Anxiety Disorders: Research Studies and Relaxation Techniques Review

REVIEW OF LITERATURE

Review of literature is the basic part of every research endeavours. Every researcher has to follow this procedure while conducting his/her research. Review of literature does give the researcher fundamental understanding of his/her research topic. Through review of literature basic aspect of every research can be understood at its basic foundations. Research studies should consulted by the researcher so that firm understanding should be made by researcher.One of the trademarks of science is a belief in collective wisdom gathered through vicarious experience. Thus, knowledge is a meticulous area is the product of researches and observations carried out at various times by various persons. So that concerns and tribulations relating to the phenomenon being studied are progressively brought to light and incorporated in the larger body of knowledge. Reasonably, the quantum of information in different fields is vast and it is not by any means possible for any researcher to have access to all available information. However, an endeavor has been made to present as convincingly and comprehensively as is possible, some of the major researches carried out in the area of anxiety and depression with various relaxation techniques with particular reference to the magnitudes being investigated.

We must first comprehend what research actually mean at its real sense. It is another word for congregation of information. The more information we have the closer we get of making our own conclusion. Research is the result of progressing knowledge created in the past. The research that investigator do and confirmation that are assembled will have impact on his future work, thus each research donates a drop of to the vast marine of knowledge, hence knowledge is therefore the computation total of a mass of researchers conducted by dissimilar investigators over a vast period of time. Not only does research add to knowledge per se, but by illuminating and raising new concerns, it aggravates further researches. In termination research is very crucial to our everyday decision making. It weapons you from incorrect information and save time and money. Therefore, it is necessary to be familiar with developments which have taken place in the sphere of our research. This will facilitate to assistance from vicarious experience, by selecting problems that are relevant and avoiding the boundaries and disadvantages which become apparent only after the research has been conducted. In this chapter an effort has been made to summarize the researches which have been conducted in the vicinity since it is humanly impracticable to list all the work that has been done, imperative milestone and main studies which provide standpoint of the work are being put forward. Studies carried out during the last decades are being given extraordinaryimportance although key studies conducted earlier are also being referred to. First of all investigator will scrutinize studies related relaxation and their impact on anxiety and depression.

Anxiety

Anxiety is a standard human emotion that everyone experiences at times. Numerous people feel anxious, or nervous, when countenanced with a trouble at work, before taking a test, or making an imperative decision. Anxiety disorders, however, are dissimilar. They can cause such distress that it interferes with a person's capability to lead a regularlife.An anxiety disorder is a stern mental illness. For people with anxiety disorders, worry and fear are invariable and overwhelming, and can be crippling. The exact cause of anxiety disorders is mysterious; but anxiety disorders — like supplementary forms of mental illness — are not the result of personal limitations, a character flaw, or poor upbringing. As scientists continue their research on mental illness, it is becoming comprehensible that numerous of these disorders are rooted by a combination of factors, including changes in the brain and environmental stress.

Like other brain illnesses, anxiety disorders may be rooted by tribulations in the execution of brain circuits that regulate fear and other emotions. Studies have shown that relentless or long-lasting stress can alter the way nerve cells within these circuits transmit information from one region of the brain to another. Other studies have shown that people with certain anxiety disorders have changes in certain brain structures that control memories linked with strong emotions. In addition, studies have shown that anxiety disorders run in families, which means that they can at least partly be inherited from one or both parents, like the risk for heart disease or cancer. Moreover, certain environmental issues such as a trauma or significant event — may trigger an anxiety disorder in people who have an inherited defenselessness to mounting the disorder.The majority anxiety disorders begin in childhood, adolescence, and early adulthood. They occur somewhat more often in women than in men, and occur with equal regularity in whites, African-Americans, and Hispanics. Providentially, much progress has been made in the last two decades in the management of people with mental illnesses, including anxiety disorders. Although the exact treatment approach depends on the type of disorder.There is no sole set of biological or psychological process that describes anxiety; in a simple way it is consider anxiety merely in objective terms, that is, in a condition of the organism. This is because the notion of anxiety is used differently by dissimilar people, and even the same individual may use anxiety another way on diverse occasions. Anxiety is frequently a diffuse, unpleasant and scratchy feeling of apprehension, accompanied by one or more bodily sensation that receives in the same manner in the person, it is anchanging signal that warns an individual of looming danger and enables him to take manner to deal with it. The huge numbers of researches conducted by the researchers in the field of anxiety are offered below.

Timothy, Snyder, Mitchel and Delsman(1982) studied the hypothesis that psychological symptoms may provide as self-protective function by providing ansubstitute explanation for potential failure in evaluative situations. The prediction was that greater reported anxiety should result when anxiety was a viable explanation for underprivileged performance. On an intelligence test, and lower reported anxiety should result when anxiety was not a viable explanation for underprivileged performance.

Robert, Harris, Snyder, Raymond and Jennifer(1986) investigated the levels of test anxiety, type-A and type-B coronary-brone behavior, fear of failure and covert self-esteem as predictors of self handicapping performance attributions for college women who are positioned either high or low on evaluative test or task situation. The results designated that only high levels of test anxiety and high levels of covert self-esteems were related the womenï¿½ï¿½ï¿½s self-handicapping ascriptions.

Halode (1985) anxiety and parental attitudes of acceptance, concentration, overprotection and avoidance; revealed (i) the anxiety is negatively predisposed with perceived parental acceptance, (ii) that it is positively inclined with perceived parental, concentrations and avoidance, (iii) that sex has shown its interaction effect with perceived parental acceptance upon anxiety (iv) that highly, moderately and poorly avoided boys shown more anxiety as compared to the highly, moderately and poorly avoided girls, and (v) that out of the three parental attitudes; the attitude of avoidance engaged first position, concentration second position and that of acceptance last position in their relative strength; of inducing anxiety in college students. Thus perceived parental attitude of acceptance seems more encouraging in making the individuals less anxious and better adjusted in life.

Rahe, Richard H. (1988) point out that cardiovascular disorders, gastrointestinal ailments troubles with the reproductive system, dermatologic disorders, and other disturbances and disorders are significantly influenced by anxiety. In addition studies of hostage and prisoners of war point out that a personï¿½ï¿½ï¿½s reactions to severe stress are predictive of his/her future physical and mental health.

Beck (1988) the measurement of parents depression, i.e. child-mother and father ï¿½ï¿½ï¿½ mother with moderate or high, or depression symptoms results have been revealed that mothers normally reported more symptoms of depressions in their children than did children or fathers.

Stress and anxiety disorders, fear and anxiety disorders and behavior problems in children of parents with anxiety have been accounted(Silverman, 1988), Wandy (1988). What aspects of anxiety disorders may influence children who live with anxious parents have been explored and preliminary results propose that avoidance in agoraphobia may be the key variable connected with child maladjustmentï¿½ï¿½ï¿½.Ohja (1986)analysed inter-group differences of anxiety-scores of subjects and accomplished that urban students are higher on anxiety than their rural counterparts and family size appears to be a noteworthy factor of manifest anxiety.

Fuller, Marrie and David (1998) observed the composition of negative emotions in a clinical sample of children and adolescents. The authors sought to define the featuresconnected with childhood anxiety and depression using a structural equations/ confirmatory factor analytic loom involving multiple information i.e. parents and child reports of symptoms. Sample comprised of 216 children and adolescents. Results of proportional modeling best supported 3- factors solution (fear, anxiety and depression) that were consisted with current conceptual models of anxiety and depression.

Mark, Scan and William (1998) examined the relationship among anxiety and social desirability and self reported anxiety in young children. Sample encompassed of 1,786 children with age ranged 7 to 14 years old. Results designated that anxiety and lie scores did not correlate for either gender or age grouping, however, anxiety scores interacted with lie scores in a different way for males and females in term of the conformity between childrenï¿½ï¿½ï¿½s and teachersï¿½ï¿½ï¿½ rating anxiety. Indications are that social desirability levels may in part explain the consistent discrepancies found between child and adults reports of anxiety.

Jeffery (1999)examined the association between youth and parent perceptions of family environment and social anxiety. Sample comprised of 2,708 students of 7th, 8th, 9th, and 11th, grade students and 404 of their parents. Subjects countering higher level of social anxiety, perceived their parents as being more socially isolating overly worried about othersï¿½ï¿½ï¿½ opinions, ashamed of their shyness and poor performance, and less socially active than did youth reporting lower level of social anxiety, parents perception of child rearing style and family surroundings however, did not differ between parents of socially anxious and non socially anxious children.

Rabian, Embry and MacIntyre(1999)accomplished study on behavioral validation of the childhood anxiety sensitivity index (CASI). The sample comprised of 56 children with age ranged 8 to 11 years old asked to complete the CASI as well as self report measure of state anxiety and trait anxiety and subjective fear. Results designated that the CASI was significant predictor of the degree of state anxiety and subjective fear reported in response to the challenge task, even after controlling for pre task. The results supported that the validity of the CASI in preadolescence children and suggest that CASI possesses exceptional clinical utility relative to measure of trait anxiety.

Tari (1999)observed genetic and environmental influences on rating of manifest anxiety by parents and children. The sample comprised of large numbers of children with age ranged 8 to 10 years old. Results showed that substantial difference in genetic effect according to both gender and informant. For children self report, temporal stability was mostly a function of environmental effects.

Paul, Lilienfeld, Ellis and Loney(2000) examined the connection between anxiety and psychopathy dimension in children. The sample comprised of 143 clinically referred children age ranged from 6 to 13 years. They reported that (a) measure of trait anxiety, anxiety and fearfulness (low fearfulness) exhibited low correlation (b) conduct problem tended to be positively correlated with trait anxiety and fearful inhibitions. These results bear potentially significant implication for the diagnosis and etiology of psychopathy and antisocial behavior.

Erin, Patricia, Hammen and Robyne(2001)examined the role of perceived parenting behavior in the affiliation between parent and offspring anxiety disorder in a high risk sample of adolescent. The sample encompasses of 816, fifteenyears old children. Results recommended that maternal anxiety disorder significantly exhibited the presence of anxiety disorder in children, but there was no evidence that perceived parenting played a mediating role in the connection between mother and child anxiety disorders.

Paz (2001)observed parent and child group therapy for childhood anxiety disorders using a manual based cognitive-behavior technique. Sample included of 24 children with age ranged from 6 to 13 years old children with an anxiety disorder (separation anxiety, over anxious disorder or both) and their parents participated in a 10 session of treatment. Findings signified that anxiety symptoms decreased extensively during the treatment and follow up periods. Children of mothers with an anxiety disorder enhanced more than children of non anxious mothers, where as the anxiety level of anxious mothers remained stable.

Jennifer (2002) examined parent-child relations and anxiety disorder among children. It is an observational study in which sample comprised of clinically anxious children and nonclinical anxious children with age ranged from 7 to 15 years. The findings shown that mother of anxious children were more negative during the interaction than mother of nonclinical children. The results supported the relationship between an over involved parenting style and anxiety among children.

Mark (2003)performed study on learning and intimacy in the families of anxious children. The objective of this study is to review the literature on the role of the family in the development of anxiety problems in children. Promisingconfirmation shows that specific parent child social learning processes, operating within the context of the quality and consistency of intimate associations, an imperative in the development of anxiety problems. These processes interact within childï¿½ï¿½ï¿½s temperament in predicting the development of anxiety problems. Family with both an inhibited child and anxious parents are predominantly prone to becoming entrapped in social learning processes that foster escalating anxiety problems.

Peter, Cor and Miranda (2003) examined association between child and parent reported behavior inhibition and symptoms of anxiety and depression in normal adolescents. The sample involved of large number of young adolescents with age range from11 to 15 years old with their parent. Results demonstrated that parents and children agreement for behavior inhibition and symptoms of anxiety and depression was rather modest. Furthermore, the data specified that high level of child and parent reported behavioural inhibitions were accompanied by high levels of anxiety disorder symptoms and depression.

Ora and Avigdor (2003)observed family environment, discrepancies among actual and desirable environment and childrenï¿½ï¿½ï¿½s test and trait anxiety. The sample consisted of 456 respondents. The main results were that childrenï¿½ï¿½ï¿½s levels of anxiety were negatively correlated with discrepancy between actual and desirable family environment.

Miles and Wardle (2006) studied the role of health anxiety on the psychological impact of participating in colorectal cancer screening. It was forecasted that health anxiety would be connected with more worry about cancer before screening, a greater increase in worry if polyps were detected and less reassurance after a clear result. As expected, health anxious participants were more anxious and more worried about bowel cancer both before and after screening.

Carleton, Abrams, Asmundson, Gordon, Antony and McCabe (2009) in a study of pain linked anxiety and anxiety sensitivity across anxiety and depressive disorders. On the basis of findings it is recommended that pain-related anxiety is generally comparable across anxiety and depressive disorders; however, painrelated anxiety was typically higher (p < .01) in individuals with anxiety and depressive disorders relative to a community sample, but comparable to or lower than a chronic pain sample. Findings implied that pain-related anxiety may indeed be a construct independent of other basic fears, warranting subsequent hierarchical investigations and consideration for inclusion in treatments of anxiety disorders.

Worcester and Le Grande (2008) supported that anxiety and depression are frequent after acute cardiac events. They can have a foremost adverse impact upon outcomes, although past studies report conflicting results regarding the associations between anxiety, depression and outcomes such as mortality. Depression has been shown to be linked with non-adherence of patients. Cardiac rehabilitation programes conducted during early convalescenceprovidea valuable opportunity to recognize and support patients who experienceanxietyand depression, and encourage adherence to advice. Clinical data shore upthepositive effects upon patientsï¿½ï¿½ï¿½ psychological outcomes of cardiac rehabilitation programs offering group exercise, education and behavioral interventions.However, more rigorous research is obligatory to confirm such benefits.Systematicscreening of patients should be undertaken on entry to cardiac rehabilitationtoidentify high-risk patients and to assist them.

Wiltink, Michal, Subic-Wrana, Eckhardt-Henn, Dieterich and Beutel (2009)studied dizziness: anxiety health care consumption and health behavior-result from a representative Garman survey. Symptoms of dizziness were accounted by 15.8% of the participants. Of the participants with dizziness, 28.3% accounted symptoms of at least one anxiety disorder (generalized anxiety, social phobia, panic). Persons with dizziness accounted more somatic problems such as hypertension, migraine, diabetes, etc. Co-morbid anxiety was associated with increased health care use and impairment. It was concluded that dizziness is a highly prevalent symptom in the general population. A subgroup with comorbid anxiety is distinguished by an increased subjective impairment and health care utilization due to their dizziness. Because treatment options for distinct neurotologic disorders are also acknowledged to reduce psychological symptoms, and in order to avoid unnecessary medical treatment, early neurologic and psychiatric/psychotherapeutic referral may be designated.

Depression

Depressionis a serious mental health apprehension that will touch most people's lives at some point in their lifetime and the suffering continued by people with depression and the lives lost to suicide attest to the great burden of this disorder on individuals, families, and society. Enhanced recognition, treatment, and prevention of depression are critical public health priorities. Organizations such as the National Institute of Mental Health (NIMH), one of the world's foremost mental health biomedical organizations, conducts and supports research on the causes, diagnosis, prevention, and treatment of depression in the United States. Substantiation from neuroscience, genetics, and clinical examination demonstrate that depression is a disorder of the brain. Modern brain imaging technologies are enlightening that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters — chemicals used by nerve cells to communicate — are perhaps out of balance. Genetics research designates that susceptibility to depression results from the influence of multiple genes acting together with environmental factors. Studies of brain chemistry and of mechanisms of action of antidepressant medications continue to inform the development of new and better medical and psychotherapy treatments.

In the language of clinical psychology, depression is a syndrome, a bunchofemotional, physical, and behavioral symptoms distinguished by sadness, low self esteem, loss of pleasure, and, sometimes, difficulty functioning. If theseproblems persist for more than two weeks, cause real suffering, and interferewith the business and pleasure of daily life you may have a clinical depression.Indailydialogue people say they are depressed when they are feeling unhappy, down, blue, sad, or hopeless. Almost everyone has experienced these emotions, and many people ultimately suffer some adversity or loss that couldgive them reason to be anxious or depressed at times. These feelings are justone part of everyday life for most people. However, if the feelings are overwhelming or persistent, you may benefit frompsychological evaluation and treatment. Depression of this type can beeffectivelyabridged or even removed with treatment that is often relativelysimple. Professional intervention in serious depression can diminish suffering andimprove the quality of life.

In the United States today, psychological symptoms are prearranged into diagnosticcategories written by the American Psychiatric Association (APA) and known asDSM-IV criteria. These categories are pragmatic constructs and do not capturethe richness of mental and emotional life. However they are functional in determiningwhether medication might reduce your symptoms and, if so, which medicationsshould be tried. There are numerous sub-categories of depression. The most widespread are major depression and dysthymia.Depression is the most invasive emotional state among congenital and acquired handicap; This applies to children that have sensory or orthopaedically handicap or any chronic disability. Denial is recurrently present and may take the form of hyperkinetic behavior, delinquent or antisocial activities during adolescence, or a marked increase in passive dependent attitudes. Reviews the confirmation suggesting that depressive illness is a noteworthy consequence of, or at least associated with chronic physical illness or handicap in children. While psychological effects depressedpersonis not illness specific, certain illness related factors seem to be associated with depression.

PysZcynski and Greenberg (1989)recommend that depression involves the loss of a person or goal that has served as the basis for security and self-worth, and have also stressed that depression occurs to the extent that the individual who experiences such as loss of a person or goal fails to disengage the cycle and continues to self-focus in the absence of any way to regain what was lost.

The imprudent ffects of sadness, disappointment, and self-hate are closely linked with the depressive individuals low self-esteem. As the defining distinctiveness of the ï¿½ï¿½ï¿½affective disorderï¿½ï¿½ï¿½ of depression, they are more typically looked on as needing explanation than as source of explanation in themselves. Rehmï¿½ï¿½ï¿½s (1977) points to the depressive persons weakened capacity to afford positive emotional experiences for himself or herself. In this sense, the lack of self-reinforcement is being used to account for the dejected mood and low self-esteem of the depressed person. Wolpe (1979) argued on the foundation of certain animal studies that depression results from stern and prolonged anxiety produced by conditioning, cognition, interpersonal helplessness, or remembrance.

Beck (1976) theories propose that information networks associated to the self provide the paramount memory access and that depressive individualsposses negatively toned network that are associated with self esteem. Ingram (1984)structure on this work and on other information ï¿½ï¿½ï¿½ processing models, planned a more general account of depressive cognition. He illustrated on four concepts; network theories, affect nodes, depth of processing and cognitive capacity. Integratedinto cognitive networks are emotions nodes that, when activated, excite other elements associated with the emotion. When a network is widespread and complex, information is highly complicated and central in the individuals awareness. As a outcome, a greater part of the persons cognitive capacity is occupied, Ingram assumed that depressive individuals possess widespread negative networks and that, as a result, negative information will be most complicated and will occupy the greater proportion of cognitive capacity, when a depression ï¿½ï¿½ï¿½ causing experience occurs, activation spreads through the individuals loss-associated network, whose contents then come into conscious awareness. Phenomenologically, it may seen to the individual that negative memories keep coming back-again and again, thus continueD depressive feelings.

Beck (1984) depressed persons are predominantly prone to recognize negative words and scenes, where non depressed persons have a positive bias. Dumbar and Lishman (1984) found that depressed persons selectively emphasized negative attribution cues in accounting for failure. Velten (1968) conducted a study in which subjects are asked to read sad statements, to view sad films, or to think of sad events with a consequent deepening of negative emotion. Thus, it may be the depressed persons make themselves unhappy by engaging impulsively in the attention selectivity that the subjects in these studies used under experimental direction.

Sanchoz, Lewinsohn and Larson (1980),allocated depressed out patients (N=32) to either group assertion training or ï¿½ï¿½ï¿½traditionalï¿½ï¿½ï¿½ group psychotherapy. The findings show that over a comparatively short period of time, assertiveness training is more helpful than traditional Psychotherapy in increasing self-reported assertiveness and alleviating depression.

Hayman and Cope (1980) twenty-six moderately depressed females (mean age 21.3 yrs) were allocated randomly to assertiveness training. The findings supported the effectiveness of treatment. Experimental subjects became extensivelymore assertive and engaged in appreciably more activities than control subjects. Eight weeks after treatment, the experimental subjectsï¿½ï¿½ï¿½ scores indicated notably less depression. Other results include noteworthy negative correlations between measures of depression and assertiveness.

Borkovec and Andrews (1987)investigated thirty volunteers who were having depressive symptoms and who were given 12 sessions of training in progressive muscular relaxation. Sixteen of them were given cognitive therapy during 10 of those sessions and the remaining 14 were given non directive therapy. Therapy was supplied by 16 graduate student clinicians. The group as a whole showed sizeable reductions in depressive symptoms and daily self-monitoring, although relaxation plus cognitive therapy produced considerably greater development than relaxation plus non-directive therapy. On several pre-therapy, post-therapy comparisons, relaxation decreases depression and the findings show noteworthy positive relation between relaxation and outcomes.

Alexander (1995)evaluated literature comparing relaxation and meditation techniques. Meta-analysis shows transcendental meditation (TM) to be extensively more effectual than other forms of relaxation or meditation in (i) reducing psycho-physiological arousal (ii) dropping stress (iii) escalating positive mental health on measures of self esteem and (iv)reducing alcohol, nicotine, and illicit drug use relative to standard treatment and prevention programmes. Randomized controlled traits show that the TM technique appreciably reduced hypertension and mortality in the elderly compared with a mental or physical relaxation technique.

Janowick and Hackman (1995)investigated the efficacy ofassertiveness training and relaxation in endorsedself-esteem and changes indepressive symptoms among adolescents. Two groups were givenassertiveness training and a yogic relaxation technique referred to asshavasana. Pre and post test measures were taken on the personal orientationinventory and behavioral relaxation scale. Both groups showed noteworthy increases in scores on self-esteem and decreased scores on depression.

Marcotte (1996) studied the efficacy of cognitive behavioural therapy on adolescent depression. The findings suggest that short-term group cognitive behavioural interventions are efficient with early and late adolescents. Treatment components incorporated relaxation, cognitive restructuring, self-control skills, communication and problem solving skills. No single strategy seems to be more effective than the other.

Aniljose and Asha (2005) investigated the competence of creativity training among children at risk of depression. The participants were divided into two groups experimental and control groups. Experimental groups were given one month creativity training as a wrap up. The findings show that creativity training is effective for children at risk of depression and experimental group shows more symptom diminution than control group.

Ellias and Bernard (2006) investigated the effectiveness of cognitive behavioural therapy to childhood disorders. They found that persons who can accept events and attributes no matter how negative, will experience normal feelings of disenchantment and frustration, but will rarely manifest clinical depression. The increasing prevalence of depression in the child and adolescent population practitioners would be well directed to consider this approach in the prevention and treatment of depression in young clients. To encourage school-based prevention programs that teach the connection between thoughts, feelings and behaviours, combined with a complete intervention approach will hopefully empower young people to deal with this serious mental health problem.

Sloman (2002) in Sydney, Australia investigated to measure the effects of progressive muscle relaxation and guided imagery on anxiety and quality of life in people with sophisticated cancer. In the study, 56 people with complex Cancer who were experiencing anxiety and depression were randomly assigned to 1 of 4 treatment conditions: (1) Progressive muscle relaxation training, (2) guided imagery training, (3) both of these treatment and (4) control group. Subjects were tested before and after learning muscle relaxation and guided imagery technique for anxiety, depression and quality of life using the Hospital Anxiety and Depression Scale and the Functional Living Index Cancer Scale. The findings indicated that there is no noteworthyenhancement for anxiety; however, significant positive changes occurred for depression and quality of life.

Larun, Nordheim, Ekeland,Hagen and Heian (2006)evaluated the effect of exercise interventions in dropping or preventing anxiety or depression in children and young people up to 20 years of age. The trials were united using meta-analysis method. The findings show that the depression scores showed a statistically noteworthy difference in favor of the exercise group. They conclude that there appears to be anconsequence in favor of exercise in reducing depression and anxiety scores in the general population of children and adolescents.

Lee and Overholser (2006) invented an integrated treatment plan for person with depression and personality dysfunction. The confronts encountered by the therapist include: (i) differentiating borderline personalityfrom depressive symptoms, (ii) maintaining the therapeutic alliance (iii) managing impulsivity and self-destructive tendencies (iv) staying focused on long term therapeutic goals and (v) coping with non compliance. Over the course of 27 sessions, the client was able to make positive changes in mood, self-image and impulsive tendencies. Although the clientï¿½ï¿½ï¿½s boarder line personality traits intricate the course of treatment for depression, neglecting these personality problems would have left the client vulnerable to depressive relapse.

A studyinformation on the efficacy of Cognitive Behavioral Therapy (CBT), Adolescent Skill Training – a group specified preventive intervention(Young, Mufson and Davies, 2006). Adolescents in the two intervention conditions are compared on depression symptoms. The findings show that adolescents who receive Cognitive Behavioral Therapy and Adolescent Skill Training have considerably fewer depression symptoms and better overall functioning at post-intervention and at follow-up.

Bolton and Bass (2007) conducted a study to assessing the effect of locally feasible interventions on depression and anxiety among adolescent survivors of war and displacement in Northern Uganda. The intervention methods are locally urbanized screening tools that assessed the usefulness of interventions in reducing symptoms of depression and anxiety. Activity based intervention Interpersonal Psychotherapy was used with persons wait listed to receive treatment at study end. The measure is a decrease in score on a depression symptom scale.

Brugtein-Klomek(2007) investigated the efficacy of interpersonal Psychotherapy for depressed adolescents. The endeavor of the study was to pioneer the theoretical formulation, practical application and efficacy of interpersonal Psychotherapy for depressed adolescents. The tool used Beckï¿½ï¿½ï¿½s Depression Inventory to 120 Boys and girls from school. The findings show that interpersonal Psychotherapy is an evidence based Psychotherapy for depressed adolescents in both hospital-based and community outpatient settings.

Horowitz, Garber, Ciesla Young and Mlysort (2007)estimated the efficacy of intervention programsfor preventing depressive symptoms in adolescents. Participants were 380high School students randomly allocated to a Cognitive Behavioral Program (CB), an Interpersonal Psychotherapy Adolescent Skill Training Program (IPX-AST) or a no-intervention control. The intervention concerned eight 90minutes weekly session run in small groups during wellness classes. At postintervention, students in both the CB and IPT-AST groupsreportedappreciably lower levels of depressive symptoms than did those in the nointervention group.

Newman and Motta (2007)examined the effects of aerobic exercise on children PTSD, Depression and Anxiety. Procedures included Children's PTSD Inventory, Childrenï¿½ï¿½ï¿½s Depression Inventory and the Revised Children's Manifest Anxiety Scale. This small ï¿½ï¿½ï¿½nï¿½ï¿½ï¿½ study utilized a staggered baseline, pre/post repeated measures design. The findings show that this study provided support for the positive effects of aerobic exercise on reducing PTSD, Depression and Anxiety.

Ramsay and Main (2007)developed a quasi experimental pretest-post test design to evaluate the effectiveness of counselling type, in a sample of individuals diagnosed with low self esteem, high in anxiety and depression. Nine females underwent group peer counselling and nine underwent personcounselling. Both group peer counselling and individualcounselling are found to considerably increasing self-esteem, self reported levels of overall life satisfaction and reduced anxiety and depression.

An assessment of the effectiveness of Cognitive Behaviour Therapy for 12-14 year old school children was done by Habib, Seif (2007). The sample comprised 198 boys and 136 girls. Students were evaluated using the Child Depression Inventory and the Coopersmith Self-Esteem Inventory. The 32 children with depression were givedCognitiveBehaviour Therapy. They were assessed 3 months after the intervention using the same tools and the findingsdesignate the effectiveness of this therapy and lessening in depressive symptoms.

RELAXATION

Gavito, Ledezma, Morale, Villalba and Ortegosoto (1999) studied the effect of induced relaxation on painand anxiety in thoracotomised patients. The objectives of the study were to discoverwhether learned muscular relaxation is accommodating in the pharmacologicaltreatment for retreating the severity of postoperative pain and to observewhether this pain is associated to anxiety and depressive symptoms present inpatients preoperatively. The chosen patients were applied the HospitalAnxiety and Depression Scale (HADS). After pain was estimated by means ofa Visual AnalogueScale (VAS) the patients were assigned to one of the twogroups. The first group received muscular relaxation training (Schultzï¿½ï¿½ï¿½stechnique) whereas the second were given only the customary medical treatment.Evaluation of patients lasted until they were released from the hospital.There were no noteworthychanges regarding either anxiety or depression.Scores on VAS decreased in both groups over time. But the experimentalgroupaccounted decreased pain after relaxation instruction. There was nocorrelation of pain with either anxiety or depression.Sloman (1995)examined the usefulness of arelaxation technique involving progressive muscle relaxation and guidedimagery as a nursing intervention for the administration of cancer pain inpatients admitted in an oncology ward. The dependent variables incorporatedwere the pain sensations using the Short-Form McGill Pain Questionnaire(SF-MPQ) measured on a visual analogue scale, the total weekly intake ofmorphine or associated opioid measured in milligrams and non-opioid PRNanalgesia measured in terms of the number of doses taken weekly by thepatient. The study included 67 patients (48 males and 19 females) between37 to 80 years of age. The study was a randomised pretest-posttest controlgroup experimental design, assigning subjects randomly to one of the threegroups that received (1) relaxation and imagery by use of audiotapes, (2) livetrainingunswervingly from a registered nurse, and (3) no precise training inrelaxation or imagery techniques. The findings showed no noteworthymoderator effects at the 0.05 level using analysis of covariance for age andseparate ANOVA for gender and diagnosis. The study accomplishedthatprogressive muscle relaxation united with guided imagery producednoteworthy reductions in pain sensation, present pain intensity, overall painseverity, and non-opioid PRN analgesia. It was also established that the treatmentfailed to diminish pain effect or morphine intake for cancer pain control.

Cotanch (1983) hearsay that relaxation may be advantageous in reducinganxiety, nausea and vomiting related with chemotherapy. Nine out oftwelve patients in her study accounted some assistanceconnectedwithchemotherapy. Philip (1988) experiencedProgressive Muscle Relaxation with 46chronic pain sufferers at a pain clinic. The subjects were not cancer patient but endured from a variety of conditions. His findings showed significantdiminution in pain ratings by treatment subjects compared to those in thecontrol group. He accomplished that progressive muscle relaxation could relieve chronic pain.

Kaempfer (1982) found in his study that progressive emuscle relaxation (PMR) might be very tiring for the weak since a continuouseffort is required to extract the response and the subjects may have difficultyacquiring the skill.

Sitaram (1994) examined in a controlled situation the usefulnessofbehavioral intervention (Relaxation & Cognitive Behaviour Therapy) intheadministration of chronic pain in cancer patients. The findings revealed anoteworthyenhancement in pain coping behavioural intervention in contrasttomedical modes of pain relief.

Joy and Sreedhar(1998) conducted a study on the efficiencyofGuidedSomato -Psychic Relaxation urbanized by Sreedhar (1996) in theadministration of indispensable hypertension and its connected psychological factorslike anxiety and depression. The sample consisted of 7 female mild essentialhypertensiveswho were under medication with the same drug and dosage. Ofthis, 4 constituted the study group. Small-N design with pre-assessment, midassessmentand post-assessment was utilized for the study. The measurementsconsisted of the measurements of blood pressure (both systolic & diastolic),anxiety and depression. Each patient in the study group was given a total of10 relaxation sessions, and the mid-assessment was done after the 5thsession. The patients in the comparison group were requisite to presentthemselves only for the various assessments. The investigation also included a twoweeks follow up. The findingsexpose that there was a substantialdropinthe levels of blood pressure, anxiety and depression in each patient in thestudy group. The patients in the contrast group had very little variations inthe levels of blood pressure, anxiety and depression. Hence the studyfound that GSPR is effectual for patients with essential hypertension anditsassociated psychological factors like anxiety and depression.

Chlan (2000) reports the results of findingsontheassessment of the usefulness of muscle relaxation training in plummetingaggressivebehaviour in mentally handicapped patients. A pretest-postteststudy design showed that there was a diminution of 14.7% in aggressivebehaviour in the subjects after the muscle relaxation training. Hence musclerelaxation training emerged to be effectual in dropping the frequency of someaggressivebehaviour. The techniques appear to produce a relaxationresponse that may smash the pain muscle-tension-anxiety scale and helppain relief through calming effect

Mir and Raich (1999) did a investigation on the effects of relaxation andinformation provision as a preoperative preparation for surgery. The aims of the investigations were (1) to reproduce the previous finding on effects ofrelaxation in preparation for surgery (2) to analyze the contacteffectbetweentypes of intervention andcoping style onpatients pain level and thereturn to the normal daily activities. Ninety cholecystectomy patients wererandomly assigned to one of 3 groups. The first group expectedcompletesensory and procedural information. The second group, were trained inrelaxation while the third group acted as a control group. The findingsofassessment of coping style confirmed the positive effects of relaxationtraining in the preparation of low monitoring patients. Low monitors trained inrelaxation experienced less surgical pain through recovery process andperformed at a higher activity level at follow up compared to controls. Nointeraction effect was pragmatic when the interaction between coping style andthe type of interaction was studied.

Gonzalez and Amigo (2000) conducted an investigation to see the consequenceofprogressive relaxation training on cardiovascular variables. The numeralofsessions and the lasting of training that produce animportant reduction on BP (Blood Pressure) and HR (Heart Rate) are also studied. The studyreportedthat PRT produced a momentous reduction on BP & HR in each session. Theminimum number of session in order to active noteworthy difference was five.

Chlan (2000) found that music therapy is a non pharmacological nursing intervention that can be used as harmonizing adjunct in the care ofpatients supported by mechanical ventilation. This article particularsthetheoretical basis of music therapy for relaxation and anxiety reduction, highlights the investigation testing like intervention in such patients, and discusses areas of required research to extend further the implementation of music therapy in critical care nursing practice in an effort to endorse a healing environment for patients.

YOGA :

Kosuri M and Sridhar GR. (2009) conducted a study of

Yoga Practice on Physical and Psychological Outcomes. The aim of

this study was to examine the effect of Yoga practice on clinical and

psychological outcomes in subjects with type 2 diabetes mellitus

(T2DM). In a 40-day yoga camp at the Institute of Yoga and

Consciousness, ambulatory subjects with T2DM not having

significant complications (n=35) participated in a 40-day yoga camp,

where yogic practices were overseen by trained yoga teachers.

Clinical, biochemical and psychological well-being were studied at

baseline and at the end of the camp. At the end of the study, there

was a reduction of body mass index (BMI) (26.514 +/- 3.355 to 25.771

+/- 3.40; P < 0.001) and anxiety (6.20 +/- 3.72 to 4.29 +/- 4.46; P <

0.05) and an improvement in total general well-being (48.6 +/- 11.13

to 52.66 +/- 12.87; P < 0.05). Participation of subjects with T2DM in

yoga practice for 40 days resulted in reduced BMI, improved wellbeing,

and reduced anxiety.

Hafner-Holter, Kopp and Gunter (2009) conducted a

study on Effects of fitness training and yoga on well-being, social

competence and body image. It describes and compares influences

from physical activity program and a yoga program on well-being,

mood, stress coping, body-image and social competence in healthy

people. 18 persons attending a gym and 21 taking part in a yoga

program answered following questionnaires before entering the

program and taking part for 20 units: Body-Image-Questionnaire (25),

Symptom ï¿½ï¿½ï¿½ Checklist ï¿½ï¿½ï¿½ 90 R (8), Complaint-List (31), Adjective Mood-

Scale (32) and a Visual Analogue Scale for assessing stress-level (10).

Statistical analyses show significant improvement in social

competence in both training groups; the gym-group show a reduction

in summarization and body-related anxiety as well as an improvement

in physical and emotional well-being. Our findings support the

evidence that physical activity in general improves psychological wellbeing,

however, gym and yoga seems to have different psychological

impacts. Future research should focus on comparing the

psychological effects of different physical activity interventions in

prevention programmes as well as exercise prescriptions in patients

with mental illness.

Chen T.L. et.al (2009) conducted a study on the effect

of yoga exercise intervention on health related physical fitness in

school-age asthmatic children to investigate the effect of yoga exercise

on health-related physical fitness of school-age children with asthma.

The study employed a quasi-experimental research design in which 31

voluntary children (exercise group 16; control group 15) aged 7 to 12

years were purposively sampled from one public elementary school in

Taipei Country. The yoga exercise program was practiced by the

exercise group three times per week for a consecutive 7 week period.

Each 60-minute yoga session included 10 minutes of warm-up and

breathing exercises, 40 minutes of yoga postures, and 10 minutes of

cool down exercises. Fitness scores were assessed at pre-exercise

(baseline) and at the seventh and ninth week after intervention

completion. A total of 30 subjects (exercise group 16; control group

14) completed follow-up. Results included: 1. Compared with children

in the general population, the study subjects (n = 30) all fell below the

50th percentile in all physical fitness items of interest, There was no

significant difference in scores between the two groups at baseline

(i.e., pre-exercise) for all five fitness items. 2. Research found a

positive association between exercise habit after school and muscular

strength and endurance among asthmatic children. 3. Compared to

the control group, the exercise group showed favorable outcomes in

terms of flexibility and muscular endurance. Such favorable

outcomes remained evident even after adjusting for age, duration of

disease and steroid use, values for which were unequally distributed

between the two groups at baseline. 4. There was a tendency for all

item-specific fitness scores to increase over time in the exercise group.

The GEE analysis showed that yoga exercise indeed improved BMI,

flexibility, and muscular endurance. After 2 weeks of self-practice at

home, yoga exercise continued to improve BMI, flexibility, muscular

strength and cardio-pulmonary fitness.

Kim Y, Lee S. (2009) stated that childhood obesity

continues to escalate despite considerable efforts to reverse the

current trends. Childhood obesity is a leading public health concern

because overweigh-obese youth suffer from comorbidities such as type

2 diabetes mellitus, non-alcololic fatty liver disease, metabolic

syndrome, and cardiovascular disease, conditions once considered

limited to adults. This increasing prevalence of chronic health

conditions in youth closely parallels the dramatic increase in obesity,

in particular abdominal adiposity, in youth. Although mounting

evidence in adults demonstrates the benefits of regular physical

activity as a treatment strategy for abdominal obesity, the

independent role of regular physical activity alone (e.g.., without

calorie restriction) on abdominal obesity, and in particular visceral fat,

is largely unclear in youth. There is some evidence to suggest that,

independent of sedentary activity levels (e.g., television watching or

playing video games), engaging in higher-intensity physical activity is

associated with a lower waist circumference and less visceral fat.

Several randomized controlled studies have shown that aerobic types

of exercise are protective against age-related increases in visceral

adiposity in growing children and adolescents. However, evidence

regarding the effect of resistance training alone as a strategy for the

treatment of abdominal obesity is lacking and warrants further

investigation.

Brown R.P. and Gerbang P.L. (2009) stated that Yoga

breathing is an important part of health and spiritual practices in

Indo-Tibetan traditions. Considered fundamental for the development

of physical well-being, meditation, awareness, and enlightenment, it is

both a form of meditation in itself and a preparation for deep

meditation. Yoga breathing (pranayama) can rapidly bring the mind

to the present moment and reduce stress. In this paper, they review

data indicating how breath work can affect longevity mechanisms in

some ways that overlap with meditation and in other ways that are

different form, but that synergistically enhance, the effects of

meditation. They also provide clinical evidence for the use of yoga

breathing in the treatment of depression, anxiety, post-traumatic

stress disorder, and for victims of mass disasters. By inducing stress

resilience, breath work enabled them to rapidly and compassionately

relieve many forms of suffering.

Benavides S. and Caballero L. (2009) stated that the

objective of this pilot study was to determine the effect of yoga on

weight in youth at risk of developing type 2 diabetes. Secondarily, the

impact of participation in yoga on self-concept and psychiatric

symptoms was measured. A 12-week prospective pilot Ashtanga yoga

program enrolled twenty children and adolescents. Weight was

measured before and after the program. All participants completed

self-concept, anxiety, and depression inventories at the initiation and

completion of the program. Fourteen predominantly Hispanic

children, ages 8-15, completed the program. The average weight loss

was 2 kg. Weight decreased from 61.2+/-20.2kg to 59.2+/-19.2kg

(p=0.01). Four of five children with low self-esteem improved,

although two had decreased in self-esteem. Anxiety symptoms

improved in the study. Ashtanga yoga may be beneficial as as weight

loss strategy in a prediominantly Hispanic population.

Javnbakht M., Hejazi Kenari R. and Hisami M. (2009)

stated that Yoga has often been perceived as a method of stress

management tool that can assist in alleviating depression and anxiety

disorders. This study sought to evaluate the influence of yoga in

relieving symptoms of depression and anxiety in women who were

referred to a yoga clinic. The study involved a convenience sample of

women who were referred to a yoga clinic from July 2006 to July

2007. All new cases were evaluated on admission using a personal

information questionnaire as well as Beck and Spielberger tests.

Participants were randomly assigned into an experimental and also a

control group. The experimental group (n=34) participated in twice

weekly yoga class of 90 minutes duration for two months. The control

group (n=31) was assigned to a waiting list and did not receive yoga.

Both groups were evaluated again after the two-month study period.

The average prevalence of depression in the experimental group pre

and post Yoga intervention was 12.82+/-7.9 and 10.79+/-6.04

respectively, a statistically insignificant decrease (p=0.13). However,

when the experimental group was compared to the control group,

women who participated in yoga classes showed a significant decrease

in state anxiety (p=0.03) and trait anxiety (p<0.001). Participation in a

two-month yoga class can lead to significant reduction in perceived

levels of anxiety in women who suffer from anxiety disorders. This

study suggests that yoga can be considered as a complementary

therapy or an alternative method for medical therapy in the treatment

of anxiety disorders.

Hart C.E. and Tracy B.L. (2008) conducted a study on

Yoga as steadiness training effects on motor variability in young

adults. Exercise training programs can increase strength and improve

sub-maximal force control, but the effects of yoga as an alternative

form of steadiness training are not well described. The purpose was to

explore the effect of a popular type of yoga (Bikram) on strength,

steadiness and balance. Young adults performed yoga training (n =

10, 29+/-6 years, 24 yoga sessions in 8 weeks) or served as controls

(n = 11, 26 +/- 7 years). Yoga sessions consisted of 1.5 hours of

supervised, standardized postures. Measures before and after

training included maximum voluntary contraction (MVC) force of the

elbow flexors (EF) and knee extensors (KE), steadiness of isometric EF

and KE contractions, steadiness of concentric (CON) and eccentric

(ECC) KE contractions, and timed balance. The standard deviation

(SD) and coefficient of variation (CV,SD/mean force) of isometric force

and the SD of acceleration during CON and ECC contractions were

measured. After yoga training, MVC force increased 14% for KE

(479+/- 175 to 544+/- 187 N, p < 0.05) and was unchanged for the EF

muscles (219+/- 85 to 230 +/-72 N p > 0.05). The CV of force was

unchanged for EF (1.68 to 1.73%, p > 0.05) but was reduced in the KE

muscles, similarly for yoga and control groups (2.04 to 1.55%, p <

0.05). The variability of CON and ECC contractions was unchanged.

For the yoga group, improvement in KE steadiness was correlated with

pre training steadiness (r=-0.62 to -0.84, p < 0.05); subjects with the

greatest reductions with training. Percent change in balance time for

individual yoga subjects averaged +228% (19.5 +/- 14 to 34.3 +/- 18

secon ds, p < 0.05), with no change in controls. For young adults, a

short-term yoga program of this type can improve balance

substantially, produce modest improvements in leg strength, and

improve leg muscle control for less-steady subjects.

Chaya et al., (2006) investigated the net change in the

basal metabolic rate (BMR of individuals actively engaging in a

combination of yoga practices (asana or yogic postures, meditation

and pranayama or breathing exercises) for a minimum period of six

months, at a residential yoga education and research center at

Bangalore. The measured BMR of individuals practicing yoga through

a combination was compared with that of control subjects who did not

practice yoga but led similar lifestyles. This study shows that there is

significantly reduced BMR, probably linked to reduced arousal, with

the long-term practice of yoga using a combination of stimulatory and

inhibitory yogic practices.

Madanmohan and associates (2005) planned to

undertake a comparative study of the ï¿½ï¿½ï¿½Effect of short term (three

weeks) training in savitri (slow breathing) and bhastrika (fast

breathing) pranayama on respiratory pressures and enurance,

reaction time, blood pressure, heart rate, rate-pressure product and

double productï¿½ï¿½ï¿½. Thirty student volunteers were divided into two

groups of fifteen each. Group I was given training in savitri

pranayama that involves slow, rhythmic, and deep breathing. Group

II was given training in bhastrika pranayama, which is bellows-type

rapid and deep breathing. Parameters were measured before and after

three-week training period. Savitri pranayama produced a significant

increase in respiratory pressures and respiratory endurance. In both

the groups, there was an appreciable but statistically insignificant

shortening of reaction time. Heart rate, rate-pressure product and

double product decreased in savitri pranayama group but increased

significantly in bhastrika group. It is concluded that different types of

pranayama produce different physiological responses in normal young

volunteers.

Brown and Gerbarg (2005) found Yogic breathing a

unique method for balancing the autonomic nervous system and

influencing psychological and stress-related disorders. Part I of this

series presented a neurophysiologic theory of the effects of Sudarshan

Kriya Yoga (SKY). Part II reviewed clinical studies, their own clinical

observation, and guidelines for the safe and effective use of yoga

breathing techniques in a wide range of clinical conditions. The

authors avow that although more clinical studies are needed to

document the benefits of programs that combine pranayama (yogic

breathing) asanas (yoga postures), and meditation, there is sufficient

evidence to consider Sudarshan Kriya Yoga to be a beneficial, low risk,

low-cost adjunct to the treatment of stress, anxiety, post-traumatic

stress disorder (PTSD), depression, stress-related medical illnesses,

substance abuse, and rehabilitation of criminal offenders. SKY has

been used as a public health intervention to alleviated PTSD in

survivors of mass disasters. Yoga techniques enhance well-being,

mood, attention, mental foucs, and stress tolerance. Proper training

by a skilled teacher and a 30-minute practice every day will maximize

the benefits. Health care providers play a crucial role in encouraging

patients to maintain their yoga practices.

Barshankar et al., (2003) examined the effect of yoga

on cardiovascular function in subjects above 40 years of age. Pulse

rate, systolic and diastolic blood pressure and Valsalva ratio were

studied in 50 control subjects (not doing any type of physical exercise)

and 50 study projects who had been practising yoga for 5 years. From

the study it was observed that significant reduction in the pulse rate

occurs in subjects practicing yoga (P<0.001). The difference in the

mean values of systolic and diastolic blood pressure between study

group and control group was also statistically significant (P<0.01 and

P<0.001 respectively). The systolic and diastolic blood pressure

showed significant positive correlation with age in the study group (rl

systolic=0.631 and rl diastolic =0.610) as well as in the control group

(r2 systolic =0.981 abd r2 diastolic =0.864). The significance of

difference between correlation coefficient of both the groups was also

tested with the use of Z transformation and the difference was

Significant (Z systolic =4.041 and Z diastolic =2.901). Valsalva ratio

was found to be significantly higher in yoga practitioners than in

controls (P<0.001). Our results indicate that yoga reduced the age

related deterioration in cardiovascular functions.

Virtanen et.al. (2003) The purpose of study was to

determine whether psychological factaors are associated with heart

rate variability (HRV), blood pressure variability (BPV), and baroreflex

sensitivity (BRS) among healthy middle-aged men and women. A

population-based sample of 71 men and 79 women (35-64 years of

age) was studied. Five-minute supine recordings of ECG and beat-tobeat

photoplethysmograpic finger systolic arterial pressure and

diastolic arterial pressure were obtained during paced breathing.

Power spectra were commuted using a fact Fourier transforms for lowfrequency

(0.01-0.15 Hz) and high-frequency (0.15-0.10 Hz) powers.

BRS was calculated by cross-spectral analysis of R-R interval and

systolic arterial pressure variability ties. Psychological factors were

evaluated by three self-report questionnaires: the Brief Symptom

Inventory, and the Toronto Alexithymia Scale. It was found anxiety

and hostility is related to reduced BRS and increased low-frequency

power of BPV. Reduced BRS reflects decreased parasympathetic

outflow to the heart and may increase BPV through an increased

sympathetic predominance.

Selvanayaki (2002) conducted a study on ï¿½ï¿½ï¿½Effect of

selected asana, pranayama, and combination of asana and

pranayama on systolic and diastolic blood pressure among college

womenï¿½ï¿½ï¿½. For this study she selected 45 college women ranging

between 18 to 22 years, and divided them in three groups that

underwent training for six weeks. ANCOVA was applied and it was

concluded that systolic and diastolic blood pressure were not

significantly improved by the influence of asana, pranayama and the

combination of asana and pranyama.

Karuppasamy (2002) conducted a study on ï¿½ï¿½ï¿½Effect of

physical training and asanas on selected physiological variable and

motor ability component among college menï¿½ï¿½ï¿½. For this study, he

selected 30 college men age ranging between 18 to 19 years and

divided them in three groups, which underwent six weeks training

programme of asana and physical training and a control group that

did not do any training. He used ANCOVA and found out that there

was significant effect of asana on pulse rate but there is no change in

speed.

Ray, et.al. (2001) undertook a study to observe the

beneficial effects of yogic practices during training period on the young

trainees. 54 trainees of 20-25 years age group were divided randomly

in two groups i.e. yoga and control group. Yoga group (23 males and

5 females) was administered yogic practices for the five months of the

course while control group (21 males and 5 females) did not perform

yogic exercises during this period. From the 6th to 10th months of

training both the groups performed the yogic practices. Physiological

parameters like heart rate, blood pressure, oral temperature, skin

temperature in resting condition: responses to maximal and sub

maximal exercise, body flexibility were recorded. Psychological

parameters like personality, learning arithmetic and psychomotor

ability and mental well being were also recorded. Various parameters

were taken before and during the 5th and 10th month of training

period. Initially there was relatively higher sympathetic activity in

both the groups due to the new work/training environment but

gradually it subsided. Later on at the 5th and 10th month, yoga group

had relatively lower sympathetic activity than the control group.

There was improvement in performance at sub maximal level of

exercise and in anaerobic threshold in the yoga group. There was

improvement on various psychological parameters like reduction in

anxiety and depression and a better mental function after yogic

practices.

Murugesan, Govindarajulu and Bera (2000) selected

thrity-three (N=33) hypertensives, aged 35-65 years, from Govt.

General Hospital, Pondicherry, and examined with four variables viz.,

systolic and diastolic blood pressure, pulse rate and body weight. The

subjects were randomly assigned into three groups. The exp. Group-I

underwent selected yoga practices, exp. Group-II received medical

treatment by the physician of the said hospital and the control group

did not participate in any of the treatment stimuli. Yoga imparted in

the morning and in the evening with 1 hr/session, day-1 for a total

period of 11-weeks. Medical treatment comprised drug intake every

day for the whole experimental period. The result of pre-post test with

ANCOVA revealed that both the treatment stimuli (i.e. yoga and drugs)

were effective in controlling the variables of hypertension.

Madan Mohan, et al., (2000) studied the effects of yoga

training on cardiovascular response to exercise and the time course of

recovery after the exercise. Cardiovascular response to exercise was

determined by Harvard step test using a platform of 45 cm height.

The subjects were asked to step up and down the platform at a rate of

30/min for a total duration of 5 min or until fatigue, whichever was

earlier. Heart rate (HR) and blood pressure response to exercise were

measured in supine position exercise and at 1,2,3,4,5,7 and 10

minutes after the exercise. Rate-pressure product (RPP = (HR x

SP)/100) and double product (Do P = HR x MP), which are indices of

work done by the heart were also calculated. Exercise produced a

significant increase in HR, systolic pressure, RPP & DoP and a

significant decrease in diastolic pressure. After two months of yoga

training, exercise induced changes in these parameters were

significantly reduced. It is concluded that after yoga training a given

level of exercise leads to a midler cardiovascular response, suggesting

better exercise tolerance.

Schell, Allolio and Schoake (1994) conducted a study

on physiological and psychological effects of Hatha-Yoga exercise in

healthy women. They measured heart rate, blood pressure, the

hormones cortisol, prolactin and growth hormones and certain

psychological parameters in a yoga practicing group and a control

group of young female volunteers prior and after the experimental

period. There were no substantial differences between the groups

concerning endocrine parameters and blood pressure. The heart rate

was significantly different in yoga group having a significant decrease

in heart rate during the yoga practice. In the personality inventory

the yoga group showed markedly higher scores in life satisfaction and

lower scores in excitability, aggressiveness, openness, emotionality

and somatic complaints. Significant differences could also be

observed concerning coping stress and mood at the end of the

experiment. The yoga group had significant higher scores in high

spirits and extra va

Methodology is of a supreme importance in any scientific inquiry, as validityand the reliability of the facts primarily depend upon the system of investigation. The present study was conducted to examine ï¿½ï¿½ï¿½Assessing the effectiveness of relaxation techniques in management of anxiety and depressionï¿½ï¿½ï¿½. The concept of methodology includes four aspects, namely, participants, measures, procedure and data analysis. These four aspects of overall research methodology can be taught of as forming a case for execution of present study. Additionally, the methodology provides detailed information about how the subject used for the study, the description of the participants and the measured used in the study.

Research Design

One of the vital parts of the whole Methodology is the research design. A research design is a blueprint or a detailed plan as to how a research study is to be completed. That is how it would operationalize variables so that they can be measured, how to select a sample of interest to the research topic, how to collect data to be used as a basis for testing hypothesis and how to analyze the results, (Thyer, 1993). Mohsin (1984) defines a design as ï¿½ï¿½ï¿½research design contains a built-in system of checks against all factors that might affect the validity of the research outcomesï¿½ï¿½ï¿½.

Present study used a mixed of between group descriptive, correlational and multivariate designs. To examine the socio-demographic characteristics of couples the descriptive statistics were used. Pearsonian Correlation was used to examine the relationship of various independent variables on the dependent variables. Multivariate design was used to examine the relationships of different variables and to explain variance in the scores on the dependent measures. The detailed description about the design and statistical analysis used in the present study has been described under the heading Statistical Analysis of Data below.

Participants

The participants for the present study consisted of 40 patients/adults. These participants drawn from Jordan. The sample was divided in terms of the variable of gender, i.e., males and females. The age range of participants wasï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½

Measures

In order to achieve the goals of the present study, two measures were used namely i.e., Hamilton Anxiety Rating Scale (HAM-A) and Back Depression Inventory BDI-II. Demographic questionnaire prepared by the researcher was also included in the study. These measures are given in Appendix. In both the measures the Cronbachï¿½ï¿½ï¿½s alpha was found satisfactory.

1. Hamilton Anxiety Rating Scale (HAM-A)

Hamilton Anxiety Rating Scale (HAM-A) was developed by Hamilton (1959). The HAM-A was one of the first rating scales developed to measure the severity of anxiety symptoms, and is still widely used in both clinical and research settings. The scale consist of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological stress) and somatic anxiety (physical complaints related to anxiety). Every item is scores from 0 (not present) to 4 (sever), with a total score range of 0-56, where less than 17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe. The HAM-A does not provide any standardized probe questions. Despite this, the reported levels of inter-rater reliability for the scale appear to be acceptable.

2. Back Depression Inventory BDI-II

The second scale of the present study was Back Depression Inventory Second Edition (BDI-II, 1996) was used. BDI-II is a 21 item self report instrument intended to assess the existence and severity of symptoms of depression as listed in the American Psychiatric Associationï¿½ï¿½ï¿½s Diagnostic and Statistical Manual of Mental Disorders Forth Edition (DSM-IV; 1994). This new revised edition replaces the BDI and BDI-1A, and includes items intending to index symptoms of severe depression, which would require hospitalization.

Yoga therapy :

is a type of therapy that uses yoga postures, breathing exercises, meditation, and guided imagery to improve mental and physical health. The holistic focus of yoga therapy encourages the integration of mind, body, and spirit. Modern yoga therapy covers a broad range of therapeutic modalities, incorporating elements from both physical therapy and psychotherapy.

Issues Treated by Yoga Therapy

Yoga therapy is a growing field and scientific evidence has begun to emphasize its efficacy. It is used to treat existing mental and physical health issues, but can also be used as a self-care strategy for prevention and maintenance.

Yoga therapy is well established as a treatment for depression and anxiety. A meta-analysis cited in the Primary Care Companion for CNS Disorders found that yoga therapy also shows promise for the treatment of posttraumatic stress (PTSD) and schizophrenia. Additionally, yoga therapists have begun to develop treatment modalities to suit children with autism. The book Yoga Therapy for Children with Autism and Special Needs, written in 2013 by yoga teacher Louise Goldberg, is already considered a critical text for novice and experienced yoga therapists alike.

According to a 2012 article in Social Work Today magazine, yoga therapy is also emerging as an effective treatment for substance abuse issues. Mental health professionals point out the way yoga positively impacts the parts of the mind and body susceptible toaddiction. Studies have shown that yoga boosts the neurotransmitter GABA (gamma-aminobutyric acid), which is important because GABA levels are statistically low in people who experience substance abuse, anxiety, and depression.

Because of its concentration on mind and body integration, yoga therapy is also used to address many physical health issues. It has been effectively used to treat back pain, heart conditions, asthma, chronic fatigue, hypertension, multiple sclerosis, and side effects of chemotherapy.

Practice and Benefits of Yoga Therapy

Yoga therapy is practiced in a wide range of formats. Physical therapists, for example, often implement yoga techniques in their delivery of massage and other treatments. Yoga therapy practice can resemble physical therapy, rehabilitative therapy, and/or psychotherapy. Unlike a standard yoga class, yoga therapy sessions are typically conducted in one-on-one or small group settings. Yoga therapy can be provided as an adjunct therapy to complement other forms of treatment, or it can be used to directly treat a specific issue. Yoga techniques range from simple to advanced, and can be enjoyed by people of all ages.

Potential benefits from yoga therapy include stress reduction, psychological well-being, improved diet, and efficient functioning of bodily systems. A 2011 qualitative study from Inkanyiso: Journal of Humanities and Social Sciences examined the effects of yoga therapy on anxiety. The findings not only indicated that yoga therapy effectively reduced subjects' anxiety, but improvement across several dimensions of physical and mental health including physicality, relaxation, and mindfulness.

History of Yoga Therapy

Yoga therapy is rooted in the ancient practice of yoga, which originated thousands of years ago in India. Yoga made its way to the United States in the late 1800s, but yoga therapy emerged in a formal manner in the 1980s as the result of a study conducted by Dr. Dean Ornish. The study illustrated how the implementation of a healthy lifestyle program could reverse heart disease. Ornishï¿½ï¿½ï¿½s program included therapeutic yoga and was the first of its kind to highlight the benefits of using yoga in this way. This program for treating heart disease was approved for insurance coverage in 1990 and it marked the beginning of the medical field's acceptance of yoga as a treatment option.

In 1983, the Biomedical Yoga Trust was founded to further develop and standardize the field of yoga therapy. The International Association of Yoga Therapists (IAYT) was founded in 1989 and has since hosted yoga conferences, published the Journal of the International Association of Yoga Therapists, and contributed to the creation of yoga therapy training standards. Both organizations have facilitated research to explore the extent of yoga therapy's potential.

What to Expect from Yoga Therapy

When a person decides to initiate yoga therapy, the therapist will first conduct an initial assessment. This assessment is designed to do the following:

ï¿½ï¿½ï¿½ Identify health problems

ï¿½ï¿½ï¿½ Assess lifestyle and physical capability

ï¿½ï¿½ï¿½ Discuss reasons for seeking therapy

ï¿½ï¿½ï¿½ Create a course of treatment

Once the treatment plan is established in this first consultation, the frequency of sessions is agreed upon and sessions are scheduled. From this point, therapy sessions will most likely include the following components:

ï¿½ï¿½ï¿½ Breathing Exercises (Prayanama): The therapist will guide the person in therapy through a series of breathing exercises ranging from energizing breaths to balancing breaths.

ï¿½ï¿½ï¿½ Physical Postures (Asana): The therapist will teach the person in treatment appropriate yoga poses that address problem areas. For example, the ï¿½ï¿½ï¿½Legs Up the Wallï¿½ï¿½ï¿½ pose is used to treat things like anxiety and insomnia. In this pose, the person lays on his or her back with legs positioned up against the wall.

ï¿½ï¿½ï¿½ Meditation: Relaxation and mindfulness are the focus of meditation when it is combined with yoga poses.

ï¿½ï¿½ï¿½ Guided Imagery: The yoga therapist attempts to calm the body and mind by providing a guided visualization intended to bring inner peace.

ï¿½ï¿½ï¿½ Homework: An important element for any yoga practice is to find a way to incorporate it into daily life. Yoga therapists provide instructions on how to use what has been learned in treatment at home.

Who Offers Yoga Therapy?

The most well-known professional title to describe a yoga therapist is Certified Yoga Therapist, credentialed as CYT. However, because the field of yoga therapy is fairly young, no official, formalized certification process exists. However, there are many organizations and education programs accredited by the IAYT that offer training and certification. Some well-respected training programs include:

ï¿½ï¿½ï¿½ Integrative Yoga Therapy

ï¿½ï¿½ï¿½ American Viniyoga Institute

ï¿½ï¿½ï¿½ Essential Yoga Therapy

ï¿½ï¿½ï¿½ Phoenix Rising Yoga Therapy

ï¿½ï¿½ï¿½ YogaLife Institute

ï¿½ï¿½ï¿½ Any training program accredited by the International Association of Yoga Therapists (IAYT)

Though therapists vary in education and experience, most well-trained yoga therapists have a strong knowledge base in:

ï¿½ï¿½ï¿½ Yoga philosophy, techniques, and education

ï¿½ï¿½ï¿½ Therapeutic yoga techniques

ï¿½ï¿½ï¿½ Anatomy and physiology

ï¿½ï¿½ï¿½ Diet and nutrition

ï¿½ï¿½ï¿½ Basic understanding of medical care and first aid

ï¿½ï¿½ï¿½ Basic understanding of business ethics

When deciding on a yoga therapist, it is important to know that there are many types. Some are yoga teachers, yogis, and gurus while others are psychotherapists, psychologists, and physical therapists. The Yoga Journal website suggests seeking out word-of-mouth referrals and yoga studio recommendations. The most crucial thing is to find a therapist who has solid experience and training, and with whom you can develop a positive therapeutic relationship.

Procedure

The questionnaire used in the present study included demographic information sheet, marital adjustment scale, emotional intelligence scale and mental health inventory. After seeking required permission from concerned authorities ''fhais national centre for mental health hospital'', then we return back to the physical records to choose our deliberate sample, then the participants were personally contacted. They were briefed about the purpose of research and questionnaire used in the study. After seeking consent of the participant a suitable time and date was fixed for data collection.

Before administering the questionnaire, the purpose of the study was again explained to the participants and they were assured that their responses will be kept confidential and will be used only for research and academic purpose only. A good rapport was build with the participants for getting correct responses. Some necessary instruction and guidelines were provided to them for properly filling the questionnaire. After this, the questionnaires were provided to them and they were requested to fill-up the questionnaire as per the instructions given in the questionnaire. It took an average of 30 minutes for the participants to complete the questionnaire. After completion of the questionnaire participants returned the questionnaire and they were thanked for their participation and cooperation.

the researcher has applied Yoga therapy on the target group for a month distributed on four days a week, in which the patients have been trained for almost an hour.

The yoga program has been applied on the group that suffered from anxiety and depression, and then the level of depression and anxiety has been measured pre and post applying the program. The program has had an important influence on elevating the level of anxiety and depression on the patients; moreover, a comparison between the target and control group has been applied which resulted in a clear difference between the two groups with respect to the intensity of anxiety and depression the researcher has found out more favorable results regarding the level of anxiety and depression with the target group.

Deep relaxation in yoga: The corpse posture

The corpse posture considered as simplest and the most difficult of all yoga postures is the corpse posture, also widely known as the dead pose. The corpse posture is an exercise in mind over matter. The only props you need are your body and mind.

The objectives of the program

The corpse posture program aims to get rid of stress and anxiety and fear and to gain experience of controlling the tension on the body and the members of the Lean and worked daily duties comfortably and be seen as positive images.

The program content:

Person starts to exercise corpse pose by doing a series of movements, here is how you do the corpse pose:

1. Lie flat on your back, with your arms stretched out and relaxed by your sides, palms up (or whatever feels most comfortable), place a small pillow under your head if you need one and another large pillow under your knees for added comfort.

2. Close your eyes.

3. Form a clear intention to relax, some people finds it helpful to picture them lying in white sand on a sunny beach.

4. Take a couple of deep breaths, lengthening exhalation.

5. Contract the muscles in your feet for a couple of seconds and then consciously relax them. Do the same with the muscles in your calves, upper legs, buttocks, abdomen, chest, back, hands, forearms, upper arms, shoulders, neck, and face.

6. Periodically scan all your muscles from your feet to your face to check that they are relaxed. You can often detect subtle tension around the eyes and the scalp muscles. Also relax your mouth and tongue.

7. Focus on the growing bodily sensation of no tension and let your breath be free.

8. At the end of the session, before opening your eyes form the intention to keep the relaxed feeling for as long as possible.

9. Open your eyes, stretch lazily, and get up slowly.

Important guidelines when implementing the program:

1. Practice 10 to 30 minutes; the longer the duration the better.

2. Training atmosphere: the atmosphere must be calm and help to relax and focus.

3. Skill needed: should lead the exercise required to be full, so to get to the overall perception of performance.

4. Proper performance must focus on the proper performance only, so as not to affect performance and repeat conceivable wrong in installing errors.

Phases of the program

It includes three phases, as follows:

Phase I: Part primer: calm and relaxation exercises (Relaxation Exercise), as follow:

Breathe deeply with closing eyes, the patient will do this movement for one time, then he/she will (sitting) constriction of the hands and feet, and total relaxation and repeat it for three time, finally will breathe deeply

Phase II: the main part: The corpse posture, the patient will lie flat on his/her back, with your arms stretched out and relaxed by your sides, palms up (or whatever feels most comfortable), place a small pillow under your head if you need one and another large pillow under your knees for added comfort and repeat it for two times, then Close his/her eyes, after that he/she will form a clear intention to relax, some people finds it helpful to picture them lying in white sand on a sunny beach for three times, then take a couple of deep breaths, lengthening exhalation for one time, after that contract the muscles in your feet for a couple of seconds and then consciously relax them. Do the same with the muscles in your calves, upper legs, buttocks, abdomen, chest, back, hands, forearms, upper arms, shoulders, neck, and face for three times, then periodically scan all your muscles from your feet to your face to check that they are relaxed. You can often detect subtle tension around the eyes and the scalp muscles. Also relax your mouth and tongue for three times, after that focus on the growing bodily sensation of no tension and let your breath be free for two times, then at the end of the session, before opening your eyes form the intention to keep the relaxed feeling for as long as possible for two times, finally he/she will open eyes, stretch lazily, and get up slowly.

Phase III: concluding part: calm and relaxation exercises (Relaxation Exercise), as follow:

Essay: Anxiety Disorders: Research Studies and Relaxation Techniques Review

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