The Effects of Mindful Yoga Meditation on Stress Reduction
A Clinical Scholarly Project by
Doris I. Okoli
Brandman University
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Marybelle and S. Paul Musco School of Nursing and Health Professions
IE Irvine, California
Submitted in partial fulfillment of the requirements for the degree of
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Doctor of Nursing Practice
April 2020
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Committee in charge:
Patric Schine, DNP, FNP-BC, AAHIVS, Chair
Tyke Hanisch, DNP, APRN, FNP-C, Dean
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Patric Schine, DNP, FNP-BC, AAHIVS, Committee Chair
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Tyke Hanisch, DNP, APRN, FNP-C, Dean
April 2020
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The Effects of Mindful Yoga Meditation on Stress Reduction
Copyright © 2020
by Doris I. Okoli
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ACKNOWLEDGEMENTS
I give thanks to God for his mercy and helping to guide me through this challenging program. I
would like to thank my wonderfully supportive husband for his patience and understanding
during these past couple of years. I would like to thank my family for their encouraging words
throughout this journey. Lastly, I would like to thank Brandman University for the opportunity to
obtain this DNP degree and my chair Dr. Patric Schine for his help and guidance with
completing my oral defense and manuscript.
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ABSTRACT
The Effects of Mindful Yoga Meditation on Stress Reduction
by Doris I. Okoli
Background: Stress is a universal problem that has a detrimental effect on the mental, physical,
and psychological health of individuals (Chong, Tsunaka, Tsang, Chan, & Cheung, 2011). Over
the course of time there has been an undeniable increase in the popularity of yoga as a
complementary treatment modality, health maintenance resource and disease prevention agent
(Chong et al., 2011). Purpose: The purpose of this clinical scholarly project is to assess if the use
of mindful yoga meditation to reduce overall perceived stress in adult Bfit gym yoga class
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participants over a one-month period is an effect stress reduction method. Method: A prospective
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cohort qualitative study was used for this project. The physical activity readiness questionnaire
(PAR-Q), and the perceived stress scale (PSS) were used as data collection tools. Twenty-five
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participants from Bfit gym were involved in this study. PSS and PAR-Q pre-intervention scores
were recorded. Results: Study results were inconclusive; however, many peer reviewed studies
did support the clinical relevance of this clinical scholarly project. Recommendations for future
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project implementation were made. Conclusion: Yoga meditation, and other mind-body practices
have been identified as an aid in training the body to cope with stress and anxiety and to improve
overall health and well-being (Wei, 2015). By integrating the use of yoga as a complementary
treatment modality for stress reduction, the potential adverse effects experienced from use of
traditional medications used to treat stress and stress related illnesses can be significantly
reduced.
Keywords: Stress, anxiety, yoga, mindfulness, gym
Chapter I: Background and Significance
Stress is defined as the inability to cope with a real or imagined threat to one’s mental,
physical, emotional, and spiritual well-being (Chong et al., 2011). This often results in a
sequence of physiological responses and some form of adaptation (Chong et al., 2011). When
people hear the word stress, it is often associated with something negative. However not all
stress is bad stress (U.S. Department of Health and Human Services [HHS], 2018). Stress can be
both positive and negative (Centers for Disease Control [CDC], 2015). When we experience
typical non-life-threatening situations, stress can act as a motivator (HHS, 2018). Similar to what
we feel when we need to take a test or interview for a new job (HHS, 2018). However, when
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stress becomes long term and chronic, this is when it can be harmful to your health (HHS, 2018).
Background and Significance
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Stress is a universal problem that has a detrimental effect on the mental, physical, and
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psychological health of individuals (Chong et al., 2011). “Stress can be brought on by school,
work, family life, daily responsibilities, or sudden life changes such as losing a job, divorce,
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illness or a traumatic life event” (HHS, 2018). It is inevitable that everyone will experience stress
some time in their lives but learning to successfully cope with stressors is where most find it
challenging (HHS, 2018). When the body is exposed to constant prolonged stress there is always
a chance for the inability to adapt (Chong et al., 2011). In this instance, the individual will enter
a stage of exhaustion, which in extreme situations results in physical illness or emotional
disorders (Chong et al., 2011). When under constant pressure the body is unable to deliver
signals to return to normal functioning (HHS, 2018). This often leads to chronic stress levels
which have disturbing effects on the digestive, reproductive cardiovascular, immune, metabolic,
and psychological system (Harkess, Delfabbro, Mortimer, Hannaford, & Cohen-Woods, 2017).
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Although western medicine and public health across the United States are becoming more
successful at preventing and curing diseases that for centuries resulted in mortality and disability,
this has not slowed down the increasing number of humans still developing chronic diseases at
alarming rates (West, Otte, Geher, Johnson & Mohr, 2004).
Studies have reported that many common diseases are known to be exasperated by stress
(West et al., 2004). “Stress-related difficulties in chronic disease do not respond well to
traditional primary, secondary, or tertiary medical or public heath approaches” (West et al.,
2004). The growth in the use of complementary alternative medicine (CAM) has been linked to
the perceived need for care that develops from the stress of modern life (West et al., 2004).
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Given the prevalence of stress and its ability to have an impact on both psychological and
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physical health, there seems to be an increasing interest in the value of engaging in interventions
that potentially address both the physical and psychological consequences of chronic stress
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(Harkess et al., 2017). Finding a low cost, safe and sustainable solution for combating stress will
not only benefit the healthcare system but it will also save millions of individuals from
developing deadly diseases linked to prolonged elevated stress levels.
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Problem Statement
Research reveals that almost 80% of all diseases and illness are related to stress,
particularly coronary heart disease, cancer, migraine, hypertension, and insomnia (Chong et al.,
2011). Other health conditions that result from prolonged stress include asthma, obesity, and
diabetes (HHS, 2018). Unmanaged stress may reduce an individual's overall immune function
and increase his or her vulnerability to chronic pain, lung cancer, and cardiovascular disease. In
addition, unmanaged prolonged stress can have serious negative effects on an individual’s
quality of life (Chong et al., 2011). Apart from physical illnesses, chronic stress can also have a
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serious impact on mental health. Anxiety and depression are two leading psychiatric illness that
can both be caused or exacerbated by stress and a lack of stress control (HHS, 2018).
Studies show that the presence of stress weakens the body’s physiological system, which
causes a rapid advancement in the disease process (Seaward, 2012). Stress and other intense
emotional responses by the body directly affect our ability to remain healthy or fight off diseases
(Seaward, 2012). A clear connection exists between stress and emotion that has a direct influence
on the progression of cancer, HIV, cardiovascular disease, and other illnesses through the
nervous, endocrine, and immune systems (Seaward, 2012). Researchers believe the leading cause
of death for the average person is caused by preventable lifestyle diseases or non-communicable
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diseases (Seaward, 2012). Non-communicable diseases include tobacco use, sedentary lifestyle,
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lack of regular exercise, unhealthy diets and chronic psychosocial stress (Stephens, 2017). These
diseases pathology develop over several years and even decades (Seaward, 2012). Traditionally
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infectious diseases are treated with medication however, lifestyle diseases are more preventable
and can be corrected by altering lifestyle habits, controlling stress levels and altering behavior
that contribute to its cause (Seaward, 2012).
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Throughout medicine stress has been identified as one of the most common patient
complaints (Dimsdale, 2008). Although an infinite number of medications exists to treat many of
the health conditions exacerbated by stress. There is also a matching list of side effects that cause
the benefits to not out weight the risks. In addition to being both expensive and addictive some
medications can lead to dangerous or even lethal adverse effects. Due to the concern of over
prescription and potential side effects that medications can cause. Researchers are now seeking
more nonpharmacological and noninvasive treatments (Shohani et al., 2018). Seeking
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alternatives for traditional medications has been reported as a top is a priority in the medical field
if not a necessity.
Historical and Societal Perspective
In 1983, Time Magazine rereferred to stress as “The Epidemic of the Eighties” (The
American Institute of Stress [AIS], 2017). However, since then not much has changed. “75 - 90
percent of all visits to primary care physicians in the United States are for stress related
problems” (AIS, 2017). According to surveys conducted by AIS adults report feeling under more
stress now than a decade or two ago (AIS, 2017). From a societal perspective, increased stress
levels are being seen in almost every age group (AIS, 2017). Children, teenagers, college
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students and the elderly are reporting higher stress levels compared to that of the average
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working adult (AIS, 2017). The elderly report their stress stemming from concerns with crime
and violence while the younger generation is anxious about daily peer pressures, substance abuse
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and social isolation (AIS, 2017). Although 75 - 90 % of patients come into their health care
providers with complaints centered around stress. Less than 3% of doctors talk to their patients
about how to reduce their overall stress levels (Wei, 2015).
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Traditionally, patients are given medication to treat stress related health conditions. These
medications can include SSRIs, benzodiazepines, cardiac, blood pressure, and pain medications
among many others. However, with the staggering amount of deaths and reported side effects
from traditional medications, more and more people are looking toward alternative means to
traditional health care. One intervention that has been shown to decrease stress levels is
mindfulness-based yoga meditation (Evans et al., 2011). Yoga is regarded as a mind-body
intervention that arose in India 4000 years ago (Chong et al., 2011). Mindfulness is defined as
moment to moment non-judgmental awareness (Evans et al., 2011). It is cultivated through the
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regular practice of mindfulness meditation and emphasizes an open awareness to the contents of
the mind (Evans et al., 2011). The expression yoga originated from the Sanskrit word Yuj,
meaning to unite or to yoke (Chong et al., 2011). Yoga refers to a discipline of asceticism and
meditation that relates to spiritual experiences and gaining insight into the nature of existence
(Chong et al., 2011).
Yoga is an ancient practice that is believed to offer physical, emotional, mental, and
interpersonal benefits (Brems, 2015). Over the years yoga has begun to attract more scientific
support and well deserved attention from researchers (Brems, 2015). In the past decade, peer-
reviewed published literature provides researched evidence which supports the effectiveness of
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yoga in a variety of health and mental health related settings (Brems, 2015). Yoga meditation,
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and other mind-body practices help to train the body to cope with stress and improve overall
health and well-being (Wei, 2015). There is an undeniable increase in the popularity of yoga as a
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complementary treatment modality, health maintenance resource and disease prevention agent
(Chong et al., 2011). Therefore, this projects goal is to assess if the use of mindful based yoga
meditation will reduce overall perceived stress in adult Bfit gym yoga class participants over a
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one-month period.
Incidence and Prevalence
According to The American Institute of Stress 55% of Americans report feeling stressed
throughout the day (Milenkovic, 2019). In a study conducted by Harvard School of Public Health
[HSPH]. (2014) 49% of participants reported experiencing a major stressful life event within the
past year. In addition, 37% reported experiencing some amount of unmanageable stress within
the past month (HSPH, 2014). Chronic stress is a big little problem that affects the lives of
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millions, when properly managed it can be productive but when mismanaged the effects can be
detrimental.
In the 13th annual Stress in America survey, the American Psychological Association
(APA) found that while overall U.S. stress levels have not changed significantly over the past
few years, the number of Americans who say they are experiencing stress about specific issues
has risen (APA, 2019). The Harris Poll conducted a 2019 survey on behalf of the APA from
August 1, 2019 to September 3, 2019. This survey included 3,617 adults ages 18 and older living
in the U.S. (APA, 2019). When participants were asked to describe their commonest personal
stressors, 6 out of 10 adults (64%) reported work as a significant stressor and 60% reported
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money as a significant source of stress (APA, 2019).
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Americans report experiencing higher than average levels of stress and lower levels of
overall health (APA 2019). Although Americans rate a healthy stress level as a 3.8 on a scale of
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1-10 (APA, 2019). The average American rates their own stress level at 4.9 out of 10 (APA,
2019). Making Americans among the most stressed population in the world (Milenkovic, 2019).
The United States has now surpassed Greece, whose population was previously reported as the
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most stressed out population in the world in 2012 (Milenkovic, 2019).
Taking a closer look by generation, Gen Z adults report the highest average stress level
(5.8), followed by Gen Xers (5.5) and Millennials (5.4); Boomers and older adults have
significantly lower than average stress levels comparatively (4.2 for Boomers and 3.0 for older
adults) (APA, 2019).
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