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Effects of Mind Sound Resonance Technique (Yogic relaxation) on


Psychological States, Sleep Quality, and Cognitive Functions in Female
Teachers: A Randomized, Controlled Trial

Article  in  Advances in mind-body medicine · March 2017

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ORIGINAL RESEARCH

Effects of Mind Sound Resonance Technique


(Yogic Relaxation) on Psychological States, Sleep
Quality, and Cognitive Functions in Female
Teachers: A Randomized, Controlled Trial
Manas Rao, MSc; Kashinath Metri, BAMS, MD, PhD; Nagaratna Raghuram, MBBS, MD, FRCP;
Nagendra R. Hongasandra, ME, PhD

ABSTRACT
Context • Several studies have revealed a high rate of psychological distress (P < .001), and (5) 44.79% for
physical and psychological problems from stress among fatigue (P < .001). A significant improvement occurred for
schoolteachers. Yoga is one of the mind-body interventions that group for 2 variables: (1) 44.94% for quality of sleep
known to alleviate stress and effects. The mind sound (P < .001), and (2) 12.12% for self-esteem (P < .001). An
resonance technique (MSRT), a yoga-based, mindfulness 11.88% increase occurred for the group for cognitive
relaxation is recognized as having a positive influence on function, but the change was not significant (P = .111). On
physical and psychological health. the other hand, the control group showed significant
Objectives • The study intended to examine the effects of increases in 5 variables: (1) 55.56% for perceived stress
an MSRT intervention for 1 mo on perceived stress, (P < .001), (2) 13.32% for state anxiety (P < .001),
quality of sleep, cognitive function, state and trait anxiety, (3) 21.28% for trait anxiety (P < .001), (4) 20.95% for
psychological distress, and fatigue among female teachers. psychological distress (P = .103), and (5) 16.44% for
Design • The study was a randomized, controlled trial. fatigue (P < .001). The group also showed significant
Setting • The study occurred at 2 primary schools in decreases in 3 variables: (1) 3.51% for self-esteem
Bangalore City, India. (P < .001), (2) 21.39% for quality of sleep (P = .003), and
Participants • Sixty female teachers, aged between 30 and (3) 17.60% for cognitive function (P = .002). A comparison
55 y, from the 2 schools were enrolled in the study. between the 2 groups showed significant differences in
Intervention • The participants were randomly divided 7 variables: (1) perceived stress (P < .001), (2) quality of
into an MSRT group (n = 30) and a control group (n = 30). sleep (P < .001), (3) state anxiety (P < .001), (4) trait anxiety
Participants in the MSRT group participated in MSRT for (P < .001), (5) psychological distress (P = .006), (6) fatigue
30 min/d, 5 d/wk, for the duration of 1 mo. The participants (P = .005), and (7) self-esteem (P < .001). No significant
in the control group followed their normal daily routines. differences existed between the groups in cognitive
Outcome measures • Perceived stress, sleep quality, function (P = .083).
cognitive function, anxiety, psychological distress, fatigue, Conclusions • In the current study, the practice of MSRT
and self-esteem were assessed using standardized assessment facilitated a reduction in the levels of stress, anxiety,
tools at baseline and after 1 mo of the intervention. fatigue, and psychological distress. The relaxation
Results • In the MSRT group, a significant reduction technique also enhanced the levels of self-esteem and
occurred for 5 variables: (1) 47.01% for perceived stress quality of sleep among female teachers working in primary
(P < .001), (2) 28.76% for state anxiety (P < .001), schools. (Adv Mind Body Med. 2017;31(1):4-9.)
(3) 13.35% for trait anxiety (P < .001), (4) 32.90% for

Manasa Rao, MSc, is a yoga therapist, at SVYASA University


in Bangalore, India. Kashinath Metri, BAMS, MD, PhD, is a Corresponding author: Kashinath Metri, BAMS, MD, PhD
scholar and assistant professor at SVYASA University in E-mail address: kgmhetre@gmail.com
Bangalore, India. Nagaratna Raghuram, MBBS, MD, FRCP, is
chief medical officer of the Holist Health Center at SVYASA
University in Bangalore, India. Nagendra R. Hongasandra,
ME, PhD, is the chancellor of SVYASA University in
Bangalore, India.

4 ADVANCES, WINTER 2017, VOL. 31, NO. 1 Rao—MSRT and Psychological States, Sleep, and Cognition
T
eachers play a vital role in shaping society by molding psychological disorder, (2) had a recent history of a surgical
young and impressionable minds. A tremendous intervention, (3) had sleep problems or were on sleep medication,
increase in the number of schools and in student (4) had neurological or metabolic disorders, (5) had experienced
enrollment throughout the globe during the past 5 decades a head injury or stroke, or (6) were pregnant.
has increased teachers’ responsibilities and stress levels.1,2
Recently, the number of teachers increased throughout the Procedures
world and especially in India.3 MRST is a mindfulness-based, yogic relaxation
Some research has shown that a significant number of technique that includes generation of an internal vibration
teachers suffer from various kinds of psychological and and resonance all over the body after chanting the
physical problems,4 which include voice disorders,5 Mahamrityunjaya mantra and syllables such as A, U, M, and
psychological stress, low self-esteem,6 burnout syndrome,7 and OM, repeatedly. It can be practiced in a sitting or a supine
sleep problems.8,9 Those problems are more predominant position.22,23
among female teachers, with the possible reasons being The intervention was carried out in a silent room at
responsibilities toward society, the school environment 11:00 AM to 12:00 PM in a supine posture. Regular attendance
(as these are added on to their household work and family was assessed by maintaining an attendance register, and
duties),10 family expectations,11 and safety issues. Women are participants with 70% attendance were included in the
more prone to anxiety disorders than men,12 and hence, an statistical analysis.
intense need exists for a novel intervention for those educators.
Yoga is an ancient science that has evolved for thousands Intervention
of years13 and, currently, it is popular as complementary and All the subjects were given a serial number based on
alternative medicine. Regular practice of yoga can help in alphabetical order of their names. The participants were
many health-related conditions, such as asthma, diabetes, randomly divided into an MSRT group (n = 30) and a control
hypertension, osteoarthritis,14 and fatigue.14 It also has been group (n = 30) using computer-based random number
shown to have a positive influence on several mental health generating software.22 Participants in the MSRT group
conditions such as anxiety disorder, schizophrenia, engaged in 30 minutes of MSRT 5 days per week, for
depression, etc.15 It is a well-known stress buster,16 and it also 1 month. The control group followed their normal daily
can alleviate the effects of stress on health.17 routines only.
Research has shown that yoga can improve sleep,18
increase self-esteem,19 enhance cognitive function,20 and Outcome Measures
encourage mindfulness. Yoga has been found to be an Perceived stress, sleep quality, cognitive function,
effective strategy for coping with stress and improving anxiety, psychological distress, fatigue, and self-esteem were
well-being in medical students.21 assessed using standardized assessment tools at baseline and
The mind sound resonance technique (MSRT) is a after 1 month of intervention.
mindfulness-based yoga technique consisting of recitation of Cohen’s Perceived Stress. Cohen’s perceived stress scale
a mantra that repeatedly generates a sound resonance (PSS) is valid and reliable tool to measure perceived stress.23
throughout the body and, thereby, takes the mind to deeper Perceived stress was assessed using PSS. It is the most widely
states of relaxation.21 It is a standard yoga technique, shown used psychological instrument for measuring the perception
to be effective in reducing pain and anxiety and improving of stress. It consists of 10 items.24 A higher score suggests a
cognitive function. greater degree of perceived stress. PSS scores are obtained by
reversing responses (eg, 0 = 4, 1 = 3, 2 = 2, 3 = 1, and 4 = 0) to
METHODS the 4 positively stated items (items 4, 5, 7, and 8) and then
Participants summing across all scale items. A short 4-item scale can be
We made an announcement through posters regarding made from questions 2, 4, 5, and 10 of the PSS 10-item scale
the study in 2 schools of Bangalore City, India. From a total Sleep Quality. The Pittsburgh sleep quality index (PSQI)
of 84 participants willing to participate in the study, who is a valid and reliable tool to assess sleep quality. The
were screened for inclusion and exclusion criteria, 61 eligible individual self-rates each of 7 areas of sleep. Numerous
participants were identified. One of these could not studies using the PSQI in a variety of older adult populations
participate in the study due to a personal reason. Potential internationally have validated PSQI’s high reliability.25 A
participants were female teachers at 2 primary schools who higher score suggests a greater degree of poor sleep quality.
were between 30 and 55 years. The schools were located in Cognitive Function. The digit letter substitution test
Bangalore City, India. (DLST)26 measures cognitive function, such as scanning
Potential participants were included in the study if they memory, psychomotor speed, and visual attention. The test
(1) were female teachers, (2) were aged between 30 and 55 years, consists of a sheet of 8 rows × 12 columns of randomly
(3) were willing to participate in the study, and (4) had no arrayed digits. The key at the top of each sheet pairs each of
previous exposure to any form of yoga practice. Potential the 9 digits with 9 selected letters. Individuals have to write
participants were excluded if they (1) suffered from any the corresponding letters in the empty box below each digit

Rao—MSRT and Psychological States, Sleep, and Cognition ADVANCES, WINTER 2017, VOL. 31. NO. 1 5
and to substitute as many letters for digits as possible in the subscale determines a subscale score that remains on the
test time of 90 seconds. In the current study, the test’s same 0-to-10 numeric scale. Should there be missing item
supervisors timed each test on a standard stopwatch. data, if the respondent has answered at least 75% to 80% of
Anxiety. Anxiety is a feeling of fear, worry, or uneasiness, the remaining items on that particular subscale, a score can
usually generalized and unfocused as an overreaction to a be determined by calculating the subscale mean score based
situation that is only subjectively seen as intimidating.27 Both on the number of items answered and substituting that mean
state and trait anxiety were assessed using Spielberg’s value for the missing item score (mean-item substitution).
State-Trait Anxiety Inventory, which is a valid instrument for The total subscale score can then be recalculated. To calculate
measuring anxiety in adults.28 It consists of 40 items; the first the total fatigue score, add the 22 item scores together and
20 (X-1) assess state anxiety and the later 20 (Y-1) assess trait divide by 22 to keep the score on the same numeric 0-to-10
anxiety. Both the X-1 state and Y-1 trait scales comprise scale. Severity codes are as follows: 0 = none, 1–3 = mild,
20 items each and are scored on 4-point forced-choice 4–6 = moderate, and 7–10 = severe.
Likert-type response scales. Scores range from 20 to 80, with Self-esteem. In sociology and psychology, self-esteem
higher scores suggesting greater levels of anxiety. Low scores reflects a person’s overall, subjective emotional evaluation of
suggest mild anxiety, median scores suggest moderate his or her own worth. It is a judgment of as well as an attitude
anxiety, whereas high scores suggest severe anxiety. Both toward the self. Self-esteem encompasses beliefs (eg, “I am
scales include direct and reverse-worded items. competent” or “I am worthy”) and emotions such as triumph,
Direct-worded items represent the presence of anxiety in a despair, pride, and shame.31The study used Rosenberg’s
statement such as, “I feel worried.” Reverse-worded items self-esteem scale,32 which is a 10-item scale that measures
represent the absence of anxiety in a statement such as, “I feel global self-worth by determining both positive and negative
secure.” The 4-point A-State intensity response scale is as feelings about the self. All items are answered using a 4-point
follows: Likert scale, with 1 = strongly agree, 2 = agree, 3 = disagree,
and 4 = strongly disagree. A higher score suggests a greater
1. Not at all. degree of self-esteem.
2. Somewhat.
3. Moderately so. Statistical Analysis
4. Very much so. The data analysis was performed using SPSS version 10
(IBM, Armonk, NY, USA). The research team applied the
The 4-point A-Trait frequency response scale is as follows: Shapiro-Wilk test to assess normality. The paired sample
t test and Wilcoxon’s signed-rank test were used to find
1. Almost never. differences within a group, for normal and nonnormal data,
2. Sometimes. respectively. The independent sample t test and
3. Often. Mann-Whitney U test served to identify differences between
4. Almost always. the groups. Significance required P < .05.

Psychological Distress. Psychological distress was RESULTS


measured using the general health questionnaire (GHQ-12). Sixty female teachers participated in the study. No
GHQ-12 is the instrument most frequently used to screen for significant differences existed in participants’ ages,
psychological distress. The scale assesses the individual’s socioeconomic statuses, and educational backgrounds
experience of a particular symptom or behavior for a between the groups (Table 1).
specified timeframe. Each item in the scale is rated on a
4-point scale: 1 = less than usual, 2 = no more than usual, Table 1. Demographics
3 = rather more than usual, and 4 = much more than usual. It
provides a total score of 12 or 36 on the basis of the scoring MSRT Group Control Group
method selected, with 2 methods being available: bimodal Mean ± SD Mean ± SD
(0-0-1-1) or Likert (0-1-2-3) scoring. A higher score suggests Variables (n = 30) (n = 30)
a greater degree of psychological distress.29 Age, y 43.0 ± 9.77 40.0 ± 7.32
Fatigue. Subjective fatigue was assessed using the revised Socioeconomic status upper middle & upper middle &
version of the Piper Fatigue Scale (PFS).30 The PFS consists of middle class middle class
22 items and 4 subscales: (1) behavioral/severity—6 items,
Educational status, y 17.0 ± 1.5 17.3 ± 1.2
(2) affective meaning—5 items, (3) sensory—5 items, and
(4) cognitive/mood—6 items. The standardized alpha for the
entire scale is .97, indicating that some redundancy still may Abbreviations: MSRT, mind sound resonance technique;
exist among the items. SD, standard deviation.
Adding the items contained on each specific subscale
together and dividing by the number of items on that

6 ADVANCES, WINTER 2017, VOL. 31, NO. 1 Rao—MSRT and Psychological States, Sleep, and Cognition
Table 2. Changes From Baseline to Postintervention for the MSRT (n = 30) and Control (n = 30) Groups

MSRT Group Control Group


Baseline Postintervention Baseline Postintervention
Variables Mean ± SD Mean ± SD P Value Mean ± SD Mean ± SD P Value
Perceived stress (PSS) 21.06 ± 6.53 11.16 ± 4.30 <.001a 18.00 ± 4.80 28.00 ± 3.62 <.001a
Sleep quality (PSQL) 5.63 ± 3.31 3.10 ± 1.26 <.001a 4.86 ± 2.52 5.90 ± 1.93 .003a
Cognitive function (DLST) 51.66 ± 20.70 57.80 ± 25.19 .111 55.66 ± 17.31 45.86 ± 18.20 .002a
State anxiety 44.30 ± 12.49 31.56 ± 5.81 <.001a 43.53 ± 10.08 49.33 ± 7.61 <.001a
Trait anxiety 43.23 ± 10.86 37.46 ± 7.16 <.001a 42.76 ± 9.91 51.86 ± 7.45 <.001a
Psychological distress (GHQ) 13.80 ± 8.18 9.26 ± 6.77 <.001a 10.36 ± 5.81 12.53 ± 5.55 .10
Fatigue 93.16 ± 56.78 51.43 ± 25.33 <.001a 93.83 ± 34.34 78.40 ± 40.99 <.001a
Self-esteem 28.63 ± 4.58 32.10 ± 3.16 <.001a 27.63 ± 4.13 26.66 ± 3.41 .89
a
Significant change from preintervention to postintervention.

Abbreviations: MSRT, mind sound resonance technique; SD, standard deviation; PSS, perceived stress scale; GHQ, general
health questionnaire; PSQL, Pittsburgh sleep quality index; DLST, digit letter substitution test.

Table 3. Comparison of the MSRT (n = 30) and Control (n = 30) Groups Postintervention

MSRT Group Control Group


Baseline Postintervention Baseline Postintervention
Variables Mean ± SD Mean ± SD Mean ± SD Mean ± SD P Value
Perceived stress (PSS) 21.06 ± 6.53 11.16 ± 4.30 18.00 ± 4.80 28.00 ± 3.62 <.001a
Sleep quality (PSQL) 5.63 ± 3.31 3.10 ± 1.26 4.86 ± 2.52 5.90 ± 1.93 <.001a
Cognitive function (DLST) 51.66 ± 20.70 57.80 ± 25.19 55.66 ± 17.31 45.86 ± 18.20 .083
State anxiety 44.30 ± 12.49 31.56 ± 5.81 43.53 ± 10.08 49.33 ± 7.61 <.001a
Trait anxiety 43.23 ± 10.86 37.46 ± 7.16 42.76 ± 9.91 51.86 ± 7.45 <.001a
Psychological distress (GHQ) 13.80 ± 8.18 9.26 ± 6.77 10.36 ± 5.81 12.53 ± 5.55 .006a
Fatigue 93.16 ± 56.78 51.43 ± 25.33 93.83 ± 34.34 78.40 ± 40.99 .005a
Self-esteem 28.63 ± 4.58 32.10 ± 3.16 27.63 ± 4.13 26.66 ± 3.41 <.001a

a
Significant change from preintervention to postintervention.

Abbreviations: MRST, mind sound resonance technique; SD, standard deviation; PSS, perceived stress scale; GHQ, general
health questionnaire; PSQL, Pittsburgh sleep quality index; DLST, digit letter substitution test.

Within-group Comparisons (P = .006), and (5) 16.44 for fatigue (P < .001). The group also
MSRT Group. At the completion of 1 month of MSRT showed significant decreases in 3 variables: (1) 3.51% for
practice (Table 2), the study found significant reductions in self-esteem, (2) 21.40% for quality of sleep (P = .003), and
5 variables: (1) 47.01% for perceived stress (P < .001), (3) 17.61% for cognitive function (P = .002).
(2) 28.76% for state anxiety (P < .001), (3) 13.35% for trait
anxiety (P < .001), (4) 32.90% for psychological distress Between-group Comparisons
(P < .001), and (5) 44.79% for fatigue (P < .001). The group When the groups were compared, the study found the
also showed significant improvements in 2 variables: MSRT group’s results for 7 variables were significantly
(1) 44.94% for quality of sleep (P < .001), and (2) 12.12% for different than those of the control group: (1) perceived stress
self-esteem (P < .001). The DLST score for cognitive function (P < .001), (2) quality of sleep (P < .001), (3) state anxiety
increased 11.89%, but the change was not significant (P = .111). (P < .001), (4) trait anxiety (P < .001), (5) psychological
Control Group. The study found significant increases distress (P = .006), (6) fatigue (P = .005), and (7) self-esteem
for 5 variables: (1) 55.56% for perceived stress (P < .001), (P < .001). No significant differences in the DLST scores for
(2) 13.32% for state anxiety (P < .001), (3) 21.28% for trait cognitive function existed between the groups (P = .083).
anxiety (P < .001), (4) 20.95% for psychological distress

Rao—MSRT and Psychological States, Sleep, and Cognition ADVANCES, WINTER 2017, VOL. 31. NO. 1 7
DISCUSSION to prevent and manage stress and its effects on health. The
The aim of the present study was to determine the efficacy technique also leads to deep relaxation, which helps in
of 1 month of MSRT practice on a number of variables, downregulating the hypothalamus-pituitary-axis and reduces
including psychological states, cognitive function, sleep anxiety36 and stress.37 Those results may also explain the
quality, and fatigue in female teachers. After 1 month of the improvements in self-esteem and sleep quality that also have
intervention, the research team observed significant decreases been observed.
in perceived stress (P < .001), state anxiety (P < .001), trait Teaching is a profession that was once thought to be a
anxiety (P < .001), psychological distress (P < .001), and fatigue routine occupation, but it has now become a very complex
(P = .005), together with significant improvements in sleep one. Issues such as litigation, liability, accountability, tenure,
quality (P < .001) and self-esteem (P < .001). and unionization, together with increasingly diverse
In the control group, significant increases in perceived responsibilities and fast-changing ideas, have made teaching
stress (P < .001), state anxiety (P < .001), trait anxiety more stressful. The 2 most cited causes of stress are work
(P < .001), psychological distress (P = .006), and fatigue pressure and students’ misbehavior. A large number of
(P < .001) were observed, together with significant decreases teachers find themselves unable to unwind after school, with
in self-esteem (P < .001), quality of sleep (P = .003), and schoolwork obligations encroaching on personal time.38
cognitive function (P = .002). Teachers need to focus on improving their psychological
The current study clearly showed that MSRT is a feasible, conditions, which directly affects not only their performance
cost-effective, easy-to-accomplish, nonpharmacological but also their quality of life, hence facilitating a congenial
intervention that teachers can use without affecting their atmosphere at school.
daily routines. It can prevent many psychological conditions, This study has several limitations such as (1) small
especially excessive stress. The research team strongly sample size; (2) lack of objective variables; (3) lack of proper
recommends implementing MSRT in school curriculums to blinding; and (4) other possible causes of stress other than
promote teachers’ well-being and, thus, improve the overall jobs, such as family issues, relationship conflicts, and others,
school atmosphere. were not taken into consideration.
A few other studies have looked into the effects of MSRT
on various psychological and physiological variables. In one CONCLUSIONS
study, practice of MSRT reduced state anxiety and improved Practice of MSRT can facilitate a reduction in levels of
cognitive function immediately after the intervention, for stress, anxiety, fatigue, and psychological distress. The
patients with generalized anxiety disorder.33 In another study, relaxation technique also enhances levels of self-esteem and
10 days of an MSRT intervention helped to reduce chronic the quality of sleep in female teachers working in primary
neck pain, tenderness, state and trait anxiety, blood pressure, schools.
and pulse rate while improving neck flexion and extension as
compared with conventional physiotherapy.34 In a third ACKNOWLEDGEMENTS
The authors acknowledge all the women in this study for their participation.
study, improvements in cognitive function were observed
immediately following an MSRT practice in patients with AUTHOR DISCLOSURE STATEMENT
All persons who meet authorship criteria are listed as authors, and all authors certify
type 2 diabetes mellitus.35 that they have participated sufficiently in the work to take public responsibility for the
In the current study, the research team found results content, including participation in the concept, design, analysis, writing, or revision of
following the MSRT that were similar to those of the previous the manuscript. Furthermore, each author certifies that this material or similar material
has not been and will not be submitted to or published in any other publication. And
studies. Two of those previous studies, however, examined authors of this manuscript declare that we do not have any conflict of interest regarding
MRST’s immediate effects, although the one study was a publication and the details mentioned in this manuscript.
10-day intervention. To the best of the research team’s
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