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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 18-23

Immediate role of two yoga-based breathing technique on state anxiety in patients suffering from anxiety disorder: A self as control pilot study


1 Asst. Registrar (Academics), SVYAA Yoga University, Bengaluru, Karnataka, India
2 Division of Yoga and Humanities, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India

Date of Web Publication14-Dec-2017

Correspondence Address:
Dr. Balaram Pradhan
Eknath Bhavan, # No-19, Gavipuram Circle, Bengaluru - 560 019, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijny.ijoyppp_9_16

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  Abstract 

Objective: To evaluate immediate effect of Nadisodhana Pranayama on state anxiety in patients suffering with anxiety disorder. Materials and Methods: The study was performed on psychiatric participants (male = 10; female = 12) with age range of 18 to 49 years, age mean ± standard deviation (30.22 ± 09.08). The baseline data were used. The self as control design was followed participants participated in Nadisodhana and Breath awareness for 10 min. the same time for two consecutive days. The sequence of the session was assigned randomly to the participants. The state anxiety was assessed using state-trait anxiety inventory (STAI) before and immediately after each session. Results: Within-group comparison showed that due to alternate nostril breathing and breath awareness, STAI scores reduced or significant reduction of STAI scores in both groups (P < 0.001). In between-group comparison baseline was statistically matched (P = 0.596) whereas after intervention there was significant difference in STAI scores (P < 0.001; Mann–Whitney test). The percentage change of state anxiety was 25% after Nadisodhana whereas 8% after breath awareness. Conclusion: This pilot study shows that both Nadisodhana and breath awareness are effective mind-body practices to reduce state anxiety in patients suffering from anxiety neurosis. However, the immediate effect in reducing state anxiety was better after Nadisodhana (25%) compared to breath awareness (8%).

Keywords: Anxiety, Nadisodhana, yoga


How to cite this article:
Kumar N, Pradhan B. Immediate role of two yoga-based breathing technique on state anxiety in patients suffering from anxiety disorder: A self as control pilot study. Int J Yoga - Philosop Psychol Parapsychol 2017;5:18-23

How to cite this URL:
Kumar N, Pradhan B. Immediate role of two yoga-based breathing technique on state anxiety in patients suffering from anxiety disorder: A self as control pilot study. Int J Yoga - Philosop Psychol Parapsychol [serial online] 2017 [cited 2018 Jun 20];5:18-23. Available from: http://www.ijoyppp.org/text.asp?2017/5/1/18/220777


  Introduction Top


Anxiety is a disabling mental disorder characterized by persistent worrying, tension, and higher sympathetic activity; it is a specific type of disorder characterized by bodily symptoms of physical tension and apprehension about the future.[1] The term anxiety covers four experiences in any individual such as physical tension, mental retardation, panic thoughts, and pathological symptom fear; it is also called a neurosis disorder characterized by recurrent attacks of long time fear, mental apprehension, dizziness, and feeling of about to fall.[2] Anxiety is a normal response to a specific stress; anxiety is considered as a problem when it becomes too much; during anxiety state, there are recurrent episode of symptoms such as breathing difficulty, chest pain, sweating, palpitation, nausea, headache.[3] Anxiety is unpleasant feelings of dangerous events, such as the feeling of imminent death.[4] Anxiety can be either a short-term “state” or a long-term “trait”. Whereas trait anxiety represents worrying about future upcoming events.[5]

Estimates of the current prevalence of anxiety disorder ranged between 0.9% and 28.3% and past year prevalence between 2.4% and 29.8% across the world.[6] Prevalence data for anxiety disorders suggest that the lifetime prevalence and 12-month prevalence for any anxiety disorder are over 15% and 10%, respectively, with higher prevalence in developed countries.[7] Anxiety disorders are most common mental illness in the United states; approximately 40 million American adults aged 18 and older or about 18.1% of people in this age group in a given year have an anxiety disorder. Anxiety disorders frequently co-occur with depressive disorders or substance abuse (NIMH). Severity of anxiety disorder was as follows: 22.2%–26.2% were serious, 37.3% moderate, and 40.4% mild.[8] It is estimated that the cost of care for anxiety disorders was $42.3 billion US in 1990. Symptoms of anxiety and symptoms of depression were prevalent in medical students (43% and 14%, respectively) and in humanities students (52% and 12%, respectively).[9]

Yoga is a 3000-year-old tradition which has been practiced in India. It is now considered as a holistic approach to health, and it is classified by National Institutes of Health as a form of complementary and alternative medicine.[10] Regular practice of yoga helps to build a better connectivity between the mind and body through a series of postures, breathing exercises, and meditation. It can be an important tool for stress reduction; yoga is a way of life; it consists of four components which are physical postures to develop strength and flexibility, breathing exercises to decrease respiratory cycles, deep relaxation technique to enhance ability to release anxiety, and meditation practice to increase stress regulation skill.[11] Yoga practice involves distinct techniques such as physical postures (asana), controlled breathing (Pranayama), deep relaxation, and meditation.[12] Yoga offers several practices that help in mastery over the modifications of the mind.[13] Yoga is found to be an effective tool in managing stress levels.[14] Yoga is a way of life consisting four components: physical postures to develop strength and flexibility, breathing exercises to enhance the respiratory function, deep relaxation techniques to reduce anxiety symptoms, and meditation practices to promote stress regulation skills.[11] Yoga reduces sympathetic tone and brings the state of parasympathetic dominance; ultimately, yoga balances both the sympathetic and parasympathetic nervous system.[15] Yogic relaxation leads to a state of parasympathetic dominance that promotes cardiac vagal modulation which could be beneficial in conditions (hypertension) characterized by increased sympathetic activity.[16] There is evidence that yoga reduces the anxiety symptoms.[17] These yogic techniques have a specific effect on one's mental state.[18],[19] Evidences support that yoga helps in reducing anxiety disorders.[20] Yoga reduces stress and chronic pain and corrects sleeping patterns and enhances overall well-being in anxiety patients.[21] Evidence-based research proves that there is direct and indirect benefits of such practices. It has been found that practice of yoga-based meditation triggers neurotransmitters which reduce the psychological disorders such as anxiety.[22] Evidence says Sudarshan Kriya Yoga is beneficial, low risk, low-cost treatment of stress, anxiety, and stress-related medical illness.[23]

Yoga along with regular care was effective in reducing symptoms of depression compared with regular practices. Further research showed that there are benefits in anxiety. Only yoga may be particularly beneficial in mental health care in the broader community.[24] In another study on mindfulness-based stress reduction, results shows a 35% reduction of distress. Mindfulness facilitates a distress reduction in a group of health professionals.[25] Addressing the mechanisms underlying hatha, yoga's potential stress-reduction benefits, inflammatory and endocrine responses were noted among regular and nonpractitioner of yoga. When subjected to stressors before hatha yoga practices, the yoga practitioner shows speeded recovery and produced stress in response to the stressors than the counterpart.[26]

Breathing alternately through left and right nostril Known as Nadisodhana. Conventionally, this practice called Nadisodhana Pranayama is considered to reach a state of satisfaction and reduce restlessness, as well as achieve physical and mental balance.[27]Nadisodhana Pranayama is one of the controlled breathing also called as alternate nostril breathing, which activates and harmonizes ida and pingala nadis. Sodhana means “to purify.” In English, this practice is called “channels” purification Pranayama.[12]Pranayama comprises of two word, “Prana” which means breath/air and “ayama” means controlling. Pranayama is an exact science. It is the fourth limb of Ashtanga yoga. “Tasmin Sati Svasa prasvasayorgativicchedah Pranayamah”– regulation of breath or the control of Prāëa is the stoppage of inhalation and exhalation.[28] Yoga-controlled breathing acts on both mind and body complex. Apart from that metabolic control of breathing affects breath, that which called as yogic breathing.[29] Brainstem respiratory neurons indicate that influences from higher centers can modify metabolic breathing.[30],[31] Mental conflict especially conflict between the intellect (called Vijnanamaya Kosha in Sanskrit) and the instinct (called Manomaya Kosha in Sanskrit) causes a disturbances in the subtle, life energy, called Prana in Sanskrit.[32]

This concept of imbalance in subtle life energy is discussed in yoga text but it is not discussed in allopathic medicine. Traditional yogic texts suggest a solution for the imbalance in prana, through slow, deep breathing.[12] It has been said that “when the mental state disturbed, the life energy (Prana) gets unbalanced and this leads to irregular breath which causes anxiety; hence, to regulate the breath, yoga practitioner should regulate the breath.”[12] Apart from slow, deep, yogic-controlled breathing, Nadisodhana includes awareness of the movement of air in the nasal passages.[33] Yogic and slow breathing had a balancing effect on autonomic nervous system through enhancing parasympathetic activation.[34] Slow and deep breathing also enhances psychophysiological arousal, decreased sympathetic activity, and stress responses.[35]Nadisodhana Pranayama acts as yogic-controlled breathing which has balancing effect on sympathetic and parasympathetic nervous system.

State anxiety is a root cause of many modern diseases which we see in such as respiratory problems, cardiovascular problems, psychiatric problems, and nervous problems. It is known to arise problem and inability to describe body-mind complex. This study aims to establish Nadisodhana Pranayama as one of the solutions. Hence, the study was planned with an aim to evaluate immediate role of Nadisodhana pranayama on state anxiety in anxiety patients and compare it with breath awareness.


  Materials and Methods Top


Participants of anxiety disorder who had no general medical and chronic diseases such as cardiac disease, diabetes, substance abuse, arthritis, and head injury, which could read and write in English-Hindi language, were included in the study. Participants having any chronic illness related to other ailments and those who had back pain and unable to seat in meditative posture were excluded from the study. Patients were recruited from Holistic Health Home-Arogyadhama, Bengaluru, India, those who were suffering from anxiety neurosis only. They were diagnosed by a psychiatrist. A total of 23 participants were screened within 3-month period, from August 2016 to October 2016; of all, 22 participants who satisfied the inclusion criteria formed the final sample size. A total 22 individuals: 10 male and 12 female in the age range of 18–49 years (mean age ± standard deviation; 30.22 ± 09.08 years). This study was approved by ethics committee of S-vyasa. All participants are educated about the parameters and intervention, and they have duly signed informed consent form previously to the study.

Design of the study

This was a self as control study having two session, Experimental session (Nadisodhana Pranayama) and control session (Breath awareness). All participants were assessed on State-Trait anxiety inventory (STAI-S) before and after a period of Nadisodhana Pranayama and Breath awareness. The two sets of measurement were taken on successive days. They are asked to sit comfortably on the floor in cross-legged posture with eyes closed. All participants were asked to practice Nadisodhana Pranayama for 10 min on day first and called same participants to practice breath awareness on day second. Each participants took both Nadisodhana Pranayama and breath awareness session in two consecutive days.

Interventions

Alternate nostril breathing (Nadisodhana Pranayama)

Alternate nostril breathing involves breathing through left and right nostrils alternatively.[36] In this, procedure was sitting comfortably in crossed-leg posture. Adopt Nasika Mudra; hold the fingers of the right hand in front of the face. Rest the index and middle fingers gently on the eyebrow center. Both fingers should be relaxed. The thumb is above the right nostril and ring finger above the left. These two digits control the flow of breath in the nostrils by alternately pressing on the nostril, blocking the flow of breath, and vice versa. The thumb and ring finger of the right hand were used to manipulate the nostrils. This is a yoga gesture (Nasika Mudra in Sanskrit) prescribed to press the nostrils one by one during Nadisodhana Pranayama.[37]

Breath awareness

during the breath awareness, the participants maintained awareness of breath without manipulation of nostrils and breath. During this practice, participant's awareness was directed to the movement of air into and out of their nostrils. They are asked to observe the natural breathing patterns which are going in and coming out of the nostrils. This is also called as natural breathing.[38]

Assessments tool: State-trait anxiety inventory

The outcome measure was assessment of state anxiety levels. It is self-assess using a self-rated scale called Spielberger's State Anxiety Inventory (STAI; Form X-1) at previous and immediately after the end of the experimental (Nadisodhana) and control (Breath awareness) sessions. STAI is reliable, and valid tool with a high degree of internal consistency with Cronbach's alpha 0.86 for total scores; average reliability coefficients were acceptable for both internal consistency and test-retest.[39] It includes separate measures of state anxiety and trait anxiety each consisting 20 items rated on a 4-point scale from 1 to 4 which range from 20 (minimum) to 80 (maximum). Form “S” evaluates state anxiety that how individuals feel “at this moment.” In India, its reliability and validity are well established for adult populations. State anxiety shows different emotional condition characterized by feelings of nervousness, tension, worries, and apprehension, and increased activity of autonomic nervous system.[40]


  Results Top


State-trait anxiety inventory

The baseline STAI score was not found normally distributed by using Shapiro–wilk test (P < 0.05). Within-group comparison showed that STAI scores found significant reduction in STAI scores in both groups (P < 0.001; Wilcoxon signed-rank test) as shown in [Table 1] and [Graph 1], [Graph 2]. The percentage change of state anxiety was 25% after Nadisodhana whereas 8% after breath awareness. Between-group comparison baseline was statistically matched (P = 0.596) whereas after intervention result found significant difference (P < 0.001; Mann–Whitney test) as shown in [Table 2] and [Table 3].
Table 1: Demographic data

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Table 2: Means, median, and standard deviations of state-trait anxiety inventory scores before and after Nadisodhana and breath awareness

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Table 3: Mann–Whitney U-test both prestate-trait anxiety inventory scores and poststate-trait anxiety inventory scores

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  Discussion Top


This self as control study was designed to assess the efficacy of yoga-based breath technique to the conventional psychiatric program for patients suffering from anxiety neurosis. Analysis of outcomes indicated that there is significant reduction within group for both NSD and BAW (Nonparametric Wilcoxon signed-rank test) for the variables STAI (P < 0.001) scores. The present study found significant reduction/change in state anxiety immediately after both Nadisodhana Pranayama (25%) and breath awareness sessions (8%). Between-group comparison baseline was statistically matched (P = 0.596) whereas after intervention result found significant difference (P < 0.001; Mann–Whitney test).

The possible mechanism of how alternate nostril breathing affects the central nervous system is not clearly understood. However, it showed that due to airflow into the nostril, mechanical receptors in nasal mucosa are activated and this signal is transmitted to hypothalamus, which is considered to highest center for autonomic regulation.[41] Some studies on alternate nostril breathing have reported their physiological and psychological effects including oxygen consumption in brain which would have reduced the stress response and resulting in low anxiety.[42] Previous study has suggested that yogic breathing like both nostrils alternately produces changes and it balances the autonomic nervous system.[43]

The practice of yoga balances the autonomic nervous system which consists of two parts: one is sympathetic nervous system and other is parasympathetic nervous system. However, individual asana and breathing exercises and breathing practices can affect the sympathetic or parasympathetic nervous system and the entire effect of yoga practice to bring out the parasympathetic slowness; in a study, the change in sympathetic activity was observed due to the change in blood pressure. Overall, there is parasympathetic dominance after practice of alternate nostril breathing.[44] Different types of yogic breathing practices might have reduced anxiety.[45]


  Conclusion Top


This pilot study suggests that Nadisodhana pranayama and breath awareness is effective mind-body practices to re4duce state anxiety in patients suffering from anxiety disorder immediately after the practice. This study should be done with a large sample size and randomized controlled design.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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