A randomised comparative trial of yoga and relaxation to reduce stress and anxiety☆
Introduction
Stress is experienced in response to a range of physical, occupational and emotional stimuli. Within manageable parameters one's sense of well-being is maintained, but if these stimuli go beyond normal limits they become stressors.1 Continued exposure to stress can lead to physical and mental symptoms such as anxiety and depression.
Current treatment for anxiety involves psychological and pharmacological interventions and these are well-supported by evidence from randomised controlled trials. Research suggests that individuals experiencing mental health problems may not seek out professional support indicating a need for appropriate and most importantly evidence-based self-help strategies.2 Therefore, much greater effort needs to be directed towards recovery and rehabilitation beyond current processes.
Mind body interventions are increasingly being used to assist with stress reduction. Relaxation is one modality that can be taught as a form of self-help to achieve a state of mental calm3 and its benefits have been supported in a systematic review evaluating the effects in relation to hypertension, headaches, insomnia and anxiety.4 In a separate review, the use of relaxation techniques to reduce psychosocial symptoms among people with cancer has also been undertaken5 which have been found to have a beneficial effect on depression, anxiety and hostility. Relaxation may therefore play a positive role with in improving psychosocial outcomes.
Yoga is an increasingly popular therapy, used to maintain wellness and assist with the management of a range of health complaints. A review of the literature identified two trials evaluating the effects of yoga on reducing anxiety and stress. In a trial of 114 subjects by Khasky and Smith, yoga and imagery were found to be more effective at increasing a relaxed state compared to the control group (p < 0.003) and guided imagery was more effective than yoga in reducing negative thoughts (p < 0.03).6 Malathi and Damodaran randomised 50 stressed medical students to yoga or to a non-intervention control group.7 A reduction in stress, improved sense of well-being and confidence was found in the yoga group (p < 0.001). However, the findings from both trials are limited though by their poor quality.
Limited research provides further impetus for ongoing investigation of the effects of yoga on stress and anxiety. It is essential for people to have informed evidence-based choices about effective health care; health professionals also need to be able to advise on and appropriately refer people to new and proven forms of health care that provide valid alternatives to which they seek access. Coulter and Willis identified the necessity of increasing the evidence base of CAM and this study relating to yoga seeks to do that.8
The primary aim of the study was to compare yoga and relaxation treatment modalities at 10 and 16 weeks from study baseline to determine if either of these modality would reduce stress, anxiety, blood pressure and improve quality of life. The secondary aim of the study was to determine if yoga and relaxation are acceptable and safe treatment modalities.
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Method
A randomised comparative trial was undertaken between April and November 2004, in South Australia (SA). The trial was promoted using the media and community flyers, and was approved by the University of South Australia Research and Ethics Committee. Subjects were eligible to participate, if they were, aged between 18 and 65 years, experiencing mild or moderate levels of stress determined by the General Health Questionnaire-12 (GHQ-12),9 and able to attend and participate in the classes.
Recruitment and follow-up
A total of 131 subjects were randomised to the trial. Data were received from 119 (90%) subjects at the end of the 10 week intervention and 117 (89%) subjects at the end of the 6 week follow-up (Fig. 1). Ten subjects withdrew from the yoga group following the first or second session. The reasons given included, ill health, too busy or an unspecified reason. In the relaxation group 13 subjects withdrew. Their reasons included being too busy, ill health or an unspecified reason.
The mean age of
Discussion
This study investigated the health benefits of yoga in reducing stress, anxiety and quality of life. The health status of study participants comprised levels of stress, with mild to moderate levels of anxiety, which improved for both groups by the end of the intervention. These findings extend those of previous research and indicate both interventions were effective and acceptable to subjects for managing their stress and anxiety. In general, yoga was as effective as relaxation techniques in
Acknowledgements
The authors would like to thank the study participants for their involvement in the trial, Lea Papworth research assistant, Julie Wilson yoga teacher, Professor Tony Winefield and Associate Professor Maureen Dollard (Centre for Applied Psychological Research, Work and Stress Research Group, University of South Australia) for their contributions.
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This study was funded by The University of South Australia.
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Currently on leave from the University of South Australia.