Effects Of Yoga On Depression And Anxiety Of Women: A Study Analysis

HLT1RAE Research And Evidence In Practice 5

Study Background and Objectives

Yoga is frequently regarded as an important stress management tool the can be used to assist individuals during alleviating mental health condition like depression and anxiety disorders (Sharma, 2014). The study conducted by Javnbakht, Kenari and Ghasemi (2009) mainly aims to evaluate the influence of yoga during the process of relieving the symptoms of complex mental health problems like depression and anxiety. The main focus group selected by the author for this analysis are the women who were referred to a yoga clinic during the tenure of July 2006 to July 2007. The selected group of participants were randomly assigned in two different groups one is placebo group (n= 31) and another one is experimental group (n = 34). The experimental group participated in weekly yoga classes two times per week for tenure of 90 minutes for duration of 2 months. The control or the placebo groups did not receive yoga. Both the groups are evaluated after 2 months with the help of personal information questionnaire along with Beck and Speilberger tests. The analysis of the result highlighted that prevalence of depression in the test group during pre-yoga condition was 12.82 +/- 7.9 and post yoga condition was 10.70 +/- 6.04. The difference in the depression level was however statistically insignificant with p = 0.13. However, when the experimental group was compared with the control or the placebo group, it was found that women who participated in the yoga classes showed a prominent decrease in the level of state anxiety (p= 0.03) and trait anxiety (p< 0.001). The perceptive representation of the test highlighted that the after 2 months of yoga, the level of depression of the experimental group decreased by 11.8%  (previously it was 44.1%) and was found to be 32.3%. Thus from the extracted results, the authors concluded that the participation in yoga classes for 2 months can cause significant reduction in the perceived level of stress and anxiety among the women who suffer from anxiety disorders (Javnbakht, Kenari & Ghasemi, 2009). The authors further recommended that yoga can be regarded as an alternative non-pharmacological therapy for the treatment of anxiety related disorders.

The authors of the study included only the female patient within the study. Thus the study scores less in the domain of sample validity. According to Krupnikov and Levine (2014), sample validity ensures that selected group of sample covers a broad range within the concept under the study such that, the result is replicable and is valid over a wide range of sample. However, selection of only female participants in the study highlighted the “expert” bias. According to Nolen-Hoeksema and Hilt (2013) the level of stress and depression differs with age, gender and occupation. However, Javnbakht, Kenari and Ghasemi (2009) only included female participants who documented psychological disorders or are under doctor’s recommendation for taking yoga as a therapy for recovery.

Methodology

The Javnbakht, Kenari and Ghasemi (2009) used 21-ietm Beck depression inventory questionnaires for ascertaining depression among the selected group of participants. According to Wang and Gorenstein (2013), Beck and Depression Inventory (BDI) questionnaires asses the depressive symptoms of the patients and rates their intensity on the scale from 0 to 3 (total score provided is 0 to 63). Higher the BDI score, greater is the indication of the depressive mood. 0 to 9 score is regarded as depressive mood, 10 to 18 as low depressive mood, 19 to 20 moderate depressed mode and 30 to 63 score is the indicators of severely depressed mood. Thus it can be said that single tool, BDI score is used to analyze the depression score of the selected groups of the participations and hence the study is reliable. According to Noble and Smith (2015), reliability is the degree to which an assessment tool produces consistent and stable results. In order to elucidate the level of anxiety, the authors used State-Trait anxiety inventory (Speilberger questionnaire). It is a widely used method for the assessment of anxiety symptoms. It consists of 20 different items of state and anxiety and 20 different items for trait anxiety. Use of same tool for the detection anxiety further increased the reliability of the selection of the focus group (Spielberger, Gonzalez-Reigosa, Martinez-Urrutia, Natalicio & Natalicio, 2017).

The authors, Javnbakht, Kenari and Ghasemi (2009) excluded individuals with previous reported cases of psychiatric disorders, drug abuse and previous experience of yoga. The authors mainly included T-test and Wilcoxon statistical tests with SPSS 13.0 software in order to analyze the results and the results are valid and reliable. The analysis of the results highlighted the prevalence of depression between the test and the placebo groups have no significant difference. However, the difference was indicated in the level of anxiety. The mean state of anxiety score before undertaking yoga was 2.29 among the test group. This state of anxiety was decreased to 1.85 after yoga intervention. The state of anxiety was highlighted in 41.2% of cases before the conduction of yoga and the percentage got decreased to 20.6% after the conduction of yoga and this result was statistically significant with a P value of 0.03 (Javnbakht, Kenari & Ghasemi, 2009).

There are no significant threats in internal validity of the study. According to Kessler and Vesterlund (2015), internal validity of the study is the extent to which the experiment is free from errors and any type of difference that is being reflected in the measurement due to the presence of independent variable. The authors use the common tools in order to measure the level of anxiety and depression among the selected group of participants both the placebo and the experimental group. This lead to eradication of threats associated with the internal validity of the study. However, internal validity also encompasses the alternative explanation of the results. Javnbakht, Kenari and Ghasemi (2009) though provided the possible reasons underlying the decrease in the level of anxiety after yoga but failed to highlight the possible reasons why the level of depression remained before and after the conduction of yoga.

Results and Discussion

The external validity of the study is defined as the extent to which the results of the research can be inferred to the world at large. This is mainly measured in the domain of establishment of the causal relationships (Kessler & Vesterlund, 2015). This from the above definition of the external validity, it can be highlighted that there are threats to the external validity of the study.  The reason behind this is, the study’s focus group is the female population. This restriction of the focus group to the female is the principal threat to the external validity of the study. The physiological system of men and different from women and so is the level of stress and depression. Thus, the statistical results in relation of yoga and the level of anxiety, which is relevant to women, might not be applicable to men. Thus, the results cannot be inferred to the world at large. Another threat to the external validity of the research is the Javnbakht, Kenari and Ghasemi (2009) failed to mentioned the yoga postures or the ashanas which were used during the 2 months long yoga session (twice a week for 90 minutes). This gap is proper explanation and tabulation of the type of yoga ashanas and the duration of the each ashanas hampered or endangered the external validity of the research. The reason behind this is, according to Gothe, Pontifex, Hillman, McAuley (2013), different yoga postures has different effects on different parts of the body thus proper knowledge, and utility of each posture must be noted in order to get the desired results.

The critical analysis of the research highlighted that the study scores less in the domain of external validity. In order to overcome the potential threats associated with the external validity of the results the inclusion and the exclusion criteria of the focus group must be more stringent and defined. The inclusion of the focus group must be designed in such a way the it included both the gender, male and female this will help inferred research results to the world at large. Moreover, the age limit of the groups must be also be defined. For example, the research conducted by Ibrahim, Kelly, Adams and Glazebrook (2013) highlighted the young adults or the adults who are either students are working professionals are the main victims of anxiety and depression. Specific selection focus group (with age limit) might help to infer the relation of the results at large. Moreover, the stretching exercise or the yoga postures, which were used in the research during the tenure of 2 months, must also be elaborated in details. Such that other authors who are planning to replicate the same results might get an understanding of the effect of postures in reducing the depression or the level of anxiety. Proper explanation of the postures and its underlying mechanism to reduce the level of anxiety or anxiety trait will help in the establishment of casual relationships.

References

Gothe, N., Pontifex, M. B., Hillman, C., & McAuley, E. (2013). The acute effects of yoga on executive function. Journal of physical activity and health, 10(4), 488-495. https://doi.org/10.1123/jpah.10.4.488

Ibrahim, A. K., Kelly, S. J., Adams, C. E., & Glazebrook, C. (2013). A systematic review of studies of depression prevalence in university students. Journal of psychiatric research, 47(3), 391-400. https://doi.org/10.1016/j.jpsychires.2012.11.015

Javnbakht, M., Kenari, R. H., & Ghasemi, M. (2009). Effects of yoga on depression and anxiety of women. Complementary therapies in clinical practice, 15(2), 102-104. doi:10.1016/j.ctcp.2009.01.003

Kessler, J., & Vesterlund, L. (2015). The external validity of laboratory experiments: The misleading emphasis on quantitative effects (Vol. 18, pp. 392-405). Oxford, UK: Oxford University Press.

Krupnikov, Y., & Levine, A. S. (2014). Cross-sample comparisons and external validity. Journal of Experimental Political Science, 1(1), 59-80. https://doi.org/10.1017/xps.2014.7

Noble, H., & Smith, J. (2015). Issues of validity and reliability in qualitative research. Evidence-Based Nursing, ebnurs-2015. https://dx.doi.org/10.1136/eb-2015-102054

Nolen-Hoeksema, S., & Hilt, L. M. (2013). The emergence of gender differences in depression in adolescence. In Handbook of depression in adolescents (pp. 127-152). Routledge. Access date: https://www.taylorfrancis.com/books/e/9780203809518/chapters/10.4324%2F9780203809518-12

Sharma, M. (2014). Yoga as an alternative and complementary approach for stress management: a systematic review. Journal of Evidence-Based Complementary & Alternative Medicine, 19(1), 59-67. https://doi.org/10.1177/2156587213503344

Spielberger, C. D., Gonzalez-Reigosa, F., Martinez-Urrutia, A., Natalicio, L. F., & Natalicio, D. S. (2017). The state-trait anxiety inventory. Revista Interamericana de Psicologia/Interamerican Journal of Psychology, 5(3 & 4).  DOI: https://dx.doi.org/10.30849/rip/ijp.v5i3%20&%

Wang, Y. P., & Gorenstein, C. (2013). Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Revista Brasileira de Psiquiatria, 35(4), 416-431. https://dx.doi.org/10.1590/1516-4446-2012-1048