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CHAPTER 1

INTRODUCTION

1.1 STRESS

Stress is often termed as a twentieth century syndrome, born out of

man`s race towards modern progress and its ensuing complexities. In other words,

stress is a dynamic process involving both the individual and the environment. There

can be innumerable stress factors since different individuals react differently to the

same stress conditions. Competition and constant changes result in a demanding

environment that often turns stressful. The negative effects of stress on health are

well known [1].

1.2 DEFINITION OF STRESS

Stress can generally be defined as the reaction of individuals to demands

(stressors) imposed upon them, where the well-being of individuals is detrimentally

affected by their failure to cope with the demands of their environment [2]. However

within an academic framework as defined by Selye [3], the stimulus or the ‘stress’ is

referred to as a ‘stressor’ which does not cause us to be ‘stressed out’, but rather is

something which causes a ‘stress response’ within the body. In recent years stress

has been more usefully defined as transactional concept. People are not disturbed by

situations per se but by the ways they appraise and react to situation [4].

1.3 THEORIES OF STRESS

Stress is a multidimensional phenomenon and conceptualized in several

ways. It has been studied from three major perspectives: 1) stress as a response, 2) a

stimulus, and 3) a relation.

a) Stress as a response: According to Hans Selye (1976) [5], stress is

defined as "the non-specific response of the body to any demand made upon it."

Moreover, stress is a state or condition of the body produced by diverse nocuous

agents and manifested by a syndrome of changes. The factors that produce stress are

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called stressors and can be a wide variety of mental, emotional, and other

psychological events. He also identified three components of physiologic stress that

are the stressor, the physiologic or chemical disturbance produced by the stressor,

and the body’s adaptative response to the stressor.

b) Stress as a Stimulus: Stimulus definitions focus on events in the

environment such as natural disasters, noxious conditions, illness, or being laid off

from work. This approach assumes that certain situations are normatively stressful

but a person’s perception of the event as positively toned or negatively toned is

irrelevant; and there is a common threshold beyond which disruption occurs [6].

c) Stress as a transaction: According to Lazarus & Folkman in 1984

[7], stress is best understood in terms of the individual’s cognitive interpretation of

potentially stressful events. How events are perceived is more important than the

objective events themselves. Stress is neither an environmental stimulus nor a

psychological response, but rather a relationship between environmental demands

and the ability to deal with them. Thus, stress is seen as a transaction between

individual and environment.

1.4 TYPES OF STRESS

Figure 1.1 shows the various types of stress based on the effect, duration,

cause and type of stressor.

Figure 1.1 Types of stress

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1.5 STRESS RESPONSE

Organisms however do not passively respond to the effects of stress-

they respond in a more complex way.

1.5.1 GENERAL ADAPTATION SYNDROME (GAS)

Selye in 1956 [3] labelled the universal response to stressors the general

adaptation syndrome or GAS.

Alarm is the first stage. When the threat or stressor is identified or

realized, the body's stress response is a state of alarm. During this stage adrenaline

will be produced in order to bring about the fight-or-flight response. There is also

some activation of the hypothalamic pituitary adrenal (HPA) axis, producing cortisol.

Resistance is the second stage. If the stressor persists, it becomes

necessary to attempt some means of coping with the stress. Although the body begins

to try to adapt to the strains or demands of the environment, the body cannot keep

this up indefinitely, so its resources are gradually depleted

Exhaustion is the third and final stage in the GAS model. At this point,

all of the body's resources are eventually depleted and the body is unable to maintain

normal function. At this point the initial autonomic nervous system (ANS) symptoms

may reappear (sweating, raised heart rate etc.). If stage three is extended, long term

damage may result and can manifest itself in obvious illnesses such as ulcers,

depression, diabetes, trouble with the digestive system or even cardiovascular

problems, along with other mental illnesses.

The stress response incorporates a variety of different physiological

systems all supporting homeostasis. The exact nature of the co-ordination is

complex. Coordination of the stress response however is governed by the nervous

and endocrine systems. However the brain is the central organ of the stress response

[8] which in turn influences other systems such as the cardiovascular system and the

immune system [9].

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1.5.2 Physiological Changes in Response to a Stressor

Three physiological pathways known to demonstrate extraordinary

responsiveness with respect to psychosocial stimuli:

(1) The Neural axis

(2) The Neuroendocrine axis and

(3) The Endocrine axis

1.5.2.1 The Neural Axis

Three neural axes comprise the neural stress response: (1) the

sympathetic nervous system (SNS), (2) the parasympathetic nervous system (PNS),

and, (3) the neuromuscular nervous system. These neural pathways are the first of all

stress response axes to become activated during stress arousal and are quickest.

When a threat is perceived, neural impulses descend to the posterior

hypothalamus (in the case of a sympathetic activation) and the anterior hypothalamus

(in the case of a parasympathetic activation). The specific end-organ effects of the

sympathetic and the parasympathetic nervous systems are summarized in Table 1.1

[10].

Table 1.1 Responses of Effector Organs to Autonomic Nervous System Impulses

SNS PNSFunction Ergotropic; catabolism Trophotropic; anabolismActivity Diffuse DiscreteAnatomy Emerges from spinal cord Thoracolumbar CraniosacralLocation ofganglia

Close to spinal cord Close to target organ

Postganglionicneurotransmitter

Noradrenalin a (adrenergic) Acetylcholine (cholinergic)

Specific actionsPupil of eye Dilates ConstrictsLacrimal gland – Stimulates secretion

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Table 1.1 (Contd.)Salivary glands Scanty, thick secretion Profuse, water secretionHeart Increases heart rate Decreases heart rate

Increases contractility Decreases metabolismIncreases rate of idiopathicpacemakers in ventricles -

Blood vesselsSkin and mucosa Constricts –Skeletal muscles Dilates –Cerebral Constricts DilatesRenal Constricts –Abdominalviscera

Mostly constricts –

Lungs: bronchialtubes

Dilates Constricts

Sweat glands Stimulates a Constricts

Liver Glycogenolysis for release ofglucose

Expels bile

Spleen Contracts to release bloodhigh in erythrocytes –

Adrenal medulla Secretes adrenaline(epinephrine) andnoradrenaline(norepinephrine) a

–

Gastrointestinaltract

Inhibits digestion Increases digestion

Decreases peristalsis andtone

Increases peristalsis and tone

Kidney Decreases output of urine ?Hair follicles Piloerection –Male sex organ Ejaculation Erection

1.5.2.2. The Neuroendocrine Axis

Physiologist Walter Cannon first wrote about a phenomenon that he

termed homeostasis, which is an adaptational effort of the body to stay in balance.

Cannon in 1953 [11] wrote extensively on one particular aspect of the ANS’s role in

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the stress response—the neuroendocrine process. The “fight-or- flight” response is

referred as an “active coping” system. This active coping system has been referred to

as the “sympathoadrenomedullary system” (SAM).

The “fight-or- flight” response can be activated in human beings by

numerous and diverse psychological influences, including varied psychosocial

stimuli and is thought to be a mobilization of the body to prepare for muscular

activity in response to a perceived threat. The response innervates the adrenal gland,

or more specifically, the adrenal medulla which secretes catecholamines:

norepinephrine (noradrenaline) and epinephrine (adrenaline).

The adrenal medullary cells are divided into two types: A cells, which

secrete epinephrine, and N cells, which secrete norepinephrine. About 80% of the

medullary catecholamine activity in humans is accounted for by epinephrine [12] or

observed in humans as a result of activation of this axis in response to psychosocial

stressor exposure. Table 1.2 summarizes the specific somatic effects [19] by adrenal

medullary axis stimulation.

Table 1.2 Effects of Adrenal Medullary Axis Stimulation

Increased arterial blood pressureIncrease blood supply to brain (moderate)Increased heart rate and cardiac outputIncreased stimulation of skeletal musclesIncrease plasma free fatty acids, triglycerides, cholesterolIncreased release of endogenous opioidsDecreased blood flow to kidneysDecreased blood flow to gastrointestinal systemDecreased blood flow to skinIncreased risk of hypertensionIncreased risk of thrombosis formationIncreased risk of angina pectoris attacks in persons so proneIncreased risk of arrhythmiasIncreased risk of sudden death from lethal arrhythmia, myocardialischemia, myocardial fibrillation, myocardial infarction

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1.5.2.3 Endocrine Axis

The most chronic and prolonged somatic responses to stress are the

result of the endocrine axes and reviews [13] demonstrate that these axes can be

activated in humans by numerous and diverse psychological stimuli, including varied

psychosocial stimuli. Figure 1.2 depicts the effect of stress on the endocrine axis.

Fig 1.2. Effect of Stress on Endocrine axis

The neural sensory information processed in the limbic system

(hippocampus and amygdala) activates the paraventricular nucleus (PVN) in the

hypothalamus, which synthesize corticotrophin-releasing hormone (CRH) and

arginine vasopressin (AVP). These substances activate the anterior pituitary, where

proopiomelanocortin (POMC) is produced. CRH and AVP cleave POMC into

adrenocorticotrophic hormone (ACTH) and beta-endorphins which are released into

the systemic circulation. ACTH is transported by the blood to the adrenal glands to

stimulate the synthesis of corticosteroids [14] namely mineralocorticoids

(aldosterone), glucocorticoid (cortisol) and androgens (dehydroepiandrosterone

(DHEA)). Cortisol is the major stress hormone with effective responses to the stress

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stimuli in many body tissues including the brain [15]. The adrenal cortical response

axis has been referred to by various authors as the hypothalamic–pituitary–adrenal

cortical system (HPAC). Activation of this system in the aggregate has been

associated with the helplessness/hopelessness depression syndrome, passivity, the

perception of no control, immunosuppression, and gastrointestinal symptomatology.

Behaviourally, the HPAC system appears to be activated when active coping is not

possible; thus, it has been called the “passive coping” system. The effects of the

glucocorticoids in apparent response to stressful stimuli are summarized in Table 1.3.

Table 1.3 The Effects of the Glucocorticoid Hormones and HPAC Activation

Increased glucose production (Gluconeogenesis)

Exacerbation of gastric irritation

Increased urea production

Increased release of free fatty acids into systemic circulation

Increased susceptibility arteherosclerotic processes

Increased susceptibility to nonthrombotic myocardial necrosis

Thymicolymphatic atrophy (demonstrated in animals only)

Suppression of immune mechanisms

Exacerbation of herpes simplex

Increased ketone body production

Appetite suppression

Associated feeling of depression, hopelessness, helplessness, and loss of control

The Somatotropic Axis activated during stress releases the somatotropin-

releasing factor (SRF) which stimulates the anterior pituitary which thereby releases

the growth hormone (somatotropic hormone) into the systemic circulation which

stimulates the release of the mineralocorticoids. Selye [3], and also produces a

diabetic-like insulin-resistant effect, as well as mobilization of fats stored in the body

which increases the concentration of free fatty acids and glucose in the blood[16].

Stress response in human is also said to affect the thyroid axis [17]. Thyroid

hormones have been shown to increase general metabolism, heart rate, heart

contractility, peripheral vascular resistance (thereby increasing blood pressure), and

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the sensitivity of some tissues to catecholamines. Stimulation of posterior pituitary

results in the release of the hormones vasopressin (antidiuretic hormone, or ADH)

and oxytocin and prolactin into the systemic circulation [18].

1.5.3 Biochemical and Hematological Changes in Response to Stressor

Endocrine changes during stress may cause certain biochemical changes.

� Increase the concentration of circulating lipids and lipoproteins.

� Increase blood glucose level by decreasing glucose uptake and

increased glycolysis and gluconeogeneis.

� In liver, cortisol is anabolic and hence it increase protein synthesis,

increases hepatic uptake of amino acids, increase m-RNA formation

and synthesis of proteins including plasma proteins, enhances urea

synthesis from amino acid.

1.5.4 Immune System Alterations in Response to a Stressor

Stress has long been associated with altered immune function. A

bidirectional communication exists between the central nervous and immune systems

which involves common peptide hormones and receptors that regulate the immune

response via feedback mechanisms [19]. Several molecules induced during the

response to stress have been implicated in immunomodulation, including

catecholamines, neuropeptides, and steroid hormones. Glucocorticoids are said to

have both immunosuppressive [20] and immunoenhancing properties as well [21].

CRH can enhance or diminish immune responses independent of glucocorticoids

[22].

Any psychological or behavioural event such as anger, anxiety, and

especially depression that is capable of affecting the autonomic nervous system's

activity or hormonal activity is also able to influence the immune system, showing

that the brain and the immune system are sufficiently well connected and influenced

by each other [23]. During stress, innate immune mechanisms are preserved while

adaptive responses are clearly compromised. During periods of stress there are likely

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to be important demands on the immune system due to infection, thus stress

regulation of the immune response may have evolved to provide a well-orchestrated

immune defence to ensure survival [24].

The overall effects of chronic stress (Figure 1.3) on immune modulation

are therefore diverse and include decreased NK cell function, down-regulation of T-

and B-cell responses, an imbalance in cytokine production (e.g., Th1 Th2 shift),

Stress may also be linked to the induction of proinflammatory cytokines such as

IL-6.

Fig 1.3 Immune System Alterations in Response to a Stressor

1.5.5 Psychological Changes in Response to a Stressor

Both behavioral and psychological changes occur in response to a

stressor; the impact of which depends on whether the stressor is acute or chronic.

Figure 1.4 clearly depicts the psychological, physiological, emotional and

behavioural changes associated with stress. Psychological changes in response to a

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stressor include, but are not limited to, anxiety, depression, fear, sadness, anger and

confusion. While the concept of fear has been of concern to humanity since ancient

times, the concept of anxiety was not fully recognized as a distinct and pervasive

human condition until the late 1800s. Chronic stress and a lack of coping resources

accessible by an individual can often lead to the development of psychological issues

such as depression and anxiety. Figure 1.4 shows the changes associated with stress.

Figure1.4 Psychological, Physiological, Emotional and Behavioural Changes

Associated with Stress.

1.6 STRESS AS A RISK FACTOR FOR VARIOUS DISEASES

“Stress” is often implicated in the pathogenesis of illnesses; however, its

direct culpability is not easily established. To gain a better understanding of how

stress can lead to illness, it is useful to invoke the concept of allostatic load, first

introduced in 1993 by McEwen and Stellar [25]. In their words, “The (cumulative)

strain on the body produced by repeated ups and downs of physiologic response, as

well as by the changes in metabolism can predispose the organism to disease which

is defined as a state of allostatic load.” There is likely a connection between stress

and illness.

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Chrousos in 2000 [26] has reviewed evidence showing that stress-

induced chronic increase in hormones like cortisol, catecholamines, and interleukin-6

provide a hormonal milieu conducive to the development of visceral obesity (and

the insulin-resistance-dyslipidemia syndrome), hypertension, atherosclerosis,

osteoporosis, and immune dysfunction. Additional stress-related illnesses include

conditions such as depression [27], irritable colon [28], peptic ulcer [29], diabetes

mellitus [30] as well as rheumatoid arthritis [31]. Although the role of stress in

causation of various diseases may have been overestimated by some authors, there is

little doubt that, in many cases, stress plays a critical role in determining clinical

outcome. Mechanism by which activation of the stress system may increase the risk

of diseases is shown in Table 1.4.

Table 1.4 Stress Response and its Clinical Effect

Abbreviation: SNS-Sympathetic Nervous System, GH- Growth

Hormone, IGF-1 – insulin Like Growth factor -1, TSH-Thyroid stimulating hormone,

LH-Luteinizing Hormone, T3-Triiodothyronine

Adapted from: Stress: A Risk Factor for Serious Illness VanItallie.

BT [32]

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Evidence from prospective observational studies provides support for

stress as an important factor in certain diseases. Hence, development of interventions

that can reduce the behavioral and biological sequelae of psychological stress and the

demonstrated efficacy of such interventions would provide clinical data on the

clinical importance of the work.

1.7 STRESS MANAGEMENT:

Stress management refers to a wide spectrum of techniques and

psychotherapies aimed at controlling a person's levels of stress, usually for the

purpose of improving everyday functioning. There are a number of allopathic and

alternative/complementary treatments that are effective in eliminating or reducing

stress and stress-related disorders (Fig 1.5).

• Medications may include drugs to control anxiety and depression as

well as drugs that treat such physical symptoms of stress as indigestion or high blood

pressure.

• Psychotherapy, including insight-oriented and cognitive/behavioral

approaches, is effective in helping them reframe their perceptions and interpretations

of stressful events.

• Therapeutic massage, hydrotherapy, and bodywork are forms of

treatment that are particularly helpful for people who tend to carry stress in their

muscles and joints.

• Aromatherapy, pet therapy, humor therapy, music therapy, and other

approaches that emphasize sensory pleasure are suggested for severely stressed

people who lose their capacity to enjoy life.

• Naturopathic recommendations regarding diet, exercise, and

adequate sleep, and the holistic approach of naturopathic medicine can help persons

with stress-related disorders to recognize and activate the body's own capacities for

self-healing.

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• Relaxation techniques, anxiety reduction techniques, breathing

exercises, yoga, and other physical exercise programs improve the body's relaxation

response.

Fig 1.5 Types of Stress Management Strategies

Among the above said stress management techniques, Yoga a 3,000

year old tradition, is now regarded in the western world as a holistic approach to

health and is classified by the National Institutes of Health as a form of

Complementary and Alternative Medicine (CAM).

1.8 YOGA AND YOGA CONCEPTS

Yoga is an Indian life science philosophy with a rich and varied history

which is a practical discipline incorporating a wide variety of practices the goal of

which is to develop a state of mental and physical health, well-being, inner harmony

and ultimately “a union of the human individual with the universal and transcendent

existence” [33]. Although yoga is historically a systematic process of spiritual

unfolding spiritual discipline, it has also been used clinically as a therapeutic

intervention. Yoga goes to the roots of a poor lifestyle and when presented in a

comprehensive manner, tends to convince the patient that a good lifestyle is not only

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healthier, but also more enjoyable than a poorer lifestyle. It saves money and can be

performed anywhere which is a constructive point of yoga.

1.9 DEFINITION OF YOGA

“Yoga is the control of the fluctuations of the mind.”

- Patanjali’s Yoga Sutra 1.2; c. 150 C.E.

The etymology of yoga is derived from the Sanskrit verb yuj, meaning

“to yoke or join together.” As the opening quotation suggests, yoga as a

psychospiritual technology is focused on controlling the fluctuations of the mind,

with the physical body serving as just one tool toward that end.

1.10 DIFFERENT SCHOOLS OF YOGA

There are different yoga schools and the major schools of yoga are BKS

Iyengar School of Yoga, Bikram Yoga, Ashtanga Yoga, Kripalu Yoga, Integral

Yoga, Kundalini Yoga, Artistic Yoga. Their basic goal is more or less the same and

they all help to achieve mastery over body and mind. It is just the approach that is

different. Apart from these major schools of yoga, various styles of yoga are being

practiced worldwide.

Table 1.5: Types of Yoga Schools and Founders

Year Name of Yoga School Name of the Founder1906 Yoga Sri Tirumalai Krishnamacharya

1920 Agni Yoga Nicholas Roerich and his wife HelenaRoerich (theosophy)

1921 Integral Yoga Sri Aurobindo

1946 Kriya Yoga Paramahansa Yogananda1948 Yoga of Synthesis Swami Sivananda1950s Satyananda Yoga Swami Satyananda Saraswati1955 Ananda Marga Shri Shri Anandamurti

1960s Transcendental Meditation Maharishi Mahesh Yogi

1970 Bikram Yoga Bikram Choudhury

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Table 1.5 Contd.,

1971 Himalayan Institute of YogaScience and Philosophy Swami Rama

1970s Siddha Yoga Swami Muktananda

1970s Surat Shabd Yoga Sant Mat movement, Kirpal Singh

1970s Sahaja Yoga Sri Nirmala Srivastava

1981 Art of Living Sri Sri Ravi Shankar

1984 Yoga for human excellenceand Kayakalpa Yogiyaraj Vethathri Maharishi

1992 Isha Foundation Sadhguru Jaggi Vasudev

1997 Ananda yoga Swami Kriyananda

1.11 LAND OF YOGA -INDIA

India is rightly called the land of yoga. All systems of yoga developed

from this ancient land. Historians and leaders in the yoga community say they

believe that a man named Patanjali was the first to codify yoga, by writing a text in

northern India around the third century B.C.[34]. Patanjali wrote the Yoga-Sutras

that outlined an eight-limbed path for yoga, also known as astanga yoga. These eight

aspects of yoga encompass what yoga gurus consider the five layers of the human

being: the anatomical, physiological, mental, intellectual, and spiritual bodies.

1.12 EIGHT LIMBS OF YOGA

Yoga was originally developed as a method of discipline and attitudes to

help people reach spiritual enlightenment. Yoga is often depicted metaphorically as a

tree and comprises eight aspects, or ‘‘limbs. The eight limbs are comprised of ethical

principles for living a meaningful and purposeful life; serving as a prescription for

moral and ethical conduct and self-discipline, they direct attention towards one's

health while acknowledging the spiritual aspects of one's nature. Traditionally, the

limbs are practiced in succession, culminating in the attainment of enlightenment.

Any of the eight limbs may be used separately, but within yoga philosophy the

physical postures (asanas) and breathing exercises (pranayama) prepare the mind and

body for meditation and spiritual development.

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Fig 1.6. Eight Limbs of Yoga

1.12.1 Asanas (Physical Postures)

In Sanskrit asana, means "staying" or "abiding". Asana, the practice of

physical postures is the most commonly known aspect of yoga and is used as a tool

to calm the mind and move into the inner essence of being. One definition of asana is

that a postural pattern created by deviating the head and trunk from the center of

gravity and having the pattern maintained purposefully for a length of time, and then

released in a smooth and effortless manner [35]. The postural pattern is initiated

slowly and with attention to internal proprioception and maintaining a full

diaphragmatic breath. True asana is described classically as having the qualities of

stability (sthira), ease (sukha) [36], and effortlessness or minimized effort (prayant

shaithilya). An asana is not a braced or artificially sustained “pose” that would create

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or maintain inappropriate or sustained biomechanical stress to soft tissue or articular

surfaces. From the yoga therapeutic perspective, asana is also an attitude that is

psychophysiologic in nature, in which the state of mind or mindfulness is of the

utmost importance, hence linking the physical position with the higher koshas.

Asanas are often practiced as pairs, known as counter poses.

Biomechanically this creates balance by soft tissue lengthening, hyaline cartilage

compression and distraction, and reversing intervertebral disc pressures and dural

stretch. These counter forces are also delivered to the internal organs, composed of

smooth muscle or the glands of the endocrine system. The practitioner experiences

the more subtle effects of the higher koshas through this counterbalance, bringing

about a balance in emotions and the biochemical manifestations of that balance. This

mechanical stimulation coupled with the relaxation response has been cited as one

potential source of many of the nonmusculoskeletal benefits of yoga [37].

1.12.2 Pranayama (Breath Control)

"Improve Your Breathing (Pranayam)

To Reduce Stress and Increase Your Performance"

- Ingrid Bacci

Pranayama is a Sanskrit word composed of the words ‘prana’ meaning

vital lifeforce and “ayama” meaning restraint. An alternative root of the word is

given by Ramamurti Mishra who says that “Expansion of individual energy into

cosmic energy is called pranayama” which gives a deeper insight into the purpose of

pranayama to a yoga practitioner. It goes hand in hand with the asana or pose. In the

Yoga Sutra, the practices of pranayama and asana are considered to be the highest

form of purification and self discipline for the mind and the body, respectively.

Pranayama consists of three phases: ‘‘puraka’’ (inhalation);

‘‘kumbhaka’’ (retention) and ‘‘rechaka’’ (exhalation) that can be either fast or slow

[38]. Although all pranayama has three phases, different forms of pranayama evoke

dissimilar and sometimes opposite responses in the subject depending on variables

such as which nostril is used or the speed of the respiration. Different forms of

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pranayama activate different branches of the ANS effecting oxygen consumption,

metabolism and skin resistance. A calm, peaceful mind is content and non-violent

and more receptive to the sense withdrawal (pratyahara) and deep concentration

(dharana) that bring about states of meditation.

Pranayama channels the prana in the body to calm, rejuvenate and uplift

the mind. It serves as an important bridge between the external, active and highly

physical practice of yoga asana and the subtle internal practices that lead the yogi

into deeper states of meditation.

1.12.3 Meditation (Dhyana)

The word mediation is derived from two Latin words: meditari (to think,

to dwell upon, and to exercise the mind) and the mederi (to heal). It is originally

from Sanskrit word “medha” which means wisdom. “Meditation means being

meditative, silent, peaceful, with no thoughts in the mind and it is consciousness

without content”. When a mirror is not reflecting anything, it is meditation”, said

Gautam Buddha [39].

The term meditation refers to a broad variety of practices (much like the

term sports) that includes techniques designed to promote relaxation, build internal

energy or life force (qi, ki, prana, etc.) and develop compassion [40]. The aim of

meditation is overcoming negative minds and cultivating productive thoughts [41].

The attitudes needed for meditation are non-judging, patience, beginners’ mind, trust,

acceptance, and letting go [42].

1.12.3.1 Types of Meditation

In the present biomedical researches’, Ospina et al [43] broadly divided

meditation into five categories; mantra meditation, mindfulness meditation, yoga, Tai

Chi and Qigong. First, mantra meditation is composed of transcendental meditation

(TM), relaxation response and clinically standardized meditation. They share

common characteristics to develop deep concentration by repeating silently or aloud

the mantra (a word or phrase). This is so-called concentration meditation of Buddhist

meditation. Second, mindfulness meditation is composed of vipassana meditation,

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Zen meditation, mindfulness-based stress reduction (MBSR) and mindfulness-based

cognitive therapy (MBCT). The hallmark of this category is to cultivate mindfulness

and wisdom of oneself. Third, yoga is an ancient Indian system that comprises basic

forms of postural movement, meditation, breathing technique and relaxation [44].

Fourth, Tai Chi is the Chinese art for individual health and well being. It involves

gentle body movement in continuous sequence, breathing patterns and mental

concentration [45]. Fifth, Qigong is quite similar to Tai Chi in terms of body

movement but relates to breathing attention with meditation basis. However, Qigong

emphasizes the concept of Qi flow (flow of internal vital energy) as well [45].

1.13 PURPOSE OF YOGA

Generally put, yoga is a disciplined method utilized for attaining a goal.

In the Yoga Sutras, Patanjali indicates that the ultimate goal of yoga is a state of

permanent peace or Kaivalya. As the power of the mind is properly harnessed and

focused (stable, without fluctuation), the physical outcomes are, enhanced flexibility,

posture, balance, strength, and physical health [36] and thus used as a complete

exercise program and physical therapy routine [35].

1.14 YOGA THERAPY

Yoga therapy is the “process of empowering individuals to progress

toward improved health and well-being through the application of the philosophy and

practice of Yoga” [46]. At the physical level Yoga and its cleansing practices have

proven to be extremely effective for various disorders. The elements of yoga directly

addressing health concerns are known as yoga therapeutics.

A recent summary (2012) indicates that there is relatively strong

evidence to suggest that yoga may have beneficial effects for pain-associated

disability and mental health [47]. A preceding overview (2010) shows unanimously

positive evidence emerged for depression and cardiovascular risk reduction with

yoga, with little supporting evidence to suggest benefit for patients with epilepsy,

asthma or various pain conditions [48]. Another clinical review suggests that

psychological symptoms and disorders (anxiety, depression, sleep), pain syndromes,

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autoimmune conditions (asthma, multiple sclerosis), immune conditions (lymphoma,

breast cancer), pregnancy and weight loss can all be positively affected by yoga [49].

1.15 YOGA THERAPY-SCIENTIFIC EVIDENCES

Recently McCall [50] performed a literature review to synthesize the

current hypotheses and scientific evidence for underlying mechanisms of yoga

intervention. He concluded that major effect of yoga is on the endocrine, nervous

systems as well as on the physical health. Figure 1.7 depicts a summary of evidence

as expressed in empirical and hypothetical findings of their research.

Figure 1.7: Scientific Evidence on the Effect of Yoga

Adapted from: How Might Yoga Work? An Overview of Potential

Underlying Mechanisms Review by Marcy C. Mc. Call (2013).

1.16 SCIENTIFIC YOGA RESEARCH IN INDIA

Yoga research in India began thousands of years ago, with the

experiences of the great sages. Actual studies in the laboratory began in the 1920s by

a sage, Swamy Kuvalayanada founder of a yoga center called Kaivalyadhama (in

west India). Through the 1920s until the 1960s the world over people wanted to

study extraordinary powers of exceptional yogis. Exciting experiments were

conducted at the All India Institute of Medical Sciences, New Delhi and on the late

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Swami Rama (from Rishikesh) at the Menninger Foundation (in the U.S.). However

these experiments seemed to suggest that yoga had little to do with the common man

and the effects required years of practice with extreme sacrifice. This changed when

in the late 1960s Maharishi Mahesh Yogi introduced transcendental meditation to the

world. For the first time changes were seen in University students after a short

duration of practice. This lead to research at Swami Vivekanada Yoga Research

Foundation (South India) which published and is publishing some of the most

rigorously controlled trials on the therapeutic effects of yoga, the National Institute

of Mental Health and Neurosciences (South India) and the Defense Institute of

Physiology and Allied Sciences, which took yoga to the Indian army. At this stage

most of the research and interest in yoga was in India, the place of its' origin.

However the majority of Indians located in villages knew little about yoga, assuming

the practice was for the educated, urbanized Indian. This changed with the mass

movement of Patanjali Yogpeeth, which has taken yoga and ayurveda to Indians in

remote villages. The institution is actively engaged in research. It is encouraging to

note that research on yoga which began almost a century ago in India, continues to

be of great interest in yoga institutions as well as in medical institutions of national

importance. Equally encouraging is the fact that research in this area is being actively

funded by the Government of India.

In order to formulate yoga as an evidence based medicine, further

research are to be conducted to prove the benefits of yoga and make it a daily

practice among the healthy as well as diseased population for improved health and

well being. From an evidence-based healthcare perspective, the hypothetical

underlying mechanisms to explain potential effects of yoga are in the early stages of

investigation. Research in the field of yoga is being carried out extensively in various

parts of the world on different schools of yoga. Among the various types of yoga

which have been researched widely, Sudarshan Kriya of The Art of Living (AOL)

Foundation is one among it that has been scientifically proven to be beneficial on

various health conditions.

23

1.17 SUDARSHAN KRIYA AND PRANAYAM (SK&P)

In Sanskrit Su= right, Darshan= vision, Kriya=purifying action

Sudarshan Kriya, an integral part of Art of Living programmes is a purifying

practice, whereby one receives a proper vision of one’s true self. It is a rhythmic

breathing technique combined with meditation that facilitates physical, mental,

emotional and social well-being.

Nature is replete with various rhythms and cycles - day follows night,

night follows day, seasons come and go. Similarly, there are biological rhythms to

our bodies, minds and emotions. When these rhythms are in sync, we feel a sense of

harmony and well-being. When stress or illness throws them out of order, we

experience discomfort and discontent and feel upset and unhappy. The breath

connects the body and mind. Just as emotions affect our patterns of breathing, we can

bring about changes in our mental and behavioural patterns by altering the rhythms

of our breath. It flushes our anger, anxiety and worry; leaving the mind completely

relaxed and energized.

1.17.1 Founder of Sudarshan Kriya - H. H. Sri Sri Ravi Shankar

His Holiness Sri Sri Ravi Shankar is a renowned spiritual leader and

multi-faceted humanitarian whose mission of uniting the world into a violence-free

family has inspired millions of people worldwide. Born in 1956 in Southern India,

Sri Sri's appeal transcends class, race, religion and nationality. Millions of people

revere him as their spiritual leader, and look up to him for inner peace and promoting

ecumenical values. In 1981, Sri Sri started the Art of Living Foundation, an

international non profit educational and humanitarian organization. The Foundation,

now active in more than 140 countries, offers educational and self-development

programs designed to eliminate stress and foster a sense of well-being. In Europe and

the United States, the Foundation's programs are helping inner city youth to turn

away from gang violence, drugs and alcohol. Sri Sri's Prison Programs have helped

transform the lives of an estimated 150,000 inmates around the world.

24

In 1997, Sri Sri founded the International Association for Human

Values, a humanitarian non profit organization that advances human values in

political, economic, industrial, and social spheres. While his self development

programs have popularized traditionally exclusive ancient techniques, Sri Sri's social

initiatives address an array of issues such as conflict resolution, disaster and trauma

relief, prisoner rehabilitation, youth leadership, women's empowerment, female

foeticide, child labor, and access to education. His teachings of love, practical

wisdom, and service promote harmony among people, and encourage individuals to

follow their chosen spiritual path, while honoring other paths.

1.17.2 Sudarshan Kriya (SK) process

Sudarshan Kriya emphasizes breathing in three different rhythms. The

theory mentions that the Kriya allows a healthy and pleasant mind to produce

chemical messengers, which travel from the nervous system to the immune system,

resulting in the overall betterment of both body and mind.

Sudarshan Kriya (SK) and related practices (SK&P) are derived from the

Yogic Science of Breath derived from Vedic texts. SK&P includes gentle stretches

(yoga postures), specific breathing exercises (the central technique is SK; see below),

and cognitive coping and stressor evaluation strategies. SK&P is traditionally

understood to dissolve emotional distress and create the subjective experience of rest

and well-being. The instructors in SK&P are trained by the International Art of

Living Foundation in two residential courses of two weeks each which included

approximately one year of practical field work in between.

The breathing techniques that are part of SK&P are:

(a) Three-Stage Pranayama with Ujjayi or "Victory Breath",

(b) Three sets of Bhastrika or "Bellow's Breath", and

(c) SK or the "Healing Breath Technique" and are practiced in that order.

The breathing practices are done in a sitting posture, either in a chair or

on the floor. Eyes are kept closed throughout the sessions. Normal breathing is at the

25

rate of 14 to 16 breaths per minute. Ujjayi is a slow and deep breathing technique at

2 to 4 breaths per minute. Three-Stage Pranayama with Ujjayi breath is an advanced

form using a specific ratio of inhalation and exhalation, and breath-holds.

Participants practice this component where specific arm positions are held for

approximately ten minutes in total.

First stage:

In this stage hands are kept on the pelvic bone and participants are

trained to breath in Ujjai for a definite period. Then they are asked to hold the breath

for a definite period and then asked to breathe out in Ujjai for a definite period.

Second stage:

In this stage hands are kept on chest area and breathing in and out in

Ujjai and holding the breath are done in the same fashion as for Stage I.

Third stage:

In this stage hands are kept on the back of the shoulder and breathing is

done in the same fashion as for Stage I.

The second breathing component of SK&P is Bhastrika. Here the

breathing is vigorous and faster, about twenty to thirty respiratory cycles per minute.

Three approximately one-minute rounds of Bhastrika are followed by a few minutes

of normal breathing. Arm movements are used to increase the force and depth of

inhalation and exhalation. Practice of this component lasts for approximately five

minutes. 3 stage Pranayam is followed by Bhastrika Pranayam where hand

movements up and down are coordinated with fast breath In and Out through the

nose. This is followed by Omkar meditation for 3 times followed by Sudarshan Kriya

in Gurujis recorded voice.

The central component of SK&P is SK which is an advanced cyclical

breathing exercise of slow, medium, and fast rates in succession. Slow breaths are

about 20 respiratory cycles per minute, medium breaths are about 40– 50 respiratory

cycles per minute, and the fast breathing is about 60–80 cycles per minute. The

26

participant rotates through these breathing patterns during SK. Kriya involves

regulating ones breath to the sounds of ‘So-hum’ (‘so’ for inhale & ‘hum’ for exhale).

The entire Kriya involves multiple rounds with each round having long, medium and

short inhalation and exhalation with varying rhythms and intensities.

This process continues for 35 minutes which is then followed by Yoga

nidra (tranquil state) for about 10 minutes. Towards the end of the Yoga nidra, the

participants are made to meditate for a few minutes. Once they are aware of the

environment, they are allowed to sit up and open their eyes.

The home SK instruction is given on the last day of the workshop. It

starts with 20 long and slow in and out breaths, 40 medium –length breaths and 40

small, fast ones. This 20-40-40 is done three times and lasts a total of 7-9 min. after

that the practitioners observe silence keeping his/her body for 1 min and pay

attention to their body and then finish with five long , slow so –hums after which the

practitioners lies down in supine position for deep meditation for few min.

1.17.3 The Art of Living Courses

The masterpiece of the Art of Living Course is the powerful breathing-

based technique Sudarshan Kriya. By the side of it, the AOL offers various courses,

to furnish practical knowledge and techniques to unlock their deepest potential and

bring fullness to life. Whether happy and successful or feeling the stress of poor

health, disappointments, or fear, every participant is cared for and comes away

lighter, with effective techniques for releasing mental and physical stress and

increasing his or her health, energy, peace, self-knowledge, awareness, and joy. The

art of living conducts various introductory and postgraduate courses for people of

different age. Table shows the details of some of the main courses of AOL

foundation specially designed for children, adolescent and adults.

27

Tab

le 1

.6

The

Art

of L

ivin

g C

ours

es

S.N

oC

ours

eA

ge(y

rs)

Rem

arka

ble

feat

ures

Tec

hniq

ues

1Th

e A

rt of

Liv

ing

Hap

pine

ss P

rogr

am(P

art 1

cou

rse)

18+

�R

e-di

scov

er th

e pr

esen

t mom

ent —

not

as a

conc

ept b

ut a

s a d

irect

exp

erie

nce.

�Th

e po

wer

to c

reat

e a

joyo

us li

fe th

at is

on-

purp

ose.

�Th

e co

nfid

ence

to s

tretc

h an

d gr

ow b

eyon

dlim

iting

bel

iefs

, an

d th

e ab

ility

to

lead

ade

eply

fulfi

lling

life

.�

Expe

rienc

e un

limite

d po

wer

and

free

dom

�Th

is c

ours

e in

clud

es v

alua

ble

skill

s fo

rm

anag

ing

nega

tive

emot

ions

an

dch

alle

ngin

g sit

uatio

ns,

�Fo

r im

prov

ing

focu

s an

d pr

oduc

tivity

at

wor

k an

d str

engt

heni

ng re

latio

nshi

ps�

Prac

tical

wisd

om a

nd p

roce

sses

to d

iscov

erw

hat i

s wor

king

and

not

wor

king

in li

fe�

Yog

a fo

r im

prov

ed h

ealth

and

inc

reas

edfle

xibi

lity

�Su

dars

han

Kriy

a,

a po

wer

ful

brea

thin

gte

chni

que

and

othe

r anc

ient

pra

ctic

es.

2A

RT

Exc

el C

ours

e –

All

Rou

nd

Trai

ning

in

Exce

llenc

e

8-13

�Pr

ovid

es a

n op

portu

nity

to

disc

over

the

hum

an v

alue

s the

y na

tura

lly p

osse

ss�

Giv

es th

e Si

x G

olde

n K

eys t

o Su

cces

s�

Kno

wle

dge

that

is

kid

-frie

ndly

and

ye

tde

eply

rele

vant

to st

uden

ts�

Incu

lcat

es a

stro

ng lo

ve fo

r lea

rnin

g

�Pr

ovid

ing

tool

s th

at s

timul

ate

child

ren’

sna

tura

l se

nse

of i

nqui

ry a

nd i

mag

inat

ion

whi

le e

xpan

ding

thei

r min

ds

28

(Tab

le 1

.6 C

ontd

.)

3Y

outh

Em

pow

erm

ent

Sem

inar

(YES

!)13

-17

�En

able

s yo

uth

to

succ

essf

ully

na

viga

teth

roug

h th

e ac

adem

ic

and

pers

onal

chal

leng

es o

f hig

h sc

hool

.

�Th

e pr

ogra

m

feat

ures

in

tere

sting

disc

ussio

ns,

fun

and

chal

leng

ing

gam

es,

and

a pr

actic

al

appr

oach

to

pr

oble

mso

lvin

g,

time

man

agem

ent,

hand

ling

rela

tions

hips

an

d de

alin

g w

ith

peer

pres

sure

.

4Y

outh

Lea

ders

hip

Trai

ning

Pro

gram

(YLT

P)18

– 2

7�

The

mis

sion

is

to

re

vive

an

d en

rich

com

mun

ities

thr

ough

the

upl

iftm

ent

and

trans

form

atio

n of

you

th.

�Em

pow

ers

yout

h to

tak

e re

spon

sibili

ty f

orth

eir

own

futu

re

and

that

of

th

eir

com

mun

ity.

�El

imin

ates

str

ess

usin

g in

depe

nden

tlyre

sear

ched

str

ess-

relie

ving

br

eath

ing

tech

niqu

es

5Y

outh

Em

pow

erm

ent

and

Skill

s wor

ksho

p (Y

ES+)

18-3

0�

Incr

ease

effi

cien

cy, s

treng

then

rela

tions

hips

, and

bui

ld u

nsha

kabl

eco

nfid

ence

;�

Prac

tical

kno

wle

dge

on ti

me-

man

agem

ent

and

entre

pren

eurs

hip.

�H

ighl

y fu

n an

d ch

alle

ngin

g lif

e-sk

ills a

ndca

paci

ty b

uild

ing

prog

ram

that

has

reac

hed

thou

sand

s of s

tude

nts a

nd y

oung

prof

essi

onal

s�

Asa

nas a

nd M

edita

tion

�Su

dars

han

Kriy

a &

Pra

naya

m

29

(Tab

le 1

.6 C

ontd

.)

6Li

ving

wel

l cou

rse

�U

nder

stand

ing

of p

erso

nal

curre

nt h

ealth

cond

ition

,�

Som

e sim

ple

yet

prof

ound

yo

ga

asan

asta

ught

uni

tes

and

ties

up e

very

thin

g ne

atly

and

aids

the

body

to h

eal a

nd c

orre

ct it

self.

�Im

prov

e so

cial

rel

atio

nshi

p, a

n ab

ility

to

deve

lop

a de

ep

sens

e of

be

long

ingn

ess

impr

ovin

g th

e ch

ance

s to

bon

d w

ith m

ore

peop

le a

nd t

hus

impa

ctin

g th

e he

alth

in

apo

sitiv

e w

ay.

�Th

ere

is

spec

ial

atte

ntio

n gi

ven

to

get

starte

d w

ith a

hea

lthie

r lif

esty

le f

or p

eopl

ew

ho n

eed

to m

ove

out o

f com

pulsi

ve h

abits

rela

ted

to

smok

ing,

dr

inki

ng

and

drug

abus

e.

Livi

ng

Wel

l pr

ogra

m

empo

wer

sin

divi

dual

s on

str

ateg

ies

to

dela

ypr

ogre

ssio

n of

the

cond

ition

, pre

vent

ion

ofco

mpl

icat

ions

and

man

agem

ent.

�It

also

fo

cuse

s on

th

e ill

-effe

cts

ofps

ycho

soci

al

activ

ity,

stres

s, to

bacc

o,al

coho

l or o

ther

subs

tanc

e ab

use.

�O

ne

expe

rienc

es

the

touc

h of

lif

e an

dle

aves

the

sha

dow

s of

chr

onic

illn

esse

sbe

hind

.

�D

aily

sch

edul

e an

d bu

ilds

in p

ract

ices

that

aid

in b

uild

ing

conf

iden

ce,

joy

and

ease

into

life

that

pre

vent

s com

plic

atio

ns.

�Y

oga

asan

as (P

adam

asad

hana

),�

Sury

a N

amas

kar

�Su

dars

han

Kriy

a &

Pra

naya

m�

Med

itatio

n

30

1.18 SCIENTIFIC RESEARCH ON ART OF LIVING PRACTICES

Research suggests that breathing can be affected by experiences and

circumstances. When faced with a distressing moment, the body can become over

activated and breathing can become more rapid and shallow. Fortunately, breathing

is controllable. Breathing exercises have been used to manage emotions and regulate

stress, as well as increase energy and maintain optimal arousal needed for greater

focus and performance. Because breathing exercises can be quickly learned and

provide immediate feelings of relief, they can be easily incorporated into existing

trainings or treatments. Sudarshan Kriya, a rhythmic breathing technique has been

scientifically proven to have numerous health benefits.

A number of research studies have appeared in independent, peer-

reviewed journals that attest the benefits of Sudarshan Kriya. Table 1.7 shows the

published research studies on SK&P.

31

Tab

le

1.7

: Pub

lishe

d R

esea

rch

stud

ies o

n SK

&P

Tab

le

1.7a

: Inf

luen

ce o

f SK

&P

on S

tres

s, D

epre

ssio

n A

nd A

nxie

ty

S.N

oA

utho

rY

ear

Popu

latio

n (S

ampl

esi

ze (N

)D

urat

ion

of p

ract

ice

Des

ign

Out

com

e

1Jy

otsn

a V

P[5

1]20

12

Dia

betic

pat

ient

s(49

)6

mon

ths

Pros

pect

ive

rand

omiz

edco

ntro

lled

trial

Non

-sig

nific

ant

trend

to

war

dim

prov

emen

t in

gl

ycem

ic

cont

rol,

impr

ovem

ent

in

the

qual

ity

of

life

(QO

L).

2K

atzm

anM

A [5

2]20

12

Gen

eral

ized

Anx

iety

Dis

orde

r (G

AD

) (41

)4

wee

ks

An

open

-labe

l tria

l R

educ

tions

occ

urre

d in

the

pre-

and

pos

t-in

terv

entio

n m

ean

Ham

ilton

an

xiet

ysc

ale

(HA

M-A

) to

tal

scor

e an

d ps

ychi

csu

bsca

le.

3D

esci

lo T

[53]

2010

Su

rviv

ors o

f the

200

4So

uth-

East

Asia

tsuna

mi (

183)

24 w

eeks

N

on-r

ando

miz

edstu

dyR

elie

ve p

sych

olog

ical

dis

tress

fol

low

ing

mas

s dis

aste

rs

4R

ao R

M[5

4]20

08

Early

stag

e br

east

canc

er p

atie

nts

unde

rgoi

ng su

rger

y (6

9)

4 w

eeks

R

ando

miz

edco

ntro

lled

trial

Dec

reas

e in

the

state

and

trai

t of

anx

iety

,de

pres

sion

, s

ympt

om s

ever

ity,

dist

ress

and

impr

ovem

ent

in q

ualit

y of

life

, CD

56%

and

low

er le

vels

of s

erum

IgA

6 K

jellg

ren

A[5

5]20

07

Hea

lthy

volu

ntee

rs(5

5)6

wee

ks

A c

ontro

lled

pilo

ttri

alLo

wer

ed d

egre

e of

anx

iety

, de

pres

sion

and

stres

s, an

d al

so

incr

ease

d th

eir

degr

ee o

f opt

imis

m

32

Tab

le 1

.7a

. Inf

luen

ce o

f SK

&P

on st

ress

, dep

ress

ion,

anx

iety

----

cont

d

S.N

oA

utho

rY

ear

Popu

latio

n

(Sam

ple

size

(N)

Dur

atio

nD

esig

nO

utco

me

7 V

edam

urth

acha

r[5

6]20

06.

Alc

ohol

depe

nden

tin

divi

dual

s (30

)

2 w

eeks

R

ando

miz

ed c

ontro

lled

trial

Red

uctio

ns

in

Bec

k D

epre

ssio

nIn

vent

ory

(BD

I) sc

ores

, co

rtiso

l an

dA

CTH

.

8 B

razi

er A

[57]

20

06

HIV

/AID

S(47

)-

Ran

dom

ized

con

trolle

dtri

alPo

sitiv

e ch

ange

s in

wel

l bei

ng

9 Ja

naki

ram

aiah

N[5

8] 2

000

Mel

anch

olia

(15)

4

wee

ks

Ran

dom

ized

com

paris

on

Alte

rnat

ive

to d

rugs

in m

elan

chol

ia a

s a

first

line

treat

men

t

10

Jana

kira

mai

ah N

[59]

1998

D

ysth

ymic

patie

nts (

46)

3 m

onth

s

-

Rem

issi

on

from

de

pres

sion,

el

evat

edpl

asm

a pr

olac

tin, S

tabl

e co

rtiso

l lev

els

11

Subr

aman

ian

S[6

0]20

12

Hea

lthy

Stud

ents

(43)

6 w

eeks

Ra

ndom

ized

con

trolle

d Re

duct

ion

in

anxi

ety

scor

e ,c

orts

iol,

incr

ease

in p

rola

ctin

, be

ta e

ndor

phin

and

phys

ical

as

wel

l as

men

tal

wel

l be

ing,

impr

ovem

ent i

n im

mun

ity a

nd a

cade

mic

perf

orm

ance

33

Tab

le 1

.7b.

Influ

ence

of S

K&

P o

n Br

ain

Func

tions

S.N

oA

utho

rY

ear

Popu

latio

n(S

ampl

e si

ze (N

)D

urat

ion

of p

ract

ice

Out

com

e

1 B

hatia

M [6

1]20

03

Prac

titio

ners

(19)

2-3

deca

des

Incr

ease

s in

beta

act

ivity

wer

e ob

serv

ed in

the

left

fron

tal,

occi

pita

l, an

d m

idlin

e re

gion

s of t

hebr

ain

2 B

aija

l S [6

2]20

10

Prac

titio

ners

dur

ing

Saha

j Sam

adhi

med

itatio

n (1

0)

3-7

year

sEn

hanc

ed th

eta

band

act

ivity

, inc

reas

ed th

eta

cohe

renc

e

3 Sr

iniv

asan

N [6

3]20

07

Med

itato

rs (1

0)3-

7 ye

ars

Larg

er M

ism

atch

Neg

ativ

ity(M

MN

) am

plitu

des

4 N

aga

Ven

kate

sha

Mur

thy

PJ [

64]

1997

15

dys

thym

ic a

nd 1

5m

elan

chol

icde

pres

sion

pat

ient

s

3 m

onth

sN

orm

al (E

lect

roen

ceph

alog

ram

) EEG

brai

nwav

e, si

gnifi

cant

relie

f fro

m d

epre

ssio

n

34

Tabl

e 1.

7c :

In

fluen

ce o

f SK

&P

on C

ance

r pa

tient

s

S.N

oA

utho

rY

ear

Popu

latio

n(N

)D

urat

ion

ofpr

actic

eD

esig

nO

utco

me

1 K

umar

, N [6

5]

2013

Bre

ast c

ance

r pat

ient

s( 7

8)3

mon

ths

Ran

dom

ized

study

Dec

reas

e in

cor

tisol

and

ver

bal

scor

e of

pai

n

2K

ochu

pilla

i V[6

6]20

05

Can

cer p

atie

nts

24 w

eeks

-In

crea

se in

Nat

ural

Kill

er c

ells

Tabl

e 1.

7d:

Influ

ence

of S

K&

P on

Oxi

dativ

e St

ress

and

Ant

ioxi

dant

Sta

tus

S.N

oA

utho

rY

ear

Popu

latio

n(N

)D

urat

ion

Des

ign

Out

com

e

1 Sh

arm

a [6

7]20

08

SK p

ract

ition

ers (

42)

At l

east

1ye

arO

bser

vatio

nal

Posi

tive

effe

cts o

n im

mun

ity, a

ging

,ce

ll de

ath,

and

stre

ss re

gula

tion.

2 Sh

arm

a H

[68]

20

03

Polic

e tra

iner

s (24

)5

mon

ths

Ran

dom

ised

study

Low

er le

vels

of b

lood

lact

ate

, hig

her

leve

ls o

f ant

ioxi

dant

s

3 A

gte

VV

[69]

20

11

Mild

hype

rtens

ives

(26)

2 m

onth

s O

pen

labe

lin

terv

entio

nstu

dy

Dec

reas

e in

Dia

stol

ic B

lood

Pres

sure

, Ser

um u

rea

and

plas

ma

Mal

ondi

alde

hyde

(MD

A)

35

Tab

le 1

.7 e

: In

fluen

ce o

f SK

&P

on G

ene

Exp

ress

ion

Prof

iles

S.N

oA

utho

rY

ear

Popu

latio

n(N

) D

urat

ion

Des

ign

Out

com

e

1Q

u S

[70]

2013

Hea

lthy

prac

titio

ners

of

SKY

(14)

5 m

onth

sto

5 y

ears

-

97 u

niqu

e ge

nes

2Sh

arm

a [6

7]20

08SK

pra

ctiti

oner

s(4

2)A

t lea

st 1

year

-

Exer

ted

effe

cts

on im

mun

ity, a

ging

, cel

lde

ath,

and

stre

ss re

gula

tion

thro

ugh

trans

crip

tiona

l reg

ulat

ion.

Tab

le 1

.7g

: O

ther

ben

efits

of S

K&

P

S.N

oA

utho

rY

ear

Popu

latio

n(N

) D

urat

ion

Des

ign

Out

com

e1

Jasm

in J

Parm

ar [7

1]20

13

Hel

athy

volu

ntee

rs (3

8)3

mon

ths

Com

para

tive

Stud

yR

educ

tion

in B

lood

pre

ssur

e an

dim

prov

emen

t in

card

io re

spira

tory

para

met

ers

2G

hahr

eman

iD

G [7

2]20

13

Hig

h sc

hool

stude

nts (

327)

1 w

eek

Para

llel c

ontro

l Y

ES! p

rom

ote

men

tal h

ealth

inad

oles

cent

s, po

tent

ially

prot

ectin

g th

em fr

om h

arm

ful c

opin

gbe

havi

ors

3Sa

yyed

A [7

3]

20

10

Hea

lthy

volu

ntee

rs (5

5)8

days

-D

ecre

ase

in T

otal

Cho

leste

rol,

LDL,

incr

ease

in H

DL,

sign

ifica

nt c

hang

es in

pulm

onar

y fu

nctio

ns

36

1.19 PURPOSE OF THE STUDY

Modern living has brought with it, not only innumerable means of

comfort, but also a plethora of demands that tax human body and mind. People of

different ages experience different levels and types of stress. There is no age at

which we are exempt from stress. Stresses begin from nursery children, elementary

aged children and school children. Adolescence and teenage are stressful phase in

life. Though this is the longest stage in human being‘s life which faces conflicts

among various values (morals) counter opinions by parents, monotonous and

cognitive life style can lead to copious amounts of stress on an adolescents.

Teenagers spend their life as in academics as a student in school and college.

Academic environment in India has a very oppressive nature which is

highly mark-oriented, perfectionist and encouraging the tendency to over-achieve

which eventually leads to emotional exhaustion and burnout. The stress which is

experienced by students may adversely affect their academic achievement, personal

well being and long term professional capabilities. It can lead to mental distress and

it can have a negative impact on their cognitive functioning and learning. Thus, it is

extremely crucial that to combat it immediately. Therefore stress management can be

used to help the students filter out some of the stress and enhance their performance,

mental well being and minimizes the adverse behaviour as well.

Middle aged people of age 30-50 tend to have too many responsibilities

about work and family life. Job stress plays a significant role in daily stress. This is

often spurred by office politics, workloads, worries over salary and time-sensitive

deadlines. Due to rapid changes associated with urbanization financial worries for

family expenses and children education also have a major impact on the middle aged

people. As these stresses are faced daily, it becomes a chronic stress which leads to

serious health issues like hypertension, diabetes, obesity among which hypertension

is the major health problem due to chronic stress. Hypertension (HTN) remains the

most common risk factor for cardiovascular morbidity and mortality. The incidence

of HTN is rising the world over because of common environmental factors:

37

excessive dietary sodium, obesity, physical inactivity, excessive alcohol intake,

psychologic stress.

People of different age group acquire stress from different factors and

hence have to learn how to manage their stress in a healthy and productive manner.

Innovative and assorted styles of stress management techniques may be well suitable

for each age group, for a proper outcome.

Art of living (AOL), foundation offers different variety of courses for

different age groups depending upon the type of stress they face. Evidence

supporting SK&P as alternative therapy is accumulating. Until recent times, 25

research papers have been published in scientific journals. With these intriguing

findings, it is imperative to conduct further research on SK&P to formulate it as

evidence based mind body medicine. Up to our knowledge, none of the studies

focused on specific courses of AOL namely, the YES+ an explicit course for college

students and Living well course particular for lifestyle diseases.

1.20 OBJECTIVES

With this context, the study had two objectives.

Objective 1: To find out the effect of short term structured yoga module

(YES! +) on psychological as well as biological changes associated with stress

response in healthy engineering college students during examination stress.

Objective 2: To find out the effect of structured yoga module (Living

well course) as an adjunct to antihypertensive drug therapy on psychological,

biological and molecular changes in recently diagnosed mild essential hypertensive

patients.

Each objective is presented as separate chapters (Chapter 2 and 3). As

the thesis pertains to research work carried out on the effect of yoga on exam stress

and hypertension, it is in order to introduce the reader about exam stress,

hypertension and related aspects separate introduction, materials and methods,

results, discussions and conclusion are provided for each chapters.