be good, with 
+proportionately balanced dream and deep state sleep.
+This concept of moderate lifestyle is mentioned across 
+different traditional texts. Although we have different 
+terminologies called Veda, Vedänta, yajïa, and Yoga, 
+the spirit of all these is one and the same, and as far 
+as lifestyle is concerned they all unequivocally voice 
+moderation.
+The concept of total well‑being
+Well‑being is not just limited to healthy state of 
+the physical body, but it is beyond the body as 
+human 
+existence 
+has 
+five 
+layers. According 
+to 
+taittiréya upaniñat, the very existence of the physical 
+body  (annamayakoça) is supported by the vital force/
+breath energy  (präëamayakoça), mind  (manomayakoça), 
+the 
+intellect 
+(vijïänamayakoça), 
+and 
+blissful 
+layer.  (änandamayakoça).[4] In this modern age, the 
+concept of health and well‑being is well accepted by 
+the World Health Organization, and it defines health 
+as “Health is a state of complete physical, mental, and 
+social well‑being and not merely the absence of disease 
+or infirmity.”[5] The uniqueness of this statement is not yet 
+amended since 1948. Physical and mental well‑being can 
+be well connected with the first three layers of existence 
+whereas the fourth and fifth layer is very well‑connected 
+with social and spiritual well‑being. Hence, it makes 
+sense that the well‑being as expounded by Upanishads is 
+surely a holistic approach of ideal lifestyle.
+Insights from äyurveda
+This statement of health and well‑being is very well 
+understood with more clarity by one of the ayurvedic 
+texts suçåtasaàhitä, which states as follows:
+smdae;> smai¶í smxatumli³ya>, àsÚaTmeiniNÔymna> 
+SvSw> #TyiÉxIyte. su s<.
+[Downloaded free from http://www.ijoyppp.org on Wednesday, January 27, 2021, IP: 136.232.192.146]
+Karisetty and Bhat: Yoga as a lifestyle for health and well‑being
+36
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 7  ¦  Issue 2  ¦  July‑December 2019
+samadoñaùsamägniçca samadhätumalakriyäù
+prasannätmenindriyamanäù svasthaù ityabhidhéyate || 
+Su.Sam. ||
+The hymn/verse conveys the unique understanding 
+of well‑being where all three doña/humors  (väta‑air, 
+pitta‑fire, and kapha‑water) are in balance; whose 
+appetite and digestive fire are in balanced state with 
+cellular metabolism comprising of complete digestion, 
+absorption, and assimilation; the functions of seven 
+dhätus  (tissues) with quality and quantity are normal; 
+whose mala/metabolic wastes and toxins  (sweat, urine, 
+and feces) are properly and timely excreted; the sensory 
+and motor organs with an efficiency of the right perception 
+and strength; the undisturbed mind, the ätma (soul) also 
+in a pleasant/blissful state,  (unconditionally happy and 
+devoid of stress) such a person is named as having 
+overall well‑being or Svasthaù.[6]
+This verse is explained further with modern anatomical 
+and physiological understanding.
+Sama Doçaù
+Three doña/humors; väta, pitta, and kapha are three 
+functions that regulate all physiological, psychological, 
+and spiritual facets of a person. The etymology of 
+the word “doña” is defined as “doñyati iti doçaù,” 
+meaning that which contaminates is called “doshah.” 
+The imbalance of humors causes disease in the body. 
+Väta or the air element governs breathing, movements, 
+discharges, impulses, and the human senses. Pitta or the 
+fire element deals with hunger, thirst, digestion, excretion, 
+temperature, and circulation. It also corresponds to 
+strength, energy, youth, intelligence, and executive 
+abilities. The kapha or the water element controls the 
+stability, lubrication, movements, body luster, digestive 
+tract, glands, and fluids of the body. Other factors 
+such as defect in the dhätu  (body tissues), toxins, 
+and waste materials are the result of imbalance in the 
+doñas.[7] The Table 1 showing the functionalities of sub 
+doñas/humors which are responsible for the physiological, 
+psychological, and spiritual traits are enlisted below.[8]
+Samägni (digestive fire)
+Referred to as body metabolism which comprise of the 
+functions such as digestion, absorption, and assimilation. 
+This digestive fire is mainly responsible for converting 
+assimilated food into dhätus (body tissues).[9]
+Samadhätu (the right composition of body tissues 
+within the range)
+There are seven tissues which makes the physiology 
+of the body named as rasa (plasma), rakta (blood), 
+mäàsa (muscle), asthi (bones), majja (bone marrow), 
+meda (fat) and śukra (Semen and Ova). If we look at 
+these body tissues, the abnormalities and imbalances 
+are the root cause for many kinds of diseases. Thus, 
+the physiological health is perfectly maintained by the 
+balance of these body tissues.[10]
+Malakriyäù (excretory functions)
+As far as perfect health is concerned, a lot of emphases 
+is given on excretion of metabolic wastes and toxins 
+(sweat, urine, and feces) which keep the body away 
+from diseases.
+Prasannätmenindriyamanäù (pleasant state of soul, 
+mind and sense organs)
+It is well assumed that proper excretory functions ensure 
+good health and increases the lifespan. The importance 
+of social well‑being is very much stressed by äyurveda, 
+which can be achieved only being holistic in nature 
+with contented spirit, senses, and mind. It describes the 
+methods of maintaining the ideal lifestyle for people of 
+all ages.[6]
+Moderation is the master key for well‑being
+A perfect state of health and well‑being which is devoid 
+of destructive pains such as diseases  (physical‑somatic) 
+and miseries  (mental‑psychosomatic) is achieved when 
+we strictly stick to the natural way of lifestyle which is 
+followed by moderation in food, recreation  (walking, 
+traveling, etc.,) or activities without exertion and 
+sleep‑wake up at regular disciplined time says 
+Bhagavad‑Gita  (B.G 6.17). On the contrary, if 
+moderation is lost such as meger food or overeating 
+and wakeful even at late night or one who sleep less 
+will have quick deterioration in one’s own life span. 
+One can be very active with full of positive energy for 
+discharging one’s own duties with full awareness without 
+any exertion if proper food and sleep is maintained 
+moderately.[10] Further Bhagavad Gita says, pain, grief, 
+and diseases are caused by food which is bitter, sour, 
+saline, excessively hot, pungent, dry, and burning. 
+The food which are stale, tasteless, putrid, rotten and 
+impure leads to sleep, sloth, and inadvertence.[11] Even 
+modern scientific evidence prove that overeating is an 
+early alarming sign of added psychological distress or 
+is a compromised psychological health.[12] Most of the 
+adolescents do not undergo the recommended amount 
+of sleep, resulting in significant daytime sleepiness. 
+Inadequate sleep and drowsiness impact all areas of 
+youthful functioning, including academic, emotional and 
+social, which emphasizes the importance of evaluating 
+sleepy adolescents.[13]
+Importance of Brahma Muhurta for better health 
+and well‑being
+Getting up early in the morning is utmost important 
+as per experienced seers, and it is insisted in ancient 
+scriptures. According to prätaùsüktaà of ågveda, one 
+who exposes to the nature early in the morning will be 
+[Downloaded free from http://www.ijoyppp.org on Wednesday, January 27, 2021, IP: 136.232.192.146]
+Karisetty and Bhat: Yoga as a lifestyle for health and well‑being
+37
+37
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 7  ¦  Issue 2  ¦  July‑December 2019
+charged with positive and vital energy for better health, 
+wealth, and well‑being with full of consciousness and 
+force.[14] One of the studies also supports the improved 
+attention and memory of early rising.[15]
+Key practices for health and well‑being
+Although 
+Bhagavad 
+Géta 
+and 
+Upaniñat 
+give 
+a 
+broader and philosophical understanding, the practical 
+implications are discussed in Haöhayoga texts, Pataïjali 
+Yoga Sütra, and Yoga Väsiñöha. The six cleansing 
+practices 
+– 
+ñaökarma, 
+äsanas, 
+different 
+breathing 
+techniques, and präëäyäma are the main practices for 
+physiological and psychological well‑being. One of the 
+Haöhayoga texts Gheraëda Samhitä says purification, 
+firmness, steadiness, patience, lightness, inner perception, 
+and noninvolvement are the seven practices to make the 
+body and mind free from disease and disorder.[16] Shiva 
+Samhita proclaims präëäyäma increases life energy, 
+gives strength, nourishment, makes the body full of 
+energy, destroys all diseases, and gives health.[17] Maharñi 
+Pataïjali directs the practice of one‑pointedness principle 
+or truth that leads to overcome pain and miseries. 
+Furthermore, different methods are recommended for 
+the tranquility of mind.[18] The concept of disease and 
+its root causes are well discussed in Yoga Väsiñöha. 
+Eating inappropriate food which is räjasik and tämasik, 
+an occupation which is at unsuitable places, conduct 
+of affairs in unsuitable time, and association with 
+unscrupulous people and by the diminution or overfilling 
+of the system causes diseases by directly influencing 
+the energy channels either by blocking the energy 
+flow or may lead to abnormal flow. Psychological and 
+physiological health is achieved by calming down the 
+mind. If the physiological health is still not corrected on 
+removal of mental dualities, one can resort to auspicious 
+methods of employing suitable materials and mantras/or 
+sacred words and through following the advice of science 
+of healing or medical treatment.[19]
+Dinacarya and åtucarya
+Maintaining one’s health depends on following the 
+principles elaborated according to äyurveda texts. 
+Svasthavåtta is an integral part and parcel of äyurveda 
+which primarily emphasizes on Dinacarya, åtucarya, 
+and Sadvåtta. A  daily routine  (Dinacarya) is absolutely 
+necessary to bring essential change in body, mind, and 
+consciousness. It also regularizes a person’s circadian 
+rhythm  (biological clock), helps digestion, absorption, 
+and assimilation and leads to peace, happiness, and 
+longevity. Seasonal change (åtucarya) is very evident in 
+the environment we live in. We witness various changes 
+in bio‑life around us with change in season. Human 
+being too a part of the same ecology; the body is greatly 
+influenced by the external environment. If the body is 
+unable to adopt itself to stressors due to changes in 
+specific traits of seasons, it may lead to imbalance of 
+constituents which in turn may render the body highly 
+susceptible to one or other kinds of disorders. Sadvåtta 
+refers to good personal and social behavior which 
+gives a healthy long‑life and happiness. Hence, the 
+implementation of these life principles prevents diseases 
+and preserves health.
+Time is an essential factor which advocates regulation 
+of day‑to‑day activities in a systematic manner. Early 
+waking up is described in classical texts as Brahma 
+Muhurta. This enables an individual to get sufficient 
+Table 1: Influence of väta, pitta, and kapha in regulation of physiological, psychological, and spiritual facets
+Sub‑doñas of väta
+Präëa
+Udäna
+Samäna
+Apäna
+Vyäna
+Inhalation, perception 
+through the senses and 
+mind
+Speech, self‑expression, 
+effort, enthusiasm, 
+strength, and vitality
+Intestines
+peristalsis
+Nutrient and
+Absorption
+All downward impulses such 
+as urination, elimination, 
+menstruation, sexual 
+discharges, etc.
+Skin 
+Horripilation 
+Shivering 
+Circulation, heart rhythm, 
+locomotion, etc.
+Sub‑doñas of pitta
+Päcaka
+Raïjaka
+Älocaka
+Sädhaka
+Bhräjaka
+Digestion of food, 
+nutrients, and waste
+Liver ‑ Bile/blood
+Formation of red blood 
+cells. Gives color to blood 
+and stools
+Eyes and retina
+Visual 
+perception
+Emotions such as contentment, 
+memory, intelligence, and 
+thoughts
+Luster and complexion, 
+temperature and 
+pigmentation of the skin
+Subdoñas of kapha
+Kledaka
+Avalambaka
+Bodhaka
+Tarpaka
+Çleñaka
+Humidifying and thawing 
+of the food in the initial 
+stages of digestion
+Lubrication of the heart 
+and lungs. Provides 
+strength to the back, chest, 
+and heart
+Mouth, pharynx
+Saliva
+Taste
+Brain, cerebrospinal fluid
+Calmness, happiness, and 
+stability
+Synovial fluid
+Lubrication of all joints
+[Downloaded free from http://www.ijoyppp.org on Wednesday, January 27, 2021, IP: 136.232.192.146]
+Karisetty and Bhat: Yoga as a lifestyle for health and well‑being
+38
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 7  ¦  Issue 2  ¦  July‑December 2019
+time to practice the entire Dinacarya schedule without 
+hindrances and lapse.[20] A systematic schedule is 
+absolutely necessary to bring essential change in 
+body, mind, and consciousness. A  daily schedule helps 
+to establish balance in one’s constitution also as it 
+regularizes a person’s biological clock which involves 
+digestion, absorption, and assimilation, and makes 
+self‑esteem, discipline, peace, happiness, and longevity. 
+Getting up early in the morning, elimination, cleaning 
+of senses, apply oil to the head and body  (abhyanga), 
+bathing, exercises, lunch, dinner, and bedtime are all 
+an integral part of daily routine. A human being is part 
+of the ecological system who is greatly influenced by 
+external environment. Hence, one should be following 
+these instructions to maintain body‑mind‑spirit health.[21]
+If one is undisciplined against nature with a sedentary 
+lifestyle, the health consequences and mechanism of 
+diseases are explained by Yoga Väsiñöha as follows:
+ÊrÚaMyvhare[ ÊdeRza³m[en c, Ê:kal Vyvhare[ 
+ÊjRnas¼dae;t>.31.
+]I[Tvat! va=itpU[RTvat! nafIna< rNØs<ttaE, àa[e ivxurta< yate 
+Vyaix> dehe àvtRte.32.
+durannämyavahäreëa durdeçäkramaëena ca|
+duñkäla vyavahäreëa durjanäsaìgadoñataù||31||
+kñéëatvät vä'tipürëatvät näòénäà randhrasantatau|
+präëe vidhuratäà yäte vyädhiù dehe pravartate||32||
+Eating unhealthy food which is räjasik and tämasik, 
+occupation at inappropriate places, conduct of activities 
+at unsuitable times and association with wrong people, 
+overfilling the stomach cause diseases by directly 
+blocking bioenergy flow in the energy channels.
+Health‑related consequences of an inappropriate and 
+a sedentary lifestyle have been extensively reported in 
+the scientific literature. For instance, a study reported 
+that students aged 14–17 years who routinely engage in 
+eating junk food, overeating, and lack physical activity 
+are found to be more obese. They tend to develop 
+a higher risk for various serious diseases such as 
+diabetes, heart diseases, stroke, liver diseases, infertility, 
+hypertension, arthritis, and cancer.[22]
+Conclusion
+As we are part and parcel of ecological system, we 
+cannot negate and break the natural laws. If we set our 
+day‑to‑day activities in accordance with the seasonal 
+changes as recommended by great yoga masters and 
+scriptures, surely one can achieve health, happiness, and 
+peace. As the goal of human life is to establish happiness 
+in oneself which is devoid of miseries and diseases, one 
+must follow the holistic approach for physiobiological 
+well‑being with improved quality of lifestyle.
+Financial support and sponsorship
+Nil.
+Conflicts of interest
+There are no conflicts of interest.
+References
+1. 
+Virupakshananda  S. Tarka Sangraha, Sri Ramakrishna Math. 
+Mylapore, Madras; 2007. p. 72‑3.
+2. 
+Aurobindo S. The Upanishds, Sri Aurobindo Ashram, Pondichrry; 
+1981. p. 222.
+3. 
+Aurobindo 
+S. 
+The 
+Upanishds, 
+Sri 
+Aurobindo 
+Ashram, 
+Pondicherry; 1981. p. 240.
+4. 
+Nagarathna R, Nagendra HR. Yoga for Promotion of Positive 
+Health, Swami Vivekananda Yoga Prakashana, Bengaluru; 2010. 
+p. 20‑39.
+5. 
+Saracci R. The world health organisation needs to reconsider its 
+definition of health. BMJ 1997;314:1409‑10.
+6. 
+Samal J. The concept of public health in ayurveda. Int Ayurvedic 
+Med J 2013;1:1‑5.
+7. 
+Rao  RV. Ayurveda and the science of aging. J Ayurveda Integr 
+Med 2018;9:225‑32.
+8. 
+Hankey  A. Ayurvedic physiology and etiology: Ayurvedo 
+amritanaam. The doshas and their functioning in terms 
+of contemporary biology and physical chemistry. J  Altern 
+Complement Med 2001;7:567‑74.
+9. 
+Sharma V, Chaudhary AK. Concepts of dhatu siddhanta (theory 
+of tissues formation and differentiation) and rasayana; probable 
+predecessor of stem cell therapy. Ayu 2014;35:231‑6.
+10. Shastri AM. The Bhagavad Gita. Madras: Samata Books; 2017. 
+p. 192‑3.
+11. Shastri AM. The Bhagavad Gita. Madras: Samata Books; 2017. 
+p. 431‑43.
+12. Ackard  DM, Neumark‑Sztainer  D, Story  M, Perry  C. 
+Overeating among adolescents: Prevalence and associations with 
+weight‑related characteristics and psychological health. Pediatrics 
+2003;111:67‑74.
+13. Moore M, Meltzer LJ. The sleepy adolescent: Causes and 
+consequences of sleepiness in teens. Paediatr Respir Rev 
+2008;9:114‑20.
+14. Aurobindo M. The secrets of the Veda. Vol. 15: Sri Aurobindo 
+Ashram Trust, Pondicherry; 1998. p. 44‑7.
+15. Kumaran  VS, Raghavendra  BR, Manjunath  NK. Influence of 
+early rising on performance in tasks requiring attention and 
+memory. Indian J Physiol Pharmacol 2012;56:337‑44.
+16. Niranjanananda S. Gheranda Samhita. Munger: Yoga Publication 
+Trust; 2012. p. 26‑9.
+17. Vasu CS. The Shiva Samhita. The Panini Ashram. Bhuvaneshwari 
+Ashram, Rajkot; 1914. p. 20.
+18. Baba  B. Yogasutra Patanjali. Varanasi: Motilal Banarsidass; 
+2005. p. 16‑20.
+19. Bharati  J. Essence of Yoga Vasishta. Madras: Samata Books; 
+1985. p. 262‑3.
+20. Samagandi DK, Samagandi DJ. Appraisal Essay on Sacred Clip: 
+Brahma Muhurtha. J Ayush 2013;1:1‑9.
+21. Thakkar  J, Chaudhari  S, Sarkar  PK. Ritucharya: Answer to the 
+lifestyle disorders. Ayu 2011;32:466‑71.
+22. Sharma  M, Majumdar  PK. Occupational lifestyle diseases: An 
+emerging issue. Indian J Occup Environ Med 2009;13:109‑12.
+[Downloaded free from http://www.ijoyppp.org on Wednesday, January 27, 2021, IP: 136.232.192.146]

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+A Prophet Lays Down His Pen
+Alex Hankey, PhD
+I
+n the good old days, an illumined wizard ‘‘broke his
+wand.’’ The Tempest’s Epilogue,1 spoken by Prospero, after
+he has released Ariel from his power, and sent Caliban
+(a skeptic?) packing, contains one of Shakespeare’s most no-
+table speeches. One hears not only Prospero’s illumined voice,
+‘‘Now I want / Spirits to enforce, art to enchant,’’ and Sha-
+kespeare’s, laying down His Pen, but also the Divine: ‘‘Gentle
+breath of yours, my sails / Must fill, or else my project fails, /
+Which was to please.and my ending is despair, unless I be
+relieved by Prayer.’’
+In one section of Four Quartets, T.S. Eliot’s illuminated
+signoff, God is represented as Practitioner. ‘‘The wounded
+surgeon plies the steel, / That questions the distempered
+part, Beneath the bleeding hands we feel / The sharp
+compassion of the healer’s art.’’2 If God is Practitioner, and
+Poet is Patient, the creative process is Remedy. Shake-
+speare’s triumvirate of God, Poet, and Prospero is thus
+somewhat akin to Practitioner, Patient, and Remedy, the
+subject of Milgrom’s work,3–8 from which he claims to be
+retiring.
+Over the last 10 years, Milgrom has demonstrated a
+‘‘magic touch,’’ arriving at a metaphorical model of quantum
+healing that, as he rightly suggests, may apply to all systems
+of medicine (see Milgrom’s article in this issue). His work has
+exemplified a fundamental principle: Science is not a set of
+laws, but a process of discovery, of continual renewal. Of
+this, creative minds are sure. Simple hypotheses are con-
+jectured and tested, often refuted9; limits of known laws are
+delineated. Established laws should thus be regarded not as
+sacred mantras to be endlessly and unthinkingly repeated as
+skeptics are wont to do, but as possibly simplistic, and re-
+quiring updating; as Whitehead famously suggested, ‘‘Seek
+simplicity and mistrust it.’’10 Then outdated paradigms can
+be discarded, and new ones adopted.11
+A New Medical Paradigm
+Recent
+decades
+have
+witnessed
+discoveries
+altering
+biology and medicine unrecognizably and irrevocably. La-
+marck’s rejected ideas12 have now become accepted in
+twenty-first-century epigenetics13: Genome labels modified in
+response to environmental stimuli may be inherited by both cell
+and organism. Similarly, publication of James Watson’s
+genome14 massively impacted the Genomic paradigm. The
+‘‘inborn errors of metabolism’’15 at the origin of the genomic
+paradigm are part of a wider range of phenomena, in which
+Epigenome and Proteome also play vital roles (see Box 1).
+The epigenome because a gene wrongly switched off results in
+the same ‘‘error of metabolism’’ as that of a pathogenic mutation
+of the same gene.
+The new medical paradigm is awaited, its contents debated.
+It will certainly have to include cell regulation, but even em-
+inent bioscientists have failed to acknowledge this. In 2008,
+Nurse pointed to the importance of cellular information pro-
+cesses,16 implying that processes and pathways interact, but
+despite the almost universal, mysterious, presence of feedback
+loops in cell signaling pathways, he failed to identify their
+significance. Why so many cyclic pathways, Sir Paul?
+Another fertile source of ideas is toxicology, broadly in-
+cluding both hormesis17 and homeopathy. Toxins affect
+proteomes, interfering with active sites. In toxicology,
+Box 1. The Tree of Cellular Regulation Processes
+IV METABOLOME
+The Metabolome consists
+of all metabolites in different cells
+of an organism. It is continuously altered by
+regulations of proteome activity, either directly
+through feedback from metabolites, or through
+the hierarchy of regulatory processes at the epigenetic
+level controlling the genome. Most pathology starts with
+metabolome imbalance due to genome or epigenome failure.
+III PROTEOME
+The proteome is the
+body of proteins in the organism,
+including all active enzymes catalyzing
+metabolic processes. A wrong mutation or epigenetic
+switching can have the same effect: failure of enzyme
+catalysis, stopping a single reaction, or an entire pathway.
+II EPIGENOME
+The epigenome regulates or
+modifies genome expression. A gene wrongly
+switched off results in failure to produce a peptide.
+I GENOME
+The genome encodes the proteome.
+Mutations may change amino acid sequences.
+SVYASA, Physical Science, Jigani, Bangalore, Karnataka, India.
+THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
+Volume 18, Number 2, 2012, pp. 103–105
+ª Mary Ann Liebert, Inc.
+DOI: 10.1089/acm.2011.0960
+103
+pathologies caused by failure of enzymes due to toxin–
+enzyme coupling, are similar to those due to parent gene
+mutation. Symptoms may therefore mimic genome errors.
+Toxicology’s associated fields have important implications
+for cell function.
+A Role for Homeopathy
+Homeopathy uses this connection between pathology and
+errors in metabolism in its ‘‘law of similars’’: potentized
+preparations of a toxin can cure ‘‘similar’’ pathologies.
+Clearly, it cannot correct genetic mutations, but what if
+symptoms arose from wrong epigenetic switching? Could
+homeopathy then help? Yes, if homeopathy can correct epige-
+netic errors. This leads to the hypothesis:
+Potentized remedies switch back ‘‘on,’’ specific enzymes
+wrongly switched off.
+They remedy epigenetic problems.
+Events such as vaccination, which homeopaths claim are
+pathogenic, might well trigger epigenetic problems. If the
+above hypothesis holds, then homeopathic treatment could
+eliminate them. Epigenetics provides a context for science to
+understand homeopathy. What more is needed?
+Hormesis: Active Regulation of Biosystems
+Another toxicology-related field pointing to a key ingre-
+dient of the new theory is hormesis, the phenomenon
+whereby low levels of a toxin improve health (i.e., the presence
+of a toxin stimulates a reaction that increases enzyme levels).
+This has important implications for mechanisms of regula-
+tion, including epigenetics: Biosystems actively monitor en-
+zyme processes. Toxin detection leads to increases in enzyme
+production, which compensate loss of activity. Healthy response
+to low toxin levels is thus intelligent and nonlinear. Hormesis
+is widespread, implying that:
+Most proteome enzymes are under active regulation.
+Now, the process of active regulation is carried out by
+those little-appreciated feedback loops (Sir Paul) and, in the
+form of ‘‘criticality,’’ is a central aspect of modern com-
+plexity biology. Criticality represents maximum sensitivity
+of system response. It occurs when feedback reaches the
+instability limit where any increase will drive the system
+into a limit cycle. And what could be more plausible than
+actively regulated systems maximizing their sensitivity of
+response?
+This simple idea may explain why not only active regu-
+lation (hormesis), but also ‘‘criticality’’ seems to be so wide-
+spread as to be universal. How do we know? The instability
+inherent in criticality results in a fractal distribution of responses
+to external stimuli, and fractal responses are now known to be
+the sign of healthy function, as in the much-studied phe-
+nomenon of heart rate variability.
+Over the past 2 decades, biology has thus arrived at a
+point where complexity phenomena are seen to be so
+widespread as to be effectively universal, and can now be
+understood for simple reasons: Maximum sensitivity is a
+competitive advantage for which the necessary condition is
+feedback instability, verified through observations of ‘‘criti-
+cality’’ and ‘‘fractality.’’
+Quantum Semiotics and Critical Fluctuations
+How does this connect to Milgrom’s metaphorical dis-
+course on quantum semiotics? The answer is simple: At
+feedback instabilities, excitations are not ordinary quanta, but
+highly correlated critical fluctuations originating in quantum
+uncertainty. Their description requires quantum analogs.
+Milgrom’s whimsical analysis of his own theory is thus
+appropriate to the implications of hormesis combined with
+complexity biology’s ‘‘criticality’’ and ‘‘fractality’’ regulatory
+patterns. Furthermore, these quantum-like entities are not
+quanta: Walach and Milgrom’s thesis receives support.
+How does this concern homeopathy? Fluctuations are in-
+volved in criticality regulated systems. Without them, epi-
+genetic regulation fails; enzyme regulation gets stuck. To
+restore ‘‘criticality’’ requires reintroducing fluctuations.
+Homeopathy may therefore work, providing the remedy
+consists of the quantum fluctuations, which can restore
+criticality18 and system regulation. Completing this account
+of homeopathy only requires showing that:
+Succussion of a chemical moiety amplifies its quantum
+fluctuations.
+We may soon understand homeopathic remedies’ action:
+Epigenetic failure of a critically regulated enzyme only re-
+quires the correct quantum fluctuations to restore its regu-
+lation of those of potentized toxins coupling to its active site.19
+Such fluctuations can describe can Practitioner & Patient
+as well as Remedy (proof too long to include here), pointing
+to why systems of complementary medicine are so powerful:
+Most systems of complementary medicine help restore
+regulation to misregulated systems.
+Milgrom’s labor developing key aspects of the medical
+process may come to be seen as central to the new medical
+paradigm. Here are its key concepts:
+1. Psycho-psychological (medical) states are quantum states,
+which may represent both practitioner and patient.
+2. Similar states can represent homeopathic remedies.
+3. Such states enter high-order correlations.
+Milgrom’s Mirror and Its Verification
+Milgrom’s most interesting discovery may be his de-
+scription of the way to restore health: Mirror states of im-
+balance by supplying their opposite. In 2005, Scott-Morley, a
+practitioner of electro-acupuncture, discovered something
+similar: He learned to mirror the state of patient imbalance,
+and transfer the required ‘‘vibrations’’ to water, which could
+then be used as the sole medicine needed to cure the patient.
+This idea too has origins in homeopathy. Hahnemann
+originally considered single medicines. Some still regard
+them as ideal. Milgrom describes the underlying system
+process, while Scott-Morley’s identifies a way to achieve it.
+Goodbye Mr. Chips?
+In writing widely about his theory, Milgrom has exposed
+himself to skepticism and scientism: fundamentalisms of
+scientists of a conservative bent, who consider scientific ideas
+as fact rather than process. He has defended himself and his
+104
+EDITORIAL
+discipline staunchly, often giving as good as he got. He may
+feel tired, but he can bow out on a high note, knowing his
+insights are now on the verge of being given a rigorous and
+secure scientific basis.
+Let us hope this new paradigm of regulation establishes
+itself quickly. In addition to epigenetics, advances in toxi-
+cology and complexity biology, the widespread occurrence
+of hormesis, criticality, and fractality now stand to justify
+Milgrom’s extraordinarily prescient work, and generous at-
+titude to opponents like Ernst. Like Prospero, he might say to
+his colleagues:
+Let me not,/ since I have now my dukedom got / and par-
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+Address correspondence to:
+Alex Hankey, PhD
+SVYASA
+Physical Science
+Jigani
+Bangalore, Karnataka 560106
+India
+E-mail: [email protected]
+EDITORIAL
+105
+This article has been cited by:

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+180 
+INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(2)
+E CAMDEN SCHIZOPH
+A QUALITATIVE STUDY ON THE NEEDS OF CAREGIVERS 
+OF INPATIENTS WITH SCHIZOPHRENIA IN INDIA
+A. JAGANNATHAN, J. THIRTHALLI, A. HAMZA, V.R. HARIPRASAD, 
+H.R. NAGENDRA & B.N. GANGADHAR
+ABSTRACT
+Aim: To explore the needs of caregivers of inpatients with schizophrenia in India.
+Material: Thirty caregivers of inpatients with schizophrenia participated in five focus 
+group discussions (FGD), where the needs of the caregivers were discussed. The 
+FGDs were recorded, transcribed and similar needs were grouped and ranked 
+according to their order of importance. 
+Discussion: The main needs that emerged were regarding: managing the behaviour 
+of patients; managing social-vocational problems of patients; health issues of 
+caregivers; education about schizophrenia; rehabilitation; and managing sexual 
+and marital problems of patients. 
+Conclusion: This study has identified additional needs of caregivers from those 
+found in other studies.
+Key words: needs, caregivers, schizophrenia, focus group discussion, qualitative 
+analysis
+INTRODUCTION
+The importance of the role of family caregivers in the treatment of a person with mental illness 
+cannot be overemphasized. Family caregivers provide considerable support to their ill relatives 
+even while they experience significant burden (Leff, 1994). In a survey conducted by Consumer 
+Health Sciences (CHS) and the National Mental Health Association (NMHA), one third of the 1,328 
+family caregivers surveyed said that the emotional and behavioural symptoms of the illness caused 
+them extreme hardship and was a constant source of anxiety (Consumer Health Sciences, 2008). 
+Caregivers who are in ‘high contact’ with the patient in their daily life often face the highest burden 
+(Winefield & Harvey, 1994). Family coping strategies accounted for a substantial proportion of the 
+variance observed in objective and subjective burden respectively among caregivers of persons with 
+schizophrenia (Magliano et al., 1998). This highlights the fact that studying the needs of family 
+caregivers of patients with severe mental disorders is important from a public health perspective.
+In India, the majority of the people with schizophrenia stay with their families (Thara et al., 
+1998; Murthy, 2006). There have been no systematic scientific Indian studies to assess the needs 
+of caregivers; however, several different opinions have been expressed. Some of the needs opined 
+are the need for awareness about the nature and outcome of mental illnesses in the community, 
+International Journal of Social Psychiatry. © The Author(s), 2011. Reprints and permissions:
+http://www.sagepub.co.uk/journalsPermissions.nav Vol 57(2): 180–194  DOI: 10.1177/0020764009347334
+ 
+JAGANNATHAN ET AL.: A QUALITATIVE STUDY ON THE NEEDS OF CAREGIVERS 
+181
+the need for primary psychiatric and other professional treatment, and psychosocial rehabilitation 
+(Goswami, 2006; Janardhan, 2006). Caregivers of inpatients report experiencing a significantly 
+higher burden than caregivers of outpatients. Unmet needs of the patients have also been found to 
+be significantly related to caregiver burden (Cleary et al., 2005). Meeting these needs would help 
+to enhance the level of functioning of the patient (Solomon & Draine, 1994) and to decrease the 
+emotional problems of family members (Johnson, 1994). 
+Family members of a patient with chronic schizophrenia have multiple needs. The major con-
+cerns and support needs of individuals who assume this stressful role include obtaining support, 
+reducing risks to their own well-being, and promoting the well-being of the mentally ill (Chafetz & 
+
+Barnes, 1989). They often express the need for more support and complain of not having enough 
+opportunities to relieve the burden imposed on them (Angermeyer et al., 2000). Educational 
+needs include gaining information about early warning signs of the illness and relapse, the effects 
+of medication and ways of coping with the patient’s bizarre and assaultive behaviour (Chien & 
+Norman, 2003). Often family members living with ill persons are less aware of the psychiatric nature 
+of the illness (Padmavathi et al., 1998). Thus it is necessary to understand the needs of families 
+of persons with mental illness and to develop specific interventions to meet them in order to help 
+reduce caregiver burden (Cleary et al., 2006; Murthy, 2006).
+The present study was conducted in order to assess the needs of the caregivers of schizophrenic 
+patients in India. India spends a mere 0.83% of its total health budget on mental health compared 
+to England and Wales which spends 13.8% (WHO, 2001); thus, the extent to which the needs of 
+caregivers will be met in India is likely to be different. Furthermore, given the differences in the 
+socio-cultural milieu, the results of the studies done in other cultures may not be relevant in an 
+Indian context. 
+Further, studies using scales to assess caregiver needs have the limitation of forcing the re-
+spondents to answer from a list. For instance, studies either focus on specific needs such as edu-
+cational needs (Chien & Norman, 2003) or on groups of needs such as counselling and support 
+services, education and financial entitlements (Wancata et al., 2006; Barrowclough et al., 1998). We 
+used a qualitative approach to assess the needs of caregivers for several reasons: (a) this approach 
+is useful in tapping a broader range of needs that are specific to the context in which it is used; 
+
+(b) studying the needs of caregivers involves probing of sensitive, emotional and personal themes 
+of needs, which is more suited to a qualitative approach (Hiday et al., 2002; Padget, 1998); and 
+(c) qualitative studies are especially helpful when one intends to generate impressions and to 
+
+develop assessment scales, programmes or services (Stewart et al., 2007).
+METHOD
+Sample
+The participants were 30 caregivers of inpatients with schizophrenia at the National Institute 
+of Mental Health and Neuro Sciences (NIMHANS) in Bangalore, India – a tertiary care centre. 
+NIMHANS has a 900-bed teaching hospital with training and research facilities in psychiatry and 
+other neurosciences. In April 2008, caregivers of all inpatients with schizophrenia were screened. 
+In total, 59 patients with a diagnosis of schizophrenia were admitted to the hospital during this 
+period. Caregivers of patients with a diagnosis of schizophrenia were included in the study if they 
+were to continue to provide care for them following discharge and if they spoke Kannada, Tamil, 
+English or Hindi. Caregivers with psychiatric or neurological disorders and those caring for another 
+182 
+INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(2)
+relative with psychiatric illness were excluded. Thirty eight caregivers who fulfilled these inclusion 
+and exclusion criteria were approached. Of these 38 caregivers, 30 consented to participate in 
+the study. These included families from different socioeconomic backgrounds, different states of 
+
+India and from different carer roles. The 30 caregivers thus recruited participated in five focus 
+group discussions (FGDs), with approximately six caregivers participating in each of the FGDs. 
+The sociodemographic data of the caregivers who participated in the FGDs and a profile of their 
+ill relatives were compiled (Table 1).
+Focus group discussion 
+From the range of qualitative research methods available, the FGD method was selected (vis-à-
+vis individual interviews), as it is less time-consuming, economical and has the benefits of group 
+processes (Stewart et al., 2007). The discussions followed the recommendations of Stewart et al. 
+(2007) – they involved six to eight individuals who discussed the research question ‘What are the 
+needs of family caregivers of inpatients with schizophrenia?’ for approximately 1.5–2.5 hours. The 
+FGD was conducted under the direction of a moderator (AJ/HVR) who promoted interactions and 
+ensured that the discussions remained focused on the topic of interest. 
+Script
+A standardized script for conducting the FGD was developed on the basis of the aims of the 
+study, literature review and discussion with four experienced focus group researchers. The script 
+
+followed a semi-structured format using open-ended questions in a face-to-face ‘conversational’ style 
+rather than a formal question/answer format. (The script is available from the authors on request.) 
+Although the group discussion script was flexible in nature, some direction was given when the 
+focus was lost and probes were used when necessary. The script included discussion about the felt 
+needs of the caregivers in caring for their relative with schizophrenia, and the grouping and ranking 
+of similar needs according to their order of importance. 
+Procedure
+The study was reviewed and approved by the Institute’s ethics committee. Written informed consent 
+of the family caregivers was obtained to participate in the study and a sociodemographic sheet 
+eliciting information on their age, occupation, monthly income, marital status, patient variables 
+and family constellation was completed. Each FGD was video-recorded and was facilitated by 
+the researcher (psychiatric social worker) and a co-facilitator. The researcher facilitated the group 
+process and the co-facilitator helped in recording the observations of the group session (audio/video 
+and by taking down notes). 
+The FGD involved the researcher asking the caregivers to list their needs (Appendix), group the 
+list of needs into main themes, operationally define the themes and rank them in order of importance. 
+As the methodology of free listing of needs was used, all the needs expressed by the caregivers 
+were noted. Across all five FGDs, the needs of caregivers were found to be largely comparable. 
+Thus, no needs were deleted from the list and all needs were accommodated into either one of the 
+categories/themes. In case of differences of opinion within the group about the grouping and ranking 
+of similar needs, further discussion and cross-clarification (iteration) was conducted among the 
+members who differed in their opinion till a consensus was reached. In groups where consensus 
+could not be reached, the themes were given similar ranking (e.g. in FGD-2, the themes of health 
+of caregivers, rehabilitation options and managing social/behavioural problems of patients were 
+given similar ranking).
+ 
+JAGANNATHAN ET AL.: A QUALITATIVE STUDY ON THE NEEDS OF CAREGIVERS 
+183
+Table 1
+Sociodemographic data of caregivers and patients
+Caregivers (n = 30)
+Patients (n = 29)**
+Variable
+n (%)
+mean (SD)
+Variable
+n (%)
+mean (SD)
+Variable
+n (%)
+mean (SD)
+Age of the caregiver (years)*
+ 
+50.6 (13.4)
+Education	 (years)*
+ 
+10.2  (6.4)
+Age of patient (years)*
+ 
+31 
+ (8.7)
+Gender
+  male
+  female
+ 
+13 
+(43.3)
+ 
+17  (56.7)
+Marital status
+  single
+  married
+  widowed
+ 
+3 (10)
+ 
+25 (83.3)
+ 
+2 
+(6.7)
+Gender
+  male
+  female
+ 
+17 
+ (58.6)
+ 
+12 
+ (41.4)
+Religion
+  Hindu
+  Christian
+ 
+27  (90)
+ 
+3  (10)
+Family type
+  nuclear family
+  joint family
+ 
+23 (76.7)
+ 
+7  (23.3)
+Education in years*
+ 
+11.38  (4.9)
+Economic status
+  low
+  middle
+  high
+ 
+13  (43.3)
+ 
+6  (20)
+ 
+11  (36.7)
+Relationship with the patient
+  parent
+  sibling
+  other relations
+  spouse
+ 
+21  (70)
+ 
+4  (13.3)
+ 
+3  (10)
+ 
+2  (6.7)
+Duration of the illness*
+ 
+103.60 (59.5)
+Occupation
+  unemployed
+  daily-wage labourer
+  professional
+  housewife
+  retired
+  student 
+ 
+1 
+ (3.3)
+ 
+8  (26.7)
+ 
+4  (13.3)
+ 
+8  (26.7)
+ 
+8 
+(26.7)
+ 
+1 
+ (3.3)
+Comorbid physical illness
+  nil
+  diabetes mellitus
+  hypertension
+  others
+ 
+20  (66.7)
+ 
+3  (10)
+ 
+4  (13.3)
+ 
+3  (10)
+Type of schizophrenia
+  paranoid
+  hebephrenic
+  catatonic
+  undifferentiated
+  schizoaffective
+ 
+19 
+(65.5)
+ 
+2 
+(6.9)
+ 
+1 
+(3.4)
+ 
+5 
+(17.2)
+ 
+2 
+(6.9)
+*Mean (SD), ** Two caregivers represented one patient in one of the FGDs.
+184 
+INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(2)
+Data analysis 
+The first level of data analysis was done during each of the focus group sessions. The researcher 
+made a list of needs during the discussion. The group (caregivers) then divided these needs into 
+themes and sub-themes and ranked them according to their importance. Following the technique 
+of iteration, the group went over these themes and rankings several times before finalizing them. In 
+each FGD the most important theme (based on grouping and ranking at level one and two of data 
+making) was given the highest score (equal to the number of themes listed) and the least important 
+theme was given the a score of 1. If two or more themes were deemed as having equal importance 
+during the FGD, then such themes were given similar scores. If a theme was not represented in a 
+particular FGD, it was given a score of 0 in that FGD.
+Each FGD was transcribed and further data making and analysis was conducted by the researcher 
+(second level of data making). Based on the first level of data making, the researcher reviewed 
+the listing of themes and wherever two or three themes seemed to represent a common theme, 
+they were grouped under an appropriate theme. The theme thus generated was given a score by 
+averaging the scores from the first level of data making. For example, in FGD-5, out of the six 
+themes identified by the caregivers, themes of ‘educational needs’ (score = 6) and ‘information on 
+management of side effects of medicines’ (score = 4) were grouped by the researcher as one main 
+theme of ‘education needs’ and given a score of 5. 
+The researcher then checked the remaining text for leftover lists of needs and put them under the 
+most appropriate theme. The scores for each theme across the five FGDs were totalled. The final 
+ranking of the themes corresponded to these totals; the theme with highest total score was ranked 
+as the most important need (Table 2). 
+The needs under each theme across the five FGDs were listed. A final list of themes and needs 
+under each theme was tabulated for analysis. As the sample size in each FGD was small, no 
+computer-assisted software package was used for the data analysis. Computer software would have 
+been appropriate if 30 individual interviews had been conducted instead of six groups.
+During the entire study period, the ill relative continued to receive the routine treatment prescribed 
+by the doctors at NIMHANS. The treating doctors were consulted and their approval to conduct 
+the FGD was obtained.
+RESULTS
+The main needs that emerged from the analysis of the FGDs are described in Table 2.
+I: Managing illness behaviour
+The areas in which the caregivers needed help to manage the illness behaviour of their relative 
+were: managing their non-compliance with medication; uncooperative behaviour; aggressive and 
+demanding behaviour; dealing with their illness symptoms (hallucinations/delusions, wandering, 
+insomnia, spending behaviour, reduced food intake); increased substance use; handling their 
+unpredictable behaviour; lack of interest in self-care; concentration problems; and lack of daily 
+routine. The following quotes of the caregivers depict the problems they faced in managing the 
+illness behaviour of their relative.
+‘Even when the family members advise or request, my brother says, “No I am not the patient; 
+you have a problem, so why should I take the medication?”’ (Mr S.M. (47 years), FGD-2)
+ 
+JAGANNATHAN ET AL.: A QUALITATIVE STUDY ON THE NEEDS OF CAREGIVERS 
+185
+‘If somebody visits us, and we are talking, my daughter feels as if we are talking about her. 
+Whatever topic we talk about, she tells that we are talking about her. Next when I give her food, 
+she suspects that I have mixed poison or faeces in the food.’ (Mrs J. (36 years), FGD-3)
+‘Suddenly my daughter gets angry, very angry to an extent that she does not get pacified until 
+and unless she hurts someone, even if it were my son or myself.’ (Mrs J. (36 years), FGD-3)
+‘My daughter does not do anything. I have to do everything for her… from combing her hair, 
+washing her clothes. I have to scrub and bathe her also.’ (Mrs J. (36 years), FGD-3)
+II: Managing social-vocational problems 
+Caregivers discussed various areas where they needed professional help in managing the social-
+vocational problems of their ill relative. These were: dealing with patient’s lack of interest in 
+socialization/not going out of the house; relationship problems; uninhibited behaviour; and difficulty 
+in initiating and maintaining activities/job. The following quotes of the caregivers throw light on 
+the social-vocational problems.
+‘My son is always in the home. He never goes out. He does not mix even with our relatives or 
+workers… he finds it difficult to get out of the room.’ (Mrs B.M. (60 years), FGD-2)
+‘My son comes out of the bathroom at times without wearing his clothes. Even when we tell him, 
+he does not listen. It becomes very difficult if there are guests at home.’ (Mr M.S. (45 years), 
+
+FGD-3)
+‘I would want my son to go to a job. He has forgotten about going for the job completely. He 
+does not have a mind to go for a job. (Mr M.R. (65 years), FGD-4)
+My son has changed seven companies. In no company he has worked for more than two to three 
+days… He gets a job easily. Four appointments are in hand. But after joining, he cannot maintain 
+the job.’ (Mr R. (68 years), FGD-4)
+Table 2
+Ranking, rating and percentage of importance of themes across five FGDs
+Rank order Theme
+FGD-1
+FGD-2
+FGD-3
+FGD-4
+FGD-5
+Total
+%*
+I
+Managing illness 
+behaviour of patients
+4
+6
+6
+3
+4
+23
+27.7
+II
+Managing social-
+vocational problems 
+of patients
+3
+4
+5
+2
+3
+17
+20.5
+III
+Health of caregivers
+1
+4
+4
+4
+2
+15
+18.1
+IV
+Education about illness
+5
+1
+1
+1
+5
+13
+15.7
+V
+Rehabilitation
+2
+5
+3
+0
+1
+11
+13.2
+VI
+Managing sexual and 
+marital problems of 
+patient
+0
+2
+2
+0
+0
+4
+4.8
+* Percentage of total needs score represented by the themes. Total needs score = (23 + 17 + 15 + 13 + 11 + 4) = 83. 
+186 
+INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(2)
+III: Health needs of caregivers
+Caregivers had a number of health needs. They required help in: managing their emotions (anger, 
+depression, fear); handling their stress; taking decisions; dealing with lack of social support; 
+reduced personal life; and balancing work and patient care. The following quotes of the caregivers 
+exemplify their health needs.
+‘I am always worried about the possibility of such events happening at home [violent outburst of 
+the patient]. So we continuously suffer from tension and sadness.’ (Mr M.S. (45 years), FGD-3)
+‘No facility, no neighbours, no relatives or friends came to help us when the patient was violent. 
+We were helpless and did not know what to do. [Mr C.R. is overwhelmed and starts crying.] Even 
+if I called for the ambulance at our place, they do not come. Thus we start getting negative feelings 
+like anger. We need to know how to control these feelings.’ (Mr C.R. (25 years), FGD-2)
+‘For the past 10 years [since my brother’s illness started], the concept of my personal life is 
+completely zero. I am now adjusted to this life and I stopped my studies. I now take care of my 
+brother full-time as my parents are aged.’ (Mr S. (33 years), FGD-4)
+IV: Education
+Education needs of the caregivers included: education about the illness; information on medication/
+side effects/emergency medicine (sedatives); information on available concessions/benefits offered 
+by the government; and information on how to deal with stigma. The following quotes depict the 
+caregiver needs for education.
+‘The medicines have so many side effects. The doctor does not tell us that this medicine will 
+give side effects.’ (Mr I.K. (60 years), FGD-1)
+‘In event of the patient becoming very violent and not responding to us, if there is any pill 
+which can be given to him at that time and if he sleeps… [another group member continues]… 
+one liquid… if by adding a few drops in food, he will be ok, we can then bring him to the 
+hospital. But we don’t know what to give and what not to give [pill]. We need education on that.’ 
+
+(Mr S.M. (47 years) and Mrs B.M. (60 years), FGD-2)
+‘For the patient and caregivers we should know about the concessions available from the gov-
+ernment. For other people [of other disorders] they get reimbursed for their treatment. We are 
+not getting any money from anywhere and we have to spend a lot of money.’ (Mrs B.M. (60 
+years), FGD-2)
+‘There is a lot of stigma about this illness… a lot of misconceptions about mentally ill patients. 
+They do not understand what type of illness this is, what is the problem. So educating society is 
+important.’ (Mr C.R. (25 years), FGD-2)
+V: Rehabilitation
+All caregivers cited these rehabilitation needs: knowing about financial and rehabilitation options; 
+local support groups and helpline services; office/work benefits for caregivers; and local referral 
+systems. The following quotes depict the rehabilitation needs of the caregivers.
+ 
+JAGANNATHAN ET AL.: A QUALITATIVE STUDY ON THE NEEDS OF CAREGIVERS 
+187
+‘Psychiatric patients have very few rehabilitation options… patients who are well… around 70% 
+of them, if some small jobs can be provided for them… small encouragement can be given to 
+them by the government, it would be helpful.’ (Mr I.K. (60 years), FGD-1) 
+‘Development of local support groups in city/hometowns like palliative care groups for cancer 
+patients will be a great relief to all people, wherever we are.’ (Mrs M. (52 years), FGD-2)
+‘At least in medical colleges, connected with this issue a helpline can be opened. The government 
+can do this.’ (Mrs B.M. (60 years), FGD-2)
+‘If we are government employees, at any time, we do not get leave and we can get transferred. 
+Even when I tried to convince my superiors that I had to take care of three mentally ill persons 
+at home [officers] they did not listen. They processed my transfer order. So if certain rules 
+
+and regulations to give leave to us as a caregiver of a patient are made, it would be useful.’ 
+
+(Mr C.R. (25 years), FGD-2)
+‘A small centre should be made available [developed] in our state, in any of the cities or in any 
+place in the state – with one doctor. If patient does not want to come to NIMAHNS, we do not 
+know where to take him. In every crisis situation we cannot come over here [to NIMHANS]. 
+There needs to be a local referral system.’ (Mrs B.M. (60 years), FGD-2)
+VI: Managing the sexual and marital problems of patients
+Caregivers of persons with mental illness faced a number of problems related to the sexual and 
+marital issues of the patient. They needed help in dealing with issues such as: whether to get the 
+patient married; problems in getting patient married; problems in maintaining the patient’s marriage 
+post-illness (separation/divorce issues); and problems of the patient related to sexual activities/
+marital discord. The following quotes of caregivers exemplify some of the above themes.
+‘We have seen a few girls for my son’s marriage. But all the parties we go to see, somebody in 
+our village would have already told them that he is not mentally well and the alliance would be 
+rejected.’ (Mrs B.M. (60 years), FGD-2)
+‘My brother is married but his wife does not stay with him. He has a child and his wife has put 
+the child in a hostel. This is because from 1999 he is getting treatment from NIMHANS and he 
+was not cured. After he goes back home, within a few days the symptoms relapse. So his wife’s 
+father and mother have advised her not to go back to her husband. We do not know how to deal 
+with this situation.’ (Mr S.M. (47 years), FGD-2)
+DISCUSSION
+The needs of the caregivers are extensive and vary across cultures. An in-depth assessment and 
+analysis is of paramount importance in order to develop programmes to cater to the needs of 
+caregivers in a cultural context. The present study explored the needs of caregivers of inpatients 
+with schizophrenia in India. The three main needs that emerged from the analysis of the FGDs, 
+188 
+INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(2)
+were (in order of importance) help in: (1) managing the illness behaviour of the patients; 
+
+(2) managing social-vocational problems of patients; and (3) health needs of the caregivers. 
+Some published studies have focused on specific needs such as rehabilitation and/or education 
+
+(Chien & Norman, 2003; Winefield & Harvey, 1994). Most other studies have used a standardized 
+needs questionnaire to assess caregiver needs. The Camberwell Assessment of Need (CAN), one 
+of the most widely used, is more often used with persons who are in contact with mental health 
+services and are receiving inpatient, outpatient or day-patient care (Phelan et al., 1995). The Carer’s 
+Needs Assessment (CNA) and the Relatives Cardinal Needs Assessment (RCNS), on the other 
+hand, focus on caregivers’ educational, financial, social and interpersonal, professional support 
+and health needs (Wancata et al., 2006; Barrowclough et al., 1998).
+Assessing the needs through the method of a questionnaire could limit the range of expression 
+of the needs of caregivers. The qualitative assessment method used in this study has been useful 
+in finding in-depth requirements of caregivers in each need area – an additional comprehensive 
+result, different from that of other studies. For example, under ‘health needs’ various caregivers’ 
+requirements were covered such as the need to manage stress and emotions, the need to maintain 
+balance between caregiving and personal life/work and the need to know how to take decisions in 
+stressful situations. 
+The results of the current study could also be interpreted in terms of the sample – how needs of 
+caregivers of inpatients (who had recently become ill or whose illness had exacerbated) could differ 
+from those of caregivers of outpatients (Cleary et al., 2006). The caregivers who participated in 
+this study were more patient-focused rather than carer-focused. This reflects not just the altruistic 
+preoccupations of focus group participants, but also the fact that all these caregivers were taking 
+care of patients who were currently symptomatic and required immediate hospitalization for their 
+symptom control. Managing the symptoms of the patients was always considered as the most 
+important priority. There were differences in opinion between caregivers in some groups about 
+whether rehabilitation, education or their health needs was the next important need. The homogeneity 
+of the sample (all caregivers of inpatients with schizophrenia) could be a reason for all the caregivers 
+having similar priorities in taking care of their patient. 
+Further cultural factors, such as strong family systems, could have a bearing on the results of 
+the study. In India the patient is always accompanied by the family member (who is the caregiver) 
+as compared to other countries where caregivers are not necessarily family members (Thara et al., 
+1998; Leff, 1994). 
+The sociodemographic profile of the caregivers in this study is consistent with that of earlier 
+studies on Indian caregivers of persons with schizophrenia (Srinivasan, 2006; Murthy, 2007). All 
+caregivers were family members. Most of them were parents, especially mothers who had a lower 
+income and were into late adulthood or old age. It may also be noted that the proportion of patients 
+living in nuclear families in this study (76.7%) is comparable to that of the general population of 
+India (70.4%; Office of the Registrar General and Census Commissioner, India, 2001). 
+Caregivers in the study reported that their primary need was help in managing the symptoms of 
+the patient. Due to lack of knowledge, fear and stigma associated with mental illness, caregivers 
+often found themselves at a loss as to how to do this (Gandon et al., 2008). Dealing with the social-
+vocational problems of the patient (second need), was another area of concern for the caregivers. 
+Some expressed more concern about ‘negative’ symptoms of schizophrenia (e.g. social withdrawal) 
+ 
+JAGANNATHAN ET AL.: A QUALITATIVE STUDY ON THE NEEDS OF CAREGIVERS 
+189
+than about positive ones (e.g. hallucinations) (North et al., 1998). Further caregivers seemed to 
+understand that they had to take care of their own health (third need) in order to better care for 
+the patient. 
+Apart from the above three main needs, caregivers also perceived the need for education (fourth 
+need) as important, as it would help reduce stigma in society about mental illness (Murthy, 2006). 
+Caregivers required information not only about the illness, but also about medication/side effects/
+emergency medication (sedatives) and about the available concessions/benefits offered by the 
+government (Cleary et al., 2005; Chien & Norman, 2003). The concept of stigma was discussed 
+by the caregivers who participated in FGD-2 in the context of ‘educating the society to minimize 
+the stigma in society’. Thus, the issue was considered under the category of education as the focus 
+was on educating society – clearing misconceptions, not eradicating stigma. Rehabilitation (fifth 
+need) was expressed as important by the caregivers; as most of the caregivers stayed in nuclear 
+families, they required help in the form of financial and legal concessions, office/work-related 
+benefits for caregivers, rehabilitation centres/day care near home, helpline services and local support 
+groups. Apart from the availability of these services, they also needed information about them and 
+help in accessing these services (Cleary et al., 2005). The sixth need was sexual and marital prob-
+lems and knowing how to deal with them. This was a significant need in the Indian context as 
+marriage and procreation are considered to be important stages in the Indian family life cycle 
+(Madan, 1987). Caregivers wanted to know whether to get their patient married; the stigma of 
+getting the patient married with a mental illness; and how to deal with difficulties post-marriage 
+like relapse of symptoms and marital discord.
+In a country where there are very few psychiatrists, the focus of treatment is more on symptom 
+cure. Even in a tertiary multidisciplinary centre like NIMHANS, the focus is often on needs other 
+than the health needs of the caregivers. Estimates show that 50% of patients approach NIMHANS 
+as a primary care centre (Kare et al., 2008). This makes it difficult to deal with all the needs of the 
+patients and caregivers. Needs like rehabilitation, education and sexual concerns of the patient can 
+be managed at hospital level. However, the health needs of caregivers that are equally important 
+are often not taken as part of the patients’ treatment process at the hospital. As its aim, this study 
+will attempt to develop a structured intervention programme based on the holistic coverage of all 
+the needs of the family caregivers.
+Certain methodological issues of this study need to be mentioned. The method of FGD has certain 
+inherent limitations such as the group members’ responses are not independent of one another, 
+which restricts the generalizability of the results (Stewart et al., 2007). Some of the members were 
+hesitant to talk in a group situation – especially when sharing sensitive issues. Caregivers may 
+have expressed other needs if they had been interviewed individually. Individual interviews could 
+thus have added considerable strength to the results of the study. Any interpretation of the results 
+needs to be done keeping in mind the exclusion of carers who were not comfortable with a group 
+situation. Further, the results obtained from the FGD may have been biased by a very dominant 
+or opinionated member. Future studies could examine the validity of the hierarchy of needs by 
+presenting the findings of this study to another focus group of carers.
+To counter some of these methodological limitations, informed consent of the members to 
+participate in a focus group was taken before the start of the FGD. Those members who were not 
+comfortable with talking in a group situation were not chosen for the study. Further, the moderator 
+bias was minimized by asking the group members themselves to list and rank the needs without 
+consulting the moderator.
+190 
+INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(2)
+All family caregivers who attended the FGDs emphatically stated that they required help 
+in managing all their needs and expressed their willingness to participate in any training that 
+
+addressed this.
+CONCLUSIONS
+This study is one of the first scientifically researched qualitative needs assessment studies of the 
+caregivers of inpatients with schizophrenia in India. Further, this study gives an holistic view of 
+the needs of caregivers with the list of themes and sub-themes that need to be considered for any 
+future action. It puts significant emphasis on health needs of the caregivers (third important theme), 
+which has often been ignored in other interventions. It must be noted that each patient may have 
+more than one caregiver and help of any kind to manage their health needs may have public health 
+significance.
+Finally, these findings are highly indicative and future studies could test the results in a larger 
+quantitative sample to reconfirm the validity, reliability and generalizability of the results. If validated, 
+it would enable the development of any programme developed for Indian family caregivers based on 
+the needs assessment. As an outcome of this study, the researchers plan to develop a psychosocial 
+and yoga programme for family caregivers of inpatients with schizophrenia in India.
+ACKNOWLEDGEMENTS
+The researchers would like to thank Dr Shekhar P. Seshadri, Dr Prabha S. Chandra, Dr Jayashree 
+Ramakrishnan and Dr K. Subbakrishna for their valuable input, which helped in the development 
+of the focus group script.
+REFERENCES
+Angermeyer, M.C., Diaz Ruiz de Zarate, J. & Matschinger, H. (2000) Information and support needs of the family 
+of psychiatric patients. Gesundheitswesen, 62(10), 483–486.
+Barrowclough, C., Marshall, M., Lockwood, A., Quinn, J. & Sellwood, W. (1998) Assessing relatives’ needs 
+for psychosocial interventions in schizophrenia: A relatives’ version of Cardinal Needs Schedule (RCNS). 
+Psychological Medicine, 28, 531–542.
+Chafetz, L. & Barnes, L. (1989) Issues in psychiatric caregiving. Archives Psychiatric Nursing, 3(2), 61–68.
+Chien, W.T. & Norman, I. (2003) Educational needs of families caring for Chinese patients with schizophrenia. 
+Journal of Advanced Nursing, 44(5), 490–498.
+Cleary, M., Freeman, A., Hunt, G.E. & Walter, G. (2005) What patients and carers want to know: An exploration 
+of information and resource needs in adult mental health services. Australian and New Zealand Journal of 
+Psychiatry, 39, 507–513.
+Cleary, M., Freeman, A., Hunt, G.E. & Walter, G. (2006) Patient and carer perceptions of need and associations with 
+caregiving burden in an integrated adult mental health service. Social Psychiatry and Psychiatric Epidemiology, 
+41, 208–214.
+Consumer Health Sciences (2008) National Health and Wellness Survey 2008. Princeton: Consumer Health Sciences. 
+www.chsinternational.com
+ 
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+191
+Gandon, P., Jenaro, C. & Lemos, S. (2008) Primary caregivers of schizophrenia outpatients: Burden and predictor 
+factors. Psychiatry Research, 158, 335–343.
+Goswami, M. (2006) From a family caregiver to a caregiver at the community level – ‘Ashadeep Model’. In Mental 
+Health by the People (ed. R.S. Murthy). Bangalore: People’s Action for Mental Health (PAMH).
+Hiday, V.A., Swartz, M.S., Swanson, J.W., Borum, R., Wagner, H.R. & D’Cruz, P. (2002) Families in society. Journal 
+of Contemporary Human Services, 83, 416–430.
+Janardhan (2006) Community mental health and development model evolved through consulting people with mental 
+illness. In Mental Health by the People (ed. R.S. Murthy). Bangalore: People’s Action for Mental Health 
+(PAMH).
+Johnson, D.L. (1994) Current issues in family research: Can the burden of mental illness be relieved? In Helping 
+Families Cope with the Mental Illness (eds. H.P. Lefley & M. Wasow), pp 309–328. Newark, NJ: Harwood 
+Academy.
+Kare, M., Thirthalli, J., Varghese, R.S., Ross, D., Reddy, K.S., Jagannathan, A., Venkatasubramanian, G. & 
+
+Gangadhar, B.N. (2008) Reducing the delay in treatment of psychosis. Where do we intervene? A study of 
+first-contact patients in NIMHANS. Best Poster Award at the Richmond Fellowship Asia-Pacific Conference 
+2008 on Rehabilitation Across Cultures. Bangalore: NIMHANS.
+Leff, J. (1994) Working with families of schizophrenic patients. British Journal of Psychiatry, 164 (Supp 23), 
+71–76.
+Madan, G.R. (1987) Indian Sociology. Revised Fourth Edition. New Delhi: Allied Publishers Private Ltd.
+Magliano, J., Fadden, G., Economou, M., Held, T. & Xavier, M. (1998) Burden on the families of patients with 
+schizophrenia: Results of the BIOMED 1 Study. Social Psychiatry and Psychiatric Epidemiology, 33(9), 
+112–223.
+Murthy, R.S. (2006) Mental Health by the People. Bangalore: People’s Action for Mental Health (PAMH).
+Murthy, R.S. (2007) Family and Mental Healthcare in India. Bangalore: People’s Action for Mental Health 
+(PAMH).
+North, C.S., Pollio, D.E., Sachar, B., Hong, B. & Isenberg, K. (1998) The family as caregiver: A group psychoeducation 
+model for schizophrenia. American Journal of Orthopsychiatry, 68(1), 39–46.
+Office of the Registrar General and Census Commissioner, India (2001) Census of India 2001. New Delhi: Office of 
+the Registrar General and Census Commissioner, India.
+Padget, D.K. (1998) Qualitative Methods in Social Work Research: Challenges and Rewards. New Delhi: Sage 
+Publications.
+Padmavathi, R., Rajkumar, S. & Srinivasa, T.N. (1998) Schizophrenic patients who were never treated – A study in 
+an Indian urban community. Psychological Medicine, 28, 1113–1117.
+Phelan, M., Slade, M., Thornicroft, G., Dunn, G., Holloway, F., Wykes, T., Strathdee, G., Loftus, L., McCrone, P. & 
+Hayward, P. (1995) The Camberwell Assessment of Need: The validity and reliability of an instrument to assess 
+the needs of people with severe mental illness. British Journal of Psychiatry, 167, 589–595.
+Solomon, P. & Draine, J. (1994) Examination of Adoptive Coping Among Individuals with a Seriously Mentally Ill 
+Relative. Unpublished paper. Philadelphia: Hanerman University, Department of Psychiatry and Mental Health 
+Science.
+Srinivasan, N. (2006) Together we rise – Kshema Family Power. In Mental Health by the People (ed. R.S. Murthy). 
+Bangalore: People’s Action for Mental Health (PAMH).
+Stewart, D.W., Shamdasani, P.N. & Rook, D.W. (2007) Focus Groups – Theory and Practice. Second Edition. Applied 
+Social Research Methods Series, Vol 20. New Delhi: Sage Publications. 
+Thara, R., Padmavathi, R., Kumar, S. & Srinivasan, L. (1998) Burden Assessment Schedule: Instrument to assess 
+burden on caregivers of chronically mentally ill. Indian Journal of Psychiatry, 40, 21–29.
+Wancata, J., Krautgartner, M., Berner, J., Scumaci, S., Freidl, M., Alexandrowicz, R. & Rittamannsberger, H. (2006) 
+The ‘Carers’ needs Assessment for Schizophrenia’. Social Psychiatry and Psychiatric Epidemiology, 41, 
+221–229.
+Winefield, H.R. & Harvey, E.J. (1994) Needs of family caregivers in chronic schizophrenia. Schizophrenia Bulletin, 
+20(3), 557–566.
+World Health Organization (2001) Atlas: Country Profiles on Mental Health Resources 2001. Geneva: World Health 
+Organization.
+192 
+INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(2)
+APPENDIX 
+Table 1
+Needs expressed by caregivers in FGD-1
+  1. Information on how to bring the patient to the doctor
+  2. Skills to motivate patient who is not taking medication
+  3. Contact details of doctors 
+  4. Skills to make patient cooperate with parents at home
+  5. Knowledge to handle sex problems/marriage issues of patients
+  6. Skills to control uncooperative/demanding patient 
+  7. Skills to handle emergency situations (medication, etc)
+  8. Referral to groups in local centres/day homes
+  9. Skills to handle symptoms of patient
+10. Skills to manage patients who are not going outside – e.g. not talking with relatives
+11. Skills to control the anger outbursts of the patient
+12. Need for psychotherapy for the patient
+13. Skills to motivate patient to daily activities
+14. Concessions for caregivers
+15. Knowledge on how to admit violent patients
+16. Knowledge on how to balance work and patient care
+17. Techniques to control caregivers’ anger
+18. Techniques to manage stress of caregivers – negative feelings
+19. Official rules relaxing for caregivers at work
+20. Directives/pamphlets dealing with various situations for other caregivers
+21. Educating society to minimize stigma in society
+Table 2
+Needs expressed by caregivers in FGD-2
+  1. Education about illness/medicines (mass media, school mental health programmes, doctors etc.)
+  2. Multidisciplinary teams to deal with patient(s)/caregiver(s)
+  3. To know how to motivate patient for treatment
+  4. Private services to help caregiver(s)
+  5. Skills to tackle patients if they refuse medication
+  6. Skills to motivate patient(s) to follow daily schedule
+  7. Skills to motivate patient(s) to maintain self-care (e.g. teaching girl children to manage self-care during 
+menstruation)
+  8. Skills to tackling patient(s) in social situations
+  9. Skills to manage demanding patients
+10. Skills to motivate patient(s) to cooperate in household activities
+11. Government policies (economic help)
+12. Rehabilitation centre for patient(s) 
+13. To know how to improve patients’ lack of concentration
+14. Skills to motivate patients to socialize
+15. Skills to tackle symptoms of patient(s) 
+16. Skills to make patient(s) listen to parents at home
+17. Skills to handle unpredictable behaviour of patient(s)
+18. Facilities to help working parents if they need to leave female patients at home alone 
+19. Skills to help parents gain confidence (that they can handle the patient)
+ 
+JAGANNATHAN ET AL.: A QUALITATIVE STUDY ON THE NEEDS OF CAREGIVERS 
+193
+Table 3
+Needs expressed by caregivers in FGD-3
+  1. Skills to manage problems of social behaviour in patient
+  2. Techniques on how to feed patient if they do not eat 
+  3. Techniques to help patient improve peer relationship issues (sister, brother, kids etc.)
+  4. Skills to motivate personal care of the patient
+  5. Skills to deal with difficulty in taking the patient to the doctor
+  6. Skills to deal with difficulty in administering medicines
+  7. Skills to motivating patient who is not going out
+  8. To know how to communicate with the patient 
+  9. To know how to handle problems in marriage 
+10. Patient beating the kids/relatives – how to manage
+11. Skills to manage/balance work – personal life
+12. Skills to control patient from quarrelling with neighbours 
+13. Financial concessions from government/NGO/others
+14. Skills to control angry state of the patient
+15. Skills to manage violent patient
+16. Skills to manage caregivers’ depressive feelings leading to suicidal thoughts
+17. Skills to manage unpredictable behaviour of patient
+18. Techniques to motivate patients who do not like going outside and earning
+19. Skills to manage increased sexual interests of patient 
+20. Knowledge on how to manage symptoms of patient – e.g. self-talk/laughter etc.
+21. Skills to manage caregivers’ emotions: (a) anger; (b) sadness; (c) fear
+Table 4
+Needs expressed by caregivers in FGD-4
+  1. Skills to encourage patients who do not take medicines
+  2. Skills to motivate patients who do not care for self
+  3. Skills to manage aggressive patients
+  4. Techniques to encourage patients who do not take food
+  5. Techniques to encourage patients whose social interaction is low
+  6. Techniques to motivate patient to go for job 
+  7. Skills to bring patient to hospital for treatment
+  8. Techniques to encourage patients who are not active
+  9. Techniques to help patients cope with the demands of the job and maintain it
+10. Techniques to control patient’s increased spending
+11. Techniques to control patient’s increased smoking
+12. Skills to regularize patients who are irregular/have no daily schedule
+13. Skills to immediately control patient in crisis situations
+14. Educate the patient about the illness, if he has no insight
+15. Knowledge on how to control patient symptoms like talking to self
+16. Knowledge on how to handle patient’s sleeplessness
+17. Knowledge on how to handle patient’s wandering behaviour
+18. Techniques to control depressive feeling in caregivers
+19. Skills to manage non-cooperative patient
+20. Financial help
+21. Skills to manage demanding behaviour of patient
+22. Social support
+23. Knowledge on how caregivers can take out time for their personal life 
+194 
+INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 57(2)
+Table 5
+Needs expressed by caregivers in FGD-5
+  1. Skills to push patient to do work if lazy
+  2. Skills to motivate patient to do their self-care/activities
+  3. Techniques to motivate patients who do not indulge in writing/reading
+  4. Techniques to motivate patients who do not do any work
+  5. Skills to motivate patients who do not take medicines
+  6. Techniques to reduce bidi (nicotine) intake in patients
+  7. Techniques to control anger outbursts in patient
+  8. Techniques to manage reduced sleep in patient 
+  9. Techniques to manage symptoms like self-talking in patient
+10. Techniques to manage patient behaviour like pacing, restlessness
+11. Skills to manage abnormal behaviours in patient
+12. Techniques to help patients who are not able to sustain a job
+13. Skills to help improve attention/concentration in patients
+14. Self-help centres in villages
+15. Knowledge to deal with increased sleep due to side effects of medication in patient 
+16. Knowledge to deal with weight gain in patients (due to illness/effects of medications)
+A. Jagannathan, PhD Scholar of Department of Psychiatric Social Work, National Institute of Mental Health and 
+Neurosciences (NIMHANS), Bangalore, India.
+J. Thirthalli, Associate Professor of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), 
+Hosur Road, Bangalore – 560029, India.
+A. Hamza, Assistant Professor of Psychiatric Social Work, National Institute of Mental Health and Neurosciences 
+(NIMHANS), Hosur Road, Bangalore – 560029, India.
+V.R. Hariprasad, Senior Research Fellow in Department of Psychiatry, National Institute of Mental Health and 
+Neurosciences (NIMHANS), Bangalore – 560029, India.
+H.R. Nagendra, Vice-Chancellor of Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bangalore, India.
+B.N. Gangadhar, Professor of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur 
+Road, Bangalore – 560029, India.
+Correspondence to Jagannathan Aarti, 196 ‘Srinidhi’, 1st Floor, 12th MAIN, 4th Block, Koramangala, Bangalore – 
+
+560029, India.
+Email: [email protected]

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+International Journal of Education and Psychological Research (IJEPR)	Volume 4, Issue 4, December 2015
+
+AQuantitative Study on Indian IT Professionals to Validate the Integrated Model on Job Stress
+
+
+Pammi Shesha Srinivas[1] Sony Kumari[2]
+Katte Bharathiramanachar Akhilesh[3] Hongsandra Ramarao Nagendra[4]
+
+
+Abstract:
+Impact of mental strain caused by Job stress in workforce, is much researched topic in this   digital age. It is generally accepted that mental strain caused by excessive stress (distress), is one of the main reasons for today’s wide spread nature of non-communicable diseases like hypertension, depression etc., in the knowledge based workforce. Eustress (positive state of stress) brings high alertness and helps to perform beyond the perceived capability of any worker. Most of the western popular models on job stress, considered only distress component while understanding mental state due to job stress leaving behind the Eustress component. In this integrated model on job stress, both Eustress and distress states were duly considered, by making it the unique comprehensive model on defining impact due to Job stress. This model also brings about the significance of psyche nurturing practices which play key role in modifying the impact of job stress. To validate this integrated model on Job stress, a quantitative study was performed on assessing “perceived stress levels” of Indian IT professionals by choosing Yoga based Cyclic Meditation practice as psyche nurturing practice. It was observed that “perceived stress levels” were reduced significantly in Indian IT professionals with regular practice of cyclic meditation.  This quantitative study supports claims of Integrated Job stress model that psyche nurturing practices have modifying effect on impact due to job stress in knowledge based workforce. Stress researchers across the globe, are encouraged to use this unique integrated model under multiple industry/professional setups and come   up with valuable suggestions for mental well –beings of the workforce.
+Key words: Job stress, mental strain, integrated model, Yoga, ITprofessionals
+
+
+I. BACKGROUND
+As per US National Institute for Occupational Safety & Health (1998) , [1]Job stress can be defined as the harmful physical  and  emotional  response  that  occurs  when  the requirements  of  the  job  do  not  match  the  capabilities, resources or needs of the worker. Job stress can cause poor mental health and can increase rates of work-related injuries and accidents. Stress and lack of well-being in the workplace cost more than $25.9 billion per annum in terms of sickness absence, presents and labour turn over in UK and Europe.[2] Given the impact and importance of stress at work place, popular western models on mental strain due to job stress were studied with a view of coming up with suggestions to increase  ‘stress  tolerance  levels’  of  knowledge  based workforce.
+1.1 western popular models related to job stress:
+Demand-Control Model (DCM): As per DCM model, if a worker has less control/discretion power at work, while meeting job demands, then the worker would go through mental strain caused by Job stress. [3]Based on job control and Job demand, jobs are classified as Passive jobs, active jobs, low strain jobs and high strain jobs.
+
+
+[1]Svyasa University, India [2]Svyasa University, India [3]Svyasa University, India [4]Svyasa University, India
+
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+International Journal of Education and Psychological Research (IJEPR)	Volume 4, Issue 4, December 2015
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+Person –Environment Fit Model (P-E model): The P-E fit model   characterizes   stress   as   misfit   between   person characteristics (e.gabilities, values) and Environment ( E.g Supplies,   Demands).   This   misfit   causes   negative psychological, physiological and behavioural patterns which could be collectively labelled as mental strain.[4]
+High Effort – Low Reward imbalance model:- High effort and  low  reward  model  is  derived  after  reviewing  many studies related to mental strain due to job stress, including Demand Control Model and Person Environment  model . It came to conclusion that reciprocity is the crucial element, which was not considered well in earlier related studies. The model is of the view that the work role in adult life defines a crucial link between self- regulatory functions such as self-esteem, self- efficacy and social opportunity structure. This causes individuals to invest high effort on job to be in a position to expect high rewards, which in turn increases their reciprocity capability. This model argues that any imbalance between efforts spent and rewards gained would cause a state of emotional distress.[5]
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+1.2 Quick Analysis of popular models and need for integrated model:
+All  these  popular  models  helped  to  understand  distress causing situations for work force and are outward in nature by looking at environment/ control at work place. These models do not consider ‘Eustress’component at all. It was called up on  stress  researchers  to  include  ‘eustress’  along  with ‘distress’ in the upcoming models on job stress. [6]So any forward looking integrated model on Job stress needs to consider both positive and negative states of work related stress  and  its  impact  on  worker.  Everybody  is  uniquely different in coping up with stressful scenarios faced. Some people may turn these situations into opportunities while others may lose existing opportunities. So any mental strain faced by the individual due to stress related scenario is also conditioned by the psyche-orientation of the individual.  As
+
+these popular models, do not consider psyche- orientation/ self-condition of the individuals, they are not complete in understanding  the  effects  of  Job  stress  on  Individuals. Current Integrated Model looks at the ancient Indian view on stress as well as at principles from western models, in coming up with unique model on defining impact due to job stress.
+The ancient Indian View:There is lot of literature available on  human  body-mind  complex  characteristics  in  ancient Indian  scriptures  .It  is  maintained  in  the  ancient  Indian scriptures that, continued imbalance at mind level could be termed as stress and would manifest as disease at the physical level .It was also discussed on how to train the psyche to overcome   the   state   of   imbalance.   Text   below   from MandukyaUpanishad help son understanding, techniques on achieving mental state of equilibrium.[7]
+
+?????????????????????????? ????????????????????????????
+Layesambodhayetcittaàvikñiptaàçamayetpunaù, Sakañäyaàvijïänéyätsamapräptaànacälayet.
+‘In a state of mental inactivity awaken the mind; when agitated, calm it; between these
+two states realize the possible abilities of the mind. If the mind has reached the state of
+perfect equilibrium then do not disturb it again’(Mandukya Upanishad Karika: 3.44)
+
+II.  INTEGRATED MODEL ON JOB STRESS
+In today’s modern medicalworld, it is well accepted that mental  well-being  is  a  major  vector  in  drivingphysical health.[8,9]    This is in accordance with literature from ancient Indian view.  So, by being able to condition the psyche, the response to stressful situation could also be modified, which could potentially alter impact of mental strain due to job stress on the individual. This principle is grossly missed in the existing models while describing impact of mental strain due to Job stress. Any stimulus external or internal, which can cause ‘stress’is called ‘stressor’in stress research. So in this integrated model, along with work related stressors and Person related stressors, due consideration was also given to the effect of psyche nurturing practices.Existing psyche deposits due to impact of previous stressful situations faced, also plays a significant role in responding to current and future stress stimulus situations.
+Work related stressors:   Work related stressors could be further categorized as environment stressor and organisation stressors. Work related stress variables which are governed by changing customer needs, government policies, market fluctuations,  vendor  costs,  competitive  pricing  demands, back  to  school  schedules  etc.,  come  under  environment stressors. There is a little control for employers as well as employees  of  a  business  enterprise  on  the  environment stressors.   Stressors controlled by inter department and/or intra department practices followed with in the organisation come under organisation stressors. Organisation culture in terms of setting ambitious targets, openness to employee
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+
+concerns,   cross   cultural   sensitivity,   organised   project management, Risk management	etc., also contribute to modify organisation stress variables.
+Person related stressors:   These are the stressors which arise from home as well as from work settings. Stressors like ill-health  of  family  members/friends,  financial  loss  of self/family   members/friends,growing   needs   of   family, necessity of support to family member education/health etc. come under personal related stressors arising from home. Stressors like lack of skills for current job, lack of decision making authority at work by virtue of position, over work demanded by the organisation, demanding schedules etc. come  under  person  related  stressors  arising  from  work settings.
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+Theory of operation explaining flow ofJob stress stimulus and  its  impact:  Job  stress  stimulus  for  any  worker  is generated  by  work  related  stressors.  This  stimulus  is influenced by both person related stressors as well as psyche history variable. This Job stress stimulus traverses through virtual  stress  perception  channel  in  the  psyche.  Psyche nurturing  practices  followed  by  the  worker  would  have modifying effect on the perception of job stress stimulus. Healthy psyche nurturing practices like regular practice of Yoga  etc.  may  reduce  the  agitation  of  the  mind  while perceiving the stress situations faced.[10]Un-healthy psyche nurturing practices like taking drugs/excessive alcohol etc., may   increase the agitation of the mind while perceiving the stress situations faced.  Every individual has stress tolerance capacity (TC)i.e. he /she can with stand the impact of stress situations  faced  by  being  able  to  return  to  homeostasis condition soon. If the actual perceived Job stress (JS) is less than the Tolerance capacity (TC) , then one would end up in positive stress sphere else in negative stress sphere. In the positive stress (Eustress) sphere, one would adopt positive coping  skills  like  listening,  focusing  on  solution  based approaches etc. Positive stress sphere would help to find new opportunities which in turn increases the self-esteem of the
+
+worker resulting in positive health. In the Negative stress (Distress) sphere, one would use negative coping techniques like running away from problem, unable to listen to others etc., which would result in uncertainty to solve problem at hand. One under the negative stress sphere may lose existing opportunities causing ill health effects like depression. The net impact of previous Eustress /distress experiences would be stored as deposited psyche variable in the person.  This psyche variable plays a role in influencing the next stress stimulus faced as well as stress tolerance capacity. A well nurtured psyche would be able to expand its ‘stress tolerance limits’.  .By  increasing  the  positive  effects  of  psyche nurturing practices, one can land up in eustress sphere, even if challenging  situationswere  created  due  towork  related stressors.
+
+III. VALIDATION OFTHE INTEGRATED MODEL
+IT professionals in India represent knowledge based work force as they mainly work with their mental capital. Indian IT professionals are always under constant pressure to deliver services efficiently along with being cost efficient. This requires to plan for ever changing customer requirements and forecast  market  demands  in  advance  ,  so  as  to  deliver services/products in “first time right” approach. In this web-connected world, time is the most precious thing for all the customers round the globe for IT professionals. All these factors   cause   Job   stress   for   IT  professionals.   In   a studyperformed  on  professional  stress,  depression  and alcohol use among Indian software professionalswith support of a sample size of 1071 subjects working in Bengaluru, it was observed that the software employees are professionally stressed due to job conditions and are at ten times higher risk for developing depression and also there is a significant increase in the incidence of psychiatric disorders.[11]Asurvey performed  on  call  centre  workers  from  IT  based  BPO industry  based  in  Pune  &Mumbai  indicates  that,a  high proportion   of   workers   faced   sleep   disturbances   and associated mental stress and anxiety as a result of work related  stressors.[12]     In  a  study  performed  on  200  IT professionals based out of Delhi, common problems seen among the study subjects were musculoskeletal (77.5%) and visual (76%) followed by stress (35%).[13]For these reasons, IT professionals   working in Bengaluruwere selected for validating this integrated model using quantitative methods.
+Cyclic Meditation: Cyclic Meditation(C.M) practice was chosen as psyche nurturing practice. C.M is inspired by a verse from Mandukya Upanishad .Cyclic meditation was developed by Swami Yoga Anusansandhana Samstahana, a world class Yoga university based in Bangalore, India. In a day to day life we relax, though unconsciously, by stretching and  relaxing.  In  Cyclic  Meditation  we  not  only  stretch consciously and systematically, but also relax consciously. Yoga  body  postures  (asana)  like  PadaHastasana, Ardha Chakrasana, Ardhakati  Chakrasana,  Shashankasana  and Ushtrasana are used for stretching where as Shavasana is used   for   relaxing.  Various   relaxation   techniques   are employed during Shavasana like Instant Relaxation, Quick relaxation and Deep Relaxation. This provides stimulation
+
+
+
+28
+International Journal of Education and Psychological Research (IJEPR)	Volume 4, Issue 4, December 2015
+
+
+
+followed by relaxation at muscular level as well as psyche Level.  [14]In  a  study  done  at  Swami  VivekanandYoga Anusandhan Samsthan, Bengaluru,   it was also that found Cyclic  Meditation  Technique,  to  be  more  effective  in achieving voluntary heart rate variability as compared with another  yogic  technique  of  Supine  Rest  (Savasan).[15]
+Materials   and   Methods:   Sample   sizechosen   forthis quantitative study consisted of “96” ITprofessionals. All the IT professionals were selected from Bangalore office of an Information  Technology  based  Multi-National  company, which has presence in India, Germany, Singapore, Austria, UK and U.S.A. Participants position within organisation ranged from junior engineers, senior technical leads to people managers. All participants came voluntarily to participate in the study.  Study also got permission from institution Ethical committee. Total sample size was divided into two groups, namely Yoga group and Control group.  Yoga group has both men and women employees with an average age of 31.04 years and with standard deviation of 4.57 years. Control group has both men and women employees with an average age of 32.02 years with a standard deviation of 4.582 years. Study was performed for an average duration of 2 months excluding weekends in the selected office premises. Both Men and women employees, with normal health as declared by subjects were included in the study. Subjects volunteered for the study do not have any previous experience of Yoga program as declared by subjects.   Employees who age is below 24 years or above 50 years are excluded from the study. All participants have education qualification of graduation and above. Perceived stress is measured through Perceived stress  scale  (PSS)  questionnaire  developed  by  Sheldon Cohen.	PSS  questionnaire  was  designed  to  tap  how unpredictable, uncontrollable, and overloaded respondents find their lives. The scale also includes a number ofdirect queries about current levels of experienced stress.
+
+
+V. RESULTS AND DISCUSSION
+Table   2:   indicates   response   on   Perceived   Stress(PS) component of Yoga Group, at the starting and at the end of study period.
+Table 2 :  Yoga Group
+
+
+
+
+
+
+
+
+Yoga group has shown reduction of 34.77 % in the mean value  from  pre  to  post.  The  improvement  observed  in reduction  of  perceived  stress  is  very  significant  as  p  < .01.Table 3 indicates responses on PS components of Control group, at the starting and at the end of study period.
+Table 3 : Control Group
+
+
+
+
+
+
+
+Control group has shown a reduction of 2.33 % in the mean value  of  perceived  stress  between  pre  and  post.	The improvement observed in reduction of perceived stress is not much significant as p > 0.01.
+The significance of change in PS component between Yoga and control group is measured with Mann Whitneytest.
+Table 4 : Between the Groups (Mann Whitney test)
+
+
+
+
+
+
+The baseline between yoga and control group is matched and the post value has shown highly significant result ( p< 0.01).
+
+
+
+
+IV. PROCEDURE
+PSS  questionnaires  were  administered  to  all  members participating in the study from both control and yoga groups. The intervention given to Yoga group is a 35 minute, cyclic meditation practice, whose details are mentioned earlier. Control group was administered with walking or equivalent exercise for 35 minutes and was told to write a dairy to observe  changes  taking  place.  This  is  a  pre-post  study. Participants from both groups filled up the questionnaires voluntarily before the beginning of the study period and at the end of study period.
+
+VI. CONCLUSION
+Based	on the quantitative study performed, it could be observed   that   psyche   nurturing   practices   like   cyclic meditation have  significant positive effect in reducing the perceived stress levels in Indian ITprofessionals. This study validates the integrated model on Job stress by supporting the claim that regular psyche nurturing practices would have modifying effect on perceived stress at work place.
+
+VII. LIMITATIONS
+Though psyche nurturing practices could have modifying effect  on  perceivedJob  stress  as  per  discussed  model, organizational changes would also have effect in altering Job stressors.   Certain   variables   like   Role   conflict,
+
+
+
+29
+International Journal of Education and Psychological Research (IJEPR)	Volume 4, Issue 4, December 2015
+
+
+
+Role ambiguity could also cause Job stress to employees. Organisational changes which address these concerns would also bring down the Job stress perceived by the workforce. Current study is done specific to one ITcompany , however it could  be	expanded  to  multiple  industry  domains  like nursing,  police  offers  etc.,  to  validate  this  model  more robustly.
+
+VIII. STRENGTH OFTHE STUDY
+This is the unique model in explaining the effect of psyche nurturing practices in altering job stress effects in physically healthy work force.This also brings out the positive effect of psyche nurturing practices in coping with job stress.
+
+IX. FUTURE DIRECTIONS
+Authors call up on stress researchers across the globe to use this model in all stress research by employing it under various industry set ups like police officers, nursing etc. Findings from the future data using the model would help to robustly validate this model.
+Acknowledgement-  I  would  like  to  acknowledge  my hearty thanks to S-VYASA university for their financial and technical support.
+
+12.  P   BhuyarA,   BanerjeeH,PandveP,PadmnabhanA, PatilS.Mental, physical and social health problems of call  centre  workers.	Industrial  Psychiatry  Journal 2008;17:21-25.
+13.  Sharma A K, Khera S, Khandekar J. Computer related health   problems   among   information   technology professionals  in  Delhi.  Indian  J  Community  Med 2006;31:36-38
+14.  Patil, Sarang and Telles, Shirley 2006. “Effects of Two Yoga  Based  Relaxation  Techniques  on  Heart  Rate Variability  (HRV).  International  Journal  of  Stress Management 2006;13(4): 460-475.
+15.  Patra S, Telles S. Positive impact of cyclic meditation on sleep. Med SciMonit 2009;15:CR375-81.
+
+
+X. REFERENCES
+1.	 US National Institute for Occupational Safety & Health (NIOSH). Stress at work1998.
+2.	 Cary L Cooper. Mental Capital and Well-Being. Stress and health2010.
+3.	 Robert  A  Karasek  Jr,Job  Demands.  Job  Decision Latitude  and  Mental  Strain:  Implications  for  Job Redesign.Administrative Science Quarterly 1990; 2:42.
+4.	 Jeffrey   R   Edwards,Cary   L  Cooper.  The   person-environment fit approach to stress: Recurring problems and some suggested solutions. Journal of Organizational behaviour 1990; 11: 293-307.
+5.	 Johannes  Siegrist. Adverse  Health  Effects  of  High-Effort/Low-reward conditions. Journal of Occupational Health Psychology 1996;1:27-41:
+6.	 Debra  Nilson,  Cary  Cooper.  Stress  and  health:  A positive direction. Stress and health 2005; 21: 2.
+7.	 Chinmayananda	S.   Mandukya   Upanisat.Sachin Publishers;1984.
+8.	 Karasek   R,   Theorell   T.   Healthy   work-stress, productivity and the reconstruction of working life. New York: Basic Books;1990.
+9.	 Luthans,  F.  The  need  for  and  meaning  of  positive organizational  behaviour.  Journal  of  organizational behaviour 2002; 23: 695-706.
+10.  Sony  Kumari,  Effect  of  SMET  Yoga  Module  on Emotional dynamics of Managers. AIMS international journal of management2014;Volume8.
+11.   Darshan et al. Astudy on professional stress, depression and alcohol use among Indian software professionals. Indian Journal ofPsychiatry2013;Vol 55.
+
+
+30

yogatexts/A randomised control trail of the effect of yoga on gunas.txt

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+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:1 
+ 
+! 
+ 
+Jan-Jun-2008
+2
+A randomized control trial of the effect of yoga on Gunas 
+(personality) and Health in normal healthy volunteers
+Sudheer Deshpande, Nagendra H R, Raghuram Nagarathna
+Department of Yoga Research, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India.
+Objective: To study the effi
+ cacy of yoga on Guna (yogic personality measure) and general health in normal adults.
+Methods: Of the 1228 persons who attended introductory lectures, 226 subjects aged 18–71 years, of both sexes, who satisfi
+ ed 
+the inclusion and exclusion criteria and who consented to participate in the study were randomly allocated into two groups. 
+The Yoga(Y) group practised an integrated yoga module that included asanas, pranayama, meditation, notional correction 
+and devotional sessions. The control group practised mild to moderate physical exercises (PE). Both groups had supervised 
+practice sessions (by trained experts) for one hour daily, six days a week for eight weeks. Guna (yogic personality) was 
+assessed before and after eight weeks using the self-administered Vedic Personality Inventory (VPI) which assesses Sattva 
+(gentle and controlled), Rajas (violent and uncontrolled) and Tamas (dull and uncontrolled).
+The general health status (total health), which includes four domains namely somatic symptoms (SS), anxiety and insomnia 
+(AI), social dysfunction (SF) and severe depression (SP), was assessed using a General Health Questionnaire (GHQ). 
+Results: Baseline scores for all the domains for both the groups did not differ signifi
+ cantly (P > 0.05, independent samples 
+t test). Sattva showed a signifi
+ cant difference within the groups and the effect size was more in the Y than in the PE group. 
+Rajas showed a signifi
+ cant decrease within and between the groups with a higher effect size in the PE group. Tamas showed 
+signifi
+ cant reduction within the PE group only. The GHQ revealed that there was signifi
+ cant decrease in SS, AI, SF and SP in 
+both Y and PE groups (Wilcoxcon Singed Rank t test). SS showed a signifi
+ cant difference between the groups (Mann Whitney 
+U Test). 
+Conclusions: There was an improvement in Sattva in both the Yoga and control groups with a trend of higher effect size in 
+Yoga; Rajas reduced in both but signifi
+ cantly better in PE than in Yoga and Tamas reduced in PE. The general health status 
+improved in both the Yoga and control groups. 
+Keywords: General health; guna; Yoga.
+The present age of speed and competition has increased 
+the stresses and strains resulting in an increasing 
+prevalence of life style-related health problems.[1] One 
+of the increasingly popular tools to overcome this new 
+challenge is physical activity. There is growing evidence 
+that has established the benefits of physical exercises in 
+preventing life style-related diseases[2] such as primary 
+prevention of diabetes,[3] prevention of cardiac diseases 
+through control over major risk factors such as smoking, 
+lipids, obesity and stress,[4] better quality of life of cancer 
+patients,[5] positive health in normal persons through 
+better physical fitness[6] and stress reduction.[7] Yoga 
+which is considered to be a tool for both physical and 
+mental development of an individual is being recognized 
+Original Article
+around the globe only in the last century although it has 
+been practised in India over several centuries to promote 
+positive health and well being. It gives solace for the 
+restless mind and can give great relief to the sick.[8,9] It has 
+become quite fashionable even for the common man to keep 
+fit.[10] Some use yoga for developing memory, intelligence 
+and creativity.[11] With its multifold advantages, yoga is 
+becoming a part of school education.[12] Specialists use 
+it to unfold deeper layers of consciousness in their move 
+towards spiritual perfection.[13] With growing scientific 
+evidence, yoga is emerging as an important health 
+behavior-modifying practice to achieve states of health, 
+both at physical and mental levels. Several studies have 
+demonstrated the beneficial effects of yoga on health 
+Correspondence to: Dr. Nagarathna Raghuram
+No19, Eknath Bhavan,  Gavipuram Circle, 
+K. G. Nagar,  Bangalore – 560 019. India.
+E-mail: [email protected]
+ABSTRACT
+[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009]
+3
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:1 
+ 
+! 
+ 
+Jan-Jun-2008
+behavior in many life style-related somatic problems 
+such as hypertension,[14] bronchial asthma,[15] diabetes[16] 
+including some psychiatric conditions such as anxiety 
+neurosis[17] and depressive illness[18] etc. 
+The philosophy of yoga believes that somatic problems are 
+nothing but a manifestation of an imbalance between three 
+Gunas (Sattva, Rajas and Tamas) that go to constitute the 
+body-mind complex of the individual.[19] Further, in the 
+famous scriptural text, the Gita; a guna indicates a specific 
+behavior style. Sattva is symbolized by purity, wisdom, 
+bliss, serenity, love of knowledge, spiritual excellence and 
+other noble and sublime qualities. Rajas is symbolized 
+by egoism, activity, restlessness and hankering after 
+mundane things like wealth, power, valor and comforts. 
+Tamas is related to qualities such as bias, heedlessness 
+and inertia, perversion in taste, thought and action.[20] Ill 
+health occurs if Rajas or Tamas become dominant and 
+the individual gets habituated to either of these response 
+patterns. Furthermore, the Gita goes on to analyze the 
+state of mind and says that when one is dominated by 
+these two gunas, the individual loses mastery over the 
+uncontrolled, speeded-up loop of sentences of the internal 
+dialogue, which shows up as upsurges of emotions and 
+impulsive behavior. In an ideal state of perfect health, 
+man has the complete freedom to use any of these three 
+patterns (Satva, Rajas or Tamas) of responses. Hence, 
+the degree of positive health can be measured by a tool 
+that can grade these three patterns of behavior.[19] The 
+tool can be used for assessment of interventions used for 
+treatment or prevention of diseases as well as for promotion 
+of positive health. The Vedic Personality Inventory 
+(VPI)[21] is a valid and reliable inventory that can measure 
+the three patterns of behavior.
+While Yoga is getting popular, the relative roles of yoga 
+and physical exercises have not been studied on gunas 
+and health. Hence, the present study was designed to 
+assess the changes in the personality and overall health 
+status after yoga as compared to physical exercise 
+in a randomized controlled study in normal healthy 
+volunteers.
+METHOD
+Subjects
+Of the 1228 adults who attended motivational lectures, 
+226 subjects consented to participate in the study and 
+were randomly allocated to two groups of equal size. After 
+attrition, the final sample sizes were 87 in both the yoga 
+and control groups. 
+Inclusion criteria were: (a) normal healthy volunteers, (b) 
+age 18–71 years, (c) literacy and (d) scores less than 4/5 
+in the General Health Questionnaire.[22]
+Exclusion criteria were: (a) subjects with any ailment, (b) 
+smoking and (c) substance abuse.
+Source of subjects: Normal adults were recruited from 
+five different locations in Bangalore after public talks at 
+different institutions such as colleges, health clubs, Rotary 
+Clubs, Lion’s clubs and big apartment complexes.
+Informed consent was obtained from all the subjects 
+who participated in the project and also from the 
+institutional heads where the classes were conducted. 
+The institutional ethical committee of SVYASA cleared 
+the project proposal. 
+Design
+This is a prospective, randomized, single-blind, controlled 
+study aiming to compare the efficacy of yoga (Y) and 
+physical exercise (PE) in normal healthy volunteers in 
+a South Indian population. Introductory lectures were 
+arranged in public centers such as colleges, health clubs, 
+Rotary clubs, Lion’s clubs and apartment complexes. The 
+classes were planned in five different centers in the city 
+of Bangalore. Two hundred and twenty-six persons who 
+consented to participate in the study and satisfied the 
+inclusion and exclusion criteria were randomly allotted 
+to two groups by using five random number tables 
+(different table for each center) generated from the random 
+number generator program.[23] The experimental group 
+was given Y practices and the control group was given 
+PE for one hour daily on empty stomach (6 to 7 a.m.). 
+The classes were conducted six days a week for eight 
+weeks and attendance was maintained by the teachers. 
+Trained experts (in yoga for the Y group and PT for the 
+PE group) conducted parallel sessions for the two groups 
+in different rooms in the same venue. It was ensured that 
+there was no interaction between the subjects. The tests 
+were self-administered before and eight weeks after the 
+intervention. Arrangements were made for the subjects to 
+sit in a quiet place free from distractions and influence 
+from other people. 
+Masking: The answered questionnaires were coded and 
+kept away for future scoring. A psychologist who was not 
+involved in the subject allocation or supervision of the 
+classes scored the questionnaires which were decoded 
+only after the scoring of both the before and after data 
+was completed. 
+Assessments
+Assessments were done using the following 
+questionnaires:
+1. The Vedic Personality Inventory (VPI): In 1998, Wolf 
+developed an inventory to assess three personality 
+Effect of Yoga on Gunas and Health
+[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009]
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:1 
+ 
+! 
+ 
+Jan-Jun-2008
+4
+constructs (gunas) based on their description in the 
+most ancient Indian scriptures called Vedas. Hence, 
+this inventory was named the VPI and it measures 
+the three gunas—Sattva, Rajas and Tamas. It has 30 
+items for the Sattva guna, 28 for rajoguna and 32 for 
+tamo guna. VPI has good internal consistency and 
+reliability with Cronbach’s alpha ranging from 0.850 
+for Sattva, 0.915 for Rajas and 0.699 for Tamas. In 
+terms of discriminant validity, all but one facet had 
+significant differences.[21] 
+2. General Health Questionnaire (GHQ): The GHQ 
+designed by Goldberg in order to identify psychiatric 
+morbidity in general practice, is a self-administered 
+questionnaire (English version). It has 28 items with 
+four subscales to measure somatic symptoms (SS), 
+anxiety and insomnia (AI), social dysfunction (SF) and 
+severe depression (SP). It provides information about 
+the recent mental status, thus identifying the presence 
+of possible psychiatric disturbance. This questionnaire 
+has acceptable psychometric properties and has good 
+internal consistency and reliability with Cronbach’s 
+alpha of 0.85 and validity of 0.76.[24]
+INTERVENTION
+Yoga group 
+The Integrated yoga module was selected from the 
+integrated set of yoga practices used in earlier studies on 
+the effects of yoga for positive health.[25] This integrated 
+approach is developed based on ancient Yoga texts[26] 
+to bring about a total development at physical, mental, 
+emotional, social and spiritual levels.[27] The techniques 
+include physical practices (kriyas, asanas, a healthy 
+yoga diet), breathing practices with body movements and 
+Pranayama, meditation, devotional sessions, lectures on 
+yoga, stress management and lifestyle change through 
+notional corrections for blissful awareness under all 
+circumstances (action in relaxation). Yoga was taught by 
+qualified yoga teachers.
+Physical exercise group 
+The set of physical exercises were standard execises[28] 
+meant to provide mild to moderate activity designed by 
+experts in physical education.
+Data extraction
+The scoring of the questionnaires was carried out as per 
+the instructions in the manuals. The structure of these 
+questionnaires is described below:
+1. VPI evaluates the Sattva, Rajas and Tamas gunas by 
+using a 7-point Likert-type scale. Scores for the gunas 
+are obtained by adding the responses for the items for a 
+guna and then dividing by the number of items for that 
+mode. For each subscale, a higher score indicates a greater 
+predominance of that mode. The minimum and maximum 
+possible scores for the three domains range from 1–7. 
+2. GHQ: This 28 item test using a binary method of scoring 
+(0, 0, 1, 1) yields an assessment on four robust subscales: 
+somatic symptoms (SS), anxiety and insomnia (AI), social 
+dysfunction (SF) and severe depression (SP). A sum of the 
+scores for these four subscales gives the score for total 
+health. The lower the scores in the GHQ, the better the 
+state of health. The cut-off scores for the GHQ used for 
+this study were 4 or 5 (4/5).[22]
+Statistical analysis
+Data was analyzed using the SPSS package version 10.0.
+Based on a previous study,[29] the effect size was calculated 
+to be 0.8. With a power of 0.8 and alpha set to 0.05, 
+the minimum sample size was found to be 164. This 
+calculation was done using G power.[30] The size of the 
+sample actually used was 174.
+Data at baseline was assessed for normal distribution 
+using Shapiro-Wilk’s test for both the groups. Independent 
+samples t-test was done for checking homogeneity of 
+baseline scores of the two groups. Paired samples t test 
+and independent samples t test were used for VPI which 
+had normally distributed data and Wilcoxon’s signed ranks 
+and Mann Whitney U tests were used for GHQ data which 
+were not normally distributed. An independent samples 
+t test was done to analyze between the groups and paired 
+samples test within groups. The effect size of the study 
+(mean A – mean B)/ standard deviation (SD) of difference 
+scores) is an absolute measure of the difference that exists 
+between the populations for a parameter, a concept first 
+introduced by the sociologist, J. Cohen.[31]
+As the study population had a wide age range, statistical 
+analysis was also carried out by grouping them as juniors 
+(age ≤ 24 years) and seniors (age > 24 years) based on the 
+median age. The independent samples t-test for between 
+groups and paired samples t test for within groups were 
+conducted for the two age groups. The data was also 
+analyzed using gender as a factor.
+RESULTS
+Figure 1 shows the study profile wherein of 1228 subjects 
+who attended the motivational lectures, only 226 who 
+satisfied the inclusion and exclusion criteria were selected 
+and randomly allotted to the Y and PE groups. The reasons 
+Deshpande S, et al.
+[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009]
+5
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:1 
+ 
+! 
+ 
+Jan-Jun-2008
+for dropout of 52 subjects are shown in Figure 1. 
+Table 1 shows the demographic data. There were 87 
+subjects (40 females) in each group aged 18–71 years, the 
+mean age being 29.44 ± 11.94 years. They belonged to 
+different callings such as college students, professionals, 
+housewives and retired persons. 
+The baseline values were normally distributed for Tamas 
+(P = 0.209) and Sattva (P = 0.717) and were well-matched 
+for all three domains (Independent samples t-test). 
+Table 2 shows the comparison of the baseline scores for 
+the three gunas of the VPI with the norms provided in the 
+manual. It showed that the scores are within the predicted 
+normal range. The mean value is marginally higher for 
+Sattva and lower for Rajas and Tamas in the South Indian 
+population selected in the present study as compared to 
+the norms from studies in the USA. 
+Tamas: The PE group showed a significant decrease in 
+the Tamas score from 3.24 to 2.99 (P = 0.001) (paired 
+samples t test). The senior subjects (age > 24 years) in both 
+the Y (3.09 to 2.67) and PE (3.21 to 2.83) groups showed 
+a significant decrease (P = 0.001). In gender analysis, 
+females showed a decrease with Y (P = 0.040) and males 
+showed a decrease with PE (P = 0.032). 
+Rajas: The PE group showed a significant decrease in 
+scores from 3.67 to 3.43 (P = 0.002). Seniors in both the 
+Y (3.81 to 3.51) (P = 0.002) and PE (3.62 to 3.31) groups 
+(P = 0.015) have shown significant decreases. In gender 
+analysis, males showed a decrease with PE (3.73 to 3.37) 
+(P = 0.014). Significantly greater reduction was observed 
+in the PE than in the Y group (P = 0.005) and in juniors 
+(P = 0.012).
+Sattva: Sattva scores have increased significantly in 
+both Y (4.88 to 5.26) (P = 0.001) and PE (4.91 to 5.21) 
+(P < 0.001) groups with a greater effect size in the Y 
+Table 1: Demographic data for VPI
+Age                                          Sex 
+ 
+Y 
+PE
+ 
+ 
+(n = 87) 
+(n = 87)
+ 
+ 
+31.33±11.9 5 
+32.35±11.32
+≤ 24 years (Juniors) 
+Male (m±SD) 
+26.79±12.20 
+28.00±11.76
+ 
+Female (m±SD) 
+20.00±1.75 
+20.29±1.44
+> 24 years (Seniors) 
+Male (m±SD) 
+20.61±1.82 
+20.73±1.89
+ 
+Female (m±SD) 
+38.88±9.55 
+30.85±8.56
+Gender 
+Male (m±SD) 
+41.36±13.89 
+40.82±10.85
+ 
+Range 
+18–71 
+18–58
+ 
+Female 
+40 
+40
+Categories 
+Male 
+47 
+47
+ 
+Students 
+49 
+44
+ 
+Employees 
+18 
+30
+ 
+Housewives 
+10 
+7
+ 
+Business 
+10 
+6
+Table 2: VPI scores for yoga and control groups—comparison of means (paired samples test)
+ 
+Before 
+After 
+P value 
+Effect Size 
+Before 
+After 
+P value 
+Effect Size
+ 
+Means±SD 
+Means±SD 
+ 
+ 
+Means±SD 
+Means±SD 
+ 
+ 
+Y 
+Y 
+ 
+ 
+PE 
+PE 
+ 
+Tamas 
+3.12 ± 0.51 
+2.97 ± 0.91 
+0.095 
+0.18 
+3.24 ± 0.67 
+2.99 ± 0.69 
+0.001 
+0.36
+Rajas 
+3.83 ± 0.62 
+3.72 ± 0.51 
+0.12 
+0.17 
+3.67 ± 0.62 
+3.43 ± 0.79 
+0.002* 
+0.33
+Sattva 
+4.88 ± 0.52 
+5.26 ± 0.51 
+<0.001 
+0.61 
+4.91 ± 0.53 
+5.21 ± 0.65 
+<0.001 
+0.45
+* Rajas showed a significant difference between the groups (P = 0.005) (Independent Samples Test); (Effect size = difference in means (after–before)/SD of the 
+difference scores)
+Table 3: VPI scores in age groups - Age ≤ 24 years and > 24 years (paired-samples t test)
+ 
+ 
+Before 
+After 
+P value 
+Before 
+After 
+P value
+ 
+ 
+Means±SD 
+Means±SD 
+ 
+Means±SD 
+Means±SD 
+ 
+ 
+Y  
+Y 
+ 
+PE 
+PE 
+Age ≤ 24 years 
+Tamas 
+3.16 ± 0.49 
+3.20 ± 1.63 
+0.774 
+3.28 ± 0.67 
+3.16 ± 2.13 
+0.4
+ 
+Rajas 
+3.84 ± 0.66 
+3.99 ± 0.74 
+0.286 
+3.75 ± 0.63 
+3.56 ± 0.75 
+0.152
+ 
+Sattva 
+4.67 ± 0.47 
+5.26 ± 0.55 
+<0.001 
+4.79 ± 0.44 
+5.14 ± 0.65 
+0.002
+Age > 24 years 
+Tamas 
+3.09 ± 0.53 
+2.67 ± 0.69 
+0.001 
+3.21 ± 0.68 
+2.83 ± 0.77 
+0.001
+ 
+Rajas 
+3.81 ± 0.61 
+3.51 ± 0.57 
+0.002 
+3.62 ± 0.62 
+3.31 ± 0.83 
+0.015
+ 
+Sattva 
+4.91 ± 0.59 
+5.12 ± 0.45 
+0.001 
+5.00 ± 0.59 
+5.09 ± 0.62 
+0.014
+Effect of Yoga on Gunas and Health
+[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009]
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:1 
+ 
+! 
+ 
+Jan-Jun-2008
+6
+(0.61) than in the PE (0.45) group. Juniors, seniors, males 
+and females in both the Y and PE groups have all shown 
+significant increase in Sattva scores.
+Table 5 shows the results for all variables of the GHQ.
+Somatic symptoms (SS): SS symptoms have reduced 
+significantly in both Y (0.57 to 0.29) (P = 0.011) and PE 
+(0.41 to 0.11) (P = 0.001) groups. Juniors, seniors, males 
+and females of the PE group have shown significant 
+decrease in SS. Seniors and males in the Y group have 
+shown significant decrease in SS. There was a significant 
+difference between the groups.
+Anxiety and insomnia (AI): AI symptoms have decreased 
+significantly in both the Y (0.61 to 0.08) (P < 0.01) and PE 
+(0.49 to 0.18) (P = 0.011) groups. Juniors, seniors, females 
+and males in the in Y group have shown significant 
+decrease in AI whereas only seniors and males have shown 
+significant decrease in AI in the PE group.
+Social dysfunction (SF): A significant decrease was 
+observed in both the Y (0.60 to 0.15) (P ≤ 0.001) and PE 
+(0.60 to 0.23) (P = 0.001) groups. Juniors, females and 
+males have shown significant decrease in SD with Yoga 
+whereas juniors, seniors, males and females have shown 
+significant decrease in SD due to PE. 
+Severe depression (SP): Both Y (0.44 to 0.22) (P = 0.017) 
+and PE (0.52 to 0.15) (P < 0.01) groups have shown 
+significant reduction in SP
+. Juniors, seniors, females and 
+males have shown a significant decrease in SP due to PE. 
+Only seniors and males have shown a significant decrease 
+in SP due to yoga.
+DISCUSSION
+This is a randomized, controlled, prospective study in 
+normal adults comparing the efficacy of yoga with a 
+control intervention of PE of eight weeks in 174 normal 
+adults on changes in their personality (guna) and General 
+health as assessed by VPI and GHQ. The results showed 
+that there was an increase in Sattva scores (P < 0.001) in 
+both Y and PE groups and a decrease in Rajas (P = 0.002) 
+and tamas (P = 0.01) scores in the PE group. The scores for 
+Tamas decreased significantly in seniors of both the groups 
+(females in Y and males in PE) (paired samples t test). 
+The increase in Sattva scores was higher in the Y group 
+Orientation Seminar Conducted at different parts of Bangalore 
+1228 
+Consented to participate in the project 
+226 
+Centre I 
+66 
+Centre II 
+30  
+Centre V 
+32  
+Centre III 
+50 
+Centre IV 
+48 
+Randomized 
+226 
+Yoga 
+33 
+PE 
+33 
+Yoga 
+15 
+PE  
+15 
+Yoga 
+25 
+PE 
+25 
+Yoga 
+24 
+Yoga 
+22 
+PE 
+30 
+No. of People dropped 
+52 
+No, of subjects in the project 
+174 
+Yoga 
+24 
+PE 
+16 
+Yoga 
+16 
+Reasons for dropping 
+                                                   
+Yoga       PE
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+        
+ 
+ 
+                                                      
+        
+  
+              
+ 
+                                                      
+        
+ 
+ 
+Yoga 
+87 
+PE 
+87 
+1. Change of address 
+4 
+10
+2. Unexpected duty shifts 
+5 
+7
+3. Weather conditions 
+3 
+ 2
+4. Out of station 
+7 
+3
+5. Ill health 
+3 
+–
+6. Wanted to shift to yoga 
+ 
+8
+              Total 
+       22 
+30
+Comparison between our data and Vpi data
+Deshpande S, et al.
+[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009]
+7
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:1 
+ 
+! 
+ 
+Jan-Jun-2008
+(effect size 0.61) than in the PE group (effect size 0.45) 
+(paired samples t test). The decrease in the Rajas scores 
+was significantly higher in the PE than in the Y (P=0.005) 
+(independent samples t-test) groups and this was seen 
+in juniors and males. The GHQ revealed a significant 
+improvement on all four domains and the overall health in 
+both groups after the intervention (P ≤ 0.001) (Wilcoxon’s 
+signed rank test). It can be seen from the GHQ scores that 
+PE was more effective in reducing somatic symptoms 
+(P = 0.018) (Mann Whitney test), severe depression (effect 
+size for Y = 1.46, PE = 1.60) and anxiety and insomnia 
+(effect size for Y = 0.98, PE = 1.93). 
+A similar study by Dasa[32] conducted by the use of 
+mahamantra in a three-armed, randomized prospective, 
+controlled study on 62 volunteers showed that the 
+mahamantra group had increased Sattva and decreased 
+Tamas with no significant change in Rajas scores on the VPI 
+questionnaire after a month of chanting of mahamantra, 
+20 minutes daily for four weeks. In the present study, 
+apart from an increase in Sattva and decrease in Tamas, 
+there is a significant decrease in Rajas which was not 
+observed after Mahamantra. This difference could be 
+because of the inclusion of Asanas and Pranayama to 
+the Meditation technique in the integrated yoga program 
+used in the present study as compared to the mahamantra 
+which is mainly a form of meditation. In their study, Dasa 
+et al. also showed a significant reduction in stress, anxiety 
+and depression after mahamantra as measured by State 
+Trait Anxiety Inventory (STAI) comparable to the results 
+of GHQ in this study.
+The behavior of a human being is an expression of 
+a combination of different gunas. Tamas (meaning 
+darkness) is the grossest aspect of our personality 
+characterized by excessive sleep, innocence, laziness, 
+depression, procrastination, a feeling of helplessness, 
+impulsivity, anger and arrogance (packed up with vital 
+energy). When we reduce Tamas through mastery over 
+the mind, we become dynamic, sensitive and sharp to 
+move towards Rajas (the shining one) characterized by 
+intense activity, ambitiousness, competitiveness, high 
+Table 6: GHQ scores: Age ≤ 24 years and > 24 years (Wilcoxon signed ranks test)
+ 
+ 
+Before 
+After 
+P value 
+Before 
+After 
+P value
+ 
+ 
+Means±SD 
+Means±SD 
+ 
+Means±SD 
+Means±SD 
+ 
+ 
+Y 
+Y 
+ 
+PE 
+PE 
+Age ≤ 24 years 
+SS 
+0.65 ± 0.93 
+0.43 ± 0.76 
+0.161 
+0.43 ± 0.76 
+0.14 ± 0.35 
+0.01
+ 
+AI 
+0.71 ± 0.96 
+0.10 ± 0.47 
+<0.001 
+0.66 ± 0.99 
+0.30 ± 1.00 
+0.057
+ 
+SF 
+0.80 ± 0.98 
+0.18 ± 0.44 
+<0.001 
+0.75 ± 1012 
+0.34 ± 0.64 
+0.019
+ 
+SP 
+0.45 ± 0.71 
+0.29 ± 0.68 
+0.185 
+0.64 ± 0.89 
+0.16 ± 0.43 
+<0.001
+ 
+TH 
+2.61 ± 2.54 
+1.00 ± 1.44 
+<0.001 
+2.48 ± 3.11 
+0.93 ± 1.53 
+0.001
+Age > 24 years 
+SS 
+0.47 ± 0.89 
+0.11 ± 0.39 
+0.004 
+0.40 ± 0.85 
+0.09 ± 0.29 
+0.044
+ 
+AI 
+0.47 ± 0.86 
+0.05 ± 0.23 
+0.002 
+0.33 ± 0.78 
+0.06 ± 0.26 
+0.047
+ 
+SF 
+0.34 ± 0.75 
+0.11 ± 0.31 
+0.071 
+0.44 ± 0.83 
+0.12 ± 0.32 
+0.017
+ 
+SP 
+0.42 ± 0.76 
+0.13 ± 0.41 
+0.047 
+0.40 ± 0.79 
+0.14 ± 0.41 
+0.013
+ 
+TH 
+1.71 ± 2.25 
+0.39 ± 1.00 
+0.001 
+1.56 ± 2.00 
+0.42 ± 0.00 
+0.003
+Table 4: Gender-based VPI scores (paired samples t test)
+ 
+ 
+Before 
+After 
+P value 
+Before 
+After 
+P value
+ 
+ 
+Means±SD 
+Means±SD 
+ 
+Means±SD 
+Means±SD 
+ 
+ 
+Y 
+Y 
+ 
+PE 
+PE 
+Females 
+Tamas 
+3.15 ± 0.52 
+2.80 ± 1.04 
+0.04 
+3.20 ± 0.71 
+2.97 ± 0.71 
+0.053
+ 
+Rajas 
+3.66 ± 0.62 
+3.43 ± 0.48 
+0.502 
+3.64 ± 0.63 
+3.50 ± 0.80 
+0.196
+ 
+Sattva 
+4.91 ± 0.42 
+5.20 ± 0.50 
+0.004 
+4.98 ± 0.58 
+5.23 ± 0.62 
+0.034
+Males 
+Tamas 
+3.11 ± 0.50 
+3.10 ± 0.58 
+0.924 
+3.28 ± 0.65 
+3.01 ± 0.46 
+0.032
+ 
+Rajas 
+3.96 ± 0.63 
+3.96 ± 0.41 
+0.898 
+3.73 ± 0.63 
+3.50 ± 0.79 
+0.014
+ 
+Sattva 
+4.86 ± 0.60 
+5.33 ± 0.52 
+<0.001 
+4.80 ± 0.49 
+5.19 ± 0.68 
+0.001
+Table 5: GHQ scores (Wilcoxon signed ranks test) 
+ 
+Before 
+After 
+P value 
+Before 
+After 
+P value
+ 
+Means±SD 
+Means±SD 
+ 
+Means±SD 
+Means±SD 
+ 
+Y 
+Y 
+ 
+PE 
+PE 
+SS 
+0.57 ± 0.91 
+0.29 ± 0.65 
+<0.001 
+0.41 ± 0.80 
+0.11 ± 0.32 
+0.001
+AI 
+0.61 ± 0.92 
+0.08 ± 0.38 
+<0.001 
+0.49 ± 0.90 
+0.18 ± 0.74 
+0.011
+SF 
+0.60 ± 0.91 
+0.15 ± 0.39 
+<0.001 
+0.60 ± 0.99 
+0.23 ± 0.52 
+0.001
+SP 
+0.44 ± 0.73 
+0.22 ± 0.58 
+0.017 
+0.52 ± 0.65 
+0.15 ± 0.42 
+<0.001
+TH 
+2.22 ± 2.48 
+0.74 ± 1.21 
+<0.001 
+2.02 ± 2.78 
+0.68 ± 1.28 
+<0.001
+SS: Somatic symptoms; AI: Anxiety and insomnia; SF: Social dysfunction; SP: Severe depression; TH: Total health
+SS: Somatic symptoms; AI: Anxiety and insomnia; SF: Social dysfunction; SP: Severe depression; TH: Total health
+Effect of Yoga on Gunas and Health
+[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009]
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:1 
+ 
+! 
+ 
+Jan-Jun-2008
+8
+Deshpande S, et al.
+sense of self importance, desire for sense gratification, 
+little interest in spiritual elevation, dissatisfaction 
+with one’s position, envy of others and a materialistic 
+cleverness.[33] With further growth and mastery, one moves 
+into Sattva–a dominance which includes the qualities of 
+truthfulness, stability, discipline, sense of control, sharp 
+intelligence, preference for vegetarianism, truthfulness, 
+gravity, dutifulness, detachment, respect for superiors 
+and staunch determination[21] and stability in the face of 
+adversity and also conscious action. Thus, we can see 
+that although both Rajas and Tamas have both positive 
+and negative qualities, they are the manifestation of a 
+violent state of mind in which a person lacks mastery 
+over upsurges of emotions and impulsive behaviour.[33] 
+Most of the qualities of Sattva which are manifestation 
+of a calm state of mind are achievable by different 
+yoga techniques (physical postures, pranayama and/
+or meditation) meant for mastery over the mind-body 
+complex.[34] Several earlier studies have independently 
+corroborated these notions. It has been shown that self 
+esteem as well as the sense of control and determination 
+improved after meditation.[35] Reduction in crime rate 
+after transcendental meditation (TM) supported the 
+effect of a calm state of mind on social health.[36] These 
+positive effects also show up as better perception and 
+memory as well as better motor performance (dexterity 
+and coordination tests).[37] Better academic performance 
+has also been documented.[38]
+Although in this study, Yoga has shown a better effect 
+on the Sattva guna than PE with a better effect size, the 
+main difference between Y and PE practices seems to 
+be the effect on rajas guna. The reduction in this guna 
+was significantly higher after PE than after Y (this group 
+difference was in males and juniors). The scores for Tamas 
+Table 7: Gender-based GHQ scores (Wilcoxon signed ranks test)
+ 
+ 
+Before 
+After 
+ 
+Before 
+After
+ 
+ 
+Means±SD 
+Means±SD 
+ 
+Means±SD 
+Means±SD
+ 
+ 
+Y 
+Y 
+P value 
+PE 
+PE 
+P value
+Females 
+SS 
+0.50 ± 0.99 
+0.25 ± 0.58 
+0.115 
+0.40 ± 0.74 
+0.07± 0.27 
+0.018
+ 
+AI 
+0.50 ± 0.85 
+0.02± 0.16 
+0.001 
+0.57 ± 0.98 
+0.30 ± 1.04 
+0.208
+ 
+SF 
+0.40 ± 0.81 
+0.10 ± 0.30 
+0.038 
+0.45 ± 0.81 
+0.15 ± 0.36 
+0.038
+ 
+SP 
+0.35 ± 0.62 
+0.28 ± 0.72 
+0.584 
+0.50 ± 0.85 
+0.10 ± 0.45 
+0.005
+ 
+TH 
+1.71 ± 2.35 
+0.65 ± 1.03 
+0.01 
+1.93 ± 2.80 
+0.70 ± 1.44 
+0.018
+Males 
+SS 
+0.64 ± 0.85 
+0.32 ± 0.69 
+0.027 
+0.43 ± 0.85 
+0.15± 0.36 
+0.022
+ 
+AI 
+0.70 ± 0.98 
+0.13± 0.49 
+<0.001 
+0.43 ± 0.83 
+0.08± 0.28 
+0.007
+ 
+SF 
+0.77 ± 0.96 
+0.19 ± 0.45 
+<0.001 
+0.72 ± 1.12 
+0.30 ± 0.62 
+0.009
+ 
+SP 
+0.51 ± 0.80 
+0.17 ± 0.43 
+0.008 
+0.53 ± 0.86 
+0.13 ± 0.40 
+<0.001
+ 
+TH 
+2.62 ± 2.53 
+0.81 ± 1.36 
+<0.001 
+2.11 ± 2.78 
+0.66 ± 1.15 
+<0.001
+also decreased significantly in seniors of both groups 
+(females in Y and males in PE groups) with the effect 
+size being higher in the PE than in the Y groups. Thus, 
+significantly greater reductions in Rajas and Tamas were 
+worthy of note with PE than with Y. This positive effect 
+of PE in reducing Rajas and Tamas adds to the fund of 
+knowledge about several psycho-physiological benefits 
+of PE. Hence, it appears that physical practices are more 
+effective in reducing the limitations of Rajas and Tamas 
+such as lack of mastery over upsurges of emotions and 
+impulsive behavior, while yoga improves the softer 
+qualities of Sattva. The mechanism of how physical 
+exercises may reduce Rajas and tamas and how yoga may 
+increase Sattva needs to be investigated by further studies. 
+Thus, we may conclude that both physical activity (to 
+reduce Rajas and Tamas) and Yoga (to improve Sattva) 
+may be recommended for the harmonious promotion of 
+personality. 
+The GHQ showed significant differences within groups 
+in all domains in both groups. There was a significant 
+difference in SS between the Y and PE groups (Mann 
+Whitney Test). 
+Observations by Atlantis et al. on the efficacy of physical 
+exercise practised for eight weeks in a population of 
+Australian employees showed that the intervention 
+significantly improved the Quality of Life as compared to a 
+waiting list control group (measured by SF-36). They have 
+shown an improvement of 12.8% in physical functioning, 
+9.90% in general health, 44.50% in vitality and 15.90% in 
+mental health scores.[29] The significantly better reduction 
+in SS in the Yoga group in our study may be due to deeper 
+rest and relaxation obtained in Yoga.
+TABLE 8: Comparison between our data (before and after) and standard VPI data
+ 
+n 
+Observed range 
+Observed mean±SD 
+n 
+Predicted range 
+Predicted mean±SD
+Sattva 
+ 
+3.04 - 6.17 
+4.90±0.53 
+ 
+3.00 - 6.39 
+4.67±0.75
+Rajas 
+174 
+2.11 - 5.25 
+3.76±0.63 
+247 
+2.46 - 5.96 
+4.07±1.08
+Tamas 
+ 
+1.47 - 5.38 
+3.19±0.60 
+ 
+1.43 - 6.00 
+3.49±0.90
+SS: Somatic symptoms; AI: Anxiety and insomnia; SF: Social dysfunction; SP: Severe depression; TH: Total health
+[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009]
+9
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:1 
+ 
+! 
+ 
+Jan-Jun-2008
+Effect of Yoga on Gunas and Health
+The results of the study seem to point out clear differences 
+between Y and PE on VPI whereas differences between Y 
+and PE are not found in most domains of GHQ (except SS). 
+Hence, although GHQ is a good measure of the various 
+aspects of health and disease, VPI seems to be a better 
+measure to differentiate the effects of Y and PE.
+In summary, this randomized, prospective, single-blind, 
+comparative study has shown the efficacy of both Y and 
+PE in improving all components of general health. While 
+physical exercise has reduced Rajas and Tamas, the yogic 
+practice has increased Sattva. Hence, yoga which is more 
+traditionally practised in India and cost-effective, can be 
+recommended with additional benefits of promotion of 
+the Sattva guna.
+The strength of our design is a PE intervention matched 
+with the integrated Y module. The study population was 
+taken from different parts of Bangalore from different 
+socioeconomic classes of the city. The improvement 
+observed in both groups after eight weeks of intervention 
+in all variables in both groups not only provides hitherto 
+undemonstrated evidence of the efficacy of physical 
+activity in a normal South Indian adult population but 
+also shows that yoga could be an equally effective tool. 
+This study also brings out the subtle differences in 
+the efficacy of the two interventions (Y or PE). It also 
+points out the utility of the VPI as a tool for measuring 
+the subtle dimensions of guna described in traditional 
+texts of yoga that can measure the steps of growth of 
+an individual.
+ACKNOWLEDGMENTS
+Our grateful acknowledgements for all who helped in this project. 
+We are grateful to SVYASA for supporting this study. We thank 
+the volunteers, teachers and supporters who participated in 
+this study.
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+18. Jorm AF, Christensen H, Griffiths KM, Rodgers B. Effectiveness of 
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+2002;176:S84-96. 
+19. Goyandka J. Srimadbhagavad gita Tattvavivecani, 15th ed. Govind Bhavan 
+Karyalaya, Gita Press: Gorakhpur; 1999.
+20. Das RC. Standardization of the Gita inventory of personality. J Indian Psychol 
+1991;9:47-54. 
+21. Wolf DB. The vedic personality inventory: A study of the Gunas. J Indian 
+Psychol 1998;16:26-43. 
+22. Goldberg DP, Gater R, Sartorius, Ustan TB, Piccinelli M, Gujeje O, et al. 
+The validity of two versions of the GHQ in the WHO study of mental illness 
+in general health care. Psychol Med 1997;27:191-7.
+23. Available from: http://www.randomisor.org AU:Incomplete reference.
+24. Goldberg DP, Hillier VF. A scaled version of the general Health Questionnaire. 
+Psychol Med 1979;9:139-45.
+25. Nagarathna R, Nagendra HR. Integrated Approach of Yoga Therapy for 
+Positive Health. 5th ed. SVYP: Bangalore; 2003.
+26. Lokeswarananda S. Taittiriya U. The Ramakrishna Mission Institute of 
+Culture: Calcutta; 1996. p. 136-80.
+27. Nagarathna R, Nagendra HR. Yoga, 2nd ed. SVYP: Bangalore; 2003. 
+28. Nagarathna R, Nagendra HR. Yoga for Arthritis. Swami Vivekananda Yoga 
+Prakashana: Bangalore; 2001. p. 35-51.
+29. Atlantis E, Chow CM, Kirby A, Singh MF. An effective exercise-based 
+intervention for improving mental health and quality of life measures: A 
+randomized controlled trial. Prev Med 2004;39:424-34. 
+30. Available from: http://www.uni-mannhein.de/gpower. AU:Incomplete 
+reference.
+31. Cohen J. Statistical power analysis for the behavioral sciences. Academic 
+Press: New York; 1977.
+32. Dasa DG. Effects of the Hare Krsna Maha mantra on stress, Depression and 
+The Three Gunas. VNN Vaishnava News org Networh VNN4267. 1999. 
+Available from: http://www.vnn.org/usa/US9907/US10-4267.html.
+33. Nagendra HR. The secret of action. 1st ed. SVYP: Bangalore; 2003.
+34. Holt WR, Caruso JL, Riley JB. Transcendental Meditation vs pseudo-meditation 
+on visual choice reaction time. Percept Motor Skills 1978;46:726. 
+35. Alexander CN, Robinson P, Rainforth M. Treating and preventing alcohol, 
+nicotine and drug abuse through transcendental meditation: A review and 
+statistical meta-analysis. Alcoholism Treatment Quarterly 1994;11:1-2,
+13-87. 
+[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009]
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:1 
+ 
+! 
+ 
+Jan-Jun-2008
+10
+36. Abrams AI. Transcendental meditation and rehabilitation at Folsom prison: 
+Response to a critique. Criminal Justice Behav 1979;6:13-21. 
+37. Dillbeck MC, Orme-Johnson DW. Physiological differences between 
+transcendental meditation and rest. Am Psychol 1987;42:879-81. 
+38. Kember P. The Transcendental Meditation technique and postgraduate 
+academic performance. Br J Educ Psychol 1985;55:164-6.
+Effect of Yoga on Gunas and Health
+[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009]

yogatexts/A randomized control trial of the effect of yoga on verbal.txt

@@ -0,0 +1,999 @@
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:2 
+ 
+! 
+ 
+Jul-Dec-2008
+76
+A randomized control trial of the effect of yoga on verbal 
+aggressiveness in normal healthy volunteers 
+Sudheer Deshpande, Nagendra H R, Raghuram Nagarathna
+Department of Yoga Research, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India.
+Objective: To study the effect of yoga on verbal aggressiveness in normal healthy adults. 
+Methods: Of the 1228 persons who attended introductory lectures, 226 subjects of both sexes who satisfi
+ ed the inclusion 
+and exclusion criteria and who consented to participate in the study were randomly allocated into two groups. These 226 
+subjects were between the ages of 17 and 62 years and 173/226 completed the eight weeks of intervention. The Yoga (Y) 
+group practised an integrated yoga module that included asanas, pranayama, meditation, notional correction, and devotional 
+sessions. The control group practised mild to moderate physical exercises (PE). Both groups had supervised practices (by 
+trained experts) for one hour daily, six days a week for eight weeks. 
+Verbal Aggressiveness was assessed before and after eight weeks using the self-administered Verbal Aggressive Scale. 
+Results: The baseline score of the two groups did not differ signifi
+ cantly (P = 0.66). There was a signifi
+ cant decrease in verbal 
+aggressiveness in the yoga group (P = 0.01 paired samples t-test) with a nonsignifi
+ cant increase in the PE group. ANCOVA 
+using pre- values as covariates showed a signifi
+ cant difference between the groups (P = 0.013). RMANOVA for interaction 
+between the sexes or age groups in change scores were not signifi
+ cant. 
+Conclusions: This study has demonstrated that an eight week intervention of an integrated yoga module decreased verbal 
+aggressiveness in the yoga group (in males and those below 25 years of age), with a nonsignifi
+ cant increase in the PE 
+group. 
+Keywords: Physical exercise; verbal aggression scale; Yoga.
+Original Article
+Correspondence to: Dr. Nagarathna Raghuram
+No 19, Eknath Bhavan, Gavipuram Circle, 
+KG Nagar, Bangalore – 560 019, India.
+E-mail: [email protected]
+INTRODUCTION
+Although global scientific and technological progress is 
+evidence of human intelligence and creativity, emotional 
+hypersensitivity and aggression have increased.[1] 
+Violence remains one of the greatest public health threats 
+to youth. Intentional injuries due to violence comprise 
+the second leading cause of death of US adolescents,[2] as 
+well as a substantial proportion of morbidity[3,4] such as 
+elevated depressive symptoms and posttraumatic stress 
+disorder.[5] Irritability and emotional outbursts are other 
+manifestations of violence that could be measured. The 
+verbal aggressiveness scale is a measure of violence that 
+has been used in earlier studies.[6] Verbal aggressiveness 
+is defined as an attack on an individual’s self-concept 
+instead of, or in addition to the person’s position 
+on a topic of communication, to inflict psychological 
+pain.[7] A message must attack the self-concept of the 
+receiver if it is to be considered as verbally aggressive 
+message.[8] It was found that people who are high in the 
+verbal aggression trait, differ significantly from those low 
+in verbal aggression trait in terms of their use of these 
+messages.[8]
+Yoga which encompasses several techniques including 
+physical postures, breathing techniques (Pranayama) and 
+meditation has become very popular for its applications 
+in health starting from better physical fitness[9] to a 
+better quality of life in cancer patients.[10] Yoga has been 
+used effectively for stress reduction that has resulted 
+in biochemical[11] and physiological[12] changes. Several 
+ABSTRACT
+[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009]
+77
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:2 
+ 
+! 
+ 
+Jul-Dec-2008
+studies have highlighted the psychological benefits of 
+integrated yoga practices such as anxiety, neurosis,[13,14] 
+and depressive illness.[15,16] The clinical potential of yoga 
+as a self-control technique for improving and stabilizing 
+affective states was studied by Harvey. In a three armed 
+study, Harvey compared yogic breathing exercises with 
+two control groups (a course on the philosophy of 
+meditation and a course in psychology) and demonstrated 
+that yogic breathing exercises showed an improvement in 
+mood and vigor as well as decreased tension, fatigue, and 
+depression relative to subjects in control groups.[17] The 
+mood benefits of Hatha yoga and swimming compared 
+in college students showed that yoga was as effective 
+as swimming in decreasing anxiety, confusion, tension 
+and depression, and that the acute decreases after yoga 
+were significantly greater than after swimming for men 
+who were personally selected to participate.[18] Similar 
+results have also been noted in psychiatric patients 
+with a reduction in negative emotions factor in Profile 
+of Mood States, including tension-anxiety, depression-
+dejection, anger-hostility, fatigue-inertia, and confusion-
+bewilderment after yoga.[19] The verbal aggressiveness 
+scale was also used to assess the response of basketball 
+players to the verbal aggressiveness of the coaches which 
+showed that male players were more affected than the 
+female players.[20]
+Although there are several studies on the efficacy of yoga 
+on different measures of emotional states, there are no 
+studies on any measure of aggressive responses. Also there 
+are no randomized control trials (RCTs) on the effect of 
+yoga in comparison to PE in the same study. Hence, the 
+aim of the current study was to investigate whether Yoga 
+can provide benefits comparable to PE in reducing verbal 
+aggressiveness in normal healthy adults. 
+METHODS
+Subjects
+Two hundred and twenty-six subjects who consented to 
+participate in the study, were randomly allocated into two 
+groups of equal size. The final data was available on 173 
+subjects. Inclusion criteria were (a) healthy individuals 
+of both sexes and between the ages of 18 and 71 years, 
+and (b) ability to read and write English because the 
+participant had to fill up the questionnaire available in the 
+English language. Exclusion criteria were (a) individuals 
+with diseases such as diabetes, cancer, hypertension, 
+anxiety, depression etc., (b) substance abuse, and (c) active 
+nicotine abuse. 
+Source of subjects: Normal adult volunteers who 
+consented to participate in the study were recruited from 
+different locations in Bangalore.
+Ethical clearance: Signed informed consent was obtained 
+from all the subjects and also from the institutional heads 
+where the classes were conducted. The institutional 
+ethical committee of the parent institution had cleared 
+the project proposal. 
+Design 
+This was a prospective randomized control design to 
+compare the efficacy of yoga (Y) with physical exercise 
+(PE) as a control intervention in normal healthy volunteers. 
+Motivational lectures were arranged in public centers such 
+as colleges, health clubs, Rotary clubs, Lions’ clubs and 
+apartment complexes. The classes were planned in five 
+different centers in the city of Bangalore. 
+After reading the instructions in the informed consent 
+form about the design of the study, these subjects agreed 
+to be in the allotted group. The experimental group was 
+given Y practices and the control group was given PE for 
+one hour daily on an empty stomach (6 to 7 a.m.). The 
+classes were conducted six days a week for eight weeks 
+and attendance was maintained by the teachers. Trained 
+experts in either Y or PE conducted parallel sessions for 
+the two groups in different rooms of the same building. 
+It was ensured that there was no interaction between the 
+subjects. The tests were administered on the first and last 
+day of the study before starting the classes, by arranging 
+the subjects to sit in a quiet hall, free from distractions 
+and influences from each other, with supervisors moving 
+around to clarify any doubts.
+Randomization 
+The subjects selected for the study were randomly allotted 
+into two groups by using five different random number 
+tables (different tables for each center) generated from the 
+random number generator program.[21]
+Masking
+The answered questionnaires were coded and kept away 
+for future scoring. A psychologist who was not involved 
+in the subject allocation or supervision of the classes, 
+scored the questionnaires which were decoded only after 
+the scoring of all answer sheets was completed. 
+Assessments
+The Verbal Aggressiveness Scale (VAS)—VAS [Table 1] is 
+an interpersonal model and measure. The VAS developed 
+by Infante and Wigley contains 20 items scored on a 
+5-point linear rating format with reverse scoring on ten out 
+of 20 items (questions: 1, 3, 5, 8, 10, 12, 14, 15, 17, 20). The 
+scores can range from 20 to 100. The VAS gives a single 
+overall score that describes the disposition of an individual 
+Effect of Yoga on verbal aggressiveness
+[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009]
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:2 
+ 
+! 
+ 
+Jul-Dec-2008
+78
+towards low, moderate, or high verbal aggressiveness. 
+Scores from 20–46 suggest low verbal aggressiveness, 
+47–73 suggest moderate verbal aggressiveness and 74–100 
+suggest high verbal aggressiveness. 
+Validity: This scale is stable across time. The reported 
+test-retest reliability is 0.82 for a four week period. Further, 
+cross-culture reliability has been supported in a number 
+of studies.[7]
+Interventions
+Yoga group
+Table 2 shows the list of practices used for the two 
+groups. The integrated yoga module was selected from 
+the integrated set of yoga practices used in earlier studies 
+on yoga for positive health.[22] The module was developed 
+based on ancient Yoga texts[23] to bring about a total 
+development at the physical, mental, emotional, social, 
+and spiritual levels.[24] The techniques included i) physical 
+practices (Kriyas, asanas, healthy yoga diet), ii) breathing 
+practices with body movements and Pranayama, iii) 
+meditation, iv) devotional sessions, v) lectures on yoga, 
+vi) stress management based on yogic philosophy, and vii) 
+lifestyle change through notional corrections for blissful 
+awareness under all circumstances (action in relaxation). 
+Qualified yoga teachers taught yoga.
+Physical exercise group 
+The set of physical exercises chosen for this study consisted 
+of standard practices[25] to provide mild to moderate 
+exercises designed by experts in physical education and 
+taught by trained physical education teachers. This group 
+also had interactive lectures on healthy lifestyle including 
+diet habits and stress management based on modern 
+medical knowledge. The daily sessions began with short 
+talks of five minutes on lifestyle and health covering the 
+topics of (a) healthy diet (six talks) such as classification of 
+foods, energy-yielding foods, role of animal fat and relation 
+to cholesterol, vegetarian vs nonvegetarian diet, value of 
+fiber etc., (b) value of exercise and health (six sessions) 
+explaining different type of exercises, effects on muscles, 
+joints, the value of regular sport activity etc, (c) bad effects 
+of smoking (four talks), alcohol and other chemical abuse 
+(two sessions), (d) effects of mental stress on health and 
+the role of physical exercise in management of stress. 
+This was followed by practice of the physical exercises 
+for 45 minutes with enough rest in between. The sessions 
+ended with ten minutes of self-relaxation (without guided 
+instructions) in the supine position.
+Data extraction
+The scoring of the questionnaires was carried out as per 
+the instructions in the manual and under the guidance 
+of a psychologist. They were decoded after the scoring of 
+both pre- and post- data 
+Data analysis
+Data was analyzed using SPSS version 10.0. A sample 
+size of 164 was calculated based on previous studies,[26] 
+which showed an effect size of 0.8, with a power of 0.8 
+and alpha set to 0.05. This calculation was done using G 
+power.[27] The size of the sample actually recruited was 
+226 while only data on 173/226 subjects were available 
+for analysis. 
+The statistical tests used were paired samples t-test for 
+pre-post comparison and ANCOVA for change score 
+comparison of the two groups. Interaction between males 
+Table 1: VAS Questionnaire
+1 
+I am extremely careful to avoid attacking individuals’ intelligence when I attack their ideas. 
+1 2 3 4 5
+2 
+When individuals are very stubborn, I use insults to soften their stubbornness. 
+1 2 3 4 5
+3 
+I try very hard to avoid having other people feel bad about themselves when I try to influence them. 
+1 2 3 4 5
+4 
+When people refuse to do a task I know is important without good reason, I tell them they are unreasonable. 
+1 2 3 4 5
+5 
+When others do things that I regard as stupid, I try to be extremely gentle with them. 
+1 2 3 4 5
+6 
+If individuals that I am trying to influence really deserve it, I attack their character. 
+1 2 3 4 5
+7 
+When people behave in ways that are in very poor taste, I insult them in order to shock them into proper behavior. 
+1 2 3 4 5
+8 
+I try to make people feel good about themselves, even when their ideas are stupid. 
+1 2 3 4 5
+9 
+When people simply will not budge on a matter of importance, I lose my temper and say rather strong things to them. 
+1 2 3 4 5
+10 When people criticize my shortcomings, I take it in good humor and do not try to get back at them. 
+1 2 3 4 5
+11 When individuals insult me, I get a lot of pleasure out of really telling them off. 
+1 2 3 4 5
+12 When I dislike individuals greatly, I try not to show it in what I say or how I say it. 
+1 2 3 4 5
+13 I like poking fun at people who do things that are very stupid in order to stimulate their intelligence. 
+1 2 3 4 5
+14 When I attach peoples’ ideas, I try not to damage their self-concepts. 
+1 2 3 4 5
+15 When I try to influence people, I make a great effort not to offend them. 
+1 2 3 4 5
+16 When people do things that are mean or cruel, I attack their character in order to help correct their behaviour. 
+1 2 3 4 5
+17 I refuse to participate in arguments when they involve personal attacks. 
+1 2 3 4 5
+18 When nothing seems to work in trying to influence others, I yell and scream in order to get some movement from them. 1 2 3 4 5
+19 When I am not able to refute others’ positions, I try to make them feel defensive in order to weaken their positions. 
+1 2 3 4 5
+20 When an argument shifts to personal attacks, I try very hard to change the subject. 
+1 2 3 4 5
+1 – Almost never true, 2 – Rarely true, 3 – Occasionally true, 4 – Often true, 5 – Almost always true
+Deshpande S, et al. 
+[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009]
+79
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:2 
+ 
+! 
+ 
+Jul-Dec-2008
+and females in their change scores in yoga and control 
+groups was checked by Repeated Measures ANOVA 
+(RMANOVA). As the study population had a wide age 
+range, analysis was also carried out by considering the 
+median age of 25 years as the value for grouping them 
+as juniors (age ≤ 25 years) and seniors (age > 25 years). 
+The interaction between these two groups in their change 
+scores were also checked by RMANOVA.
+RESULTS
+Figure 1 shows the trial profile of the 1228 subjects who 
+attended the motivational lectures. Two hundred twenty-
+six subjects who satisfied the inclusion and exclusion 
+criteria, were selected and randomly allotted to two 
+groups: Y and PE. The reasons for drop-out of 53 subjects 
+are shown in the figure. Data on 84 subjects in the yoga 
+group and 89 in the control group were available for the 
+final analysis.
+Table 3 shows the demographic data. There were 80 
+females and 93 males within the age range of 17–62 years. 
+The mean ages were 28.7 ± 11.6 years for the Y group 
+and 30.8 ± 11.9 years for the PE group. They belonged to 
+different categories such as college students, employees, 
+Table 2: Details of Y and PE Practices
+ 
+                  Yoga practices 
+                Physical exercise practice
+No. Duration 
+Names 
+Duration 
+Names
+1) 
+5 minutes 
+Breathing practices 
+10 minutes 
+Warm up Exercises 
+ 
+ 
+Hands in and out breathing  
+ 
+(a) loosening of ankles 
+ 
+ 
+Dog breathing 
+ 
+(b) knee caps
+ 
+ 
+Tiger breathing 
+ 
+(c) waist 
+ 
+ 
+Straight leg raise breathing 
+ 
+(d) spine 
+ 
+ 
+ 
+ 
+(e) twisting 
+2) 
+5 minutes 
+Loosening Exercises 
+ 
+(f) shoulder movements
+ 
+ 
+Jogging 
+ 
+(g) hands movement
+ 
+ 
+Forward and backward bending 
+ 
+(h) Wrist movements and rotations
+ 
+ 
+Side bending 
+ 
+(i) neck movement and rotations
+ 
+ 
+Twisting 
+ 
+(j) head movement and rotations
+ 
+ 
+Pavanamuktäsana kriya 
+ 
+ 
+ 
+ 
+5 minutes 
+Stretches
+3) 
+25 minutes  
+Äsanas 
+ 
+(a) leg stretch 
+ 
+ 
+Standing 
+ 
+(b) hand stretch
+ 
+ 
+Ardha Chakrasana 
+ 
+(c) leg to hand 
+ 
+ 
+Pada Hastasana 
+ 
+(d) sideward leg stretch (full)
+ 
+ 
+Privritta Trikonasana 
+ 
+(e) folded leg lumber stretch 
+ 
+ 
+Sitting 
+ 
+(f) dog stretch
+ 
+ 
+Vajrasana 
+ 
+(g) tiger stretch
+ 
+ 
+Supta Vajrasana 
+ 
+(h) dorsal stretch
+ 
+ 
+Chakrasana 
+ 
+ 
+ 
+Hamsasana or Mayurasana 
+10 minutes 
+Sit-ups (50 to 100 times)
+ 
+ 
+Prone postures 
+ 
+Push-ups (20 times)
+ 
+ 
+Dhanurasana 
+ 
+Squats
+ 
+ 
+Supine postures 
+ 
+ 
+ 
+Sarvangasana 
+10 minutes 
+Supine 
+ 
+ 
+Matsyasana 
+ 
+(a) single leg raising
+ 
+ 
+Ardha Shirshasana or Shirshasana 
+ 
+(b) alternative leg raising
+ 
+ 
+ 
+ 
+(c) both leg raising (50 times) 
+ 
+ 
+ 
+ 
+(d) coming up and touching the  
+ 
+ 
+ 
+ 
+knees to forehead and going back 
+ 
+ 
+ 
+ 
+(e) Cycling
+4) 
+5 minutes 
+Deep relaxation technique 
+10 Minutes 
+Supine rest (Guided relaxation)
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+5) 
+10 minutes 
+Pranayama 
+10 minutes 
+Dynamics
+ 
+ 
+Kapalabhati 
+ 
+(a) forward Backward bending
+ 
+ 
+Vibhagiya Pranayama 
+ 
+(b) side bending
+ 
+ 
+Nadishuddhi Pranayama 
+ 
+(c) bending and twisting
+ 
+ 
+Sitali, Sitkari and Sadanta 
+ 
+(Simple and legs apart)
+ 
+ 
+Bhramari Pranayama 
+ 
+(d) Twisting
+ 
+ 
+Nada Anusandhana 
+ 
+ 
+ 
+Or  
+5 minutes 
+Lectures 
+6) 
+ 
+ 
+Meditation—Om Meditation 
+ 
+ 
+ 
+ 
+ 
+7) 
+10 minutes 
+ 
+Bhajans/Lectures 
+ 
+Effect of Yoga on verbal aggressiveness
+[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009]
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:2 
+ 
+! 
+ 
+Jul-Dec-2008
+80
+business people and housewives. There were ten subjects 
+with low scores, 156 subjects with moderate scores and 
+seven subjects with high scores on the VAS. 
+Table 4 shows the changes after the intervention in the 
+two groups. The scores on VAS in the Y group (59.77 ± 
+7.51 to 57.36 ± 6.20) showed a significant decrease (P = 
+0.01). There was a nonsignificant increase in the PE group 
+(58.71 ± 9.25 to 59.93 ± 8.63). There was a significant 
+difference between the groups (P = 0.013) on ANCOVA 
+considering the pre- values as covariates. RMANOVA 
+for interaction between males and females (P = 0.68) 
+and the two age groups (P > 0.50) showed no significant 
+differences between groups.
+DISCUSSION
+This is a randomized control prospective study in normal 
+adults comparing the effects of Yoga (Y) and physical 
+exercise (PE) on verbal aggressiveness. This study has 
+demonstrated that an eight weeks’ intervention of an 
+integrated yoga module decreased verbal aggressiveness 
+in the yoga group with a nonsignificant increase in the 
+PE group. RMANOVA for interactions of change scores 
+showed no significant differences between the sexes and 
+age groups in either the yoga or control groups. 
+A comparison of the baseline VAS scores used in another 
+study by Wolf (used to validate the Rajas domain of 
+another questionnaire called Vedic personality inventory) 
+showed that the means of the baseline scores (59.23 ± 
+8.44) of our study group (n = 173) are comparable to their 
+population (n = 240) in the USA (56.04 ± 17.08).[28]
+The changes found after eight weeks of intervention 
+although not very significant, suggest that continued 
+Table 3: Demographic data
+ 
+Yoga 
+PE
+ 
+(n = 84) 
+(n = 89)
+Age (years) 
+28.73 ± 11.56 
+30.81 ± 11.86
+Range (years) 
+17–67 
+18–62
+Female 
+40 
+40
+Male 
+44 
+49
+Category of people
+Students 
+42 
+44
+Employees 
+18 
+23
+Housewives 
+14 
+12
+Business  
+10 
+ 10
+Orienta
on Seminar Conducted at different parts of Bangalore
+ 
+1228  
+Consented to par
cipate in the project
+ 
+Centre I 
+66 
+Centre II 
+30 
+Centre V 
+32 
+Centre III 
+50
+Centre IV 
+48 
+Randomized 
+226 
+Yoga 
+33
+PE 
+33
+Yoga 
+15
+PE. 
+15
+Yoga 
+25
+PE 
+25
+Yoga 
+24
+Yoga 
+23
+PE 
+30
+No. of People who dropped out 
+53
+No. of subjects in the project 
+173
+Yoga 
+24
+PE 
+16
+Yoga 
+16
+Reasons for dropping 
+                                                   
+Yoga     PE  
+1. Change of address                       4         10 
+2. Unexpected duty shis               5           7
+3. Weather condi
ons                     3           2  
+ 
+4. Out-of-town
+                              
+8  
+         
+3
+ 
+ 
+ 
+ 
+        
+ 
+Yoga 
+84
+PE 
+89
+226
+5. Ill health                                         3            -
+6. Wanted to shi to yoga                            8
+Total                                23         30
+Figure 1: Trial profile
+Deshpande S, et al. 
+[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009]
+81
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:2 
+ 
+! 
+ 
+Jul-Dec-2008
+practices may show greater degree of changes. The type 
+of assessment tool used may also not be the most suitable 
+one to bring out the subtle changes that may have occurred 
+after the yoga practices.
+A study on the relationship between verbal aggressiveness 
+and state anxiety in sports by Alexandra et al.[20] showed 
+that male basketball players were more affected by verbal 
+aggressiveness of their coaches compared to female 
+basketball players as assessed by VAS administered 
+immediately after the game. In their study, they also 
+observed a positive correlation between their anxiety 
+and VAS scores in male players. It is known that yoga 
+with its holistic approach uses several techniques to calm 
+down the mind and reduce the anxiety state. Our earlier 
+studies have shown that in community home girls and 
+congenitally blind children, sympathetic tone reduced 
+after yoga practices which resulted in significant decreases 
+in resting heart rates and breath rates, thus reducing fear 
+and anxiety.[29] The sympathetic tone reduction could be a 
+valuable treatment modality for the reduction of anxiety. 
+Another study on PT teachers also showed that yoga 
+reduced their sympathetic activity after three months of 
+yoga practices.[30] A significant reduction in anxiety scores 
+was observed in patients with anxiety neurosis[31] after 
+a yoga program. Based on these observations, we may 
+suggest that the reduction in aggressiveness in the present 
+study could be due to the reduction in their baseline 
+anxiety and sympathetic reactivity. 
+The rate of violent victimization among 12 to 24 year-olds 
+is nearly twice as high as that among adults ≥ 25 years 
+(Bureau of Justice Statistics, 1996). In the present study, 
+the changes observed in VAS after yoga practices suggest 
+that yoga can be used for the reduction of violence.
+According to the most widely used scriptural reference 
+on yoga, the sage Patanjali[32] defines yoga as a technique 
+for developing mastery over the modifications of the 
+mind and goes on to highlight many techniques that 
+help in achieving this mastery. They are classified under 
+eight major streams including injunctions for social and 
+personal behavior (yama niyama), body postures (asanas), 
+breathing (pranayama), and meditation (pratyahara, 
+dharana, dhyana, and samadhi) techniques that lead 
+to mastery over any of the modifications in the mind. 
+Furthermore, the sage Vasistha[24] in his famous work, Yoga 
+Vasistha, defines yoga as a technique to slow or calm the 
+mind directly through deep internal awareness. Hence, 
+it was hypothesized that verbal aggressiveness, one of 
+the manifestations of an uncontrolled fast mind, can be 
+decreased by these techniques of yoga. 
+The strength of this study is the good sample size and 
+the design in which the control group also had the same 
+duration of interaction with the instructor and learnt 
+nonyogic physical practices comparable to the integrated 
+Yoga module. And the study population was taken from 
+different parts of Bangalore from different socio-economic 
+classes of the city. 
+Some limitations of the study were (a) this could not be a 
+blinded RCT as yoga is a self-corrective learning process, 
+(b) although we ensured that both groups had not done 
+any yoga practices before recruitment, the possibility that 
+the control group participants may have been exposed 
+earlier to the concepts and philosophy of yoga (as it is 
+widely available in Indian media) could not be ruled out, 
+(c) although significant, the difference found after eight 
+weeks of intervention was small, raising the utility of just 
+an hour’s practice in today’s busy schedules. However, 
+it may be possible that continued longer durations of 
+practice may show greater degrees of changes. This was 
+noticed in asthma and schizophrenia projects, where 
+shorter yoga intervention did not result in any significant 
+changes but greater significance was seen when the 
+intervention was increased.[33] Furthermore, a justification 
+for yoga intervention would be the potential for other 
+health benefits with yoga (such as positive effects on 
+blood pressure, well being etc) and the complications 
+and costs associated with drug therapy as pharmaceutical 
+intervention. Future studies are required to study the 
+Effect of Yoga on verbal aggressiveness
+Table 4: Results of VAS after the intervention in both groups
+ 
+                     Y 
+ 
+ 
+ 
+                         PE  
+ 
+n 
+Before 
+After 
+P† 
+n 
+Before 
+After 
+P† 
+P*
+Whole group 
+84 
+59.77 ± 7.51 
+57.36 ± 6.20 
+0.017 
+89 
+58.71 ± 9.25 
+59.93 ± 8.63 
+0.268 
+0.013
+Age ≤ 25years 
+47 
+60.31 ± 7.10 
+57.60 ± 6.32 
+0.072 
+41 
+58.31 ±10.06 
+59.49 ± 8.83 
+0.532 
+Age > 25 years 
+37 
+59.15 ± 8.01 
+57.09 ± 6.14 
+0.126 
+48 
+59.02 ± 8.67 
+60.28 ± 8.54 
+0.346 
+Females 
+40 
+60.38 ± 7.96 
+57.74 ± 6.48 
+0.053 
+80 
+58.55 ± 8.97 
+61.25 ± 7.38 
+0.73 
+Males 
+44 
+59.23 ± 7.96 
+57.20 ± 6.48 
+0.156 
+49 
+58.84 ± 8.91 
+58.86 ± 7.38 
+0.987 
+Legend: P† = significance pre-post within groups (paired t test)
+P* = significance between groups (ANCOVA with pre- values as covariates)
+n = Number
+Interactions between change scores (pre/post) between sexes (males/females) and the two age groups (≤ 25 / >25) in the yoga and control groups were 
+checked by using RMANOVA that showed that there was no significant difference between the two groups (P > 0.5).
+[Downloaded free from http://www.ijoy.org.in on Tuesday, January 06, 2009]
+International Journal of Yoga 
+ 
+! 
+ 
+Vol. 1:2 
+ 
+! 
+ 
+Jul-Dec-2008
+82
+physiological indicators of anxiety that may correlate with 
+VAS. Also, a third arm with only lectures for education 
+may be included in future studies. 
+In summary, this randomized, prospective, single-blind, 
+comparative study has shown the efficacy of Yoga in 
+decreasing verbal aggressiveness. Hence, yoga may be 
+recommended in schools to deal with the problem of 
+violence among students, which is still a live issue in all 
+parts of the world.
+ACKNOWLEDGMENTS
+My grateful acknowledgments for all who helped in this project. 
+We are grateful to SVYASA for supporting this study. We thank 
+the volunteers, teachers and supporters who participated in 
+this study.
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yogatexts/A randomized controlled study on assessment of health status, depression, and anxiety in coal miners with copd.txt

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+137
+© 2016 International Journal of Yoga | Published by Wolters Kluwer - Medknow
+A randomized controlled study on assessment of health 
+status, depression, and anxiety in coal miners with chronic 
+obstructive pulmonary disease following yoga training
+Rajashree Ranjita, Sumati Badhai, Alex Hankey, Hongasandra R Nagendra
+Division of Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana Yoga University, Bengaluru, Karnataka, India
+Address for correspondence: Dr. Rajashree Ranjita, 
+ 
+Swami Vivekananda Yoga Anusandhana Samsthana, No. 19, Eknath Bhavan, Gavipuram Circle, 
+ 
+Kempegowda Nagar, Bengaluru ‑ 560 019, Karnataka, India. 
+ 
+E‑mail: [email protected]
+increasingly affect the psychological well‑being of working 
+populations,[4] coal miners being more susceptible due to 
+highly risky and stressful working environments.[5] Prior 
+studies have documented association of depression and 
+anxiety among COPD patients[6‑9] more than non‑COPD 
+individuals.[10] Clinically significant symptoms of 
+depression were found in around half COPD patients[11,12] 
+while the prevalence of anxiety has been estimated at 
+INTRODUCTION
+Chronic obstructive pulmonary disease (COPD) is a 
+complex, treatment‑resistant disease with multiple 
+comorbidities, depression, and anxiety being the two of 
+the most important and least treated among them.[1] Other 
+than cigarette smoking, there is an increasing evidence 
+of occupational exposures as a major risk factor for 
+COPD[2,3] found the prevalence of COPD in nonsmoking 
+coal miners was 19% in a study. Depression and anxiety 
+Original Article
+Context: Psychological comorbidities are prevalent in coal miners with chronic obstructive pulmonary disease (COPD) and 
+contribute to the severity of the disease reducing their health status. Yoga has been shown to alleviate depression and anxiety 
+associated with other chronic diseases but in COPD not been fully investigated.
+Aim: This study aimed to evaluate the role of yoga on health status, depression, and anxiety in coal miners with COPD.
+Materials and Methods: This was a randomized trial with two study arms (yoga and control), which enrolled 81 coal miners, 
+ranging from 36 to 60 years with stage II and III stable COPD. Both groups were either on conventional treatment or combination 
+of conventional care with yoga program for 12 weeks.
+Results: Data were collected through standardized questionnaires; COPD Assessment Test, Beck Depression Inventory and 
+State and Trait Anxiety Inventory at the beginning and the end of the intervention. The yoga group showed statistically significant 
+(P < 0.001) improvements on all scales within the group, all significantly different (P < 0.001) from changes observed in the 
+controls. No significant prepost changes were observed in the control group (P > 0.05).
+Conclusion: Yoga program led to greater improvement in physical and mental health status than did conventional care. Yoga 
+seems to be a safe, feasible, and effective treatment for patients with COPD. There is a need to conduct more comprehensive, 
+high‑quality, evidence‑based studies to shed light on the current understanding of the efficacy of yoga in these chronic conditions 
+and identify unanswered questions.
+Key words: Anxiety; COPD assessment test; chronic obstructive pulmonary disease; depression; yoga.
+ABSTRACT
+Access this article online
+Website: 
+www.ijoy.org.in
+Quick Response Code
+DOI: 
+10.4103/0973-6131.183714
+How to cite this article: Ranjita R, Badhai S, Hankey A, 
+Nagendra HR. A randomized controlled study on assessment of health 
+status, depression, and anxiety in coal miners with chronic obstructive 
+pulmonary disease following yoga training. Int J Yoga 2016;9:137-44.
+This is an open access article distributed under the terms of the Creative 
+Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows 
+others to remix, tweak, and build upon the work non‑commercially, as long as the 
+author is credited and the new creations are licensed under the identical terms.
+For reprints contact: [email protected]
+[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82]
+Ranjita, et al.: Effect of yoga on depression, anxiety in COPD
+International Journal of Yoga • Vol. 9 • Jul-Dec-2016
+138
+40%.[13‑15] About one‑third of COPD sufferers is afflicted 
+by both.[16] The presence of these comorbid symptoms 
+significantly contributes to the impaired health status 
+in patients with COPD[17,18] irrespective of the degree of 
+airflow limitation.[19] Therefore, optimizing the health 
+status is an important goal in COPD management.[20] In a 
+systematic review, it has been reported that comprehensive 
+pulmonary rehabilitation benefits in a reduction in 
+short‑term depression and anxiety.[21] Limited evidence is 
+available on the effect of mindfulness‑based treatments 
+such as yoga for the management of depression and anxiety 
+in COPD patients.
+Yoga is a way of life, mainly has four primary 
+components: Physical postures to develop strength and 
+flexibility, breathing exercises to enhance respiratory 
+functioning, deep relaxation techniques to cultivate the 
+ability to release anxiety, and meditation/mindfulness 
+practices to promote emotion and stress regulation 
+skills.[22] Psychosomatic ailments arise due to a 
+disturbance in the mind.[23] The level of documented 
+evidence of yoga’s psychophysiological benefits for 
+depression and anxiety is progressively increasing.[24‑32] 
+Similarly, some research has been conducted on 
+yoga’s application to COPD[33‑37] but no study has been 
+published assessing the effect of yoga on coal miners, 
+for whom the condition is a major work‑related health 
+hazard. Hence, this study was aimed to evaluate the 
+effects of a 12 weeks program of the Integrated Approach 
+of Yoga Therapy (IAYT) on health status, depression, and 
+anxiety of COPD in coal miners compared to controls on 
+conventional care, based on the hypothesis that it would 
+improve the health status by decreasing depression and 
+anxiety symptoms. IAYT is a combination of breathing 
+practices, physical postures, pranayama, kriya, 
+meditation, relaxation techniques, and lectures.[22] Its 
+therapeutic applications as a supplementary therapy 
+for chronic health conditions in asthma,[38] cancer,[39] 
+diabetes,[40] schizophrenia,[41] and low back pain[42] are 
+well established.
+MATERIALS AND METHODS
+Participants
+Eighty‑one male nonsmoking coal miners with ages ranging 
+from 36 years to 60 years were recruited for the study. 
+They were all present coal miners of Rampur Colliery, 
+Odisha. A total of 279 coal miners were screened, of 
+whom 36 declined to sign the informed consent form. 
+Rest 243 underwent clinical examination, of these 162 met 
+any one of exclusion criteria and finally 81 registered for 
+the trial and were randomized into two groups, yoga and 
+waitlist controls. Figure 1 depicts the flow diagram of 
+the study, showing screening, enrollment, intervention, 
+assessments, and analysis.
+Inclusion criteria
+The inclusion criteria were as follows: Physician diagnosed 
+COPD with spirometric evidence of chronic airflow 
+limitation (forced expiratory volume in 1 s/forced vital 
+capacity, post bronchodilator <0.70), Global initiative for 
+Obstructive Lung Disease (GOLD) stage I and II COPD;[1]
+clinically stable for at least 3 months; literate to complete 
+the questionnaires.
+Exclusion criteria
+Exclusion criteria were: Prior experience of yoga; recent 
+COPD exacerbation; cognitive impairment; myocardial 
+infarction or recurrent angina within the previous 
+6 months; hospitalization within 3 months; and respiratory 
+tract infection within 1 month of enrollment.
+Informed consent
+The aim of the study was conveyed to those agreeing to 
+participate in the study; signed informed consent was 
+obtained from all participants prior to baseline assessment.
+Design
+This is a randomized, waitlist control, single‑blind clinical 
+trial in which 81 participants were assigned to two groups 
+(yoga and control) using a computer generated random 
+number table obtained from http://www.randomizer.org. 
+Numbered opaque envelopes were used to implement 
+the random allocation to conceal the sequence until 
+interventions were assigned.
+Study protocol
+At enrollment, medical, exposure histories, pulmonary 
+symptoms, and information about current pharmacological 
+treatments were obtained, and clinical examinations 
+performed by a specialist physician. Comorbid diagnoses 
+were established from clinical histories and examination 
+findings, supported by reviews of available medical 
+records. The yoga group practiced a set of integrated 
+yoga practices specially designed for COPD for 90 min 
+daily, 6 days/week for 12 weeks. Participants of control 
+group continued conventional therapy, completing all 
+assessments at the same times as the yoga group; they 
+were offered yoga at the end of the study. All participants 
+were asked to refrain from participating in any other yoga 
+classes during the study period.
+Blinding and masking
+Double blinding is not considered possible for yoga 
+interventions, where participants and trainer can 
+recognize group assignment. However, giving and scoring 
+[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82]
+Ranjita, et al.: Effect of yoga on depression, anxiety in COPD
+139
+International Journal of Yoga • Vol. 9 • Jul-Dec-2016
+the assessments were masked wherever feasible. The 
+statistician responsible for randomization, and subsequent 
+data analysis was not involved in administering the 
+intervention and was thus blind to the source of the data. 
+The clinical psychologist who administered and scored the 
+psychological questionnaires and the staff, who carried out 
+assessments, were blind to membership of the intervention 
+groups. Coded answer sheets were analyzed only after the 
+study’s completion.
+Study approval
+The study was approved by the Institution Ethics 
+Committee (Swami Vivekananda Yoga University, 
+Bangalore) through RES/IEC/28/2014 in accordance with 
+the Helsinki Declaration.
+Intervention
+The IAYT module was developed by Swami Vivekananda 
+Yoga Anusandhana Samasthana specifically for COPD. It 
+included simple and safe practices at physical, mental, 
+emotional, and intellectual levels. The yoga practice 
+protocol was designed in consultation with S‑VYASA’s 
+Medical Director. The daily schedule is detailed in 
+Table 1.
+Assessments
+Assessments were made on both groups before and after 
+the 12 weeks of intervention. The following questionnaires 
+were completed by all participants.
+COPD assessment test
+COPD Assessment Test (CAT) is a short questionnaire 
+developed for assessing and monitoring COPD in 
+routine clinical practice. It provides a valid, reliable, and 
+standardized measure of the impact of COPD on a patient’s 
+health and well‑being.[43,44] It consists of 8 items rated using 
+a Likert‑type scale of 0–5, providing a score out of 40, 
+higher scores representing the poorer quality of life (QoL). 
+Despite the small number of items, it covers a broad range 
+of effects on patients’ health. It takes less time to complete 
+than other health‑related QoL questionnaires.[45] CAT is 
+sensitive to changes in disease progression over time and 
+to the effectiveness of treatments.[46,47] Internal consistency 
+is excellent with Cronbach’s α =0.88 and test‑retest 
+reliability good in stable patients (ICCC = 0. 8).[43]
+Beck depression inventory
+All participants completed the Beck Depression 
+Inventory (BDI), 2nd edition.[48] BDI‑II is a self‑report 
+Total patients screened
+(n = 279)
+Declined informed consent 
+(n = 36)
+Underwent clinical examination
+(n = 243)
+Did not meet the inclusion
+criteria (n = 162)
+Random assignment (n = 81)
+Yoga group
+(n = 41)
+Control group
+(n = 40)
+Intervention 12
+weeks 
+Drop outs
+(n = 5)
+Drop outs
+(n = 4)
+Incomplete questionnaires
+(n = 1)
+Illness (n = 2)
+Out of station (n = 1)
+Reasons for
+drop out
+Incomplete questionnaires
+(n = 2)
+Illness (n = 1)
+Less attendance (n = 2)
+Final analysis
+Yoga (n = 36)
+Final analysis
+Control (n = 36)
+Figure 1: Flow of participants over study period
+[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82]
+Ranjita, et al.: Effect of yoga on depression, anxiety in COPD
+International Journal of Yoga • Vol. 9 • Jul-Dec-2016
+140
+questionnaire of 21 items scored from 0 to 3. It is 
+designed to assess depressive symptoms experienced 
+within the previous 2 weeks. It has high internal 
+consistency (Cronbach’s α =0.92); mean test‑retest 
+reliability is 0.72.[49] BDI‑II scores range from 0 to 63, 
+with categorical depression ratings of “minimal” (0–13), 
+“mild” (14–19), “moderate” (20–28), and “severe” 
+(29–63). BDI is considered a valid measure of depressed 
+mood for diverse populations.
+State trait anxiety inventory
+State and Trait Anxiety Inventory (STAI) is a reliable, 
+valid, and widely used measure of anxiety for clinical 
+practice and research, with a high degree of internal 
+consistency.[50] Cronbach’s α is 0.85 for the total scores.[51] 
+It includes separate measures of state anxiety and trait 
+anxiety each comprising 20 items rated on a 4 point 
+scale from 0 to 3 which range from 20, minimum, to 80, 
+maximum. Form S evaluates state anxiety, how subjects, 
+feel “at this moment;” while Form T assesses trait anxiety, 
+how the respondent feels “most of the time.” In India, 
+its reliability and validity are well established following 
+extensive use in adult populations. State anxiety reflects 
+subjective and transitory emotional states characterized 
+by consciously perceived feelings of nervousness, tension, 
+worries, and apprehension, and heightened autonomic 
+nervous system activity. In contrast, trait anxiety refers 
+to relatively stable individual differences in anxiety 
+proneness as a personality attribute that denotes general 
+tendency to respond with anxiety to perceived threats in 
+the environment.
+Data collection
+Clinical and demographic information were collected 
+using medical records and study‑specific forms. Adherence 
+and compliance were monitored through the use of daily 
+patient diaries and attendance records kept by the yoga 
+instructors. No make‑up sessions were provided for missed 
+classes. All participants were instructed to continue their 
+routine daily activities during the 12‑week intervention 
+period but were asked not to start a new yoga or exercise 
+regimen on their own during that time. A feedback form 
+was used to assess enjoyment and helpfulness of the 
+yoga intervention, and to ask whether participants would 
+recommend it to others.
+Table 1: Integrated approach of yoga therapy for 
+chronic obstructive pulmonary disease used in this study
+Name of the practices
+Duration (min)
+Breathing practices
+10
+Standing
+Hands in and out breathing
+1
+Hands stretch breathing
+1
+Ankle stretch breathing
+1
+Sitting
+Dog breathing
+1
+Rabbit breathing
+1
+Tiger breathing
+1
+Sasäìkäsana breathing (moon pose)
+1
+Prone
+Bhujaìgäsana breathing
+1
+Śalabhāsana breathing
+1
+Supine
+Straight leg raising breathing
+1
+Loosening practices
+10
+Forward and backward bending
+1
+Side bending
+1
+Twisting
+1
+Pawanmuktäsana kriyä (alternate leg)
+1×2
+Rocking and rolling
+1×2
+Surya Namaskära × 3 rounds
+1×3
+Yogäsanas (physical postures)
+20
+Standing
+Ardhakati cakräsana (lateral arc pose)
+2
+Pädahastäsana (forward bend pose)
+2
+Ardha cakräsana (half wheel pose)
+2
+Sitting
+Vakräsana (twisting posture)
+2
+Ardhamatsyendräsana (half spinal twist posture)
+2
+Paścimottānāsana (sleeping thunderbolt posture)
+2
+Prone
+Bhujaìgäsana (serpent pose)
+2
+Śalabhāsana (locust pose)
+2
+Supine
+Sarväìgäsana (shoulder stand pose)
+2
+Matsyäsana (fish pose)
+2
+Yogä chair breathing
+10
+Instant relaxation technique
+1
+Neck muscle relaxation with chair support
+1
+Neck movements in Vajräsana
+1
+Sasäìkäsana movement
+1
+Relaxation in Tadäsana
+1
+Neck movements in Tadäsana
+1
+Ardha cakräsana - Pädahastäsana
+1
+Quick relaxation technique
+3
+Präëäyäma
+10
+Kapälabhäti (frontal brain cleansing)
+2
+Vibhägiya präëäyäma (sectional breathing)
+2
+Näòéśodhana präëäyäma (alternate nostril 
+breathing)
+2
+Ujjayi präëäyäma (diaphragmatic breathing)
+2
+Bhrämaré präëäyäma (bee breathing)
+2
+Meditation
+10
+Nädänusandhäna (alternate day)
+10
+Om Meditation (alternate day)
+10
+DRT in Çaväsana (corpse pose)
+10
+Yogic counseling/lectures
+10
+Yoga philosophy and health, basis and applications 
+of yoga, Pancakoña viveka (five layers of existence), 
+COPD causes, complications and relation to 
+stress, Stress reaction and its management. Lifestyle 
+modification, diet and exercise, emotion and coping
+Table 1: Contd...
+Name of the practices
+Duration (min)
+Kriyä (once a week)
+90
+Theory on kriyä
+10
+Jala Neti
+20
+Sutra Neti
+20
+Vamana Dhouti
+25
+DRT
+15
+DRT = Deep relaxation technique, COPD = Chronic obstructive pulmonary disease
+Contd...
+[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82]
+Ranjita, et al.: Effect of yoga on depression, anxiety in COPD
+141
+International Journal of Yoga • Vol. 9 • Jul-Dec-2016
+Statistical analysis
+Data were analyzed using SPSS version 18.0 
+(IBM Corporation, USA). Within group changes and between 
+group treatment effects associated with participation in the 
+yoga intervention were evaluated using Chi‑square tests 
+for categorical data and paired t‑tests and independent 
+sample t‑tests for continuous data. P < 0.05 was considered 
+significant.
+RESULTS
+Descriptive features
+The study population initially consisted of 81 coal miners 
+with COPD. Five and four participants dropped out of 
+yoga and control group, respectively, for personal reasons 
+unrelated to the study, giving a final sample size of 72 (36 
+in each group). Total participants in GOLD stage II category 
+were 52.8% in yoga and 58.3% in controls, and in GOLD 
+stage III 47.2% in yoga and 41.7% in controls. Demographic 
+variables of patient’s average age, duration of employment 
+in coal mines, and duration of disease since diagnosis were 
+comparable as were initial test scores at baseline (all P > 
+0.05) [Table 2].
+COPD assessment test
+The practice of yoga for 12 weeks has significantly 
+lowered the CAT scores (P < 0.001) in the yoga group, 
+indicating better health status, whereas no significant 
+difference was observed in the control group (P = 0.294). 
+The results further revealed that the change occurred in 
+the yoga group was 23.05% and in the control group was 
+− 2.52%. Between‑group differences were statistically 
+significant (P < 0.001, independent t‑test) [Table 3].
+Beck depression inventory
+In both the groups, mean depression scores were reduced, 
+but the magnitude of change is statistically significant 
+and higher (P < 0.001, 25.53%) in the yoga group as 
+compared to the control group (P = 0.095, 3.23%). In 
+addition, significant group mean differences were observed 
+between yoga and control group’s post intervention scores 
+(P = 0.002) [Table 3].
+State and trait anxiety inventory
+The yoga group showed significantly lower scores in both 
+state and trait anxiety (P < 0.001), but controls showed no 
+significant change (P = 0.192 and P = 0.383, respectively). 
+State anxiety decreased by 15.98% in yoga and increased 
+by 1.98% in controls. A similar trend was observed in trait 
+anxiety also. It decreased by 13.35% in yoga and increased 
+by 1.46% in controls. Independent t‑tests gave statistically 
+significant differences between groups at posttest, P = 0.032 
+and P = 0.034, respectively. Overall anxiety score was 
+significantly reduced by 14.64% within the yoga group 
+(P < 0.001), whereas and there was slight increase by 1.71% 
+(P = 0.054) reported in the control group [Table 3].
+DISCUSSION
+To the best of our knowledge, this is the first 
+randomized‑controlled study investigating physical and 
+psychological health benefits associated with yoga practice 
+on coal miners with COPD. The study evaluated the impact 
+of yoga on their disease‑specific health status, depression, and 
+anxiety levels. Results suggested that IAYT practice facilitates 
+improvements in health status and reduces self‑reported 
+depression and anxiety levels after 12 weeks of practice.
+The results are consistent with previously reported 
+interventions based on yoga, which demonstrated positive, 
+beneficial effects on psychological and psychosocial 
+factors in diverse conditions such as diabetes,[40] cancer,[52] 
+CAD,[53] low back pain,[54] osteoarthritis of the knee,[55] and 
+pregnancy.[56,57] It is reported in a study that pranayama 
+(yogic breathing) mitigates posttraumatic stress disorder 
+and depression.[58] Another study on patients who 
+participated in education and stress management in 
+addition to exercise training during a 12‑week intervention 
+reported reductions in depression and anxiety.[59]
+A study reported that changes in depression and state and 
+trait anxiety did not significantly differ between the two 
+interventions (6 weeks of weekly yoga classes together 
+with exercise, compared to a 6 weeks weekly group 
+exercise) (GDS15, P = 0.749, STAI‑S, P = 0.595, STAI‑T, 
+P = 0.407).[60] Another study has similarly obtained unclear 
+effects following yoga intervention.[61]
+The pathophysiology of depression and anxiety among 
+COPD patient is complex and poorly understood. The 
+Table 2: Baseline characteristics of participants in both 
+yoga and control group
+Variables
+Mean±SD
+P (independent 
+sample t-test)
+Yoga 
+(n=36)
+Control 
+(n=36)
+Age
+53.69±5.66
+54.36±5.40
+0.611*
+Duration of employment 
+in coal mines
+28.36±4.62
+27.72±4.23
+0.543*
+Duration of disease 
+since diagnosis
+9.92±3.25
+10.69±2.54
+0.262*
+CAT
+20.69±5.53
+21.81±5.48
+0.395*
+BDI
+22.25±8.47
+24.14±9.21
+0.368*
+STAI (S)
+39.61±8.73 37.92±10.92
+0.469*
+STAI (T)
+41.06±7.82
+39.86±8.88
+0.547*
+STAI (total)
+80.67±16.06 77.78±19.27
+0.492*
+*Not significant. CAT = COPD assessment test, BDI = Beck depression inventory, 
+STAI = State-trait anxiety inventory, STAI (S) = State anxiety, STAI (T) = Trait anxiety, 
+SD = Standard deviation, COPD = Chronic obstructive pulmonary disease
+[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82]
+Ranjita, et al.: Effect of yoga on depression, anxiety in COPD
+International Journal of Yoga • Vol. 9 • Jul-Dec-2016
+142
+physical, emotional, and social impact of COPD may cause 
+a self‑perpetuating cycle that has a severe impact on a 
+patient’s physical and mental health status.[21] It has been 
+shown that high scores on perceived stress and anxiety 
+are related to increase in hypothalamic‑pituitary‑adrenal 
+(HPA) axis activity.[62] The effects of yoga in our results can 
+be explained by reduction in levels of psychophysiological 
+arousal via triggering neurohormonal mechanisms 
+that suppress sympathetic activity,[63,64] balance in the 
+autonomic nervous system responses,[65] alterations in 
+neuroendocrine arousal[66,67] through better regulation 
+of the HPA axis[68] resulting in reductions in stress and 
+anxiety.[32] Better psychological health resulting from stress 
+reduction might be due to relaxation techniques[69] which 
+contribute to the observed improvements in CAT scores in 
+our study. Thus, these psychological changes may explain 
+the physiological changes observed as better outcomes 
+seen in previous studies on integrated yoga in asthma.[38] 
+Yoga unites body, mind, and spirit; and enhances attention 
+by calming down the restless mind.[22] Thus, the deep 
+physiological rest that is achieved by the components of 
+pranayama, meditation, and other mindfulness practices 
+incorporated in the integrated yoga program could be 
+the major factors explaining observed benefits. Overall, 
+antidepressant effects of yoga programs can be attributed 
+to stress reduction.[70] Another study concluded the 
+practice of meditation strengthens the mental resolve 
+and hence decreases anxiety.[71] Yoga practices decrease 
+parasympathetic nervous system and GABAergic activity 
+that underlies stress‑related disorders which result in 
+amelioration of disease symptoms.[72] Reductions in 
+psychological hyper‑reactivity and emotional instability 
+achieved by yoga may be due to reduced efferent vagal 
+reactivity[73] already recognized as a main psychosomatic 
+factor in asthma,[74] might have similar physiology in 
+COPD also.
+This study is the first of its kind to conclude that integrated 
+yoga can act as an imperative line of therapy in the 
+management of COPD in coal miners. The novel aspects 
+of this study were (a) the randomized control design, 
+(b) good sample size, (c) incorporation of integrated yoga 
+approach, and (d) good compliance. A major constraint of 
+the study is the lack of an active control group. It would 
+have been valuable to include physiological measures of 
+stress such as Galvanic Skin Response and Heart Rate 
+Variability to overcome the subjectivity of self‑report 
+and to throw light on the mechanisms. In spite of the 
+aforementioned limitations, significant results were 
+manifested in a short time suggesting yoga therapy could 
+be a non‑pharmacological alternative for the management 
+of COPD. The current state of understanding necessitates 
+further assessment to evaluate benefits of yoga for COPD in 
+diverse populations, especially associated with depression 
+and anxiety followed over longer time periods. Robust 
+effectiveness and implementation studies are required 
+to determine whether yoga therapy can decrease medical 
+utilization. In addition, the findings of this study may 
+also provide evidence supporting the incorporation of 
+yoga into standardized pulmonary rehabilitation programs 
+as a practical adjunct to improve the management of 
+psychosocial symptoms associated with COPD.
+CONCLUSION
+In this study, 12 weeks of integrated yoga enhanced health 
+status and reduced depression and anxiety in coal miners 
+with COPD. Any system that can bring symptomatic relief 
+and improve different aspects of QoL of COPD patients 
+merits incorporation into standard COPD treatments. 
+Further research is warranted to confirm these preliminary 
+findings and facilitate implementation in clinical settings.
+Acknowledgment
+The authors would like to express gratitude Mr. Rajeev Lochan 
+and Soubhagyalaxmi Mohanty for assisting with manuscript 
+preparation. Thanks are due to Mr. Kunja Bihari Badhai, 
+senior yoga instructor for his experienced support and 
+advice. Also to Mr. Arjun Biswal for coordinating the 
+program. Special thanks to Dr. R Nagarathna, who offered 
+critical and thoughtful recommendations in the initial 
+development of the program and Dr. Balaram Pradhan, Ph.D. 
+for statistical analysis.
+Table 3: Change scores within yoga and control, and difference between groups with 95% CI
+Variables
+Yoga (n=36)
+Control (n=36)
+Between group
+Pre$
+Post$
+Pre$
+Post$
+Post 
+versus 
+post#
+P
+Group × 
+time 
+interaction
+P
+Mean±SD
+CI (LB-UB)
+Mean±SD
+CI (LB-UB)
+Mean±SD
+CI (LB-UB)
+Mean±SD
+CI (LB-UB)
+CAT
+20.69±5.53 18.82-22.56 15.92±6.51*** 13.71-18.12 21.81±5.48 19.95-23.66 22.36±5.65 20.45-24.27 0.001
+<0.001
+BDI II
+22.25±8.47 19.38-25.12 16.56±7.03*** 14.18-18.93 24.14±9.21 21.02-27.25 23.36±10.49 19.81-26.91 0.002
+<0.001
+STAI (S)
+39.61±8.73 36.66-42.56 33.28±9.92*** 29.92-36.63 37.92±10.92 34.22-41.61 38.67±10.92 34.97-42.36 0.032
+<0.001
+STAI (T)
+41.06±7.82 38.41-43.70 35.58±9.14*** 32.49-38.67 39.86±8.88 32.49-38.67 40.44±9.89 37.10-43.79 0.034
+<0.001
+STAI total 80.67±16.06 75.23-86.10 68.86±17.96*** 62.79-74.94 77.78±19.27 71.26-84.30 79.11±19.77 72.42-85.80 0.024
+<0.001
+$Paired t-test; #Independent t-test. BDI = Beck depression inventory, STAI = State-trait anxiety inventory, STAI (S) = State anxiety, STAI (T) = Trait anxiety, SD = Standard 
+deviation, CI = Confidence interval, LB = Lower bound, UB = Upper bound, CAT = COPD assessment test, COPD = Chronic obstructive pulmonary disease. 
+***Highly significant
+[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82]
+Ranjita, et al.: Effect of yoga on depression, anxiety in COPD
+143
+International Journal of Yoga • Vol. 9 • Jul-Dec-2016
+Financial support and sponsorship 
+Nil.
+Conflicts of interest
+There are no conflicts of interest.
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+68.	 Pascoe MC, Bauer IE. A systematic review of randomised control trials on the 
+effects of yoga on stress measures and mood. J Psychiatr Res 2015;68:270‑82.
+69.	 Manzoni GM, Pagnini F, Castelnuovo G, Molinari E. Relaxation training for 
+anxiety: A ten‑years systematic review with meta‑analysis. BMC Psychiatry 
+2008;8:41.
+70.	 Deberry S, Davis S, Reinhard KE. A comparison of meditation‑relaxation 
+and cognitive/behavioral techniques for reducing anxiety and depression in 
+a geriatric population. J Geriatr Psychiatry 1989;22:231‑47.
+71.	 Telles S, Nagarathna R, Nagendra HR. Autonomic changes while mentally 
+repeating two syllables – One meaningful and the other neutral. Indian J 
+Physiol Pharmacol 1998;42:57‑63.
+72.	 Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga 
+on the autonomic nervous system, gamma‑aminobutyric‑acid, and allostasis 
+in epilepsy, depression, and post‑traumatic stress disorder. Med Hypotheses 
+2012;78:571‑9.
+73.	 Raghuraj P, Ramakrishnan AG, Nagendra HR, Telles S Effect of two selected 
+yogic breathing techniques of heart rate variability. Indian J Physiol Pharmacol 
+1998;42:467‑72.
+74.	 Nagendra HR, Nagarathna R. An integrated approach of yoga therapy 
+for bronchial asthma: A 3‑54‑month prospective study. J Asthma 
+1986;23:123‑37.
+[Downloaded from http://www.ijoy.org.in on Wednesday, July 27, 2016, IP: 14.139.155.82]

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+See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/342505102
+A randomized study on the energy difference measured by electro photonic
+image on caregivers practiced Indian aesthetic dance and yoga
+Article  in  International Journal of Community Medicine and Public Health · June 2020
+DOI: 10.18203/2394-6040.ijcmph20203013
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+                                 International Journal of Community Medicine and Public Health | July 2020 | Vol 7 | Issue 7    Page 2770 
+International Journal of Community Medicine and Public Health 
+Hegde JR et al. Int J Community Med Public Health. 2020 Jul;7(7):2770-2777 
+http://www.ijcmph.com 
+pISSN 2394-6032 | eISSN 2394-6040 
+Original Research Article 
+A randomized study on the energy difference measured by electro 
+photonic image on caregivers practiced Indian aesthetic dance and yoga 
+Jayashree R. Hegde1*, Sridhar K. Melukote1, Karuna Vijayendra2, Deepeshwar Singh3  
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+INTRODUCTION 
+Caregivers (CGs) are the main supporters concerning 
+education, shelter, food, and protection to grow and 
+develop children with NDDs with full potentials.1 The 
+prevalence of NDDs in children is increasing at 1-3% 
+globally and in India, nearly 12% of children aged 2-9 
+years are prone to it.2,3  
+The stressors created on family members by persistent 
+caring of the children with NDDs, is referred to as a 
+caregiver’s burden, that affects their health physically, 
+psycho-emotionally, socially, and financially.4 Such 
+conditions pose CGs prone to negative attitudes such as 
+stress, worries, sadness, rejection, pessimism about 
+future, aggression, avoidance, irrational belief in a child’s 
+disability, greater risk for higher levels of hostility, and 
+ABSTRACT 
+ 
+Background: Electro photonic image (EPI) technique based on the bio-energy field, is growing as a novel technique 
+in the fields of alternative medicine, conventional practices, psycho-physiology, psychology, and consciousness. In 
+this study, the EPI instrument is used to assess emotional pressure which is termed as activation coefficient (AC), 
+communication energy (C) level of various organ systems, and entropy (E) in the human energy field is assessed in 
+the caregivers (CGs) of children with neurodevelopmental disorders (NDDs).  
+Methods: Immediate effect of Indian aesthetic dance (n=31) and yoga (n=30) practices for 75 minutes were assessed 
+in two randomized experimental groups that are later compared with the control group (n=30). The statistical analysis 
+was done using IBM SPSS Version 21.0.  
+Results: The activation coefficient of intervention groups showed a significant reduction in stress levels (p<0.001). 
+Indian aesthetic dance intervention group showed significant improvement in the energy level of the organ systems 
+namely respiratory, endocrine, musculoskeletal and digestive system (p<0.001); cardiovascular, nervous and immune 
+systems (p<0.01) and yoga group in respiratory, musculoskeletal, nervous system (p<0.001); and cardiovascular, 
+endocrine, and immune system (p<0.01). Both the intervention groups showed a significant reduction in entropy 
+(p<0.001) post-intervention compared to the control group.  
+Conclusions: The EPI parameters used for CGs of children with NDDs explore the possibility of using this 
+instrument for measuring the bioenergy field that infers the health status of CGs before and after dance and yoga 
+interventions.  
+ 
+Keywords: CGs, Electro photonic imaging, Gas discharge visualization, Indian aesthetic dance, Neurodevelopmental 
+disorders, Yoga 
+1Department of Yoga and Humanities, 3Department of Yoga and Life Sciences, Swami Vivekananda Yoga 
+Anusandhana Samsthana (S-VYASA), Bangalore, Karnataka, India 
+2Department of Humanities, RASA Research International Study House, Bangalore, Karnataka, India 
+  
+Received: 04 April 2020 
+Revised: 18 May 2020 
+Accepted: 19 May 2020 
+ 
+*Correspondence: 
+Jayashree R. Hegde, 
+E-mail: [email protected] 
+ 
+Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under 
+the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial 
+use, distribution, and reproduction in any medium, provided the original work is properly cited. 
+DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20203013 
+Hegde JR et al. Int J Community Med Public Health. 2020 Jul;7(7):2770-2777 
+                                International Journal of Community Medicine and Public Health | July 2020 | Vol 7 | Issue 7    Page 2771 
+social withdrawal.1 These negative attitudes can lead 
+them to a higher level of perceived stress, depression, 
+anxiety, and lower levels of subjective well-being.5 
+Previous studies have mentioned that uncontrolled mental 
+agitation finds the channel in physical force resulting in 
+the form of muscle strain, skeletal injury, and chronic 
+illnesses, vascular disorders, etc.6,7 
+At this juncture, a first-hand reliable diagnosis would help 
+to reduce the growing subjective burden in CGs. The 
+Diagnostic and Statistical Manual fourth edition (DSM-
+IV) mentions a few screening methods developed by 
+clinicians and psychiatrists across the world. Apart from 
+DSM-IV, many clinicians have been using self-screening 
+methods such as carer QOL, perceived burden scale 
+(PBS), perceived caregiver burden (PCB) Barthel index 
+(BI), subjective burden scale (SCB), short portable mental 
+status 
+questionnaire 
+(SPMSQ), 
+cummings 
+neuropsychiatric 
+inventory 
+(CARS), 
+brief 
+COPE, 
+caregiver strain index (CSI) and Hamilton anxiety rating 
+scale (HARS).8 Though these scales have required 
+validity and reliability, CGs have shown resentment due 
+to higher number of items and the understanding of the 
+content and scoring methods being time-consuming.  
+On the other hand, the requirement of the CGs’ subjective 
+burden needs well structured, goal-oriented, and time-
+limited interventions which are in infancy stage.9 At 
+present, 
+various 
+treatment 
+modalities, 
+such 
+as 
+interpersonal therapy, family/couple therapy, supportive 
+therapy, cognitive-behavioral therapy, and several other 
+complementary and alternative medicine interventions for 
+informal CGs are prevailing.10,11 Nevertheless, these 
+interventions have shown limited benefits. Few studies 
+reported the effectiveness of creative movements in dance 
+and yoga intervention, enhancing positive emotions and 
+mental health scores among CGs.12,13 Both the 
+interventions have found to be safe, practicable, 
+acceptable, and subjectively useful for the physical and 
+psychological health of CGs.14,15 Therefore, the present 
+study is attempting to explore the impact of Indian 
+aesthetic dance (IAD) based on Indian dramaturgical text 
+“Natya-Sastra” and yoga interventions for mental health 
+in CGs of children with NDDs. 
+As an answer to the requirement of non-invasive methods 
+in the identification of health status and measurement of 
+the effectiveness of the intervention, the electro photonic 
+imaging (EPI) technique is growing as a novel technique 
+for a health assessment with its versatile applications and 
+unique features.16 Few studies have explored the 
+usefulness of EPI in psycho-physiology, psychology, and 
+consciousness researches.17  
+There is no study found on the EPI instrument used to 
+measure the baseline health status and post-intervention 
+effect among CGs of NDDs. Hence, the present study 
+aimed to investigate the health status among CGs of 
+children 
+with 
+NDDs 
+following 
+IAD 
+and 
+yoga 
+interventions with EPI parameters. 
+METHODS 
+Study design 
+This was a randomized control design. 
+Study period, settings and location 
+This paper is part of the main study wherein subjects 
+from three different special schools situated at the 
+Bengaluru urban district of Karnataka, a state located in 
+the southern part of India. Subjects were enrolled from 
+August to November 2018. Trial was done in December 
+2018 assembling all the subjects in a common place to 
+avoid temperature differences and bring common 
+atmosphere.  
+Participants 
+Totally 91 subjects between 28-65 years (males=2; and 
+female=89) of age participated in the study. The mean 
+age of the IAD group (41.04±9.17 years), yoga group 
+(40.86±8.95 years), and control group (42.27±9.08 years) 
+were not significantly different. However, to ensure the 
+underlying conditions not to affect the outcome or limit 
+the benefits of intervention, few exclusion criteria were 
+set. The exclusion criteria for the subjects were subjects 
+consuming medication influencing cognitive abilities, 
+mood balance, or coordination, prone to hearing 
+impairment, having another relative with neurologic and 
+psychiatric illness, had formal yoga training, or practicing 
+yoga regularly for the past one month. Subjects were 
+qualified without having exclusion criteria and agreed for 
+randomization into any of the three groups with a 
+commitment to attend classes.  
+Procedure for allocation of subjects 
+The institutional ethics committee of S-VYASA approved 
+the research study and a clinical trial registered in the 
+Clinical Trial Registry of India (CTRI/2018/08/015256), 
+Government of India. The study objectives were 
+explained to CGs, and written informed consent was 
+obtained. All the subjects completed the socio-
+demographic questionnaire and the Zarit burden scale. 
+The demographic information of participants is given in 
+Table 1. Based on the scores of the burden scale, 
+participants were randomized into three groups, i.e., (i) 
+IAD (n=31), (ii) yoga (n=30), and (iii) control (n=30), 
+using the website randomizer.com. Further, the allocation 
+was concealed for participants using sealed, opaque 
+envelopes 
+generated 
+by 
+a 
+statistician, 
+and 
+the 
+randomization was blinded to prevent them from 
+predicting caregiver’s allocation. 
+Interventions 
+There were three groups in the study, of which two were 
+active interventions, i.e., IAD and yoga; and the third 
+group was the control group. Interventions were given by 
+Hegde JR et al. Int J Community Med Public Health. 2020 Jul;7(7):2770-2777 
+                                International Journal of Community Medicine and Public Health | July 2020 | Vol 7 | Issue 7    Page 2772 
+more than 10 years of experienced trainers in different 
+halls of the same premise simultaneously to match the 
+timings. The control group was engaged in the way they 
+wish, such as some were reading newspapers, books of 
+their choice, knitting, etc. The duration of practices was 
+for 75 minutes. 
+ 
+Table 1: Baseline characteristics of CGs (n=91). 
+ 
+Dance 
+Yoga 
+Control 
+Total 
+Age group (mean±SD)    
+41.04±9.17) 
+40.86±8.95) 
+42.27±9.08) 
+41.51±9.07) 
+Relation with child, N (%) 
+Mother 
+28 (89.29) 
+30 (100) 
+29 (96.56) 
+87 (95.60) 
+Other relative 
+3 (10.71) 
+0 (0) 
+1 (3.44) 
+4 (4.40) 
+Employment status, N (%) 
+Homemakers 
+22 (70.97) 
+29 (96.67) 
+24 (80.00) 
+75 (82.42) 
+Employed 
+9 (29. 03) 
+1 (3.33) 
+6 (20.00) 
+16 (17.58) 
+Education, N (%) 
+Illiterate 
+1 (3.23) 
+1 (3.33) 
+2 (6.67) 
+4 (4.40) 
+Primary school 
+0 (0%) 
+0 (0%) 
+1(3.33) 
+1 (1.1) 
+Middle and high school 
+7 (22.78) 
+15 (50.00) 
+18 (60.00) 
+40 (43.95) 
+Secondary school 
+15 (48.39) 
+7 (23.33) 
+5 (16.67) 
+27 (29.67) 
+Graduation 
+7 (22.78) 
+7 (23.33) 
+5 (16.67) 
+19 (20.88) 
+Income, N (%) 
+High income group 
+1 (3.23) 
+0 
+0 
+1 (3.23) 
+Mid income group 
+12 (38.71) 
+11 (36.67) 
+13 (43.33) 
+36 (39.56) 
+Low income group 
+18 (58.06) 
+19 (63.33) 
+17 (56.67) 
+54 (59.34) 
+Languages known, N (%) 
+Single 
+10 (32.26) 
+12 (40.0) 
+20 (66.67) 
+42 (46.15) 
+Multiple 
+19 (61.29) 
+20 (66.67) 
+10 (33.33) 
+49 (53.85) 
+Child with neurodevelopmental disorders, N (%) 
+Single disorder 
+17 (54.84) 
+10 (33.33) 
+17 (56.67) 
+44 (48.33) 
+Multiple disorder 
+14 (45.16) 
+20 (66.67) 
+13 (43.33)) 
+47 (51.67) 
+ 
+IAD 
+Dance group began the intervention with warm-up 
+exercises to train the physical constitution of the 
+participants facilitating flexibility of joints, reduce 
+lethargy.18,19 That followed varieties of hand gestures and 
+various body movements, namely hand, neck, head, 
+eyebrows, eyes, shoulder, chest, waist, thighs, shanks, 
+and feet, as described in Nātyaśastra a magnum opus, 
+dates back to 1500 B.C.20 Those who wished to mime the 
+negative incidents with the child were provided an 
+opportunity. Then steps and song with lyrics were taught. 
+At the end relaxation was given. 
+Yoga protocol 
+Yoga group participants started to practice with loosening 
+exercise (shithila), physical stances (asana) in standing, 
+sitting, supine and prone postures, continued breathing 
+practices (pranayama), meditation, and instant and quick 
+relaxation techniques. 
+Procedure for data collection 
+The baseline data collected by reading from 10 fingers of 
+each subject using EPI technology by compact GDV 
+BIOWELL camera. Data collected from the participant 
+with a sitting position. Calibration of the equipment was 
+carried out before acquiring data. After each recording, 
+the dielectric glass surface was cleaned by an alcoholic 
+solution.  
+Outcome measure 
+Electro photonic imaging (EPI) technique 
+The EPI technique is a scientific method based on the 
+Kirlian effect on coronal electrical discharge surrounding 
+an object when exposed to a high electrical field.21 The 
+EPI facilitates the assessment by placing the fingertips on 
+a dielectric glass plate of the instrument and stimulation 
+of electrons at the fingertips. It happens by applying a 
+short electric pulse of a high voltage (10 kV) at high 
+frequency (1024 Hz) but the low current that is in micro 
+Amperes.22 These jerked out electrons induce ionization 
+of the air molecules and produce a glow around the 
+finger. This glow, captured by a CCD-camera placed 
+underneath the glass plate, is known as the electro-
+photonic image.23 The data collected from each finger, 
+which was divided into sectors, and each sector 
+correspond 
+to 
+one 
+organ 
+and 
+organ 
+system. 
+https://www.bio-well.com. 
+Hegde JR et al. Int J Community Med Public Health. 2020 Jul;7(7):2770-2777 
+                                International Journal of Community Medicine and Public Health | July 2020 | Vol 7 | Issue 7    Page 2773 
+Parameters analysed 
+The captured EPI Images were loaded into the EPI 
+software, and the coronal discharges corresponding to the 
+organs and organ systems were exported into a 
+spreadsheet. The relevant variables used to this study 
+were (a) activation coefficient (AC): measure the level of 
+stress and range from 2-4 in healthy people. (b) 
+Communication energy (C): measures the total energy of 
+communication for each organ system. The energy of 
+light in Joules. 5 Joules are considered normal. A range of 
+4-6 is considered a normal zone. Less than 4 indicates 
+weakness, and more than 6 indicates hyperactivity caused 
+by an imbalance in the organ systems. In due course, the 
+organ system tries to fix this imbalance naturally to bring 
+back normal range. If it does not happen, the organ 
+system gets weakened day by day. In this regard, a 
+change of 0.5 Joules can pose the intervention as 
+effective. (c) Entropy (E): indicate the coherence of the 
+energy. It means less entropy specifying more energy. 
+Data analysis  
+The statistical analysis was done using SPSS 21.0 (IBM 
+Corp., Armonk, NY). The normality test for the data 
+showed no significant difference in age. Repeated 
+measures of ANOVA were carried out separately, 
+followed with Bonferroni correction for each assessment. 
+The statistically significant value was considered at 
+p<0.05. 
+RESULTS 
+The data analysis was done using repeated-measures 
+ANOVA with two factors: Factor 1: Levels (pre and 
+post), and Factor 2: Groups (dance, yoga, and control). 
+The means and standard deviation of the outcome 
+measures are given in Table 2. 
+ 
+Figure 1: Activation coefficient of dance and yoga 
+groups before and after the intervention compared to 
+the control group. 
+The repeated measure analysis of ANOVA for AC 
+showed a significant difference (p<0.001) in the post 
+scores of dance and yoga with a reduction of 31% and 
+26%, respectively, compared to the control group, which 
+showed increased AC of 7% (Figure 1). 
+Table 2: Pre and post values of activation coefficient, energy of organ systems and entropy. 
+Vari-
+ables 
+Dance (n=31) 
+ 
+P value 
+Yoga (n=30) 
+Mean±SD 
+ 
+P value 
+Control (n=30) 
+ 
+Mean±SD 
+ 
+ 
+ 
+ 
+Mean±SD 
+ 
+Pre 
+Post 
+%  
+change  
+Pre 
+Post 
+%  
+change  
+Pre 
+Post 
+%  
+change 
+AC 
+4.023±
+0.827 
+2.785± 
+0.538 
+-31 
+0.001*** 
+3.709±
+0.432 
+2.754± 
+0.580 
+-26 
+0.001*** 
+3.580± 
+0.530 
+3.845± 
+1.020 
+7 
+C of 
+Cardv  4.901±
+1.112 
+5.688± 
+0.921 
+16 
+0.01** 
+4.820±
+0.837 
+5.700± 
+0.986 
+18 
+0.01** 
+4.723± 
+0.870 
+4.536±
+0.980 
+-4 
+Resp 
+6.663±
+1.171 
+5.127± 
+0.584 
+-23 
+0.001*** 
+6.449±
+1.053 
+5.159± 
+0.626 
+-20 
+0.001*** 
+6.504± 
+1.564 
+6.352±
+1.320 
+-2 
+Endo 
+4.927±
+0.740 
+5.903± 
+0.963 
+20 
+0.001*** 
+4.869±
+0.831 
+5.719± 
+0.869 
+17 
+0.01** 
+4.762± 
+1.030 
+4.767±
+1.032 
+0.1 
+Musk 
+6.585±
+0.931 
+5.139± 
+0.870 
+-22 
+0.001*** 
+6.252±
+0.678 
+5.326± 
+0.583 
+-15 
+0.001*** 
+6.252± 
+1.104 
+6.270±
+0.997 
+-0.28 
+Digst 
+4.719±
+0.669 
+5.938± 
+0.750 
+26 
+0.001*** 
+6.834±
+0.990 
+5.130± 
+0.697 
+-24 
+0.09 
+4.716± 
+1.364 
+4.692±
+0.883 
+-0.5 
+Nrvs 
+4.107±
+0.954 
+4.941± 
+0.937 
+20 
+0.002** 
+4.283±
+0.985 
+4.968± 
+1.003 
+16 
+0.001*** 
+4.245± 
+0.999 
+3.990±
+1.136 
+-6 
+Imn 
+4.031±
+0.976 
+4.737± 
+1.093 
+18 
+0.005** 
+4.020±
+1.053 
+4.799± 
+0.975 
+19 
+0.003** 
+4.047± 
+1.078 
+3.841±
+1.185 
+5 
+E 
+2.494±
+0.610 
+1.833± 
+0.468 
+-27 
+0.001*** 
+2.520±
+0.560 
+1.868± 
+0.508 
+-26 
+0.001*** 
+2.319± 
+0.417 
+2.339±
+0.312 
+-0.86 
+Note: SD-standard deviation; AC-Activation Coefficient; C-Communication energy; CARDV-Cardiovascular system; RESP-Respiratory 
+system; ENDO-Endocrine system; MUSK-Musculoskeletal system; DIGST-Digestive system; NRVS-Nervous system; IMN-Immune 
+system; E-Entropy. *Significant difference in Dance group and Yoga over control group *=p<0.05; **= p<0.01; ***=p<0.001. 
+Significance levels are after Bonferroni correction. 
+0
+1
+2
+3
+4
+5
+D_Pr
+D_Po
+Y_Pr
+Y_Po
+C_Pr
+C_Po
+AC pre-post
+Mean
+SD
+Hegde JR et al. Int J Community Med Public Health. 2020 Jul;7(7):2770-2777 
+                                International Journal of Community Medicine and Public Health | July 2020 | Vol 7 | Issue 7    Page 2774 
+ 
+Figure 2: Percentage change in entropy after the 
+interventions compared to control. 
+ 
+  
+  
+Figure 3: Subsample images of energy difference of 
+IAD, yoga and control group captured by EPI 
+instrument pre-measurement and post-intervention. 
+(A) A subsample energy field of a subject of IAD 
+group; (B) A subsample energy field of a subject of 
+yoga group; (C) A subsample energy field of a subject 
+of control group.  
+A: pre- energy 52 Joules (×10-2). post- energy 70 Joules (×10-
+2); B: pre- energy 59 Joules (×10-2). post- energy 79 Joules 
+(×10-2). C: pre- energy 48 Joules (×10-2). post- energy 37 
+Joules (×10-2). 
+Further, post-assessment of dance group showed a 
+difference in communication energy (C) level of the 
+internal organ systems, namely, respiratory (23%) 
+endocrine (20%), musculoskeletal (22%) and digest 
+systems 
+(26%) 
+with 
+significant 
+level 
+(p<0.001); 
+cardiovascular (16%), nervous (20%) and immune 
+systems (18%) with p<0.01 independently compared to 
+control group. Further, post-assessment of yoga group 
+showed a difference in the energy level of respiratory 
+(20%), musculoskeletal (15%), nervous system (16%) 
+with a significant level (p<0.001); and cardiovascular 
+(18%), endocrine (17%), and immune system (19%) with 
+p<0.01. The result table of mean, standard deviation is 
+given in Table 2. 
+Concerned with the entropy (E), both the intervention 
+groups showed a significant difference (p<0.001) post-
+intervention compared to the control group. Figure 2 
+shows the percentage change of E after the intervention 
+compared to the control group. Figure 3 displays the 
+subsampled image of the energy difference of all three 
+groups at pre and post captured by the EPI instrument. 
+DISCUSSION 
+The present study aimed to investigate whether EPI 
+parameters can be used for the analytical purpose of the 
+baseline health status of CGs and to measure the 
+immediate effect of IAD and yoga intervention compared 
+to the control group. The scores of activation coefficient 
+(AC) is concurrent with the findings by non-EPI scales of 
+previous studies, that repeated physical movements in 
+dance are associated with improvement in mental 
+functioning by enhancing the coordination in different 
+parts of the body and mind.24,25 This coordination brings 
+positive effect in CGs in reducing emotional pressure in 
+CGs.24 Compared to the subjects of the control group, 
+IAD intervention showed a significant reduction of AC 
+which is 31%, which indicates that the dance backed by 
+music could facilitate the hippocampus to inhibit 
+defensive behaviours by modifying the cortisol level in 
+response to the psychological burden.26  
+The substantial reduction (26%) in the AC parameter of 
+the yoga group suggests the eight weeks of intervention 
+showing a significant effect on the CGs of NDDs. 
+Previous findings support the asanas relaxing muscles and 
+nerves, which are under stress and strain constantly.27 
+Regular practice of yoga could bring chemical changes 
+such as increasing serotonin levels in the blood which 
+reduces AC, and release of phenyl-ethylamine, which is 
+converted to phenylacetic acid, which elevates mood and 
+relieves from depression.27  
+The C measured by EPI showed a regulation in the 
+communication energy level in the organ systems, 
+namely, 
+cardiovascular, 
+respiratory, 
+endocrine, 
+musculoskeletal, digestive, nervous, and immune systems 
+in both the intervention groups compared to control 
+group.  
+The C of the respiratory system of the dance group is 
+regulated after the intervention. Concerning C, a score of 
+27%
+26%
+-
+0.86%
+D_Po
+Y_Po
+C_Po
+A 
+B 
+C 
+Hegde JR et al. Int J Community Med Public Health. 2020 Jul;7(7):2770-2777 
+                                International Journal of Community Medicine and Public Health | July 2020 | Vol 7 | Issue 7    Page 2775 
+more than 6 indicates hyperactivity caused by an 
+imbalance in the organ systems. After the intervention, 
+scores of C is reduced by 23%, in the dance group that 
+might be the indication of the respiratory system in a 
+balanced state. 
+The 18% changes found in the cardiovascular systems of 
+the dance group are concurrent with the findings of the 
+earlier studies that the consistent practice of dance help 
+enhanced vital respiratory capacity of the respiratory 
+system. And FEV1values suggesting the relationship of 
+dance with pulmonary functions of the cardiovascular 
+system.28 Also, diaphragmatic stretching practiced in 
+yoga, improves respiratory and abdominal cavity 
+expansion, and breath control and concentration might 
+clear the blockages in the energy channels (also called 
+nadis) of the body to balance the energy system of the 
+body.29,30 Additionally, deep breathing (pranayama) 
+mechanism assists in the reduction of blood pressure, 
+which tends to reduce sympathetic activity and restores 
+baroreceptor sensitivity in the cardiovascular system.31 
+Just 75 minutes of yoga intervention showed an enhanced 
+C level of 18% in the cardiovascular system. 
+Furthermore, the study scores showed the enhanced C 
+level of the endocrine system of intervention groups (20% 
+and 18% of dance and yoga, respectively) compared to 
+the control group at -0.1%. This effect is coexisting with 
+the earlier studies, which mentions that dance and yoga 
+can modulate the concentration of serotonin and 
+dopamine neurohormones by stabilizing the sympathetic 
+nervous system towards regulating mood and social 
+behaviour.32,33 Further, the balanced energy of dance 
+(with -22%) and yoga (-15%) level of the musculoskeletal 
+system is concurrent to the fact that dance and yoga 
+improves the volume of the postcentral gyrus and, 
+somatosensory fibers end in this area which conveys 
+information 
+from 
+proprioceptive 
+organs 
+such 
+as 
+neuromuscular spindles, joint, and sinew receptors 
+felicitating musculoskeletal system.34,35  
+Similarly, the digestive system of both the intervention 
+groups of the study showed a regulated C score in dance 
+(26%) and yoga (-24%). Whereas the control group 
+showed reduced C of 0.5% with sitting and doing regular 
+activities. It may be because, dance and yoga can regulate 
+the weight and body fat, and can even control diabetes 
+mellitus by negating the property like glycosylated 
+hemoglobin.36,37 
+Further, the central nervous system tends to generate new 
+neurons spontaneously during new learning and memory. 
+These neurons, being natured with plasticity, could help 
+the CGs on managing stressful situations even after the 
+intervention period, as reflected in the nervous system.38 
+The study results coexisted with the earlier findings with 
+enhanced C of dance group by 20% and yoga group 16% 
+compared to the control group at -6%. 
+Like other body systems, the C level of the immune 
+system of intervention groups is concurrent to the earlier 
+studies that dance and yoga can strengthen the immune 
+system by way of muscular action and physiological 
+processes.33,39 Even a change of 0.5 Joules in the result is 
+considered as significant effect to make the intervention 
+eligible for regular practice.40 In this study, the dance 
+group showed 18% and yoga group 19% of enhanced C 
+to immune systems compared to the control group at 5%. 
+The reduced E level showed an immediate effect of 
+interventions (dance group with 27% and yoga 26% 
+(p<0.001). Reduced E level and coherence of the energy 
+to the organ system are inversely related. It means less 
+entropy specifying more energy.40 
+The IAD, backed by the varied movements and 
+expression supported by Natyasastra a traditional 
+scripture for dramaturgy in India, needs to be explored 
+more for the therapeutic intervention in many treatment 
+areas.  
+However, we could list some limitations in the study. 
+They were as follows: we could not generalize the effect 
+of EPI parameter to male subjects as just two males 
+joined the study. Secondly, we could study only the 
+immediate effect but not the long lasting effect of the 
+intervention, as the EPI parameters are sensitive to 
+various conditions.  
+CONCLUSION  
+In conclusion, the study pointed out the significance of 
+using the EPI instrument in measuring the variation in 
+subtle energy of the psychological and functional state of 
+organ and organ system with the intervention of IAD and 
+yoga compared to the control group of CGs of children 
+with NDDs. Further, this device is an entirely non-
+invasive, less time consuming, and safe method where the 
+electric current flow through a pulse current in micro 
+amps that does not affect any cell and tissue or other 
+physiological changes. However, a longitudinal study 
+may help to know the better effect of interventions. 
+Funding: No funding sources 
+Conflict of interest: None declared 
+Ethical approval: The study was approved by the 
+Institutional Ethics Committee of University and 
+registered in the Clinical Trials Registry - India (CTRI) 
+[CTRI/2018/08/015256] 
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+ 
+Cite this article as: Hegde JR, Melukote SK, 
+Vijayendra K, Singh D. A randomized study on the 
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+View publication stats
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yogatexts/A randomized trial comparing effect of yoga and exercises on quality of life in among nursing population with chronic low back pain.txt

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+© 2018 International Journal of Yoga | Published by Wolters Kluwer ‑ Medknow
+208
+Introduction
+Nursing profession is the largest chunk 
+of health‑care professionals.[1] Physical, 
+psychological, 
+and 
+psychosocial 
+challenges contribute to musculoskeletal 
+disorders among nurses. Chronic low 
+back pain (CLBP) is the most common 
+musculoskeletal disorder among the nurses. 
+It is reported that 63%–86% of nursing 
+professionals suffer from LBP in their 
+lifetime.[1,2] CLBP in nurses is multifactorial, 
+and the risk factors pertain to lifestyle, 
+physical, 
+psychological, 
+psychosocial, 
+and occupational domains, namely, age, 
+gender, physical status, smoking, workplace 
+stress, awkward postures, poor ergonomics, 
+carrying and repositioning of patients, 
+prolonged standing, night shifts, working 
+without sufficient breaks, and psychological 
+stress are important causative/risk factors 
+for CLBP in nurses. Nurses are required 
+to lift and transport patients or equipment, 
+often in difficult environment particularly 
+Address for correspondence: 
+Assoc. Prof and Head.  
+Nitin J Patil, 
+Department of Integrative 
+Medicine, Sri Devaraj Urs 
+Academy of Higher Education 
+and Research, Kolar - 563 103, 
+Karnataka, India.  
+E-mail: [email protected]
+Abstract
+Background: Chronic low back pain  (CLBP) adversely affects quality of life  (QOL) in nursing 
+professionals. Integrated yoga has a positive impact on CLBP. Studies assessing the effects of 
+yoga on CLBP in nursing population are lacking. Aim: This study was conducted to evaluate the 
+effects of integrated yoga and physical exercises on QOL in nurses with CLBP. Methods: A  total 
+of 88 women nurses from a tertiary care hospital of South India were randomized into yoga group 
+(n = 44; age – 31.45 ± 3.47 years) and physical exercise group (n = 44; age – 32.75 ± 3.71 years). 
+Yoga group was intervened with integrated yoga therapy module practices, 1 h/day and 5 days a week 
+for 6 weeks. Physical exercise group practiced a set of physical exercises for the same duration. All 
+participants were assessed at baseline and after 6 weeks with the World Health Organization Quality 
+of Life‑brief  (WHOQOL‑BREF) questionnaire. Results: Data were analyzed by Paired‑samples 
+t‑test and Independent‑samples t‑test for within‑ and between‑group comparisons, respectively, using 
+the Statistical Package for the Social Sciences  (SPSS). Within‑group analysis for QOL revealed a 
+significant improvement in physical, psychological, and social domains  (except environmental 
+domain) in both groups. Between‑group analysis showed a higher percentage of improvement in 
+yoga as compared to exercise group except environmental domain. Conclusions: Integrated yoga 
+was showed improvements in physical, psychological, and social health domains of QOL better than 
+physical exercises among nursing professionals with CLBP. There is a need to incorporate yoga as 
+lifestyle intervention for nursing professionals.
+Keywords: Exercises, low back pain, nurses, quality of life, yoga
+A Randomized Trial Comparing Effect of Yoga and Exercises on Quality of 
+Life in among nursing population with Chronic Low Back Pain
+Original Article
+Nitin J Patil, 
+Nagaratna R1, 
+Padmini Tekur2, 
+Manohar PV3, 
+Hemant Bhargav4, 
+Dhanashri Patil
+Department of Integrative 
+Medicine, Sri Devaraj Urs 
+Academy of Higher Education 
+and Research, 3Department 
+of Orthopedics, Sri Devaraj 
+Urs Medical College, 
+Kolar, 1Medical Director, 
+Arogyadhama, S-VYASA 
+Yoga University, 2Division 
+of Yoga and Life Sciences, 
+S-VYASA Yoga University,
+4Integrated Centre for Yoga
+(NICY), NIMHANS, Bengaluru,
+Karnataka, India
+in developing nations where lifting aids are 
+not always available or practicable. These 
+multiple factors contribute toward higher 
+prevalence of CLBP in this population.[3] 
+CLBP is one of the main concerns, which 
+negatively impacts the quality of life (QOL) 
+leading to reduced work productivity, 
+absenteeism, 
+and 
+disabilities 
+among 
+nurses.[4] Harrington and Gill stated that 
+LBP is the most common cause of early 
+retirement on grounds of ill health, sickness 
+absenteeism, job changes, and a fall in the 
+work speed among the working population. 
+Especially for young nurses, the mental 
+demands of work have a critical influence 
+on their QOL and workability.[5]
+QOL 
+measurements 
+are 
+being 
+used 
+increasingly relevant in the evaluation of 
+disease progression, treatment, and the 
+management of musculoskeletal disorders. 
+QOL is recognized as a concept representing 
+individual 
+responses 
+to 
+the 
+physical, 
+mental, and social effects of illness on daily 
+Access this article online
+Website: www.ijoy.org.in
+DOI: 10.4103/ijoy.IJOY_2_18
+Quick Response Code:
+How to cite this article: Patil NJ, Nagaratna R, Tekur P, 
+Manohar PV, Bhargav H, Patil D. A randomized trial 
+comparing effect of yoga and exercises on quality of 
+life in among nursing population with chronic low back 
+pain. Int J Yoga 2018;11:208-14.
+Received: January, 2018. Accepted: April, 2018.
+This is an open access journal, and articles are distributed under 
+the terms of the Creative Commons Attribution-NonCommercial-
+ShareAlike 4.0 License, which allows others to remix, tweak, and 
+build upon the work non-commercially, as long as appropriate 
+credit is given and the new creations are licensed under the 
+identical terms.
+For reprints contact: [email protected]
+Patil, et al.: Yoga for nurses with low back pain
+International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018
+209
+living, which influences the extent of personal satisfaction 
+with life circumstances that can be achieved. Measuring 
+QOL is recognized as an important add‑on to objectify 
+clinical effectiveness in recent clinical trials.[6,7] CLBP is 
+a major deterrent for QOL, and the QOL scores correlate 
+with pain and disability of CLBP. Furthermore, QOL 
+correlated inversely with poor quality of sleep in nursing 
+population. Such multifactorial problems of CLBP demand 
+a multifaceted approach for management.[8‑10]
+Yoga has emerged as a popular mind‑body therapy for 
+CLBP as suggested by emerging scientific literature across 
+the globe.[11] Yoga adopts a multifaceted approach utilizing 
+practices at body (postures), breath (breathing techniques), 
+and mind levels  (meditation and relaxation techniques), 
+respectively. According to national surveys, yoga practice 
+and research have increased exponentially and in the last 
+decade with over 10 million Americans practicing yoga for 
+health reasons in 2002 and over  13 million in 2007.[11‑13] 
+Literature review reveals that viniyoga, hatha yoga, Iyengar 
+yoga, and integrated yoga are the most commonly used 
+forms to treat LBP.[14‑16]
+In a systematic review, Chou and Huffman concluded 
+that there was a fair evidence reflecting efficacy of 
+yoga therapy in subacute or CLBP.[17] In another similar 
+review 
+which 
+included 
+four 
+randomized 
+controlled 
+trials  (RCTs), it was observed that the intervention by 
+Iyengar yoga and viniyoga for a period of 12–24  weeks 
+was beneficial in CLBP.[15] Yet, another meta‑analysis 
+consisting of eight RCTs by Cramer et  al. found strong 
+evidence for short‑term effectiveness  (pain, back‑specific 
+disability, and global improvement parameters) and 
+moderate evidences (back‑specific disability) for long‑term 
+effectiveness of yoga on CLBP. Yoga was not found to be 
+associated with serious adverse events.[18]
+A study by Tekur et  al. had observed usefulness of yoga 
+intervention in improving QOL in patients with CLBP. 
+However, this study was used in general population with 
+intense residential yoga intervention. We did not come 
+across any study that has assessed the same in nursing 
+population with an OPD or outdoor setup intervention 
+(1 h/day). As discussed earlier, nursing population is more 
+prone for CLBP due to specific demands of the occupation.
+Thus, the present randomized controlled study was planned 
+to compare the effect of integrated yoga and physical 
+exercise of similar intensity on QOL of nurses suffering 
+from LBP.
+Methods
+Subjects
+This study was conducted among nursing population, 
+who were diagnosed by an orthopedician to be suffering 
+from CLBP. Participants were working in the tertiary 
+care teaching hospital in Kolar district of Karnataka state 
+in India. They were randomly divided into two groups: 
+yoga (n  =  44; age  –  31.45  ±  3.47  years) and physical 
+exercise (n = 44; age – 32.75 ± 3.71 years) using random 
+number generator  (www.randomizer.org). Participants in 
+the two groups did not differ much in relation to their age, 
+education, or duration of illness between the groups as 
+shown in Table 1.
+Two groups’ randomized controlled single‑blind design was 
+followed with participants from both the groups (yoga and 
+exercise) receiving intervention for 6  weeks. Assessments 
+for QOL were performed at two points of time at baseline 
+and after 6 weeks of interventions. The statistician and the 
+interviewer were unaware of the allocation status of the 
+participants.
+The inclusion requirements were as follows:  (a) female 
+nurses with diagnosis of either nonspecific LBP, lumbar 
+spondylosis, or intervertebral disc prolapse, suffering 
+from LBP for 3  months or more as diagnosed by an 
+orthopedician and  (b) knowledge of English, Hindi, 
+and Kannada language. The exclusion criteria were as 
+follows:  (a) pain due to organic causes such as infective 
+and inflammatory conditions, metabolic disorders, and 
+posttraumatic condition,  (b) patients with degenerative 
+disorders of muscles,  (c) patients with comorbid cardiac 
+or neuropsychiatric illness,  (d) history of major surgery 
+or injury in the past, (e) pregnant women, and (f) patients 
+with neurological complications of CLBP.
+Written informed consent was taken from all the 
+participants before the study and Institutional Ethical 
+Clearance was obtained.
+Study profile
+From January 2015 to December 2016, nurses were 
+screened and referred by the orthopedician. Out of 176 
+nurses referred for the study, 88 satisfied the study criteria. 
+Table 1: Sociodemographic and clinical variables 
+comparison between yoga and exercises
+Variables
+Yoga
+Exercises
+Number of participants (only female)
+44
+44
+Age (mean±SD)
+31.45±3.47
+32.75±3.71
+Education
+ANM
+8
+3
+GNM
+28
+32
+Bachelor of nursing
+8
+9
+CLBP
+3 months‑1 year
+34
+37
+>1 year
+10
+07
+Causes
+Nonspecific/muscle spasm
+37
+35
+Lumbar spondylosis
+6
+3
+Intervertebral disc prolapse
+4
+3
+SD=Standard deviation, ANM=Auxiliary nursing midwifery, 
+GNM=General nursing midwifery, CLBP=Chronic low back pain
+Patil, et al.: Yoga for nurses with low back pain
+International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018
+210
+Informed consent was obtained. Baseline assessments 
+were done, and they were randomly allocated to yoga 
+(n  =  44) and control  (n  =  44) groups. They underwent 
+intervention  (either integrated yoga or physical exercise) 
+for 6  weeks; repeat assessments were performed on both 
+groups. There were no dropouts in the study. Figure  1 
+provides a flow diagram of the study profile.
+Materials
+Assessment
+The World Health Organization Quality of Life‑brief 
+(WHOQOL‑BREF) questionnaire English and Kannada 
+version was used to assess the QOL of the participants.
+WHOQOL‑BREF developed by the WHO is a standardized 
+comprehensive 
+instrument 
+for 
+assessment 
+of 
+QOL 
+comprising 26 items. The scale provides a measure of 
+an individual’s perception of QOL on four domains: 
+(1) physical health  (seven items),  (2) psychological 
+health  (six items),  (3) social relationships  (three items), 
+and  (4) environmental health  (eight items). In addition, it 
+also includes two questions for “overall QOL” and “general 
+health” facets. The domain scores are scaled in a positive 
+direction (i.e., higher scores denote higher QOL). The range 
+of scores is 4–20 for each domain. The internal consistency 
+of WHOQOL‑BREF ranged from 0.66 to 0.87 (Cronbach’s 
+alpha coefficient). The scale has been found to have good 
+discriminant validity. It has good test–retest reliability and 
+is recommended for use in health surveys and to assess the 
+efficacy of any intervention at suitable intervals according 
+to the need of the study.[19,20]
+Intervention
+Integrated approach of yoga therapy  (IAYT) is based on 
+the basic principle that there are five layers of the existence 
+to human beings, namely, Annamaya Kosa  (physical 
+level), Pranamaya Kosa  (subtle energy level), Manomaya 
+Kosa (emotional level), Vijnanamaya Kosa  (level of 
+intellect), and Anandamaya Kosa  (level of bliss). Yogic 
+pathophysiology propounds that the disturbances at the 
+emotional level  (adhi) percolate to the physical level 
+(vyadhi) through the layer of prana. Furthermore, all layers 
+are interrelated and they affect each other indirectly. The 
+IAYT is an approach which consists in not only dealing 
+with physical layer but also includes using techniques to 
+operate on different layers of our existence. The practices 
+at body level  (Annamaya Kosa) include yogasanas, 
+loosening practices, at subtle energy level  (Pranamaya 
+Kosa) include breathing practices and pranayama, and 
+at the mind level  (Manomaya Kosa) are meditations and 
+relaxation techniques.
+A 1‑h integrated yoga therapy module  (IYTM) was 
+designed after reviewing the literature in the field of yoga 
+and LBP by utilizing the components of yoga at the body, 
+subtle energy, and mind level, respectively. The designed 
+IYTM was validated by subject experts.[21] Tekur et  al. 
+used as a similar intervention in an earlier study.[22] This 
+yoga module was practiced 5 days a week for 6 weeks. The 
+details of yoga practice are provided in Table 2.
+Self and physician refered nursing professionals with CLBP 
+(Recruitment Period :  January 2015  to December 2016)
+Assessed for  Inclusion and Exclusion criteria, 
+Obtained informed consent form
+Randomly allocatted to Yoga and Exercise group
+Outcome measures were assessed at baseline for All 88 subjects
+Group 1 - Yoga; n = 44
+Group 2 Exercise; n = 44
+Intervention: 1 Month (1 Hour per Day / 5 Days a week)
+Group1 - IYTM  for CLBP
+Group 2 - Physical Exercise
+Assessement of outcome measures were repeated
+Statistical Analysis
+Report writting
+Figure 1: Trail profile
+Table 2: Intervention: Integrated yoga therapy module 
+versus physical exercises
+List of practices in IYTM for CLBP List of physical exercises
+Supta udarakarshanasana (folded leg 
+lumbar stretch)
+Standing hamstring stretch
+Shava udarakarshanasana (crossed leg 
+lumbar stretch)
+Cat and camel
+Pavanamuktasana 
+(wind‑releasing pose)
+Pelvic tilt
+Setu bandhasana breathing (bridge 
+pose lumbar stretch)
+Partial curl
+Vyaghrasana (tiger breathing)
+Piriformis stretch
+Bhujangasana (serpent pose)
+Extension exercise
+Shalabhasana breathing (locust pose)
+Quadriceps leg raising
+Uttanapadasana (straight leg raise pose) Trunk rotation
+Ardha kati chakrasana (lateral arc pose) Double knee to chest
+Ardha chakrasana (half wheel pose)
+Bridging
+Quick relaxation techniques
+Hook lying march
+Nadi shuddhi (alternate nostril 
+breathing)
+Single knee to chest stretch
+Bhramari (humming bee breath)
+Lumbar rotation
+Nadanusandhana (A, U, M, AUM 
+chanting)
+Press up
+Deep relaxation technique
+Curl ups
+Laghoo shankhaprakshalana (yogic 
+colon cleansing) (weekly once)
+IYTM=Integrated yoga therapy module, CLBP=Chronic low 
+back pain
+Patil, et al.: Yoga for nurses with low back pain
+International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018
+211
+Control group intervention
+Control group practiced physical exercise of similar 
+intensity as IYTM for the same duration and frequency 
+as shown in Table  2 provides the details of control 
+intervention.
+Data collection
+Data were taken at the same time of the day on 
+the 1st and 43rd day. Orientation to yoga program was given 
+to the participants for 3  days, and then on the next day, 
+predata collection was done after satisfactory performance. 
+WHOQOL‑BREF assessments were done on day 1 and 
+day 43 (after 6  weeks). A  trained psychologist assisted in 
+data collection.
+Data analysis
+Statistical Package for the Social Sciences (SPSS) - (Version 
+21.0., Armonk, NY: IBM Corp.) was used for all analyses. 
+Data of all four domains were normally distributed on 
+Shapiro–Wilk test. Hence, the parametric tests were used. 
+“Paired‑samples t‑test” and “Independent‑samples t‑test” 
+were used to analyze within‑  and between‑group data, 
+respectively.
+Results
+Within‑group comparisons in yoga group
+Within‑group pre‑  and postcomparison showed that, 
+after the yoga intervention, there was a significant 
+improvement in three domains of WHOQOL‑BREF, 
+namely, physical (P  <  0.01), psychological  (P  <  0.01), 
+and social  (P  <  0.01) with a trend of insignificant 
+positive impact in environmental domain  (P  =  0.07) 
+[Table 3].
+Within‑group comparisons in exercise group
+Similar to yoga group, exercise group also showed a 
+significant improvement in three domains, namely, physical 
+(P < 0.01), psychological (P < 0.01), and social (P < 0.01) 
+with no significant difference in the environmental domain 
+(P = 0.95) [Table 4].
+Between‑group comparisons in yoga versus control 
+group
+Preintervention data
+There was a no significant difference between the 
+yoga and control groups at the baseline for all the four 
+domains of WHOQOL‑BREF:  (a) physical  (P  =  0.296), 
+(b) psychological  (P  =  0.987),  (c) social  (P  =  0.661), and 
+(d) environmental (P = 0.904) as shown in Table 5.
+Postintervention data
+There was a significant difference between the yoga and 
+control groups after the intervention in the following 
+domains of WHOQOL‑BREF:  (a) physical  (P  <  0.01), 
+(b) psychological  (P  <  0.01), and  (c) social  (P  <  0.01) 
+with the scores of yoga group being higher than 
+those of the control group for all the three domains, 
+respectively. 
+There 
+was 
+no 
+significant 
+difference 
+between 
+the 
+groups 
+for 
+environmental 
+domains 
+(P = 0.249).
+Table 3: Within yoga group (pre and post) comparison of 
+World Health Organization Quality of Life‑BREF scores
+Variables
+Pre/
+post
+Yoga group
+Mean±SD
+Percentage change
+P
+Physical 
+domain QOL
+Pre
+41.27±6.603
+44.12
+<0.001
+Post
+59.48±9.041
+Psychological 
+domain QOL
+Pre
+34.91±5.356
+97.07
+<0.001
+Post
+68.80±13.428
+Social domain 
+QOL
+Pre
+43.07±12.705
+55.02
+<0.001
+Post
+66.77±12.004
+Environmental 
+domain QOL
+Pre
+55.70±5.325
+2.81
+0.078
+Post
+57.27±6.028
+QOL=Quality of life, SD=Standard deviation
+Table 4: Within exercise group (pre and post) 
+comparison of World Health Organization Quality of 
+Life‑BREF scores
+Variables
+Pre/
+post
+Exercise group
+Mean±SD
+Percentage change
+P
+Physical 
+domain QOL
+Pre
+39.82±6.377
+25.33
+<0.005
+Post
+49.91±8.575
+Psychological 
+domain QOL
+Pre
+34.93±7.315
+20.89
+<0.001
+Post
+42.23±7.358
+Social domain 
+QOL
+Pre
+44.09±8.757
+14.49
+<0.001
+Post
+50.48±8.609
+Environmental 
+domain QOL
+Pre
+55.84±5.278
+0.089
+0.957
+Post
+55.89±5.136
+QOL=Quality of life, SD=Standard deviation
+Table 5: Between group (yoga vs. exercise) comparison 
+of World Health Organization Quality of Life‑BREF 
+scores
+Variables
+Pre/post
+Group
+Mean±SD
+P
+Physical 
+domain QOL
+Pre
+Yoga
+41.27±6.60
+0.296
+Pre
+Exercise
+39.82±6.34
+Post
+Yoga
+59.48±9.04
+<0.005
+Post
+Exercise
+49.91±8.57
+Psychological 
+domain QOL
+Pre
+Yoga
+34.91±5.36
+0.987
+Pre
+Exercise
+34.93±7.31
+Post
+Yoga
+68.80±13.43
+<0.001
+Post
+Exercise
+42.23±7.36
+Social domain 
+QOL
+Pre
+Yoga
+43.07±12.70
+0.661
+Pre
+Exercise
+44.09±8.76
+Post
+Yoga
+66.77±12.00
+<0.001
+Post
+Exercise
+50.48±8.61
+Environmental 
+domain QOL
+Pre
+Yoga
+55.70±5.33
+0.904
+Pre
+Exercise
+55.84±5.28
+Post
+Yoga
+57.27±6.03
+0.249
+Post
+Exercise
+55.89±5.14
+Patil, et al.: Yoga for nurses with low back pain
+International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018
+212
+Discussion
+At the end of 6 weeks of intervention as mentioned before, 
+we observed that both the groups showed significant 
+improvements in physical, psychological, and social 
+domains of WHOQOL‑BREF, whereas the environmental 
+domain did not show significant improvements in either 
+of the groups. As compared to the control group, patients 
+who 
+performed 
+yoga 
+reported 
+significantly 
+higher 
+scores on the psychological domain  (yoga  –  97.7% and 
+control – 20.89%). It was further observed that percentage 
+improvement in physical and social domains was higher 
+in the yoga group as compared to the exercise group 
+(physical domain: yoga  –  44.12% vs. control  –  25.33%; 
+and social domain: yoga – 55.02% vs. control – 14.49%).
+Previously, Tekur et  al.[22] demonstrated the usefulness 
+of a 7  day intensive residential integrated yoga in 
+improving QOL in 80  patients with CLBP in a highly 
+controlled setting where patients were away from their 
+occupational and other duties. They observed a significant 
+improvement in all the four domains of WHOQOL‑BREF 
+in the yoga‑based lifestyle module as compared to physical 
+exercise‑based lifestyle change module. One of the 
+limitations with such trials is that they are not practical for 
+working young nursing population and difficult to replicate 
+such studies. In our study, we used 1‑h yoga program 
+which included all major components of yoga therapy, 
+namely, asanas, pranayama, and relaxation. The exercise 
+group also followed similar duration and frequency of 
+intervention. We also observed improvement in physical, 
+psychological, and social domains in both the groups 
+but not in the environmental domain. The percentage 
+improvements were higher in yoga group than the exercise 
+group for physical, psychological, and social domains, 
+respectively. This may be because the intervention offered 
+by Tekur et al. was much more intensive than ours and the 
+residential setup involved exposure to such an environment 
+which was significantly different from the workplace. We 
+performed this research in much more pragmatic setup and 
+observed similar outcomes.
+Underplaying mechanism of integrated yoga therapy 
+module
+The probable mechanism of action of yoga may be 
+through improvement of autonomic functions through 
+triggering 
+neurohormonal 
+mechanisms 
+that 
+suppress 
+sympathetic activity through downregulation of the 
+hypothalamic–pituitary–adrenal axis.[23] Mindfulness‑based 
+practices may also enhance cognitive flexibility, which may 
+further reduce stress, anxiety, and pain, thereby improving 
+QOL.[24] Furthermore, the cellular effects of mechanical 
+and fluid pressure on structures such as cartilage suggest 
+that yoga postures might alter joint function. Low levels of 
+intermittent fluid pressure, as occur during joint distraction, 
+have been shown in  vitro to decrease production of 
+catabolic cytokines, such as interleukin‑1 and tumor 
+necrosis factor.[25] Yoga may be one way to provide the 
+motion and forces on joints needed to preserve integrity. In 
+addition, pranayama, meditations, and relaxation techniques 
+following yogasanas help to relax joints and muscles, 
+reduce oxidative stress, and calm the mind.[26] This study 
+implicates a probable role of integrated yoga therapy in the 
+management of patients suffering from CLBP.
+In a cross‑sectional study on 501 nurses from different 
+hospitals of Turkey, it was observed that there was a positive 
+correlation between QOL as assessed by WHOQOL‑BREF 
+and job satisfaction  (assessed using Short‑Form Minnesota 
+Questionnaire).[27] Similarly, another cross‑sectional study 
+on 435 female nurses from five regional centers in Taiwan 
+revealed that associations between scores on the sleep‑quality 
+and QOL scales were statistically significantly inversely 
+correlated.[28] Another survey on 1534 nursing professionals 
+from eight different hospitals in Taiwan found that improved 
+QOL of nurses translated into better workability (which may 
+indirectly contribute to better health‑care service delivery to 
+the patients).[29] In the above study, it was also observed that 
+mental demands of work were a critical influence on QOL 
+and workability, especially in young nursing professionals. 
+The authors further recommended countermeasures such as 
+enhancing the ability to cope with the job’s mental demands 
+for improving and maintaining the workability of nurses.
+Yoga may be considered one such intervention which 
+has been found useful in enhancing the ability to cope 
+with mental demands and thereby improve QOL and 
+workability of nurses. An anonymous E‑mail survey 
+was conducted between April and June 2010 of North 
+American nurses interested in mind‑body training to 
+reduce stress.[30] Of the 342 respondents, 96% were women 
+and 92% were Caucasian. Most  (73%) reported one or 
+more health conditions, notably anxiety  (49%), back 
+pain  (41%), gastrointestinal problems such as irritable 
+bowel syndrome (34%), or depression (33%). Their median 
+occupational stress level was 4 (0 = none and 5 = extreme 
+stress). Nearly all  (99%) reported already using one or 
+more mind‑body practices to reduce stress. The most 
+common mind‑body practices used by the nurses were 
+as follows: intercessory prayer  (86%), breath‑focused 
+meditation  (49%), healing or therapeutic touch  (39%), 
+yoga/tai 
+chi/qi 
+gong 
+(34%), 
+or 
+mindfulness‑based 
+meditation  (18%). The greatest expected benefits were for 
+greater spiritual well‑being (56%); serenity, calm, or inner 
+peace (54%); better mood (51%); more compassion (50%); 
+or better sleep (42%).[30]
+Physical domain of WHOQOL‑BREF features such as 
+mobility, fatigue, pain, sleep, and work capacity. The higher 
+percentage of improvement in the yoga group compared to 
+exercises therapy group can be credited to better reduction in 
+pain and disability with improvement in spinal flexibility.[31]
+Psychological domain features such as feelings, self‑esteem, 
+spirituality, thinking, learning, and memory. The higher 
+Patil, et al.: Yoga for nurses with low back pain
+International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018
+213
+percentage of improvement in the yoga group compared to 
+exercises therapy group may be credited to better reduction 
+in stress, anxiety, and depression.[31,32]
+Social domain of WHOQOL‑BREF features questions 
+relating to problems in interpersonal relationships and 
+social support. Yoga also acts like cognitive behavioral 
+therapy; this may be the reason for the superior impact of 
+yoga intervention compared to physical exercises in nurses 
+with CLBP.
+Environmental domain deals with problems relating 
+to financial resources, physical safety, and physical 
+environment such as pollution, noise, and climate. As 
+working environment remained same throughout, this 
+might have been the reason, we did not able to notice any 
+significant changes in the environmental domain in both 
+the groups.
+Thus, yoga appears to be an integrated therapeutic tool 
+and feasible intervention for improving QOL in nursing 
+professionals compared to physical exercise as it offers 
+holistic approach.
+The strengths of the study are as follows:  (a) this 
+multidisciplinary study encompasses the fields of yogic 
+science, orthopedics, and psychology;  (b) a large sample 
+of 88 CLBP patients were enrolled for the study with 
+no dropouts,  (c) no earlier study has reported effect 
+of integrated yoga intervention on QOL of nurses 
+suffering from CLBP;  (d) because the study involved 
+a pragmatic approach, the acceptability and adherence 
+to therapy were good; and  (e) as yoga and control 
+program was delivered through a standard protocol, 
+it could be reproduced in the exact way for future 
+interventions.
+This study has a few limitations, namely: this study was 
+a preliminary attempt to assess the response of nursing 
+population suffering from CLBP, and future studies 
+should incorporate more objective variables such as 
+electromyography, radio‑imaging, biochemical measures, 
+and other advanced objective variables of autonomic 
+functions.
+Conclusions
+IYTM improves physical, psychological, and social 
+health domains of QOL among nursing professionals with 
+CLBP more than the physical exercises. There is a need 
+to incorporate yoga as lifestyle intervention for nursing 
+professionals with CLBP.
+Acknowledgments
+We are thankful for the management of Sri Devaraj Urs 
+Academy of Higher Education and Research, Tamaka, 
+Kolar, India, for their support throughout. We acknowledge 
+the participants who gave their consent and participated 
+in this study. We acknowledge Dr. Ananta Bhattacharyya, 
+Dr.  Balaram Pradhan, and Mr. Ravishankar S. for their 
+support.
+Financial support and sponsorship
+Nil.
+Conflicts of interest
+There are no conflicts of interest.
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+© 2018. This work is published under
+https://creativecommons.org/licenses/by-nc-sa/4.0/ (the “License”).
+Notwithstanding the ProQuest Terms and Conditions, you may use this content
+in accordance with the terms of the License.

yogatexts/A recipe for Policy research in AYUSH educational and research.txt

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+www.jimcr.com	
+INTEGRATIVE MEDICINE CASE REPORTS  VOLUME 2  NUMBER 1  JANUARY 2021
+IMCR
+EDITORIAL
+1
+A recipe for Policy research in AYUSH educational and research  
+programs
+Kalyan Maity1, Vijaya Majumdar1, Amit Singh1, Akshay Anand2*
+Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru, Karnataka, India1
+Neuroscience Research Lab, Department of Neurology, PGIMER, Chandigarh, India2
+*Corresponding Author:
+Akshay Anand, PhD
+Professor, Neuroscience Research Lab
+Department of Neurology, PGIMER, Chandigarh, India
+Contact no: +91-9914209090
+E-mail: [email protected]
+Yoga, Ayurveda, and Siddha represent the ancient science of 
+healthy living originated in India. Some of the oldest texts 
+from around 5000 years back, such as Vedas and Upanishads, 
+provide evidence of such lifestyle. Many seals and fossils from 
+Indus Valley Civilization authenticate the practice of Yoga in 
+ancient India. According to yogic tradition, Shiva, one of the 
+Hindu Gods, is the first yogi (Adi yogi) and the first teacher 
+(Adi Guru). The meticulous practice of Yoga is widely believed 
+to play a major role to overcome mental and physical suffer-
+ing and leads to self-regulation, and finally to self-realization 
+or liberation. Since the Pre-Vedic period around 2700 B.C., 
+people started practicing Yoga. Later on, Patanjali Maharshi 
+(between 3rd to 6th centuries BC) systematized and codified 
+knowledge of Yoga through his Yoga Sutras. Later, with the 
+help of many sages and masters, Yoga spread through differ-
+ent traditions, lineages and Guru-shishya parampara. Various 
+Yoga schools viz. Jnana, Bhakti, Karma, Raja, Dhyana, Patan-
+jali, Kundalini, Hatha, Laya, Jain, Buddha, Hatha etc. which 
+follow their own practice, principles and tradition. However, 
+they all lead to the same goal. The history of modern Yoga 
+started in 1893 when the Parliament of Religions was held. 
+After that many yogacharya, teachers and practitioners tried 
+to spread Yoga, not only in India but worldwide (1). One of 
+the milestones in the history of Yoga has been the adoption of 
+the International Day of Yoga. The Honorable Prime Minister 
+ 
+Sri Narendra Modi addressed the world community on 
+27th  September 2014 in 69 sessions of the United Nations 
+General Assembly (UNGA) (2). The proposal was approved on 
+11th December 2014 by 193 members of UNGA to establish 
+21 June as “International Day of Yoga”. Six months later after 
+passing the resolution and confirmation to establish IDY, the 
+first IDY held in 2015. Several Yogic events were organized and 
+publicized throughout India as well as abroad and got nation-
+al and international publicity that Yoga has originated from 
+Indian culture. The essential and pivotal role of Yoga in edu-
+cation, pedagogy, curriculum, as well as clinical research has 
+been realized well across the globe (3). To achieve the same, 
+AYUSH Ministry was established November 9, 2014 (http://
+ayush.gov.in) to facilitate research and educational activity in 
+Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoe-
+opathy. The existence and excellence of Yoga-based research-
+es in the premier Institutes of India is another milestone to-
+wards the implementation of yogic sciences in the academic 
+sphere. Several Yoga departments and centers in the premier 
+Institutes and central universities of India, their existence and 
+establishment, is the result of the consultative meeting on 
+Yoga Education in Universities held in Bangalore on 2nd Janu-
+ary 2016, chaired by the Hon’ble Minister for Human Resource 
+Development in the presence of Vice-Chancellors from Indian 
+universities. It was resolved to set up a Department of Yogic 
+Art and Science in the Universities and constitute a committee 
+on Yoga Education in universities to look into various aspects 
+pertaining to setting up of these Departments. Further, collab-
+orative efforts were made to support Psychology, Philosophy, 
+and Yogic Science at different collaborating organizations, 
+by utilizing their respective expertise, knowledge, resources 
+ 
+and infrastructure (https://www.nhp.gov.in/list-of-yoga- 
+institutes_mtl). The aim of such centers was to understand 
+KEY WORDS 
+Ayush
+Integrative health
+Yoga
+Research
+INTEGRATIVE MEDICINE CASE REPORTS  VOLUME 2  NUMBER 1  JANUARY 2021
+www.jimcr.com
+IMCR
+EDITORIAL
+2
+deeper knowledge of Yoga philosophy and Yoga therapy based 
+on classical Yogic texts. For the last several years, S-VYASA 
+University has been doing research on evidence-based Yoga 
+& its application, to prevent diseases and to promote posi-
+tive health (https://svyasa.edu.in/Research_Publications.
+html). Swami Vivekananda Yoga Anusandhana Samsathana 
+ 
+(S-VYASA), established in 1986, is a pioneer Institute in the 
+field of Yoga Research. It is the first and foremost Institute 
+with a broad vision of scientifically evaluating yoga, its appli-
+cations, and policies led by Dr. H R Nagendra (4).
+A tremendous increase in Yoga participation has been 
+reported in the US since 2005. About 30 million people per-
+form Yoga daily to get health benefits (5,6). The increased 
+global interest in Yoga in recent decades could be based on 
+the health-promoting benefits of Yoga. Yoga therapy is evolv-
+ing rapidly and advocated as a safe and effective intervention 
+by National Health Services (UK) and National Institutes of 
+Health (US) (7–13). A continuous rise in Yoga schools and 
+practitioners is also evident across the globe (5). The science 
+of Yoga and the underlying technology of this mind-body med-
+icine need a more thorough investigation through carefully 
+designed mechanistic and clinical studies. There are many 
+challenges and barriers that hinder the realization of the op-
+timal potential of Yoga in education and Research (14). For 
+example, the current understanding of Yoga is limited as a be-
+havioral therapy or lifestyle intervention (14). Barriers to the 
+practice of Yoga and the knowledge gap in its understanding 
+also serve as the key determinants of the success of Yoga for 
+its successful implementation as public health administration 
+as well as its practical acceptance in the academic sector. Mod-
+ern lifestyle, occupational pressure, family commitments are a 
+few suggested barriers for Yoga Practice (9).
+Many Western medical schools viz. Columbia University, 
+Harvard University, Johns Hopkins University, University of 
+California, Stanford University, and research centers in Europe 
+have rapidly developed centers of excellence in Mind-Body 
+medicine. However there is a lack of active participation of many 
+of the corresponding premier Indian Institutions and Universi-
+ties. There is an urgent need to evaluate the perceptions and 
+barriers as perceived by the Institutions of National Eminence 
+and their Ethical and Academic committees that belong to the 
+Indian scientific and academic community for successful eval-
+uation of Yoga-based research and educational programs. This 
+can provide a necessary policy framework for evidence-based 
+decisions for Yoga research, barrier and benefits of Yogic prac-
+tices and identify the knowledge gap in the research and health 
+care fraternity. There is a need to develop policies that promote 
+the participation of the Indian Institutions and Universities that 
+have not shown their active participation in Yoga research so 
+far. An evaluation of Institutions that have been ranked highest 
+in MHRD’s National Institutional Ranking Framework (NIRF) 
+(https://www.nirfindia.org/Home) provides a framework to 
+methodologically rank Institutions across the country driven 
+by the overall recommendations by a Core Committee set up by 
+MHRD. This process can aim to assess the performance of the 
+Institutions based on broad parameters that cover “Teaching, 
+Learning and Resources,” “Research and Professional Practic-
+es,” “Graduation Outcomes,” “Outreach and Inclusivity,” and 
+“Perception”. The active participation of Institutes with high 
+NIRF rankings and inclusion assessment of AYUSH programs 
+in such Institutions along with their Ethical committees would 
+trigger changes that may lead to the adoption of Integrative 
+medicine in such Institutes and utilize the public health poten-
+tial of AYUSH research conducted since the launch of Ministry 
+of AYUSH. Until new publication characterized by biomarker, 
+animal models and cell culture studies have dominated the life 
+science ranking (15–33).
+References
+1.	
+Certification of yoga professionals guide book, Ministry of AYUSH, Govern-
+ment of India, 2016.
+2.	
+Bhattacharyya A, Patil NJ, Muninarayana C. “Yoga for promotion of health”: 
+conference held on International day of yoga-2015 at Kolar. Journal of 
+Ayurveda and integrative medicine. 2015 Oct;6(4):305.
+3.	
+Marques CS, Ferreira J, Rodrigues RG, Ferreira M. The contribution of 
+yoga to the entrepreneurial potential of university students: a SEM 
+approach. International Entrepreneurship and Management Journal. 
+2011 Jun 1;7(2):255–78.
+4.	
+Nagendra HR, Anand A. Indian PM’s evidence based wellness approach 
+inspires politico-scientific activism. Annals of Neurosciences. 2019; 
+26(1):3.
+5.	
+McCall MC. In search of yoga: Research trends in a western medical data-
+base. Int J Yoga. 2014;7(1):4–8.
+6.	
+Birdee GS, Legedza AT, Saper RB, Bertisch SM, Eisenberg DM, Phillips RS. 
+Characteristics of yoga users: results of a national survey. Journal of 
+General Internal Medicine. 2008 Oct 1;23(10):1653–8.
+7.	
+Hoyez AC. The ‘world of yoga’: the production and reproduction of thera-
+peutic landscapes. Soc Sci Med. 2007 Jul;65(1):112–24.
+8.	
+Dayananda H, Ilavarasu JV, Rajesh S, Babu N. Barriers in the path of yoga 
+practice: An online survey. Int J Yoga. 2014;7(1):66–71. 
+9.	
+Chu P, Gotink RA, Yeh GY, Goldie SJ, Hunink MM. The effectiveness of yoga 
+in modifying risk factors for cardiovascular disease and metabolic 
+syndrome: A systematic review and meta-analysis of randomized 
+controlled trials. European journal of preventive cardiology. 2016 
+Feb;23(3):291–307.
+10.	 Aljasir B, Bryson M, Al-shehri B. Yoga practice for the management of type II 
+diabetes mellitus in adults: a systematic review. Evidence-Based 
+Complementary and Alternative Medicine. 2010;7(4):399–408.
+11.	 Posadzki P, Ernst E. Yoga for asthma? A systematic review of randomized 
+clinical trials. Journal of Asthma. 2011 Aug 1;48(6):632–9.
+12.	 Kirkwood G, Rampes H, Tuffrey V, Richardson J, Pilkington K. Yoga for anx-
+iety: a systematic review of the research evidence. British journal of 
+sports medicine. 2005 Dec 1;39(12):884–91.
+13.	 Tabish SA. Complementary and Alternative Healthcare: Is it Evidence- 
+based? Int J Health Sci (Qassim). 2008;2(1):5–9.
+14.	 Mutalik G, Tillu G, Patwardhan B. AyurYoga, the confluence of healing 
+sciences: A call for global action. J Ayurveda Integr Med. 2019;10(2): 
+79–80. 
+15.	 Sharma NK, Gupta A, Prabhakar S, Singh R, Bhatt AK, Anand A. CC chemo-
+kine receptor-3 as new target for age-related macular degeneration. 
+Gene. 2013 Jul 1;523(1):106–11.
+16.	 Anand A, Banik A, Thakur K, L Masters C. The animal models of dementia 
+and Alzheimer’s disease for pre-clinical testing and clinical transla-
+tion. Current Alzheimer Research. 2012 Nov 1;9(9):1010–29.
+17.	 Anand A, Gupta PK, Sharma NK, Prabhakar S. Soluble VEGFR1 (sVEG-
+FR1) as a novel marker of amyotrophic lateral sclerosis (ALS) in the 
+North Indian ALS patients. European Journal of Neurology. 2012 
+May;19(5):788–92.
+www.jimcr.com	
+INTEGRATIVE MEDICINE CASE REPORTS  VOLUME 2  NUMBER 1  JANUARY 2021
+IMCR
+EDITORIAL
+3
+18.	 Goyal K, Koul V, Singh Y, Anand A. Targeted drug delivery to central ner-
+vous system (CNS) for the treatment of neurodegenerative disorders: 
+trends and advances. Central Nervous System Agents in Medicinal 
+Chemistry (Formerly Current Medicinal Chemistry-Central Nervous 
+System Agents). 2014 Apr 1;14(1):43–59.
+19.	 Kamal Sharma N, Gupta A, Prabhakar S, Singh R, Sharma S, Anand A. Single 
+nucleotide polymorphism and serum levels of VEGFR2 are associ-
+ated with age related macular degeneration. Current neurovascular 
+ 
+research. 2012 Nov 1;9(4):256–65.
+20.	 Anand A, Saraf MK, Prabhakar S. Sustained inhibition of brotizolam in-
+duced anterograde amnesia by norharmane and retrograde amne-
+sia by l-glutamic acid in mice. Behavioural brain research. 2007 Aug 
+22;182(1):12–20.
+21.	 Anand A, Saraf MK, Prabhakar S. Antiamnesic effect of B. monniera on 
+L-NNA induced amnesia involves calmodulin. Neurochemical re-
+search. 2010 Aug 1;35(8):1172–81.
+22.	 Singh T, Prabhakar S, Gupta A, Anand A. Recruitment of stem cells into the 
+injured retina after laser injury. Stem cells and development. 2012 
+Feb 10;21(3):448–54.
+23.	 Gupta PK, Prabhakar S, Abburi C, Sharma NK, Anand A. Vascular endothe-
+lial growth factor-A and chemokine ligand (CCL2) genes are upregu-
+lated in peripheral blood mononuclear cells in Indian amyotrophic 
+lateral sclerosis patients. Journal of neuroinflammation. 2011 Dec 1; 
+8(1):114.
+24.	 Vinish M, Prabhakar S, Khullar M, Verma I, Anand A. Genetic screen-
+ing reveals high frequency of PARK2 mutations and reduced Par-
+kin expression conferring risk for Parkinsonism in North West 
+India. Journal of Neurology, Neurosurgery & Psychiatry. 2010 Feb 
+1;81(2):166–70.
+25.	 Anand A, Tyagi R, Mohanty M, Goyal M, De Silva KR, Wijekoon N. Dystro-
+phin induced cognitive impairment: mechanisms, models and thera-
+peutic strategies. Annals of neurosciences. 2015 Apr;22(2):108.
+26.	 Banik A, Brown RE, Bamburg J, Lahiri DK, Khurana D, Friedland RP, Chen 
+W, Ding Y, Mudher A, Padjen AL, Mukaetova-Ladinska E. Translation 
+of Pre-Clinical Studies into Successful Clinical Trials for Alzheimer’s 
+Disease: What are the Roadblocks and How Can They Be Overcome? 
+1. Journal of Alzheimer’s Disease. 2015 Jan 1;47(4):815–43.
+27.	 Anand A, Sharma NK, Gupta A, Prabhakar S, Sharma SK, Singh R, Gupta PK. 
+Single nucleotide polymorphisms in MCP-1 and its receptor are as-
+sociated with the risk of age related macular degeneration. PloS one. 
+2012 Nov 21;7(11):e49905.
+28.	 Sharma K, Sharma NK, Anand A. Why AMD is a disease of ageing and not 
+of development: mechanisms and insights. Frontiers in aging neuro-
+science. 2014 Jul 10;6:151.
+29.	 Sharma NK, Gupta A, Prabhakar S, Singh R, Sharma SK, Chen W, Anand A. As-
+sociation between CFH Y402H polymorphism and age related macular 
+degeneration in North Indian cohort. PloS one. 2013 Jul 29;8(7):e70193.
+30.	 Mathur D, Goyal K, Koul V, Anand A. The molecular links of re-emerging 
+therapy: a review of evidence of Brahmi (Bacopa monniera). Fron-
+tiers in pharmacology. 2016 Mar 4;7:44.
+31.	 Anand A, Thakur K, Gupta PK. ALS and oxidative stress: the neurovascular 
+scenario. Oxidative medicine and cellular longevity. 2013 Oct;2013.
+32.	 English D, Sharma NK, Sharma K, Anand A. Neural stem cells—trends and 
+advances. Journal of cellular biochemistry. 2013 Apr;114(4):764–72.
+33.	 Sharma NK, Prabhakar S, Gupta A, Singh R, Gupta PK, Gupta PK, Anand 
+A. New biomarker for neovascular age-related macular degeneration: 
+eotaxin-2. DNA and cell biology. 2012 Nov 1;31(11):1618–27.
+doi: 10.38205/imcr.020101

yogatexts/A review of the scientific studies on cyclic meditation.txt

@@ -0,0 +1,336 @@
+IJOY
+Online full text at
+http://www.ijoy.org.in
+Published by  Medknow Publications
+International 
+Journal of Yoga
+0973-6131
+Volume 2 | Issue 2 | Jul-Dec 2009
+C o n t e n t s
+}
+The power of Prana
+}
+A review of the scientific studies on cyclic meditation
+}
+Cardiovascular and metabolic effects of intensive Hatha Yoga training in middle-aged and older women from 
+northern Mexico
+}
+Effect of yogic education system and modern education system on memory
+}
+Motion analysis of sun salutation using magnetometer and accelerometer
+}
+Normative data for the digit-letter substitution task in school children
+}
+Effects of yoga on symptom management in breast cancer patients: A randomized controlled trial
+International Journal of Yoga 
+ y 
+ Vol. 2: 
+ y 
+ Jul-Dec-2009
+46
+A review of the scientifi
+ c studies on cyclic meditation
+Pailoor Subramanya, Shirley Telles
+Indian Council of Medical Research, Center for Advanced Research in Yoga and Neurophysiology, SVYASA, Bangalore, India
+Address for correspondence: Dr. Shirley Telles,
+Patanjali Yogpeeth, Maharishi Dayanand Gram, Bahadrabad, 
+Haridwar-249 402, Uttarakhand, India. 
+E-mail: [email protected]
+DOI: 10.4103/0973-6131.60043
+Review Article
+GENERAL
+Yoga is an ancient science, originating in India, which 
+has components of physical activity, instructed relaxation 
+and interoception.[1] Yoga includes diverse practices, 
+such as physical postures (asanas), regulated breathing 
+(pranayama), meditation and lectures on philosophical 
+aspects of yoga.[2-3] Meditation is the seventh of eight 
+steps prescribed to reach an ultimate stage of spiritual 
+emancipation (Patanjali, circa 900 B.C.).[4] While many 
+practitioners do learn meditation directly, others find it 
+easier to first pass through the other stages - learn yoga 
+postures (asanas) and regulated breathing (pranayamas). 
+It is postulated that when a novïce attempts to meditate 
+directly, there could be two responses based on the quality 
+of the mind viz., (i) a rajasic – active (personality) mind 
+would be restless all through the session and (ii) a tamasic 
+– a mind with inertia could fall asleep. This problem 
+of the mind is addressed in the Mandukya Upanishad. 
+Based on this a technique of ‘moving meditation’, which 
+combines the practice of yoga postures with guided 
+meditation was evolved, called cyclic meditation (CM), by 
+H.R. Nagendra, Ph.D., which has its’ origin in an ancient 
+Indian text, Mandukya Upanishad.[5] It is interesting to 
+note that CM does induce a quiet state of mind, which is 
+compatible with the description of meditation (dhyana 
+or effortless expansion), according to Patanjali. The 
+description states: ‘Tatra pratyayaikatanata dhyanam’ 
+(Patanjali’s Yoga Sutras, Chapter 3: Verse 2). This means 
+that the uninterrupted flow of the mind towards the object 
+chosen for meditation is dhyana.[4] Indeed, all meditations, 
+irrespective of the strategies involved are believed to help 
+reach this state. There are several strategies in meditation 
+which include breath awareness, awareness of internal 
+sensations, directing the attention to a mantra or a koan, 
+and keeping the eyes open with the gaze fixed on the object 
+of meditation. 
+The verse on which CM is based, states: ‘In a state of mental 
+inactivity awaken the mind; when agitated, calm it; between 
+these two states realize the possible abilities of the mind. 
+If the mind has reached states of perfect equilibrium do 
+not disturb it again’. The underlying idea is that, for most 
+persons, the mental state is routinely somewhere between 
+the extremes of being ‘inactive’ or of being ‘agitated’ and 
+hence to reach a balanced/relaxed state the most suitable 
+technique would be one which combines ‘awakening’ and 
+‘calming’ practices. 
+In CM, the period of practicing yoga postures constitutes 
+the ‘awakening’ practices, while periods of supine rest 
+comprise ‘calming practices’. An essential part of the 
+practice of CM is being aware of sensations arising in 
+the body.[6] This supports the idea that a combination 
+of stimulating and calming techniques practiced with 
+a background of relaxation and awareness (during CM) 
+may reduce psycho physiological arousal more than 
+resting in a supine posture for the same duration. The 
+practice of CM, includes yoga postures (asanas) which 
+involve muscle stretching and this has diverse benefits. 
+The effects, benefits and possible mechanisms underlying 
+CM are given below. 
+SCIENTIFIC STUDIES ON CM 
+The studies described below were all carried out at the 
+Swami Vivekananda Yoga Research Foundation, Bangalore, 
+India, where the technique was devised.
+Studies on autonomic and respiratory variables
+In a previous study, heart rate variability (HRV) was 
+studied in 42 male volunteers in CM and supine rest 
+(SR) sessions. The high frequency (HF) power of the 
+HRV increased during both CM and SR practice, which 
+is considered to suggest increased vagal tone.[7] However, 
+there was a marginally greater increase during CM (4.4 
+%) compared to during SR (1.0 %). In the same study the 
+low frequency (LF) power which is believed to correlate 
+with sympathetic activity was significantly less during 
+both CM (1.8 % decrease) and SR (0.3 % decrease). The 
+study showed parasympathetic dominance. The exact 
+mechanism underlying the effect of CM on the autonomic 
+nervous system is difficult to determine. The effect may be 
+47
+International Journal of Yoga 
+ y 
+ Vol. 2: 
+ y 
+ Jul-Dec-2009
+brought about by reduced cortical activity, which in turn 
+may modify the activity at the level of the hypothalamus.
+An earlier study on 35 male volunteers (between 20-
+46 yrs of age) showed a significant decrease in oxygen 
+consumption and increase in breath volume were 
+recorded after guided relaxation practiced for 10 minutes 
+compared to the equal duration of supine rest. During 
+guided relaxation the power of the LF component of the 
+heart-rate variability spectrum reduced, whereas the 
+power of the HF component increased, suggesting reduced 
+sympathetic activity.[8] However, another study on 40 male 
+volunteers (16 to 46 yrs) showed that Isometric relaxation 
+technique practiced for a minute showed a reduction in 
+the physiological signs of anxiety and stress.[9] 
+More recently, a study on 30 male volunteers (20 to 33 years) 
+showed a decrease in heart rate (HR), low frequency power 
+(LF power), LF/HF ratio, and an increase in the number of 
+pairs of Normal to Normal RR intervals differing by more 
+than 50 ms divided by total number of all NN intervals 
+(pNN50) following the practice of cyclic meditation (CM) 
+suggestive of a shift towards sympatho-vagal balance in 
+favor of parasympathetic dominance during sleep.[10] 
+Studies on applications in reducing occupational stress 
+levels
+In a subsequent study correlating CM and heart 
+rate variability, a two-day CM program decreased 
+occupational stress levels and baseline autonomic 
+arousal in 26 asymptomatic, male, middle managers,[11] 
+suggesting significant reduction in sympathetic activity. 
+The mechanisms underlying the decrease in occupational 
+stress levels may be related to decreased autonomic arousal 
+(sympathetic activation) as well as psychological factors, 
+though this remains a speculation.
+Studies on metabolism and oxygen consumed
+An earlier study on oxygen consumption showed that a 
+period of CM significantly reduced oxygen consumption 
+to a greater degree (32.1%) than a comparable period of 
+supine rest.[12] A recent study also showed that after the 
+practice of CM oxygen consumption decreased (19.3 %) 
+compared to following SR (4.8 %). Also, the change in 
+oxygen consumption suggested that after the practices (but 
+not during) there was a period of physiological relaxation 
+which was more after CM compared to SR.[13] 
+The energy expenditure (EE), respiratory exchange ratio 
+(RER) and heart rate (HR) of 50 male volunteers were 
+assessed before, during, and after the sessions of CM and 
+sessions of supine rest. CM reduced the energy expenditure 
+more than supine rest alone.[14] The studies cited above 
+were conducted using the self-as-control design. Reduction 
+in oxygen consumption due to CM practice could be related 
+to decreased oxygen consumption of the brain and the 
+skeletal muscles (which are probably more relaxed with 
+the practice of CM).
+Studies on attention and electrophysiology
+Earlier studies showed that despite the changes suggestive 
+of parasympathetic dominance following CM, there was a 
+decrease in the P300 peak latency and an increase in the 
+P300 peak amplitude when the P300 was obtained using 
+an auditory oddball paradigm.[15] The P300 component of 
+event-related brain potentials (ERPs) is generated when 
+persons attend to and discriminate stimuli which differ 
+in a single aspect. More recently, middle latency auditory 
+evoked potentials (0-100ms range) were examined in 47 
+male volunteers before and after the practice of CM which 
+has resulted in prolonged latencies of evoked potentials 
+generated within the cerebral cortex, supporting the idea 
+of cortical inhibition after CM.[16] The studies cited above 
+were conducted using the self-as-control design. The 
+mechanism by which CM may improve attention while 
+reducing sympathetic tone may be related to increased 
+proprioceptive input (during the practice of asanas) to the 
+Reticular Activating System (RAS), which in turn keeps 
+cortical areas receptive and active.[17] This is difficult to 
+understand as generally increased alertness and vigilance 
+is associated with an increase in sympathetic tone.
+Studies on performance in cancellation task
+In a previous study, the effect of CM practice on 
+performance in a letter cancellation task, was assessed 
+in 69 male volunteers (whose ages ranged from 18 to 
+48 years).[18] There was improved performance in the 
+task which required selective attention, concentration, 
+visual scanning abilities, and a repetitive motor response 
+following CM. The results were interpreted to suggest 
+that the improved performance after CM suggests that the 
+practice not only globally enhances performance but also 
+selectively reduces the probability of being distracted. 
+Again, it is difficult to understand how CM practice, 
+associated with reduced sympathetic activity, increases the 
+performance in an attention task. As described above this 
+may be via increased proprioceptive input to the reticular 
+activating system.
+Study on memory and anxiety
+In a recent study 57 male volunteers (group average age 
+± S.D., 26.6 ± 4.5 years) the immediate effect of CM 
+and SR were studied on memory and state anxiety. A 
+cyclical combination of yoga postures and supine rest 
+in CM improved memory scores immediately after the 
+practice and decreased state anxiety more than rest in a 
+classical yoga relaxation posture (shavasana).[19] Like the 
+Scientifi
+ c studies on CM
+International Journal of Yoga 
+ y 
+ Vol. 2: 
+ y 
+ Jul-Dec-2009
+48
+P300 event-related potential and the letter cancellation 
+task, performance in the memory task requires increased 
+alertness. The mechanism (as described above) remains 
+speculative.
+Study on polysomnography
+In a recent study, whole night polysomnography measures 
+and the self-rating of sleep were assessed on the night 
+following a day in which 30 male volunteers practiced 
+CM twice (approximately 22:30 minutes each time). This 
+was compared to another night when they had two, equal 
+duration sessions of supine rest (SR) on the preceding day. 
+The percentage of slow wave sleep (SWS) was significantly 
+more in the night following CM practice than the night 
+following SR;  percentage of rapid eye movement (REM) 
+sleep and the number of awakenings per hour were less. 
+The practice of CM during day time has been shown 
+to increase the percentage of slow wave sleep in the 
+subsequent night.[20] CM has a number of components 
+which may facilitate sleep such as increased physical 
+activity, muscle stretching, interoception, and guided 
+relaxation.
+CONCLUSION
+The practice of CM in general appears to bring about a 
+state of low physiological activation, as described above, 
+with reduced oxygen consumption and a shift in the 
+sympathovagal balance towards vagal dominance. A period 
+of CM practice significantly reduces oxygen consumption 
+and energy expenditure to a greater degree (32.1%) than 
+a comparable period of supine rest. The CM program has 
+also been shown to decrease occupational stress levels and 
+baseline autonomic arousal. There is also an improved 
+performance in a letter cancellation task which requires 
+selective attention, concentration, visual scanning abilities, 
+and a repetitive motor response following CM. Moreover, a 
+study of the P300 following CM suggested that participants 
+showed a better ability to discriminate auditory stimuli 
+of different pitches in a P300 auditory oddball task. The 
+prolonged latencies of evoked potentials, generated within 
+the cerebral cortex after the practice of CM, supported the 
+idea of cortical inhibition after CM. The practice of CM 
+during day time has been shown to increase the percentage 
+of slow wave sleep in the subsequent night. This 
+suggests that CM practice (i) reduces autonomic arousal, 
+(ii) improves attention, and (iii) improves quality of sleep. 
+ACKNOWLEDGMENT
+The authors gratefully acknowledge H.R. Nagendra, Ph.D. who 
+derived the cyclic meditation technique from ancient yoga texts. 
+REFERENCES
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+10. Patra S, Telles S. Heart rate variability during sleep following the practice 
+of cyclic meditation and supine rest. Appl Psychophysiol Biofeedback 2009; 
+In Press. 
+11. 
+Vempati RP, Telles S. Baseline occupational stress levels and physiological 
+responses to a two day stress management program. J Indian Psychol 
+2000;18:33-7. 
+12. Telles S, Reddy SK, Nagendra HR. Oxygen consumption and respiration 
+following two yoga relaxation techniques. Appl Psychophysiol Biofeedback 
+2000;25:221-7. 
+13. Sarang PS, Telles S. Oxygen consumption and respiration during and 
+after two yoga relaxation techniques. Appl Psychophysiol Biofeedback 
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+14. Sarang, SP, Telles S. Cyclic meditation: A moving meditation-reduces energy 
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+Monit 2009;15:CR375-81.
+Subramanya and Telles

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+3
+© 2021  Indian Journal of Ayurveda and Integrative Medicine KLEU | Published by Wolters Kluwer - Medknow
+Suchitra S. Patil, R. Nagarathna 1, H. R. Nagendra
+ 
+Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, 1Department of Yoga and Life Sciences, 
+Arogyadhama, SVYASA, Bengaluru, Karnataka, India
+Address for correspondence: Dr. Suchitra S. Patil, Swami Vivekananda Yoga Anusandhana Samsthana, Eknath Bhavan, No. 19, 
+Gavipuram Circle, Kempegowda Nagar, Bengaluru ‑ 560 019, Karnataka, India. E‑mail: [email protected]
+Submitted: 18-Feb-2021, Revised: 25-Feb-2021, Accepted: 02-Mar-2021, Published: 17-Apr-2021
+ABSTRACT
+Background: In Western psychology, inventories are available for state (temporary change) and trait (which is the basis of 
+personality‑character) aspects of personality. Ayurveda inventories for measuring tridosha (which is the basis of both trait 
+and state of personality) in children have been developed and standardized, which pertains to trait aspect of personality. 
+There is no scale to assess the state aspects of tridosha in children.
+Methods: The design of the study was descriptive type. Sampling design was purposive sampling. The 6‑item Tridosha 
+State Scale for Children (TSSC) was developed on the basis of translation of the Sanskrit verses describing the states of 
+vāta, pitta, and kapha prakriti, which represent the temporary change in tridosha and by taking the opinions of experts (ten 
+Āyurveda experts and three psychologists who helped in judging the items and assessed. The study was carried out in Bapuji 
+School, Davangere. The scale was administered on 108 children in the age group of 8–12 years (mean age: 9.75 ± 1.30). 
+Moreover, for 30 children, the scores are compared with Caraka Child Personality Inventory (CCPI) – a self‑rating scale to 
+measure the trait aspects of prakriti).
+Results: TSSC was associated with excellent internal consistency. The Cronbach’s alpha for Vataja, Pittaja, and Kaphaja 
+scales was 0.826, 0.885, and 0.911, respectively. Scores on Vātaja, Pittaja, and Kaphaja scales were inversely correlated, 
+suggesting that they are mutually exclusive. Correlation of scores on subscales with CCPI was 0.97, 0.92, and 0.94, 
+respectively, for Vata, Pitta, and Kapha.
+Conclusions: The state of tridosha in children can be measured reliably by this instrument. This can be utilized by clinicians 
+and researchers to check the immediate effect of the interventions.
+Key words: Health, state, tridosha
+Introduction
+According to Western psychologists, Allport, Cattell, and 
+Guilford personality is made up of traits which are the 
+dispositions or a fundamental construct that accounts for 
+behavior regularity or consistency.[1] Trait is a permanent 
+character in one’s personality, while state is a temporary 
+change in personality or reaction of an individual to a situation.
+Ayurveda classics proclaim tridosha (Vata, Pitta, and Kapha 
+metabolic principles maintaining the functions of the body) 
+forms trait (character) and state (temporary -mood) aspects 
+of the personality. Accordingly, scriptures quote the state of 
+tridosha changes in a day, afternoon, night, during, before, 
+and after digestion. Detailed description of character of 
+personality formed by tridosha is explained.[2‑9]
+A Self‑Rating Scale to Measure States of Tridosha in Children
+This is an open access journal, and articles are distributed under the 
+terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 
+4.0 License, which allows others to remix, tweak, and build upon the 
+work non‑commercially, as long as appropriate credit is given and 
+the new creations are licensed under the identical terms.
+For reprints contact: [email protected]
+How to cite this article: Patil SS, Nagarathna R, Nagendra HR. 
+A self‑rating scale to measure states of tridosha in children. Indian J 
+Ayurveda lntegr Med  2021;2:3-7.
+Original Article
+Access this article online
+Website:
+www.ijaim.in
+Quick Response Code
+DOI:
+10.4103/ijaim.ijaim_1_21
+[Downloaded free from http://www.ijaim.in on Monday, June 6, 2022, IP: 136.232.192.146]
+Patil, et al.: State scale for children
+4
+ Indian Journal of Ayurveda and Integrative Medicine KLEU / Volume 2 / Issue 1 / January-June 2021
+Statistical model of dosha prakriti based on analysis of a 
+questionnaire has been developed.[10] An analysis of tridosha 
+physiology, linking it to process of cellular physiology, has 
+been carried out.[11,12] Similarly, a genetic basis of tridosha 
+constitution has been postulated.[13‑15] Importance of doshas 
+in health and treatment methods has been discussed.[16] A 
+study comparing the Āyurveda personality concepts and 
+Western psychology concepts is available.[17] Ayurveda 
+tridosha theory and four elements of Buddhist medicine and 
+Chinese humorology have been compared.[18,19] Importance 
+of Prakriti in aging has been discussed.[20] Differences in 
+cardiovascular responses to postural changes, exercise, and 
+cold pressor test of different prakriti have been explained.[21] 
+Left and right hemisphere chemical dominance has been 
+observed with predominance of doshas.[22] A scale to measure 
+tridoshas in psychotic patients has been developed.[23] A 
+parent‑rating scale and self‑rating scales are developed 
+and standardized to measure the trait aspects of tridosha 
+in children.[23,24] Scales to assess the state and trait aspects 
+of personality and anxiety are developed and standardized 
+according to Western psychology concepts.[25‑27]
+However, a simple self‑rating scale to assess the state aspects 
+of tridosha in personality of children according to Āyurveda 
+comprehensive concepts is not available. This may point 
+to observe the immediate changes in tridoshas after the 
+intervention.
+The objective of the present study was to develop a self‑rating 
+scale “Tridosha State Scale for Children” (TSSC) to assess the 
+mood state of the children pertaining to respective doshas 
+and to correlate with the trait prakriti scale Caraka Child 
+Personality Inventory (CCPI).[24] The reliability of subscales 
+was supported by Cronbach’s alpha co‑efficient ranging from 
+0.54 to 0.64 and split‑half analysis ranging from 0.60 to 0.66.
+Methods
+“TSSC” was developed based on six important Sanskrit 
+characteristics from nine authoritative ancient Ayurveda texts 
+describing characteristics typical of state aspect of Vātaja, 
+Pittaja, and Kaphaja Prakṛti.  Twenty‑five items in Sanskrit and 
+translation in English were presented to ten Āyurveda experts 
+for content validity. They were asked to judge the correctness 
+of each statement and to check (1) if the items constructed 
+represented acceptable translation of the Sanskrit in the 
+original texts and (2) whether the items selected represent 
+the state aspects of Vātaja, Pittaja, and Kaphaja Prakṛti?
+All the experts agreed on all items. Finally, six questions of 
+TSSC were framed. The scale was again presented to five 
+Āyurveda experts and two psychologists who reviewed the 
+format of this scale and recommended a two‑point scoring 
+(0 and 1); this was adopted in the final CCPI. Suggestions in 
+the phrasing of questions were also incorporated.
+The final TSSC has six items – two items for Vāta state, 
+2 items for Pitta state, and 2 items for Kapha state subscales. 
+The scale was to be answered by the children [Appendix 1].
+Data collection and analysis
+Item difficulty level was analyzed by administering the scale 
+on 108 children in the age group of 8–12 years.
+For testing the reliability and validity, the final scale of 6 items 
+was administered on 30 children who were the students of 
+Bapuji School in Davangere, Karnataka, India, of both sexes 
+with an age range of 8–12 years.
+The Statistical Package for Social Sciences (SPSS‑16.0, SPSS 
+Inc., Chicago, Ill., USA) was used for data analysis. The data 
+were analyzed for reliability. Cronbach’s alpha test was 
+applied for reliability analysis. Discriminant validity was 
+analyzed by Pearson’s correlation analysis. This was done to 
+check the degree of association between Vātaja, Pittaja, and 
+Kaphaja scores.
+Table  1 gives the demographic data of the children. 
+Sixty‑eight boys were there and 40 girls were there 
+(age: 9.75 ± 1.30).
+Results
+Content validity
+Among seven experts, who served as judges, all six questions 
+were agreed by four to five experts.
+Internal consistency
+An analysis of the data collected from 30 children showed 
+that the Cronbach’s alpha is at an acceptable range.[28]
+Table 2 gives the reliability coefficients of Vata, Pitta, and 
+Kapha subscales ranging above 0.8.
+Table 3 gives the correlation between Vata, Pitta, and Kapha 
+subscales. Vata has correlated significantly negatively with 
+Pitta and Kapha. Pitta has correlated significantly negatively 
+with Kapha.Table 4 gives the correlations of subscales of TSSC 
+Table 1: Demographic data
+Sample
+n/mean
+Percentage/SD
+Gender
+68 boys/n=108
+62.9
+Age
+9.75
+1.30
+SD: Standard deviation
+[Downloaded free from http://www.ijaim.in on Monday, June 6, 2022, IP: 136.232.192.146]
+Patil, et al.: State scale for children
+5
+ Indian Journal of Ayurveda and Integrative Medicine KLEU / Volume 2 / Issue 1 / January-June 2021
+and CCPI. Vata scale of TSSC correlated highly significantly 
+with vata scale of CCPI. Similarly, Pitta and Kapha scales of 
+TSSC correlated highly significantly with Pitta and Kapha 
+subscales of CCPI.
+Discussion
+The present study has described the development and initial 
+standardization of a self‑rating scale TSSC to measure the 
+state of tridosha with six items.
+The reliability of subscales was supported by Cronbach’s alpha 
+co‑efficient ranging from 0.800 to 0.911. This supported the 
+consistency of the scale[29] [Table 2]. Correlation between 
+Vātaja, Pittaja, and Kaphaja scale scores was negative, 
+suggesting discriminant validity [Table 3]. Correlation values 
+range from 0.332 to 0.657, significance at 99% confidence 
+for all correlations. This suggests that the three subscales 
+measure different aspects of state of personality of the 
+children. Correlation with CCPI[24] supported criterion related 
+validity[30] [Table 4].
+The strength of the study was that it is the first attempt 
+to standardize a self‑rating scale to measure the state 
+aspects of Prakriti of the children, which is an important 
+step to analyze the immediate effect of an intervention.[1,9] 
+This scale was developed with an intention to check the 
+immediate effect of yoga and meditation on tridoshas 
+importantly. Although published scales are available to 
+assess the Prakriti of the children,[23,24] there are no scales to 
+assess the state of tridosha. Hence, TSSC can be potentially 
+used to measure the mood state because of predominant 
+doshas in children.
+Limitations of the study
+Although TSSC is a reliable valid instrument, it has not 
+addressed test–retest reliability. The study should be done on 
+more number of samples and norms should be established.
+Conclusions
+A TSSC is a reliable and valid instrument. Researchers can 
+employ this instrument to assess the immediate effect of 
+diet, yoga, and personality development program on the 
+prakriti of the children.
+Acknowledgment
+We thank Dr. Kishore, Dr. Aarti Jagannathan, Dr. Uma, and 
+Āyurveda experts in Hubli, Bengaluru Āyurveda College, for 
+their support and participation in the study.
+Financial support and sponsorship
+Nil.
+Conflicts of interest
+There are no conflicts of interest.
+References
+1.	
+Misched M. Introduction to Personality. New York: Holt. Rinehart and 
+Winston Inc.; 1971.
+2.	
+Tripati R. Ashtanga Sangraha: Hindi Commentary. 2nd ed. New Delhi: 
+Choukamba Publications; 2001.
+3.	
+Panday GS. Caraka Samhita: Hindi Commentary. 5th ed. New Delhi: 
+Choukamba Publications; 1997.
+4.	
+Shastry KA. Sushruta Samhita: Hindi Vyakhya. 15th ed. New Delhi: 
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+Joshi RR. A biostatistical approach to ayurveda: Quantifying the tridosa. 
+J Altern Complemen Med 2005;11:221‑5.
+11. 
+Hankey A. The scientific value of Ayurveda. J Altern Complement Med 
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+Hankey A. A test of the systems analysis underlying the scientific theory 
+of ayurveda tridosa. J Altern Complement Med 2005;11:385‑90.
+13. 
+Patwardhan B, Joshi K, Chopra A. Classification of human population 
+based on HLA gene polymorphism and the concept of Prakriti in 
+ayurveda. J Altern Complement Med 2005;11:349‑53.
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+Prasher B, Negi S, Aggarwal S, Mandal AK, Sethi TP, Deshmukh SR, 
+et al. Whole genome expression and biochemical correlates of extreme 
+constitutional types defined in Ayurveda. J Transl Med 2008;6:48.
+Table 2: Reliability coefficients of the tridosha subscales
+Subscales
+Cronbach’s alpha
+Vata
+0.826
+Pitta
+0.885
+Kapha
+0.911
+Table 4: Correlation with Caraka Child Personality Inventory 
+(trait scale)
+r
+Vs versus Vt
+0.97**
+Ps versus Pt
+0.92**
+Ks versus Kt
+0.94**
+Table 3: Correlation among subscales
+Tridosha
+r
+P
+Vataja versus Pittaja
+0.425**
+<0.01
+Vataja versus Kaphaja
+0.657**
+<0.01
+Pittaja versus Kaphaja
+0.332**
+<0.05
+[Downloaded free from http://www.ijaim.in on Monday, June 6, 2022, IP: 136.232.192.146]
+Patil, et al.: State scale for children
+6
+ Indian Journal of Ayurveda and Integrative Medicine KLEU / Volume 2 / Issue 1 / January-June 2021
+16.	
+Mishra L, Singh BB, Dagenais S. Healthcare and disease management 
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+Endo J, Nakamura T. Comparative studies of the tridosha theory in 
+Ayurveda and the theory of the four deranged elements in Buddhist 
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+Mahdihassan  S. A  comparative study of Chinese cosmology 
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+2011;32:20‑4.
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+to postural changes, exercise, and cold press or test: Do they vary in 
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+Complement Alternat Med 2011;2011:251850.
+22.	
+Kurup RK, Kurup PA. Hypothalamic digoxin, hemispheric chemical 
+dominance, and the tridosha theory. Int J Neurosci 2003;113:657‑81.
+23.	
+Suchitra SP, Devika HS, Gangadhar BN, Nagarathna R, Nagendra HR, 
+Kulkarni R. Measuring the tridosha symptoms of unmāda (psychosis): 
+A preliminary study. J Altern Complement Med 2010;16:457‑62.
+24.	
+Suchitra  SP, Aarati  J, Nagendra  HR. Development and initial 
+standardization of Ayurveda: J Ayurveda Integr Med 2014;5:205‑8.
+25.	
+Spielberger CD. State‑Trait Anxiety Inventory: Bibliography. 2nd ed. 
+Palo Alto, CA: Consulting Psychologists Press; 1989.
+26.	
+Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual 
+for the State‑Trait Anxiety Inventory. Palo Alto, CA: Consulting 
+Psychologists Press; 1983.
+27.	
+Marteau TM, Bekker H. The development of a six‑item short‑form of 
+the state scale of the Spielberger State‑Trait Anxiety Inventory (STAI). 
+Br J Clin Psychol 1992;31:301‑6.
+28.	
+Freeman FS. Theory and Practice of Psychological Testing. 3rd ed. 
+New Delhi: Surjeet Publications; 2006.
+29.	
+Anastasi A, Urbina S. Psychological Testing. 7th ed. New Delhi: Pearson 
+Education; 2005.
+30.	
+Nunnaly JC. Psychometric Theory. 2nd ed. New York: Mc‑Grow‑Hill; 
+1978.
+[Downloaded free from http://www.ijaim.in on Monday, June 6, 2022, IP: 136.232.192.146]
+Patil, et al.: State scale for children
+7
+ Indian Journal of Ayurveda and Integrative Medicine KLEU / Volume 2 / Issue 1 / January-June 2021
+Appendix 1
+Tridosha State Scale for Children
+Instructions: There are no correct or wrong answers. Fill how you are feeling right now?
+1.	 I am active Yes/No
+2.	 I am upset Yes/No
+3.	 I am sweating Yes/No
+4.	 I am tensed Yes/No
+5.	 I feel enthusiastic Yes/No
+6.	 I feel silence Yes/No
+[Downloaded free from http://www.ijaim.in on Monday, June 6, 2022, IP: 136.232.192.146]

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+Original Article
+	
+Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2
+85
+A self-rating scale to measure tridos
+.as in 
+children
+S.P. Suchitra, H.R. Nagendra1
+Life Sciences, 1Vice Chancellor, Swami Vivekananda Yoga Anusandhana Samsthana, Yoga University, Bangalore
+INTRODUCTION
+A
+yurveda, the ancient life science is an aspect of Vedic lore 
+is broadly based on the principles of tridoṣas‑ vāta, pitta 
+and kapha. Tridoṣas are fundamental principles which maintain 
+bodily function (just as the sun, moon and air maintain the 
+universe, somatic functions are maintained by the dos
+.as).[1‑9]
+Western psychologists propose type and trait theories 
+for personality. Father of modern medicine, Hippocrates 
+ABSTRACT
+Background: Self  –  rating inventories to assess the 
+Prakr
+.ti (constitution) and personality have been developed 
+and validated for adults. To analyze the effect of personality 
+development programs on Prakr
+.ti of the children, standardized 
+scale is not available. Hence, present study was carried out to 
+develop and standardize Caraka Child Personality inventory (CCPI).
+Materials and Methods: The 77‑ item CCPI scale was developed 
+on the basis of translation of Sanskrit verses describing va
+-taja (a), 
+pittaja (b) and kaphaja prakr
+.ti (c) characteristics described in 
+Ayurveda texts and by taking the opinions of 5 Ayurveda experts 
+and psychologists. The scale was administered on children of the 
+age group 8-12 years in New Generation National public school, 
+Bangalore.
+Results: This inventory was named CCPI and showed excellent 
+internal consistency. The Cronbach’s alpha for A, B and C scales 
+were 0.54, 0.64 and 0.64 respectively. The Split ‑ Half reliability 
+scores for A, B and C subscales were 0.64. 0.60 and 0.66 
+respectively. Factor validity coefficient Scores on each item was 
+above 0.4. Scores on va
+-taja, pittaja and kaphaja scales were 
+inversely correlated. Test-retest reliability scores for A,B and C 
+scales were 0.87,0.88 and 0.89 respectively. The result of CCPI was 
+compared with a parent rating scale Ayurveda Child Personality 
+Inventory (ACPI). Subscales of CCPI correlated significantly 
+highly (above 0.80) with subscales of ACPI which was done for 
+the purpose of cross‑validation with respect to ACPI.
+Conclusions: The prakr
+.ti of the children can be measured 
+consistently by this scale. Correlations with ACPI pointed toward 
+concurrent validity.
+KEY WORDS: Tridosha, prakriti, va
+-ta, pitta, kapha, Ayurveda
+classifies individuals as choleric, melancholic, sanguine, and 
+phlegmatic based on the predominance of bodily humors. 
+This comes close to Ayurveda’s description of personalities 
+except for the description of vāta in the latter. Sheldon’s 
+Somato‑type classification ectomorphic, endomorphic, 
+mesomorphic types of personalities have been correlated 
+with Ayurveda prakṛti.[12] Other psychologists do not 
+consider wide‑ranging aspects of the personality.[10]
+Ayurveda classics[1‑9] propose a comprehensive analysis of 
+personality, encompassing physical‑physiological aspects 
+like color of the eyeball, texture of hair, appetite, sleep, 
+behavior, attitudes and interests, memory, intelligence, 
+mental stamina of an individual to come to a conclusion 
+about the tridoṣa state of the individual. The biological 
+qualities of tridoṣas also influence mental and behavioral 
+qualities. The texts suggest seven types of personality (vāta, 
+pitta, kapha, vāta–pitta, vāta–kapha, pitta–kapha, sama) 
+determined by predominance of a single, a pair, or all of 
+the doṣas.
+Ayurveda considers the balanced state (sama) of Tridoṣa 
+as health. Person with predominance of single and 
+double doṣas will certainly be vulnerable to diseases, as 
+vitiation of tridoṣas is the cause for the manifestation of 
+disease.[3] Accordingly, Ayurveda recommends specific 
+diet and daily regimen for different types of personalities 
+to maintain health.Studies have discussed the importance 
+of Ayurveda[11], tridoṣas.[12] A Statistical model of doṣa prakṛti 
+based on analysis of a questionnaire has been developed.[13]
+An analysis of the tridoṣa physiology, linking it to processes 
+of cellular physiology has been carried out. These studies 
+postulate the correspondence of functions of Vāta with 
+input/output  (homeostasis); Functions of Pitta with 
+Access this article online
+Quick Response Code:
+Website:
+www.ancientscienceoflife.org
+DOI:
+10.4103/0257-7941.139042 
+[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82]
+86 	
+Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2
+Suchitra and Nagendra: Self rating scale to asses prakr
+.ti
+turnover (negative entropy production); and functions of 
+kapha with storage of the cellular functions.[14‑16] Similarly, a 
+genetic basis of tridoṣa constitution has been postulated.[17‑20] 
+A study comparing the Ayurveda personality concepts and 
+western psychology concepts is available.[21‑22] Ayurveda 
+tridoṣa theory and four elements of Buddhist medicine, 
+Chinese humorolgy has been compared.[23,24] Importance 
+of prakṛti in ageing has been discussed.[25] Effect of 
+isotonic exercise on different types of prakṛti has been 
+observed.[26] A difference in metabolism of different prakṛti 
+has been explained.[27] Left and right hemisphere chemical, 
+dominance has been observed with predominance of 
+doṣas.[28] Another study postulated  ADP‑induced maximal 
+platelet aggregation was highest among the vāta‑pitta 
+prakṛti individuals.[29] Relationship between vāta prakṛti 
+and Parkinson’s disease has been studied.[30] A scale to 
+measure tridoṣas in psychotic patients has been developed.[31] 
+Ayurveda Child Personality Inventory (ACPI), a parent 
+rating scale to measure tridoṣas in children has been 
+standardized.[32]  Chinese humorology and cosmology have 
+been compared showing that as humors control all the 
+activities of the body similarly in other form they control the 
+universe. [33] Scale to measure tridoṣas in psychotic patients 
+has been developed and standardized.[34] Ayurveda guṇa 
+inventory has been developed and standardized.[35]
+The scale has been developed based on Sanskrit verses 
+quoted in nine texts and content validitation of 10 
+Ayurveda experts and three psychologists had three 
+subscales ‑ vāta (number of items in scale‑46), pitta (number 
+of items in scale‑44), kapha (number of items in scale‑47). It 
+was associated with good Cronbach’s alpha (above 0.5) and 
+the Split‑Half scores for all subscales (above 0.6 except pitta 
+scale which was 0.39). Factor validity coefficient Scores on 
+each items was above 0.5.
+However, a simple self ‑ rating scale to assess the personality 
+of children, (as parents are often not available during 
+personality development camps etc) according to Āyurvedic 
+comprehensive concepts is not available.
+Aims of the present study were
+(i)	
+
+To develop a self‑rating scale Caraka child personality 
+inventory (CCPI)
+(ii)	 
+To measure tridoṣas in children and to compare with 
+criterion ACPI, parent rating scale to establish of 
+validity of the scale.
+MATERIALS AND METHODS
+Ethical clearance was approved by research board of 
+SVYASA  (Yoga University). The CCPI was developed 
+based on 522 characteristics from nine authoritative ancient 
+Ayurveda texts in Sanskrit describing characteristics typical 
+of vātaja, pittaja and kaphaja prakṛti. Item reduction was 
+carried out by deleting the repeated items, ambiguous 
+items, and by selecting those items specifically suitable for 
+children [Table 1].
+155 items were shortlisted out of 522 in the texts and, 
+translation in English, were presented to ten Ayurveda 
+experts. They were asked to judge the correctness of each 
+statement and to check (1) whether any of the item was 
+repeated or if any item should be added? (2) Whether the 
+features of vātaja, pittaja and kaphaja prakṛti selected for the 
+scale are correct and (3) if the items constructed represented 
+acceptable translation of the Sanskrit in the original texts. 
+147 items were retained. Out of which, some of items were 
+changed and refined [Table 2].[36]
+Based on the final list of statements from the Sanskrit texts, 
+77 questions of CCPI were framed by the researcher. The 
+scale was again presented to five Ayurveda experts and 
+one psychologist, who reviewed the format of this scale 
+and recommended a two point scoring (zero and one), 
+this was adopted in the final CCPI. Suggestions about the 
+Table 1: Texts and number of items
+Text
+Vāta prakr
+. ti
+Pitta prakr
+. ti
+Kapha prakr
+. ti
+a
+b
+c d a
+b
+c d a
+b
+c d
+Caraka Sam
+. hitā
+28 1 (27) 1 2 21
+0
+2 5 21 0 (21) 6 1
+Suśruta sam
+. hitā
+25 13 (12) 2 0 21 8 (14) 3 0 28 7 (21) 3 1
+As
+.t
+.ān
+. ga samgraha
+25 16 (9) 3 0 26 19 (7) 0 0 40 19 (21) 3 0
+As
+.t
+.ān
+. ga hṛdaya
+24 20 (4) 2 1 31 26 (5) 1 1 43 38 (5) 4 0
+Bhela Sam
+. hitā
+16 11 (5) 3 0 18 10 (8) 1 0 24 14 (0) 8 0
+Bhāvaprakāśa
+8
+7 (1)
+0 0 8
+8 (0) 0 0 6
+6 (0)
+0 0
+Harita Sam
+. hitā
+16
+7 (9)
+2 0 16 9 (7) 0 0 16
+9 (7)
+4 0
+Śārangadhara Sam
+. hitā
+6
+6 (0)
+0 0 5
+5 (0) 0 0 5
+4 (1)
+1 0
+Kāśyapa Sam
+. hitā
+28 28 (0) 0 0 21 21 (0) 0 0 21 21 (0) 0 0
+Number of initial items (Sanskrit) collected from Nine Ayurveda texts with number 
+of repeated, ambiguous items and items not concerned with children. a: Initial 
+number of items, b: Repeated (retained) number if items, c: Ambiguous items, 
+d: Items not concerned with children
+Table 2: Content validity by experts
+Experts
+Comment
+1 (RH)
+Agreed all questions except 3,4,5 questions
+2 (AH)
+Agreed all questions
+3 (SUG)
+Agreed all questions 4,5 questions
+4 (RA)
+Agreed for all items except 10,11 questions
+5 (SHK)
+Agreed for all items except 11,12 questions
+6 (AAJ)
+Suggested changes in the format of questions
+RH: Raju H, AH: Ahalya, SUG: Suguna, RA: Ramesh A, SHK: Shekahr K, AAJ: 
+Arati Jaggannath
+[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82]
+	
+Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2
+87
+Suchitra and Nagendra: Self rating scale to asses prakr
+.ti
+phrasing of questions were incorporated. All questions 
+which were agreed upon by three to four Ayurveda experts 
+and psychologist, were retained.
+The final CCPI had 77 items ‑ 26 items for vātaja prakṛti 
+(A‑scale) 24 items for pittaja prakṛti (B‑scale) and 27 items 
+for kaphaja prakṛti (C‑scale) subscales. The questionnaire was 
+to be answered by the children (Appendix 2).
+Data collection and analysis
+Item difficulty level was analyzed by administering the 
+scale on 30 children on the age group 8‑12 years. Informed 
+consent of the children and parents was taken in prescribed 
+format (See Appendix‑3). For testing the internal consistency 
+and validity, the scale was administered on children who 
+were the students of New generation National Public school 
+in Bangalore, of both sexes between the age of 8 to 12 years 
+[Table 3].
+The final 77 item CCPI was administered on 200 children. 
+Ayurveda child personality inventory (ACPI), a parent 
+rating scale was administered on 30 parents of the children. 
+Comparison was done for the purpose of cross‑validation. 
+To assess Test‑retest reliability, CCPI was administered on 
+30 children, after an interval of 15 days.
+The Statistical Package for Social Sciences (SPSS‑16.0) was 
+used for data analysis. The data was analyzed for reliability. 
+The split‑half and Cronbach’s alpha tests were applied for 
+internal consistency analysis. Pearson’s correlation analysis 
+was done to check the degree of association between 
+vāta, pitta and kapha scores and Test and Retest reliability. 
+Principal component analysis (factor analysis) was done to 
+check the validity.
+RESULTS
+Content validity
+Amongst six experts, who served as judges all 77 questions 
+were agreed upon by four to five experts.[38]
+Item difficulty level
+This is defined as the presence of a said symptom expressed 
+as the percentage of children who score positive to that 
+item.[20‑22] The results obtained from the administration of 
+ACPI on parents of 60 children showed 136 items that had 
+a coefficient less than 0.9 (answered yes by the most) and 
+more than 0.3 (answered yes by the least number of subjects) 
+were retained.
+Internal consistency
+An analysis of the data collected from 200 children showed 
+the Cronbach’s alpha for V, P and K scales were 0.54, 0.64 
+and 0.64 respectively. The Split‑Half reliability for V, P and K 
+scale were 0.64, 0.60 and 0.66 respectively. This shows that 
+the three scales have acceptable internal consistency.[37,39]
+Test‑Retest reliability
+Scores on 30 Children revealed V, P and K scales have good 
+correlation, 0.87,0.88 and 0.89 respectively before and after 
+15 days of assessment.
+Correlations
+The subscales (Vāta, Pitta, Kapha) correlated significantly 
+(negatively) with each other [Table 4].
+Factor analysis
+Factor analytic co‑efficient obtained for each items in 
+the V‑scale, P‑scale, and K‑scale for total score was 
+more than 0.3. [Table 3].
+Correlation with ACPI –parent rating scale
+V, P, K subscales correlated significantly positively with V, 
+P, K scales of parent rating scale [Table 5].
+Table 3: Demographic data
+Sample
+Boys
+Girls
+Total
+Gender (boys)
+104
+96
+200
+Age range
+8‑12 years
+8‑12 years
+8‑12 years
+Mean±SD
+10.13±1.23
+10.0±1.18
+10.27±1.28
+Mean and standard deviation of demographics. Out of 200, children 104 were 
+boys, 96 were girls, aged around 8‑12 years. Mean age being 10.27. Studying in 
+3rd standard to 7th standard, mean education being 4.65. SD: Standard deviation
+Table 4: Correlation among subscales
+Scales
+Correlation
+Significance
+Vāta vs Pitta
+−0.31**
+P<0.01
+Vāta vs Kapha
+−0.49**
+P<0.01
+Pitta vs Kapha
+−0.66**
+P<0.01
+(**) r‑Pearson correlation values and significance of correlation between subscales 
+which is at 99% confidence level. Pitta highly negatively correlating with Kapha, 
+Vāta having less correlation with Pitta
+Table 5: Correlation with ACPI
+Vp vs Vc
+r=0.89**
+Pp vs Pc 
+r=0.85**
+Kp vs Kc 
+r=0.90**
+Pearson correlation (r) of each subscales of CCPI with subscales of parent rating 
+scale ACPI (**P<0.01). Vāta, Pitta, Kapha subscales of CCPI correlated highly 
+positively with Vāta, Pitta, Kapha subscales of ACPI (Parent rating scale)
+[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82]
+88 	
+Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2
+Suchitra and Nagendra: Self rating scale to asses prakr
+.ti
+DISCUSSION
+The present study has described the development and 
+initial standardization of 77 items, self‑ rating, the CCPI 
+as an instrument to assess the personality (prakṛti) of the 
+children.
+The reliability of subscales was substantiated by Cronbach’s 
+Alpha co‑efficient ranged from 0.54 to 0.64 and Split‑half 
+analysis ranging from 0.60 to 0.66. This provided the 
+evidence of homogeneity of items.[40]
+For the ACPI (a parent rating scale to assess the prakṛti of 
+the children of the age group 6‑12 years), Cronach’s alpha 
+ranged from 0.55 to 0.84, spilt‑half coefficient ranged from 
+0.39 to 0.84. The construct validity of items of subscales was 
+supported by Factor –analysis which was done to check the 
+association of the items with subscales. Factor loadings for 
+Vāta scale ranged from 0.41‑0.7, for pitta scale 0.47 ‑0.72, for 
+kapha scale 0.41‑0.76 Appendix‑1.While of ACPI, 0.55‑0.86, 
+0.55‑0.78, 0.46‑0.77 respectively for vāta, pitta and kapha 
+scales. This proved to be a good correlation of items with 
+respective subscales.
+Correlation between vātaja, pittaja and kaphaja scale 
+scores was negative, suggesting discriminative validity. 
+Values ranging from 0.31 to 0.66, significance at 99% 
+confidence for all correlations. Although of ACPI was 
+0.16 to 0.82, significance for vāta‑ pitta correlation was at 
+95% confidence.
+Correlation with parent rating scale provided evidence 
+of concurrent validity. Classical texts of Ayurveda state 
+that when vāta and kapha (cold) increases, pitta decreases., 
+similarly when vāta decreases kapha increases.
+Applying the inventory to children, further helped to 
+measure the prakṛti of the children. Among selected 
+sample 27% were vāta‑pitta, 27%were pitta‑kapha, 
+33% were vāta‑kapha, 9% were kapha, 2%were sama, 2% were 
+pitta [Table 6].
+Changes in scores were observed between boys and 
+girls [Table 7]. Most girls scored high in kapha, vāta‑kapha 
+and pitta‑kapha prakṛti scales. Similarly Boys scored high in 
+pitta, vāta‑pitta prakṛti scales. Boys score was high in Pitta 
+indicating high aggressiveness and Girls scores were high 
+in Kapha indicating higher patience.
+Subscales of CCPI correlated highly (‘r’above 0.8), positively 
+with subscales of ACPI, parent rating scale  [Table  5], 
+suggesting criterion related validity.
+The difference in the results of self‑rating and parent‑rating 
+scales, may be because of discrepancy in types of prakṛti 
+of children, which was different in parent rating scale 
+study and self‑rating study, as both inventories were 
+administered in different schools, and variance in 
+ 
+race was observed [Ayurveda texts claim that prakṛti can be 
+influenced by race/ethnicity].[3]
+The Strength of the study is that it is the first attempt to 
+develop a consistent, self –rating scale to measure prakṛti of 
+the children. Knowing one’s prakṛti is the first step towards 
+maintaining one’s health.[1‑9] A  balanced state of three 
+doṣas is considered as health.[4] A tool as developed in this 
+study will be useful in assessing the clinical significance of 
+prakṛti based regimen in prevention of somatic and mental 
+illnesses.
+Though published scales are available to assess the 
+prakṛti of an individual,[11] they have been designed 
+for adultswhereas children require a different mode of 
+questioning. Hence, CCPI can be potentially used to 
+identify the predominant doṣas in children, and thus will 
+help to plan suitable regimens at an early age to maintain 
+health of the children.
+A study has revealed significant effect of Yoga on 
+tridoṣas.[32] And treatment modalities are different for 
+Table 7: Mean differences between Boys and Girls
+Sample
+Vāta
+Pitta
+Kapha
+Boys
+11.3
+11.8*
+11.8
+Girls
+11.2
+10.0
+13.6*
+Mean scores of Boys and Girls in each subscales. Showing high scores on kapha 
+in girls (13.6, for boys it is 11.8), high scores on pitta in Boys (11.8, for girls it is 
+10.0). Changes were significant P<0.05 (One sample t‑test). *P<0.001
+Table 6: Mean dos
+.a scores for three different diagnostic groups
+Doṣa→
+Diagnosis↓
+Vātaja
+Pittaja
+kaphaja
+Vāta‑pitta (n=17)
+14.3
+13.8
+7.0
+Pitta‑kapha
+7.1
+13.5
+14.9
+Vāta‑Kapha
+13.6
+7.0
+14.4
+Kapha
+7.0
+7.1
+20.8
+Pitta
+7.0
+20.7
+7.2
+Sama
+11.4
+11.5
+12
+Distribution of different categories of prakṛti children (who particularly scored high 
+in one or two subscales) sample scores in each subscales.Children scoring high 
+in Vāta‑Pitta scored 14.3 and 13.8 in respective Vāta‑Pitta scales., who scored 
+high in Pitta‑Kapha scored 13.5 amd 14.9 in respective scales and who scored 
+high in Vāta‑kapha scored 13.6 and 14.4 in respective scales. And who were 
+predominant in single dosahs, scored 20.8 (kapha prakṛti) ,20.7 (Pitta prakṛti) in 
+respective scales. Who were of sama prakṛti scored 11.4,11.5,12 in vāta, pitta, 
+kapha scales respectively
+[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82]
+	
+Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2
+89
+Suchitra and Nagendra: Self rating scale to asses prakr
+.ti
+different prakṛti.[1‑9] Thus, the study is a initial step towards 
+positive health.
+Limitations of the study: Though CCPI is a consistent, 
+valid instrument, it has not addressed the  norms of the 
+scale. Further studies are needed to confirm whether the 
+items used in the inventory are sensitive enough to assess 
+prakr
+.ti with predominance of a particular doṣa. Studies 
+should be done on more number of samples and norms 
+should be established.
+CONCLUSIONS
+A CCPI is a consistent and valid instrument. Its reliability 
+to assess the prakṛti should be further studied. Tridoṣa 
+measure may point out to diet and regimen plans 
+management to prevent the disease and maintain the 
+health of the children.
+ACKNOWLEDGMENT
+We thank, Dr.Kishore, Dr. Aarti Jagannathan, Dr.Uma and 
+Āyurveda experts in Hubli, Bengaluru Ayurveda College, for their 
+support and participation in the study.
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+Suchitra and Nagendra: Self rating scale to asses prakr
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+Address for correspondence:
+S.P
+. Suchitra, 
+Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Eknath 
+Bhavan, No.19, Gavipuram Circle, Kempegowda Nagar,  
+Bangalore - 560 019, India. 
+E-mail: [email protected]
+How to cite this article: Suchitra SP, Nagendra HR. A self-rating scale 
+to measure tridos
+.as in children. Ancient Sci Life 2013;33:85-91.
+Source of Support: Nil. Conflict of Interest: None declared.
+Table 1: Factor analytic coefficients of each item
+Vāta
+Loadings
+Pitta
+Loadings
+Kapha
+Loadings
+v1
+0.665
+p1
+0.698
+k1
+0.616
+v2
+0.575
+p2
+0.727
+k2
+0.618
+v3
+0.566
+p3
+0.574
+k3
+0.679
+v4
+0.553
+p4
+0.607
+k4
+0.646
+v5
+0.580
+p5
+0.837
+k5
+0.510
+v6
+0.608
+p6
+0.673
+k6
+0.567
+v7
+0.614
+p7
+0.520
+k7
+0.414
+v8
+0.417
+p8
+0.447
+k8
+0.612
+v9
+0.490
+p9
+0.528
+k9
+0.764
+v10
+0.578
+p10
+0.423
+k10
+0.693
+v11
+0.443
+p11
+0.617
+k11
+0.536
+v12
+0.631
+p12
+0.555
+k12
+0.628
+v13
+0.540
+p13
+0.590
+k13
+0.521
+v14
+0.550
+p14
+0.565
+k14
+0.625
+v15
+0.453
+p15
+0.559
+k15
+0.529
+v16
+0.589
+p16
+0.586
+k16
+0.764
+v17
+0.548
+p17
+0.615
+k17
+0.600
+v18
+0.569
+p18
+0.740
+k18
+0.602
+v19
+0.580
+p19
+0.704
+k19
+0.646
+v20
+0.476
+p20
+0.781
+k20
+0.605
+v21
+0.651
+p21
+0.644
+k21
+0.581
+v22
+0.573
+p22
+0.638
+k22
+0.582
+v23
+0.713
+p23
+0.471
+k23
+0.608
+v24
+0.587
+p24
+0.491
+k24
+0.596
+v25
+0.540
+k25
+0.680
+v26
+0.635
+k26
+0.421
+k27
+0.579
+Factor loadings‑correlations of each item with respective subsales
+APPENDIX‑1
+APPENDIX ‑2
+Caraka child personality inventory
+For children
+Instructions: There is no right or wrong answer. Select the 
+appropriate answer suitable to you and give explanation where 
+necessary
+A‑scale
+1
+I get skin problems easily
+Yes/No
+2
+I am thin
+Yes/No
+3
+Green lines (veins) are visible over 
+my arm than others
+Yes/No
+4
+My hair is rough and split
+Yes/No
+5
+Usually I hear some sound in my 
+knee while walking
+Yes/No
+6
+My nails grow faster than others
+Yes/No
+7
+Time taken by me to button my 
+cloth usually is
+_____
+8
+I eat food fast
+Yes/No
+9
+I eat _____ and _____ for 
+my breakfast (tell how much 
+also) (e.g.: 2 idlis, 2 dosa etc.)
+10
+I get tired easily during exercise
+Yes/No
+11
+I usually wake‑up in between sleep
+Yes/No
+12
+I usually talk in low pitch
+Yes/No
+13
+I can understand, what teacher 
+teaches faster than others
+Yes/No
+14
+I usually forget the issues faster 
+than others
+Yes/No
+15
+I have some plans for this year
+Yes/No 
+16
+Sometimes I like my relatives, 
+sometimes not
+Yes/No
+17
+If a classmate doesn’t behave 
+properly with me
+I will be silent/I will also 
+behave badly with him
+18
+When my parents ask me to stop 
+watching television do, I do it 
+immediately
+Yes/No
+19
+If my brother/sister/friend are 
+praised in front of me
+I beat them/I will 
+become concerned 
+unhappy/I am not much
+20
+I usually finish my home‑work, 
+before playing
+Yes/No
+contd...
+[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82]
+	
+Ancient Science of Life / Oct-Dec 2013 / Vol 33 / Issue 2
+91
+Suchitra and Nagendra: Self rating scale to asses prakr
+.ti
+APPENDIX ‑3
+Format of Informed consent
+I have been informed completely about the scale which is 
+about to measure the personality of My Son/Daughter……
+………………….I am agreeing completely for the analysis 
+of His/Her personality.
+Signature of the parent/Guardian
+Appendix ‑2: Contd...
+21
+I usually don’t think much about 
+person who have helped me
+Yes/No
+22
+I usually don’t like to make new 
+friends
+Yes/No
+23
+I like hard chapatti, bread much
+Yes/No
+24
+I like hot drinks much
+Yes/No
+25
+I can give stage performance easily
+Yes/No
+26
+I bite my teeth when not allowed 
+to do what I like to do
+Yes/No
+B‑scale
+1
+I get body pain after heavy exercise
+Yes/No
+2
+My body color is‑brown
+Yes/No
+3
+I usually have bad – breath
+Yes/No
+4
+Color of my eyes is brown
+Yes/No
+5
+Color of my nails is pink
+Yes/No
+6
+Color of my lips is pink
+Yes/No
+7
+I have small, brown eye‑lashes
+Yes/No
+8
+Color of my hair is brown
+Yes/No
+9
+I feel hungry in every
+______hours
+10
+Time taken for taking bath by me is
+______
+11
+I eat _____ and _____ for 
+lunch (tell how much also) 
+(e.g.,‑2 chapatis, one bowl rice etc.)
+12
+I drinks more water than others
+Yes/No
+13
+I sweat a lot compared to others
+Yes/No
+14
+I go for urine often
+Yes/No
+15
+I usually get prizes in sports
+Yes/No
+16
+I usually get head‑ache, eye‑pain if 
+I read for longer duration
+Yes/No
+17
+I change my decisions easily
+Yes/No
+18
+I can learn new subjects easily
+Yes/No
+19
+I usually get ______ grade in tests
+Yes/No
+20
+I usually admit my mistakes
+Yes/No
+21
+When my sister/brother/friend are 
+paid more attention in front of me
+I get angry/I want to 
+behave such a way, 
+parents pay attention 
+to me
+22
+My health gets upset when I eat 
+excessive sour taste foods
+Yes/No
+23
+I like cold drinks a lot
+Yes/No
+24
+My anger comes down quickly
+Yes/No
+C‑scale
+1
+I get leg and arm pain often
+Yes/No
+2
+I am liked by some friends/all friends
+3
+My body color is bright white
+Yes/No
+Appendix ‑2: Contd...
+4
+My eyes are big
+Yes/No
+5
+My hair is curly and thick
+Yes/No
+6
+My chest is wider comparatively
+Yes/No
+7
+My forehead is bigger
+Yes/No
+8
+My eye‑brows are big
+Yes/No
+9
+I usually take _____ minutes to 
+wear a dress
+10
+I eat food slowly
+Yes/No
+11
+I sweat less than others
+Yes/No
+12
+I will not get tired after exercise 
+for longer time
+Yes/No
+13
+I can wait, if food is delayed 
+sometimes
+Yes/No
+14
+I usually sleep good for longer time
+Yes/No
+15
+When my brother/sister/cousin 
+quarrels with me
+I also want to quarrel/I 
+want to keep quite
+16
+I usually talk in loud voice
+Yes/No
+17
+I usually get adjusted to new 
+school easily
+Yes/No
+18
+I usually can remember issues 
+happened years back as it is
+Yes/No
+19
+When my friend/classmate helps me
+I feel very thankful/I 
+want to remember for 
+always
+20
+I remember the scolding of my 
+parents a lot
+Yes/No
+21
+I want to give money to the beggars
+Yes/N
+22
+I like spicy foods
+Yes/No
+23
+I like to share my things with my 
+brother/sister
+Yes/No
+24
+I can withstand/tolerate pain
+Yes/No
+25
+I want to become ______ in my life
+26
+I like to serve my guests
+Yes/No
+27
+If my parents give money to me I 
+want to spend on:
+____
+contd...
+[Downloaded free from http://www.ancientscienceoflife.org on Wednesday, July 27, 2016, IP: 14.139.155.82]

yogatexts/A statistical model for quantification of Panchakośas of large collective entities.txt

@@ -0,0 +1,3987 @@
+74
+© 2018 International Journal of Yoga - Philosophy, Psychology and Parapsychology | Published by Wolters Kluwer - Medknow
+A Statistical Model for Quantification of Panchakośas of Large 
+Collective Entities
+Bhalachadra Laxmanrao Tembe, Promila Choudhary1, H R Nagendra1
+Access this article online
+Quick Response Code:
+Website: www.ijoyppp.org
+DOI: 10.4103/ijny.ijoyppp_16_17
+Address for correspondence: Dr. Bhalachadra Laxmanrao Tembe, 
+Indian Institute of Technology Bombay, Mumbai ‑ 400 076, 
+Maharashtra, India. 
+ 
+E‑mail: [email protected]
+and meanings for the kośas in these different entities. 
+Although there could be multiple sets of definitions of 
+these kośas, the effort would be all the same worthwhile, 
+particularly if such a definition could provide a means 
+for healing these sheaths in these units.
+The first step would be to define the five kośas for 
+families. Since human beings are strongly interacting 
+systems, the manomaya kośa of a family is unlikely to 
+be a linear combination of the manomaya kośas for the 
+individual members of the family. In addition, in children 
+Original Article
+Introduction
+T
+he panchakośa viveka that has been formalized in 
+the Taittiriya Upaniśad[1] provides a way to classify 
+a human being into five interrelated sheaths. Such a 
+classification helps in studying these sheaths individually 
+as well as jointly and has also provided a basis for 
+therapy[2‑5] for curing individuals, in whom these sheaths 
+are not functioning in an optimal manner. These five 
+sheaths are developed differently in different individuals. 
+It is natural to expect that an analogous classification will 
+be useful to study different units in societies, such as a 
+family and communities in villages and cities, and this 
+could be extended to countries as well as the whole world.
+Such an extension of the concept of kośa  (sheaths) to 
+different units will require reasonable to good definitions 
+Department of Chemistry, 
+Indian Institute of 
+Technology Bombay, 
+Mumbai, Maharashtra, 
+1Directorate of Distance 
+Education, SVYASA 
+University, Bengaluru, 
+Karnataka, India
+How to cite this article: Tembe BL, Choudhary P, Nagendra HR. 
+A statistical model for quantification of Panchakośas of large collective 
+entities. Int J Yoga - Philosop Psychol Parapsychol 2018;6:74-93.
+This is an open access journal, and articles are distributed under the terms of the 
+Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows 
+others to remix, tweak, and build upon the work non-commercially, as long as 
+appropriate credit is given and the new creations are licensed under the identical terms.
+For reprints contact: [email protected]
+There are several ways of assessing the well‑being of individuals as well as 
+a collection of individuals. The panchakośa model is an evolved model for 
+analyzing the well‑being of individuals. For large collections of individuals 
+such as nations, several ways are available for estimating the gross national 
+happiness indices. In the present article, quantification of the five sheaths or the 
+panchakośa of large collections of individuals is outlined. Methodology: The 
+methodology uses large sets of data available from reliable sources such as World 
+Development Indicators reports as well as the United Nations Organization data. 
+Different characteristics of nations and its people are used as parameters for 
+quantifying the five kośas of collective entities and these are rescaled so that a 
+numerical estimate is made on a scale of 0–100 for each kośa. Results: The data 
+for the five kośas can be combined to get an effective quantitative measure of 
+happiness or well‑being of a nation. The happiness levels in different kośas for 
+24 countries from different continents are estimated by a simple weighted average 
+or a statistical method using 41 parameters. The results show a fair amount of 
+ruggedness after the number of parameters increases beyond about 5 or 6 for 
+each kośa. Conclusions: This Panchakośa Model of Happiness‑I appears to be a 
+fairly systematic way of analyzing the happiness levels in different kośas and can 
+be used as a basis for a healthy model of development and interactions of large 
+collective entities such as nations.
+Keywords: Collective panchakośas, happiness levels, normalized parameters, 
+quantification
+Abstract
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+75
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+aged 0–15  years, these kośas are generally not fully 
+developed. To develop and characterize the kośas of the 
+families, one needs to collect the data of several family 
+members and this is an arduous task. Similar argument 
+will apply to a cooperative society or a village or a city. 
+While modern family counseling services contribute 
+toward solving problems in families, the elders in joint 
+families in the past and the village elders in ancient 
+and even recent times continue to provide valuable 
+suggestions to maintain healthy manomaya kośas of 
+families and villages.
+If we turn our attention to a group of persons in very 
+large numbers such as the states of a country or countries 
+themselves, we can use the methods of statistics to come 
+up with a suitable definition of the five kośas of countries. 
+A recent mathematical definition of happiness[6,7] and the 
+metric developed for gross national happiness (GNH)[8,9] 
+can provide suitable guidelines to provide definitions 
+for different kośas of collective entities such as nations. 
+Possible steps toward this approach are outlined below. 
+Such a definition for families too will certainly be useful.
+• Annamaya kośa: An estimate for this kośa may be 
+derived using the following data: Available land and 
+water resources, agricultural area, gross domestic 
+product (GDP), gross national product (GNP), road, 
+rail, water, and air connectivity.[10‑19] The proposed 
+method will be normalized to the population.
+• Prānamaya kośa: Life expectancy, employment 
+levels, deaths caused by cancer and AIDS, the 
+number of doctors available, internet and mobile 
+connectivity, etc.[20‑36]
+• Manomaya kośa: Mental health status of the country, 
+crime and insurgency levels, corruption levels, strikes 
+and agitations, suicide levels, divorce levels, smoking 
+and drug related problems, number of professional 
+counseling centers, psychiatric centers, number of 
+jailed persons.[37‑43]
+• Vijyānamaya kośa: Literacy, educational institutions 
+at 
+various 
+levels, 
+index 
+of 
+entrepreneurship, 
+effectiveness of legal systems, research institutions, 
+research publications, conferences and workshops, 
+effectiveness in legislations.[44‑49]
+• Ānandamaya kośa: GNH, levels of charity, and social 
+work.[50‑52] This is a difficult kośa to measure as 
+Bhrigu relates this kośa to a state of bliss. The closest 
+measures are taken from different approaches of 
+happiness in societies including the social measures 
+and the Cantril ladder.[53‑66] These include the ideas 
+of happiness in education,[61] the Sach’s happiness 
+report,[62] quality‑of‑life research,[64] quality‑of‑life 
+scale reliability,[65] and sensitivity of subjective 
+well‑being measures.[66]
+After developing an index system, it will be applied to the 
+following nations: India, Pakistan, China, Japan, Bhutan, 
+Singapore  (Asia), United  Kingdom  (UK), Sweden, the 
+Netherlands, Romania, Greece, Russia  (Europe), the 
+United States of America  (USA), Brazil, Mexico, Chile, 
+Nicaragua  (America), Egypt, Nigeria, Ethiopia, Yemen, 
+Niger, Namibia  (Africa) and Australia. It would be 
+interesting to compare the countries which have similar 
+economies. It will also be interesting to explore the role if 
+any of the basic differences of religion, spirituality, and the 
+political economy of these countries has an impact on the 
+differences in the happiness parameters of these nations.
+Most planning models of growth of nations do not 
+include spiritual levels  (levels of happiness) in their 
+conceptualization or implementation. This leads to 
+societies or nations where happiness levels do not increase 
+in spite of exceptional technological levels. A study such 
+as the proposed one could help in a complementary or a 
+supportive manner toward the well‑being of a nation in a 
+manner similar to how an Integrated Approach to Yoga 
+Therapy  (IAYT)[2‑5] is having an impact on the health 
+of individuals. The methodology of the present work is 
+given in the next section. Data and results are given in the 
+results and discussion section, followed by conclusions.
+Methodology
+The subject of happiness is subtle, difficult, as well 
+as elusive. The concept of happiness has evolved 
+over time, right from the Vedic period as well as 
+from the time of Aristotle. The notion of happiness 
+as activity, virtue, satisfaction of desire, pleasure 
+(Eudaemonism vs. Hedonism), fortune, stoic nature, 
+duty, transcendence, utilitarianism, self‑realization, and 
+supreme good has evolved over time, and a perfect 
+definition has not been arrived at.[55] The conventional 
+economic approach took monetary and physical 
+income as the most important indicator for well‑being. 
+This has serious limitations. The capability approach 
+to well‑being has been developed by Amartya Sen 
+and Martha Nussbaum, and the happiness approach 
+to well‑being has been championed by Richard 
+Easterlin’s aim to overcome the conventional economic 
+approaches.[56] Even the methods of education as well 
+as therapy, whose primary aim is to increase the overall 
+happiness in a society, do get questioned from time to 
+time.[57] Even more challenging is the task to define 
+a quantitative scale for happiness. This too has been 
+discussed for a long time in literature. A  lot of effort 
+across all the continents has been invested in arriving 
+at a scale. We shall mention only representative efforts 
+in this area. These will also help us in setting up a 
+statistical model.
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+76
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+There are significant differences between the happiness 
+in ānandamaya kośa and the happiness that is 
+understood in common practice. The ānandamaya kośa 
+mentioned in the Taittiriya Upaniśad goes well beyond 
+the manomaya and vijyānamaya kośas; it is thought to 
+be a dominantly subjective experience, approaching 
+bliss, intuitive harmony, and peace[58] and is not easy to 
+measure. However, as a first approximation, we shall 
+adopt a measure obtained from the common measures of 
+happiness and extend it to our statistical model.
+Among several models that are available in literature, we 
+choose two statistical models. One is an experimental 
+definition of happiness which has been recently verified 
+by functional nuclear magnetic resonance measurements[6] 
+and which is based on the subjective response to rewards. 
+We refer this model as a Computational Model‑I (CM‑I). 
+The other is the GNH Index for happiness defined in the 
+studies in Bhutan.[8] We refer this second model as Survey 
+Model‑I (SM‑I). In the work presented here, we construct 
+a model based on the panchakośa analysis. We refer this 
+model as a panchakośa Model of Happiness‑I (PKMH‑I).
+CM‑I analyzes happiness as a subjective response to 
+rewards, such as money that might elicit affective and 
+motivational responses.[6] The behavioral findings were 
+based on two laboratory‑based behavioral experiments as 
+well as a large‑scale smartphone‑based experiment. The 
+relationship between reward‑related task events, neural 
+responses to those events, and subjective well‑being 
+was also probed by functional magnetic resonance 
+imaging  (fMRI). fMRI is used to trace task‑dependent 
+neural activity in the ventral striatum of the brain, a 
+major projection site for dopamine neurons, correlated 
+with subsequent reports of subjective well‑being.
+By repeatedly asking participants to report on their 
+subjective emotional state, their feelings can be related 
+to antecedent life events including rewards. The subjects 
+were asked to perform a probabilistic reward task, in 
+which they are asked to choose between certain and 
+risky monetary options. After every few trials, they were 
+asked the question, “How happy are you right now?” 
+Such an approach is expected to elicit rapid changes in 
+affective state. Similarly, experience sampling adapted 
+to laboratory and fMRI settings was also used for 
+corroboration of data obtained from questionnaires in 
+a survey using mobile response data. The experiential 
+sampling questions make no reference to past events and 
+concern the present overall subjective emotional states.
+From brain responses to rewards, it is known 
+that midbrain dopamine neurons represent reward 
+prediction error  (RPE) signals in animals and humans. 
+Neuroimaging studies report the correlations of RPEs 
+in the ventral striatum. This is an area of the brain 
+that is a target for dopamine projections, in tasks from 
+reinforcement learning to gambling. Many studies have 
+also related subjective feelings about discrete events 
+to neural activity. The behavioral data on a sample 
+of 21–26 persons were fitted using a CM inspired 
+by models of dopamine function. It was shown that 
+momentary subjective well‑being is explained not by 
+task earnings but by the cumulative influence of recent 
+reward expectations and prediction errors, resulting 
+from those expectations. Temporal difference errors that 
+dopamine neurons are thought to represent are closely 
+related to these quantities. In the first case, the happiness 
+at time t is fitted by the following model.[6]
+Happiness (t) = w0 + w1 Σj γt‑j CRj + w2 Σj γt‑j EVj + w3 
+Σj γt‑j RPEj
+where CRj refers to certain rewards, EVj refers to expected 
+values or outcomes and RPEj refers to reward prediction 
+error  (differences between experienced and predicted 
+rewards). The summation is for j going from 1 to t. All the 
+coefficients w0, w1, w2, and w3 turned out to be positive. 
+All the gammas  (γt‑j) are forgetting factors which are all 
+positive and these decay exponentially as one goes back 
+further to earlier events. The weights for EVs were smaller 
+than the weights for RPEs. One advantage of CM‑I is that 
+it is based on experimentally measurable data and also 
+data based on surveys (a smartphone‑based platform: The 
+Great Brain Experiment, www.thegreatbrainexperiment.
+com; for iOS  [Apple] and Android  [Google] systems). 
+The sample consisted of 18,420 anonymous unpaid 
+participants who made over  200,000 happiness ratings.  
+However, experiments which require highly sophisticated 
+equipment  (such as fMRI) and also huge surveys are 
+prohibitively expensive and cannot be readily extended 
+to other samples.
+In the GNH model used in Bhutan which is referred 
+here as SM‑I, a comprehensive study was undertaken 
+using 124 variables grouped into nine equally weighted 
+domains to define an index of happiness.[8]
+A quantitative GNH value has been proposed to be an 
+index function of the total average per capita of the 
+following nine measures:
+1. Economic wellness or living standard indicated via 
+direct survey and statistical measurement of economic 
+metrics such as consumer debt, average income to 
+consumer price index ratio, and income distribution
+2. Environmental wellness or ecological resilience 
+indicated 
+via 
+direct 
+survey 
+and 
+statistical 
+measurement of environmental metrics such as 
+pollution, noise, and traffic
+3. Physical wellness or health indicated via statistical 
+measurement of physical health metrics such as 
+severe illnesses
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+77
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+4. Mental 
+wellness 
+or 
+psychological 
+well‑being 
+indicated 
+via 
+direct 
+survey 
+and 
+statistical 
+measurement of mental health metrics such as 
+usage of antidepressants and rise or decline of 
+psychotherapy patients
+5. Workplace wellness  (time use) indicated via direct 
+survey and statistical measurement of labor metrics 
+such as jobless claims, job change, workplace 
+complaints, and lawsuits
+6. Social wellness or community vitality indicated via 
+direct survey and statistical measurement of social 
+metrics such as discrimination, safety, divorce rates, 
+complaints of domestic conflicts and family lawsuits, 
+public lawsuits, crime rates
+7. Political wellness or good governance indicated via 
+direct survey and statistical measurement of political 
+metrics such as the quality of local democracy, 
+individual freedom, and foreign conflicts
+8. Education 
+indicated 
+via 
+literacy, 
+schooling, 
+knowledge
+9. Cultural diversity indicated via customs in societies, 
+values, sports, drama, and films.
+The above nine domains were built from 124 variables 
+which constitute the basic building blocks of GNH. 
+These variables could be packed into 33 clusters, but 
+the important feature is that subjective variables had 
+smaller weights. A  threshold or sufficiency level was 
+attached to each variable. The population was finally 
+categorized into deeply happy  (77% level sufficiency), 
+extensively 
+happy 
+(66%–76% 
+level 
+sufficiency), 
+narrowly happy  (50%–65% level sufficiency), and 
+unhappy  (<50% level of sufficiency). Furthermore, it is 
+to be noted that one needs to score equally high points 
+in all the domains to be happy. Using a complementary 
+matrix of sufficiency indices and the normalized weights 
+for each of the factors, a GNH index has been defined. 
+The concept of multidimensional poverty of  Alkire and 
+Foster[60] has also been used in defining the GNH.
+The weights of 33 variables, i.e.  weights of different 
+variables in nine domains in the GNH model of Bhutan, 
+are depicted in Table 1 .
+The method of estimating the GNH placed the data 
+collected from people from different districts and age 
+groups into a matrix form. The main data matrix M is 
+an n  ×  d matrix with rows, i ranging from 1 to n. The 
+rows i refer to individuals and columns j ranging from 1 
+to d refer to different dimensions of achievements. Rows 
+represent individuals and columns represent achievements 
+in dimensions. To obtain a GNH, one needs a set of 
+criteria for the range of sufficiency (adequateness) of the 
+parameter to be placed into different levels of happiness. 
+If the element Mij is less than some critical value Zj for 
+a given column  (predefined), then a depravation matrix 
+G is defined, whose element Gij is 1 if Mij < Zj. Nonzero 
+values of depravation matrix indicate depravation. For 
+each of the d dimensions, weighting factors are applied 
+such that the sum of weights Wj  =  1. By summing the 
+weighted columns, the depravation for the dimension is 
+obtained. Let us call the depravation row vector as D. 
+If this is subtracted from the unit row vector U, U − D 
+gives the GNH row vector, which can be normalized and 
+summed to get the GNH index. Details of the indices 
+are given in the Bhutan report.[8]
+As we mentioned, ours is a modeling study wherein the 
+data are collected from different sources, particularly 
+the sites of the United  Nations Organization and the 
+World Development Indices/Indicators of the World 
+Bank. From these data, statistical methods are used for 
+Table 1: Weights of different variables in nine domains 
+in the gross national happiness model of Bhutan
+Domain
+Indicators
+Weight (%)
+Psychological 
+well‑being
+Life satisfaction
+33
+Positive emotions
+17
+Negative emotions
+17
+Spirituality
+33
+Health
+Self‑reported health
+10
+Healthy days
+30
+Disability
+30
+Mental health
+30
+Time use
+Work
+50
+Sleep
+50
+Education
+Literacy
+30
+Schooling
+30
+Knowledge
+20
+Value
+20
+Cultural 
+diversity and 
+resilience
+Zorig chusum skills (skills in arts and 
+crafts)
+30
+Cultural participation
+30
+Speak native language
+20
+Driglam Namzha (the way of harmony)
+20
+Good 
+governance
+Political participation
+40
+Services
+40
+Governance participation
+10
+Fundamental rights
+10
+Community 
+vitality
+Donation (time and money)
+30
+Safety
+30
+Community relationship
+20
+Family
+20
+Ecological 
+diversity and 
+resilience
+Wildlife damage
+40
+Urban issues
+40
+Responsibility toward environment
+10
+Ecological issues
+10
+Living 
+standard
+Per capita income
+34
+Assets
+33
+Housing
+33
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+78
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+converting them into suitable normalized parameters 
+in the range of 0–100 for each kośa. The subjects 
+used herein include all the members in the country for 
+analysis purposes. A  plan of computing the happiness 
+of the PKMH‑I is outlined below. Since the collected 
+data are based on statistical reports, the chances of 
+subjectivity are considerably reduced and equal weights 
+may be assigned to each of the parameters of the present 
+study. If we choose to define a scale of 0–100, the 
+PKMH‑I may be defined as:
+PKMH‑I for a kośa = Σ wi yi,
+where 
+wi 
+is 
+the 
+weight 
+of 
+the 
+parameter 
+(in fraction or percentage) and yi is the normalized 
+statistical measure of the parameter (in the range of 0–1 
+or from 0% to 100%). We will compute an overall score, 
+but individual kośa scores will be more informative.
+Since our model is a statistical method, the required data 
+are collected from a wide range of sites and from recent 
+reported literature. While there could be some uncertainties 
+and minor variations in the data from different sources, 
+these data will certainly help us to come up with a 
+quantitative model which can be improved by additional 
+checks on the self‑consistency of the data. The application 
+of the method across more than one calendar or financial 
+year and extending to other countries can be explored later.
+In our proposed model PKMH‑I, we are using N (presently 
+41) variables that are presumed to be independent. 
+Although there are a few residual dependences among 
+these variables, we test for the impact of these by 
+randomly removing, say 10% of the variables and noting 
+their impact on the final results. The robustness of a 
+statistical model is known to increase when the number 
+of variables contributing to the model increases. The N 
+variables are redistributed into different kośas by taking 
+n1 parameters or variables for the annamaya kośa, n2 
+for the prānamaya kośa, n3 variables for the manomaya 
+kośa, n4 for the vijyānamaya kośa, and n5 variables for the 
+ānandamaya kośa. Of course, N = n1 + n2 + n3 + n4 + n5.
+The rationale is based on extending the ideas relevant 
+to the kośa of a given individual to large collections 
+of individuals. Prānamaya kośa for an individual 
+refers to the human body, the intake of food, clothing, 
+and shelter.[54] For a large collection, this kośa will 
+consider the total food available for the nation; the total 
+Table 2: Annamaya kośa parameters
+Country
+A1
+A2
+A3
+A4
+A5
+A6
+A7
+A8
+A9
+A10
+A11
+A12
+China
+9,572,900.0
+54.8
+1.4
+49.0
+3603.0
+9.4
+4660.0
+112.0
+645.0
+2.6
+3.8
+1,368,999,940.0
+India
+3,166,414.0
+60.3
+9.6
+91.0
+1150.0
+48.0
+4865.0
+65.0
+1083.0
+78.0
+0.9
+1,267,000,060.0
+Pakistan
+881,912.0
+35.1
+2.9
+91.0
+833.0
+45.0
+262.0
+7.0
+494.0
+9.0
+0.6
+181,000,000.0
+Bhutan
+38,394.0
+13.6
+0.2
+53.0
+1847.0
+33.6
+10.0
+0.0
+2220.0
+0.0
+1.8
+575,000.00
+Singapore
+718.0
+7.2
+3.0
+1.0
+36,525.0
+4.4
+3.4
+0.2
+2300.0
+0.0
+2.7
+5,540,000.00
+Japan
+337,930.0
+12.5
+3.5
+0.5
+38,890.0
+8.3
+1215.0
+27.0
+1650.0
+0.0
+13.7
+128,000,000.0
+UK
+242,900.0
+71.0
+8.9
+0.1
+39,883.0
+3.9
+394.0
+17.0
+1220.0
+0.1
+3.0
+64,000,000.0
+Sweden
+450,295.0
+7.5
+8.9
+0.1
+47,097.0
+1.0
+580.0
+9.9
+624.0
+0.1
+2.7
+9,753,000.00
+Netherlands
+41,850.0
+55.6
+18.4
+0.1
+42,984.0
+1.8
+139.0
+3.0
+778.0
+0.0
+4.7
+16,909,000.0
+Romania
+238,391.0
+59.0
+3.6
+18.3
+5685.0
+12.8
+84.1
+13.6
+637.0
+0.0
+6.3
+19,942,000.0
+Greece
+131,990.0
+63.4
+1.0
+15.0
+18,358.0
+10.0
+116.0
+2.5
+652.0
+1.0
+4.9
+10,816,000.0
+Russia
+17,098,242.0
+13.1
+4.4
+12.7
+6599.0
+8.0
+1396.0
+86.0
+460.0
+5.0
+9.7
+143,000,000.0
+USA
+9,526,468.0
+44.7
+4.6
+0.1
+46,393.0
+2.1
+6587.0
+225.0
+715.0
+6.3
+3.0
+318,000,000.0
+Brazil
+8,515,767.0
+33.0
+9.5
+21.0
+5740.0
+7.1
+1751.0
+27.0
+1761.0
+10.0
+2.3
+201,000,000.0
+Mexico
+1,964,375.0
+54.9
+1.0
+21.3
+8199.0
+13.6
+379.0
+26.7
+758.0
+16.5
+1.7
+127,000,000.0
+Chile
+756,102.0
+21.2
+1.6
+9.9
+9540.0
+1.8
+77.7
+5.3
+1522.0
+0.3
+2.0
+17,819,000.0
+Nicaragua
+130,373.0
+41.8
+41.8
+52.2
+900.0
+23.0
+23.9
+0.0
+2280.0
+1.6
+1.1
+6,071,000.00
+Australia
+7,692,024.0
+52.8
+0.8
+0.1
+36,487.0
+1.8
+823.0
+38.0
+534.0
+0.1
+3.9
+22,700,000.0
+Egypt
+1,003,450.0
+3.7
+0.6
+71.6
+1428.0
+30.7
+137.0
+5.1
+51.0
+15.0
+1.7
+87,000,000.0
+Nigeria
+923,678.0
+79.1
+1.4
+96.0
+1019.0
+36.4
+193.0
+3.5
+1160.0
+24.2
+0.5
+177,000,000.0
+Ethiopia
+1,104,300.0
+35.7
+0.7
+95.4
+900.0
+40.4
+49.5
+0.5
+848.0
+23.0
+6.3
+100,000,000.0
+Yemen
+527,968.0
+44.7
+0.1
+82.0
+800.0
+46.6
+72.4
+0.0
+167.0
+6.0
+0.7
+26,000,000.0
+Niger
+1,127,000.0
+34.7
+0.0
+96.0
+849.0
+43.0
+19.0
+0.1
+151.0
+8.0
+0.3
+17,138,000.0
+Namibia
+825,615.0
+44.1
+0.1
+89.0
+4442.0
+23.1
+44.1
+2.4
+285.0
+0.3
+2.7
+2,283,000.00
+The vertical columns indicate the actual values of different parameters for different countries, such as total land + water area in km2 (A1), 
+percentage of agricultural area (A2), percentage of water (A3), percentage of people below poverty lines, measured as less than 4 US 
+dollars per day (A4), percentage of malnourished people (A5), GNP in million US dollars (A6), road lengths in 1000 km (A7), rail length in 
+1000 km (A8), average precipitation rate in mm per year (A9), the populations of homeless people (A10), the number of hospital beds per 
+1000 population (A11) and the total populations of these countries (A12). GNP: Gross national product
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+79
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+While most indices do serve the purpose of quantifying 
+the happiness levels of populations, there are several 
+ambiguities if the domains are not made sufficiently 
+distinct. For example, in Table  1  (GNH model), mental 
+health is not included in psychological well‑being. This 
+would correspond to the manomaya kośa. Similarly, 
+harmony and spirituality are counted in distinct domains, 
+while they should be classified under ānandamaya 
+kośa. The state of bliss cannot be obtained unless there 
+are peace, harmony, and contentment. The panchakośa 
+model (PKMH‑I) provides a less ambiguous and a more 
+unique way of classifying the parameters of the above 
+domains and this model is quantified in the present work.
+As we mentioned, this is a modeling study wherein the 
+data are collected from different sources, particularly the 
+sites of the United  Nations Organization and the World 
+Development Indices/Indicators of the World Bank. From 
+the data, statistical methods are used for converting 
+the data into suitable parameters in the range of 0–100 
+for each kośa. The subjects used herein include all the 
+members in the country for analysis purposes. Since the 
+collected data are based on statistical reports, the chances 
+of subjectivity are considerably reduced and equal 
+space, water resources, GDP, etc. are also considered. 
+For the prānamaya kośa of a nation, life expectancy, 
+employment, etc. are considered. There are negative 
+characteristics such as HIV and cancer deaths too. The 
+collective manomaya kośa deals with the mental and 
+emotional health of a nation. Crime and corruption affect 
+mental health negatively. Thus, the least corrupt country 
+will have a better mental health for this particular 
+parameter. One feature of these models is that we 
+cannot easily say that the specification of parameters 
+is complete for any kośa. However, the advantage is 
+that if more parameters are identified, they can be very 
+easily included in the model. Another feature is that 
+all parameters are not completely independent. Large 
+amount of corruption will lead to crime, and thus, these 
+two, namely, corruption and crime, are not independent. 
+However, they are both very good indicators of the 
+mental health of a nation. In fact, larger the set of 
+parameters one uses for specification of a kośa, the effect 
+of interdependencies of the parameters gets diminished. 
+For the vijyānamaya kośa, the intellectual growth of a 
+nation through its academic and research institutions can 
+provide a very good measure.
+Table 3: Annamaya kośa normalized parameters (relative scale factors)
+Country
+A1N
+A2N
+A3N
+A4N
+A5N
+A6N
+A7N
+A8N
+A9N
+A10N
+A11N
+China
+23.3
+54.8
+14.1
+51.0
+14.4
+90.6
+48.7
+11.7
+64.5
+99.8
+38.0
+India
+8.3
+60.3
+95.5
+9.0
+4.6
+52.0
+100.0
+20.5
+100.0
+93.8
+9.0
+Pakistan
+16.3
+35.1
+28.6
+9.0
+3.3
+55.0
+29.7
+7.9
+49.4
+95.0
+6.0
+Bhutan
+100.0
+13.6
+2.0
+47.0
+7.4
+66.4
+26.0
+0.0
+100.0
+97.4
+18.0
+Singapore
+0.4
+7.2
+30.0
+99.0
+100.0
+95.6
+100.0
+100.0
+100.0
+99.6
+27.0
+Japan
+8.8
+12.5
+35.5
+99.5
+100.0
+91.7
+100.0
+79.9
+100.0
+100.0
+100.0
+UK
+12.7
+71.0
+89.0
+99.9
+100.0
+96.1
+100.0
+70.0
+100.0
+99.8
+30.0
+Sweden
+100.0
+7.5
+88.7
+99.9
+100.0
+99.0
+100.0
+22.0
+62.4
+99.1
+27.0
+Netherlands
+8.3
+55.6
+100.0
+99.9
+100.0
+98.2
+100.0
+71.9
+77.8
+99.8
+47.0
+Romania
+39.9
+59.0
+35.7
+81.7
+22.7
+87.2
+35.3
+57.0
+63.7
+99.9
+63.0
+Greece
+40.7
+63.4
+10.0
+85.0
+73.4
+90.0
+87.9
+18.9
+65.2
+90.8
+49.0
+Russia
+100.0
+13.1
+44.1
+87.3
+26.4
+92.0
+8.2
+5.0
+46.0
+96.5
+97.0
+USA
+100.0
+44.7
+46.0
+99.9
+100.0
+97.9
+69.1
+23.6
+71.5
+98.0
+30.0
+Brazil
+100.0
+33.0
+95.0
+79.0
+23.0
+92.9
+20.6
+3.2
+100.0
+95.0
+23.0
+Mexico
+51.6
+54.9
+10.4
+78.7
+32.8
+86.4
+19.3
+13.6
+75.8
+87.0
+17.0
+Chile
+100.0
+21.2
+16.3
+90.1
+38.2
+98.2
+10.3
+7.0
+100.0
+98.0
+20.0
+Nicaragua
+71.7
+41.8
+100.0
+47.8
+3.6
+77.0
+18.3
+0.0
+100.0
+73.6
+11.0
+Australia
+100.0
+52.8
+7.6
+99.9
+100.0
+98.2
+10.7
+4.9
+53.4
+99.6
+39.0
+Egypt
+38.5
+3.7
+6.0
+28.4
+5.7
+69.3
+13.7
+5.1
+5.1
+82.8
+17.0
+Nigeria
+17.4
+79.1
+14.1
+4.0
+4.1
+63.6
+20.9
+3.8
+100.0
+86.3
+5.3
+Ethiopia
+36.9
+35.7
+7.0
+4.6
+3.6
+59.6
+4.5
+0.5
+84.8
+77.0
+63.0
+Yemen
+67.8
+44.7
+1.0
+18.0
+3.2
+53.4
+13.7
+0.0
+16.7
+76.9
+7.0
+Niger
+100.0
+34.7
+0.2
+4.0
+3.4
+57.0
+1.7
+0.1
+15.1
+53.3
+3.1
+Namibia
+100.0
+44.1
+1.2
+11.0
+17.8
+76.9
+5.3
+2.9
+28.5
+89.0
+27.0
+The vertical columns indicate normalized values of different variables (on a scale of 0‑100) for different countries, such as total land + 
+water area (A1N), percentage of agricultural area (A2N), percentage of water (A3N), percentage of people below poverty lines, measured 
+as <4 dollars per day (A4N), percentage of malnourished people (A5N), GNP in US dollars (A6N), road lengths in 1000 km (A7N), rail 
+length in 1000 km (A8N), average precipitation rate (A9N), the populations of homeless people (A10N) and the number of hospital beds 
+per 1000 members of population (A11N). GNP: Gross national product
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+80
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+weights may be assigned to each of the parameter of the 
+present study. Other models for unequal weights will also 
+be alluded to. The next section describes the quantitative 
+characterization of the kośas followed by conclusions 
+and perspectives.
+Results
+We present the results for each kośa first and then 
+combine them for a total score. The data extraction has 
+been primarily done using the internet and published 
+articles. The major sites used are the WHO sites and the 
+sites that use published literature from reputed journals. 
+Later, a comparison with mainly published literature data 
+could be made.
+We have collected the data for 24 countries from across 
+the continents. These countries are China, India, Pakistan, 
+Bhutan, Singapore, and Japan (from the Asian region); 
+UK, Sweden, the Netherlands, Romania, Greece, and 
+Russia (from the European region); USA, Brazil, Mexico, 
+Chile, Nicaragua, and Australia  (from the American and 
+Australian continents); and Egypt, Nigeria, Ethiopia, 
+Yemen, Niger, and Namibia (from the African continent). 
+This will enable us to compare countries across the 
+continents. We begin with the annamaya kośa parameters.
+Annamaya kośa parameters
+Annamaya kośa has to deal with all the physical 
+resources available to the nation and how well they get 
+distributed in the population. Land and water resources 
+have to be scaled to the population. As outlined in the 
+Methods section, the total score for each kośa has to 
+be scaled or normalized between 0 and 100. There are 
+11 parameters chosen for the annamaya kośa and each 
+of these parameters has been given 9.09 weightage for 
+estimating the total annamaya kosha happiness parameter. 
+To calculate the relative values of each parameter, the 
+parameter is individually scaled between 0 and 100, and 
+then, the values for all parameters are averaged. The 
+actual values of these parameters are given in Table 2. 
+The first parameter is the land and water area available 
+for each country  (A1). The parameters are labeled 
+from A1 to A11 for annamaya kosha, B1 to B9 for 
+prānamaya kosha, C1 to C9 for manomaya kosha, and 
+so on. The areas in km2 per person in Australia, Russia, 
+Bhutan, Brazil, and USA are 0.366, 0.122, 0.054, 0.043, 
+and 0.03 km2, respectively, and for all other countries, 
+the values are much smaller. We assign all values >0.03 
+km2 per person as 100% and scale the remaining areas 
+by the ratios of actual area per person divided by 0.03. 
+In this way, countries such as India and Japan get at 
+Table 4: Prānamaya kośa parameters
+Country
+B1
+B2
+B3
+B4
+B5
+B6
+B7
+B8
+B9
+China
+75.1
+4.0
+75.2
+145.0
+2.3
+1.5
+482.0
+46.0
+93.2
+India
+65.0
+6.8
+67.8
+75.0
+17.0
+0.6
+349.0
+24.0
+78.0
+Pakistan
+65.0
+7.4
+67.5
+95.0
+4.0
+0.8
+143.0
+11.0
+77.0
+Bhutan
+70.0
+2.5
+69.0
+95.0
+3.5
+0.1
+2.0
+30.0
+60.0
+Singapore
+68.0
+2.0
+83.0
+100.0
+0.5
+1.9
+5.0
+73.0
+148.0
+Japan
+71.7
+4.2
+84.0
+115.0
+3.3
+2.1
+175.0
+86.0
+95.0
+UK
+73.4
+5.5
+80.4
+137.0
+3.3
+2.8
+506.0
+90.0
+130.0
+Sweden
+74.4
+7.2
+82.0
+112.0
+0.3
+3.3
+249.0
+94.8
+122.9
+Netherlands
+74.3
+6.8
+81.1
+157.6
+1.8
+3.2
+27.0
+94.0
+121.0
+Romania
+58.5
+6.8
+74.7
+149.0
+1.2
+2.4
+54.0
+49.8
+123.4
+Greece
+49.3
+25.2
+80.3
+123.7
+10.0
+4.4
+81.0
+59.9
+111.0
+Russia
+68.8
+6.2
+70.2
+130.0
+29.0
+4.3
+1216.0
+61.4
+156.0
+USA
+67.4
+7.2
+79.6
+124.0
+3.3
+2.4
+15095.0
+84.0
+103.0
+Brazil
+66.7
+8.0
+73.3
+115.0
+7.5
+1.8
+4000.0
+51.0
+141.0
+Mexico
+61.0
+4.9
+75.4
+71.7
+13.6
+2.0
+1819.0
+43.0
+90.2
+Chile
+62.3
+6.5
+78.4
+119.7
+1.8
+1.0
+366.0
+66.5
+122.9
+Nicaragua
+60.0
+5.9
+72.7
+91.4
+3.0
+0.9
+143.0
+15.5
+115.0
+Australia
+72.0
+4.5
+82.0
+120.0
+4.4
+3.8
+464.0
+83.0
+133.0
+Egypt
+46.0
+8.1
+73.4
+116.8
+30.7
+2.8
+86.0
+49.6
+112.8
+Nigeria
+60.0
+4.9
+52.6
+70.0
+170.0
+0.4
+60.0
+38.0
+94.5
+Ethiopia
+45.0
+17.5
+60.7
+80.8
+40.4
+0.4
+61.0
+1.9
+21.8
+Yemen
+46.0
+35.0
+51.9
+67.9
+466.0
+0.2
+26.0
+20.0
+68.0
+Niger
+45.0
+11.7
+54.7
+53.1
+43.0
+0.0
+27.0
+1.7
+44.0
+Namibia
+45.0
+27.4
+51.8
+58.1
+23.1
+0.4
+129.0
+13.9
+114.0
+The columns represent the employment rates (B1), unemployment rates (B2), life expectancy (B3), the number of cancer deaths per 
+100,000 of population (B4), the number of HIV deaths per lakh of population (B5), the number of doctors per 1000 of population (B6), the 
+number of airports (B7), the percentage of internet users (B8), the number of mobile phones per 100 members of population (B9)
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+81
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+least 7% relative value. Dividing all areas by the 
+highest value of 0.366 give a value of  <10% to the 
+USA and hardly any value to countries such as India 
+and Japan. This discussion illustrates that there is some 
+degree of arbitrariness in these computations. However, 
+if the number of parameters is increased, the impact of 
+this arbitrariness is significantly minimized. The next 
+parameter is the agricultural area in each country (A2). 
+Nigeria has the highest value of 79%. For this parameter, 
+we simply use the percentage of agricultural area. Thus, 
+although India and Nigeria have very low scores for 
+the land area available per person, the large agricultural 
+area in these countries helps these countries to gain 
+quite a bit in their scores through the agricultural area 
+percentages. The percentage of water in the countries 
+ranges from 0.1 to 18.4 (A3). This is multiplied by 10 to 
+convert it into a percentage. For all countries where the 
+percentage exceeds 100, a value of 100 is assigned. The 
+purpose for rescaling the larger percentages (over 100) 
+to 100 is to get a good spread in the normalized values. 
+The distributions at the higher ends are often very far 
+from a normal distribution, and this rescaling helps in 
+keeping the overall parameters in a reasonable range 
+between 0 and 100 across all countries. Poverty lines 
+and malnutrition are an indication of severe deficiency 
+in the annamaya kośa  (A4). The indexed measure for 
+poverty line is 100  minus the percentage of persons 
+living at an income of < 4 US Dollars a day. Countries 
+such as Australia, UK, Japan, and Russia get high scores 
+here. However, India, Nigeria, Pakistan, and Bhutan all 
+get small scores. For malnutrition (A5), the scaling used 
+is 100 minus ten times the percentage of malnourished. 
+Countries such as USA, Russia, and China get high 
+scores, while India, Bhutan, Pakistan, and African 
+countries get small scores. The next parameter is GNP 
+measured in million US Dollars  (2005 value). For this 
+parameter, the value of 25,000 million US $ and above 
+is taken as 100 and other GNPs are divided by 25,000 
+million US $ and this fraction is multiplied by 100 to 
+get a percentage. For the malnutrition parameter  (A6), 
+we take 100  minus the percentage of malnourished 
+population. Road lengths  (A7) and rail lengths  (A8) 
+are considered next. These are first divided by the area 
+of the country. To get the normalized values between 
+0 and 100, the ratio is multiplied by 100,000 for road 
+length ratio and 1,000,000 for the rail length ratio. 
+For road lengths, India, Singapore, Japan, Sweden, 
+UK, and the Netherlands score a 100, while for rail 
+lengths, only Singapore and the Netherlands score high. 
+Precipitation rate  (A9) is scored as follows. Countries 
+Table 5: Normalized Prānamaya kośa parameters (relative scale factors)
+Country
+B1N
+B2N
+B3N
+B4N
+B5N
+B6N
+B7N
+B8N
+B9N
+China
+75.1
+96.0
+75.2
+59.7
+97.7
+36.5
+3.4
+46.0
+93.2
+India
+65.0
+93.2
+67.8
+79.2
+83.0
+16.2
+7.3
+24.0
+78.0
+Pakistan
+65.0
+92.6
+67.5
+73.6
+96.0
+20.2
+10.8
+11.0
+77.0
+Bhutan
+70.0
+97.5
+69.0
+73.6
+96.5
+2.5
+3.5
+30.0
+60.0
+Singapore
+68.0
+98.0
+83.0
+72.2
+99.5
+48.0
+100.0
+73.0
+100.0
+Japan
+71.7
+95.8
+84.0
+68.1
+96.7
+53.5
+34.5
+86.0
+95.0
+UK
+73.4
+94.5
+80.4
+61.9
+96.7
+69.2
+100.0
+90.0
+100.0
+Sweden
+74.4
+92.8
+82.0
+68.9
+99.7
+82.5
+36.9
+94.8
+100.0
+Netherlands
+74.3
+93.2
+81.1
+56.2
+98.2
+80.0
+43.0
+94.0
+100.0
+Romania
+58.5
+93.2
+74.7
+58.6
+98.8
+60.0
+15.1
+49.8
+100.0
+Greece
+49.3
+74.8
+80.3
+65.6
+90.0
+100.0
+40.9
+59.9
+100.0
+Russia
+68.8
+93.8
+70.2
+63.9
+71.0
+100.0
+4.7
+61.4
+100.0
+USA
+67.4
+92.8
+79.6
+65.6
+96.7
+60.5
+100.0
+84.0
+100.0
+Brazil
+66.7
+92.0
+73.3
+68.1
+92.5
+44.0
+31.3
+51.0
+100.0
+Mexico
+61.0
+95.1
+75.4
+80.1
+86.4
+50.0
+61.7
+43.0
+90.2
+Chile
+62.3
+93.5
+78.4
+66.8
+98.2
+25.0
+32.3
+66.5
+100.0
+Nicaragua
+60.0
+94.1
+72.7
+74.6
+97.0
+22.5
+73.1
+15.5
+100.0
+Australia
+72.0
+95.5
+82.0
+66.7
+95.6
+96.2
+4.0
+83.0
+100.0
+Egypt
+46.0
+91.9
+73.4
+67.6
+69.3
+70.0
+5.7
+49.6
+100.0
+Nigeria
+60.0
+95.1
+52.6
+80.6
+0.0
+10.0
+4.3
+38.0
+94.5
+Ethiopia
+45.0
+82.5
+60.7
+77.6
+59.6
+10.0
+3.7
+1.9
+21.8
+Yemen
+46.0
+65.0
+51.9
+81.1
+0.0
+5.0
+3.3
+20.0
+68.0
+Niger
+45.0
+88.3
+54.7
+85.2
+57.0
+0.5
+1.6
+1.7
+44.0
+Namibia
+45.0
+72.6
+51.8
+83.9
+76.9
+10.0
+10.4
+13.9
+100.0
+The columns represent rescaled values of employment rates (B1N), unemployment rates (B2N), life expectancy (B3N), the number of cancer 
+deaths per 100,000 of population (B4N), the number of HIV deaths per lakh of population (B5N), the number of doctors per 1000 of population 
+(B6N), the number of airports (B7N), the percentage of internet users (B8N), the number of mobile phones (B9N)
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+82
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+Table 6: Manomaya kośa parameters
+Country
+C1
+C2
+C3
+C4
+C5
+C6
+C7
+C8
+C9
+China
+7.8
+40.0
+119.0
+22.0
+−0.4
+42.8
+37.0
+0.5
+1.5
+India
+21.1
+36.0
+33.0
+3.0
+−0.1
+54.3
+16.0
+1.0
+4.8
+Pakistan
+9.3
+28.0
+41.0
+3.0
+−0.5
+23.6
+16.0
+1.0
+4.8
+Bhutan
+17.8
+63.0
+143.0
+5.0
+0.0
+67.8
+13.0
+0.5
+6.0
+Singapore
+20.0
+82.0
+900.0
+15.0
+2.5
+95.2
+30.0
+0.5
+0.5
+Japan
+18.5
+74.0
+149.0
+36.0
+0.0
+89.4
+26.0
+0.5
+0.4
+UK
+6.2
+76.0
+148.0
+47.0
+2.2
+94.2
+32.0
+2.1
+1.1
+Sweden
+12.3
+89.0
+60.0
+47.0
+5.5
+97.6
+24.0
+2.5
+1.0
+Netherlands
+8.2
+83.0
+75.0
+43.0
+2.0
+97.1
+39.0
+0.5
+1.0
+Romania
+10.5
+43.0
+144.0
+28.0
+−0.2
+63.5
+35.0
+0.8
+2.0
+Greece
+3.8
+40.0
+111.0
+25.0
+2.3
+67.3
+32.0
+2.0
+1.5
+Russia
+19.5
+28.0
+563.0
+51.0
+0.3
+26.4
+28.0
+2.0
+16.2
+USA
+12.1
+73.0
+698.0
+53.0
+4.3
+89.9
+38.0
+1.5
+6.5
+Brazil
+5.8
+42.0
+301.0
+21.0
+−0.1
+55.3
+19.0
+1.0
+28.5
+Mexico
+4.2
+34.0
+212.0
+15.0
+−1.6
+38.0
+11.0
+1.0
+27.0
+Chile
+12.2
+71.0
+242.0
+3.0
+0.3
+88.0
+17.0
+0.6
+4.0
+Nicaragua
+4.7
+28.0
+160.0
+18.0
+−3.1
+28.8
+10.0
+1.0
+13.5
+Australia
+10.6
+81.0
+151.0
+43.0
+6.2
+96.1
+24.0
+0.5
+1.3
+Egypt
+1.7
+32.0
+76.0
+17.0
+−0.2
+31.3
+7.0
+3.0
+3.0
+Nigeria
+6.5
+25.0
+32.0
+10.0
+−0.1
+11.5
+15.0
+2.0
+14.9
+Ethiopia
+11.5
+33.0
+111.0
+10.0
+−0.2
+40.9
+5.0
+3.0
+13.0
+Yemen
+3.7
+18.0
+53.0
+10.0
+2.6
+8.2
+5.0
+2.5
+3.0
+Niger
+3.5
+34.0
+40.0
+10.0
+−0.6
+27.4
+4.0
+2.0
+5.5
+Namibia
+2.7
+48.0
+144.0
+10.0
+0.1
+63.0
+4.0
+3.6
+20.0
+The columns give the values of suicide rate per year for 100,000 population (C1), the corruption index on a scale wherein 0 is the most corrupt 
+and 100 is the least corrupt (C2), prison population rate (C3), percentage of divorces to marriages (C4), the net migration rate (C5), the and 
+the rule of law index (C6), smoking and alcohol related deaths (C7), drugs related deaths (C8) and deaths due to violence (C9)
+with  >1000  mm rain per year get a score of 100, 
+while countries with  <1000  mm rain get a score of 
+0.1 times the rain in mm. The populations of homeless 
+people  (A10) are scored by subtracting the percentage 
+of homeless people from 100. The number of hospital 
+beds per 1000 of population (A11) is the last parameter 
+for the annamaya kośa. This number is multiplied by 10 
+to get a normalized score. The total populations of these 
+individual countries are given in the last column (A12).
+Table  3 presents the normalized data for all these 
+parameters on a scale of 0–100. The columns are labeled 
+as A1N to A11N and they correspond to columns A1 to 
+A11 which contain the actual/unscaled/nonnormalized 
+data given in Table  2. The scaling procedure has been 
+described above.
+Prānamaya kośa parameters
+Prāna is energy and the flow of prāna is the flow of 
+energy. For a population, Prana represents its vitality 
+and vibrancy. This is by and large determined by the 
+mobility of the population  and how the population 
+spends its energy and thus gainfully employed. For 
+computing the index for this kośa, we have identified the 
+following parameters. They are employment rates  (B1), 
+unemployment rates  (B2), life expectancy  (B3), the 
+number of cancer deaths per lakh of population  (B4), 
+number of HIV deaths per lakh of population  (B5), the 
+number of doctors per 1000 members of population (B6), 
+the number of airports  (B7), the percentage of internet 
+users  (B8), and the percentage of mobile phone 
+users  (B9). These parameters are depicted in Table  4. 
+Normalizing these is a bit easier than normalizing the 
+annamaya kośa parameters. Employment rate is counted 
+as it is since it is a percentage. The unemployment rate 
+is counted as 100  minus the unemployment percentage 
+rate. Life expectancy is the next parameter. Japan with a 
+life expectancy value of 84 gets 84%, while Nigeria with 
+a 52.6‑year life expectancy gets a score of 53. Cancer 
+death data are age normalized per 100,000 of population. 
+Maldives has the highest value of cancer deaths per 
+100,000 population. The data for all the countries are 
+normalized with 360 as the highest value. Countries with 
+values close to 360 get 0%, while countries with smaller 
+cancer deaths get a larger score. HIV deaths are in the range 
+of 1/100,000–6/100,000 of population. The normalized 
+score for this parameter is 100 times (1 − number of HIV 
+deaths/10). The number of airports is divided by the area 
+of the country and multiplied by 106/15. With this scaling, 
+UK, USA, and Singapore get a normalized score of 100. 
+Since the number of internet users and the number of 
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+83
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+mobile users are given in percentages, there is no need to 
+rescale them. Only when the values are >100%, the value 
+of 100 is assigned to the normalized parameter. Table  5 
+gives the normalized parameters  (relative scale factors) 
+for prānamaya kośa. The normalized scores are given 
+in columns B1N to B9N of Table 5 corresponding to the 
+columns B1 to B9 of Table 4.
+Manomaya kośa parameters
+Manomaya kośa of large collection of people deals with 
+the mental satisfaction of the countries or societies. Mobs 
+that are rioting have an extremely ill‑developed manomaya 
+kośa. They may do anything in frenzy and we witness 
+these phenomena on several occasions. A war is the “best 
+example” of a disturbed and highly tense population. The 
+after‑effects of the World Wars are still being felt and so 
+are the effects of riots. The indices for the manomaya kośa 
+comprise the following factors. They are suicide rate per 
+year for 100,000 population  (C1), corruption index on a 
+scale wherein 0 is the most corrupt and 100 is the least 
+corrupt  (C2), prison population rates  (C3), percentage of 
+divorces to marriages (C4), net migration rate (C5), rule of 
+law index (C6), smoking‑ and alcohol‑related deaths (C7), 
+drug‑related deaths (C8), and violence‑related deaths (C9). 
+These indices are not strongly correlated with the GNP 
+of a nation. Rich countries have suicide rates comparable 
+to the poor countries and they have higher divorce rates. 
+While the causes need to be analyzed carefully, these data 
+indicate that even countries with a very large GNP or 
+GDP need to improve their manomaya kosha. The scale 
+for suicide rates is computed as 100 minus 100 multiplied 
+by suicide rate/25. The last denominator is chosen to be 
+a slightly larger value than the largest suicide rate. Least 
+suicide rates get high scores in the happiness indices. In 
+the corruption index, 0 corresponds to the most corrupt. 
+As the values range between 0 and 100, the actual value 
+may be taken either as a percentage of corruption‑less‑ness 
+or as a percentage of being uncorrupted. For prison 
+population rates, we take the value of 0.1  times the rate. 
+Large prison populations or conviction rates are both good 
+and bad. Here, we take it to be good as it may increase 
+order in society at least due to the fear of being punished. 
+The negative or bad part is that so many crimes are 
+committed in the first place. The divorce rates are given 
+in column C4. Higher rates of divorce indicate smaller 
+capacities to accommodate alternative points of view. The 
+index is calculated as 100 minus the percentage of divorce 
+rate. Low divorce rates indicate greater stability, although a 
+flip side of this is that if there is greater inequality between 
+Table 7: Normalized manomaya kośa parameters (relative scale factors) corresponding to the columns C1 to C9 of 
+Table 6
+Country
+C1N
+C2N
+C3N
+C4N
+C5N
+C6N
+C7N
+C8N
+C9N
+China
+61.0
+40.0
+11.9
+78.0
+48.0
+42.8
+63.0
+90.0
+94.0
+India
+0.0
+36.0
+3.3
+97.0
+49.8
+54.3
+84.0
+80.0
+80.8
+Pakistan
+53.5
+28.0
+4.1
+97.0
+47.6
+23.6
+84.0
+80.0
+80.8
+Bhutan
+11.0
+63.0
+14.3
+95.0
+50.0
+67.8
+87.0
+90.0
+76.0
+Singapore
+0.0
+82.0
+90.0
+85.0
+62.5
+95.2
+70.0
+90.0
+98.0
+Japan
+7.5
+74.0
+14.9
+64.0
+50.0
+89.4
+74.0
+90.0
+98.4
+UK
+69.0
+76.0
+14.8
+53.0
+60.8
+94.2
+68.0
+58.0
+95.6
+Sweden
+38.5
+89.0
+6.0
+53.0
+77.3
+97.6
+76.0
+50.0
+96.0
+Netherlands
+59.0
+83.0
+7.5
+57.0
+59.8
+97.1
+61.0
+90.0
+96.0
+Romania
+47.5
+43.0
+14.4
+72.0
+48.8
+63.5
+65.0
+84.8
+92.0
+Greece
+81.0
+40.0
+11.1
+75.0
+61.6
+67.3
+68.0
+60.0
+94.0
+Russia
+2.5
+28.0
+56.3
+49.0
+51.4
+26.4
+72.0
+60.0
+35.2
+USA
+39.5
+73.0
+69.8
+47.0
+71.6
+89.9
+62.0
+71.0
+74.0
+Brazil
+71.0
+42.0
+30.1
+79.0
+49.5
+55.3
+81.0
+80.0
+0.0
+Mexico
+79.0
+34.0
+21.2
+85.0
+41.8
+38.0
+89.0
+80.0
+0.0
+Chile
+39.0
+71.0
+24.2
+97.0
+51.8
+88.0
+83.0
+88.0
+84.0
+Nicaragua
+76.5
+28.0
+16.0
+82.0
+34.3
+28.8
+90.0
+80.0
+46.0
+Australia
+47.0
+81.0
+15.1
+57.0
+81.2
+96.1
+76.0
+90.4
+94.8
+Egypt
+91.5
+32.0
+7.6
+83.0
+49.0
+31.3
+93.0
+40.0
+88.0
+Nigeria
+67.5
+25.0
+3.2
+90.0
+49.5
+11.5
+85.0
+60.0
+40.4
+Ethiopia
+42.5
+33.0
+11.1
+90.0
+48.8
+40.9
+95.0
+40.0
+48.0
+Yemen
+81.5
+18.0
+5.3
+90.0
+63.0
+8.2
+95.0
+50.0
+88.0
+Niger
+82.5
+34.0
+4.0
+90.0
+47.1
+27.4
+96.0
+60.0
+78.0
+Namibia
+86.5
+48.0
+14.4
+90.0
+50.2
+63.0
+96.0
+28.0
+20.0
+The columns give the normalized values of suicide rate (C1N), the corruption index (C2N), prison population rate (C3N), percentage of divorces 
+to marriages (C4N), the net migration rate (C5N), the rule of law index (C6N), smoking‑ and alcohol‑related deaths (C7N), drugs‑related 
+deaths (C8N) and deaths due to violence (C9N)
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+84
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+men and women, women may be far more accommodative 
+so as to avoid divorce even at a great personal cost. 
+Net migration percentages are given in column C5. An 
+influx into a country indicates that there is a considerable 
+well‑being. People migrate to better environments. This is 
+a major reason for the overcrowding of cities all over the 
+world. The normalized index for this parameter is taken as 
+50 + 5 times the migration rate. The migration rates are in 
+the range of 5–6 per 1000 of population. A country with 
+a high rate of migration will have a large value of this 
+parameter. The rule of law index given in column C6 is 
+given as a percentage. Higher values of this index indicate 
+conformity of the population to the prevailing laws. This is 
+taken as a percentage. Alcohol‑related and smoking‑related 
+deaths are in the range of 0–50 per lakh of population. This 
+parameter is normalized as 100 minus the parameter value, 
+C7. Drug‑related deaths are in the range of 0–5 (C8). For 
+this, normalization is done as 100  minus five times the 
+value of the parameter. Violence‑related deaths are in the 
+range of 0–25 (C9). This is normalized  as 100 minus four 
+times  the parameter value  (C9N). The manomaya kośa 
+parameters are given in Table 6.
+The normalized values of the manomaya kośa parameters 
+are summarized in Table 7.
+Vijyānamaya kośa parameters
+Vijyānamaya kośa parameters include the literacy rate 
+percentage  (D1), percentage of graduates  (D2), number 
+of research papers  (D3), the number of researchers per 
+million of population  (D4), number of colleges and 
+universities  (D5), the ratio of male literacy to female 
+literacy  (D6), and the role of voice of people and the 
+accountability of the governance (D7). For an individual 
+human being, this kośa corresponds to “viveka” or the 
+ability for discrimination. For a society, these parameters 
+should reflect its ability to increase intellectual and social 
+awareness. There has been a remarkable increase in these 
+factors along with economic development. Literacy, arts, 
+culture, science, and education contribute to this kośa. 
+For normalizing, for the first two columns (D1 and D2), 
+which represent percentages of literacy and graduates, the 
+values are taken as such. The next three parameters are 
+normalized as follows. The number of research papers in 
+million is multiplied by 250 to get the rescaled values in 
+the range of 0–100. Many countries such as China, India, 
+UK, and USA score high on this scale, while the African 
+countries score low values. The number of researchers 
+per million of population is multiplied by 0.02 to get 
+normalized scores in the range of 0–100. Singapore and 
+Table 8: Vijyānamaya kośa parameters
+Country
+D1
+D2
+D3
+D4
+D5
+D6
+D7
+China
+95.0
+14.0
+0.6
+990.0
+2555.0
+0.9
+5.4
+India
+63.0
+4.0
+0.5
+160.0
+1622.0
+0.6
+61.1
+Pakistan
+55.0
+3.0
+0.1
+150.0
+291.0
+0.7
+27.1
+Bhutan
+53.0
+3.0
+0.0
+10.0
+4.0
+0.6
+43.8
+Singapore
+96.0
+30.0
+0.0
+6400.0
+40.0
+1.0
+45.3
+Japan
+99.0
+53.7
+1.0
+4000.0
+989.0
+1.0
+79.3
+UK
+99.0
+47.0
+0.7
+4020.0
+292.0
+1.0
+92.1
+Sweden
+99.0
+42.0
+0.5
+5180.0
+53.0
+1.0
+99.5
+Netherlands
+99.0
+35.0
+0.7
+3500.0
+139.0
+1.0
+98.5
+Romania
+97.7
+20.0
+0.1
+800.0
+108.0
+1.0
+60.1
+Greece
+98.9
+32.0
+0.2
+2200.0
+79.0
+1.0
+67.5
+Russia
+99.7
+55.5
+0.3
+2500.0
+1531.0
+1.0
+20.2
+USA
+99.0
+43.0
+2.9
+3900.0
+3289.0
+1.0
+79.8
+Brazil
+90.4
+10.0
+0.5
+700.0
+1613.0
+1.0
+60.6
+Mexico
+95.1
+16.0
+0.2
+386.0
+942.0
+1.0
+55.0
+Chile
+98.6
+41.0
+0.1
+300.0
+79.0
+1.0
+80.3
+Nicaragua
+82.8
+3.0
+0.0
+10.0
+40.0
+1.0
+35.5
+Australia
+99.0
+45.0
+0.3
+3500.0
+211.0
+1.0
+93.6
+Egypt
+73.8
+5.0
+0.1
+500.0
+62.0
+0.8
+14.8
+Nigeria
+61.3
+2.0
+0.1
+70.0
+136.0
+0.8
+29.6
+Ethiopia
+49.1
+2.5
+0.0
+42.0
+35.0
+0.6
+12.8
+Yemen
+63.9
+0.0
+0.0
+10.0
+28.0
+0.6
+10.3
+Niger
+28.7
+0.5
+0.0
+10.0
+1.0
+0.3
+39.9
+Namibia
+88.8
+2.0
+0.0
+10.0
+4.0
+1.0
+66.5
+The columns include the literacy rate percentage (D1), percentage of graduates (D2), number of research papers in millions (D3), number of 
+researchers per million of population (D4), number of colleges and universities (D5), the ratio of female literacy to male literacy (D6) and 
+voice and accountability (D7)
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+85
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+Sweden score 100 in the normalization. The number of 
+universities and colleges is divided by the population of 
+the country and multiplied by 6 × 106 to get normalized 
+values in the range of 0–100. The next column  (D6) is 
+the ratio of female literacy to male literacy. This value 
+is converted to a percentage by multiplying by 100. 
+Treating all human beings  (as well as other creatures 
+as well) as equal is a great sign of viveka and it is 
+reassuring to note that this aspect of development is far 
+more encouraging in the present century than what it 
+used to be, a 100  years or even 50  years ago. Having 
+a good representation of female members in panchayats 
+or local bodies of governance and legislative assemblies 
+and reserving seats for them in these bodies is very 
+encouraging for the social and global Vijyānamaya kośa. 
+The last column is the role of the voice of the people and 
+the accountability of the government (D7). This is higher 
+for democratic countries where the people have a greater 
+say in the mode and functioning of the government. 
+Since this is given as a percentage, the value is already 
+normalized. The Vijyānamaya kośa parameter values are 
+given in Table 8.
+The normalized scores/indices for the Vijyānamaya kośa 
+parameters are given in Table 9.
+Anandamaya kośa parameters
+The parameters for ānandamaya kośa include the values 
+for the human development index  (E1), charity work in 
+terms of money  (E2) and time  (E3) given, world giving 
+rank index  (E4), and the Cantril ladder of life scale 
+gallup (E5). Among all the kośas, it is hardest to compute 
+the values for this kośa as ānanda or the state of bliss is 
+indescribable. When Bhrigu attains this state, he does 
+not return to his father Varuna for confirmation since 
+he is convinced that he is in the state of Brahman. For a 
+nation, instead of estimating the state of bliss, it is easier 
+to estimate the extent of spirituality through the acts of 
+giving or the extent of karma yoga in their citizens. To 
+add a bit of corresponding materialistic content as well 
+as to consider the opinions of populations  (happiness has 
+a strong subjective component too), we have considered 
+the human development index and the Cantril ladder. The 
+Cantril ladder is one of the scales to measure global life 
+satisfaction.[59‑66] It may be considered as a satisfaction 
+with life scale  (SWLS). Among various components of 
+subjective well‑being, the SWLS assesses global life 
+satisfaction. Many of these scales do not consider features 
+such as loneliness that are responsible for dissatisfaction. 
+The SWLS is shown to have favorable psychometric 
+Table 9: Normalized 1 Vijyānamaya kośa parameters (relative scale factors)
+Country
+D1N
+D2N
+D3N
+D4N
+D5N
+D6N
+D7N
+China
+95.0
+14.0
+100.0
+19.8
+11.2
+91.0
+5.4
+India
+63.0
+4.0
+100.0
+3.2
+7.7
+65.0
+61.1
+Pakistan
+55.0
+3.0
+25.0
+3.0
+9.6
+67.0
+27.1
+Bhutan
+53.0
+3.0
+2.5
+0.2
+31.0
+56.0
+43.8
+Singapore
+96.0
+30.0
+5.0
+100.0
+43.3
+99.0
+45.3
+Japan
+99.0
+53.7
+100.0
+80.0
+46.4
+100.0
+79.3
+UK
+99.0
+47.0
+100.0
+80.4
+27.4
+100.0
+92.1
+Sweden
+99.0
+42.0
+100.0
+100.0
+32.6
+100.0
+99.5
+Netherlands
+99.0
+35.0
+100.0
+70.0
+49.3
+100.0
+98.5
+Romania
+97.7
+20.0
+31.5
+16.0
+32.5
+98.5
+60.1
+Greece
+98.9
+32.0
+56.2
+44.0
+43.8
+100.0
+67.5
+Russia
+99.7
+55.5
+68.2
+50.0
+64.2
+99.5
+20.2
+USA
+99.0
+43.0
+100.0
+78.0
+62.1
+100.0
+79.8
+Brazil
+90.4
+10.0
+100.0
+14.0
+48.1
+100.0
+60.6
+Mexico
+95.1
+16.0
+52.5
+7.7
+44.5
+97.5
+55.0
+Chile
+98.6
+41.0
+22.5
+6.0
+26.6
+99.5
+80.3
+Nicaragua
+82.8
+3.0
+0.2
+0.2
+39.5
+100.0
+35.5
+Australia
+99.0
+45.0
+69.0
+70.0
+55.8
+100.0
+93.6
+Egypt
+73.8
+5.0
+30.0
+10.0
+4.3
+81.0
+14.8
+Nigeria
+61.3
+2.0
+25.0
+1.4
+4.6
+78.0
+29.6
+Ethiopia
+49.1
+2.5
+2.5
+0.8
+2.1
+61.0
+12.8
+Yemen
+63.9
+0.0
+2.5
+0.2
+6.5
+58.0
+10.3
+Niger
+28.7
+0.5
+0.2
+0.2
+0.4
+35.0
+39.9
+Namibia
+88.8
+2.0
+0.5
+0.2
+10.5
+99.0
+66.5
+The columns include the normalized values of literacy rate (percentage, D1N), percentage of graduates (D2N), number of research papers (D3N), 
+number of researchers per million of population (D4N), number of colleges and universities (D5N), the ratio of male literacy to female 
+literacy (D6N) and voice and accountability (D7N)
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+86
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+properties, including high internal consistency and high 
+temporal reliability. Scores on the SWLS correlate well with 
+other measures of subjective well‑being and also correlate 
+predictably with specific personality characteristics. SWLS 
+is suited for use with different age groups. Thus, we thought 
+that this ladder can be added as one of the parameters for 
+the anandamaya kośa. Cantril’s ladder elicits respondents 
+to rate their current life satisfaction on a ladder that ranges 
+from 0 to 10, where 0 reflects worst imaginable life 
+satisfaction and 10 reflects best imaginable life satisfaction. 
+Respondents are first asked to describe these two anchors 
+and then requested to rate their current life satisfaction 
+on this “ideographically anchored” continuum. These 
+parameters are given in Table 10.
+For normalization, the human development index (E1) and 
+the Cantril ladder (E5) are already in the 0–100 scale. Charity 
+work in terms of money and time is also in a percentage. 
+The world giving indices are ranked from 1 to 222. Since 
+all these countries chosen here have ranks between 0 and 
+100, the percentage is calculated as 100 minus the rank of 
+the country. If all the countries in the world are included, 
+then a formula such as  (222  −  rank) ×100/221 is more 
+appropriate for normalization. The normalized ānandamaya 
+kośa parameters are given in Table 11.
+Combined 
+happiness 
+indices 
+and 
+graphical 
+representations
+The data obtained in the last five sections of the previous 
+section are summarized in Table 12. Each column gives 
+the total happiness index for a given kosha, which is 
+averaged over all the parameters for that kosha with 
+equal weightage. The last column gives an overall 
+happiness index, the statistical index that was sought in 
+the present work. The next few figures present these data 
+in a pictorial way.
+The happiness indices for the five kośas and the total 
+happiness index (averaged over the five kośas) for the 24 
+countries are shown in Figures 1‑6.
+To see how sensitive the normalized parameters are to 
+the choice of the parameters, we recalculate the total 
+happiness indices by choosing  (n1, n2, n3, n4, n5) to 
+be  (10, 8, 8, 6, 4). We have done this by removing the 
+last parameter for each one of the kośas. This altered set 
+of total happiness indices is given in Figure  7. We see 
+that none of the happiness indices for the same countries 
+between the two figures  [Figures  6 and 7] differ by 
+Table 11: Normalized ānandamaya kośa 
+parameters (relative scale factors)
+Country
+E1N
+E2N
+E3N
+E4N
+E5N
+China
+71.9
+4.0
+11.0
+10.0
+46.5
+India
+58.6
+12.0
+14.0
+31.0
+50.0
+Pakistan
+53.7
+8.0
+20.0
+39.0
+52.0
+Bhutan
+58.4
+15.0
+15.0
+89.0
+58.0
+Singapore
+90.1
+15.0
+15.0
+36.0
+70.0
+Japan
+89.0
+23.0
+17.0
+10.0
+61.0
+UK
+89.2
+29.0
+73.0
+93.0
+69.0
+Sweden
+89.8
+52.0
+12.0
+60.0
+74.0
+Netherlands
+91.5
+77.0
+39.0
+88.0
+74.0
+Romania
+78.5
+14.0
+5.0
+0.0
+60.0
+Greece
+85.3
+8.0
+5.0
+0.0
+57.0
+Russia
+77.8
+20.0
+6.0
+0.0
+53.0
+USA
+91.4
+39.0
+60.0
+99.0
+72.0
+Brazil
+74.4
+15.0
+25.0
+10.0
+66.5
+Mexico
+75.6
+25.0
+20.0
+15.0
+67.0
+Chile
+82.2
+48.0
+16.0
+50.0
+66.0
+Nicaragua
+61.4
+30.0
+20.0
+33.0
+52.0
+Australia
+93.3
+38.0
+70.0
+94.0
+74.0
+Egypt
+68.2
+19.0
+6.0
+0.0
+47.0
+Nigeria
+50.4
+28.0
+29.0
+80.0
+58.0
+Ethiopia
+43.5
+24.0
+13.0
+28.0
+42.0
+Yemen
+50.0
+17.0
+7.0
+0.0
+44.0
+Niger
+33.7
+11.0
+11.0
+0.0
+42.0
+Namibia
+33.7
+17.0
+17.0
+0.0
+42.0
+The columns in this table correspond the respective columns of 
+Table 10. The columns are the normalized values for the human 
+development index (E1N), charity work in terms money given (E2N) 
+and time given (E3N), world giving rank index (E4N) and the Cantril 
+ladder of life scale gallup (E5N)
+Table 10: The parameters for ānandamaya kośa
+Country
+E1
+E2
+E3
+E4
+E5
+China
+71.9
+4.0
+11.0
+90.0
+46.5
+India
+58.6
+12.0
+14.0
+69.0
+50.0
+Pakistan
+53.7
+8.0
+20.0
+61.0
+52.0
+Bhutan
+58.4
+15.0
+15.0
+11.0
+58.0
+Singapore
+90.1
+15.0
+15.0
+64.0
+70.0
+Japan
+89.0
+23.0
+17.0
+90.0
+61.0
+UK
+89.2
+29.0
+73.0
+7.0
+69.0
+Sweden
+89.8
+52.0
+12.0
+40.0
+74.0
+Netherlands
+91.5
+77.0
+39.0
+12.0
+74.0
+Romania
+78.5
+14.0
+5.0
+108.0
+60.0
+Greece
+85.3
+8.0
+5.0
+120.0
+57.0
+Russia
+77.8
+20.0
+6.0
+100.0
+53.0
+USA
+91.4
+39.0
+60.0
+1.0
+72.0
+Brazil
+74.4
+15.0
+25.0
+90.0
+66.5
+Mexico
+75.6
+25.0
+20.0
+85.0
+67.0
+Chile
+82.2
+48.0
+16.0
+50.0
+66.0
+Nicaragua
+61.4
+30.0
+20.0
+67.0
+52.0
+Australia
+93.3
+38.0
+70.0
+6.0
+74.0
+Egypt
+68.2
+19.0
+6.0
+120.0
+47.0
+Nigeria
+50.4
+28.0
+29.0
+20.0
+58.0
+Ethiopia
+43.5
+24.0
+13.0
+72.0
+42.0
+Yemen
+50.0
+17.0
+7.0
+134.0
+44.0
+Niger
+33.7
+11.0
+11.0
+102.0
+42.0
+Namibia
+33.7
+17.0
+17.0
+100.0
+42.0
+The columns include the values for the human development index 
+(E1), charity work in terms money given (E2) and time given (E3), 
+world giving rank index (E4) and the Cantril ladder of life scale 
+gallup (E5)
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+87
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+Table 12: Computed happiness indices in the five kośas
+Country
+Anna (11)
+Prāna (9)
+Mano (9)
+Vijāna (7)
+Ānanda (5)
+Total Average
+China
+46.4
+64.7
+58.8
+48.1
+28.7
+49.3
+India
+50.3
+57.1
+53.9
+43.4
+33.1
+47.6
+Pakistan
+30.5
+57.1
+55.4
+27.1
+34.5
+40.9
+Bhutan
+43.4
+55.8
+61.6
+27.1
+47.1
+47.0
+Singapore
+69.0
+82.4
+74.7
+59.8
+45.2
+66.2
+Japan
+75.3
+76.1
+62.5
+79.8
+40.0
+66.7
+UK
+79.0
+85.1
+65.5
+78.0
+70.6
+75.6
+Sweden
+73.2
+81.3
+64.8
+81.9
+57.6
+71.8
+Netherlands
+78.0
+80.0
+67.8
+78.8
+73.9
+75.7
+Romania
+58.7
+67.6
+59.0
+50.9
+31.5
+53.5
+Greece
+61.3
+73.4
+62.0
+63.2
+31.1
+58.2
+Russia
+56.0
+70.4
+42.3
+65.3
+31.4
+53.1
+USA
+71.0
+82.9
+66.4
+80.3
+72.3
+74.6
+Brazil
+60.4
+68.8
+54.2
+60.4
+38.2
+56.4
+Mexico
+48.0
+71.4
+52.0
+52.6
+40.5
+52.9
+Chile
+54.5
+69.2
+69.6
+53.5
+52.4
+59.8
+Nicaragua
+49.5
+67.7
+53.5
+37.3
+39.3
+49.5
+Australia
+60.6
+77.2
+70.9
+76.1
+73.9
+71.7
+Egypt
+25.0
+63.7
+57.3
+31.3
+28.0
+41.1
+Nigeria
+36.2
+48.3
+48.0
+28.8
+49.1
+42.1
+Ethiopia
+34.3
+40.3
+49.9
+18.7
+30.1
+34.7
+Yemen
+27.5
+37.8
+55.5
+20.2
+23.6
+32.9
+Niger
+24.8
+42.0
+57.7
+15.0
+19.5
+31.8
+Namibia
+36.7
+51.6
+55.1
+38.2
+21.9
+40.7
+In each column, the averaging is done with equal weights to all the parameters (indicated in parenthesis) for that kośa. The last column is 
+the average over the five kośas for each country, which is the total country happiness index
+Figure 1: Total happiness indices in the annamaya kośas for 24 countries
+more than 5%–6%. However, the average values of the 
+individual koshas change by about 10%.
+This confirms our stand that as the number of parameters 
+increases beyond 7 or 8, there is a great degree if 
+invariance between the predictions from different 
+parameterizations. This supports one of the goals of the 
+model to capture the essence of the kośas.
+Another model to consider is to look at various linear 
+combinations of different kośas to see if this has a major 
+impact on the happiness indices. In principle, all the 
+kośas have a great degree of independence; otherwise, 
+a person such as Shri Ramakrishna who paid so little 
+attention to his annamaya kośa could have hardly 
+attained the highest states of Samadhis, so characteristic 
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+88
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+Figure 2: Total happiness indices in the pranamaya kośas for 24 countries
+Figure 3: Total happiness indices in the manomaya kośas for 24 countries
+Figure 4: Total happiness indices in the vijnyanamaya kośas for 24 countries
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+89
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+Figure 5: Total happiness indices in the anandamaya kośas for 24 countries
+Figure 6: Total happiness indices (averaged over all the kośas) for 24 countries
+Figure 7: Total happiness indices (averaged over all the kośas) for twenty four countries with different parameterization (the last parameter for each 
+kośa removed) than the one used in Figure 6
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+90
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+of the ānandamaya kośa. The result of a recalculation 
+with the weights of 1, 1.1, 1.3, 1.5, and 1.7 for the 
+annamaya, prānamaya, manomaya, vijyānamaya, and 
+ānandamaya kośas, respectively, for the 24 countries is 
+shown in Figure  8. The new results do not differ from 
+the old ones by more than 2%–4%. The deviations are 
+both positive and negative. An explanation could be that 
+the values of happiness parameters for different kośas of 
+different countries have very weak correlations between 
+themselves.
+Discussion
+We thus have a quantitative model for happiness indices 
+of different nations based on the panchakośas (PKMH‑I) 
+that are familiar to the individuals as outlined in the 
+Taittiriya Upaniśad. The available data could be classified 
+into the parameters for different kośas and simple 
+normalization procedures could be adopted to give a 
+spread of each of the parameters between 0 and 100. As 
+the weights for each of the parameter chosen for a given 
+kośa were the same, the final score for a kośa could be 
+simply computed as an equally weighted average. The 
+scores for different kośas for each country are quite 
+different, and thus, these can be used as good indicators 
+for a holistic planning for a nation, just as IAYT has 
+been used for improving the health of individual patients. 
+A remarkable observation is that the countries with very 
+high level of satisfaction or happiness  (many affluent 
+countries) are not having equally high values of the 
+manomaya kośa parameters  (except for Australia and 
+Singapore which are rather small populations), while 
+a small country such as Bhutan with a difficult terrain 
+and a low value of annamaya kośa parameter has a 
+happiness level at the manomaya kośa in the same range 
+as for countries such as UK, Japan, and USA. It is thus 
+not surprising that the GNH[8] Index study of Bhutan has 
+been praised so highly. There is so much to learn even 
+from such a small country.
+We note that some of the results are on the expected lines. 
+Countries with high levels of annamaya kośa tend to do 
+quite well on the vijyānamaya kośa. While our model 
+can certainly be improved, let us assess how this can be 
+used by these nations. The two dominant messages are 
+that even for the countries with large values of happiness 
+indices, improvements are certainly possible and those 
+areas can be identified by looking at individual kośas. In 
+countries with large natural resources, a lot of room exists 
+for improvements in manomaya and ānandamaya kośas. 
+The second message is that for countries with low scores, 
+all is not lost as there are areas in which they are doing 
+well. These countries just have to plan better and adopt 
+a more holistic model of development. This also brings 
+out the main feature that only economic development 
+is not a complete development and the countries may 
+now choose to interact so that they can increase mutual 
+happiness indices rather than try to dominate one another 
+through military or economic wars. The interaction 
+models between countries that led to tragedies such as 
+the Bhopal Gas Tragedy or even the models where 
+powerful countries simply go and occupy smaller and 
+weaker countries are so harmful to both the interacting 
+countries. Had the British or the North Americans 
+considered to interact favorably with the manomaya kośa 
+of all its occupied territories, they would have been a 
+much happier nation and society today and would have 
+increased goodwill toward themselves from a large part 
+of the world. Their nations would not have faced such 
+intense security threats so often. Thus, the interaction 
+model that uses the Upaniśadic kośa concepts has a lot to 
+offer for the models of interaction between the countries. 
+Figure 8: A total happiness model with weights of 1, 1.1, 1.3, 1.5, and 1.7 for the annamaya, Pranamaya, manomaya, Vijyanamana, and anandamaya 
+kośas, respectively
+[Downloaded free from http://www.ijoyppp.org on Monday, January 25, 2021, IP: 136.232.192.146]
+Tembe, et al.: Panchakosha model of happiness of nations
+91
+International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 6  ¦  Issue 2  ¦  July‑December 2018
+This is where quantification of the kośas is likely to be 
+of good use.
+An interesting feature in the normalized kośas is that the 
+so‑called developed countries do very well in all the other 
+four kośas relative to the manomaya kosha. The opposite 
+is true for Asian and African countries (except Russia) 
+which do much better in the manomaya kośa relative 
+to the other four kośas. A  possible explanation is that 
+in these developing countries, the population is aware 
+of the deficiencies in theirs annamaya, prānamaya, 
+and vijyānamaya koshas and adopt themselves better 
+to the limited resources. The opposite seems to be 
+true in developed countries, wherein there is a lot of 
+material prosperity and comfort. In their quest for 
+material happiness, their populations have lost quite a 
+bit in emotional tolerance as witnessed by larger divorce 
+rates and problems associated with drugs, smoking, 
+and alcohol. We thus note that our model provides an 
+alternative to the present available models of happiness.
+Conclusions and Perspectives
+Improvements in our model are certainly possible as there 
+are many factors such as the environment that need to be 
+considered in greater detail. The factors such as freedom 
+for individual pursuit and the aggressive policies of 
+nations in interfering with the affairs of remote countries 
+to increase their individual domination need to be taken 
+into account in a more elaborate manner. These data will 
+also help economically developed countries to inspect 
+their policies with other nations, by asking the question: 
+Do our policies with other nations help us to increase the 
+happiness levels of both countries? These will clearly 
+bring out the answer that either wars of sanctions or 
+vetos do not add to the happiness indices in any of the 
+kośas. Thus, there is a need for greater harmony and 
+peace rather than aggression. Just as the purpose of 
+yoga is to harmonize and elevate different kośas of the 
+individual bodies, these indices can be used to plan the 
+activities of nations to improve harmony and peace.
+Another feature of this study is that we did not get data 
+for all the parameters that we initially planned to get and 
+some new parameters were found along the way. Some 
+parameters had to be inferred from other available data. 
+A considerable portion of the data is from fairly reliable 
+web‑sites. However, these need to be cross checked 
+with published literature from the journals of the social 
+sciences. Some of the data need to be checked for internal 
+consistency as well. Another interesting observation is 
+that the aggregate happiness index computed for Bhutan 
+in its national study was well over 60 and the percentage 
+of very happy people was 43. The value that we compute 
+is near 46. A  conclusion from this observation is that 
+when we develop a comparative and nonsurvey‑based 
+scale, there is a greater objectivity. At the same time, 
+there is some satisfaction that the numbers represented 
+here can be classified into different kośas and that our 
+value and the national value for aggregate GNH for 
+Bhutan have a strikingly close similarity.
+The greatest strength of this study, like all statistical 
+models, is the opportunity it provides for quantitative 
+classification of the kośas of populations based on the 
+model proposed in the Taittiriya Upaniśad. At the time of 
+Bhrigu and Varuna, there were hardly any hospitals or even 
+machines to measure weights or blood pressures. While 
+Bhrigu’s analysis was entirely spiritual and theoretical, 
+it is remarkable that this model provides a basis for an 
+alternative therapy to improve the physical and mental 
+health of people. It would be certainly tempting to speculate 
+that a study such as this or a similar one which analyzes 
+the overall state of a nation into well‑defined and distinct 
+segments could be used to improve the development 
+models that nations use in their planning. Another strength 
+of this study is that the number of parameters used for 
+each kośa can be easily increased systematically so that all 
+the koshas can be comprehensively defined. We may then 
+get good limiting values for the well‑being of nations in 
+their different kośas.
+Financial support and sponsorship
+Nil.
+Conflicts of interest
+There are no conflicts of interest.
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yogatexts/AN EVALUATION OF THE ABILITY TO VOLUNTARILY REDUCE THE HEART RATE AFTER A MONTH OF YOGA PRACTICE.txt

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yogatexts/AUTONOMIC AND RESPIRATORY MEASURES IN CHILDREN WITH IMPAIRED VISION FOLLOWING YOGA AND PHYSICAL ACTIVITY PROGRAMS.txt

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+International Journal of Rehabilitation and Health, Vol. 
+4, No. 2, 1998
+Autonomic and Respiratory Measures in Children
+with Impaired Vision Following Yoga and Physical
+Activity Programs
+Shirley Telles1,2 and Rajesh B. Srinivas1
+We conducted assessments of 28 children with impaired vision (VI group), with ages rang-
+ing from 12 to 17 years, and an equal number of age-matched, normal-sighted children
+(NS group). The VI group had significantly higher rates of breathing, heart rates, and
+diastolic blood pressure values compared to the NS group (Mann-Whitney U test). Twenty-
+fourofthe VI group formed pairs matched for age and degree of blindness, and we ran-
+domly assigned members of the pairs to two groups, viz., yoga and physical activity. Both
+groups spent an hour each day practicing yoga or working in the garden, depending on
+their group. After 3 weeks, the yoga group showed a significant decrease in breath rate
+(Wilcoxon paired signed ranks test). There was no change after the physical activity pro-
+gram. The results showed that children with visual impairment have higher physiological
+arousal than children with normal sight, with a marginal reduction in arousal following
+yoga.
+INTRODUCTION
+Young people with impaired vision have significantly higher levels of anxiety related to
+physical injury compared to an age-matched group of subjects with normal vision (Ollendick
+et al., 1985). In addition, one study reported that, in comparison to persons who have
+vision, persons who are blind have a significantly higher heart rate while walking along an
+unfamiliar route as well as for 5 minutes afterward (Wycherley and Wicklin, 1970). The
+authors ascribed this to psychological rather than physical stress.
+The purpose of the present study was to compare the autonomic and respiratory mea-
+sures of children with congenital visual impairment with those of a group of age- and
+sex-matched children with normal vision. This was the first part of the study. The second
+part of the present study aimed at comparing the effects of yoga practice with physical
+activity in children with visual impairment. The practice of yoga, as based on relaxation
+1 Vivekananda Kendra Yoga Research Foundation, No. 9, Appajappa Agrahara, 1st Main, Chamarajpet, Bangalore
+560 018, India.
+2To whom correspondence should be addressed. Fax: 91.80.6610666. e-mail: [email protected].
+KEY WORDS: visual impairment; normal sight; autonomic measures; yoga; gardening.
+117
+1068-9591/98/0400-0117$15.00/0 © 1998 Plenum Publishing Corporation
+(Nagendra, 1989), is able to bring about reduced sympathetic activity along with other
+physiological signs of reduced arousal (Joseph et al., 1981; Wallace et al., 1971).
+METHODS
+Subjects
+In the first part of the study, we selected 28 children (aged between 11 and 17 years;
+group average age ± SD, 14.2 ± 1.9 
+years) at random from a special school for persons with
+visual impairements (Raman Maharshi Academy for the Blind, Bangalore, India). All of
+them had congenital visual impairment with an uncorrectable visual acuity of 6/60 or less
+in the better eye from birth, which is the conventional description of blindness (Sheridan,
+1969). Blindness was due to peripheral 
+causes, e.g., microphthalmos, congenital cataract, 
+or
+optic atrophy. We selected 28 children with normal vision (6/6 without correction) so as to
+match exactly those with impaired vision with respect to age and sex. We obtained 
+informed
+consent of the subjects and their guardians 
+in accordance with the ethical guidelines of the
+Indian Council of Medical Research, New Delhi, India.
+The second part of the study involved 24 children of the 28 assessed in the first part of
+the study. We selected these 24 children because we could match them to form pairs on the
+basis of age, sex, and degree of visual impairment. 
+The method for grading appears below,
+under Measurements. We then randomly assigned subjects of a pair to either of two groups,
+viz., yoga or physical activity. The group average ages ± SD were 14.1 ±1.9 years (yoga
+group) and 14.1 ± 2.2 years (physical activity group).
+Design of the Study
+In the first part of the study, we randomly selected 40 children with ages between 11
+and 17 years from among a total of 340 children attending a special school for persons
+who are blind. Of the 40, we selected 28 children with congenital visual impairment for the
+first part of the study (VI group) because we could exactly match them with 28 children
+with normal sight (NS group). We based matching on age and sex and assessed both groups
+(visually impaired and normal sighted) under similar conditions, described in detail below.
+The second part of the study involved 24 children with impaired vision of the 28
+assessed in the first part of the study. We conducted the baseline assessment in the same
+way as in the first part of the study, 1 month later. After this, the yoga group received training
+in yoga and the physical activity group spent time in an outdoor activity (i.e., gardening)
+for the allotted hour for 5 days a week. The yoga instructor spent an equal amount of time
+with children of both groups. After 3 weeks, we assessed both groups once more, with the
+final assessments performed by the same persons under similar conditions as the baseline
+assessments.
+Measurements
+Recordings for the first part of the study (VI group versus NS group), as well as for the
+second part (yoga versus physical activity group of visually impaired children), took place
+in a moderately lit, sound-attenuated room. After an initial 15-min period of supine rest,
+US
+Telles and Srinivas
+we conducted assessments for 10 min, also in the supine position and with eyes closed. We
+recorded the blood pressure from the right arm using a standard sphygmomanometer while
+the subject was in a seated position. It was not possible to obtain blood pressure records for
+the second part of the study.
+We used a 10-channel polygraph (Polyrite, Recorders and Medicare, Chandigarh,
+India) to record the electrocardiogram (EKG), respiration, and skin resistance level (SRL).
+We recorded the EKG using the standard limb lead I configuration. We recorded skin
+resistance using Ag/AgCl disk electrodes with electrode gel (Medicon, Madras, India)
+placed in contact with the volar surfaces of the distal phalanges of the index and middle
+fingers of the left hand. We used a low-level DC preamplifier and passed a constant current
+of 10 nA. between the electrodes. We recorded respiration using a volumetric pressure
+transducer. Subjects stood erect and an experimenter placed the transducer around the
+trunk, approximately 5 cm below the lower costal margin. We recorded blood pressure with
+a sphygmomanometer.
+We graded degree of visual impairment for all the children with impaired vision as
+follows: grade 0, inability to differentiate between light and dark; grade 1, ability to differ-
+entiate between light and dark; grade 2, ability to perceive gross movements; and grade 3,
+ability to count fingers held at a distance of 30 cm.
+Data Extraction and Analysis
+Data extraction took place similarly for both parts of the study. We obtained heart rates
+(beats per minute) by counting the QRS complexes in successive 60-sec epochs, continu-
+ously, and we similarly calculated breath rate (in cycles per minute) by counting the breath
+cycles in 60-sec epochs, continuously. We sampled SRL at 20-sec intervals and, for data anal-
+ysis, used the average of the values obtained during the 10 minute session for each subject.
+We compared the data for the VI group and the NS group using the Mann-Whitney U
+test. We compared the data for the yoga and physical activity groups obtained at the end of
+3 weeks to the respective baseline data using the Wilcoxon paired signed ranks test.
+Yoga Training
+A trained instructor taught the yoga intervention. Individuals with normal vision learn
+yoga by observing a demonstration while listening to instructions. Persons with visual
+impairment received detailed verbal instructions to compensate. In addition, the instructor
+spent time with each subject correcting their practice (e.g., repositioning their limbs) with
+verbal instructions. Subjects received special emphasis on relaxing between practices and
+being aware of body sensations. Practices included simple yoga postures and yoga breathing
+exercises (50 min), followed by guided relaxation (10 min). Throughout the practices, the
+emphasis was on awareness (of physical and other sensations) and relaxation.
+Physical Activity
+The physical activity group did not learn yoga. During the allotted hour, they spent
+time in the garden doing a comparable amount of physical activity 
+as the yoga group, such as
+bending forward and stretching upward. The yoga instructor spent time with these children
+every day and was equally familiar with them as with the yoga group.
+Autonomic and Respiratory Measures in Children with Impaired Vision
+119
+RESULTS
+Part 1
+In comparison with subjects who had normal sight, subjects with impaired vision
+had significantly higher breath rates, diastolic blood pressure values, and heart rates. For
+breath rate, Za = 2.71 and Z.01(2)a = 2.57, hence p < .01; for diastolic blood pressure,
+Za = 3.79 and Z.001(2)a = 3.20, hence p<.001; and for heart rates, Za = 1.66 and
+Z.05(l)a = 1.64, hence p < .05. The group mean values ± SD appear in Table I.
+Part 2
+There was a significant decrease in the breath rate of the yoga group at the end of
+3 weeks as indicated by the Wilcoxon paired signed ranks test [t = 10, t .05(2)12 = 13, hence
+p < .05]. The group mean values ± SD appear in Table II.
+DISCUSSION
+The present study occurred in two parts. Part 1 showed that children with impaired
+vision had higher diastolic blood pressure values and heart and breath rates compared with
+children of the same age who had normal sight. Comparing children with impaired vision
+randomly assigned to yoga and physical activity (i.e., gardening groups), 3 weeks of yoga
+practice caused a reduction in the rate of breathing.
+Table I. Autonomic Measures in Children with Visual Impairment
+(VI) and Normal Sight (NS) (Group Means ± SD)
+Heart rate (beats/min)
+Breath rate (cycles/min)
+Skin resistance (kf)
+Systolic BP (mm Hg)
+Diastolic BP (mm Hg)
+VI(N = 28)
+88. 
+8 ± 14.5*
+22.8 ±5.4**
+176.7 ± 153.3
+113. 0± 11.5
+76.1 ±6.4***
+NS(N = 28)
+81.6± 11.3
+19.2 ±3.2
+136.9 ± 100.9
+110.7 ±9.5
+66.5 ± 8.9
+Note. Mann-Whitney U test. VI versus NS. N, number of subjects.
+*p<.05(1).
+**p<.0l 
+(2).
+***p<.001 (2).
+Table II. Heart Rate (HR), Rate of Respiration (RR), and Skin Resistance (SR) in Two
+Groups (Yoga, Physical Activity) of Children with Impaired Vision Before and After
+the 3-Week Programs (Group Mean ± SD)
+HR (beats/min)
+RR (cycles/min)
+SR (k£)
+Yoga training (N= 12)
+Before
+89.0 ± 19.4
+21. 
+4 ±6.3
+130.8 ± 124.8
+After
+82.8 ± 13.4
+17.5 ±6.9*
+67.6 ± 74.0
+Physical activity (N = 12)
+Before
+84.7 ±8.1
+22.9 ±5.1
+128.7 ± 103.0
+After
+84.9 ± 12.3
+21. 
+5 ±4.8
+136.3 ± 172.6
+Note. Wilcoxon paired signed ranks test, after versus before. N, number of subjects.
+*p<0.05(2).
+120
+Telles and Srinivas
+An increase in breath rate correlates experimentally with evoked fear and anxiety
+(Ax, 1953) as well as before situations such as parachute jumping (Fenz and Jones, 1972).
+The nature of waveforms recorded in a standard spirogram using a strain gauge transducer
+show that there are different patterns as the immediate response to six selected emotions,
+including fear and anxiety (Bloch et al., 1991). These two emotions are particularly likely to
+cause irregularity of breathing, with frequent periods of breath holding, whereas anger and
+sadness produce regularly recurring abnormal patterns. Visual assessment of the records of
+the children with impaired vision and those with normal sight showed that the former had
+irregular breath cycles with frequent periods of breath holding. This may be due to higher
+levels of fear and anxiety among children with visual impairments. This is in keeping
+with data that indicate higher levels of fear (particularly related to physical injury) among
+children with visual impairments (Ollendick et al., 1985). These subjects were possibly
+apprehensive because they were not familiar with the laboratory. In connection with this,
+it is important to note that the subjects with normal sight were also visiting the laboratory
+for the first time. Also, we made equal effort to reduce the apprehension of both groups by
+explaining the procedure in detail and answering their questions.
+A low resting heart rate is an indicator of routine physical activity (Williams and
+Sperryn, 1962). One study found that children with impaired vision have poor physiological
+adjustment to exercise compared to their normal-sighted counterparts (Hopkins et al., 1987).
+The authors of the study ascribed the findings to an overall lower level of physical activity
+in children with visual impairments. This hypothesis provides an explanation for the higher
+resting heart rates found in the children with impaired vision in the present study and could
+also apply to the higher (though not abnormally so) diastolic blood pressure values, relative
+to the children with normal vision.
+In Part 2, we assessed the effect of two programs (yoga and increased physical activity
+during gardening) using the same parameters as for the first part of the study. Previous
+reports have shown that yoga reduces psychophysiological signs of arousal (e.g., Wallace
+et al., 1971). The present results revealed that the yoga group showed a significant reduction
+in respiratory rate after 3 weeks of practice, but the group who spent time gardening showed
+no change. The reduction in respiratory rate is consistent with previous literature describing
+effects of yoga on the rate of respiration. The practice of yoga reduces the breath rate, both
+as an immediate effect (Wallace et al., 1971) and over a 3-month period (Joseph et al.,
+1981).
+The present study showed that practicing yoga for 3 weeks reduced the breath rate in
+children with impaired vision. Other known effects of yoga practice (e.g., a reduction in heart
+rate or an increase in skin resistance) were not present. In fact, there was a nonsignificant
+decrease in skin resistance following yoga, which was not fully explainable. It is possible that
+the duration of practice required to bring about a change in these parameters among persons
+with visual impairments is longer than that for other individuals because the former have
+higher baseline heart and breath rates and diastolic blood pressure values. The unfamiliar
+laboratory setting may have contributed to these higher values.
+The practice of yoga also modified the irregularity of breathing observed in the baseline
+assessment. These results are similar to the effects of yoga observed in community home
+children (Telles et al., 1997). As described earlier, an increase in breath rate occurs in
+response to fear, anxiety, and other psychological stressors (Ax, 1953).
+Hence, the present results suggest that children with visual impairments have higher
+levels of cardiac sympathetic activation and faster breathing than children with normal
+Autonomic and Respiratory Measures in Children with Impaired Vision
+121
+sight. A comparison of 3 weeks of yoga practice with a physical activity program showed
+that after the practice of yoga, the rate and irregularity of respiration declined among
+children with visual impairments. 
+There were no other significant changes for these subjects.
+Yoga techniques involve increased physical activity, with an emphasis on relaxation and
+awareness. This type of program appears to be useful for children with visual impairments
+to help them reduce irregularities in breathing associated with anxiety.
+ACKNOWLEDGMENTS
+The authors are grateful to the staff and the children of the Raman Maharshi Academy
+for the Blind, Bangalore, India, for their enthusiastic participation in the study.
+REFERENCES
+Ax, A. F. (1953). The physiologic differentiation between fear and anger in humans. 
+Psychosam. Med. 15:433-442.
+Bloch, S., Lemeignan, M., and Aquilera, T. N. (1991). Specific respiratory patterns distinguish among human
+basic emotions. Int. J. Psychoxom. 11: 141-154.
+Fenz, W. D., and Jones, G. B. (1972). Individual differences in physiologic arousal and performances in sports
+parachutists. Psychosom. Med. 34: 1-8.
+Hopkins, W. D., Gaeta, H., Thomas, A. C., and Hill, P. M. (1987). Physical fitness of blind and sighted 
+children.
+Eur. J. Appl. Phyxiol. 56(1): 69-73.
+Joseph, S., Sridharan, S. K. B., Patil, M. D., Kumaria, 
+A., Selvamurthy, 
+W., Joseph, N. T., and Nayar, H. S. (1981).
+Study of some physiological and biochemical parameters in subjects undergoing yogic training. Indian J.
+Med. Res. 74: 120-124.
+Nagendra, H. R. (1989). Yoga—Its Basis and Applications, Vol. I, Vivekananda Kendra Yoga Anusandhan Samas-
+than, Bangalore.
+Ollendick, T. H., Matson, J. L., and Helsel, W. J. (1985). Fears in visually impaired and normal sighted youths.
+Behav. Res. 23(3): 375-378.
+Sheridan, M. D. (1969). Vision screening procedures for very young children or handicapped children. In Gardiner,
+P. A., MacKeith, M. A. C., and Smith, V. (eds.), Aspects of Developmental and Pediatric Ophthalmology.
+Clinics in Developmental Medicine, Heinemann Medical, London, pp. 39-40.
+Telles, S., Narendran, S., Raghuraj, P., Nagarathna, R., and Nagendra, H. R. (1997). Comparison of changes in
+autonomic and respiratory parameters of girls after yoga and games at a community home. Percept. Motor
+Skills 84: 251-257.
+Wallace, R. K., Benson, H., and Wilson, A. F. (1971). A wakeful hypometabolic physiologic state. Am. J. Physiol.
+221:795-799.
+Williams, J. G. P., and Sperryn, P. N. (1962). Sports Medicine, Edward Arnold, London.
+Wycherley, R. J., and Wicklin, B. H. (1970). The heart rate of blind and sighted pedestrians on a town route.
+Ergonomics 13(2): 181-192.
+122
+Telles and Srinivas

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yogatexts/AWARENESS OF COMPUTER¬USE RELATED HEALTH RISKS IN SOFTWARE COMPANIES IN BANGALORE.txt

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+ 
+Indian J Med Sci Vol. 58 No.5, May 2004  
+ 
+AWARENESS OF COMPUTERUSE RELATED HEALTH RISKS IN SOFTWARE 
+COMPANIES IN BANGALORE 
+ 
+SHIRLEY TELLES, RAJENDRA DEGINAL & LOKESH HUTCHAPPA 
+ 
+Sir,  
+There are important physiological, biochemical, somatic and psychological indicators of stress 
+related to work where human computer interaction occurs '. Prevention is the best management 
+of computer-related ailments since it is more effective, lasts longer, and costs less." Among 
+software development organizations worldwide, several are in India, in Bangalore city." Hence 
+this study evaluated the awareness of computer-use related health risks in software companies in 
+Bangalore.  
+ 
+Forty-three software companies in Bangalore were contacted. Twenty companies participated 
+and the manager for human resource development (HRD) filled in a questionnaire.  
+ 
+The questions were: (1) Are you aware that using a computer for over 5 hours a day can cause 
+health problems (yes/no)?; (2) If your answer was 'yes', what was the source of your 
+information? (books/ newspapers/ television/ experience of yourself or others/ other source 
+(specify)); (3) Name three health problems which you think are the most likely to occur; (4) In 
+your company are you using any lifestyle modification strategy? (yes/no); (5) If your answer was 
+'yes', what strategy does the company use? (6) If your answer to Question (4) was 'no', which of 
+the following was the most important reason for not using any strategy? (time constraints/ lack of 
+belief in such strategies/ poor response/ financial constraints/ lack of infrastructure/ no access to 
+a trained person/ any other reason (specify)).  
+ 
+In fifteen companies the number of software engineers was between 100 and 500 and five 
+companies had between 500 and 1000 employees. Seventeen out of twenty HRD managers were 
+aware of the health risks. Eleven had got the information from newspapers, five from the 
+employees' experience, and one from a television program. When asked about the three most 
+likely complaints, fifteen out of seventeen mentioned (i) visual strain, (ii) back pain, and (iii) 
+other musculoskeletal pains. Two mentioned 'psychological strain' and 'weight gain' as other 
+likely hazards. Two others did not know the likely problems. Ten out of seventeen were using 
+some lifestyle modification strategy, while seven were not. The following strategies were used: 
+indoor and outdoor games, yoga including meditation, health checkups, health advice, 
+recreational facilities, and a 'rooftop cafeteria'. The use of these strategies was optional. In the 
+case of the seven companies where no strategy was used, five of them gave the reason that they 
+had 'no access to a trained person to administer the strategy' and for two of them 'time 
+constraints' were the limiting factor.  
+ 
+Hence HRD managers in most software companies are aware of health risks of prolonged 
+computer use and which complaints are most probable. However the management strategies did 
+not seem adequate. In view of the increasing number of software companies across India this 
+topic requires attention.  
+ 
+ 
+ 
+ 
+ 
+ACKNOWLEDGMENT  
+ 
+The project was funded by a grant from the Central Council of Research in Yoga and 
+Naturopathy (CCRYN), Ministry of Health & Family Welfare, Govt. of India.  
+ 
+SHIRLEY TELLES, RAJENDRA DEGINAL & LOKESH HUTCHAPPA  
+Vivekananda Yoga Research Foundation, Bangalore, India E-mail: [email protected]  
+ 
+REFERENCES  
+ 
+1. Smith MJ, Conway FT, Karsh B10 Occupational stress in human computer interaction. Ind 
+Health. 1999;37:157-73.  
+2. Bawa J. Computers and your health. 1996.  
+Celestial Arts: Berkeley,CA.  
+3. Killcrece G., Kossakowski K-P, Ruefle R. et al.  
+Organizational models for computer security incident response teams (CSIRTs). Handbook 
+Carnegie-Mellon University(CMU)/Software Engineering Institute-2003-HB-001-15213-
+3890. 2003. SEI: Pittsburgh, PA.  
+ 

yogatexts/AYURVEDA FOR CHEMO-RADIOTHERAPY INDUCED SIDE EFFECTS IN CANCER PATIENTS_unlocked.txt

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+Journal of Stem Cells 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ISSN: 1556-8539 
+Volume 8, Number 2 
+ 
+ © Nova Science Publishers, Inc. 
+ 
+ 
+ 
+ 
+AYURVEDA FOR CHEMO-RADIOTHERAPY INDUCED SIDE 
+EFFECTS IN CANCER PATIENTS 
+ 
+ 
+ 
+Kashinath Metri1, Hemant Bhargav1, 
+Praerna Chowdhury1, and 
+Prasad S. Koka2, 3‡ 
+1Division of Yoga and Life Sciences, Swami 
+Vivekananda Yoga Anusandhana Samsthana 
+University, 19 Eknath Bhavan, Gavipuram Circle, 
+Kempegowda Nagar, Bangalore, India 
+2Department of Virology and Immunology, 
+Haffkine Institute, Acharya Donde Marg, Parel, 
+Mumbai, India 
+3Laboratory of Stem Cell Biology, Torrey Pines 
+Institute for Molecular Studies, 3550 General 
+Atomics Court, San Diego, California, USA 
+ 
+                                                        
+ Corresponding Authors: Kashinath G Metri, BAMS, MD. 
+Assistant Professor, S-VYASA University. Mob: +91 
+9035257626. Email: [email protected]. 
+ Email: [email protected] 
+‡ Email: [email protected] 
+ABSTRACT 
+ 
+Chemotherapy drugs and radiotherapy are highly toxic and 
+both damage adjacent healthy cells. Side effects may be 
+acute (occurring within few weeks after therapy), 
+intermediate or late (occurring months or years after the 
+therapy). Some important side effects of chemotherapy are: 
+nausea, 
+vomiting, 
+diarrhea, 
+mucositis, 
+alopecia, 
+constipation etc; whereas radiation therapy though 
+administered locally, can produce systemic side effects 
+such as fatigue, anorexia, nausea, vomiting, alteration in the 
+taste, sleep disturbance, headache, anemia, dry skin, 
+constipation  etc. Late complications of these therapies also 
+include pharyngitis, esophagitis, laryngitis, persistent 
+dysphagia, fatigue, hepatotoxicity, infertility and cognitive 
+deficits. These arrays of side effects have a devastating 
+effect on the quality of life of cancer survivors. 
+Due to the inadequacy of most of the radio-protectors and 
+chemo-protectors in controlling the side effects of 
+conventional cancer therapy the complementary and 
+alternative medicines have attracted the view of researchers 
+and medical practitioners more recently. This review aims 
+at providing a comprehensive management protocol of 
+above mentioned chemo-radiotherapy induced side effects 
+based on Ayurveda, which is an ancient system of 
+traditional medicine practiced in Indian peninsula since 
+5000 BC. When the major side effects of chemo-
+radiotherapy are looked through an  ayurvedic perspective, 
+it appears that they are the manifestations of aggravated 
+pitta dosha, especially under the group of disorders called 
+Raktapitta 
+(haemorrhage) 
+or 
+Raktadushti 
+(vascular 
+inflammation). Based on comprehensive review of ancient 
+vedic literature and modern scientific evidences, ayurveda 
+based interventions are put forth. This manuscript should 
+help clinicians and people suffering from cancer to combat 
+serious chemo-radiotherapy related side effects through 
+simple but effective home-based ayurveda remedies. The 
+remedies described are commonly available and safe. These 
+simple ayurveda based solutions may act as an important 
+adjuvant to chemo-radiotherapy and enhance the quality of 
+life of cancer patients. 
+ 
+Keywords: 
+Ayurveda, 
+Cancer, 
+Chemotherapy, 
+Radiotherapy, Side Effects 
+Kashinath Metri, Hemant Bhargav, Praerna Chowdhury et al. 
+116 
+INTRODUCTION 
+ 
+Cancer is a major illness and a leading cause of 
+death world over, causing suffering of large 
+population and global economic loss worldwide [1, 
+2]. There were 12.7 million cancer cases and 7.2 
+million deaths due to cancer worldwide in the year 
+2008 [2]. Thus, studies are being conducted globally 
+to prevent cancer or develop nontoxic therapeutic 
+agents which include those using ayurvedic herbal 
+medications [3]. In the last few decades though there 
+has been tremendous advancement in the diagnostic 
+modalities and treatment of cancer which has 
+increased cancer survival rates, the long term effects 
+of these treatment modalities on the quality of life of 
+the cancer survivors have attracted the attention [4]. 
+ 
+ 
+Conventional Management of Cancer and 
+Its Side Effects 
+ 
+Conventional 
+management 
+of 
+cancer 
+encompasses four major strategies – surgery, radiation 
+therapy 
+(including 
+photodynamic 
+therapy), 
+chemotherapy (including hormonal therapy and 
+molecular targeted therapy) and biologic therapy 
+(including immunotherapy and gene therapy). These 
+modalities are usually given in combination, and they 
+work through different mechanisms to a synergistic 
+effect [5]. Adverse effect of these therapies and drug 
+resistance are two important obstacles in better 
+outcome of treatment and quality of life of the patient 
+respectively. Chemotherapy drugs and radiotherapy 
+are highly toxic and both damage adjacent healthy 
+cells. Most of the patients suffer from adverse effects 
+of chemotherapy and radiation therapy. These side 
+effects may be acute (occurring within few weeks 
+after therapy), intermediate or late (occurring months 
+or years after the therapy) [6]. Some important side 
+effects of chemotherapy are: nausea, vomiting, 
+diarrhea, mucositis, alopecia, constipation etc [5,7]; 
+whereas radiation therapy though administered 
+locally, can produce systemic side effects like fatigue, 
+anorexia, nausea, vomiting, alteration in the taste, 
+sleep disturbance, headache, anemia, dry skin 
+constipation etc. Late complications of these therapies 
+also include pharyngitis, esophagitis, laryngitis, 
+persistent 
+dysphagia, 
+fatigue, 
+hepatotoxicity, 
+infertility and cognitive deficits [5-7]. There is also a 
+possibility of development of secondary cancer due to 
+chemo-radiotherapy [6]. These arrays of side effects 
+have a devastating effect on the quality of life of 
+cancer survivors. 
+To manage these, usually three kind of 
+therapeutic agents are used in conventional medicine; 
+first, which are given to prevent tissue damage before 
+the symptoms appear, they are called protectors, 
+second those that are given during or shortly after a 
+course of radiation therapy (mitigators) and third are 
+the treatments given when toxicity develops months 
+to years after therapy [6]. Due to failure of most of the 
+radio-protectors and chemo-protectors in controlling 
+the side effects of conventional cancer therapy 
+completely, the complementary and alternative 
+medicines have attracted the view of researchers and 
+medical practitioners more recently. This review aims 
+at providing a comprehensive management protocol 
+of above mentioned chemo-radiotherapy side effects 
+based on Ayurveda, which is the most ancient system 
+of traditional medicine of the world that has been 
+practiced in Indian peninsula since 5000 BC [8]. After 
+an extensive literature survey of both traditional 
+ayurvedic texts and modern scientific literature we 
+provide an ayurveda based approach and solution to 
+above mentioned problems. 
+ 
+ 
+Ayurveda Based Approaches towards 
+Mitigating Chemo-Radiotherapy Side 
+Effects 
+ 
+Ayurveda is a well-documented traditional system 
+of medicine [9]. Ayurveda considers human body as 
+an indivisible whole and is based on the principle that 
+health is a state of stability of network of interrelated 
+functions of body, mind and consciousness whereas 
+disease manifests itself as a byproduct of disturbance 
+in the stability of this network [10].  
+According to Ayurveda, vata, pitta and kapha are 
+three basic humors (doshas) responsible for all the 
+physiological processes in the body; vata causes 
+motion, pitta helps metabolism and kapha is 
+responsible for structure or stability. Health is 
+identified as balanced functioning of these three 
+doshas [11].  
+ 
+Ayurveda for Chemo-radiotherapy Induced Side Effects in Cancer Patients 
+117
+Qualities of the Three Doshas 
+ 
+An ancient samskrit ayurvedic text called 
+Ashtanga Samgraha (Ash. Sam.) [12] describes the 
+qualities of three doshas. Literal meaning of the word 
+vata is “air”. The qualities of vata as per ayurvedic 
+science include: dryness, cold, lightness, mobility, 
+penetration and roughness. These are responsible for 
+all kinds of movements in the body such as 
+circulation, nerve impulse, respiration etc [Ash. Sam. 
+19/3 ; ref no. 12].  
+Qualities of pitta mentioned in ayurvedic texts 
+include: heat, sourness and moisture together. Bodily 
+functions 
+such 
+as 
+appetite, 
+thirst, 
+digestion, 
+metabolism, body heat, eyesight, softness of the body, 
+lustre, mental calmness, and intelligence are governed 
+by the pitta dosha. Pitta manifests itself through the 
+processes 
+of 
+digestion, 
+metabolism, 
+oxidation, 
+conjugation, reduction, enzymatic and hormonal 
+activities etc.  
+The third dosa is kapha, which has the qualities 
+of moisture, steadiness, coolness, heaviness, softness 
+and stickiness. Kapha is responsible for body 
+moisture, stability of the joints, firmness of the body, 
+bulk, strength, weight and endurance [Ash. Sam. 19/3 
+; ref no. 12]. 
+ 
+ 
+Chemo-Radio Therapy Side Effects As 
+Manifestations of Aggravated Pitta Dosha 
+ 
+When the major side effects of chemo-
+radiotherapy are looked through an ayurvedic 
+perspective, it appears that they are the manifestations 
+of aggravated pitta dosha especially under the group 
+of disorders called Raktapitta (haemorrhage) or 
+Raktadushti (vascular inflammation). 
+The signs and symptoms of aggravated pitta as 
+per ancient ayurveda texts are: dav (burning 
+sensation), 
+mukhapaka 
+(stomatitis), 
+trushna 
+(excessive thirst), osha (feeling of hot sensation in the 
+body), galpaka (pharyngitis), payupaka (urethritis), 
+gudapaka (proctitis), davatu (acid regurgitation), dava 
+(burning sensation in the oral cavity), abhishandha 
+(conjunctivitis) [Ash. Sam. 20/14; ref no. 12]. 
+Ayurveda 
+texts 
+also 
+mention 
+“atapa 
+sevana” 
+(excessive exposure to sunlight or radiations) as one 
+of the cause for increase in the pitta dosha. This leads 
+to excess of pitta and imbalance in the nature 
+(prakruthi vikruthi). 
+ 
+ 
+Aggravated Pitta Dosha As Fundamental 
+Basis for Management of Chemo-
+Radiotherapy Side Effects 
+ 
+Ayurveda principles describe that to reduce pitta 
+dosha our lifestyle should be such that it promotes 
+other qualities (qualities of kapha and vata) and it 
+should oppose the qualities of pitta. According to the 
+sage Charaka, one of the famous authors of ancient 
+ayurvedic texts, “Virechana” (therapeutic purgation) 
+is the best treatment for aggravated pitta dosha. The 
+line of management is; first – snehana (oleation 
+therapy) with pure or medicated ghee (clarified 
+butter), then followed by virechana (therapeutic 
+purgation) using ayurveda herbal medications such as 
+draksha (vitex venifera or raisins), vidarikhanda 
+(pueraria tuberosa), ikhsuras (saccaurum officinarum 
+or sugar cane juice) and trivrutta (operculina 
+turpethum) and then finally administration of 
+medications (shamana) which are having sweet, 
+astringent, bitter taste and are cold in potency for e.g. 
+draksha, sugarcane, kharjura (phoenix dactylifera or 
+dates), 
+yashtimadhu 
+(glyccrhiza 
+glabra), 
+vasa 
+(adatoda vasika), Chandana (santalum album or 
+sandalwood), ushir (vtiveria zizanioides) preparation 
+containing rose and honey (gulkand), milk and ghee 
+(clarified butter) etc. 
+Along with this one should adopt a cool 
+atmosphere around [Ash. Sam. 21/4; ref no. 12]. 
+Vasadi ghrita (calrified butter medicated with 
+Adatoda Vasika ), shatavaryai ghrita (calrified butter 
+medicated with asparagus racemosa) and kiratatiktadi 
+churna (swetia chirata) are special multidrug 
+preparations recommended by Charaka for treatment 
+of diseases born out of aggravated pitta as mentioned 
+in an authentic ayurveda text called Charak Samhita 
+Chikitasasthana (Cha. Sam.) [Cha. Sam. 4/76, 4/88, 
+4/97; ref no. 13].  
+Figure 
+1 
+shows 
+schematic 
+summary 
+of 
+management of aggravated pitta dosha. 
+ 
+ 
+Kashinath Metri, Hemant Bhargav, Praerna Chowdhury et al. 
+118 
+ 
+Figure1. Schematic Representation of Management of Aggravated Pitta dosha. 
+ 
+AYURVEDA-BASED MANAGEMENT 
+OF COMMON CHEMO-RADIOTHERAPY 
+SIDE EFFECTS IN CANCER PATIENTS 
+ 
+Following paragraphs in this section of the 
+manuscript describe major side effects of chemo-
+radiotherapy one by one along with probable 
+ayurveda based remedies for the problem on the basis 
+of both ancient ayurvedic and modern scientific 
+literature survey: 
+ 
+ 
+Radio-Protective Effects of Ayurveda 
+Polyherbal Preparations 
+ 
+Chavanprash avaleha is a well-known ayurvedic 
+poly herbal preparation, which has Indian gooseberry 
+(embelica officinalis) as its principal component. In a 
+randomised control study, oral administration of 
+another poly herbal ayurvedic preparation called 
+Rasyana avaleha (embelica officinalis is the principle 
+ingredient) has shown significantly better effect in 
+controlling the adverse effects of chemotherapy and 
+radiotherapy than the control group [14]. Similarly in 
+an animal study it was observed that Chavanprash 
+avaleha has a potential radio-protective effect in the 
+animals which are exposed to gamma radiation [15]. 
+A 
+review 
+describes 
+a 
+polyherbal 
+ayurvedic 
+preparation called Triphala which contains three 
+ingredients 
+viz. 
+haritaki 
+(Terminala 
+chebula), 
+vibhitaki (Terminala belerica) and amalaki (Embilica 
+officinalis), as useful in cancer as an anti-cancer, 
+chemo-protective and radio-protective agent [16]. 
+Another ayurvedic herb – guduchi (Tinospora 
+cardifolia) has shown its potent radio protective effect 
+in animal experiments. In an animal study it was 
+found that radiation induced testicular injury was 
+significantly ameliorated in the experimental group 
+who consumed guduchi, leading to significant 
+increase in the body as well as the tissue weight in 
+Ayurveda for Chemo-radiotherapy Induced Side Effects in Cancer Patients 
+119
+comparison with the control group (which was 
+deprived of the herb) [17]. 
+ 
+ 
+Anorexia 
+ 
+Nearly 80% of the cancer patients develop 
+anorexia-cachexia syndrome in advanced stages 
+which is worsened further with the administration of 
+chemotherapy [18]. Anorexia is the commonest 
+chemotherapy side effect and is associated with 
+weight loss, fatigability and decreased appetite which 
+further leads to reduced chances of better outcome 
+and diminished survival [19]. 
+Ayurveda recognizes this condition as arochak in 
+which patient feels loss of interest, hunger, and taste 
+in the food. Ancient ayurvedic treatise called Charak 
+samhita [13] recommends mouth gargles by the liquid 
+formulations made from the herbs such as shunthi 
+(dried ginger) maricha (Black pepper), pippali 
+(Pepper longum) ), lodra (Symplocos racemosa), teja 
+patra 
+(Cinnamomum 
+zeylanicum) 
+and 
+yavaksharas(Hordeum vulgare) [Cha. Sam. 26/217; 
+ref no. 13]. As per Sharangdhar Samhita (Sha. Sam.) 
+Lavangadi churna is another polyherbal preparation 
+indicated for patients suffering from anorexia due to 
+chronic illnesses [Sha. Sam. 6/65-69; ref no. 20], it 
+also improves physical strength. This polyherbal 
+preparation indicated in the diseases of throat 
+tuberculosis, etc. Other important causes of anorexia 
+are oral ulcers and dryness of mouth induced by 
+chemo and radiotherapy. In such cases another multi-
+herb preparation called Khadiradi vati is advised for 
+chewing several times in a day [Cha. Sam. 26/213; ref 
+no. 13]. 
+ 
+ 
+Mucositis 
+ 
+Oral mucositis is one of the common and serious 
+complications 
+of 
+chemotherapy. 
+Chemotherapy-
+induced mucositis is highly painful condition without 
+any definite cure; this condition is an important cause 
+of poor quality of life in cancer patients receiving 
+chemotherapy [21]. 
+As per Charak Samhita, the symptoms of 
+mucositis resemble the sign and symptoms of pittaja 
+mukh roga, which is basically due to increased pitta 
+dosha in the body. Mouth gargles with kalaka churna 
+mixed with liquids such as water and honey is 
+indicated for such health problems, it is written in the 
+text that this treatment cures all types of mouth 
+disorders caused by excess of pitta dosha (i.e. 
+showing signs of inflammation such as heat, redness 
+and burning sensation)[Cha. Sam. 26/195-199; ref no. 
+13]. 
+Recent scientific study showed that local 
+application of Yastimadhu (Glycrrhiza Glabra or 
+licorice) powder (mixed with honey) in the oral 
+cavity, prior to radiotherapy, reduces radiotherapy 
+induced mucositis [22]. Oral application of honey is 
+considered as a simple remedy for skin and mucosal 
+surface damage as a result of radiotherapy [23]. 
+Another ayurvedic herb called arka (caltropus 
+procera) has shown its anti-inflammatory property 
+against chemotherapy induced mucositis [24]. 
+Rectal mucosal damage is also a common 
+complication of radiotherapy in ano-rectal carcinoma. 
+In one study, oral administration of triphala prior to 
+the radiotherapy, daily for consecutive five days, 
+significantly reduced the mucosal damage associated 
+with radiotherapy [25]. 
+ 
+ 
+Nausea and Vomiting 
+ 
+They are the most common occurrence during 
+chemo-radiotherapy. In spite of use of anti-emetic 
+drugs, 70% of patients show persistent symptoms 
+[26]. Ayurveda recognizes this condition as Chardi. 
+Nausea and vomiting induced by chemo-radiotherapy 
+can well correlate with pittaja chhardi (pitta dosha 
+dominant). The treatment mentioned for the same in 
+ayurveda is as follows: Powder of haritaki (terminal 
+chebula) mixed with honey or the Juice of resins or 
+cold water processed with tender leaves of mango 
+(mangifera indica) and jamun (Syzygium Cumini) are 
+all indicated for nausea and vomiting [27]. Multidrug 
+preparations like Kalyanaka Grita, Jivaneeya Ghrita 
+are also useful in the treatment of vomiting. 
+Khandkushmandavaleha a poly-herbal preparation is 
+indicated in various conditions like vomiting, 
+hoarseness of the voice, fatigue, debility, burning 
+sensation and cough [27]. Eladi churna is another 
+multi-drug preparation which has potential of curing 
+any kind of vomiting [Sha. Sam. 6/65-69; ref no. 20]. 
+Kashinath Metri, Hemant Bhargav, Praerna Chowdhury et al. 
+120 
+One scientific study has shown that ginger 
+(Zingiber officinalis) supplementation at daily dose of 
+0.5g-1.0g significantly aids in reduction of the 
+severity of acute chemotherapy-induced nausea in 
+adult cancer patients [26].  
+ 
+ 
+Anemia 
+ 
+Anemia is another common condition in cancer 
+patients receiving chemotherapy. It significantly 
+hampers the quality of life and is an important cause 
+for blood transfusion in cancer patients [28]. 
+Ayurveda mentions anemia under the heading of 
+pandu roga. The treatment of pandu roga includes 
+systemic 
+purificatory 
+therapy 
+(Panchakarma), 
+oleation therapy (internal and external application of 
+medicated oil or ghee) followed by purgation, dietary 
+modifications and oral medications. Charak samhita 
+advocates use of cow’s urine with other formulations 
+for anemia. Cow’s urine with haritaki or with triphala 
+decoction or cow’s milk is also indicated in case of 
+anemia [Cha. Sam. 16/64; ref no. 13]. Dhatriavaleha 
+is one of the best multidrug preparations for 
+panduroga mentioned in ayurveda texts [Cha. Sam. 
+16/16; ref no. 13]. 
+In a recent scientific study Dhatriavaleha was 
+found as a good adjuvant in the management of 
+thalassemia by reducing symptoms of fatigue, 
+abdomen pain, pallor and joint pain in thalassemia 
+patients [29].  
+ 
+ 
+Diarrhoea 
+ 
+Fifty to eighty percent of patients receiving 
+chemotherapy 
+suffer 
+from 
+diarrhea 
+which 
+is 
+contributor to poor quality of life and reduced 
+treatment output [30]. Ayurveda identifies this 
+condition as atisara. pittaja atisara is a type of 
+atisara which is characterized by symptoms of 
+excessive thirst, burning sensation and fainting. These 
+symptoms are commonly found in diarrhea associated 
+with 
+chemo-radiotherapy. 
+Treatment 
+remedy 
+mentioned in ayurveda is pepper powder with honey 
+or butter milk with powder of chitraka. It has 
+potential to cure all kind of diarrheas [Cha. Sam. 
+29/79; ref no. 13]. Pippalyadi yoga and dadimastaka 
+churna are also few of the multi-drug preparations 
+indicated in diarrhea [Cha. Sam. 29/113; ref no. 13, 
+Sha. Sam. 6/65-69; ref no. 20]. 
+Brahmi (Boswellia serrate) [31] and Jatiphala 
+(Myristica fragrans) [32] are other herbs with proven 
+anti-diarrheal properties. 
+ 
+ 
+Sleep Disturbances 
+ 
+Disturbed sleep is a major problem in patients 
+receiving radiotherapy [33]. Ayurveda considers sleep 
+as one of the important components of health. As per 
+ayurveda, disturbed sleep leads to anxiety, worry, 
+stress and vomiting [Cha. Sam. 21/55-56; ref no. 13]. 
+Ayurvedic management of disturbed sleep includes 
+whole body massage, bath, food items such as rice 
+with curd or milk or ghee etc., meat soup of aquatic or 
+forest animals, listening to soft and pleasant music, 
+taking 
+pleasant 
+smell, 
+sleeping 
+in 
+soft 
+and 
+comfortable bed [Cha. Sam. 21/52-54; ref no. 13]. 
+Kshirbala oil and mahamasha oil are considered good 
+for body massage. 
+The herbs Shweta Musli (borivilianum) and 
+Atmagupta (Velvet bean) have significantly increased 
+sleep quality in a scientific study [34]. Methionic 
+extract of another herb called Mundi (S. Indicus) has 
+shown its sedative property [35]. 
+ 
+ 
+Constipation 
+ 
+Constipation is another major problem in patients 
+receiving specific chemotherapeutic agents such as 
+cisplatin [36]. According to ayurveda, increased pitta 
+aggravates vata, which leads to drying up of the colon 
+and causes constipation [37]. 
+Erand tail (caser oil) with the decoction of 
+triphala or milk or with meat soup is indicated in 
+constipation caused by increased pitta and vata dosha 
+[Cha. Sam. 26/27-28; ref no. 13]. Triphala powder 2-
+6 gms with warm water and ghee is considered as 
+good remedy for constipation [Cha. Sam. 26/27-28; 
+ref no. 13]. 
+In a scientific study a polyherbal preparation, 
+which contains ayurvedic herbs such as Isabgol husk, 
+senna extract and triphala, has shown its efficacy and 
+Ayurveda for Chemo-radiotherapy Induced Side Effects in Cancer Patients 
+121
+safety in the management of functional constipation 
+[38]. 
+ 
+ 
+Fatigue 
+ 
+Deterioration of the general physical health with 
+reduced exercise tolerance and muscle strength and 
+fatigue are common manifestations of chemotherapy 
+related side effects [39]. Ayurveda recognizes fatigue 
+as krish or dourbalya and advocates use of drugs 
+which are having the property of promoting strength 
+(Balya). Ashwagandha (Withenia Somnifera) and 
+Shatavari (Asparagus Racemosa) are the famous 
+drugs which are mentioned in this category [Cha. 
+Sam. Sutra 4/7; ref no. 13]. 
+In a randomized control trial, consumption of 
+medicated ghee called Ashwagandha ghrita lead to 
+significant improvement in shoulder stretch and 
+weight bearing capacity. It indicates that this 
+formulation may help in the patient suffering from 
+fatigue [40].  
+Also in many studies anti-tumor activity of 
+Ashwagandha has been reported. In one of them 
+ashwagandha has shown anti-tumor property on 
+chinese hamster ovary (CHO) cells carcinoma, hence 
+it can synergize with conventional therapies of cancer 
+[41]. 
+ 
+ 
+Cognitive Deficits 
+ 
+Nearly 
+61% 
+of 
+the 
+patients 
+receiving 
+chemotherapy have cognitive declines in learning, 
+attention and processing speed and cognitive 
+difficulties in the domains of executive function, 
+memory, psychomotor speed, and attention [42].  
+Ayurveda uses terms like dhriti, medha, smriti 
+etc., which are different facets of cognition. There 
+several drugs mentioned under the heading of Medhya 
+rasayana which improve these facets of cognition 
+[Cha. Sam. chi 1/73; ref no. 13]. Multi-drug 
+formulations 
+like 
+shankhapushpa 
+(Convolvolus 
+pluricaulis), 
+Brahmi 
+(Bacopa 
+monniera), 
+Mandukaparni (Centella asiatica), Vacha etc. are 
+considered as medhya rasayana [Cha. Sam. chi 1/73; 
+ref no. 13]. Chavanprash is one of the rasayana 
+which has vast use as per ayurveda, in relation to 
+cognition, it improves memory and intellect. It also 
+helps in relieving excessive thirst and fatigue which is 
+commonly seen during cancer treatment [Cha. Sam. 
+chi 1/73; ref no. 13].  
+In recent study, Chavanprash has shown its 
+protective effect against memory impairment along 
+with decreased free radical generation and increased 
+scavenging of free radicals [43]. In another animal 
+experimental study ayurvedic herb Brahmi (Bacopa 
+monniera) which is considered as one of the best 
+medhya rasayanas ( which enhances the intellect and 
+memory) has shown its effect improving the special 
+learning performance and enhancing the memory 
+retention [44].  
+Another herb Ashwaganda (Withania Somnifera) 
+has a cognition promoting effect and was found useful 
+in children with memory deficit and in old age people 
+loss of memory [45]. Ashwaganda also been shown to 
+have anti-tumor property in an animal study where it 
+reduced cell proliferation and increased apoptosis 
+[46]. 
+In another animal experiment, a poly herbal 
+preparation 
+containing 
+Withania 
+somnifera 
+(Ashwagandha), Nardostachys jatamansi (Jatamansi), 
+Rauwolfia 
+serpentina 
+(Sarpagandha), 
+Evolvulus 
+alsinoides (Shankhpushpi), Asparagus racemosus 
+(Shatavari), Emblica officinalis (Amalki), Mucuna 
+pruriens (Kauch bij extract), Hyoscyamus niger 
+(Khurasani Ajmo), Mineral resin (Shilajit), Pearl 
+(Mukta Shukhti Pishti), and coral calcium (Praval 
+pishti) has shown significant improvement in learning 
+and memory retrieval [47]. 
+ 
+ 
+Pharyngitis 
+ 
+Phyaryngitis is another common problem in 
+patients receiving chemo-radiotherapy. A spray 
+prepared from five aromatic essential oils (Eucalyptus 
+citriodora, Eucalyptus globulus, Mentha piperita, 
+Origanum syriacum, and Rosmarinus officinalis) has 
+shown better immediate relief from the symptoms of 
+sore throat than placebo control group [48]. 
+ 
+ 
+ 
+ 
+ 
+Kashinath Metri, Hemant Bhargav, Praerna Chowdhury et al. 
+122 
+Skin Toxicity 
+ 
+Cutaneous adverse effects are among the more 
+common adverse effects of newer antitumor drugs, 
+they occur in up to 34% of patients receiving 
+multikinase inhibitors, up to 90% of those receiving 
+selective tyrosine kinase inhibitors (such as EGFR or 
+mutant BRAF inhibitors) and up to 68% of those 
+receiving immunotherapeutic agents (such as CTLA4 
+inhibitors) 
+[49]. 
+Commonly 
+found 
+cutaneous 
+conditions side effects are - sebostasis, epidermal 
+atrophy, xerosis cutis, itching, dry eczema and 
+vulnerability of the skin to fissures - especially on the 
+fingers, toes, and heels [49]. 
+The above mentioned symptoms of the skin 
+toxicity due to chemotherapy or radiotherapy are 
+similar to skin disease due to increased vata dosha as 
+mentioned in the Charaka samhita. While describing 
+the treatment of these conditions Charaka mentioned 
+Abhyanga (massage) and swedana karma (sudation 
+therapy) and basti (enema) for vata related disorders 
+[Cha. Sam. chi 28/30; ref no. 13]. Bala taila is 
+mentioned in the context of treatment of vata related 
+disorders. This oil can be used for massage, enema or 
+internal use also. So body massage with bala taila 
+may help to overcome skin related problems due to 
+chemotherapy or radiotherapy [Cha. Sam. Chi. 
+28/148-154; ref no. 13]. 
+ 
+ 
+Infertility 
+ 
+Cancer treatment affects fertility through both 
+psychological as well as physiological effects; 
+infertility could cause long-term distress [50].  
+Ayurveda has explained in detail about male 
+infertility under the heading klaibya and female 
+infertility under vandhya. Regarding the treatment in 
+both male and female infertility Sage Charaka 
+prescribed all the therapeutic cleansing procedures. 
+These procedures are vamana (emesis therapy), 
+virechana (therapeutic purgation), basti (enema with 
+medicated decoctions or oils) etc. Once cleansing is 
+over one should follow the prescribed dietary 
+regimens [Cha. Sam. chi 30/45, 30/196; ref no. 13]. 
+ 
+ 
+Male Infertility and Ayurveda 
+ 
+This condition is called klaibya in ayurveda. The 
+therapy which is given to maintain or regain the 
+fertility in order to have good progeny is called 
+vajikarana. Bhavprakash (Bha. Pra.) is another 
+ayurveda text which describes that one should avoid 
+everything which is the cause of the infertility [Bha. 
+Pra. 72/22; ref no. 51]; stress anxiety are given as the 
+common factors which contribute to infertility along 
+with chemotherapy. These factors can be removed by 
+the help yoga brahatashatavari grita, which is poly-
+herbal preparation indicated for problems related to 
+reproductive system both in male and female [Bha. 
+Pra. 26/30; ref no. 51]. Several single drugs and poly-
+herbal preparations are mentioned in ayurveda texts 
+for infertility. Wheat powder cooked with milk along 
+with cow ghee [Bha. Pra. 72/39; ref no. 51] or milk 
+preparation with powder of wheat mixed with powder 
+of kapikachhu (Mucuna pruriens) should be taken first 
+then one should drink the milk which is also good 
+aphrodisiac [Bha. Pra. 72/39; ref no. 51]. Several 
+multidrug preparations like gorakshadi modak, 
+amrapaka, vanari vati are also considered as few of 
+the best aphrodisiac agents [Bha. Pra. 25/27; ref no. 
+51]. 
+In a recent clinical study on the Ayurvedic herb 
+Mucuna pruriens (Kapikachhu), which is considered 
+as a best among the Aphrodisiac, has significantly 
+reduced psychological stress and seminal plasma lipid 
+peroxide levels along with significant improvement in 
+the sperm count and motility at the end of three 
+months [52]. In an animal experiment, herb Tribulus 
+terrestris also mentioned as Gokshura in the 
+Ayurvedic text, has shown its aphrodisiac property by 
+increasing mount frequency, intromission frequency, 
+and penile erection index, as well as a decrease in 
+mount latency and intromission latency along with 
+increase in the serum testosterone levels [53]. 
+ 
+ 
+Female Infertility 
+ 
+Infertility is common in women receiving 
+chemotherapy [54]. Vandhya is the term used to 
+denote this condition in females in Ayurveda. Like in 
+male infertility female also should undergo systemic 
+cleansing procedures and then oral medication. 
+Ayurveda for Chemo-radiotherapy Induced Side Effects in Cancer Patients 
+123
+Following are the few remedies told in the Ayurveda - 
+as the first and for most line of treatment, the women 
+should avoid all foods and lifestyles that aggravate 
+this problem. The herb of choice for female infertility 
+is ashoka (Saraca asoca Roxb De Wilde) – by its 
+astringent taste and cold potency, it strengthens the 
+uterus. It stops bleeding by contracting the uterine 
+blood vessels and promoting uterine muscular 
+contraction. 
+It 
+stimulates 
+uterine 
+function 
+by 
+stimulating the decidual and ovarian functions. 
+Kumari (Aloe vera) is another herb that improves 
+blood flow to the decidual membrane and it stimulates 
+uterine musculature to contract. It thus improves the 
+menstrual flow. It should not be given during 
+pregnancy as it may cause abortion [55]. It is useful in 
+inducing ovulation. Shatavari (Asperagus recemosus) 
+also nourishes the uterus and gives strength to the 
+muscles. It induces ovulation and it also prevents 
+abortion or miscarriage. Ashokarista (fermented 
+medicine which is prepared by using Saraca asoca and 
+other herbs) is most commonly used to regulate the 
+menstrual cycle, improve endometrium and to 
+stimulate ovulation. From the 4th day of the 
+menstruation, Ashokarista, in combination with 
+Kumaryasava (fermented medicine which is made by 
+using Aloe vera and other herbs) should be given. It is 
+usually combined with Aloes compound [a tablet 
+which is made by using Aloe vera, Manjista (Rubia 
+cardifolia), etc], Rajapravrtinivati (asafoetida, etc) to 
+induce ovulation [55].  
+ 
+ 
+Ayurvedic anti-oxidants 
+ 
+Psychological stress due to cancer diagnosis and 
+cancer treatment itself can be cause for deficiency of 
+anti-oxidants. Deficiency of anti-oxidants may have 
+impact on tolerance of normal tissue to antitumor 
+treatment and anti-oxidant supplements may lead to 
+dose reductions and compromised treatment outcome 
+[56].  
+Recently, studies have been conducted on the 
+Ayurvedic medicinal herbs and many of them are 
+found to be rich in antioxidants. Amalaki Rasayana 
+(AR) is one among them. AR is a polyherbal 
+preparation mentioned in the Charaka Samhita, it 
+revitalizes and rejuvenates the cells to work against 
+age-related deterioration. In one of the in-vitro studies 
+on methanoic extract of AR, its antioxidant property 
+and free radicals scavenging activity have been 
+demonstrated [57]. Selagenella bryipteris is another 
+ayurvedic herb with proven anti-cancer, anti-oxidant, 
+ani-inflammatory and chemo protective activity [58]. 
+Other drugs such as vyaghra nakhi (Capparis 
+zeylanica), amalaki (Amlica officinalis), bhunimba 
+(Andrographis 
+paniculata), 
+Mango 
+(Mongefera 
+indica), haritaki (Terminalia chebula), Brahmi (Bopa 
+monniera) etc. are other powerful anti-oxidants [59-
+61]. One of the most well-known preparations called 
+Triphala is a polyherbal ayurvedic compound which 
+contains three ingredients viz. Haritaki (Terminala 
+chebula), vibhitaki (Terminala belerica) and Amalaki 
+(Embilica officinalis). It is a potent anti-oxidant and 
+laxative. Experimental studies on triphala have 
+emphasized its importance as an anti-cancer, chemo-
+protective and radio-protective agent, especially 
+Haritaki 
+have 
+been 
+shown 
+to 
+reduce 
+lipid 
+peroxidation by increasing the glutathione levels [62-
+63]. 
+ 
+ 
+Hepatotoxicity 
+ 
+Many of the chemotherapeutic agents are 
+hepatotoxic and they commonly cause hepatic injury 
+in the patients [64]. 
+Ayurveda identifies abnormalities related to liver 
+by the term yakrittodar. It is associated with 
+symptoms of fatigue, anorexia, constipation, nausea, 
+vomiting, excessive thirst, emaciation, mild fever, 
+loss of taste, abdominal distension, indigestion, 
+prominent veins on the abdomen fainting, dyspnoea 
+and cough [Cha. Sam. Chi. 13/38, ref no. 13].  
+Ayurveda recommends systemic purificatory 
+therapy (panchakarma) depending on dominancy of 
+the dosha (considering the strength of the patient). 
+Massage, medicated enemas and intake of milk are 
+strongly 
+recommended. 
+Oral 
+administration 
+of 
+different poly-herbal preparations is also given for 
+long term [Cha. Sam. Chi. 13/67; ref no. 13]. 
+The multi-drug preparations such as rohitaka 
+ghrita, 
+panchakola 
+ghrita, 
+pippalyadi 
+churna 
+panchgavya ghrita etc. are recommended in such 
+conditions associated with liver and abdominal 
+diseases [Cha. Sam. chi 13/83-85, 13/149, 13/79; ref 
+no. 13]. 
+Kashinath Metri, Hemant Bhargav, Praerna Chowdhury et al. 
+124 
+In a recent animal study where albino rats were 
+exposed to gamma radiations, the rats treated with 
+Ashwagandha 
+(Withenia 
+somnifera) 
+showed 
+significant reduction in serum hepatic enzymes, DNA 
+damage, malondialdehyde (MDA levels), hepatic 
+nitrates and significant increase in heme-oxygenase, 
+super oxide dismutase and glutathione peroxidase 
+activity respectively, as compared to the controls. 
+This suggests its hepato-protective and anti-oxidant 
+enhancing effect against radiation induced hepato-
+toxiticity [65]. In another animal study, root extract of 
+ayurveda herb Himsra (Capparis sepiaria L) was 
+found to have significant hepato-protective property 
+against acetaminophen induced hepatotoxicity [66]. 
+Similarly, ayurvedic polyherbal formulation called 
+Punarnavastaka kwath has also been demonstrated to 
+have hepato-protective property against CCL-4 
+induced hepatotoxicity [67]. Liv 52 is another multi-
+herb preparation proven to have hepato-protective 
+effects against CCL-4 induced liver toxicity [68]. 
+Kumaryasava 
+is 
+another 
+important 
+polyherbal 
+compound shown to reduce liver weight that is 
+increased due to CCL-4 induced hepatotoxicity [68]. 
+Table 1 summarizes all major chem.-radiotherapy 
+related side effects and ayurveda based remedies for 
+them. 
+ 
+Table 1. Summary of Chemo-radiotherapy side effects and Ayurveda based remedies 
+ 
+S. No. 
+Side effects of 
+chemo-radiotherapy 
+Ayurvedic remedy 
+Classical 
+Research based 
+1 
+Mucositis 
+Khadiradi vati for chewing 
+Mouth gargles with kala churna [ Cha. Sam. 
+26/195-199; ref no. 13] 
+Oral application of Yestimadhu powder 
+with honey [22] 
+Triphala administration for five day prior 
+to chemo [23] 
+2 
+Nausea and Vomiting 
+powder of Haritaki with honey or 
+Khandkushmandavaleha [28] 
+Eladi churna [29] 
+Gut-Gard a extract from the ayurvedic 
+herb Yestimadhu (glycrrhiza glabra) 
+[Kadur Ramamurthy Raveendra et al] 
+2012 
+Ginger supplementation [26] 
+3 
+Anaemia 
+Oliation, purgation, oral intake cows urine 
+with milk or 
+Cow’s urine with decoction of triphala for 7 
+days [ Cha. Sam. 16/64; ref no. 13] 
+Dhatriavaleha [29] 
+4 
+Diarrhoea 
+Pippali powder with honey then butter milk 
+with powder of chitraka or Pippalyadi yoga 
+[ Cha. Sam. 29/79; ref no. 13] 
+Dadimashtaka churna 
+[ Cha. Sam. 29/113; ref no. 13, Sha. Sam. 
+6/65-69; ref no. 20] 
+Extract from herb Brahmi [31] and 
+Jatiphala 
+[32] 
+5 
+Constipation 
+Triphala with warm water and ghee(evidence 
+based) 
+[Cha. Sam. 26/27-28; ref no. 13] 
+Constipation caused by vata and pitta castor 
+oil (Erand taila) with decoction of triphala 
+or milk or meat soup. [56,47] 
+Isab husk, senna extract and Triphala. 
+TLPL/AY/01/2008 
+[Cha. Sam. 26/27-28; ref no. 13] 
+6 
+Pharyngitis 
+Khadiradi vati for chewing 
+Spray of five aromatic plant oils [48] 
+7 
+Sleep problem 
+Whole body massage, bath, rice with curd or 
+ghee or milk etc. music, comfortable bed, 
+cuddling before sleeping. 
+[Cha. Sam. 21/52-54; ref no. 13] 
+Methoinic extract of Mundi (Sphaeranthus 
+indicus) has sedative effect [35] 
+dietary supplement of Shweta musli and 
+atmagupta [43] 
+8 
+Hepatotoxicity 
+Panchakola ghrita 
+Rohitaka ghrita 
+[Cha. Sam. chi 13/83-85, 13/149, 13/79; ref 
+no. 13]. 
+Punarnavashtaka kwath [65] 
+Syr Liv 52 [68] 
+Syr Kumaryasav [68] 
+ 
+Ayurveda for Chemo-radiotherapy Induced Side Effects in Cancer Patients 
+125
+S. No. 
+Side effects of 
+chemo-radiotherapy 
+Ayurvedic remedy 
+Classical 
+Research based 
+9 
+Male Infertility 
+Gokshuradi modaka 
+[Bha. Pra. 25/27; ref no. 51]. 
+Mucuna pruriens [52] 
+10 
+Female infertility 
+Brahatashatavari Ghrita 
+Ashokarista [55] 
+11 
+Fatigue 
+Ashwagandha , Shatavari 
+[Cha. Sam. Sutra 4/7; ref no. 13] 
+Ashwagandha ghrita [41] 
+12 
+Skin changes 
+Massage with bala taila 
+[Cha. Sam. chi 28/30; ref no. 13] 
+ 
+13 
+Cognitive deficit 
+Kalyanaka GritaCharaka chikatsa 9 
+Chavanprash 
+[Cha. Sam. chi 1/73; ref no. 13]. 
+Chavanprash [43] 
+Ashwagandha [46] 
+ 
+ 
+ 
+Ayurvedic drugs having anti-cancer 
+property: Scientific Evidences 
+ 
+In series of animal experiments Wathaferin A, a 
+constituent of Ashwagandha (Withenia somnifera) has 
+been found effective in reducing mammary tumor 
+size, microscopic tumor area and incidences of 
+pulmonary metastasis [69-70]. It is being shown that 
+Aswagangadha selectively kills cancer cells by 
+inducing of ROS-signaling [71]. In another study, 
+Bhandirah (Clerodendrum viscosum) was shown to 
+have selective bioactivity against cervical cancer 
+cells, its pro-apoptotic, anti-proliferative, and anti-
+migratory activities were demonstrated in a dose-
+dependent fashion against cervical cancer cell lines 
+[72]. In one of the studies, Haridra (Curcuma longa) 
+with an active ingredient of curcumin was shown to 
+bind to cancer cell surface membrane and then 
+infiltrate into cytoplasm to initiate apoptotic process. 
+It was also reported that curcumin induced growth 
+inhibition and cell cycle arrest at G2/M phase in the 
+glioblastoma and medulloblastoma cells. This shows 
+that 
+curcumin 
+has 
+anti-cancer 
+property 
+[73]. 
+Manjistha (Rubia cardifolia) is another widely used 
+herb. Recent in-vitro study used its methanolic extract 
+to induce apoptosis in HEP-2 (Human laryngeal cell 
+line) as evidenced by cytotoxicity, morphological 
+changes and modification in the levels of pro-oxidants 
+[74]. Another study showed that aqueous extract of 
+Palash 
+(Butea 
+monosperma) 
+inhibited 
+cell 
+proliferation and accumulation of cells in G1 phase. 
+Also there was a marked reduction in the levels of 
+activated Erk1/2 and SAPK/JNK along with induction 
+of apoptotic cell death [75]. Triphala is another useful 
+ayurveda formulation for treatment and prevention of 
+cancer [76].  
+ 
+ 
+Ayurveda for Inhibition of Cancer Stem 
+Cells: Hypothesis 
+ 
+Many studies report association of inflammation 
+and cancer. The identification of transcription factors 
+such as NF-κB, AP-1 and STAT3 and their gene 
+products such as tumor necrosis factor, interleukin-1, 
+interleukin-6, chemokines, cyclooxygenase-2, 5-
+lipooxygenase, matrix metalloproteases, and vascular 
+endothelial growth factor have provided the molecular 
+basis for the role of inflammation in cancer [77]. 
+These inflammatory pathways may get activated by 
+tobacco, stress, dietary agents, obesity, alcohol, 
+infectious agents, irradiation, and environmental 
+stimuli. These pathways have been implicated in 
+transformation, cancer cell survival, proliferation, 
+invasion, chemo-resistance, and radio-resistance in 
+cancer. The survival and proliferation of most types of 
+cancer cells themselves appear to be dependent on the 
+activation of these inflammatory pathways through 
+their precursors, presumably cancer stem cells [77].  
+Ayurveda works on the fundamental principles of 
+tridosha and panchamahabhuta (five basic elements 
+of nature). According to ayurveda the inflammatory 
+process is manifestation of abnormally increased pitta 
+dosha. Most of the above mentioned herbs in the 
+management of chemo-radiotherapy side effects are 
+pitta dosha mitigating and thus, these herbs may 
+indirectly inhibit growth of cancer stem cells via 
+reducing inflammation. Further scientific studies are 
+needed in this area. Till now one study on methanolic 
+extract of the whole fruit of bitter melon also called 
+Kashinath Metri, Hemant Bhargav, Praerna Chowdhury et al. 
+126 
+karravella (Momordica charantia) has shown dose-
+dependent reduction in the number and size of 
+colonospheres. The extracts also inhibited cancer stem 
+cells by reducing the expression of DCLK1 and Lgr5, 
+which are markers of quiescent and activated stem 
+cells [78]. 
+Rasayana is one among the eight limbs of 
+ayurvedic treatment which acts through various ways. 
+The emerging data suggest that the possible 
+mechanisms 
+may 
+be 
+by 
+immune-stimulation, 
+quenching 
+free 
+radicals, 
+enhancing 
+cellular 
+detoxification mechanisms; repair damaged non-
+proliferating cells, inducing cell proliferation and self-
+renewal of damaged proliferating tissues, and 
+replenishing them by eliminating damaged or mutated 
+cells with fresh cells [79]. These rasayana may also 
+inhibit cancer stem cells; future studies should test the 
+effect of these groups of medications on cancer stem 
+cell survival and growth. 
+ 
+ 
+CONCLUSION 
+ 
+This manuscript highlights a very important area 
+of chemo-radiotherapy induced side effects in cancer 
+patients. All the major and common side effects are 
+covered and based on comprehensive review of 
+ancient vedic literature and modern scientific 
+evidences, ayurveda based management strategies are 
+put forth. This manuscript should help clinicians and 
+people suffering from cancer to combat serious 
+chemo-radiotherapy related side effects through 
+simple but effective home-based ayurveda remedies. 
+The remedies described are commonly available and 
+safe. These simple ayurveda based solutions may act 
+as an important adjuvant to chemo-radiotherapy and 
+enhance the quality of life of cancer patients. Future 
+studies 
+should 
+scientifically 
+test 
+these 
+recommendations for various side effects induced by 
+conventional management of cancer. 
+ 
+ 
+ACKNOWLEDGMENT 
+ 
+Dr. Prasad S Koka is funded by Ramalingaswami 
+Fellowship Re-entry Scheme of the Department of 
+Biotechnology, Government of India, New Delhi.  
+ 
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yogatexts/Acute effects of 3G mobile phone radiations on frontal haemodynamics during a cognitive task in teenagers.txt

@@ -0,0 +1,1733 @@
+Full Terms & Conditions of access and use can be found at
+http://www.tandfonline.com/action/journalInformation?journalCode=iirp20
+Download by: [14.139.155.82]
+Date: 27 July 2016, At: 04:08
+International Review of Psychiatry
+ISSN: 0954-0261 (Print) 1369-1627 (Online) Journal homepage: http://www.tandfonline.com/loi/iirp20
+Acute effects of 3G mobile phone radiations on
+frontal haemodynamics during a cognitive task
+in teenagers and possible protective value of Om
+chanting
+Hemant Bhargav, Manjunath N. K., Shivarama Varambally, A.
+Mooventhan, Suman Bista, Deepeshwar Singh, Harleen Chhabra, Ganesan
+Venkatasubramanian, Srinivasan T. M. & Nagendra H. R.
+To cite this article: Hemant Bhargav, Manjunath N. K., Shivarama Varambally, A. Mooventhan,
+Suman Bista, Deepeshwar Singh, Harleen Chhabra, Ganesan Venkatasubramanian,
+Srinivasan T. M. & Nagendra H. R. (2016) Acute effects of 3G mobile phone radiations
+on frontal haemodynamics during a cognitive task in teenagers and possible
+protective value of Om chanting, International Review of Psychiatry, 28:3, 288-298, DOI:
+10.1080/09540261.2016.1188784
+To link to this article:  http://dx.doi.org/10.1080/09540261.2016.1188784
+Published online: 07 Jun 2016.
+Submit your article to this journal 
+Article views: 135
+View related articles 
+View Crossmark data
+Citing articles: 1 View citing articles 
+ORIGINAL ARTICLE
+Acute effects of 3G mobile phone radiations on frontal haemodynamics
+during a cognitive task in teenagers and possible protective value of
+Om chanting
+Hemant Bhargava, Manjunath N. K.a, Shivarama Varamballyb, A. Mooventhana, Suman Bistaa,
+Deepeshwar Singha, Harleen Chhabrab, Ganesan Venkatasubramanianb, Srinivasan T. M.a and
+Nagendra H. R.c
+aAnvesana Research Laboratories, Division of Yoga and Life Sciences, S-VYASA Yoga University, Bangalore, India; bDepartment of
+Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; cS-VYASA Yoga University,
+Bangalore, India
+ABSTRACT
+Mobile phone induced electromagnetic field (MPEMF) as well as chanting of Vedic mantra ‘OM’
+has been shown to affect cognition and brain haemodynamics, but findings are still inconclusive.
+Twenty right-handed healthy teenagers (eight males and 12 females) in the age range
+of 18.25 ± 0.44 years were randomly divided into four groups: (1) MPONOM (mobile phone ‘ON’
+followed by ‘OM’ chanting); (2) MPOFOM (mobile phone ‘OFF’ followed by ‘OM’ chanting); (3)
+MPONSS (mobile phone ‘ON’ followed by ‘SS’ chanting); and (4) MPOFSS (mobile phone ‘OFF’
+followed by ‘SS’ chanting). Brain haemodynamics during Stroop task were recorded using a
+64-channel fNIRS device at three points of time: (1) baseline, (2) after 30 min of MPON/OF expos-
+ure, and (3) after 5 min of OM/SS chanting. RM-ANOVA was applied to perform within- and
+between-group comparisons, respectively. Between-group analysis revealed that total scores on
+incongruent Stroop task were significantly better after OM as compared to SS chanting
+(MPOFOM vs MPOFSS), pre-frontal activation was significantly lesser after OM as compared to SS
+chanting in channel 13. There was no significant difference between MPON and MPOF conditions
+for Stroop performance, as well as brain haemodynamics. These findings need confirmation
+through a larger trial in future.
+ARTICLE HISTORY
+Received 8 January 2016
+Revised 10 April 2016
+Accepted 7 May 2016
+Published online 2 June 2016
+KEYWORDS
+Electro-magnetic field;
+mobile phone; om chanting;
+pre-frontal activation; Stroop
+Introduction
+With over 5.9 billion reported mobile phone users,
+mobile phone constitutes to a new rapidly growing
+exposure network in the world, putting almost all the
+humans into a wide spectra of electromagnetic radi-
+ation. Mobile phones emit a radiofrequency electro-
+magnetic field (MPEMF), a large part of energy of
+which is absorbed into the user’s head (Schonborn,
+Burkhardt, & Kuster, 1998). Accumulating evidence
+suggests that MPEMF may alter brain physiology.
+Modulating effects of MPEMF on the human electro-
+encephalogram in waking and sleep have repeatedly
+been demonstrated in recent years, while results on
+cognitive
+performance
+are
+inconsistent
+(Regel
+&
+Achermann, 2011). The lack of a validated tool, which
+reliably assesses changes in cognitive performance
+caused by MPEMF exposure, may contribute to the
+current
+inconsistency
+in
+outcomes
+(Regel
+&
+Achermann, 2011). Some behavioural studies have sug-
+gested that EMF might have a facilitative effect on
+cognitive performance (Preece et al., 2005; Smythe &
+Costall, 2003), although more recent studies primarily
+revealed an impairment of mental abilities or no effect
+at all (Haarala, Aalto et al., 2003; Haarala, Bj€
+ornberg
+et al., 2003; Regel & Achermann, 2011). Results of a
+meta-analysis suggested that MPEMF might have a
+small impact on human attention and working mem-
+ory
+(Barth,
+Ponocny,
+Ponocny-Seliger,
+Vana,
+&
+Winker, 2010). All these studies have chiefly been per-
+formed on adults and children. Studies on teenage
+group are lacking. This age-group is among the most
+prolific users of mobile phones, which puts them at
+higher risk for MPEMF exposure-related effects (Aydin
+et al., 2011).
+Functional near-infrared spectroscopy (fNIRS) is a
+new non-invasive optical method that can measure the
+real
+time
+change
+in
+oxygenated
+haemoglobin
+(oxyHb) and deoxygenated haemoglobin (deoxyHb)
+concentrations and their sum, i.e. total haemoglobin
+(totalHb) or blood volume in the brain areas, suggesting
+CONTACT Hemant Bhargav
+[email protected]
+Anvesana Research Laboratories, Division of Yoga and Life Sciences, S-VYASA Yoga
+University, Bangalore, India
+ 2016 Institute of Psychiatry
+INTERNATIONAL REVIEW OF PSYCHIATRY, 2016
+VOL. 28, NO. 3, 288–298
+http://dx.doi.org/10.1080/09540261.2016.1188784
+Downloaded by [14.139.155.82] at 04:08 27 July 2016 
+activation (increase in oxygenation) or deactivation
+(reduction in oxygenation) of a particular brain area
+(Ferrari & Quaresima, 2012). An fNIRS device has
+excellent temporal resolution, and fNIRS results are
+physiologically comparable to fMRI and PET results
+(Obrig & Villringer, 2003). In a study using fNIRS, local
+cerebral blood flow (CBF) on short-term exposure to
+MPEMF was measured in 26 boys, aged 14–15 years.
+Temperatures were also measured from both ear canals,
+and skin temperatures at several sites of the head,
+trunk, and extremities. It was found that local CBF and
+ear canal temperature did not change and the auto-
+nomic nervous system was not interfered with by
+MPEMF (Lindholm et al., 2011). The study showed the
+utility of fNIRS for EMF-related research. Compared to
+previous studies using PET, fNIRS provides a much
+higher time resolution, which allows investigation of
+the short-term effects of EMF non-invasively, without
+the use of radioactive tracers and with high sensitivity.
+The Stroop task is a useful test of selective attention
+and
+inhibition
+and
+involves
+frontally
+mediated
+cognitive processes such as response inhibition and
+interference
+resolution
+(Stroop,
+1935).
+Functional
+neuro-imaging studies have found several areas of the
+prefrontal cortex that appear to be specifically acti-
+vated during the performance Stroop task. The Stroop
+task has been used in several PET, fMRI, and fNIRS
+studies (Taylor, Kornblum, Lauber, Minoshima, &
+Koeppe, 1997).
+OM is a cosmic sound that has a harmonizing effect
+on the system (Kumar, Nagendra, Manjunath, Naveen,
+& Telles, 2010). An fMRI study assessed neuro-haemo-
+dynamic correlates of ‘OM’ chanting and found signifi-
+cant deactivation in bilateral orbito-frontal, anterior
+cingulate, para-hippocampal gyri, thalami, and hippo-
+campi, and right amygdala as compared to chanting of
+the sound Ssss or ‘SS’. Since similar observations have
+been recorded with vagus nerve stimulation treatment
+which
+is
+used
+in
+depression
+and
+epilepsy
+management, the study findings argued for a potential
+role of OM chanting in clinical practice (Kalyani,
+Venkatasubramanian, Arasappa, Rao, Kalmady, Behere,
+et al., 2011). Another recent study used fNIRS to assess
+the immediate effect of 20 min of OM meditation (men-
+tal chanting with effortless defocusing on syllable ‘OM’)
+on Stroop task and found better performance and effi-
+ciency (deactivation of pre-frontalcortices) after OM
+meditation (Deepeshwar, Vinchurkar, Visweswaraiah,
+& Nagendra, 2014).
+Very few studies have assessed the effect of MPEMF
+exposure on cognitive functions and brain haemo-
+dynamics in adolescent population using fNIRS (Kwon
+& H€
+am€
+al€
+ainen,
+2011). Similarly, the effect of OM
+chanting on the above variables after mobile phone
+exposure has not been assessed before. We hypothe-
+sized that MPEMF exposure of 30 min would affect
+Stroop
+task
+performance
+and
+pre-frontal
+haemo-
+dynamics during the task in teenagers, and OM chant-
+ing of 5 min following MPEMF exposure will have a
+balancing effect on changes induced by MPEMF. The
+present pilot study was planned to assess feasibility of
+the protocol for future larger trails.
+Materials and methods
+Participants
+We enrolled 20 right-handed teenagers (eight males
+and 12 females) in the age range of 18.25 ± 0.44 years
+from educational institutes in Bangalore city of India.
+All subjects were healthy, as assessed by general health
+questionnaire (GHQ-12), their mean GHQ score was
+0.8 ± 0.69,
+and
+average
+body
+mass
+index
+was
+21.7 ± 3.7 kg/m2. Subjects were fresh admissions in an
+undergraduate degree course after recently clearing
+their higher secondary school examinations and their
+last academic performance was with an aggregate of
+72.48 ± 11.3%, suggesting absence of mental retardation
+or other significant psychological morbidity. Subjects
+who were able to read and write in English language
+were selected. Subjects who had visual disturbances or
+colour blindness (screened using Ishihara Charts) or
+those with a peak flow rate below 150 L/min were
+excluded; those who were regular meditators or who
+were regularly chanting OM (or other similar mantras)
+for the last 1 month or more were also excluded.
+Similarly, female subjects were excluded during men-
+struation. Subjects were given a week long orientation
+in performing OM chanting or producing the sound
+‘sssss
+. . .’
+(SS)
+for
+same
+duration
+before
+the
+assessments.
+Study design
+A four groups randomized controlled design was fol-
+lowed. Each subject was exposed to mobile phone on/
+off for 30 min and then was asked to chant OM or SS
+for 5 min. Depending on the status of phone (on or off)
+and whether it is followed by chanting OM or SS, sub-
+jects
+were
+randomly
+divided
+into
+four
+groups.
+Randomization was performed using an online ran-
+domization program (www.randomizer.org). It was gen-
+der-stratified randomization to include equal number of
+males and females (two males and three females) in
+each
+group.
+Four
+groups
+were
+as
+follows:
+(1)
+INTERNATIONAL REVIEW OF PSYCHIATRY
+289
+Downloaded by [14.139.155.82] at 04:08 27 July 2016 
+MPONOM group: In this group, subjects were exposed
+to MPEMF through a mobile phone in ‘ON’ mode for
+30 min and after this subjects chanted OM for 5 min;
+similarly,
+in
+(2)
+MPOFOM
+group:
+Subjects
+were
+exposed to mobile phone in ‘OFF’ mode and chanted
+OM; in (3) MPONSS group: Subjects were exposed to
+mobile phone in ‘ON’ mode followed by ‘SS’ chanting;
+and, lastly in (4) MPOFSS group: subjects were exposed
+to mobile phone in ‘OFF’ mode and chanted ‘SS’ after-
+wards. Assessments were done at three points of time
+in each group: (1) Baseline; (2) After mobile phone on/
+off exposure; and (3) after OM/SS chanting. Table 1
+provides demographic details of the subjects in each
+group. Demographic details did not differ significantly
+between the groups. A schematic representation of the
+study design is provided in Figure 1. Signed informed
+consent was taken from the subjects who were above
+18 years of age and from the guardian/parents of those
+below 18 years of age. Research was approved by insti-
+tutional ethical committee.
+EMF exposure settings
+The source of EMF was a 2100 MHz 3G mobile phone
+with a Universal Mobile Telecommunications System’s
+(UMTS) network. It was an FCC approved device and
+had a head specific absorption ratio (SAR) of 0.4 W/
+Kg and body SAR of 0.54 W/Kg. Subjects sat on a
+comfortable chair with head resting on the chair and
+two identical mobile phones were kept at 0.5 cm dis-
+tance from the tragus, one on each side, using an
+adjustable wooden stand. On calling mode, the device
+emitted average EMF energy of 1.305 ± 0.94 mW/m2
+(with peak value of 2.34 mW/m2) at 5 mm. Left side
+mobile was kept in off mode permanently with battery
+removed. Right side mobile status only was changed
+depending on the group to which the subject belongs.
+Identical phones were kept on both sides at the same
+distance from the ear to rule out lateralization effects
+on brain haemodynamics. When subjects were exposed
+to MPEMF, i.e. in MPON groups, fully charged mobile
+was placed on the right side and a call was made for
+30 min from another phone. Both the phones (caller
+and receiver) were kept mute throughout. During
+sham exposure, the right side mobile was kept off with
+battery removed. Subjects were unaware of the group
+status
+they
+were
+allocated
+to.
+A
+counterbalanced
+experiment with eight independent subjects, each with
+four trials, indicated that the subjects could not detect
+the EMF exposure condition any better than by guess-
+ing (response accuracy 50%). FNIRS cap was fixed on
+the head of the subject and recording was taken in a
+dark room with a computer screen displaying Stroop
+task. Figure 2 shows the settings of the study. During
+the 30- min period of mobile phone on/off exposure,
+subjects
+heard
+an
+audio
+describing
+geography
+of
+Karanataka state. To ensure that subjects remained
+awake during this period, subjects were asked to
+Table 1. Demographic details of the subjects.
+Variables/Group
+MPONOM (mean ± SD)
+MPOFOM (mean ± SD)
+MPONSS (mean ± SD)
+MPOFSS (mean ± SD)
+n
+5
+5
+5
+5
+Age (years)
+18.40 ± 0.548
+18.40 ± 0.548
+18.20 ± 0.447
+18.20 ± 0.447
+Gender (numbers)
+Male (n ¼ 2)
+Female (n ¼ 3)
+Male (n ¼ 2)
+Female (n ¼ 3)
+Male (n ¼ 2)
+Female (n ¼ 3)
+Male (n ¼ 2)
+Female (n ¼ 3)
+Height (m)
+1.64 ± 0.06
+1.63 ± 0.08
+1.61 ± 0.12
+1.63 ± 0.05
+Weight (kg)
+53.60 ± 4.10
+52.98 ± 6.61
+56.80 ± 8.32
+61.40 ± 20.71
+BMI (kg/m2)
+20.41 ± 1.83
+20.10 ± 1.94
+21.69 ± 3.71
+22.40 ± 7.01
+Head circumference (cm)
+53.80 ± 1.10
+54.40 ± 1.82
+55.00 ± 1.41
+55.20 ± 0.84
+Last academic performance (%)
+74.20 ± 8.56
+77.60 ± 7.96
+71.36 ± 12.13
+72.76 ± 12.01
+GHQ-12 scores
+0.9 ± 0.44
+0.8 ± 0.50
+0.8 ± 0.31
+0.7 ± 0.66
+MPONOM: mobile phone ‘ON’ followed by ‘OM’ chanting; MPOFOM: mobile phone ‘OFF’ followed by ‘OM’ chanting; MPONSS: mobile
+phone ‘ON’ followed by ‘SS’ chanting; MPOFSS: mobile phone ‘OFF’ followed by ‘SS’ chanting.
+Figure 1. Schematic representation of the study design. R: Rest; C: Congruent task; I: Incongruent task.
+290
+H. BHARGAV ET AL.
+Downloaded by [14.139.155.82] at 04:08 27 July 2016 
+answer 10 simple multiple choice questions at the end,
+based on the audio. Those scoring more than 50%
+were only included in the study further.
+fNIRS device
+We used a 64 channel continuous wave fNIRS device
+(NIRx Medical Technologies, LLC, NY, USA) with a
+sampling rate of 15.6 Hz. With eight light emitting
+sources and eight detector probes, 18 channels were
+measured quasi-simultaneously over both the pre-
+frontal cortices using two wavelengths of near-infrared
+light (760 nm and 850 nm). Probes were fixed on the
+head based on 10–20 system using whole head stand-
+ard sized caps (NIRScaps) for the age group assessed.
+Figure 3 provides the montage and Table 2 provides
+the channel distribution of fNIRS device followed in
+the study.
+Stroop task and procedure
+Subjects were seated comfortably on a reclining chair
+in a Faraday cage, facing a 21-inch LCD monitor
+placed at a distance of 70 cm from their eyes. The cog-
+nitive paradigm used in the present study was Stroop
+task. The traditional 100 item paper and pencil version
+of Stroop was projected on a computer screen and ver-
+bal responses were recorded. The Stroop task was
+designed based on the paradigm followed in previous
+research (Taniguchi, Sumitani, Watanabe, Akiyama, &
+Ohmori, 2012). During the Stroop task subjects were
+asked to read as many words as possible on a com-
+puter screen displaying 100 words. Subjects were ran-
+domly presented with words ‘red’, ‘blue’, ‘yellow’, and
+‘green’ which were written in red, blue, yellow, and
+green ink. The task was presented in block design that
+consisted of rest periods and two test conditions: con-
+gruent and incongruent. In the congruent condition
+the name of the word was congruent with the colour
+of the ink and subjects were asked to read them out.
+In incongruent conditions, the four words were written
+in incongruent colours. The time for Stroop task was
+fixed and it was given using an automated software for
+a total duration of 2 min and 30 s in the following
+blocks: 30 s rest - 30 s task (congruent) - 30 s rest -
+30 s task (incongruent) - 30 s rest. In the rest periods,
+clear instructions were shown to the subject for the
+next task condition, for e.g. before congruent condition
+the instruction was: ‘Please read the words on the
+screen loudly and as quickly as possible’ and before
+Figure 3. Montage of the study.
+Figure 2. Settings of the study.
+INTERNATIONAL REVIEW OF PSYCHIATRY
+291
+Downloaded by [14.139.155.82] at 04:08 27 July 2016 
+the incongruent condition the instruction was: ‘Please
+read the colour of the words on the screen loudly and
+as quickly as possible’. Each subject was given orienta-
+tion to the task 1 day prior to data collection. The
+responses (number of total, correct, and incorrect
+responses in 30 s of each condition) were recorded
+manually by two trained psychologists using an answer
+key for each condition. Both psychologists were blind
+to the group allocations of the subject. Data was con-
+sidered valid only when the scores from both the psy-
+chologists were matching. The fNIRS measurement
+was performed during the whole task. Markers were
+applied for each task condition (congruent and incon-
+gruent)
+during
+recording
+to
+segregate
+respective
+haemodynamic responses.
+OM/SS chanting procedure
+All the subjects were trained in ‘OM’ chanting by an
+experienced yoga teacher and an orientation training
+of 1 week was given to all the subjects before data col-
+lection. The subjects were trained to chant ‘OM’ loudly
+without distress and interruption—the vowel (O) part
+of the ‘OM’ for 5 s continuing into the consonant
+(M) part of the ‘OM’ for the next 10 s, maintaining a
+ratio of 1:2. The control condition was continuous
+production of ‘sssss . . .’ or ‘SS’ syllable for the same
+duration. This was chosen to control for the expiratory
+act of chanting ‘OM’, but without the vibratory sensa-
+tion around the ears (Kalyani et al., 2011).
+Data extraction and analysis
+NIRS optical intensity data was processed by NIRstar
+acquisition software and extracted using accompanying
+topography
+software
+(nirsLAB;
+NIRx
+Medical
+Technologies, LLC). Data were corrected for the effects
+of vascular pulsation (Gratton & Fabiani, 2010). Pulse
+corrected data were filtered using a low-pass (zero
+phase
+shift)
+filter
+with
+a
+cut-off
+frequency
+at
+0.01–0.2 Hz. For every subject, the channel measure-
+ments showing low signal-to-noise ratio were dis-
+carded. Linear trends of continuous oxyHb changes
+and fluctuations were also eliminated. For oxyhaemo-
+globin (oxyHb) concentration changes a 30 s baseline
+was taken for analysis. To obtain haemodynamic data,
+the
+modified
+Beer–Lambert
+Law
+was
+applied
+to
+artifact-free segments (Hoshi, Kobayashi, & Tamura,
+1985). We focused on oxyHb concentration changes
+for further analysis because they provide the most
+robust signal-to-noise ratio and are the most sensitive
+parameter of cerebral blood flow (Hoshi et al., 1985;
+Sato et al., 2012). Values for changes in oxyHb were
+obtained during the contrast of interest (Incongruent
+minus Congruent Stroop), i.e. Stroop interference, for
+all 18 channels at three points of time: (1) Baseline,
+(2) Post mobile on/off, and (3) Post OM/SS for all the
+four
+groups
+(MPONOM,
+MPOFOM,
+MPONSS,
+MPOFSS). Similarly, Stroop task performance was
+assessed at these three points of time for the four
+groups.
+Analysis
+of
+variance-repeated
+measures
+(RM-
+ANOVA) was used for data analysis using SPSS ver-
+sion 10. For analysis of Stroop performance, Stroop
+task condition (correct, incorrect, and total scores for
+each condition: congruent and incongruent) was the
+dependent variable with ‘group’ as between-subjects
+and ‘time point’ as within-subject factor. For haemo-
+dynamics data, one multivariate RM-ANOVA analysis
+was performed for all the 18 fNIRS channels. Channels
+1–18 were the dependent variable (level), with ‘group’
+as between-subjects and ‘time point’ as within-subject
+factor.
+Post-hoc
+comparisons
+between
+individual
+groups/time points were made through Bonferroni’s
+correction after checking for significance of main
+effects or interactions.
+Results
+Forty-six subjects were screened, out of which 30 gave
+consent to participate in the study. Out of 30, 24 satis-
+fied the selection criteria and orientation training was
+started.
+Finally,
+four
+subjects
+left
+the
+project
+in
+between and final data collection was successfully per-
+formed on 20 subjects.
+Stroop performance
+As depicted in Figure 4, for Stroop incongruent total
+scores (task condition), RM-ANOVA revealed signifi-
+cant main effects for the time points, F(2, 15) ¼ 28.57,
+p < 0.001, and a significant interaction between group
+and time point, F(6, 32) ¼ 4.64, p < 0.05. Follow-up
+Bonferroni’s adjustment showed that total scores in
+Table 2. Channel distributions followed in the study while using fNIRS device.
+Left side
+S1-D1
+S2-D1
+S2-D2
+S3-D1
+S3-D3
+S4-D1
+S4-D2
+S4-D3
+S4-D4
+Ch-1
+2
+3
+4
+5
+6
+7
+8
+9
+Right side
+S5-D5
+S5-D6
+S5-D7
+S5-D8
+S6-D6
+S6-D8
+S7-D7
+S7-D8
+S8-D8
+10
+11
+12
+13
+14
+15
+16
+17
+18
+S1–S8: Sources; D1–D8: Detectors; Ch1–18: Channels.
+292
+H. BHARGAV ET AL.
+Downloaded by [14.139.155.82] at 04:08 27 July 2016 
+incongruent Stroop task were significantly better in
+MPOFOM group after OM chanting as compared to
+those in MPOFSS group after SS chanting (Table 3;
+Figure 4). Within-group analysis showed that there
+was a significant improvement in total scores of incon-
+gruent Stroop task after OM chanting in MPONOM
+(p < 0.01) and MPOFOM (p < 0.001) groups as com-
+pared to the baseline and in MPOFOM group as com-
+pared to the post-mobile values (p < 0.05), respectively
+(Table 4). Also, in MPONSS group, there was a signifi-
+cant improvement in scores of same task condition
+after
+SS
+chanting
+as
+compared
+to
+the
+baseline
+(p < 0.01; Table 4). For other task conditions no sig-
+nificant main effects or interactions were observed.
+fNIRS results
+Multivariate RM-ANOVA for all the 18 channels
+revealed
+significant
+main
+effects
+for
+levels
+[F(2,
+5) ¼ 6.18; p < 0.05; Effect Size ¼0.62] and significant
+interaction between level and group [F(6, 12) ¼ 5.82,
+p < 0.05; Effect Size ¼0.60]. Subsequent RM-ANOVA
+tests for each channel showed significant main effects
+for the time points in fNIRS channels 2, 6, 7, 8, 10,
+13, and 18 [Channel 2: F(2, 26) ¼ 3.51, p < 0.05;
+Channel 6: F(2, 26) ¼ 3.27, p < 0.05; Channel 7: F(2,
+26) ¼ 6.11,
+p < 0.01;
+Channel
+8:
+F(2,
+26) ¼ 6.05,
+p < 0.01;
+Channel
+10:
+F(2,
+26) ¼ 3.11,
+p < 0.05;
+Channel 13: F(2, 26) ¼ 3.41, p < 0.05; Channel 18: F(2,
+26) ¼ 3.46,
+p < 0.05]
+and
+a
+significant
+interaction
+between group and time point for channels 13 and 18
+[Channel 13: F(6, 26) ¼ 2.50, p < 0.05; Channel 18:
+Figure 4. Graph showing changes in total scores of incongru-
+ent Stroop task in all the four groups at three points of time:
+Group: 1: MPONOM; 2: MPONSS; 3: MPOFOM; 4: MPOFSS; Level:
+1: Baseline; 2: After 30 min of MPON/OF exposure; 3: After OM/
+SS chanting. Y-axis: Total scores during Stroop Incongruent
+Task.
+Table 3. Comparison within groups for Stroop performance at the baseline, after mobile phone on/off exposure and after OM/SS
+chanting.
+Group
+Task
+condition
+Scores
+Baseline
+(mean ± SD) (1)
+After mobile
+(mean ± SD) (2)
+After OM/SS
+(mean ± SD) (3)
+F values
+(df hypothesis,
+error)
+Effect
+size
+pa value
+(1 vs 2)
+pa value
+(2 vs 3)
+pa value
+(1 vs 3)
+MPONOM
+CT
+C
+47.00 ± 12.79
+51.40 ± 14.69
+53.00 ± 6.86
+(2,15) 1.71
+2.53
+1
+1
+1
+IC
+1.00 ± 1.00
+1.00 ± 0.71
+1.00 ± 1.22
+(2,15) 0.91
+0.01
+1
+1
+1
+T
+50.40 ± 6.11
+51.60 ± 5.77
+53.20 ± 5.97
+(2,15) 0.81
+1.14
+1
+1
+1
+ICT
+C
+25.60 ± 3.97
+27.40 ± 7.37
+30.60 ± 4.22
+(2,15) 2.48
+2.06
+1
+0.934
+0.072
+IC
+1.80 ± 2.17
+1.20 ± 1.30
+1.60 ± 1.14
+(2,15) 0.51
+0.24
+0.624
+0.533
+1
+T
+27.40 ± 3.97
+28.60 ± 7.47
+32.20 ± 4.66
+(2,15) 6.03
+2.03
+1
+0.821
+0.033*
+MPONSS
+CT
+C
+45.80 ± 3.19
+43.20 ± 6.30
+46.40 ± 7.50
+(2,15) 3.76
+1.38
+1
+0.342
+1
+IC
+1.20 ± 1.30
+2.20 ± 1.48
+1.60 ± 1.14
+(2,15) 0.34
+0.41
+0.267
+0.914
+1
+T
+48.40 ± 4.62
+46.20 ± 4.92
+49.80 ± 4.92
+(2,15) 0.84
+1.48
+1
+0.276
+1
+ICT
+C
+25.20 ± 3.56
+29.20 ± 3.96
+30.00 ± 5.39
+(2,15) 2.1
+2.09
+0.057
+1
+0.072
+IC
+2.00 ± 1.58
+1.80 ± 1.92
+2.00 ± 1.58
+(2,15) 0.24
+0.09
+1
+1
+1
+T
+27.20 ± 3.42
+31.00 ± 2.83
+32.00 ± 4.95
+(2,15) 6.79
+2.06
+0.215
+1
+0.028*
+MPOFOM
+CT
+C
+46.40 ± 6.02
+48.80 ± 3.63
+50.00 ± 3.67
+1.93 (2,15)
+1.49
+0.466
+1
+1
+IC
+0.40 ± 0.89
+0.20 ± 0.45
+0.40 ± 0.55
+(2,15) 0.21
+0.24
+1
+1
+1
+T
+49.80 ± 13.41
+56.00 ± 12.19
+54.80 ± 5.81
+(2,15) 21.5
+2.60
+0.662
+1
+1
+ICT
+C
+26.00 ± 5.10
+30.60 ± 3.91
+35.40 ± 2.07
+(2,15) 2.87
+3.83
+0.141
+0.084
+0.065
+IC
+1.80 ± 1.48
+1.60 ± 0.89
+1.40 ± 1.14
+(2,15) 0.10
+0.16
+1
+1
+1
+T
+27.80 ± 4.60
+32.20 ± 4.02
+36.80 ± 2.77
+(2,15) 21.5
+3.67
+0.234
+0.034*
+0.052
+MPOFSS
+CT
+C
+51.40 ± 3.78
+49.40 ± 9.15
+52.60 ± 6.39
+(2,15) 1.17
+1.31
+1
+0.226
+1
+IC
+1.20 ± 1.30
+1.40 ± 1.67
+1.40 ± 1.14
+(2,15) 0.21
+0.94
+1
+1
+1
+T
+45.80 ± 2.39
+43.80 ± 6.02
+48.60 ± 7.02
+(2,15) 1.1
+1.96
+1
+0.19
+1
+ICT
+C
+21.40 ± 8.88
+24.20 ± 5.97
+24.80 ± 4.32
+(2,15) 1.2
+1.48
+0.985
+1
+0.616
+IC
+3.40 ± 3.97
+2.60 ± 2.19
+2.00 ± 2.35
+(2,15) 2.7
+0.57
+1
+0.211
+0.404
+T
+24.80 ± 5.02
+26.80 ± 4.44
+26.80 ± 2.39
+(2,15) 1.32
+0.94
+0.958
+1
+0.871
+CT: Congruent task; ICT: Incongruent task; C: Correct score; IC: Incorrect score; T: Total score.
+aRepeated measures ANOVA after Bonferroni’s adjustment.
+*p < 0.05.
+INTERNATIONAL REVIEW OF PSYCHIATRY
+293
+Downloaded by [14.139.155.82] at 04:08 27 July 2016 
+F(2, 26) ¼ 2.53, p < 0.05]. Post-hoc analysis through
+Bonferroni’s
+correction
+further
+revealed
+that
+pre-
+frontal oxygenation was significantly lesser in the
+MPOFOM group after OM chanting as compared to
+the MPONSS group after SS chanting in channel 13
+(p < 0.05) and channel 18 (p < 0.05; Table 5; Fig. 5
+and 6). Within-group analysis showed that there was a
+significant reduction in oxygenation after OM chanting
+in the MPOFOM group as compared to post-MPOF
+values in channels 2, 6, 7, 8, 13, and 18 (Table 5).
+Also, in the MPONSS group, there was a significant
+increase in pre-frontal oxygenation in channel 10 after
+SS chanting as compared to the baseline (p < 0.05;
+Table 5). For other fNIRS channels no significant
+main effects or interactions were observed.
+Discussion
+The present pilot work was planned to assess feasibility
+of the protocol for future larger trails. We found the
+protocol to be feasible and none of the subjects
+reported any side-effects. We did not observe any sig-
+nificant difference between MPON or MPOF condi-
+tions
+for
+Stroop
+Task
+performance
+or
+brain
+haemodynamics, but there was a tendency for better
+Stroop incongruent performance and reduced oxygen-
+ation in some channels after OM chanting as com-
+pared
+to
+SS
+chanting.
+Previously,
+Regel
+and
+Achermann (2011) reviewed 41 studies, where distinct
+cognitive tasks were employed at various levels of diffi-
+culty
+to
+evaluate
+effects
+of
+MPEMF.
+Six
+studies
+revealed an increase in performance speed, and seven
+studies reported a decrease. Similarly, accuracy of per-
+formance was reduced and elevated in several experi-
+ments. Most of the previous studies have not found
+any effect of MPEMF exposure for less than 20 min on
+brain haemodynmaics (Regel & Achermann, 2011);
+therefore, in the present trial we chose a duration of
+30 min for exposure. In the present study, even after
+30 min of MPEMF exposure, we did not observe any
+significant improvement or decline in cognitive per-
+formance or changes in brain haemodynamics. The
+present study used a task (Stroop task) which requires
+less duration and yet is complex enough to elicit a
+cognitive response (Stroop, 1935). Previously, a cross-
+sectional study used the Stroop task to find out associ-
+ations between cognitive performance and mobile
+phone use and found that mobile phone use was asso-
+ciated with faster and less accurate responding to
+higher level cognitive tasks (Abramson et al., 2009).
+In
+another
+study,
+the acute
+effect
+of
+45 min
+of
+MPEMF exposure was tested on 168 subjects using
+the Stroop paradigm. Subjects were in the age range
+Table 4. Comparison between MPOFOM and MPOFSS groups for Stroop Performance (Incongruent Task) at the baseline, after mobile phone on/off exposure and after OM/SS
+chanting.
+Correct score
+Incorrect score
+Total score
+MPOFOM
+MPOFSS
+F value
+(df contrast,
+error)
+pa value
+MPOFOM
+MPOFSS
+F value
+(df contrast,
+error)
+pa value
+MPOFOM
+MPOFSS
+F value
+(df contrast,
+error)
+pa value
+Baseline
+26.00 ± 5.10
+21.40 ± 8.88
+(3,16) 0.67
+1
+1.80 ± 1.48
+3.40 ± 3.97
+(3,16) 0.91
+1
+27.80 ± 4.60
+24.80 ± 5.02
+(3,16) 0.63
+1
+After mobile on/off
+30.60 ± 3.91
+24.20 ± 5.97
+(3, 16) 0.32
+0.5
+1.60 ± 0.89
+2.60 ± 2.19
+(3,16) 0.63
+1
+32.20 ± 4.02
+26.80 ± 4.44
+(3,16) 0.33
+0.63
+After OM/SS
+35.40 ± 2.07
+24.80 ± 4.32
+(3,16) 5.38
+0.005**
+1.40 ± 1.14
+2.00 ± 2.35
+(3,16) 0.17
+1
+36.80 ± 2.77
+26.80 ± 2.39
+(3,16) 5.6
+0.006**
+MPOFOM: mobile phone off followed by Om chanting; MPOFSS: Mobile phone off followed by ‘SS’ chanting.
+aRM-ANOVA after Bonferroni’s adjustment.
+**p < 0.01.
+294
+H. BHARGAV ET AL.
+Downloaded by [14.139.155.82] at 04:08 27 July 2016 
+of 18–42 years. It was observed that, with neutral
+Stroop condition, the mean reaction time of subjects
+was significantly lesser when exposed to MPEMF
+signals than in the sham condition, whereas with
+incongruent Stroop condition, there was no signifi-
+cant difference between the groups (Cinel, Boldini,
+Fox, & Russo, 2008). In the present study, we did
+not
+find
+any
+difference
+in
+performance
+between
+MPEMF and sham exposure for either congruent or
+incongruent Stroop task after 30 min of exposure.
+This may be due to a very small sample size in the
+present study as compared to the study by Cinel
+et al. (2008). Probably, 45 min of MPEMF exposure
+would have produced some changes in cognitive per-
+formance, as observed by Cinel et al. (2008), but,
+since the institutional ethical committee did not per-
+mit exposure of mobile phone radiation for more
+than 30 min to teenagers, the duration of 30 min
+was chosen for our study.
+A previous positron emission tomography (PET)
+study found increased cerebral blood flow (CBF) in
+the prefrontal cortex after 30 min exposure to a 900-
+Table 5. Significant changes in oxyHb levels (lmol/l) in different groups across fNIRS channels.
+Group
+Channel
+Side
+Baseline
+(mean ± SD)
+(1)
+After mobile
+(mean ± SD)
+(2)
+After OM/SS
+(mean ± SD)
+(3)
+F values
+(df hypoth-
+esis, error)
+Effect size
+pa value
+(1 vs 2)
+pa value
+(2 vs 3)
+pa value
+(1 vs 3)
+MPOFOM
+2
+Left
+1.41 ± 6.43
+4.50 ± 2.77
+4.95 ± 5.94
+(2, 26) 3.51
+0.46
+1
+0.03*
+0.18
+6
+Left
+2.12 ± 4.91
+3.67 ± 3.43
+7.58 ± 3.60
+(2, 26) 3.27
+0.46
+0.28
+0.03*
+0.51
+7
+Left
+3.76 ± 9.24
+9.21 ± 3.37
+2.27 ± 8.42
+(2, 26) 6.11
+0.52
+0.55
+0.04*
+0.11
+8
+left
+0.33 ± 5.22
+6.40 ± 2.27
+5.17 ± 2.88
+(2, 26) 6.05
+0.64
+0.40
+0.002**
+0.26
+13
+Right
+2.27 ± 5.87
+2.36 ± 2.00
+6.74 ± 5.72#
+(2, 26) 3.41
+0.42
+0.86
+0.04*
+0.32
+18
+Right
+1.34 ± 10.46
+4.11 ± 1.50
+8.16 ± 8.39$
+(2, 26) 3.46
+0.57
+0.55
+0.03*
+0.016*
+MPONSS
+10
+Right
+1.94 ± 7.19
+0.70 ± 8.10
+3.77 ± 4.78
+(2, 26) 3.11
+0.49
+1
+1
+0.011*
+13
+Right
+0.81 ± 6.55
+0.40 ± 5.56
+1.68 ± 2.40#
+(2, 26) 0.74
+0.04
+1
+0.71
+1
+18
+Right
+0.54 ± 4.66
+2.16 ± 6.82
+1.11 ± 3.40$
+(2, 26) 0.72
+0.04
+1
+0.75
+1
+oxyHb: oxygenated haemoglobin; fNIRS: functional near infrared spectroscopy; MPOFOM: mobile phone ‘OFF’ followed by ‘OM’ chanting; MPONSS: mobile
+phone ‘ON’ followed by ‘SS’ chanting.
+aRepeated measures ANOVA after Bonferroni’s adjustment
+*p < 0.05;
+**p < 0.01.
+#Significant between-group differences; F(6, 26) ¼ 2.50, p < 0.05.
+$Significant between-group differences; F(2, 26) ¼ 2.53, p < 0.05.
+Figure 5. Graph showing changes in oxyHb levels in channel
+13 during Stroop task in all the four groups at three points of
+time: Group: 1: MPONOM; 2: MPONSS; 3: MPOFOM; 4: MPOFSS;
+Level: 1: Baseline; 2: After 30 min of MPON/OF exposure; 3:
+After OM/SS chanting. Y-axis: Concentration of oxygenated
+haemoglobin (oxyHb) expressed in lmol/l.
+Figure 6. Graph showing changes in oxyHb levels in channel
+18 during Stroop task in all the four groups at three points of
+time: Group: 1: MPONOM; 2: MPONSS; 3: MPOFOM; 4: MPOFSS;
+Level: 1: Baseline; 2: After 30 min of MPON/OF exposure; 3:
+After OM/SS chanting. Y-axis: Concentration of oxygenated
+haemoglobin (oxyHb) expressed in lmol/l.
+INTERNATIONAL REVIEW OF PSYCHIATRY
+295
+Downloaded by [14.139.155.82] at 04:08 27 July 2016 
+MHz GSM signal (Huber et al., 2005). Another
+similar PET study showed decreased cerebral blood
+flow
+in
+the
+temporal
+cortex
+after
+a
+continuous
+51 min exposure to a 902-MHz GSM signal (Aalto
+et al., 2006). A brain energy metabolism study done
+using PET on 13 young male subjects exposed to a
+pulse modulated 902.4 MHz GSM for 33 min while
+performing
+a
+simple
+visual
+vigilance
+task
+also
+showed that relative cerebral metabolic rate of glu-
+cose was significantly reduced in the temporo-par-
+ietal junction and anterior temporal lobe of the right
+hemisphere ipsilateral to the exposure (Kwon et al.,
+2011). Another study investigated the effects induced
+by an exposure to a GSM signal on brain BOLD
+(blood-oxygen-level dependent) response, as well as
+its time course while performing a Go–No-Go task.
+BOLD response of active brain areas and reaction
+times (RTs) while performing the task were meas-
+ured both before and after the exposure. It was
+observed that reaction times to the somato-sensory
+task did not change as a function of exposure (real
+vs sham) to GSM signal. BOLD results revealed sig-
+nificant activations in inferior parietal lobule, insula,
+precentral, and postcentral gyri associated with Go
+responses
+after
+both
+‘real’
+and
+‘sham’
+exposure,
+whereas no significant effects were observed in the
+between-group analysis. The authors concluded that
+there were no changes in BOLD response as a con-
+sequence of EMFs exposure (Curcio et al., 2012).
+Most of these researches used a 900 MHz GSM sig-
+nal which corresponds to the 2G spectrum and the
+results were mixed. In the present study, depending
+on
+the
+increasing
+use,
+we
+exposed
+subjects
+to
+2170 MHz UMTS (which corresponds to 3G spec-
+trum MPEMFs) to find that results may not differ
+much with the band width of EMFs. Very few stud-
+ies have used a fNIRS device to assess effects of
+MPEMF
+before.
+In
+one
+study
+(Wolf,
+Haensse,
+Morren,
+&
+Froehlich,
+2006),
+effects
+of
+GSM
+900 MHz signals (EMF) were assessed on the cere-
+bral blood circulation using near-infrared spectropho-
+tometry in a three armed (12 W/kg, 1.2 W/kg,
+sham), double blind, randomized crossover trial in
+16 healthy volunteers. During exposure there was a
+borderline significant short -term responses of oxy-
+haemoglobin
+(oxyHb)
+and
+deoxyhaemoglobin
+(deoxyHb)
+concentration,
+which
+correspond
+to
+a
+decrease of cerebral blood flow and volume. The
+authors found that there was no detectable dose–res-
+ponse relation or long-term response within 20 min
+of exposure and the detection limit was a fraction of
+the
+regular
+physiological
+changes
+elicited
+by
+functional activation. The above study did not use a
+cognitive task along with the fNIRS device. In the pre-
+sent study, we did not assess the effect of MPEMF dur-
+ing the exposure on brain haemodynamics, but only
+after the exposure, on the haemodynamic responses
+during a cognitive challenge to understand the mechan-
+ism through which MPEMF exposure may affect cogni-
+tive
+functions.
+Our
+results
+also
+demonstrated
+no
+significant change. The only effect we observed was a
+slight tendency towards higher activation during Stroop
+interference after MPEMF exposure in channel 10
+(right side) in the MPONSS group after SS chanting as
+compared to the baseline. Since the sample size in the
+present work is very small as compared to previous
+researches; it is difficult to draw definitive conclusions
+at present. Cognition enhancing effects of OM chanting
+have been reported in a few studies before. In a com-
+parative study, middle latency auditory evoked poten-
+tials were recorded in 18 male volunteers with ages
+between 25–45 years before, during, and after 20 min of
+OM chanting as compared to chanting of syllable ‘one’.
+There was a significant difference between senior and
+naive subjects’ response in terms of increase and reduc-
+tion in peak amplitude of Na waves, suggesting experi-
+ence dependent neural changes due to OM chanting
+(Telles, Nagarathna, & Nagendra, 1994). Previously,
+Deepeshwar et al. (2014) assessed the immediate effect
+of 20 min of OM meditation (mental chanting with
+effortless defocusing on syllable ‘OM’) on Stroop task
+using fNIRS technology. They found that the mean
+reaction time was shorter during Stroop colour word
+task with concomitant reduction in total haemoglobin
+after OM meditation as compared to random thinking
+for same duration, suggestive of improved performance
+and efficiency after OM meditation in task-related to
+attention. Our findings with OM chanting of 5 min are
+similar to this study (Deepeshwar et al., 2014), i.e. there
+may be lesser pre-frontal activation with better per-
+formance on cognitive tasks after OM chanting. This
+may suggest improved efficiency, i.e. better cognitive
+output with lesser utilization of resources after OM
+chanting. Previous researches also report that medita-
+tion may induce a state of reduced psycho-physiological
+arousal
+with
+enhanced
+awareness
+and
+attention
+(Subramanya & Telles, 2009). Thus, chanting OM ver-
+bally may have similar effects, as produced by mental
+chanting with effortless defocusing on syllable OM,
+even when it is chanted for as low a duration as 5 min.
+Although
+there
+were
+between-group
+differences
+(MPOFOM vs MPOFSS) where incongruent Stroop
+task performance after OM chanting was significantly
+better as compared to SS chanting, this result was
+296
+H. BHARGAV ET AL.
+Downloaded by [14.139.155.82] at 04:08 27 July 2016 
+found within the MPOFOM group only and not in the
+MPONOM group. In our study, each subject per-
+formed the Stroop task three times and the last per-
+formance was after OM/SS chanting. As Stroop tasks
+are
+known
+to
+produce
+a
+practice
+effect
+(Lemay,
+B
+edard, Rouleau, & Tremblay, 2004), the possibility of
+the results being obtained simply due to practice effect
+cannot be denied. Also, the sample size in our study is
+very small to draw any conclusion. Deactivation of
+pre-frontal cortices following OM chanting may be
+due to the vibrations produced by the sound ‘OM’,
+which may have a stimulating effect on branch of
+vagus nerve in the ear canal (Kalyani et al., 2011).
+Although the present study followed a randomized
+controlled design and used an objective functional
+neuro-imaging device, along with a standard validated
+cognitive task to assess effect of MPEMF exposure and
+OM chanting on teenagers, small sample size is a major
+limitation which restricts generalization of the results.
+As a traditional version of Stroop was used, it was not
+possible to record the reaction time along with Stroop
+performance scores. In future, we plan to overcome
+these shortcomings and repeat the same protocol with
+larger sample size to confirm the findings.
+Conclusion
+Although it was observed that MPEMF exposure of
+30 min did not produce any significant impact on cog-
+nition or brain haemodynamics of teenagers, and OM
+chanting had some cognition enhancing effect which
+was associated with lesser oxygenation of pre-frontal
+cortices during the task in some channels, no definite
+conclusion can be drawn from this preliminary study.
+The study protocol followed in the present study was
+found feasible and a future trial with larger sample
+size is implicated.
+Acknowledgements
+The authors are thankful to the Science and Engineering
+Research
+Board
+(SERB),
+Department
+of
+Science
+and
+Technology (DST), Ministry of Science and Technology,
+Government of India for funding this research work.
+Disclosure statement
+The authors report no conflicts of interest. The authors alone
+are responsible for the content and writing of the paper.
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yogatexts/Acute effects of mobile phone radiations on subtle energy levels of teenagers using electrophotonic imaging technique.txt

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+3/1/2017
+Acute effects of mobile phone radiations on subtle energy levels of teenagers using electrophotonic imaging technique: A randomized controlled study :...
+http://ijoy.org.in/printarticle.asp?issn=0973­6131;year=2017;volume=10;issue=1;spage=16;epage=23;aulast=Bhargav
+1/4
+ORIGINAL ARTICLE
+Year : 2017  |  Volume : 10  |  Issue : 1  |  Page : 16­­23
+Acute  effects  of  mobile  phone  radiations  on  subtle  energy  levels  of  teenagers  using  electrophotonic  imaging  technique:  A
+randomized controlled study
+Hemant Bhargav1, TM Srinivasan2, Suman Bista1, A Mooventhan1, Vandana Suresh1, Alex Hankey2, HR Nagendra1,  
+1 Division of Yoga and Life Sciences, S­VYASA Yoga University, Bengaluru, Karnataka, India
+2 Division of Yoga and Physical Sciences, S­VYASA Yoga University, Bengaluru, Karnataka, India
+Correspondence Address:
+Hemant Bhargav
+No. 19, Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar, Bengaluru ­ 560 019, Karnataka 
+India
+Abstract
+Background: Mobile phones induce radio frequency electromagnetic field (RF­EMF) which has been found to affect subtle energy levels of adults through Electrophotonic Imaging
+(EPI) technique in a previous pilot study. Materials and Methods: We enrolled 61 healthy right­handed healthy teenagers (22 males and 39 females) in the age range of 17.40 ± 0.24
+years from educational institutes in Bengaluru. Subjects were randomly divided into two groups: (1) (mobile phone in «DQ»ON«DQ» mode [MPON] at right ear) and (2) mobile phone
+in «DQ»OFF«DQ» mode (MPOF). Subtle energy levels of various organs of the subjects were measured using gas discharge visualization Camera Pro device, in double­blind
+conditions, at two points of time: (1) baseline and (2) after 15 min of MPON/MPOF exposure. As the data were found normally distributed, paired and independent samples t­test were
+applied to perform within and between group comparisons, respectively. Results: The subtle energy levels were significantly reduced after RF­EMF exposure in MPON group as
+compared to MPOF group for following areas: (a) Pancreas (P = 0.001), (b) thyroid gland (P = 0.002), (c) cerebral cortex (P < 0.01), (d) cerebral vessels (P < 0.05), (e) hypophysis (P =
+0.013), (f) left ear and left eye (P < 0.01), (g) liver (P < 0.05), (h) right kidney (P < 0.05), (i) spleen (P < 0.04), and (j) immune system (P < 0.02). Conclusion: Fifteen minutes of RF­EMF
+exposure exerted quantifiable effects on subtle energy levels of endocrine glands, nervous system, liver, kidney, spleen, and immune system of healthy teenagers. Future studies
+should try to correlate these findings with respective biochemical markers and standard radio­imaging techniques.
+How to cite this article:
+Bhargav H, Srinivasan T M, Bista S, Mooventhan A, Suresh V, Hankey A, Nagendra H R. Acute effects of mobile phone radiations on subtle energy levels of teenagers using
+electrophotonic imaging technique: A randomized controlled study.Int J Yoga 2017;10:16­23
+How to cite this URL:
+Bhargav H, Srinivasan T M, Bista S, Mooventhan A, Suresh V, Hankey A, Nagendra H R. Acute effects of mobile phone radiations on subtle energy levels of teenagers using
+electrophotonic imaging technique: A randomized controlled study. Int J Yoga [serial online] 2017 [cited 2017 Mar 1 ];10:16­23 
+Available from: http://www.ijoy.org.in/text.asp?2017/10/1/16/186163
+Full Text
+ Introduction
+With about 7.3 billion mobile phone subscribers worldwide, mobile phones have become a prevalent means of communication and a part of everyday life. [1] The use of mobile
+phones has increased enormously among individuals of all age groups, globally, in the last two decades. [2] The mobile phones are low power radio devices which work with
+electromagnetic fields (EMFs) and are considered the strongest source of human exposure to radio frequency (RF) EMF. The RF­EMF generated by mobile phone base stations
+ranges between 400 MHz and 3 GHz, a large part of energy of which is absorbed by the user's head. [3],[4] Exposure to high power RF energies may lead to various health hazards
+ranging from neurocognitive deficits, autonomic abnormalities to brain cancers. [5],[6],[7],[8]
+It has been estimated that 75% of teenagers own cell phones. [9] A recent study showed that children and teenagers who need to communicate nearly 24 h a day belong to the largest
+group of smartphone users. Authors claimed that nowadays cell phones and tablets may be seen in the hands of children as little as 2 years in age. [10] RF­EMFs may penetrate
+deeper into the brain areas of children and teenagers due to higher water content and ion concentration of the developing brain and smaller head circumference as compared to
+adults. [11] Thus, teenagers are more susceptible to potential RF­EMF­induced side effects.
+Electro­photo imaging (EPI) or gas discharge visualization (GDV) is based on the well­known Kirlian effect. [12] The measurement of electrophotonic imaging (EPI) is based on the
+electrical activity of the human organism. This activity is quite different in diseased condition of a human body as compared to the activity in a healthy body. The biophysical principles
+in the investigation of EPI technique are based on the ideas of quantum biophysics. [12] This method draws stimulated electrons and photons from the surface of the skin under the
+influence of a pulsed EMF. This process is well­studied through physical, electronic methods and is known as "photoelectron emission." [13] EPI is being used as diagnostic and
+research tool in more than 63 countries. [14] EPI consists of an electrode covered with dielectric (usually a glass plate), generator of the electrical field of a high voltage 12 kV, high
+frequency 1000 Hz, and low current and applied for less than a millisecond. The resultant discharge pattern is photographed using a CCD video camera. [15] From the fingertips of the
+subject, electrons are pulled by the impressed voltage and this avalanche of electrons is captured by the CCD camera. According to Korean acupuncture practices which are based
+on Chinese philosophy, different sectors of fingertips are connected to different organs of the body through meridians, and these meridians allow electrons from those organs to be
+drawn, providing the subtle energy status of the organ. From the information obtained from ten fingertips of the individual, electrophotonic mapping of the whole body is possible
+through a software program. Investigating these images of fingertips, which change dynamically with emotional and health status, one can identify areas of congestion or energy
+balance in the whole system. [15] Previously, only one pilot study on 17 adult subjects investigated the effects of RF­EMF on subtle energy levels. [16] In that study, the overall
+reduction in subtle energy status only was reported, but detailed energy analysis at each organ level was not performed and also the sample size was small which lead to large
+standard deviations. Moreover, that study was performed in the adult population. Therefore, the present work was planned to assess the effect of RF­EMFs on teenage students with
+detailed energy analysis at each organ level and using larger sample size. In our previous pilot studies, we did not observe a significant change in subtle energy levels of teenagers
+after 5 and 10 min of RF­EMF exposure. Therefore, duration of 15 min was chosen in the present study.
+ Materials and Methods
+Participants 
+We enrolled 62 healthy right­handed healthy teenagers (22 males and 39 females) in the age range of 17.40 ± 0.24 years from three educational institutes in Bengaluru city. All
+subjects were healthy as assessed by general health questionnaire (GHQ­12), their mean GHQ score was 0.7 ± 0.67 and the average body mass index was 21.5 ± 5.5 kg/m 2 .
+Subjects were fresh admissions in various undergraduate degree courses after recently graduating from higher secondary school examinations; their last academic performance was
+with an aggregate of 74.48% ± 10.5% (above average), suggesting the absence of mental handicap or other significant psychological morbidity. Subjects of both genders who owned
+a smartphone and those who were able to read and write in English language were included. Subjects who had a history of injury to the fingers, those with congenital diseases or
+3/1/2017
+Acute effects of mobile phone radiations on subtle energy levels of teenagers using electrophotonic imaging technique: A randomized controlled study :...
+http://ijoy.org.in/printarticle.asp?issn=0973­6131;year=2017;volume=10;issue=1;spage=16;epage=23;aulast=Bhargav
+2/4
+deformities, those who were on any kind of regular medications, or those who had undergone any surgical procedure in the past 6 months were excluded. Those performing regular
+meditation since more than a month and those using mobile phones for <5 min or more than 2 h/day (for calling purpose) on an average were also excluded from the study.
+Study design
+Two  group  pre­  and  post­randomized  controlled  design  with  double­blind  conditions  was  followed  [Figure  1].  Names  of  the  subjects  (from  different  educational  institutes),  who
+satisfied the selection criteria, were arranged in an alphabetical order and then they were randomly divided into two groups: (1) Mobile phone in "ON" mode (MPON) and (2) mobile
+phone in "OFF" mode (MPOF), based on the status of RF­EMF exposure. Randomization was performed using online randomization program (www.randomizer.org). It was gender­
+stratified randomization to include approximately an equal number of males and females (11 males and 19 females in MPON group and 11 males and 20 females in MPOF group) in
+each group, respectively. Assessments were done at two points of time in each group: (1) Baseline and (2) after MPON/MPOF exposure of 15 min. Double­blind conditions were
+followed as both, the subjects and those performing assessments, were unaware of the group allocations. Demographic details did not differ significantly between the two groups
+[Table 1]. Schematic representation of the study design is provided in [Figure 1]. Signed informed consent was taken from the subjects who were above 18 years of age and from the
+guardian/parents of those below 18 years of age. Research was approved by institutional ethical committee.{Figure 1}{Table 1}
+Radio frequency electromagnetic field exposure settings
+The source of RF­EMF was a 2100 MHz 3G mobile phone with Universal Mobile Telecommunications System's network without periodic pulsed modulation content. It was an FCC
+approved device and had head specific absorption ratio (SAR) of 0.4 W/kg and body SAR of 0.54 W/kg. Subjects sat on a comfortable chair with head resting on the chair and two
+identical mobile phones were kept at ~0.5 cm distance from the tragus, one on each side, using an adjustable wooden stand. On calling mode, the device emitted average EMF
+energy of 1.305 ± 0.94 mW/m 2 (with a peak value of 2.34 mW/m 2 ) at 5 mm. Left side mobile was kept in off mode permanently with battery removed. Only the right side mobile
+phone status was changed depending on the group to which the subject belongs. Identical phones were kept on both the sides at the same distance from the ear to rule out
+lateralization effects. When subjects were needed to be exposed to RF­EMF, i.e. in MPON groups, fully charged mobile was placed on the right side and a call was made for 15 min
+from another phone. Both the phones (caller and receiver) were kept mute throughout. During sham (MPOF) exposure, the right side mobile was kept off with battery removed.
+Subjects sat in a dark room and their finger impressions were taken on GDV Pro device.
+EPI parameters
+Comprehensive assessments of EPI energy levels at all organs were performed before and after RF­EMF and sham exposure, respectively. Only right side mobile status was
+changed. Further, in our previous pilot study, we did not observe any significant changes on left sided EPI parameters. Forty­two EPI parameters from the right side of EPI images were
+assessed. These parameters provided subtle energy levels of almost all the major organs of the body [Table 2]. [14]{Table 2}
+EPI procedure
+Electrophotonic  imaging  produced  by  "Kirlionics  Technologies  International,"  Saint­Petersburg,  Russia  (GDV  Camera  Pro  with  an  analog  video  camera,  model  number:
+FTDI.13.6001.110310) was used to collect data. The measurements were carried out two times for each subject. The readings from all ten fingers were taken. To maintain the reliability
+and reproducibility of data, the given guidelines for EPI measurements were followed. [17] The measurements were made 3 h after food intake. The subjects were asked to remove all
+metallic objects from their body which were not used by them for 24 h prior to data collection. They were also asked to minimize and if possible completely avoid cell phone use for
+previous 24 h. Subjects stood on an electrically isolated surface during the measurements. Proper instructions were given to them to place the tip of the finger on the dielectric glass.
+Calibration of the instrument was carried out before starting measurement. To clean the surface of glass, alcoholic solution was used for each subject. Hygrometer (Equinox, EQ
+310CTH) was used during data collection to record variability in atmospheric temperature and humidity. During data recording at different time intervals, the mean temperature was
+26.633.47 and humidity 52.18% measured in degree Celsius and percent, respectively, to check for atmospheric effects and possible variability of electrophotonic emission from
+human subjects. [18]
+Data extraction and analysis
+Raw data from each EPI diagram software were extracted onto an excel sheet for the analysis. SPSS version 10.0 (IBM Corporation, New York, US) was used to process data for
+statistical  analysis.  As  the  data  were  found  normally  distributed,  independent  t­test  and  paired  samples  t­tests  were  used  to  perform  between  and  within  group  comparisons,
+respectively, where a level of P < 0.05, P < 0.01, and P < 0.001 were considered as statistically significant, high significance, and highly significant, respectively.
+ Results
+One hundred and twelve subjects were screened, out of which 71 satisfied the selection criteria. All 71 subjects gave consent to participate in the study. Of the 71, ten subjects left the
+study and did not return on the day of assessment. Final data collection was successfully performed on sixty­one subjects.
+Within­group results
+Mobile phone in "OFF" mode group
+Many EPI parameters showed significant changes after 15 min of sham exposure compared to the baseline [Table 3]. Two areas showed a significant increase in subtle energy levels:
+Root mean square of integral area (P < 0.01) and coronary area (P < 0.01). On the other hand, twenty­six areas showed a significant reduction in subtle energy levels. These were as
+follows: Integral area, right jaw, throat, left jaw, left ear, cerebral cortex zone, cervical zone, thorax, sacrum, coccyx, blind gut, appendix, ascending colon, thorax, immune, right kidney,
+cardiovascular zone, cerebral vessel zone, hypophysis, adrenal area, urogenital system, spleen, nervous system, duodenum, ileum, and mammary glands [Table 3].{Table 3}
+Mobile phone in "ON" mode group 
+After RF­EMF exposure of 15 min, it was observed that 13 EPI parameters showed significant changes compared to the baseline [Table 4]. Of the 13, one area showed a significant
+increase in subtle energy levels (left ear: P < 0.01) and 11 areas showed a significant reduction. Areas showing significant reduction were as follows: Right ear, cerebral cortex zone,
+thorax, coccyx, blind gut, liver, right kidney, thyroid, pancreas, adrenal, immune system, and nervous system [Table 4].{Table 4}
+Between­group comparisons
+We observed that the subtle energy levels were significantly reduced after RF­EMF exposure in MPON group compared to MPOF group for following areas: (a) Pancreas (P = 0.001),
+(b) thyroid gland (P = 0.002), (c) cerebral cortex area (P < 0.01), (d) cerebral vessels area (P < 0.05), (e) hypophysis (P = 0.013), (f) left ear and left eye (P < 0.01), (g) liver (P < 0.05),
+(h) right kidney (P < 0.05), (i) spleen (P = 0.04), and (j) immune system [P = 0.02; [Table 2] and [Figure 2].{Figure 2}
+ Discussion
+In the present study, we observed that both RF­EMF and sham exposure of 15 min produced significant changes in EPI parameters. Overall, predominantly, most of the EPI areas
+showed a reduction in subtle energy levels after both RF­EMF and sham exposure, respectively. However, there were 11 areas where subtle energy levels were significantly lesser
+after  RF­EMF  exposure  compared  to  sham,  these  areas  predominantly  related  to  endocrine  glands  (pancreas,  thyroid,  and  adrenals),  brain  area  (cerebral  cortex  and  cerebral
+vascular area), liver, spleen, immune system and right kidney. Previously, to the best of authors' knowledge, only one pilot study measured immediate effect of mobile phone radiations
+on subtle energy levels of 17 adults. [16] The duration of exposure and details of RF­EMF characteristics were not provided in that study; therefore, it is difficult to compare the results.
+Moreover, the EPI parameters assessed in the study were markers of overall subtle energy levels and balance rather than detailed organ­wise subtle energy assessments. Authors
+observed that immediately after RF­EMF exposure, there was a definite influence on the human bioelectromagnetic field (BEM) in a way that the coronas (overall areas representing
+the subtle energy level of body) became reduced, more fragmented and incomplete. This suggests that overall subtle energy levels were reduced in the previous study. These
+findings are similar to our observations where we also found greater subtle energy reductions in 11 areas­after RF­EMF exposure compared to sham which leads to reduced size and
+3/1/2017
+Acute effects of mobile phone radiations on subtle energy levels of teenagers using electrophotonic imaging technique: A randomized controlled study :...
+http://ijoy.org.in/printarticle.asp?issn=0973­6131;year=2017;volume=10;issue=1;spage=16;epage=23;aulast=Bhargav
+3/4
+more fragmentations of the coronas.
+We observed that some areas showed a reduction in subtle energy levels after both RF­EMF as well as sham exposure. These areas are predominantly related to the spinal column
+(cervical zone, sacrum, and coccyx), thorax, gastrointestinal tract (jejunum, ileum, and blind gut), and brain activity (cerebral cortex) and these effects are most probably produced due
+to sitting still on a chair in a dark room without moving the head and body parts much (as these requirements were common to both RF­EMF and sham exposure groups). Studies
+have shown that sitting silently or performing meditations may significantly affect the subtle energy status of the subjects. [19]
+As depicted in the between­group comparisons above [Table 2], primarily the endocrine gland areas (pancreas, thyroid, and adrenals) along with liver, spleen, immune system and
+right kidney areas stand out as distinct markers of RF­EMF exposure in our study. RF­EMF had an energy lowering effect on these organs and this might suggest an enhanced risk of
+developing  malfunctioning  of  endocrine  organs  and  thereby  deficiency  of  corresponding  hormones.  This  may  increase  the  risk  of  developing  diabetes,  hypothyroidism,  or
+adrenocortical insufficiency. Interestingly, in a recent study, 159 students in the age range 12­17 years were recruited. [20] Ninety­six male students were from school­1 where students
+were exposed to high­energy RF­EMF (9.601 nW/cm 2 at a frequency of 925 MHz for a duration of 6 h daily, 5 days in a week) and 63 male students were from school­2 where
+students were exposed to low­energy RF­EMF (1.909 nW/cm 2 at a frequency of 925 MHz for 6 h daily, 5 days in a week). At the end, it was observed that the mean HbA1c for the
+students who were exposed to high­energy RF­EMF was significantly higher (5.44 ± 0.22) than the mean HbA1c for the students who were exposed to low­energy RF­EMF (5.32 ±
+0.34) (P = 0.007). The authors conclude that students who were exposed to high­energy RF­EMF generated by mobile phone base stations had a significantly higher risk of type 2
+diabetes mellitus compared to their counterparts who were exposed to low­energy RF­EMF. [20] As compared to the above study where 2G network was used, in the present study, in
+view of increasing popularity, we exposed the subjects to 3G network with average RF­EMF energy of ~130.5 nW/cm 2 at a frequency of 2100 MHz. We observed that subtle energy
+levels of organs, including pancreas, reduced significantly after 15 min of RF­EMF exposure as compared to sham. Similarly, previous studies have found the effects of RF­EMF on
+brain physiology, brain blood flow, metabolism, cognition, and autonomic functions before. [6],[7],[8] This correlates well with subtle energy changes that have been observed in the
+present study, for example, reduction in subtle energy at cerebral cortex and cerebral vessel area as compared to sham [Table 2]. This suggests that subtle energy levels may be
+affected with much lesser duration of exposure at higher RF­EMF energy. It is known that subtle energies get affected at much earlier stage before the physical manifestation of
+pathology and if the interrupting stimuli are removed, its correction also precedes a physiological correction. [13],[17],[21] Probably, this is the reason that we did not observe any
+significant reduction in baseline subtle energy levels of the pancreas or other organs for both RF­EMF as well as sham exposure group. This may be due to the fact that subjects were
+not exposed to mobile phones for last 24 h before data collection and this might have brought favorable changes in their subtle energy values.
+It is difficult to understand the possible mechanism through which RF­EMF might affect subtle energy levels of the subjects. We monitor subtle energy of "Chi" (or prānā) moving in the
+body through EPI system. The body is basically an electrical network of the nervous system and long and short distance cellular communications are also hypothesized to be through
+electromagnetic (EM) signals in the body. [22] Thus, it is likely that any EM input from outside the body will affect the electrical communication within the body. This is obvious in the
+use of devices such as cardiac pacemakers, motor nerve stimulation for muscle activity, and transcutaneous electrical nerve stimulators for pain suppression. It is likely that the
+external EM coupling as in a cell phone use is related to disruption of normal communication and control that goes on in the body. Lack of control could result in a wide range of
+cellular dysfunction.
+It is interesting to note that in the present study, though RF­EMF exposure was given on the right side only, left eye and left ear also got affected. Within­group comparisons revealed
+that subtle energy levels actually increased in the left ear and reduced in the right ear after RF­EMF exposure [Table 4]. However, below the neck, effects are more or less on the same
+side of RF­EMF exposure. This can be explained by two effects: One related to direct (contra­lateral) compensatory mechanism for the EM energy input and the second (related to
+unilateral involvement of most organs below the neck) through nervous system stimulation (global effects). These findings need more intense study to draw reliable conclusions.
+Though the present study followed a double­blind randomized controlled design with a larger sample size that included both the genders and used a novel way of assessing RF­EMF
+effects on human BEM, it has some limitations. First, we did not perform standard laboratory assessments which may include biochemical makers of dysfunction of various organs,
+imaging procedures and measurements of electrical activity (such as electroencephalogram [EEG] or electrocardiogram [ECG]), etc. This would have provided an idea about the
+strength of correlation between subtle energy changes and corresponding possible anatomical and physiological alterations induced by RF­EMF exposure. Since the changes at
+subtle energy level seem to occur much earlier than those produced at the biochemical level, it is difficult to say that a definite correlation would be found between EPI parameters and
+biochemical markers at the same moment. Still, future researches should explore this area, probably with a cohort study design. Secondly, we did not provide directions on ways to
+counteract the possible effects of RF­EMF on subtle energy levels of teenagers. [23] In the present study, we did not assess the RF­EMF energy to which subjects may already be
+exposed at home, school, or surroundings. All subjects in our study belonged to similar socioeconomic status and age range; we included subjects who owned a smartphone for more
+than last 6 months; therefore, we assume that both RF­EMF and sham exposure groups had similar baseline exposure. In future, we plan to measure associated biochemical
+variables, blood flow changes, and electrical activity of organs like heart or brain using ECG or EEG along with EPI imaging for the establishment of correlation factors. We also plan to
+assess the effect of RF­EMF exposure for longer duration (weeks to months) and at different points of time so as to develop a possible dose response curve between RF­EMF dosage
+and corresponding subtle energy changes of organs. We also plan to use possible interventions to prevent RF­EMF­induced subtle energy changes in future.
+ Conclusion
+Fifteen minutes of RF­EMF exposure exerts quantifiable effects on subtle energy levels of endocrine glands, brain, liver, kidney, and spleen of healthy teenagers. Future studies
+should try to correlate these findings with respective biochemical markers and standard radio­imaging techniques.
+Acknowledgment
+Authors are thankful to the Department of Science and Technology Science and Engineering Board (DST­SERB), Ministry of Science and Technology, Government of India.
+Financial support and sponsorship 
+Nil.
+Conflicts of interest
+There are no conflicts of interest.
+References
+1
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+Acute effects of mobile phone radiations on subtle energy levels of teenagers using electrophotonic imaging technique: A randomized controlled study :...
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+ 
+ 
+Wednesday, March 01, 2017
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yogatexts/Add-on Effect of Hot Sand Fomentation to Yoga on Pain, Disability, and Quality of Life in Chronic Neck Pain Patients.txt

@@ -0,0 +1,696 @@
+ 
+Current Problems in Diagnostic RadiologyIIMB Management ReviewJournal of Cardiac FailureJournal of Exotic Pet MedicineBiology of
+Blood and Marrow TransplantationSeminars in Spine SurgerySeminars in Arthritis & RheumatismCurrent Problems in Pediatric and
+Adolescent Helath CareSolid State Electronics Letters
+Accepted Manuscript
+Add-on effect of hot sand fomentation to yoga on pain, disability, and
+quality of life in chronic neck pain patients
+B. Nandini , A. Mooventhan Senior Medical Officer ,
+NK. Manjunath Professor
+PII:
+S1550-8307(17)30363-4
+DOI:
+10.1016/j.explore.2018.01.002
+Reference:
+JSCH 2294
+To appear in:
+The End-to-end Journal
+Received date:
+11 October 2017
+Revised date:
+5 January 2018
+Accepted date:
+5 January 2018
+Please
+cite
+this
+article
+as:
+B. Nandini ,
+A. Mooventhan Senior Medical Officer ,
+NK. Manjunath Professor , Add-on effect of hot sand fomentation to yoga on pain, disability, and quality
+of life in chronic neck pain patients , The End-to-end Journal (2018), doi: 10.1016/j.explore.2018.01.002
+This is a PDF file of an unedited manuscript that has been accepted for publication. As a service
+to our customers we are providing this early version of the manuscript. The manuscript will undergo
+copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please
+note that during the production process errors may be discovered which could affect the content, and
+all legal disclaimers that apply to the journal pertain.
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+Highlights: 
+ Addition of hot sand fomentation (HSF) to yoga provides a better reduction in pain 
+and disability in patients with non-specific neck pain than yoga alone. 
+ All the subjects were actively participated in intervention 
+ No adverse effects were reported throughout the study period. 
+ Intervention is feasible, easy, safe and cost-effective  
+  
+ 
+ 
+ 
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+Add-on effect of hot sand fomentation to yoga on pain, disability, and quality of life in 
+chronic neck pain patients        
+Running Title: Hot sand fomentation for neck pain 
+B. Nandini,1 A. Mooventhan,2 NK. Manjunath3  
+ 
+1Department of Yoga and Naturopathy, The School of Yoga and Naturopathic medicine, S-
+VYASA University, Bengaluru, Karnataka, India 
+2Senior Medical Officer, Department of Yoga, Center for Integrative Medicine and Research 
+(CIMR), All India Institute of Medical Sciences (AIIMS), New Delhi, India 
+3Professor, Division of Yoga and Life Sciences, & Head, Department of Research and 
+Development, S-VYASA University, Bengaluru, Karnataka, India 
+Number of Tables: 03 
+Number of Figures: 0 
+Word Count: 
+Abstract 
+: 250 
+Manuscript 
+: 2895 
+Corresponding contributor:  
+Dr. A. Mooventhan,  
+Senior Medical Officer, Department of Yoga, Center for Integrative Medicine and Research 
+(CIMR), All India Institute of Medical Sciences (AIIMS), New Delhi, India. 
+Mobile: +91 9844457496  
+E-mail: [email protected] 
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+Add-on effect of hot sand fomentation to yoga on pain, disability and quality of life in 
+chronic neck pain patients    
+ABSTRACT: 
+Background: Neck pain is one of the commonest complaints and an important public health 
+problem across the globe. Yoga has reported to be useful for neck pain and hot sand has 
+reported to be useful for chronic rheumatism. The present study was conducted to evaluate 
+the add-on effect of hot sand fomentation (HSF) to yoga on pain, disability, quality of sleep 
+(QOS) and quality of life (QOL) of the patients with non-specific neck pain.      
+Materials and Methods: A total of 60 subjects with non-specific or common neck pain were 
+recruited and randomly divided into either study group or control group. Both the groups 
+have received yoga and sesame seed oil (Sesamum Indicum L.) application. In addition to 
+yoga and sesame seed oil, study group received HSF for 15-minutes per day for 5-days. 
+Assessments were taken prior to and after the intervention. 
+Results: Results of the study showed a significant reduction in the scores of visual analogue 
+scale for pain, neck disability index (NDI), The Pittsburgh Sleep Quality Index (PSQI), and a 
+significant increase in physical function, physical health, emotional problem, pain, and 
+general health both in study and control groups. However, reductions in pain and NDI along 
+with improvement in social functions were better in the study group as compared with control 
+group.  
+Conclusion: Results of this study suggest that addition of HSF to yoga provides a better 
+reduction in pain and disability along with improvement in the social functioning of the 
+patients with non-specific neck pain than yoga alone.  
+Keywords: Chronic pain; Fomentation; Naturopathy; Neck pain; Yoga  
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+BACKGROUND: 
+Back pain and neck pain are the major musculoskeletal problems in modern society causing 
+considerable costs in health care.[1] Non-specific[2] or common neck pain[3]  is defined as the 
+pain with a postural or mechanical basis[2] caused by altered neck mechanics, advanced age-
+related changes, additional load on the neck, occupational hazards as in computer 
+professionals or call center workers, faulty sleeping habits and sudden violent jerking injuries 
+to the neck as in whiplash injury and not due to any organic lesions.[3] It is an important public 
+health problem across the globe.[4] About two-thirds of people will experience neck pain at 
+some time with women being affected more than men.[2] The prevalence of neck pain has been 
+reported to be up-to 20% of the working populations worldwide[4] in which common neck pain 
+accounts for more than 80%.[3] It is often associated with marked disability[5] and sickness 
+absenteeism[3,5] that could disrupt a nation’s economy apart from disrupting the personal and 
+professional life of a patient.[3] Most patients with chronic neck pain were reported to use 
+alternative or complementary methods for their pain relief. Yoga (physical postures, breathing 
+exercises, meditation, and relaxation) was reported to be a safe and effective complementary 
+therapy for pain relief including chronic neck pain.[4] In a hydrotherapy textbook, the sand bath 
+was reported to be useful in cases of chronic rheumatism. It also reported that the local 
+applications of the sand bath may be made by heating the sand in an oven and heaping it about 
+the desired part as a hot sand application or fomentation.[6] Hot sand fomentation (HSF) is 
+commonly employed in various naturopathic hospitals for pain management. There are 
+various studies reporting the effect of a combination of exercise plus infrared, exercise plus 
+pillow; exercises plus manipulation; hot or cold packs plus massage; and heat combined with 
+other physical treatment for chronic neck pain management.[2] Though yoga was reported to 
+be useful for neck pain[4] and hot sand is reported to be useful for chronic rheumatism,[6] to the 
+best of our knowledge there is no known study reporting the combined effect of yoga and HSF 
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+in patients with non-specific neck pain. Thus, the present study was conducted to evaluate the 
+add-on effect of HSF to yoga on pain, disability, quality of sleep (QOS) and quality of life 
+(QOL) in patients with non-specific neck pain. 
+ MATERIALS AND METHODS 
+Study Design: 
+This is a parallel group randomized controlled study. All the subjects were randomly (1:1 
+ratio) divided into either study group (n=30) or control group (n=30). The study group 
+received HSF for 15-minutes a day for the period of 5-days along with yoga and sesame seed 
+oil application while the control group received yoga and sesame seed oil application alone 
+for the same period. Assessments were taken prior to and after the intervention. 
+Subjects: 
+A total of 60 subjects with non-specific or common neck pain age range from 24 to 56 years 
+were recruited from a holistic health centre in South India, based on the following inclusion 
+and exclusion criteria. Inclusion criteria: Subjects with the age range of 20-60 years with 
+non-specific or common neck pain due to ligament strain, sprain of the neck muscles or 
+spasm (myalgia), cervical spondylosis without any neurological impairment and who were 
+willing to participate in the study were included in the study. Exclusion criteria: Subjects 
+with uncommon neck pains due to organic causes such as congenital conditions like wry neck 
+also known as torticollis (a twisted and tilted neck), inflammatory conditions like rheumatoid 
+arthritis, metabolic disorders like osteoporosis, neoplastic conditions, infective conditions like 
+tuberculosis, and posttraumatic conditions with ligament or bone injuries; subjects with the 
+history of mental illness; and those who underwent yoga and other naturopathy treatments for 
+the past 1 month were excluded from the study. The study was conducted in Anvesana 
+research laboratories that include an inpatient holistic healthcare centre, S-VYASA 
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+University, Bengaluru, India. The study protocol was approved by the institutional ethics 
+committee (RES/IEC-SVYASA/106/2017) and a written informed consent was obtained 
+from each subject.  
+Interventions:  
+Both Study and Control Groups: Practice of Yoga (Loosening practices, asanas, pranayama, 
+relaxation and meditation techniques and lecture on yoga philosophy), low fat and low salt 
+vegetarian diet and application of sesame seed oil (also called as Gingelly oil) [the oil that is 
+derived from the seeds of plant species Sesamum Indicum L., a herbaceous annual belonging 
+to the Pedaliaceae family. It has been reported to have anti-inflammatory effect. The main 
+constituents of sesame seed oil include fatty acids (palmitic acid, palmitoleic acid, stearic 
+acid, oleic acid, linoleic acid, linolenic acid, and eicosanoic acid), lignans, and antioxidants, 
+such as ??-tocopherol.][7] were common for both study group and control group (Table 1).   
+Study Group: Along with yoga and sesame seed oil application, study group subjects have 
+received HSF that consists of approximately 250 gm. of sand devoid of thorns, shells and 
+pebbles heated up to tolerable temperature (39-40oC) using a pan placed on the stove. The 
+procedure of the preparation of HSF is as follows: As soon as the sand in the vessel was 
+properly heated it was poured at the centre of the double layer cotton cloth of dimensions 15 x 
+15 cm to tie it as a bolus. A strong thick thread was used to tie up the upper portion of the 
+bolus to avoid the outflow of the sand from small openings during the treatment procedure. 
+The free end of the cloth is then folded and tied to form a handle. Then the fomentation was 
+given by means of keeping it over (5 seconds) and taking it away from the painful region (2 
+seconds) which was continued for the duration of 15 minutes a day in the evening between 
+5:00 pm and 6:00 pm for the period of 5 consecutive days. In order to maintain the 
+temperature, the HSF bag was replaced by a new HSF bag every 5 minutes. Thus, we used 3 
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+HSF bags to complete one session. The intervention was given by two (1 male and 1 female) 
+institutionally qualified therapists.      
+Control Group: Control group subjects were under their normal routine and did not receive 
+HSF for the same period.  
+Assessments: 
+The primary (visual analog scale for pain and neck disability index) and secondary outcome 
+[quality of sleep (QOS), and quality of life (QOL)] measures were taken before and after the 
+intervention as mentioned below: 
+Visual analog scale (VAS) for pain: It was used to evaluate subject’s intensity of pain on a 
+scale of 0 to 10, where 0 indicates no pain and 10 indicates worst pain. Subjects were advised 
+to mark on the scale to indicate their pain intensity before and after the intervention.[8] 
+Cronbach’s alpha = 0.95[9] 
+Neck Disability Index (NDI): It is a measurement tool used to measure 10 dimensions of 
+neck-specific disability, namely pain intensity, personal care, lifting, reading, headache, 
+concentration, work, driving, sleeping, and recreation. Each dimension is assessed with 1 
+item, measured on a 6-point scale from 0 (no disability) to 5 (full disability). The sum score 
+out of all 10 items is multiplied by 2 to obtain a score out of 100%. The score 0-20,  21-40, 
+41-60, 61-80, and 80-100 represents the normal, mild, moderate, severe and complete or 
+exaggerated disability. Cronbach’s alpha = 0.864. [10,11] 
+The Pittsburgh Sleep Quality Index (PSQI): It consists of seven components in 9-items 
+sleep questionnaire, which was used to evaluate subject’s QOS. The total score 0-4 indicates 
+good sleep quality, 5-10 indicate poor sleep quality, and >10 indicates the sleep disorder. 
+Cronbach’s alpha = 0.83.[12,13] 
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+Short Form-36 Version 2 (SF-36 V2) Health Survey: 
+It consists of 36-items questionnaire, which measures the health in eight dimensions. For 
+each dimension, item scores were noted, averaged, and transformed into a scale of 0-100 
+where 0 indicates worst possible health and 100 indicates best possible health.[13,14] 
+Cronbach’s alpha = 0.85[15]  
+Sample size: 
+A total of 60 subjects with non-specific or common neck pain age range from 24 to 56 years 
+were recruited. The sample size was not calculated based on any previous study or pilot study 
+which is one of the limitations of the study.  
+Randomization: 
+All the subjects were randomly divided into either study group or control group using 
+computerized randomization available at http://www.randomization.com/. A simple 
+randomization procedure was performed for 60 subjects with 1:1 ratio to get a sample size of 
+(n=30) in each group. Random allocation of the intervention was kept in opaque sealed 
+envelopes until interventions were assigned. The randomization was performed by one of the 
+authors who did not involve in any part of the investigation.  
+Blinding: 
+It was not possible for us to blind the subjects from the intervention. However, the 
+investigator was kept blind to the study group and control group. 
+Data Analysis: Statistical analysis of within-group was performed using Wilcoxon signed 
+rank test and between groups analysis was performed using Mann Whitney-U-test with the use 
+of Statistical Package for the Social Sciences (SPSS) for Windows, Version 16.0. Chicago, 
+SPSS Inc. 
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+RESULT 
+The details of the demographic variables of the study and control groups have been given in 
+table 2. Baseline characteristics were comparable and no significant differences were observed 
+between the groups in all the variables except pain and SF-36 health survey’s physical health 
+and energy scales. Results of the study showed a significant reduction in the scores of pain, 
+NDI, and social function in the study group compared to the control group. Within-group 
+analysis showed a significant reduction in VAS score for pain, NDI, PSQI and a significant 
+increase in physical function, physical health, emotional problem, pain, and general health 
+both in study and control groups, while a significant increase in energy level and social 
+functioning was observed only in study group unlike control group and no such significant 
+change was observed in emotional well being both in study and control groups (Table 3). The 
+compliance of the participants to the therapies was good due to voluntary participation and 
+there were no dropouts and none of the subjects reported any adverse effects during the study 
+period.  
+DISCUSSION 
+Research shows that spinal pain has become the largest category of medical claims, placing a 
+major burden on individuals and health care system. Yoga is quite commonly used as a 
+complementary therapy for spinal pain including neck pain.[1] Self-assessment questionnaires 
+are widely used to assess the outcome of medical management and interventions.[11] In the 
+present study, we used self-assessment questionnaires such as VAS for pain, NDI, PSQI and 
+SF-36 Healthy survey to assess the add-on effect of HSF on neck pain and disability, QOS and 
+QOL of patients with non-specific neck pain.  
+Results of this study showed a significant increase in the energy level and social functioning 
+only in the study group while no such significant changes were observed in the control group. 
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+Moreover, the significant reduction in VAS score for pain and NDI score and the significant 
+increase in social functions were better in the study group compared with control group. It 
+suggests that the improvement in pain, neck disability, general energy level and the social 
+functioning of the people with the neck pain were better in the subjects who received HSF 
+along with yoga rather than the subjects who received yoga alone. It should be noted that 
+there was a significant baseline difference in pain between the groups and that might have 
+influenced the significant difference in the post-test analysis as well. However, the reduction 
+in the pain (mean score) was better in the study group (from 7.81 to 2.63; Difference = 5.18) 
+compared with control group (from 7.33 to 5.79; Difference = 1.54). Similarly, though there 
+was a significant baseline difference in SF-36 health survey’s energy level scale in between 
+groups, within group analysis showed a significant improvement in energy level in the 
+subjects those who received yoga plus HSF rather than the subjects those who received yoga 
+alone. This suggests that HSF might have additional effect in reducing pain and in improving 
+energy level of the patients with neck pain.  
+The better reduction in pain and neck disability in the study group compared with the control 
+group might attribute to the pain reducing and muscle relaxing effect of HSF. Improvement 
+in the energy level and social functioning of the study group unlike the control group might 
+attribute to the better reduction of pain and neck disability in the study group compared with 
+the control group. As mentioned in a previous study,[3] the tension that is associated with 
+stress is stored mainly in the neck muscles, diaphragm and the nervous system. Stress is 
+reported to produce spasm by interfering with coordination of different muscle groups 
+involved in the functioning of the neck. Thus, if these areas are relaxed, stress can get 
+reduced or if the stress reduced, these areas can be relaxed and these help in minimizing the 
+impact of stress in people with neck pain. In a previous study, yoga has been found to be an 
+effective tool in reducing stress levels that might have helped in reducing the pain and 
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+disability by reducing the tension over the neck muscles indirectly.[3] According to a 
+hydrotherapy text, hot applications were reported to be effective in reducing pain and muscle 
+tension directly.[6] This explains the reason, why there was a better reduction in pain and 
+disability in the study group compared with control group. 
+Within group analysis of the present study showed a significant reduction in the scores of 
+VAS for pain, NDI, and PSQI and a significant increase SF-36 health survey especially in 
+physical function, physical health, emotional problem, pain, and general health both in study 
+and control groups. It suggests that practice of yoga with or without HSF was effective in 
+improving the problems that are associated with chronic neck pain such as neck pain, 
+disability, QOS and QOL.   
+The previous study on one of the advanced guided yoga relaxation techniques called “mind 
+sound resonance technique (MSRT)” was reported to add significant complimentary benefits 
+to conventional physiotherapy by reducing pain, tenderness, disability and providing 
+improved flexibility in patients with common neck pain.[3] Regular yoga practice has shown 
+to produce a significant reduction in time to fall asleep, decreased sleep disturbance during 
+night time, better sleep quality, decreased use of medications for sleep and improve overall 
+QOS[16] and also felt more rested and energetic in the morning.[17] Previous studies on yoga 
+practices showed improvement in pain, neck-related disabilities and health-related QOL in 
+patients with chronic non-specific neck pain.[18-20] And, sustained yoga practice seems to be 
+the most important predictor of long-term effectiveness in neck patients. A systematic review 
+has reported that the yoga can decrease pain and increase functional ability in patients with 
+spinal pain including neck pain.[1] Thus, the findings of the present study are consistent with 
+the reports of the previous studies.  
+Non-specific neck pain has reported to be associated with anxiety, depression[2] stress and 
+tension.[3] Yoga is fast advancing as an effective therapeutic tool in physical, psychological 
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+and psychosomatic disorders. And the practice of yoga was found to be effective in reducing 
+stress, anxiety, pain[3] (by down regulating the hypothalamic pituitary adrenal axis and the 
+sympathetic nervous system)[4] and disability.[3,4] Moreover, yoga has shown to influence the 
+functional status of neck muscles of patients with neck pain[19] and reported to be an effective 
+method for treating neck pain by improving strength, flexibility and endurance that is a basic 
+goal of most rehabilitation programs for neck pain.[1] Thus, the reduction in pain and 
+disability and the improvement in QOS and QOL after yoga with or without HSF might 
+attribute to the effect of yoga on stress, anxiety, modulation of the hypothalamic pituitary 
+adrenal axis and the sympathetic nervous activity.  
+A qualitative study reported that the chronic neck pain patients those who have participated in 
+yoga intervention have changed on five dimensions of human experience: 1) Physically, most 
+participants cited renewed body awareness, both during yoga practice and in daily lives, 2) 
+Cognitively, participants reported increased perceived control over their health, 3) 
+Emotionally, they noted greater acceptance of their pain and life burdens, 4) Behaviourally, 
+they described enhanced use of active coping strategies, and 5) Socially, they reported 
+renewed participation in an active life.[21] In a previous study, intake of the vegetarian diet 
+has shown to be effective in reducing pain, tenderness, inflammatory markers and in 
+improving physical functioning of patients with rheumatoid arthritis.[22] Thus, the vegetarian 
+diet provided in the present study might also have attributed to the reduction in pain and 
+improvement in the health-related problems of neck pain.   
+Strength of the study: This is the first study evaluating the add-on effects of HSF to yoga in 
+patients with non-specific neck pain, the standard study design was adopted, and no adverse 
+effects were reported by the subjects throughout the study period. Limitations of the study: 
+Small sample size, short-term intervention, and lack of objective variables and assessments 
+such as stress, anxiety, muscle tension, flexibility, sleep architecture. Hence, long-term 
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+studies are required with larger sample size and above-mentioned variables for the better 
+understanding of the effect and its underlying mechanisms.   
+CONCLUSION 
+Result of this study suggests that yoga with or without HSF is effective in reducing pain, 
+disability, and in improving QOS and QOL of patients with non-specific neck pain. However, 
+an addition of HSF to yoga provides a better reduction in pain and disability along with 
+improvement in the social functioning of the patients with non-specific neck pain than yoga 
+alone.  
+SOURCE OF FUNDING: Nil,  
+CONFLICT OF INTEREST: None declared 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
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+10. Vernon H, Mior S. The Neck Disability Index: A study of reliability and validity. J 
+Manipulative Physiol Ther. 1991;14:409-415 
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+11. McCarthy MJ, Grevitt MP, Silcocks P, Hobbs G. The reliability of the Vernon and 
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+survey questionnaire. Eur Spine J. 2007;16:2111-7. 
+12. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh 
+Sleep Quality Index: A new instrument for psychiatric practice and research. 
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+14. Jenkinson C, Stewart-Brown S, Petersen S, Paice C. Assessment of the SF-36 version 
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+15. Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, et al. 
+Validating the SF-36 health survey questionnaire: new outcome measure for primary 
+care. BMJ. 1992;305(6846):160-4. 
+16. Manjunath NK, Telles S. Influence of Yoga and Ayurveda on self-rated sleep in a 
+geriatric population. Indian J Med Res. 2005;121:683-90. 
+17. Bankar MA, Chaudhari SK, Chaudhari KD. Impact of long term Yoga practice on 
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+Randomized-controlled trial comparing yoga and home-based exercise for chronic 
+neck pain. Clin J Pain. 2013;29:216-23. doi: 10.1097/AJP.0b013e318251026c. 
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+20. Michalsen A, Traitteur H, Lüdtke R, Brunnhuber S, Meier L, Jeitler M, et al. Yoga for 
+chronic neck pain: a pilot randomized controlled clinical trial. J Pain. 2012;13:1122-
+30. doi: 10.1016/j.jpain.2012.08.004. 
+21. Cramer H, Lauche R, Haller H, Langhorst J, Dobos G, Berger B. "I'm more in 
+balance": a qualitative study of yoga for patients with chronic neck pain. J Altern 
+Complement Med. 2013;19:536-42. doi: 10.1089/acm.2011.0885. 
+22. Kjeldsen-Kragh J, Haugen M, Borchgrevink CF, Laerum E, Eek M, Mowinkel P, et 
+al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. 
+Lancet. 1991;338:899-902. 
+ 
+ 
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+TABLES: 
+Table 1: Detailed daily activities to study group and control group  
+Time 
+Schedule 
+5:30 am 
+OM meditation 
+6:00 am 
+Practice of asana (postures) 
+7:30 am 
+Breakfast  
+8:00 am 
+Bhagavat Geetha chanting followed by lecture on Yoga 
+9:00 am 
+Discussion with the ward doctors and assessment of vitals  
+10:00 am 
+Pranayama (breathing exercise) practices  
+11:00 am 
+Sukshma Vyayama (loosening exercise) 
+12:00 pm 
+Lecture on Yoga philosophy 
+1:00 pm 
+Lunch break  
+3:00 pm 
+Cyclic meditation 
+4:00 pm 
+Loosening exercise followed by asana 
+5:00 pm 
+Sesame oil application (for both the groups) followed by hot sand 
+fomentation (only for study group)  
+6:00 pm 
+Bhajan (Singing of sacred scriptures) 
+6:30 pm 
+Relaxation techniques  
+7:30 pm 
+Dinner  
+8:30-9:00 pm 
+Happy Assembly (interactions among the patients) 
+ 
+ 
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+Table 2: Demographic variables of the study group (n = 30) and control group (n = 30) 
+Variable 
+Study group (n = 30) 
+Control group (n = 30) 
+p value 
+Age (Years) 
+32.70±6.04 
+35.27±8.28 
+0.202¶ 
+Gender 
+Female 14/Male 16 
+Female 13/Male 17 
+- 
+Height (cm) 
+159.53±3.56 
+160.52±4.57 
+0.395¶ 
+Weight (kg) 
+62.77±6.72 
+64.27±8.22 
+0.327¶ 
+BMI (kg/m2) 
+24.66±2.40 
+24.66±2.38 
+0.842¶ 
+Note: BMI = Body mass index. ¶ = Mann-Whitney U Test. 
+ 
+ 
+ 
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+19 
+ 
+Table 3: Baseline and post-test assessments of study group and control group   
+Variables Assessment Sample 
+size (n) 
+Study group with 
+within group 
+analysis  
+(Wilcoxon signed 
+ranks test) 
+Control group 
+with within 
+group analysis  
+(Wilcoxon 
+signed ranks test) 
+Between 
+groups 
+analysis 
+(Mann-
+Whitney 
+U 
+Test)  
+p value 
+VAS 
+Baseline 
+29 
+7.81±1.08 
+7.33±0.83 
+0.019 
+Post test 
+29 
+2.63±0.98 
+5.79±1.18 
+<0.001 
+ 
+p<0.001 
+p<0.001 
+ 
+NDI 
+Baseline 
+30 
+34.47±7.31 
+34.80±6.34 
+0.846 
+Post test 
+30 
+11.20±5.37 
+23.73±7.10 
+<0.001 
+ 
+p<0.001 
+p<0.001 
+ 
+PSQI 
+Baseline 
+30 
+14.90±7.53 
+11.93±6.41 
+0.84 
+Post test 
+30 
+6.97±3.00 
+8.93±5.33 
+0.268 
+ 
+p<0.001 
+p<0.001 
+ 
+SF-36 Health Survey 
+PF 
+Baseline 
+30 
+45.00±20.97 
+54.17±18.29 
+0.154 
+Post test 
+30 
+71.00±20.02 
+66.17±18.08 
+0.201 
+ 
+p<0.001 
+p<0.001 
+ 
+PH 
+Baseline 
+30 
+20.00±27.39 
+35.83±31.27 
+0.023 
+Post test 
+30 
+59.17±41.25 
+59.17±34.42 
+0.819 
+ 
+p<0.001 
+p=0.002 
+ 
+ACCEPTED MANUSCRIPT
+ACCEPTED MANUSCRIPT
+20 
+ 
+EP 
+Baseline 
+30 
+27.78±30.43 
+27.78±31.66 
+0.826 
+Post test 
+30 
+64.44±43.71 
+51.67 ±35.11 
+0.204 
+ 
+p=0.001 
+p=0.003 
+ 
+Energy 
+Baseline 
+30 
+44.58±10.42 
+53.17±10.54 
+0.004 
+Post test 
+30 
+58.25±12.85 
+56.50±11.38 
+0.581 
+ 
+p<0.001 
+p=0.188 
+ 
+EW 
+Baseline 
+30 
+65.33±12.66 
+64.53±11.49 
+0.840 
+Post test 
+30 
+66.33±12.66 
+67.87±12.32 
+0.800 
+ 
+p=0.628 
+p=0.091 
+ 
+SF 
+Baseline 
+30 
+42.50±17.47 
+40.00±12.88 
+0.742 
+Post test 
+30 
+64.08±13.20 
+55.25±17.58 
+0.035 
+ 
+p<0.001 
+p=0.091 
+ 
+Pain 
+Baseline 
+30 
+40.75±17.47 
+39.83±16.58 
+0.745 
+Post test 
+30 
+69.00±16.95 
+49.92±17.09 
+<0.001 
+ 
+p<0.001 
+p=0.011 
+ 
+GH 
+Baseline 
+30 
+48.58±13.39 
+43.58±14.35 
+0.399 
+Post test 
+30 
+62.17 ±12.30 
+56.17±12.01 
+0.054 
+ 
+p<0.001 
+p<0.001 
+ 
+Note: All the values are in Mean ± Standard deviation. VAS= Visual analogue scale; NDI= 
+Neck disability index; PSQI= Pittsburgh sleep quality index; SF = Short form; PH= Physical 
+functioning; PH= Physical Health; EP= Emotional problem; EW= Emotional wellbeing; SF= 
+Social functioning; GH= General Health 
+ 
+ 

yogatexts/Add-on Yoga Therapy for Social Cognition in Schizophrenia_ A Pilot Study.txt

@@ -0,0 +1,207 @@
+Int J Yoga. 2018 Sep-Dec; 11(3): 242–244.
+doi: 10.4103/ijoy.IJOY_45_17
+PMCID: PMC6134743
+PMID: 30233119
+Add-on Yoga Therapy for Social Cognition in Schizophrenia: A Pilot
+Study
+Ramajayam Govindaraj, Shalini Naik,  NK Manjunath,  Urvakhsh Mehta Mehta,  BN Gangadhar,  and
+Shivarama Varambally
+Department of Psychiatry, NIMHANS Integrated Centre for Yoga, NIMHANS, Bengaluru, Karnataka, India
+Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
+Department of Yoga and Life Sciences, S-VYASA, Bengaluru, Karnataka, India
+Address for correspondence: Dr. Ramajayam Govindaraj, Department of Psychiatry, NIMHANS Integrated
+Centre for Yoga, NIMHANS, Hosur Road, Bengaluru - 560 029, Karnataka, India. E-mail:
+[email protected]
+Received 2017 Aug; Accepted 2017 Nov.
+Copyright : © 2018 International Journal of Yoga
+This is an open access journal, and articles are distributed under the terms of the Creative Commons
+Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the
+work non-commercially, as long as appropriate credit is given and the new creations are licensed under the
+identical terms.
+Abstract
+Background:
+Yoga as a mind–body therapy is useful in lifestyle-related disorders including neuropsychiatric
+disorders. In schizophrenia patients, yoga has been shown to significantly improve negative symptoms,
+functioning, and plasma oxytocin level.
+Aim:
+The aim of the study was to study the effect of add-on yoga therapy on social cognition in
+schizophrenia patients.
+Materials and Methods:
+In a single pre-post, study design, 15 schizophrenia patients stabilized on antipsychotic medication for
+6 weeks were assessed for social cognition (theory of mind, facial emotion recognition, and social
+perception [SP]) and clinical symptoms (negative and positive symptoms and social disability) before
+and after twenty sessions of add-on yoga therapy.
+Results:
+There was a significant improvement in the social cognition composite score after 20 sessions of yoga
+(t[13] = −5.37, P ≤ 0.001). Clinical symptoms also reduced significantly after twenty sessions of yoga.
+Conclusion:
+Results are promising to integrate yoga in clinical practice, if proven in well-controlled clinical trials.
+Keywords: Schizophrenia, social cognition, yoga
+1
+2
+1
+1
+1
+1
+2
+Introduction
+Schizophrenia is a severe mental disorder affecting young adults with a lifetime prevalence of 1%. It is
+characterized by three important symptom clusters, namely, positive, negative, and cognitive
+symptoms. Except for the positive symptoms, there are no effective treatments available for the
+negative and cognitive symptoms.[1] In addition, the existing treatments are not free of side effects;
+some causing extrapyramidal side effects and others causing metabolic side effects.[2]
+Unavailability of effective biological treatments for negative and cognitive symptoms adds to the
+already existing burden of socio-occupational dysfunction associated with these symptom clusters.
+Psychosocial interventions are available targeting a few or most of the domains of social cognition with
+or without neurocognition training. However, the majority of them (for example, cognitive
+enhancement therapy and social cognition interaction training) are highly resource intensive and their
+feasibility in developing countries are questionable though they might be effective. Moreover, they
+were developed keeping in mind the Western patient population and their cultural validity in other
+cultures. Hence, there is a need to explore the role of other complementary therapies such as yoga for
+an integrated approach in treating patients with schizophrenia.
+Yoga as a mind–body therapy is useful in lifestyle-related disorders including neuropsychiatric
+disorders.[3,4] In healthy adults and elderly, yoga is found to be efficacious in improving cognitive
+skills.[5] Yoga has been shown to significantly improve negative symptoms and functioning in
+schizophrenia patients.[6,7] In a recent study, along with improvements in functioning, yoga also
+increased oxytocin levels in patients with schizophrenia.[8]
+In this study, we hypothesized that practice of yoga for 1 month would improve social cognition in
+patients with schizophrenia.
+Materials and Methods
+Setting
+The study was conducted in a tertiary care neuropsychiatry hospital in South India in collaboration with
+a Yoga University. The study was approved by the Ethics Committee of both the institutes.
+Study design
+The study design was a single group pre-post design.
+Sample
+Patients with schizophrenia (outpatient n = 7 and inpatient n = 8) stabilized on antipsychotic
+medications for at least 6 weeks, and cooperative for yoga practices were recruited as a part of a larger
+randomized controlled trial after obtaining a written informed consent. Their diagnosis was made by
+their treating psychiatrists and confirmed with the Mini-International Neuro-psychiatric Interview.[9]
+They were of either gender, coming from the age group of 18–45 years with Clinical Global
+Impression-Severity[10] score of 3 or more. Patients with a history of risk of harm to self or others;
+who had received electroconvulsive therapy or yoga therapy in the last 6 months; patients with
+significant neurological disorder or head injury; and patients with substance abuse in the last 1 month
+or dependence in the last 6 months except nicotine were excluded from the study. Out of 15 patients
+recruited, one subject dropped out due to general medical illness (osteoarthritis).
+Intervention
+A trained yoga instructor taught all the participants a validated yoga module for 1 month. Subjects
+attended twenty sessions of yoga over 6 weeks. Each session lasted for 1 h. The yoga module consisted
+of asana, pranayama, and AUM chanting. Details of the module can be found in an earlier publication.
+[11]
+Assessments
+The following assessments were performed at baseline and after twenty sessions of yoga.
+1. Psychopathology was assessed using Scale for Assessment of Negative Symptoms (SANS)[12]
+and Scale for Assessment of Positive Symptoms (SAPS)[13]
+2. Socio-occupational dysfunction was assessed by Groningen social disability scale (GSDS-II)[14]
+3. Social Cognition was assessed using the social cognition rating tool for Indian setting,[15] a
+validated tool for assessing social cognition appropriate for Indian population that captures
+theory of mind and SP, and tool for recognition of emotions in neuropsychiatric disorders[16]
+that assesses facial emotion recognition. Each domain was scored as the proportion of correct
+responses on a scale of 0–100. The proportions of correct answers were converted into a global
+composite score by averaging the individual domain scores as done in earlier studies.[17]
+A trained psychiatry resident performed the clinical assessments, and a trained research scholar
+performed the social cognition assessments. Neither of them was involved in training the subjects with
+yoga. The yoga instructor monitored yoga performances of all subjects.
+Statistical analysis
+Data were tested for outliers and normality. Data were found to be normal, and there was no outlier.
+Paired t-test was applied to detect a difference in pre- and post-measures using Statistical Package for
+the Social Sciences version 24 (IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version
+24.0. Armonk, NY: IBM Corp.).
+Results
+The sociodemographic details of the subjects are shown in Table 1.
+Table 1
+Sociodemographic details
+SANS, SAPS, and GSDS scores reduced significantly, and social cognition composite score (SCCS)
+improved significantly after 1 month of yoga practice [Table 2]. Effect size (Cohen's d) for SANS,
+SAPS, GSDS, and SCCS is 2.7, 1.5, 1.9, and 1.4, respectively.
+Table 2
+Pre-post measures
+Discussion
+At the end of 1-month add-on yoga therapy, scores on psychopathology and socio-occupational
+dysfunction rating scales reduced significantly and SCCS increased significantly. Previous studies have
+shown efficacy of yoga in reducing psychopathological symptoms, especially the negative symptoms.
+This is one of the first studies exploring the role of yoga in social cognition for patients with
+schizophrenia. Unlike previous studies,[8,16] which have primarily used tasks assessing only facial
+emotion recognition deficits (FERD), this study has included most of the domains of social cognition
+including FERD. A subgroup analysis of the social cognition subdomains revealed significant changes
+in second-order theory of mind (t[13] = −2.45, P = 0.02] and SP (t[13] = −2.35, P = 0.03) but not in
+first-order theory of mind (t[13] = −1.61, P = 0.1). The changes were significant in emotion recognition
+(t[13] = −5.05, P < 0.001) and faux pas indices (t[13] = −8.0, P < 0.001) (considered as higher-order
+theory of mind) as well. Whether the improvement in SCCS is due to improvement in all the individual
+domains or improvement in some other phenomena (like mirror neuron activity) which might be
+common to all the subdomains of social cognition, needs to be explored further. For example, a recent
+pilot study has shown improvement in mirror neuron activity with yoga intervention, measured by
+functional near infra-red spectroscopy.[18] The large effect size with yoga intervention is interesting,
+but it could also be due to the chance detection passing through the threshold of significance which is
+usually kept at 0.05 (type I error). Considering the small sample size, further studies with robust design
+are required for confirming the large effect size following yoga intervention. Yoga could possibly work
+by both bottom-up and top-down approaches-promoting relaxation through asana and pranayama and
+mindfulness through chanting and positive resolution, respectively. This dual effect of yoga might well
+fit in with the dual processing theory of Social Cognition,[19] with mindfulness (yoga mediated)
+promoting controlled (reflective) processing and relaxation modulating the reflexive (automatic)
+processing. Although the results are promising, they should be interpreted with caution as there is no
+control arm in this study and may need confirmation by well-controlled studies.
+Financial support and sponsorship
+Nil.
+Conflicts of interest
+There are no conflicts of interest.
+Acknowledgment
+We thank the NIMHANS Integrated Centre for Yoga and its staffs for the logistic support in conducting
+the yoga sessions.
+We would like to acknowledge the financial support from Wellcome Trust-DBT India Alliance
+(IA/E/12/1/500755) for one of the researchers (RG) during this study period.
+Shivarama Varambally is the recipient of a current Wellcome Trust-DBT India Alliance Intermediate
+Clinical Fellowship (Grant number IA/CPHI/15/1/502026).
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+Articles from International Journal of Yoga are provided here courtesy of Wolters Kluwer -- Medknow
+Publications