The Effects of Pranayama Yoga on

Stress and Anxiety

By

Jatin Chaudhary

Supervisor

Dr. Kim Yong-Kyu

DECEMBER 2012

GRADUATE SCHOOL

DAEGU UNIVERSITY

REPUBLIC OF KOREA

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TABLE OF CONTENTS

I. INTRODUCTION ····································································································1

1. Purpose ······················································································································2

2. Hypothesis ·················································································································2

II. LITERATURE REVIEW ····················································································3

1. Yoga ···························································································································3

2. Concept of Pranayama ···························································································5

2-1. Pranayama Techniques ···············································································6

3. Stress ·························································································································9

3-1. Sources of Stress ·······················································································10

3-2. Stressors ·······································································································11

4. Anxiety ····················································································································12

III. METHOD ··············································································································13

1. Study Participants ·································································································13

2. Inventory ·················································································································14

3. Experimental Protocol ··························································································15

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3-1. Weekly Program ·························································································17

3-2. Exercise Program ·······················································································18

3-3. Yoga Asana(postures) ···············································································19

4. Statistical Analysis ·······························································································22

IV. RESULTS ·············································································································23

1. The Effect of Pranayama on Positive Stress ···············································23

2. The Effect of Pranayama on Negative Stress ·············································24

3. The Effect of Pranayama on State Anxiety ·················································25

4. The Effect of Pranayama on Trait Anxiety ·················································26

V. DISCUSSION & SUGGESTIONS ································································27

VI. CONCLUSION ····································································································29

REFERENCES ············································································································30

ABSTRACT ·················································································································37

APPENDIX ···················································································································39

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LIST OF TABLES

Table 1. Eight Limbs of Yoga ················································································4

Table 2. Characteristics of Stress ········································································11

Table 3. Subjects ·········································································································13

Table 4. Questionnaire ·······························································································14

Table 5. Study Design ·······························································································15

Table 6. Weekly Schedule ·························································································16

Table 7. Breathing Exercises ···················································································17

Table 8. Positive Stress Analysis by Independent T-test ······························23

Table 9. Positive Stress Analysis by Paired T-test ·········································23

Table 10. Negative Stress Analysis by Independent T-test ···························24

Table 11. Negative Stress Analysis by Paired T-test ···································24

Table 12. State Anxiety Analysis by Independent T-test ······························25

Table 13. State Anxiety Analysis by Paired T-test ·········································25

Table 14. Trait Anxiety Analysis by Independent T-test ······························26

Table 15. Trait Anxiety Analysis by Paired T-test ·········································26

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LIST OF FIGURES

Figure 1. Subjects ·······································································································13

Figure 2. Pose of the corpse ····················································································18

Figure 3. Child's resting pose ·················································································18

Figure 4. The monkey pose ·····················································································19

Figure 5. Crocodile pose ····························································································19

Figure 6. Cobra pose ··································································································20

Figure 7. The grasshopper pose ··············································································20

Figure 8. The wind-relieving pose. ········································································21

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The Effects of Pranayama Yoga on

Stress and Anxiety

Jatin Chaudhary

Department of Physical Education

Graduate School, Daegu University

Gyeongbuk, Korea

Supervised by prof. Kim, Yong-Kyu

(Abstract)

Stress and anxiety have been implicated as contributors to many chronic

diseases and to decreased quality of life, even with pharmacologic

treatment. Yoga has been implemented to alleviate both mental and

physical ailments. The objective of this study was to assess the effect of

pranayama yoga on negative and positive stress levels and state-trait

anxiety. Fifteen healthy women subjects(39.12±3.04 years, 57.25±4.52 kg)

attended a 6-week pranayama yoga program for 60 minutes, 3 times a

week. They were assigned into two groups: A(experimental n=8) and

B(control n=7). Both groups were requested not to participate in any

physical activity until the end of the study. The pre and post pranayama

yoga effects were assessed by using the stress scale(Cohen, Kamarch &

Mercelstein, 1983) for positive and negative stress levels and state-trait

anxiety inventory: STAI(Spielberger, 1970). The data handling of the test

results was used by WINDOWS SPSS 18.0 statistics program with

Independent T-test and Paired T-test. Statistical significance was accepted

at α=.05. This study had two major findings. First, in both positive and

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negative stress levels there were no significant changes occur within

6-weeks of pranayama practice. Second, there were positive effects in

anxiety conditions on experimental-group subjects.

The observations suggest that pranayama yoga leads to remarkable

reduction in the anxiety scores within a period of 6-weeks and contributes

to increased relaxation.

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I. INTRODUCTION

Yoga has been practiced for over thousands of years in ancient India but

recently it gained popularity in the United States and Europe. In America,

the yoga market emerged as a 5.7 billion dollar industry in 2008. The

practice of yoga has been implemented to alleviate both mental and

physical ailments, including bronchitis(Behera D, 1998), chronic pain(da

Silva GD., Lorenzi-Filho G., & Lage LV., 2007), and symptoms of

menopause(Booth-LaForce C., Thurston RC., & Taylor MR., 2007). Yoga

has also been associated with improved cardiorespiratory performance,

highlighting the aerobic nature of yoga. To focus the human mind,

traditional yoga texts instruct students to practice yogic breathing

exercises(pranayama). Pranayama is one of the central teachings in

classical yoga(Muktibodhananda, 2006). Pranayama is the science of breath

control. Many studies have reported the effect of yoga and pranayama on

various systems(Roggla, 2001; Stanescu, 1990; Sequeira, 1999). Gupta et al.,

(2006) has reported the role of pranayama on stress by focusing our mind

on our breath. The present study follows a reproducible sequence, and both

research and clinical experience demonstrate that it significantly alleviates

stress and anxiety(Gangadhar et al., 2000; Janakiramaiah N., 2000; Suarez,

2002; Weintraub, 2004). Yoga has also been shown to improve immune

function and allows patients a way to engage in self-management. Due to

its good compliance and lack of drug interactions, yoga appears to be safe

and could be encouraged to improve quality of life and, perhaps, the

symptoms of stress and anxiety. Given that there are few to no side

effects, it is relatively inexpensive and can be performed anywhere by

nearly everyone.

In this study, we focused on a yogic breathing program to determine

whether the existing primary literature supports the incorporation of yoga

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into the cognitive behavior therapy plan for stress and anxiety, or whether

additional research in the field is warranted. If deemed beneficial, yoga

could be an adjunctive option to pharmacologic therapy for patients with

stress and anxiety disorders or potential alternative to cope with daily life

stress and psychological related conditions.

1. Purpose

The purpose of this master's thesis was three-fold. First, to introduce an

important limb of yoga(pranayama) to Korean society. Second, to determine

if practice of pranayama for 6-weeks was a sufficient stimulus to decrease

stress levels. Third, to determine if pranayama practice would have

positive effects on state or trait anxiety scale.

Through this study fitness professionals and personal trainers would

become more aware of the myths of breathing, related conditions and they

can better guide their students and clients. There is no doubt that

pranayama practice can help to cure many human physical and mental

ailments, so today's enlightened medical experts should give them a fair

trial.

2. Hypothesis

2-1. Pranayama yoga would have an effect on stress.

1) Pranayama yoga would have an effect on positive stress.

2) Pranayama yoga would have an effect on negative stress.

2-2. Pranayama yoga would have an effect on anxiety.

1) Pranayama yoga would have an effect on state anxiety.

2) Pranayama yoga would have an effect on trait anxiety.

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II. LITERATURE REVIEW

1. Yoga

Yoga is the oldest system of personal development encompassing body,

mind, and spirit. The word yoga is derived from the Sanskrit root Yuj,

which means to join or to yoke. In philosophical terms, yoga refers to the

union of the individual self with the universal self(Hadi, 2007). Yoga is

based on ancient theories, observations and principles of the mind-body

connections. Yoga refers to traditional physical and mental disciplines. For

many years in India, and currently in the western world, yogic breathing

exercises(pranayama) have been used with varying success for the

treatment of chronic physiological and psychological disorders such as

asthma, chronic obstructive pulmonary disease and depression(Brown &

Gerbarg, 2005; Cooper et a.l., 2003; Pomidori et al., 2009). People practice

pranayama with different goals in mind; some for the purpose of relaxation

and spiritual gain, others with the hope that yogic breathing exercise will

provide physiological or psychological benefit. Traditional Ashtanga Yoga is

the name given to a set of practices compiled by the sage Patanjali some

time between 200 BC to 250 AD. Ashtanga yoga is translated from the

Sanskrit language as: Eight Limbs of Yoga(Hari Dass, 1999).

Modern day yoga practice has been discovered in the Western world by

many people. Hatha yoga has become increasingly popular in western

countries as a method for coping with stress and as a means of exercise

and fitness training(Schell et al., 1994). Yoga practices can also be used as

psycho-physiological stimuli to increase the secretion of melatonin which,

in turn, might be responsible for perceived well-being(Harinath et al.,

2004). During past few decades, pranayama is being discussed all over the

world, not only by yoga teachers, but also by the general public and by

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Limbs of Yoga Meaning Definition

Yama Self-restraintHow we relate to

others.

Niyama RoutinesHow we relate to

ourselves.

AsanaPostures and

physical exercises

How we relate to

our body.

PranayamaUse of breathing to

achieve focus

How we relate to our

breath.

PratyaharaWithdrawal of mind

from sense organs

How we relate to

our sense organs.

Dharana ConcentrationHow we relate to

our mind.

Dhyana MeditationMoving beyond the

mind.

Samadhi EmancipationDeep realization and

inner union.

scientists.

Table 1. Eight Limbs of Yoga

Yoga is not magic or a feat of any kind, physical or mental. Yoga is

based on a sound philosophy and deep psychology(Krishnananda, 1981). It

is an educational process by which the human mind is trained to become

more and more natural and weaned from the unnatural conditions of life.

Yoga has particular concern with psychology, and, as a study of the ‘self’,

it transcends both general and abnormal psychology. The benefits of yoga

are intensely interwoven. “Change your posture and you change the way

you breathe. Change your breathing and you change your nervous system.

This is one of the great lessons of yoga: Everything is connected(Timothy

McCall, M.D www.drmccall.com).

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2. Concept of Pranayama

Pranayama is an important anga(limb) of yoga. Prana is define as life

force or energy(in Japan = Qi, China = Chi). Ayama means to control flow

of life force through the body. Pranayama helps in controlling all the

functions of breathing namely inspiration, expiration, and retention.

Pranayama is one of the yogic techniques that can produce different

physiological responses in healthy individuals(Upadhyay et al., 2008).

Breathing techniques and patterns are regularly advocated for relaxing,

stress management, control of psycho physiological states(Ritz & Roth,

2003). Various respiratory patterns and maneuvers can provide striking

influences on the autonomic nervous system and may exacerbate or reduce

adverse responses to stressors. For example, an increased breathing rate is

a typical response to stressful situations(Grossman, 1983; Magarin, 1982).

The diaphragm is the most important muscle for inhalation. Diaphragmatic

breathing appears to lead to advantageous psychological effects through

autonomic nervous system activity. A slow, large-tidal-volume,

predominantly abdominal pattern of ventilation is associated at the

psychological level with emotional stability, sense of control over the

environment, calmness, a high level of physical and mental activity, and

relative absence of perceived or objective stressors(Grossman, 1983).

Pranayama is a science related to vital force supplying energy and

controlling the body mind complex. The mind, consisting of thoughts and

emotions is closely related to the breath. When the mind is calm and

relaxed, the breathing is smooth and slow and when the mind is stressed

breathing is fast and shallow(Shantikumarm, 1974). Pranayama aims at

normalizing and regulating the distribution of air throughout the whole

body.

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2-1. Pranayama Techniques

1) Bhastrika pranayama(deep breathing), a complete breath technique,

also called three part breathing, slowly fills and empties the entire lung

capacity(Christensen, 1987; Samskrti & Veda, 1985; Satchidananda, 1970). A

smooth maximum inhalation is accomplished by first expanding the

abdomen and lower rib cage, then expanding the middle rib cage, and

finally expanding the upper rib cage. The abdomen naturally withdraws as

the chest is fully expanded. A slow maximum exhalation follows in the

reverse order sinking the upper chest, then the middle chest, and finally

pulling in the abdomen. The complete breath may be done in either a

sitting or a standing position. The mind is focused on the breath and the

release of tension during breathing. This technique is often done three to

five times at the beginning of the yoga breathing practices. Yoga texts

recommend this technique at other times to counter stress and refresh the

mind and body.

2) Kapalbhati pranayama(rapid exhalation), two rapid breathing

techniques are used in basic yogic practices(Samskrti & Franks, 1978;

Satchidananda, 1970). One technique is a quick short forced exhalation

using the abdominal muscles, followed by a slower automatic

diaphragmatic inhalation as the abdominal muscles are relaxed. The volume

of air is smaller than normal tidal volume. The other technique has the

same short forced exhalation, but the inhalation is also short and forced

using the diaphragm and extending the abdomen. These two techniques

will be referred to here as automatic inhalation and forced inhalation,

respectively. The automatic inhalation technique is more common. Both

techniques use nasal breathing and are done in a sitting position. The

mind is focused on breathing, particularly the abdominal contractions. For

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both techniques, beginners repeat about ten to twenty cycles at a rate of

about one cycle per second. One complete breath technique is usually done

very slowly after the series of rapid cycles. After a short rest, the series

of cycles and complete breath may be repeated once or twice. Over a

period of several weeks or months the practicer may work up to two to

three cycles per second for a series of one hundred or even several

hundred cycles. In the advanced stages, breathing may be very vigorous

and the breath is held after a series of rapid cycles. Most yoga manuals

and instructors state that a person should stop and rest if any sensations

of dizziness or light headedness occur during rapid breathing. Also, rapid

breathing should not be done within about two hours after a meal. In more

advanced, vigorous practice, the stomach, bladder and bowels should be

empty.

3) Anulom-vilom pranayama(alternate nostril breathing) consists of slow

deep quiet breaths using one nostril at a time(Samskrti & Franks, 1978;

Satchidananda, 1970). The thumb and middle two fingers are used to close

off the nostrils. Three variations exist, depending on when the nostrils are

switched. In one variation, the active nostril is switched after each inhalation.

In the second variation, exhalation is through one nostril and inhalation

through the other. After a few cycles, the inhalation and exhalation nostrils

are reversed. The third variation switches nostrils after several breaths. For

all three techniques, each breath is as slow as comfortable using full lung

capacity as in the complete breath. A sitting position is used. Beginners

attempt to make the duration of inhalation and exhalation equal and do only

about six single nostril breaths between rests. With practice, the duration of

exhalation is slowly extended to twice the duration of inhalation and the

practice is continued for several minutes. The mind is focused on the slow

deep breathing in a manner similar to meditation. The advanced practice

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continues for 10 to 20 minutes or longer with the breath held after inhalation

and/or exhalation. Yoga writings use a variety of terms for alternate nostril

breathing, including nadi shodhanam, nadi suddhi and sukha purvaka.

According to yoga tradition, alternate nostril breathing improves the

functioning, coordination and balance for two modes of cognitive activity

that are reasonably similar to current concepts of right and left hemispheric

brain functioning(Rama, Ballentine, & Ajaya, 1976). Ancient yoga writings

claim that the modes of mental activity are related to which nostril is

dominant or most open to air flow. Mental capabilities corresponding the left

hemisphere dominate when the right nostril is more open. Likewise, right

hemispheric mental capabilities dominate when the left nostril dominates.

Equal air flow through both nostrils represents a balance of the two mental

modes. Yoga tradition also claims that nostril dominance and corresponding

cognitive mode alternate approximately every one(Bhole & Karambelkar,

1968) or two hours(Rama 1986). According to these writings, the cycle

becomes erratic with emotional disturbance, irregular eating or sleeping

habits, and various other life style factors.

4) Bhramri pranayama(humming bee breath) consists of very slow

smooth maximum inhalation, followed by slow smooth maximum

exhalation. Air flow is restricted by keeping the glottis in the throat

partially closed, which results in a soft uniform low hissing sound. During

inhalation, the abdominal muscles are kept slightly contracted, resulting in

increased emphasis on maximum chest expansion. The technique is

continued for a few minutes initially. In more advanced practice the breath

is held after inhalation and sometimes after exhalation. The mind is

focused on breathing, particularly the low hissing sound. Bhramri was one

of the techniques that induced the large oscillations of heart rate and blood

pressure reported by Schmidt(1983).

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3. Stress

Stress is a fact of everyday life. When people reach out for help, they

are often dealing with circumstances, situations, and stressors in their lives

that leave them feeling emotionally and physically overwhelmed. Many

people consider stress to be something that happens to them, an event

such as an injury or a job loss. Others think that stress is what happens

to our body, mind, and behaviour in response to an event(E.g. heart

pounding, anxiety, or nail biting). Stress can be a result of both positive

and negative experiences, and it is a necessary part of our daily lives.

From an evolutionary standpoint stress was necessary for survival(i.e.,

imagine hunting large prey on which one’s entire tribe is dependent) and

some stress continues to be a helpful part of our modern lives since it

motivates us to accomplish tasks or make needed changes. We all feel the

pressure of our environment during times of transition(i.e., at the time of

high school graduation) and in preparation for significant life events(i.e., in

anticipation of a job interview). Although, response to stress is often

adaptive(i.e., feeling stress before an exam may be a critical motivator in

studying for it), too much stress or an inability to cope with it can cause

negative emotional and physical symptoms. Hundred of scientific studies

have found that mind-body interventions, including yoga practices, are

effective in treating stress-related mental and physical disorders(Becker,

2000; Benson, 1996; Jacobs, 2001). Recent research has focused on cardiac

vagal tone as a marker of emotional regulation, psychologic

adaptation(Beauchaine, 2001; Sargunaraj, et al., 1996). The relationship

between breathing and emotion is bidirectional(Ley, 1999). Yogic breathing

provides a unique and powerful tool for adjusting imbalances in the

autonomic nervous system and thereby influencing a broad range of mental

and physical disorders(Sovik, 2000). Slow and deep breathing itself has a

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calming effect on the mind and helps an individual to de-stress(Sandeep et

al., 2002). The physiological and psychological benefits of yoga have been

demonstrated in several studies(Selvamurthy et al., 1983; Bal & Singh,

2010; Bal, 2010). These studies have shown that regular practice of yoga

leads to improvement in physiological functions and human performance.

Yoga and pranayama may be as effective as or better than exercise at

improving a variety of health related outcome measures(Ross and Thomas,

2010) and as a result this study was undertaken to find out the effects of

a 6-week pranayama practice on stress levels.

3-1. Sources of Stress

1) The Environment – the environment can bombard with intense and

competing demands to adjust. Examples of environmental stressors include

weather, noise, pollution, traffic, unsafe and substandard housing, and

crime.

2) Social Stressors – we can experience multiple stressors arising from

the demands of the different social roles we occupy, such as parent,

spouse, and employee. Some examples of social stressors include deadlines,

financial problems, job interviews, presentations, loss of a loved one, &

divorce.

3) Physiological – situations and circumstances affecting our body can

be experienced as physiological stressors. Examples of physiological

stressors include rapid growth of adolescence, menopause, illness, aging,

giving birth, accidents, lack of exercise, poor nutrition, and sleep

disturbances.

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Positive stress Negative stress

Motivates, focuses energy Causes anxiety or concern

Is short-term Can be short or long-term

Is perceived as within coping

abilities

Is perceived as outside of coping

abilities

Feel exciting Feels unpleasant

Improves performance

Decreases performance

Can lead to mental and physical

problems

4) Thoughts – our brain interprets and perceives situations as stressful,

difficult, painful, or pleasant. Some situations in life are stress provoking,

but it is our thoughts that determine whether they are a problem for us.

3-2. Stressors

Situations that are considered stress provoking are known as

stressors(Klinic Community Health Centre, 2010). Stress is not always a

bad thing. Stress is simply the body’s response to changes that create

taxing demands. Many professionals suggest that there is a difference

between what we perceive as positive stress and negative stress. In daily

life, we often use the term “stress” to describe negative situations. This

leads many people to believe that all stress is bad for us, which is not

true. In the present study, we focused on positive stress as well as

negative stress levels.

Table 2. Characteristics of Stress

When under stress, people find it difficult to maintain a healthy balance

between work and non-work life. At the same time, they may engage in

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unhealthy activities, such as smoking, drinking and abusing drugs. Stress

may also affect the immune system, impairing people's ability to fight

infections(Leka, Stavroula, 2003).

4. Anxiety

Anxiety is a feeling that we commonly experience when faced with

stressful life events. Anxiety can be one of the most distressing emotions

that people feel. The root meaning of the word anxiety is 'to vex or

trouble'; in either presence or absence of psychological stress, anxiety can

create feelings of fear, worry, uneasiness, and dread(Bouras, & Holt,

2007). However, anxiety should not be confused with fear, it is more of a

dreaded feeling about something which appears intimidating and can

overcome an individual(Robin Marantz Henig, 2012). Common reactions to

anxiety include; sweaty palms, muscle tension, racing heart, or light

headedness. Anxiety is a psychological and physiological state characterized

by somatic, emotional, cognitive, and behavioral components. It is the

displeasing feeling of fear and concern(Davison, 2008). Anxiety is

considered to be a normal reaction to a stressor. It may help an individual

to deal with a demanding situation by prompting them to cope with it.

However, when anxiety becomes overwhelming, it may fall under the

classification of an anxiety disorder. The psychological factors, including

anxiety, contribute significantly not only to the pathogenesis of medical

illness, but also affect their course and may be a target for effective

intervention(Schattner, 2003). So it becomes important to reduce the level

of anxiety as a part of prevention and management of diseases. Among

the various approaches to reduce the level of anxiety, yoga is the one that

combines the physical elements of a healthy lifestyle with prescriptions for

abiding mental peace(Bijlani, 2003).

- 13 -

Experiment group Control group

Participant 8 7

Gender Female Female

Average age 39.12±3.04 years 39.28±1.97 years

Average weight 57.25±4.52 kg 54.00±5.35 kg

Psychologist

consultantnone one

III. METHOD

1. Study Participants

Fifteen healthy females volunteered in the study. They were assigned

into two groups: A(experimental N=8) and B(control N=7). Expect one

participant in the control group, none of the subjects ever consulted with a

psychologist.

Table 3. Subjects information

Figure 1. Subjects

- 14 -

Factors Sub-factors Total Numbers Question no.

Stress

Positive Stress 7 4, 5, 6, 7, 9, 10, 13

Negative Stress 7 1, 2, 3, 8, 11, 12, 14

Anxiety

State-Anxiety 20 1-20

Trait-Anxiety 20 1-20

2. Inventory:

The Stress scale(Cohen, Kamarch & Mercelstein, 1983) for positive and

negative stress levels and State-Trait Anxiety Inventory: STAI(Spielberger,

1970) were used to analyze the statistical results of this study.

The questions in Stress scale subjects were asked about feelings and

thoughts during the last month. In each case, subjects were asked to

indicate how often they felt or thought a certain way. For example, in the

last month, how often have you been upset because of something that

happened unexpectedly? The answer was 1(never) to 4(very often). The

best approach was to answer fairly quickly.

The State-Anxiety scale consists of twenty statements that evaluate how

respondents feel "right now, at this moment." For example, I feel upset.

The answer was 1(not at all) to 4(very much so).

The Trait-Anxiety scale consists of twenty statements that assess how

respondents feel "generally." For example, I am a steady person. The

answer was 1(almost never) to 4(almost always). Subjects were instructed

to attempt all the questions.

Table 4. Questionnaire factors

- 15 -

3. Experimental Protocol:

Before the experiment formally began, all subjects gathered at the

venue(Taekwondo gym) and got a brief introduction of the study and

methodology of pranayama. Subjects were divided into two groups. Both

groups were requested not to participate in any physical activity until the

end of the study. Experimental group was scheduled to practice pranayama,

three times weekly for 60 minutes a day under guidance. The control

group did not receive any yoga training and requested to follow the

protocol of the study.

Table 5. Study design

- 16 -

3-1. Weekly program:

First day, a written consent was undertaken from the subjects. Pre test

of questionnaire was filled as per conditions. Control group left with their

daily routine. Experimental group positively practiced the pranayama

exercises for 60 minutes under the guidance of researcher. This routine

was followed obediently by subjects for 6-weeks. Control group was

contacted on regular basis. Last day of the study, after experimental group

finished the pranayama session, both groups gathered again and filled out

the post test questionnaire as per conditions. Open discussion was held and

written comments were collected from experimental group.

Table 6. Weekly schedule

- 17 -

3-2. Exercise program:

Starting with light warm up exercises from toe to head in sitting

position. There were four pranayama(breathing exercises) practiced

including breaks in between for yoga asana(postures or stretching) to relax

the body and to prevent the pressure in the joints and back.

Table 7. Breathing exercises and figures

- 18 -

3-3. Yoga asana(postures) practised in the study during rest:

Shav-asana(pose of the corpse): It is the primary position used in

yoga for relaxing, one is which we attempt to literally mimic the "lifeless

state" by completely letting go all the conscious tension. Lie down straight

with the back on the ground.

Figure 2. Pose of the corpse

Bal-asana(Child's Resting Pose): It's a simple relaxation position. Lie

down with the stomach on the ground. Keep both the hands under the

head. Fold the right knee slightly, the way a child sleeps.

Figure 3. Child's resting pose

- 19 -

Markat-asana(The Monkey Pose): Lie down and spread both the

hands at the shoulder level. The palm should be facing the ceiling. Fold

both the legs at the knees and keep them near the hips. Knees turn

towards right side. Left knee and ankle should rest on the right knee and

ankle. Turn the neck to the opposite side.

Figure 4. The monkey pose

Makar-asana(crocodile pose): Lie down on stomach. Joint the elbows

of both the hands, making a stand and place the palms under the chin.

Lift the chest up and keep the elbows and legs together. While inhaling,

first fold one leg at a time and then both the legs together.

Figure 5. Crocodile pose

- 20 -

Bhunjang-asana(Cobra Pose): Lie down on stomach. Keep the palms

on the ground and both the hands near the sides of the chest. The

shoulders should be lifted up. The legs should be straight and the toes

should be joined together. Inhale and slowly lift the chest and head

upwards.

Figure 6. Cobra pose

Salabh-asana(Grasshopper Pose): Lie on stomach and straighten the

right hand and keep the left hand on the back. While inhaling, lift the

head and right hand from the front, lift the left leg above the ground level.

Similarly, repeat from the left side.

Figure 7. The grasshopper pose

- 21 -

Pavanmukt-asana(Wind-Relieving Pose): Lie down straight and rest

the right knee on the chest. Interlock both the hands and keep them on

the knee. While exhaling press the knee on the chest. Life the head such

that the nose touches the knee. In the same way with the other leg and

then both the legs together.

Figure 8. The wind-relieving pose

- 22 -

4. Statistical Analysis:

The data handling of the test results was used by statistical program,

SPSS 18.0. Conventional statistical methods were used to calculate

mean(M) and standard deviation(SD). Independent T-test and Paired

T-test were applied to determine the difference in mean of stress and

anxiety within 2 groups. Statistical significance was accepted at α=.05.

- 23 -

Table 8. The difference in positive stress between groups pre and post test

test group N M SD t-value df p

precon 7 2.838 .567

-.745 13 .470exp 8 3.035 .454

postcon 7 2.918 .481

-.446 13 .663exp 8 3.052 .651

Table 9. The difference in positive stress between trials in groups

trial Npre post

t-value df pM SD M SD

con 7 2.838 .567 2.918 .481 -1.069 6 .326

exp 8 3.035 .454 3.052 .651 -.093 7 .929

IV. RESULTS

1. The effect of pranayama yoga on positive stress

1) The difference in positive stress between groups pre and post test.

The result represents the difference in positive stress between control

and experimental group in pre and post test by using Independent T-test

analysis(Table 8). Statistically, there were no significant changes occur in

positive stress levels between groups pre and post test(p>.05).

2) The difference in positive stress between trials in group.

Results of the analysis showed the difference in positive stress by using

Paired T-test(Table 9). Standard value of statistics was higher in the

test(p>.05). Thus, there was no significant effect of 6-weeks pranayama

practice on positive stress.

- 24 -

Table 10. The difference in negative stress between groups pre and post test

test group N M SD t-value df p

precon 7 2.591 .484

-.223 13 .827exp 8 2.660 .674

postcon 7 2.550 .460

-.261 13 .798exp 8 2.606 .372

Table 11. The difference in negative stress between trials in groups

trial N

pre post

t-value df p

M SD M SD

con 7 2.591 .484 2.550 .460 .220 6 .833

exp 8 2.660 .674 2.606 .372 .331 7 .750

2. The effect of pranayama yoga on negative stress

1) The difference in negative stress between groups pre and post test.

The result represents the difference in negative stress between control

and experimental group in pre and post test by using Independent T-test

analysis(Table 10). Statistically, there were no significant changes occur in

negative stress levels between groups pre and post test(p>.05).

2) The difference in negative stress between trials in group.

Results of the analysis showed the difference in positive stress by using

Paired T-test(Table 11). Standard value of statistics was higher in the

test(p>.05). Thus, there was no significant effect of 6-weeks pranayama

practice on negative stress.

- 25 -

Table 13. The difference in state anxiety between trials in groups

trial Npre post

t-value df pM SD M SD

con 7 2.321 .186 2.464 .080 -2.414 6 .052

exp 8 2.393 .156 2.443 .156 -.637 7 .544

Table 12. The difference in state anxiety between groups pre and post test

test group N M SD t-value df p

precon 7 2.321 .186

-.816 13 .429exp 8 2.398 .156

postcon 7 2.464 .080

.312 13 .760exp 8 2.443 .156

3. The effect of pranayama yoga on state anxiety

1) The difference in state anxiety between groups pre and post test.

The result represents the difference in state anxiety between control and

experimental group by using Independent T-test analysis(Table 12).

Statistically, there were no significant changes occur in state anxiety

between groups pre and post test(p>.05).

2) The difference in state anxiety between trials in group.

Results of the analysis showed the difference in state anxiety between

trials in control and experimental group by using Paired T-test(Table 13).

Standard value of statistics was higher in the test(p>.05). Thus, there was

no significant effect of 6-weeks pranayama practice on state anxiety.

- 26 -

Table 14. The difference in trait anxiety between groups in pre and post test

test group N M SD t-value df p

precon 7 2.407 .220

-1.092 13 .295exp 8 2.518 .175

postcon 7 2.450 .200

.263 13 .797exp 8 2.425 .069

Table 15. The difference in trait anxiety between trials in groups

trial Npre post

t-value df pM SD M SD

con 7 2.407 .220 2.450 .200 -1.000 6 .356

exp 8 2.518 .175 2.425 .169 2.525 7 .040

4. The effect of pranayama yoga on trait anxiety

1) The difference in trait anxiety between groups pre and post test.

The result represents the difference in trait anxiety between control

group and experimental group by using Independent T-test analysis(Table

14). Statistically, there were no significant changes occur in trait anxiety

between groups in pre and post test(p>.05).

2) The difference in trait anxiety between trials in group.

Results of the analysis showed the difference in trait anxiety by using

Paired T-test(Table 15). There were no changes occur between pre and

post test in control group trait anxiety(p>.05). However, in experimental

group there was a positive difference occur between pre and post

test(t=2.525, p<.05). Trait anxiety level in the post test(M=2.425) was lower

than the pre test(M=2.518). Therefore, results showed that 6-weeks

pranayama practice have positive effects on trait anxiety.

- 27 -

V. DISCUSSION AND SUGGESTION

Yoga practices are known to significantly improve health status, and

reduce stress and anxiety(Ross & Thomas, 2010). Since yoga aims at

perfection of the body and mind, it is natural to ask whether the progress

towards perfection is reflected in objective reproducible changes in

physiological variables. A study of Bhimani, N. T., Kulkarni, N. B.,

Kowale, A., & Salvi, S.(2011) showed the stress level has reduced after 2

months of practicing various pranayama as evident by decrease in total

stress score which is highly significant. However, the present study of

6-weeks pranayama found no significant difference in stress levels. The

duration of the current study could be insufficient for positive outcome in

stress levels. Therefore, future researchers should consider extending the

duration of the experiment in stress and breathing related studies.

This study shows that measurable improvement in the anxiety scores

occurs within 6-weeks as the result of an intervention that combines

practice of pranayama, asanas, relaxation techniques(shavasana and

meditation). Each of these measures individually can also influence the

anxiety levels favorably. Yogic relaxation can check sympathetic over

activity(Vempati R. P., & Telles S., 2002). The objective manifestations of

anxiety; a racing heart, palpitations, tremors, sweating, increased blood

pressure, dry mouth, avoidance behavior, signs of restlessness, and

heightened responsiveness decrease and slowly disappear. Prior studies

have also reported a significant reduction in the scores of trait anxiety

following meditation(Eppley KR, Abrams Al, Shear. 1989) and in state

anxiety following muscle relaxation techniques and listening to

music(Stoudenmire, J. A. 1975). Results of the current study is also

supported by(Brown R. P., & Gerbarg P. L., 2005) who suggest a sequence

breathing techniques(ujjayi, bhastrika, and sudarshan kriya) can alleviate

- 28 -

anxiety, depression, everyday stress, post-traumatic stress, and

stress-related medical illnesses. A study by Javnbakht, M., Hejazi Kenari,

& Ghasemi, M.(2009) concluded a 2-month yoga class can lead to

significant reduction in perceived levels of anxiety in women who suffer

from anxiety disorders. Another study focused on effects of Tai chi/yoga

on anxiety claimed similar results in self-reported anxiety(Tiffany Field,

Miguel Diego, & Maria Hernandez-Reif, 2010). Chris C. Streeter, Theodore

H. et al.(2010) reported: Effects of Yoga Versus Walking on Mood,

Anxiety, and Brain GABA Levels associated with greater improvement in

mood and anxiety than metabolically matched walking exercise. This was

the first study to demonstrate that increased thalamic GABA levels and

improvements in mean scores on mood and anxiety scales. Michael W.

Beets(2010) reported significant Effects of Yoga on Stress, Depression, and

Health-Related Quality of Life in a Nonclinical, Bi-Ethnic Sample of

Adolescents. A pilot study on State anxiety, psychological stress and

positive well-being responses to yoga and aerobic exercise in people with

schizophrenia demonstrated both yoga and aerobic exercise result in state

anxiety, stress reductions and increases in subjective well-being(Davy

Vancampfort, Marc De Hert, et al., 2011). These findings have implications

for add-on physiotherapist in patients with schizophrenia.

In summary, the data thus far are suggestive of beneficial outcomes

from the use of yoga as an intervention for stress and anxiety; yoga may

be considered as a possible adjunctive therapy for those experiencing

stress and anxiety.

- 29 -

VI. CONCLUSION

The overall goal of this master's thesis was to find the effects of

pranayama yoga on stress and anxiety.

1. In stress levels, there were no significant changes occur within

6-weeks of pranayama practice.

2. Results showed positive effects in anxiety conditions on

experimental-group subjects who practiced pranayama for 6-weeks.

This study suggest that yoga could be an effective treatment of anxiety

and that is has the potential to play an important therapeutic role in

addition to or indeed, instead of medication. It may also be useful for

treatment of patients affected by anxiety who would never accept drug

therapy.

- 30 -

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The Effects of Pranayama Yoga on

Stress and Anxiety

챠우터리 쟈틴

체육학과

대구대학교 대학원

지도교수 김 용 규

(국문초록)

스트레스와 불안은 많은 만성적인 질병을 유발시키고, 삶의 질을 감소시키는

요인이 되기도 한다. 프라나야마(pranayama) 요가(호흡 운동)는 불안과 스트

레스를 포함하는 많은 건강적인 요인들을 향상시키는 것으로 보여 왔었다. 이

연구의 목적은 스트레스와 불안이 프라나야마 요가 운동을 통해 효과가 나타

나는 것을 검증하기 위한 것이다. 15명의 건강한 여성을 대상으로 실험군

(n=8)과 비교군(n=7)으로 나누어 6주 동안 실시하였으며, 요가 프로그램은 일

주일에 3번 60분 동안으로 구성되었다. 두 집단 모두 실험이 종료될 때까지

어떠한 신체적인 활동에 참여하지 못하도록 요구하였다. 요가를 통한 효과를

보기위해 사전 사후에 긍정적인 스트레스와 부정적인 스트레스 그리고 불안상

태를 측정하는 설문지를 사용하여 측정하였다. 수집된 모든 데이터는 SPSS

18.0 프로그램을 이용하였고, 통계적인 유의수준은 α=.05로 설정하였다. 이 연

구에서 나타난 결과들을 살펴보면 첫째, 6주간 프라나야마 요가 참여 후에 긍

정적 스트레스 수준은 실험군과 통제군 간에 유의한 차이가 나타나지 않았다.

그리고 6주간 프라나야마 요가 참여 전과 후 간에 실험군과 통제군 모두에서

긍정적 스트레스 수준은 유의한 차이가 나타나지 않았다. 둘째, 6주간 프라나

야마 요가 참여 후에 부정적 스트레스 수준은 실험군과 통제군 간에 유의한

차이가 나타나지 않았다. 그리고 6주간 프라나야마 요가 참여 전과 후 간에

- 38 -

실험군과 통제군 모두에서 부정적 스트레스 수준은 유의한 차이가 나타나지

않았다. 6주간 프라나야마 요가 참여 후에 상태불안 수준은 실험군과 통제군

간에 유의한 차이가 나타나지 않았다. 그리고 6주간 프라나야마 요가 참여 전

과 후 간에 실험군의 상태불안 수준은 유의한 차이가 나타나지 않았다. 넷째,

6주간 프라나야마 요가 참여 후에 특성불안 수준은 실험군과 통제군 간에 유

의한 차이가 나타나지 않았다. 그리고 6주간 프라나야마 요가 참여 전과 후

간에 실험군의 특성불안 수준은 6주간 프라나야마 요가에 참여 전보다 참여

후가 유의하게 낮게 나타났다. 이러한 결론을 통해 프라나야마 요가는 심리적

안정화에 기여할 수 있는 것으로 생각된다.

- 39 -

<APPENDIX>

Items for Perceived Stress Scale

For each question choose from the following

alternatives:Never

Almostnever

Sometimes

OftenVeryoften

1)In the last month, how often have you been upset

because of something that happened unexpectedly?① ② ③ ④ ⑤

2)In the last month, how often have you felt that you

were unable to control the important things in your life?① ② ③ ④ ⑤

3)In the last month, how often have you felt nervous and

"stressed"?① ② ③ ④ ⑤

4)In the last month, how often have you dealt

successfully with day to day problems and annoyances?① ② ③ ④ ⑤

5)

In the last month, how often have you felt that you

were effectively coping with important changes that

were occurring in your life?

① ② ③ ④ ⑤

6)In the last month, how often have you felt confident

about your ability to handle your personal problems?① ② ③ ④ ⑤

7)In the last month, how often have you felt that things

were going your way?① ② ③ ④ ⑤

8)In the last month, how often have you found that you

could not cope with all the things that you had to do?① ② ③ ④ ⑤

9)In the last month, how often have you been able to

control irritations in your life?① ② ③ ④ ⑤

10)In the last month, how often have you felt that you

were on top of things?① ② ③ ④ ⑤

11)

In the last month, how often have you been angered

because of things that happened that were outside of

your control?

① ② ③ ④ ⑤

12)In the last month, how often have you found yourself

thinking about things that you have to accomplish?① ② ③ ④ ⑤

13)In the last month, how often have you been able to

control the way you spend your time?① ② ③ ④ ⑤

14)

In the last month, how often have you felt difficulties

were piling up so high that you could not overcome

them?

① ② ③ ④ ⑤

NOTE: Items 4, 5, 6, 7, 9, 10 and 13 are scored in the reverse direction.

- 40 -

- 41 -

- 42 -

Kor-Ver.

아래는 지난 한달(1개월)동안 자신이 생활하면서 겪고 느꼈던 상황을 알아

보려 합니다. 가장 가까운 내용에 √ 표 해주시길 바랍니다.

내 용전혀없었다

거의없었다

가끔있었다

자주있었다

상당히자주있었다

1)지난 한달동안 예상하지 못한 일이 생겨서 기분 나빠진

적이 얼마나 있었나요?① ② ③ ④ ⑤

2)지난 한 달 동안 중요한 일들을 통제할 수 없다고 느낀

적은 얼마나 있었나요?① ② ③ ④ ⑤

3)지난 한 달 동안 초조하거나 스트레스가 쌓인다고 느낀

적은 얼마나 있었나요?① ② ③ ④ ⑤

4)지난 한 달 동안 짜증나거나 성가신 일들을 성공적으로

처리한 적이 얼마나 있었나요?① ② ③ ④ ⑤

5)지난 한 달 동안 생활 속에서 일어난 중요한 변화들을

효과적으로 대처한 적이 얼마나 있었나요?① ② ③ ④ ⑤

6)지난 한 달 동안 개인적인 문제를 처리하는 능력에 대

해 자신감을 느낀 적은 얼마나 있었나요?① ② ③ ④ ⑤

7)지난 한 달 동안 자신의 뜻대로 일이 진행된다고 느낀

적은 얼마나 있었나요?① ② ③ ④ ⑤

8)지난 한 달 동안 해야 할 모든 일들을 다 대처할 수 없

다고 느낀 적은 얼마나 있었나요?① ② ③ ④ ⑤

9)지난 한 달 동안 생활 속에서 짜증나는 일들을 얼마나

컨트롤 할 수 있었나요?① ② ③ ④ ⑤

10)지난 한 달 동안 매사를 잘 컨트롤하고 있다고 느낀 적

이 얼마나 있었나요?① ② ③ ④ ⑤

11)지난 한 달 동안 당신이 통제할 수 없는 범위에서 발생

한 일 때문에 화가난 적이 얼마나 있었나요?① ② ③ ④ ⑤

12)지난 한 달 동안 끝마쳐야 할 일들을 생각한 적이 얼마

나 있었나요?① ② ③ ④ ⑤

13)지난 한 달 동안 시간을 보내는 방식을 컨트롤 할 수

있었던 적이 얼마나 있었나요?① ② ③ ④ ⑤

14)지난 한 달 동안 어려운 일이 너무 많이 쌓여서 극복할

수 없다고 느낀 적이 얼마나 있었나요?① ② ③ ④ ⑤

- 43 -

Kor-Ver.

아래는 지금 당신이 느끼는 현재의 정서(기분)을 알아보기 위한 것입니다. 한 문장

도 빠짐없이 √ 표 해주시길 바랍니다.

내 용전혀 그렇지없다

그렇지 않다

그렇다매우 그렇다

1) 나는 평온하다. ① ② ③ ④

2) 나는 안전하다 ① ② ③ ④

3) 나는 긴장되어 있다. ① ② ③ ④

4) 나는 자주 후회한다. ① ② ③ ④

5) 나는 편안함을 느낀다. ① ② ③ ④

6) 나는 언짢다. ① ② ③ ④

7) 나는 닥쳐올지 모르는 불행을 걱정하고 있다. ① ② ③ ④

8) 나는 쉬고 있는 느낌이다. ① ② ③ ④

9) 나는 불안하다. ① ② ③ ④

10) 나는 포근한 느낌이 든다. ① ② ③ ④

11) 나는 자신감이 없다. ① ② ③ ④

12) 나는 초조하다. ① ② ③ ④

13) 나는 안절 부절 하다. ① ② ③ ④

14) 나는 아직 긴장되어 있다. ① ② ③ ④

15) 나는 느긋한 기분이다. ① ② ③ ④

16) 나는 만족스럽다. ① ② ③ ④

17) 나는 걱정이 많다. ① ② ③ ④

18) 나는 심하게 흥분되어 몸이 떨릴 지경이다. ① ② ③ ④

19) 나는 즐겁다. ① ② ③ ④

20) 나는 유쾌하다. ① ② ③④

- 44 -

Kor-Ver.

아래는 당신이 평상시에 느끼는 현재의 정서(기분)를 알아보기 위한 것입니다. 한

문장도 빠짐없이 √ 표 해주시길 바랍니다.

내 용전혀 그렇지없다

그렇지 않다

그렇다매우 그렇다

1) 나는 유쾌하다. ① ② ③ ④

2) 나는 쉽게 피곤을 느낀다. ① ② ③ ④

3) 나는 쉽게 울고 싶은 기분이다. ① ② ③ ④

4) 나는 남들처럼 행복했으면 좋겠다. ① ② ③ ④

5) 나는 결정이 더디어서 매사에 손해를 본다. ① ② ③ ④

6) 나는 느긋하다. ① ② ③ ④

7) 나는 평온하고 침착하다. ① ② ③ ④

8) 나는 어려움이 많아서 감당해 내지 못할 것 같다. ① ② ③ ④

9) 나는 대수롭지 않은 일에 너무 걱정하는 편이다. ① ② ③ ④

10) 나는 행복하다. ① ② ③ ④

11) 나는 매사를 어렵게 생각하는 편이다. ① ② ③ ④

12) 나는 자신감이 부족하다. ① ② ③ ④

13) 나는 안전하다. ① ② ③ ④

14) 나는 위기나 어려움을 피하려고 애쓴다. ① ② ③ ④

15) 나는 우울하다. ① ② ③ ④

16) 나는 만족스럽다. ① ② ③ ④

17) 나는 사소한 생각으로 마음을 쓰고 괴로워한다. ① ② ③ ④

18) 나는 한번 낙담하면 헤어 나오기 힘들다. ① ② ③ ④

19) 나는 쉽게 동요하지 않는다. ① ② ③ ④

20) 나는 당연한 문제들로 긴장되고 짜증스럽다. ① ② ③ ④

- 45 -

ACKNOWLEDGEMENT

I attribute all my achievements in life to Late: Anita Devi(my mother)

for the moral, intellectual and physical education I received from her. To

Mr. Naresh Pal Singh(my father) who always provides me needed

guidance and support. Thanks to Natalie Jean McLean(my loving wife)

who has been giving me an enormous amount of insight in all the

circumstances. Poonam Shokeen has been a mentor and an adorable sister.

Over the past five years in Korea, I have received support and

encouragement from a great number of individuals. I would like to thank

my professors team: Dr. Kim Yong-Kyu, Dr. Ko Seong-Kyeong, and Dr.

Lee Jong-Sam for their support over past two years as I moved from an

idea to a completed study. Finally, thanks to Kim Myung-Mi for giving

me a push to get started.