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Letter to Editor
Stress management in medical students:
A yogic therapy approach
Sir,
A student under optimal stress does bring out his or her best,
however, the extremes of stress can result in stress induced
disorders and deteriorating performance.[1] Medical school
training is intended to prepare graduates for a personally
rewarding and socially meaningful career. However, the
reports have shown that this is a time of great personal distress
for medical students, and they suffer significantly higher
levels of stress than the age‑matched general population.[2]
Consequently, this excessive levels of stress in medical student
leads to burnout, dropping out, psychiatric problems, and
impact on future performance.[3] However, it is also important
to note that some stress is necessary to drive medical students
to perform better, build character, and prepare them for the
demands of future medical practice. It is now well‑known that
stress is a normal response of a body to any demands while
stressors are the demands and pressure that lead to stress.
Further, stress results due to the discrepancy between excessive
pressure and different types of demand and individual
capacities to fulfill these demands.[4,5] Similarly, the perception
of stress is under the control of students’ personal system of
belief and attitude.[6] The stressors in student also can vary
with their personal attitude, belief, and cultural background.
The distorted perceptions overemphasize their limitations
and make the situation more stressful.[7]
Academic Issues and Curriculum Planning
in Medical Education
Medical education with study burden and a busy schedule
might adversely affect the students’ mental health and there
is a concern regarding the mental well‑being of the medical
students. Similarly, the medical students have high “baseline”
traits of depression, anxiety, and stress, and these are higher
if an examination is near. Smoking and female sex predicts
the higher levels of “baseline” depression, anxiety, or stress.
The study burden and a busy schedule of medical education
are the major reasons for high depression, anxiety, and stress
scale‑21 scores.[8] This stress may negatively affect the quality
of patient care, patient safety,[9] and professionalism.[10]
The most frequently occurring stressors among the students
are related to academic issues.[11] Therefore, the academic
and nonacademic stressors need to be considered in
curriculum planning, and a mechanism need be in place
to monitor and address the medical students’ stress. The
© 2016 International Journal of Educational and Psychological Researches | Published by Wolters Kluwer - Medknow
stressed students may benefit by improving the academic
support systems via senior students, academic staff, and
counselor driven continuous mentoring. The medical
student requires increased stress awareness, improved coping
skills, and focused support. Sometimes, the involvement of
the parents may be necessary. The medical students must
be equipped with the necessary skills to assess personal
distress, determine its effect on professional growth,
recognize when to seek help, and develop the strategies to
promote mental well‑being. Stressors and starting points
for health‑promoting interventions are closely related to
the medical curriculum and its organization. Therefore,
the curriculum itself in addition to a program aimed at
improving stress management should be the primary stands
at the center of activities for enhancing students’ health.[12]
Undergraduate Medical Education
A substantial proportion of medical undergraduate students
was found to be depressed, anxious, and stressed revealing a
neglected area of the students’ psychology.[13] Undergraduate
medical education comprises the strenuous course burden
and hectic schedule for 5–6 years. Due to the expanding
knowledge and evolving therapies, the medical students
need to acquire adequate professional knowledge, skill, and
attitudes in order to prepare themselves to deal with lifelong
professional challenges independently. This course burden
and hectic schedule adversely affect the medical student’s
physical and mental health. Therefore, the medical students
suffer from depression, anxiety, and stress.[14‑16]
Postgraduate Medical Education
The competition for getting postgraduate training and
job opportunities is an additional trigger for psychological
illness. Consequently, the poor academic performance,
increased rates of substance use, and suicide is becoming
common in medical students.[17‑19] Therefore, some sound
intervention strategies or stress management program
could be incorporated in medical education to help medical
students to better deal with their stress that may lead an
effective mental well‑being among the medical students.[20]
Stress Management in Medical Students
Prior research has revealed that the medical students
participating in stress management programs demonstrated
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Letter to Editor
to improve the immunologic functioning, decreases in
depression and anxiety, increased spirituality and empathy,
enhanced knowledge of alternative therapies for future
referrals, improved knowledge of the effects of stress,
greater use of positive coping skills, and the ability to
resolve role conflicts.[21]
Yoga: An Effective Stress Management
Program
Yoga is effective in decreasing stress and improving
general well‑being in medical students.[22] In addition,
compared to the control group, the medical students
undergoing yoga reported various beneficial effects
such as better sense of well‑being, feeling of relaxation,
improved concentration, self‑confidence, improved
efficiency, good interpersonal relationship, increased
attentiveness, lowered irritability levels, and an optimistic
outlook in life were. Furthermore, these results point to
the beneficial role of yoga in not only causing a reduction
in basal anxiety level but also attenuating the increase in
anxiety score in a stressful state such as exams. Similarly,
the results of the exam indicated a statistically significant
reduction in a number of failures in the yoga group as
compared to the control group.[1] Medical students also
reported that improved pulmonary functions related to
vital capacity, tidal volume, expiratory reserve volume,
breath holding time, 40 mm endurance, and peak
expiratory flow rate following yoga training.[23] Even a
short yoga is effective in improving general and mental
well‑being in medical students. [24] Furthermore, an
increase in self‑regulation and self‑compassion after yoga
was reported by medical students.[25] The practice of yoga
even for a short period showed the ability to improve most
of the cardiovascular functions in medical students. The
regular practice of yoga for a longer period may further
improve these functions and possible result in improved
management of their daily stress.[26] Counseling certainly
helped to increase the levels of self‑confidence and the
ability of adjustment of the medical students. Moreover,
the relaxation technique, which is a part of yoga, have
time and again proved that they are adjunct to medicine
in a number of ways; thus they have to be imbibed as
a way of life for many to overcome the stress related
problems.[27] The effect of yoga and relaxation changes
in psychophysiological parameters such as anxiety level,
heart rate, blood pressure, and galvanic skin resistance in
response to the stress of examination in medical students
reported the significant improvement in choice reaction
time in yoga and relaxation group as compared to control
group.[28] Based on previous literary and experiential
review research in yoga, suggested the evidence‑based
66 International Journal of Educational and Psychological Researches / Vol 2 / Issue 1 / January-March 2016
yoga program for effective stress management in medical
student may include the following yoga practices:[1,22‑26,28‑36]
Shithilikarana Vyayama (loosening and stretching practices)
• Suryanamaskara (salutations to the sun)
Asana (postures)
• Eka Pada Pranamasana (one‑legged prayer pose)
• Simhagarjanasana (roaring lion pose)
• Bhujangasana (cobra pose)
• Shashankasana (pose of the moon or hare pose)
• Sarvangasana (shoulder stand pose)
• Matsyasana (fish pose)
• Shavasana (corpse pose)/Yoga Nidra (psychic sleep)
Pranayama (breathing practices)
• Nadi Shodhana Pranayama  (psychic network
purification)
• Ujjayi Pranayama (the psychic breath)
• Bhramari Pranayama (humming bee breath)
Dharana and Dhyana (concentration and meditation
practices)
• OM Meditation (OM chanting)
Kriya (cleansing practices)
• Jala Neti (nasal cleansing with water).
Conclusions and Recommendations
Yoga is an easy, safe, low cost, acceptable, and scientifically
validated preventive approach [28] for effective stress
management in a medical student. The aim of both
community medicine and yoga is a health promotion and
a disease prevention.[24] Therefore, there is a strong reason
to include yoga in teaching a curriculum of community
medicine. This will allow our future doctors to adopt and
maintain the positive health, and disseminate the same
to their patients and the community.
Acknowledgment
Authors acknowledge Swami Vivekananda Yoga
Anusandhana Samsthana University, Bengaluru for kind
support to carry out this work.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Anant Shhurao Kukade, Rajesh, Tikhe Sham Ganpat1,
Hongasandra Ramarao Nagendra
 Department of Yoga and Management Studies, Swami Vivekananda
Yoga Anusandhana Samsthana University, Bengaluru, Karnataka,
1
Department of Yoga,  WHO‑CC (Yoga) Morarji Desai National
Institute of Yoga, New Delhi, India
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Letter to Editor

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