CALIFORNIA STATE UNIVERSITY, NORTHRIDGE. The Relationship Between Yoga and Stress Among the

Transcription

1 CALIFORNIA STATE UNIVERSITY, NORTHRIDGE The Relationship Between Yoga and Stress Among the A graduate project submitted in partial fulfillment of the requirements For the degree of Master of Social Work By Lilit Antonyan in collaboration with Oliva Sanchez August 2016

2 The graduate project of Lilit Antonyan is approved: Dr. Allen E. Lipscomb Date Dr. Jodi Brown Date Dr. Judith A. DeBonis, Chair Date California State University, Northridge ii

3 Table of Contents Signature Page Abstract ii iv Introduction 1 Method 2 Results 5 Discussion 7 References 12 Appendix A: Pre and Posttest 14 Appendix B: PSS scoring 15 Appendix C: Capstone data codebook 15 Appendix D: Addendum 16 iii

4 Abstract The Relationship Between Yoga and Stress Among the Elderly By Lilit Antonyan Master of Social Work Exercise has been proven to enhance the overall quality of life. Through this study, researchers will conduct a small study in an elderly cohort adult day care center. This study evaluates the impact of weekly yoga on an elderly population in reducing levels of stress. The purpose of this study is to explore the levels of stress, before and after the introduction of yoga as an intervention in reducing stress levels. For the purpose of this study only first time yoga participant s pre and posttest were evaluated. The perceived stress scale was utilized to determine the level of stress that participants reported. Findings highly suggest that yoga impacts the level of stress in the elderly population in reducing stress. Key words: yoga, exercise, elderly population iv

5 Introduction As society changes and experiences significant growth in cultural, economic, and social, institutional, and individual development, the life stressors associated with the dynamics of these experiences evolve as well. To keep pace with the growing complexity of the world, individuals must be able address and manage these life stressors in most effective ways. Stress can be detrimental to the physical and mental wellbeing of individuals of all ages but can be particularly devastating to the elderly (Yancura & Aldwin, 2010). The way stress is experienced varies from person to person. It is imperative that new stress-management methods and interventions are constantly being sought after to adapt to the way in which stress is perceived and experienced. Yoga provides a non-invasive and non-drug alternative to treating stress in the elderly and it does so through a holistic approach (Diamond, 2012). The purpose of this study is to explore the yoga practice as a form of stress-reduction intervention among the elderly population and to see if there is a difference between the way men and women experience stress after intervention has been implemented. This study intends to assess the effectiveness of yoga in reducing stress among an elderly cohort population. The null hypothesis in this study is that attending yoga once a week will lead to no reduction in stress levels in a cohort of elderly study participants. The study hypothesis is that attending yoga once a week will lead to a significant reduction in stress levels in a cohort of elderly study participants. The Theoretical Framework that will be used in this study is strengths-based theory. Strengths-based theory emphasizes people's self-determination and strengths. The theory focuses on the fact that people and communities have the potential to grow, change, and learn. Communities are full of resources, and interventions are based on self- determination. This study will address a gap in the literature, by incorporating the strengths-based theoretic approach to 1

6 interpreting the direct association between yoga practice and changes in stress levels obtained through self-reporting among the geriatric population. 2

7 Method This cohort study will be conducted through a pre- and posttest. The test will be a quantitative interview and consist of 14 questions for participants to answer. The questions will pertain to life s situations and the participants level of perceived stress. The subjects for this study will be recruited via convenience sample through the El Camino Adult Day Care Center. There will be three classes that will be given the opportunity to participate in survey in order to obtain sufficient amount of data for the purpose of this study. The researchers along with the director of the facility will provide verbal information along with a consent form to the participants. Subjects must be willing to actively participate in weekly yoga classes. For the purpose of this study, elderly is defined as being 65 years of age or older. The projected number of participants is 50. One week prior to the start of the research, researchers will provide information on the study being conducted to potential participants. Subjects will be made aware that this study is voluntary and they can choose not to participate at any given time from the start of the study. During initial screening phase, researchers will give the subjects an information form to take home and review. The information form will provide information on the study, including the purpose of the study, the anticipated risks and benefits of participating, voluntary participation statement, and researchers contact information. In addition, participants will be given a screener questionnaire to take home and complete. In order to maintain anonymity, potential participants will be requested to submit the screener in a provided sealed envelope, which will then be collected by the director of the program, Ani Cholakhyan, and will be returned to researchers. Over the course of one month, participants will be asked to keep a journal and report their stress levels. 3

8 Researchers will be able to identify subjects who have never practiced yoga through the pretest and be able to utilize these subjects to conclude hypothesis. The pretest will take subjects minutes to complete. Once completed, subjects will return pretest in a sealed box that will be placed by the exit. Subjects will then participate in a one-hour yoga class. Subjects will participate in weekly yoga classes for the duration of one month. After the fourth yoga class, subjects will be given a posttest. The pre and posttest will be the same test. Upon completion of posttest subjects will return completed test in sealed box. Director of the program will assist in retain test until researchers collect data. To properly analyze the self-reported results, the researchers will use the perceived stress scale (PSS) instrument to assess the dependent variable the level of stress. The independent variable will be yoga practice. The PSS scale will help indicate how often the subject feels his/her life have been unpredictable or overloaded. The PSS scale comes with a scoring guide that will assist researchers in determining levels of stress self reported by subjects. 4

9 Results The results concluded that yoga does serve as an effective intervention in reducing stress among the elderly population. The results from the number of participants (N=18) who have never taken yoga before self reported lower levels of stress (see table 1). Table 1 shows the standard deviation (SD) before and after intervention was implemented. Table I also shows the before and after mean scores for all 18 participants, indicating lower stress levels reported after the intervention. Table 1. PSS stress levels reported by gender Paired Samples Statistics Mean N Std. Deviation Std. Error Mean Pair 1 PSSbefore PSSafter Table 2. Paired differences Paired'Samples'Test PairedDifferences 95%Confidence Intervalofthe Std. Std.Error Difference Sig.(23 Mean Deviation Mean Lower Upper t df tailed) Pair 1 PSSbefore3 PSSafter Table 2 shows the mean difference of 2.56 suggesting that the intervention was effective. 5

10 Researchers ran a statistical analysis to see if there was a significant difference in the PSS scores before and after the intervention took place, findings suggest that test is highly significant in lowering stress levels amongst the elderly population. There is a statistical difference (p<.000) in stress levels before and after engaging in yoga regiment. 6

11 Discussion Stress is the inability to cope with the real or imagined threat to one s physical, mental, spiritual or emotional well-being. Unfortunately, stress is a universal problem that can have detrimental effects on individuals at any stage of their lives. While young people experience certain set of life stressors associated with the potential pressures of what might lay ahead in life or whether they will measure up, to their established inner standards, the elderly face entirely different set of stress factors. Major psychosocial and psychological changes occur while aging, including the loss of physical health, financial and social circumstances due to retirement from a career, and the loss of a partner or loved ones. During these changes, the elderly must adjust as they are challenged to embrace and adapt to new physical and emotional needs, as well the differences in their social network, shaping their social identity, relationship with their grown-up family, and social opportunities. While the list of scholarly articles touting yoga as the cure-all stress reliever for the general population is virtually infinite, identifying peer-reviewed articles presenting studies that directly link the effects yoga on geriatric populations in relation to the cause of stress relief is actually difficult. It appears that researchers tend to focus more on the specific ailments commonly found in elderly patients, such as the loss of balance or difficulty sleeping. However, yoga has been widely known to improve stress levels. Indeed, yoga is one of the physical activities that have been more regularly provided at Adult Day Care Centers, whose main role has been to improve the quality of life of their elderly clients. Numerous studies have been conducted to show how yoga can benefit elderly patients in a multitude of ways, including improving hypertension, improving sleep, and decreasing overall depression, all of which lead to decreased stress. 7

12 The research studies on effects of yoga have focused on sleep and quality of life. Manjunath and Telles (2004) have conducted a study on yoga practice and self-reported sleep patterns among 120 geriatric patients and reported that a 6-month long participation in yoga can lead to a significant increase in the total number of hours slept. This group of lderly patients also showed a significant decrease in the amount of time it took them to fall asleep and an increase in feelings of restfulness in the morning. Manjunath and Telles (2004) also reported that the elderly participants experienced an increase in the Quality of Life. As the quality of life of an individual increases, it can be inferred that their stress level decreases. Overall, their results indicated that yoga practice, which includes activity relaxation with awareness and inputs about philosophical and emotional stability has improved the sleep patterns and increased the feeling of being refreshed on awakening in institutionalized older persons (Manjunath & Telles, 2004). Similarly, Hariprasad et al. conducted a sleep study on 120 subjects from 9 elderly homes using yoga as an independent variable to assess the Quality of Life. Their study suggestsed potential benefits of yoga therapy for elderly in improving QOL and sleep quality (Hariprasad et al., 2013). Research has also demonstrated that yoga can have beneficial effects on certain health conditions. Sahay (2007) stated that the elderly participants showed a reduction in systolic and diastolic blood pressure after 3 weeks of participation in yoga practices. Although the researcher did not intend to study a reduction in blood pressure, the effects were too significant to ignore. Although Sahay s research was not focused on a reduction of stress in elderly participants, the findings on the decrease in blood pressure in relation to yoga practice indicates that a link between yoga and a reduction in stress is possible, as elderly patients commonly worry about their health. If yoga has the potential to control blood pressure, a clinical measure that is linked 8

13 to stress, it also has high potential to improve the health in the elderly by also decreasing their stress levels. Yoga has been shown to relieve numerous ailments, including diabetes. Sahay (1994) states that yogic practices in all these studies have produced an increase in the lean body mass and a decrease in the body fat percent, which leads to an improvement in insulin sensitivity and reduction in insulin resistance (Sahay, 1994). Furthermore, bone loss is another ailment that can be arrested by yogic practice. Mukherjee et al. (2010) study findings suggest that the intervention of Bikram yoga training may be beneficial for skeletal health and could prevent bone loss. Sharma and Sharm (2007) reported that the elderly have difficulty reporting depression to their caregivers. This study focused on elderly living in rural communities that lack provisions for geriatric care. These researchers reported that depression was less common among those who had a positive approach to address their state of depression, including doing some exercises and doing yoga daily (Sharma & Sharma, 2007). Yoga has not only been found to be beneficial to the general population, it also provides significant medical advantages to the elderly population. The findings on this matter are undisputed. However, what has not been studied directly is whether yoga can reduce the stress levels of elderly patients. Studies have focused on the use of yoga to improve specific medical issues rather than stress reduction in elderly patients. Although yoga has been shown to be a successful intervention in studies assessing its impact on numerous medical issues in elderly patients, whether yoga can decrease stress in elderly patients has not been studied yet. All of the previous literature noted agrees that yoga can benefit the elderly population; however, the studies focus on different aspects of how the participants are positively impacted. 9

14 Methodological deficits of many of the studies are the sample size and the length of the study. After reviewing 8 distinct research studies, the largest sample size was found in the Manjunath and Telles (2004) study, where 120 geriatric patients were studies over the course of 6 months; in this study, however, the researchers relied on self-reported outcomes of sleep patterns, which brings validity of results into question. In fact, Roland, Jakobi, and Jones (2011) stated that the scientific evidence supporting yoga for improved fitness shows promise albeit there are methodological issues related to the current available literature. This study had several limitations that may question its validity. A limiting factor in this study is the number of participants. Researchers had hoped for t a larger set of participants that have never participated in yoga before. All yoga participants were given the option to participate, however out of the 53 who participated in the pre and posttest only 18 had never done yoga. The sample collection reflects a small portion of the elderly population in the adult day care center. Another limiting factor in this study is that its focus is on new yoga participants, which eliminates participants in yoga who already have identified yoga as an intervention in reducing stress. Because this study focuses on those who have never done yoga, it limits the number of adults who are calculated in the data. Future research should seek to conduct a more comprehensive study that can include a larger pool sample that can best accurately reflect the elderly population. Another limitation in this study is that researchers had to rely on the director of the facility to administer the pre and posttest. Researchers wanted to conduct the study anonymously, which, limited the interaction between the participants and researchers. Future research is warranted to study the effects of yoga in a qualitative manner. Because this study relies solely on self reports by its participants it brings into question its validity. This study can 10

15 be helpful and provide a more cohesive idea of the benefits that yoga may have on the elderly population. Through a qualitative study, different benefits of yoga can be identified that cannot be captured through a quantitative study. The elderly population is growing, which, will cause society to make changes that better serve the needs of this particular population. Current and new service providers must be equipped to serve the needs of this growing population. Research studies, such as this one can help identify new services and ways of implementing them. Service providers can benefit from having the knowledge and capacity that helps nurture and maintain positive lifestyles to the elderly. Cultivating a culture where the elderly population can continue to age without experiencing any excess levels of stress is very important, regular practice of yoga postures and breathing produces significant physical and psychological health benefits (Chen K.M., et al, 2007). Having a better understanding of ways in which the elderly population can deal with stress is beneficial to recipients but also to the service providers as they make themselves more desirable and appealing to potential clients. 11

16 References Chong, C.S.M., Tsunaka, M., Tsang, H.W.H., Chan, E.P., & Cheung W.M. (2011). Effects of yoga on stress management in healthy adults: A systematic review. Alternative Therapies in Health and Medicine.17(1) Franks, R., Burnett, D. O., & Evans, R. R. (2012). Risk factors and prevention strategies for suicide among the elderly. Alabama Counseling Association Journal, 38(2) Hariprisad, V.R., Sivakumar, P.T. Koparde, V., Varambally, S., Thirthally, J., Varghese, M., Basavaraddi, I.V., & Gangadhar, B.N. (2013). Effects of yoga intervention on sleep and quality of life in elderly: a randomized controlled study. Indian Journal of Pyschiatry. 55(3) Manjunath, N.K., & Telles, S. (2005). Influence of yoga and Ayurveda on self-rated sleep in geriatric population. Indian Journal of Medical Research, 121: Roland, K.P., Jakobi, J.M., & Jones, G. R. (2011). Does yoga engender fitness in older adults? A critical review. Journal of aging and physical activity. 19:62-79 Sahay, B.K. (2007) Role of yoga in diabetes. Journal of the Association of the Physicians of India. 55: Shapiro, D., Cook, I. A., Davydov, D.M., Ottaviani, C., Leuchter, A. F., & Abrams, M. (2007) Yoga as a complimentary treatment of depression:effects of traits and moods on treatment outcome. Evidence-based alternative complimentary and alternative medicine.4(4)

17 Tinetti, M. E., Baker, D. I., McAvay, G., Claus, E.B., Garrett, P., Gottschalk, M., Koch, M.L., Trainor, K., & Horwitz, R.I. (1994) A multifactorial intervention to reduce the risk of falling among elderly people living in the community. The New England Journal Of Medicine, 331(13) Sharma, R. & Sharma, R. (2012). Depression among the elderly population in a rural community: a study of its prevalence and correlates. Indian Medical Gazette. Dec (2012)

18 Appendix A Have you done Yoga before? Yes No Age: Gender: Female Male Monthly income? Less than $20,00 $20,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 $75,000 to $99,999 More than $100,00 How frequently do you do yoga a week? or more What other exercises do you do weekly? Walking Hiking Swimming Cycle Dance Jogging Stair Climbing Weight Lifting Stretching How frequently do you do other exercises a week? or more 1. In the last month, how often have you been upset because of something that happened unexpectedly? 0=never 1=almost never 2=sometimes 3=fairly often 4=very often 2. In the last month, how often have you felt that you were unable to control the important things in your life? 0=never 1=almost never 2=sometimes 3=fairly often 4=very often 3. In the last month, how often have you felt nervous and "stressed"? 0=never 1=almost never 2=sometimes 3=fairly often 4=very often 4. In the last month, how often have you felt confident about your ability to handle your personal problems? 0=never 1=almost never 2=sometimes 3=fairly often 4=very often 5. In the last month, how often have you felt that things were going your way? 0=never 1=almost never 2=sometimes 3=fairly often 4=very often 14

19 6. In the last month, how often have you found that you could not cope with all the things that you had to do? 0=never 1=almost never 2=sometimes 3=fairly often 4=very often 7. In the last month, how often have you been able to control irritations in your life? 0=never 1=almost never 2=sometimes 3=fairly often 4=very often 8. In the last month, how often have you felt that you were on top of things? 0=never 1=almost never 2=sometimes 3=fairly often 4=very often 9. In the last month, how often have you been angered because of things that were outside of your control? 0=never 1=almost never 2=sometimes 3=fairly often 4=very often 10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? 0=never 1=almost never 2=sometimes 3=fairly often 4=very often 15

20 Appendix B PSS Scoring PSS-10 scores are obtained by reversing the scores on the four positive items, e.g., 0=4, 1=3, 2=2, etc. and then summing across all 10 items. Items 4,5, 7, and 8 are the positively stated items. PSS-4 scores are obtained by reverse coding items # 2 and 3. PSS-14 scores are obtained by reversing the scores on the seven positive items, e.g., 0=4, 1=3, 2=2, etc., and then summing across all 14 items. Items 4, 5, 6, 7, 9, 10, and 13 are the positively stated items. The PSS was designed for use with community samples with at least a junior high school education, The items are easy to understand and the response alternatives are simple to grasp. Moreover, as noted above, the questions are quite general in nature and hence relatively free of content specific to any sub population group. The data reported in the article are from somewhat restricted samples, in that they are younger, more educated and contain fewer minority members than the general population. In light of the generality of scale content and simplicity of language and response alternatives, we feel that data from representative samples of the general population would not differ significantly from those reported in the article. Perceived Stress Scale (PSS) Primary Reference: Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, Purpose: To assess the degree to which people perceive their lives as stressful. High levels of stress are associated with poor self-reported health, elevated blood pressure, depression, and susceptibility to infection. Description: Subjects indicate how often they have found their lives unpredictable, uncontrollable, and overloaded in the last month. Scaling: 0 = Never; 1 = Almost Never; 2 = Sometimes; 3 = Fairly often; 4 = Very often # Items: 10 Sample Items: In the last month, how often have you been upset because of something the happened unexpectedly? In the last month, how often have you felt nervous and stressed? Psychometrics: Reliability: alpha =.78 Validity: Correlates in a predicted way with other measure of stress 16

21 (Job Responsibilities Scale, life events scales). Scoring: Reversed Items: 4, 5, 7, 8 Total Perceived Stress: Sum Items: 1, 2, 3, 4R, 5R, 6. 7R, 8R, 9, 10 Variable Names: pss_tot: Total Perceived Stress Score 17

22 Appendix C Capstone data codebook Income is coded: 1= less than 20K 2= 20-34K 3= 35-49K Other exercises is coded: 0= none 1= walking 2= walking, cycle 3= walking, hiking 4= dancing 5= hiking Freq exercise is coded: 0=0 1= 1, 2 2= 3, 4 Sex is coded: Female=1 Male=2 18

23 Paired Samples Statistics Mean N Std. Deviation Std. Error Mean Pair 1 PSSbefore PSSafter Pair 1 PSSbefore & PSSafter Paired Samples Correlations N Correlatio n Sig Mean Std. Deviatio n Paired Samples Test Paired Differences Std. Error Mean 95% Confidence Interval of the Difference Lower Upper Pair PSSbefore PSSafter **There is a statistically significant difference (p<=.000) in stress levels before and after engaging in a yoga regimen. t df Sig. (2- tailed) 19

24 Appendix D ADDENDUM The Relationship Between Yoga and Stress Among the Elderly The Relationship Between Yoga and Stress Among the Elderly is a joint graduate project between Oliva Sanchez and Lilit Antonyan. This document will explain the division of responsibilities between the two parties. Any additional information can be included in a separate document attached to this Addendum page. Student Name #1: Oliva Sanchez is responsible for all the following tasks/document sections: Edit final paper submission Scoring the assessments Collecting pre and post test from location Time manager Student Name #2: Lilit Antonyan is responsible for all the following tasks/document sections: Allocate location to conduct study Input SPSS data entries Keep paperwork in order PowerPoint Both parties shared responsibilities for the following tasks/document sections: Allocating literature reviews Creating poster Writing the capstone paper Inform participants of study Lilit Antonyan Oliva Sanchez Student Name #1 Date Student Name #2 Date Student ID Student ID _ Dr. Jodi Brown _ Dr. Jodi Brown Committee Chair Date Graduate Coordinator Date Dr. Allen E. Lipscomb Dr. Amy Levin Committee Member Date Department Chair Date _Dr. Judith A. DeBonis Committee Member Date 20