|LETTER TO EDITOR
|Year : 2016 | Volume
| Issue : 1 | Page : 65-67
Stress management in medical students: A yogic therapy approach
Anant Shhurao Kukade1, Rajesh1, Tikhe Sham Ganpat2, Hongasandra Ramarao Nagendra1
1 Department of Yoga and Management Studies, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, India
2 Department of Yoga, WHO-CC (Yoga) Morarji Desai National Institute of Yoga, New Delhi, India
|Date of Web Publication||25-Jan-2016|
Dr. Tikhe Sham Ganpat
WHO-CC (Yoga) Morarji Desai National Institute of Yoga, No. 68, Ashoka Road, New Delhi - 110 001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kukade AS, Rajesh, Ganpat TS, Nagendra HR. Stress management in medical students: A yogic therapy approach. Int J Educ Psychol Res 2016;2:65-7
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. 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. Consequently, this excessive levels of stress in medical student leads to burnout, dropping out, psychiatric problems, and impact on future performance. 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., Similarly, the perception of stress is under the control of students' personal system of belief and attitude. 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.
| 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. This stress may negatively affect the quality of patient care, patient safety, and professionalism.
The most frequently occurring stressors among the students are related to academic issues. 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 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.
| 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. 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.,,
| 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.,, 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.
| Stress Management in Medical Students|| |
Prior research has revealed that the medical students participating in stress management programs demonstrated 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.
| Yoga: an Effective Stress Management Program|| |
Yoga is effective in decreasing stress and improving general well-being in medical students. 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. 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. Even a short yoga is effective in improving general and mental well-being in medical students. Furthermore, an increase in self-regulation and self-compassion after yoga was reported by medical students. 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. 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. 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. Based on previous literary and experiential review research in yoga, suggested the evidence-based yoga program for effective stress management in medical student may include the following yoga practices:,,,,,,,,,,,,,,
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  for effective stress management in a medical student. The aim of both community medicine and yoga is a health promotion and a disease prevention. 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.
Authors acknowledge Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru for kind support to carry out this work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Malathi A, Damodaran A. Stress due to exams in medical students – Role of yoga. Indian J Physiol Pharmacol 1999;43:218-24.
Adams J. Straining to describe and tackle stress in medical students. Med Educ 2004;38:463-4.
Shah S. British medical students suffer an inordinate amount of stress compared to other university students: Fact or fiction? Adv Med Educ Pract 2015;6:337-8.
Dahan H, Bedos C. A typology of dental students according to their experience of stress: A qualitative study. J Dent Educ 2010;74:95-103.
Al-Samadani KH, Al-Dharrab A. The perception of stress among clinical dental students. Word J Dent 2013;4:24-8.
Paudel S, Subedi N, Shrestha A. Stress and its relief among undergraduate dental students in a tertiary health care centre in Eastern Nepal. Dentistry 2013;3:157.
Acharya S. Factors affecting stress among Indian dental students. J Dent Educ 2003;67:1140-8.
Kulsoom B, Afsar NA. Stress, anxiety, and depression among medical students in a multiethnic setting. Neuropsychiatr Dis Treat 2015;11:1713-22.
Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358-67.
Mareiniss DP. Decreasing GME training stress to foster residents' professionalism. Acad Med 2004;79:825-31.
Babar MG, Hasan SS, Ooi YJ, Ahmed SI, Wong PS, Ahmad SF, et al.
Perceived sources of stress among Malaysian dental students. Int J Med Educ 2015;6:56-61.
Kötter T, Pohontsch NJ, Voltmer E. Stressors and starting points for health-promoting interventions in medical school from the students' perspective: A qualitative study. Perspect Med Educ 2015;4:128-35.
Iqbal S, Gupta S, Venkatarao E. Stress, anxiety and depression among medical undergraduate students and their socio-demographic correlates. Indian J Med Res 2015;141:354-7.
Henning K, Ey S, Shaw D. Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Med Educ 1998;32:456-64.
Roberts LW, Warner TD, Lyketsos C, Frank E, Ganzini L, Carter D. Perceptions of academic vulnerability associated with personal illness: A study of 1,027 students at nine medical schools. Collaborative Research Group on Medical Student Health. Compr Psychiatry 2001;42:1-15.
Dyrbye LN, Thomas MR, Eacker A, Harper W, Massie FS Jr, Power DV, et al.
Race, ethnicity, and medical student well-being in the United States. Arch Intern Med 2007;167:2103-9.
Andrews B, Wilding JM. The relation of depression and anxiety to life-stress and achievement in students. Br J Psychol 2004;95:509-21.
Deas D, Brown ES. Adolescent substance abuse and psychiatric comorbidities. J Clin Psychiatry 2006;67:e02.
Kessler RC, Foster CL, Saunders WB, Stang PE. Social consequences of psychiatric disorders, I: Educational attainment. Am J Psychiatry 1995;152:1026-32.
Shi M, Wang X, Bian Y, Wang L. The mediating role of resilience in the relationship between stress and life satisfaction among Chinese medical students: A cross-sectional study. BMC Med Educ 2015;15:16.
Shapiro SL, Shapiro DE, Schwartz GE. Stress management in medical education: A review of the literature. Acad Med 2000;75:748-59.
Simard AA, Henry M. Impact of a short yoga intervention on medical students' health: A pilot study. Med Teach 2009;31:950-2.
Karthik PS, Chandrasekhar M, Ambareesha K, Nikhil C. Effect of pranayama and suryanamaskar on pulmonary functions in medical students. J Clin Diagn Res 2014;8:BC04-6.
Bansal R, Gupta M, Agarwal B, Sharma S. Impact of short term yoga intervention on mental well being of medical students posted in community medicine: A pilot study. Indian J Community Med 2013;38:105-8.
Bond AR, Mason HF, Lemaster CM, Shaw SE, Mullin CS, Holick EA, et al.
Embodied health: The effects of a mind-body course for medical students. Med Educ Online 2013;18:1-8.
Parshad O, Richards A, Asnani M. Impact of yoga on haemodynamic function in healthy medical students. West Indian Med J 2011;60:148-52.
Velayudhan A, Gayatridevi S, Bhattacharjee RR. Efficacy of behavioral intervention in reducing anxiety and depression among medical students. Ind Psychiatry J 2010;19:41-6.
Malathi A, Damodaran A, Shah N, Krishnamurthy G, Namjoshi P, Ghodke S. Psychophysiological changes at the time of examination in medical students before and after the practice of yoga and relaxation. Indian J Psychiatry 1998;40:35-40.
Gopal A, Mondal S, Gandhi A, Arora S, Bhattacharjee J. Effect of integrated yoga practices on immune responses in examination stress-A preliminary study. Int J Yoga 2011;4:26-32.
Balasubramanian B, Pansare MS. Effect of yoga on aerobic and anaerobic power of muscles. Indian J Physiol Pharmacol 1991;35:281-2.
Dhume RR, Dhume RA. A comparative study of the driving effects of dextroamphetamine and yogic meditation on muscle control for the performance of balance on balance board. Indian J Physiol Pharmacol 1991;35:191-4.
Iyengar B. Light on Yoga. New York: Schocken Books; 1966.
Nagendra HR, Nagaratna R. New Perspective in Stress Management. Bangalore: Vivekananda Kendra Prakashana; 2007. p. 14-79.
Saraswati S. Asana Pranayama Mudra Bandha. Bihar: Yoga Publication Trust; 2005. p. 525-39.
Brahmachari D. Yogasana Vijnana – The Science of Yoga. 1st
ed. Mumbai, India: Asia Publishing House; 1970.
Kuvalayananda S. Asana. Lonavla, India: Kaivalyadhama, S.M.Y.M. Samiti; 1998.