ORIGINAL ARTICLE Integrated yoga therapy for improving mental health in managers Tikhe Sham Ganpat, H. R. Nagendra Department of Yoga and Management, Swami Vivekananda Yoga Anusandhana Samsthana University, Prashanti Kutiram, Bangalore, Karnataka, India Address for correspondence: Dr. Tikhe Sham Ganpat, Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA) University, Prashanti Kutiram, 19, Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar, Bangalore - 560 019, Karnataka, India. E-mail: rudranath29@gmail.com A b s t r A c t background: Managers’ lives have become a never-ending race against time, technology, and targets. This race creates tension, which leads to dissatisfaction and frustration and eventually manifests itself as psychological and physiological stress with mental and emotional drain. This modern lifestyle intensifies the stress leading to “Excessive Tension” and consequent deterioration in “Executive Efficiency.” Objective: To assess mental health in managers undergoing yoga-based Self-Management of Excessive Tension (SMET) program. Materials and Methods: 72 managers with 48.75±3.86 years of mean age were participated in this study of single group pre–post design. The General Health Questionnaire data were taken on the first and sixth day of 5 days SMET program. results: The data analysis showed 68.25% decrease (P<0.001) in somatic symptoms, 66.29% decrease (P<0.001) in anxiety and insomnia, 65.00% decrease (P<0.001) in social dysfunction, 87.08% decrease (P<0.001) in severe depression, and 71.47% decrease (P<0.001) in all medical complaints. conclusion: These results suggest that participation in a SMET program was associated with improvement in mental health and may have implications for “Executive Efficiency.” Keywords: Executive efficiency, managers, self-management of excessive tension he present age of speed and competition has increased the stresses and strains resulting in an increasing prevalence of lifestyle-related health problems[1] and specifically managers’ lives have become a never-ending race against time, technology, and targets. This race creates tension, which leads to dissatisfaction and frustration and eventually manifests itself as psychological and physiological stress with mental and emotional drain. This modernlifestyleintensifiesthestressleadingto“Excessive Tension” and consequent deterioration in “Executive Efficiency.”[2] 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 lifestyle-related diseases[3] such as primary prevention of diabetes,[4] prevention of cardiac diseases through control over major risk factors such as smoking, lipids, obesity, and stress,[5] better quality of T Access this article online Quick Response Code: Website: www.industrialpsychiatry.org DOI: 10.4103/0972-6748.98415 life of cancer patients,[6] positive health in normal persons through better physical fitness,[7] and stress reduction.[8] Yoga, which is considered to be a tool forboth physical and mental development of an individual, is being recognized around the globe only in the last century although it has been practiced 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.[9,10] It has become quite fashionable even for the common man to keep fit.[11] 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 studieshavedemonstratedthebeneficialeffectsof yogaon health behavior in many lifestyle-related somatic problems such as hypertension,[12] bronchial asthma,[13] diabetes[14] including some psychiatric conditions such as anxiety neurosis[15] and depressive illness.[16] Yoga at Swami Vivekananda Yoga Anusandhana Samsthana University, Bangalore, offers a holistic and integrated stress management program called Self-Management of Excessive Tension (SMET) to combat this modern lifestyle problem and thereby one can lead a holistic way of living in health, harmony, and happiness.[2] Previous work on stress management educational program reported significant Industrial Psychiatry Journal 45 Jan-Jun 2011 | Vol 20 | Issue 1 Ganpat and Nagendra: Yoga for mental health in managers improvement in the subjective well-being inventory scores of the 77 subjects within a period of 10 days when compared with controls. These observations suggest that a short lifestyle modification and stress management educational program can make an appreciable contribution to primary prevention and management of lifestyle diseases.[17] Previous study on SMET reported decrease in occupational stress levels and baseline autonomic arousal in managers, suggesting significant reduction in sympathetic activity[18] and better emotional well-being in them.[19] Although yoga is getting popular, no previous investigation has systematically evaluated effects of yoga-based SMET program (in a residential setup) on mental health in managers. Hence, we have designed present study to assess the efficacy of 5 days SMET program on managers using general health questionnaire (GHQ). OBJECTIVES The objective of the study is to assess general health status (total health), which includes four domains namely somatic symptoms (SS), anxiety and insomnia (AI), social dysfunction (SF), and severe depression (SP), using a GHQ. MATERIALS AND METHODS subjects The subjects for the study were 72 corporate executives (63 males and 9 females), with a mean age of 48.75±3.86 years. Routine clinical examinations showed all of them in normal health, and none was using any other wellness strategy. All of them had high-fiber low-fat vegetarian diet and no caffeinated drinks, alcohol, or tobacco in any form during the 5 days residential SMET program. We got the participants’ signed consent to participate in the study after explaining the variables we would record and the study design. The institutional review board also had approved the project. We selected participants of the following inclusion and exclusion criteria to meet the study requirements fully. Inclusion criteria: Age between 45 and 60 years (males and females), physically, and mentally fit. Exclusion criteria: Taking medication, using any other wellness strategy. Design: A single group pre–post study. Assessments The GHQ: 28-item tests using a binary method of scoring (0, 0, 1, 1) yields an assessment on four robust subscales: SS, AI, SF, and SP. A sum of the scores for these four subscales gives the score for total health. Lower scores in the GHQ indicate better state of the health. The cutoff scores for the GHQ used for this study were 4 or 5 (4/5).[20] 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.[21] Intervention All the subjects participated in SMET program[2]for 5 days [Tables 1 and 2]. Practical session during SMET program: Cyclic Meditation,[1,22] a combination of stimulating and calming practices based on yoga was given to the participants. Data collection The GHQ data were collected before (Pre) and after (Post) the 5 days SMET program. Analysis Statistical analysis was done with the help of statistical package for social sciences-16. The Kolmogorov–Smirnov test showed that the data were not normally distributed. We used the Wilcoxon signed-rank test to compare means of the data collected before (Pre) and after (Post) the SMET program. Table 1: The schedule of the SMET program Time 05.00 AM 05.30 AM 06.00 AM 07.15 AM 08.00 AM 09.30 AM 10.30 AM 11.30 AM 12.05 PM 01.00 PM Activity Ablution Prayer (Prathasmaran) Asanas/special yoga technique Friendship meet (Maitri milan) - Gita sloka chanting and discourse (Satsanga) Breakfast SMET lecture session 1 SMET practice (Cyclic meditation) Milk or Ayurvedic tea (Malt) Special yoga techniques Lunch and rest Time 03.00 PM 04.00 PM 05.00 PM 06.00 PM 06.45 PM 07.30 PM 08.30 PM 09.15 PM 10.00 PM Activity SMET lecture session 2 SMET (Cyclic meditation) Tuning to nature Devotional session (Bhajan) Mind sound resonance technique Dinner Happy assembly (Yoga game session)/Cultural program Group discussion/Self Lights off SMET – Self-management of excessive tension Jan-Jun 2011 | Vol 20 | Issue 1 46 Industrial Psychiatry Journal Ganpat and Nagendra: Yoga for mental health in managers RESULTS AND DISCUSSION The data analysis [Table 3] showed 68.25% significant decrease (P<0.001) in somatic symptoms (GHQ_SS), 66.29% significant decrease (P<0.001) in anxiety and insomnia (GHQ_AI), 65.00% significant decrease (P<0.001) in social dysfunction (GHQ_SF), 87.08% significant decrease (P<0.001) in severe depression (GHQ_SP), and 71.47% significant decrease (P<0.001) in all medical complaints [Figures 1 and 2] (GHQ_Total). Table 2: Lecture session during SMET program Day Session 1 Session 2 1 Concept of stress Stress-induced problems and management 2 Stimulation-relaxations Stress and its management according to yoga 3 Stress levels and its release Recognition of stress is half the solution 4 Executive growth Depth of perception and awareness 5 Group awareness Progress in tune with nature SMET – Self-management of excessive tension Table 3: Data analysis Variables Mean±Standard deviation P Before SMET (Pre) After SMET (Post) The idea of mental health is closely related with the concept of emotional intelligence. A manager with less medical complaints will be mentally healthy and emotionally balanced and can perform better in his workplace which will reflect in the organizational effectiveness. Moreover, managers with low medical complaints are happier, healthier, and more successful in their relationships which are signs of high emotional intelligence. Persons with high emotional intelligence may strike a balance between emotion and reason, are aware of their own feelings, show empathy and compassion for others, and have high self-esteem which may be instrumental in many situations in the workplace and can help achieve organizational effectiveness.[23] Recent research has shown a positive relationship between emotional intelligence and workplace success.[24] Previous studies on yoga reported enhanced mental health as a result of the practice of yoga way of life. The results indicate the importance of yoga as an integral element in improving managerial performance in organizations.[25-27] Our study is consistent with these findings, indicating that a systematic adoption of the SMET program can result in better health among managers for their “ExecutiveEfficiency,”thuspavingthewayfortheirbetter performance as managers. GHQ_ SS 2.63±0.84 GHQ_ AI 2.47±0.99 GHQ_ SF 2.5±0.75 0.83±0.79 0.83±0.79 0.87±0.68 0.0001* 0.0001* CONCLUSION 0.0001* GHQ_ SP 2.04±0.65 0.26±0.63 0.0001* GHQ_ Total 9.64±1.87 2.75±1.51 0.0001* SMET – Self-management of excessive tension; GHQ – General health questionnaire 12.00 10.00 9.64 8.00 GHQ score 6.00 The results from the present study suggest that participation in a SMET program may be associated with improvement in mental health and may have implications for “Executive Efficiency.” Because before and after designs limit inferences about intervention effects, further research is warranted to explore the effects of SMET program for stress management using a larger, randomized controlled trial. 4.00 2.63 2.47 2.00 0.83 0.83 0.00 GHQ_Before_SS GHQ_After_SS GHQ_Before_AI GHQ_After_AI GHQ_Before_SF GHQ_After_SF GHQ_Before_SP GHQ_After_SP GHQ_Before total GHQ_After total 2.50 2.04 2.75 0.88 0.26 REFERENCES General health quetionnaire (GHQ) SS – Somatic symptoms, AI – Anxiety and insomnia, SF – Social dysfunction, SP – Severe depression Figure 1: GHQ before and after the SMET program 0 Percentage decrease -20 SS AI SF SP Total -40 -60 -80 -68.25 -66.29 -65 -71-47 -100 -87.075 General health quetionnaire (GHQ)_SS, AI, SF, SP, Total SS – Somatic symptoms, AI – Anxiety and insomnia, SF – Social dysfunction, SP – Severe depression Figure 2: Percentage decrease in GHQ after the SMET program 1. Dhirendra B. Yoga for life and living. New Delhi: Central Research Institute for Yoga; 1968. 2. Nagendra HR, Nagarathna R. New perspectives in stress management. Bangalore, India: Swami Vivekananda Yoga Publications; 2007. 3. Eriksson KM, Westborg CJ, Eliasson MC. A randomized trial of lifestyle intervention in primary healthcare for the modification of cardiovascular risk factors. Scand J Public Health 2006;34:453-61. 4. Brukner PD, Brown WJ. 3. Is exercise good for you? Med J Aust 2005;183:538-41. 5. Stampfer M, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 2000;343:16-22. 6. Courneya KS, Friedenreich CM. Physical exercise and quality of life following cancer diagnosis: A literature review. Ann Behav Med 1999;21:171-9. 7. Lamb KL, Brodie DA, Roberts K. Physical fitness and health- Industrial Psychiatry Journal 47 Jan-Jun 2011 | Vol 20 | Issue 1 Ganpat and Nagendra: Yoga for mental health in managers related fitness as indicators of a positive health state. Health Promot Int 1988;3:171-82. 8. Dimeo F, Bauer M, Varahram I, Proest G, Halter U. Benefits from aerobic exercise in patients with major depression: A pilot study. Br J Sports Med 2001;35:114-7. 9. Bloomfield HH, Cain MP, Jaffe DT. 'TM'-Discovering inner Energy and overcoming stress. 8th ed. New York: Delacorte Press; 1975. 10. Brena SH. Yoga and Medicine. New York: The Julian Press Inc; 1975. 11. Pratinidhi BP. The ten point way to health. Mumbai: DB Taraporevale Sons and Co. Pvt. Ltd; 1966. 12. McCaffrey R, Ruknui P, Hatthakit U, Kasetsomboon P. The effects of yoga on hypertensive persons in Thailand. Holist Nurs Pract 2005;19:173-80. 13. Sabina AB, Williams AL, Wall HK, Bansal S, Chupp G, Katz DL. Yoga intervention for adults with mild-to-moderate asthma: A pilot study. Ann Allergy Asthma Immunol 2005;94:543-8. 14. Bijlani RL, Vempati RP, Yadav RK, Ray RB, Gupta V, Sharma R, et al. A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. J Altern Complement Med 2005;11:267-74. 15. Brown RP, Gerbarg PL. Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I-neurophysiologic model. J Altern Complement Med 2005;11:189-201. 16. Jorm AF, Christensen H, Griffiths KM, Rodgers B. Effectiveness of complementary and self-help treatments for depression. Med J Aust 2002;176 Suppl:S84-96. 17. Sharma R, Gupta N, Bijlani RL. Effect of yoga based lifestyle intervention on subjective well-being. Indian J Physiol Pharmacol 2008;52:123-31. 18. 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. 19. Sony K, Nath NC, Nagendra HR. Effectiveness of SMET program with respect to emotional well-being among managers: An empirical study. XIMB J Manage (Vilakshan) 2007;4:165-73. 20. Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje 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. 21. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med 1979;9:139-45. 22. Subramanya P, Telles S. A review of the scientific studies on cyclic meditation. Int J Yoga 2009;2:46-8. 23. Singh D. Emotional intelligence at work: A professional Guide. New Delhi, India: Sage Publications; 2003. 24. Tischler L, Biberman J, McKeage R. Linking emotional intelligence, spirituality and workplace performance: Definitions, models and ideas for research. J Manage Psychol 2002;17:203-18. 25. Deshpande S, Nagendra HR, Raghuram N. A randomized control trial of the effect of yoga on Gunas (personality) and health in normal healthy volunteers. Int J Yoga 2008;1:2-10. 26. Deshpande S, Nagendra HR, Nagarathna R. A randomized control trial of the effect of yoga on Gunas (personality) and self esteem in normal healthy volunteers. Int J Yoga 2009;2:13-21. 27. Adhia H, Nagendra HR, Mahadevan B. Impact of adoption of yoga way of life on the emotional intelligence of managers. IIMB Manage Rev 2010;22:32-41. How to cite this article: Ganpat TS, Nagendra HR. Integrated yoga therapy for improving mental health in managers. Ind Psychiatry J 2011;20:45-8. Source of Support: Nil. Conflict of Interest: None declared. Announcement iPhone App A free application to browse and search the journal’s content is now available for iPhone/iPad. The application provides “Table of Contents” of the latest issues, which are stored on the device for future offline browsing. 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