The Effectiveness of Hatha Yoga on Symptoms of Anxiety

173 Pages·2009·0.62 MB·English

The Effectiveness of Hatha Yoga on Symptoms of Anxiety and Related Vulnerabilities,
Mindfulness, and Psychological Wellbeing in Female Health Care Employees

A dissertation proposal submitted in partial fulfillment of the requirements for the degree
of Doctor of Philosophy at George Mason University

By

Karen D. Dunn
Masters in Education
George Mason University, 2006
Bachelor of Science
George Mason University, 2005

Director: Dr. Anastasia Kitsantas, Associate Professor
Graduate School of Education

Summer Semester 2009
George Mason University
Fairfax, VA
Acknowledgements

This project represents the culmination of seven long years of education. Twenty
years ago, I could have never imagined that I would return to school at the age of 39 to
finish my bachelors’ degree, let alone my doctorate. This journey has been made possible
in large part by the love and support of my husband Bill, and my children, Chelsey and
Sam.
I will never forget the look on my husbands’ face when I told him that I believed
God wanted me to walk away from my successful career and go back to school.
Fortunately, Bill shared and continues to share my faith, and he understood and supported
my decision to answer this call to help change the lives of women. Previously, Bill had
stood by me as I worked through my very painful personal struggles in healing from an
abusive childhood. He recognized my need to make my healing complete through this
educational journey. His encouragement and belief in me sustained me toward my goal to
create positive change for others. It is with heartfelt gratitude and love that I dedicate my
dissertation to him.
My committee members each played an important role in the completion of this
manuscript and I could not have accomplished this task without them. My chair, Dr.
Anastasia Kitsantas has been a mentor and also a friend during my undergraduate and
graduate studies. Her unwavering optimism and encouragement kept me going when I
wanted to quit. I am so thankful to her for her dedication and commitment to me. I am
thankful to Dr. Todd Kashdan and his quick intellect, helpful critiques, and inspiring
passion for great science. And to Dr. Kim Sheridan I offer appreciation for her
sensitivity, knowledge, and timely responses to assist me with the specific research
methodology I needed to complete this work.

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Table of Contents

Page
List of Tables………………………………………………………………..vi
List of Figures……………………………………………………………….vii
Abstract…………………………………………………………………….. viii

I. Introduction..................................................................................................1
Background of the Problem.................................................................1
Statement of the Problem....................................................................5
Purpose of the Study............................................................................7
Significance of the Study....................................................................7
Definitions...........................................................................................8

2. Literature Review.......................................................................................11
Mindfulness: An Introduction.............................................................11
Hatha Yoga: A Mindful Practice.........................................................13
Overview of the Literature Related to Mindfulness and Related
Variables.............................................................................................20
Empirical evidence: mindfulness training and wellbeing...................22
Detailed Summaries and Analysis of Empirical Investigations
of Mindfulness-Based Interventions for Stress and/or Anxiety.........30
Anxiety...............................................................................................52
Anxiety Vulnerability.........................................................................55
Self-efficacy........................................................................................63
Summary and Conclusions.................................................................65
Research Questions and Hypotheses..................................................66

3. Methodology...............................................................................................68
Study Setting and Participants.............................................................68
Study Variables...................................................................................72
Instruments..........................................................................................72
Brief Exit Survey and Practice Logs...................................................76
Research Design..................................................................................77
Data Collection Procedures.................................................................79
Fidelity of Treatment............................................................................81
Data Analysis Procedures....................................................................81

4. Results..........................................................................................................87
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Research Question 1: Will Symptoms of Anxiety and Anxiety
Vulnerability Improve from Baseline to Post-Treatment
Assessment?.........................................................................................87
Research Question 2: Will Psychological Wellbeing,
Mindfulness, and Self-efficacy Improve from Baseline to
Post-Treatment Assessments?..............................................................96
Research Question 3: Will Participants Experience Individual
Growth Over Time as Assessed by Weekly Assessments for
Anxiety Symptoms, Perceived Stress, Mindfulness,
And Self-efficacy?...............................................................................101
Exit Survey and Practice Logs............................................................118

5. Discussion...........................................................................................122
Discussion of Results..........................................................................122

Appendix A: Mindful Breathing Exercise.......................................................132
Appendix B: Demographic Questionnaire.......................................................134
Appendix C: Beck Anxiety Inventory (BAI)..................................................135
Appendix D: Experiential Avoidance:
Acceptance & Action Questionnaire (AAQ)..................................................136

Appendix E: Anxiety Sensitivity Index (ASI) .................................................137

Appendix F: Rumination subscale of the Rumination-Reflection
Questionnaire (RRQ) .....................................................................................138

Appendix G: Perceived Stress Scale (PSS)....................................................139

Appendix H: The Philadelphia Mindfulness Scale (PHLMS).......................140
Appendix I: Psychological Scales of Wellbeing (PWB)................................142

Appendix J: State Hope Scale (SHS).............................................................146

Appendix K: Exit Survey...............................................................................147

Appendix L: Daily Practice Log.....................................................................150

Appendix M: Observation Log.......................................................................152
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List of References...........................................................................................154

v
List of Tables

Table Page
1. Comparison of the Defining Characteristics of Mindful Yoga
Practice and Symptoms of Anxiety..................................................................18
2. Empirical Studies of Mindfulness-Based Interventions for
Stress, and/or Anxiety and Wellbeing...............................................................23
3. Contents of a Six-week Hatha Yoga Intervention for Women................................78
4. Data Collection Procedures.....................................................................................80
5. Research Questions and Data Analysis Procedures.................................................85
6. Descriptive Statistics for Anxiety Symptoms and Anxiety Vulnerability................88
7. Wilcoxon Nonparametric Related Samples for Anxiety Symptoms
and Anxiety Vulnerability..................................................................................89
8. Descriptive Statistics for Mindfulness, Self-efficacy, and
Psychological Wellbeing....................................................................................96
9. Wilcoxon Nonparametric Related Samples for Mindfulness,
Self-efficacy, and Psychological Wellbeing......................................................97
10. Descriptive Statistics for the Individual Growth Parameters
for Anxiety Symptoms, Perceived Stress, Mindfulness
and Self-efficacy...............................................................................................116
11. Weekly Practice Minutes by Participant................................................................120

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List of Figures

Figure Page
1. Boxplot of scores (T1 – T7) for the BAI in Wilcoxon test..........................................90
2. Boxplot of scores (T1 – T7) for anxiety vulnerability in Wilcoxon test.....................91
3. Boxplot of score distribution (T1 – T7) for the PSS in Wilcoxon test........................92
4. Boxplot of score distribution (T1 – T7) for ASI in Wilcoxon test..............................93
5. Boxplot of the differences (T1 – T7) for the AAQ in Wilcoxon test..........................94
6. Boxplot of the differences (T1 – T7) for the RRQ in Wilcoxon test..........................95
7. Boxplot of score distribution (T1 – T7) for the PHLMS in Wilcoxon test.................98
8. Boxplot of score distribution (T1 – T7) for the SHS in Wilcoxon test.......................99
9. Boxplot of the differences (T1 – T7) for the PWB in Wilcoxon test........................100
10. Individual growth models for anxiety symptoms (BAI, 0-63)
with observed values..........................................................................................102
11. Individual growth models for perceived stress (PSS, 0-40)
with observed values and nonparametric smoothing (raw data, N = 6).............105
12. Individual growth models for mindfulness (PHLMS, 20-100)
with observed values and nonparametric smoothing (raw data, N = 6)..............107
13. Individual growth models for self-efficacy (SHS, 6-48) featuring
observed values and nonparametric smoothing (raw data, N = 6)......................109
14. Nonparametric smoothing of observed values at group level
for anxiety symptoms (BAI)...............................................................................112
15. Nonparametric smoothing of observed values at group level for
perceived stress...................................................................................................113
16. Nonparametric smoothing of observed values at group level for mindfulness
(PHLMS)............................................................................................................114
17. Nonparametric smoothing of observed values at group level
for self-efficacy....................................................................................................115

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ABSTRACT

THE EFFECTIVENESS OF HATHA YOGA ON SYMPTOMS OF ANXIETY AND
RELATED VULNERABILITIES, MINDFULNESS, AND PSYCHOLOGICAL
WELLBEING IN FEMALE HEALTH CARE EMPLOYEES

Karen D. Dunn, Ph.D.

George Mason University, 2009

Dissertation Director: Dr. Anastasia Kitsantas

The purpose of the current study was to examine the effectiveness of a Hatha
yoga program to reduce anxiety symptoms, and related vulnerabilities, and promote
wellbeing in 6 health care employees. The women in this study reported no previous
experience with a regular yoga or meditation practice, no current diagnosis of an anxiety
disorder, and were not currently under psychological treatment. Baseline and post-
treatment scores on measures to assess anxiety symptoms and related vulnerabilities,
perceived stress, mindfulness, self-efficacy, and psychological well-being were examined.
In addition, growth over time (7 data collection points) was examined for anxiety
symptoms, perceived stress, mindfulness, and self-efficacy to reveal change at the
individual and group level on these variables. It was expected that participants would
report decreases in anxiety symptoms, and related vulnerabilities in post-treatment
assessments, relative to baseline. In addition, it was also expected that participants would
report increases in psychological wellbeing, mindfulness, and self-efficacy compared to
post-treatment. Finally, it was hypothesized that participants would experience growth
(anxiety symptoms, perceived stress, mindfulness, and self-efficacy) over time. Partial
support was found for the hypotheses. Specifically, Wilcoxon tests indicated that overall,
participants experienced a significant improvement in self-efficacy from baseline to post-
treatment. In addition, the women in this sample reported growth over time for anxiety
symptoms and self-efficacy. Women with higher baseline symptoms of anxiety
experienced the most growth over time on this variable. Suggestions for future research
and educational implications are provided.
1. Introduction

“The nature of the body can only be understood as a whole, for it is the great error of our
day in the treatment of the human body, that physicians separate the soul from the body”
HIPPOCRATES

The purpose of this study was to examine the effects of a six-week yoga program
on anxiety symptoms, related vulnerabilities, mindfulness, and psychological wellbeing,
in a non-clinical population of women.
Background of the Problem
Recent studies have reported that anxiety disorders are common in the general
population, and are disproportionately higher in women relative to men. According to a
national study, lifetime prevalence for the development of an anxiety disorder is 28.8%
(Kessler, Berglund, Demler, Jin, Merikangas, & Walters, 2005). It is estimated that
anxiety disorders cost the US over $42 billon per year, comprising a third of the country’s
mental health expenditures (Greenberg, Sitisky, & Kessler, 1999). Approximately $22.84
billion of these costs are due to repeated health care utilization for relief of physical
symptoms related to the disorder costs (Anxiety Disorders Association of America;
ADAA).
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