What are the effect parents alcoholism have on their children? 

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CHAPTER II

First, to understand how yoga can be a solution, one must understand how a yoga class, specifically a yin/ restorative class, is implemented. Participants arrive to the space and sit down on their mats. Typically, they are instructed to lay down flat or engage in a supine yin yoga poses to start off the class. This signals the body to relax and sets the atmosphere to lower the body’s stress response. Then they are led in a series of deep breaths. Beginning with a long inhale filling the lungs and expanding the diaphragm, a brief retention of the oxygen, then a slow and steady exhale. This is repeated as many times as is needed, but usually until the instructor can observed physical signs of relaxation such as tension release in the shoulders, limbs and facial muscles. Participants are then led through a sequence of poses, often incorporating props to support the body and modifications for execution with out injury, strain or loss of connection with the breath. Poses are held anywhere from three to five minutes at a time. The instructor continuously cues breathing and often uses the inhale and exhale to get into and out of poses. Once it is nearing the end of the class, the pace slows down even more. This eventually leads to the savasana, mentioned above, which is a seven-minute resting period with the eyes closed. Participants are cued back to an awakened state by a few deep breaths, gentle moving of the fingers and toes, and then brought back to a seated position. This would conclude the yoga practice/ class.

Literature Review

Upon researching this topic, several studies named different causes as factors to reduce stress levels during and after participation in yoga classes. These studies explored levels of stress measured by self-reporting on a questionnaire or a stress/ anxiety assessment tool, measuring heart rate variability (HRV) and measuring cortisol levels in saliva. Above, the components of a yoga practice were highlighted in the class’ implementation, including breathing, physical activity and mindfulness. These components were investigated to find possible correlation with lowered stress levels. This study will investigate the findings in several studies and synthesize ideas and measures that they had in common.

Heart Rate Variability

Increased heart rate and blood pressure are often indicators of stress. When one is in a state of stress, the sympathetic nervous system is activated. This is sometimes referred to as the “fight or flight” response. Heart rate variability (HRV) measures the time between heartbeats and it has been used to examine the differences between the sympathetic (fight or flight) and parasympathetic (rest and digest) nervous system activity. Low frequency (LF), high frequency (HF), LF/HF ratio, normal lower frequency (nLF), normal high frequency (nHF) and nLF/ nHF ratio are all components of measurement for HRV. These and other aspects of cardiac health are often predictors of good/ poor health, tolerance for stress, and vulnerability for disease (Brown & Gerbarg).

Several studies used heart rate or HRV to measure the sample’s stress levels and found that yoga practice was an effective intervention. In the Brown & Gerbarg study, it was found that yoga aided in “Reducing sympathetic and increasing parasympathetic nervous system tone [were] integral to such therapeutic action.” (Brown & Gerbarg, 2009). Additionally, when examining HRV, the Zou et al study, in 2018, found evidence that a high HRV level can indicate one’s good health, physical ability to cope with stress, and a low HRV puts one more at risk for mental health vulnerabilities as well as impairment of the immune system. Through further investigating of yoga as a solution, it was found that “The literature included in this meta-analysis suggests that the evidence for beneficial effects of Yoga on HRV is more robust than that for Tai-Chi. Overall, it appears that as few as two sessions of 30min/week of Yoga may increase nHF (high frequency) and reduce both nLF (low frequency) and LF/HF ratio” (Zou et al., 2018). Anatomical responses can often serve as warnings for increased stress, when able to measure these responses they can be useful for monitoring stress levels.

Levels of the hormone cortisol in one’s saliva is yet another indicator of stress. “One of the primary stress response mediators in humans is the hypothalamo–pituitary–adrenal (HPA) axis. In short, environmental or psychological events perceived as stressful initiate an HPA axis response provoking a cascade of physiological events that ultimately result in the release of the steroid hormone cortisol from the adrenal gland. Cortisol is routinely used as biomarker of stress” (Schmalzl et al., 2018). This study conducted two groups with different stress intervention tactics, yoga movement and yoga breathing. Participants were swabbed the week prior to the yoga program beginning, and the week after, 4 separate times (3 hours apart) in one day during these time periods. After the intervention of the different yoga components, both showed lower levels of salivary cortisol. Biological measures can serve as support for one’s perceived level of stress.

In addition to these biological markers, self-reported levels of stress were used in several studies for further measure. In a study to examine the effect of yoga on stress, anxiety and depression in women, a twenty-one-item questionnaire was used entitled the “Depression Anxiety Stress Scale 21” (DASS-21). The study conducted four week of yoga sessions, three times a week, sixty to seventy minutes each (Shohani et al., 2018). After participants’ pre and post questionnaire scores were analyzed, the conclusion was made that “difference between mean scores of depression, anxiety, stress before and after 12 sessions of regular hatha yoga practice was statistically significant,” with the mean scores dropping 1.5 points for anxiety and 2.2 for stress (Shohani et al., 2018). Other studies used twenty item scale questionnaires, “Daily Stressors” and “Stress and Energy Test” (Granath et al, 2006; Kjellgren et al, 2007). The nature of these measurement tools is similar in that the participant reports their perceived level of stress by taking the assessment. All the dependent variables mentioned are a result of the interventions used in the study via yoga sessions.

Yoga and Stress

How exactly can taking a restorative/ yin yoga class reduce stress? Examining the independent variables, the studies included several components of a yoga class including breath, mindfulness (meditation) and physical activity.

Breathing

All the included studies mentioned the major role that breathing has in a yoga practice. In a yoga class, one either focuses on the inhale and exhale or attempts to control breath through various breathing exercises or styles. In 2009, Brown & Gerbarg highlights how

“studies have shown that mind-body interventions derived from yoga (including breathing) …ameliorate stress-related mental and physical disorders…Reducing sympathetic and increasing parasympathetic nervous system tone are integral to such therapeutic action. Cardiac vagal (parasympathetic) tone has been associated with emotional regulation and empathic response” (Brown & Gerbarg, 2009).

The “parasympathetic tone” refers to one’s ability to activate the “rest and digest” nervous system component which promotes relaxation and regulation of the emotions (Brown & Gerbarg, 2009).

In three separate studies, the breathing component of the yoga sessions were highlighted as having some causal relationship to lower levels of stress. They cite better mental concentration, momentarily forgetting the daily stresses, physical and mental pleasure, as well as lower salivary cortisol levels as results of breathing “control, regulation or techniques” (Schmalzl et al., 2018; Shohani et al., 2018; Zou et al., 2018). More specifically, the Schmalzl et al. study involved two separate groups, one which did a strictly breathing yoga practice and the other that participated in a practice that involved both breath and movement. “The experimental groups primarily differed in regard to the inclusion of an active movement component, the fact that changes in perceived stress and salivary cortisol were observed in both groups, indicates that the movement component was not necessary for driving stress reduction… it can be assumed that the breath regulation employed in both types practices was a key component underlying the reduction of stress parameters” (Schmalzl et al., 2018). A 2009 study expounded more on the specific aspects of breathing techniques and how it can affect the mental state. “The breath regulation component of yoga requires practitioners to practice long and deep diaphragmatic breathing. Such breathing movement may promote maximization of isometric muscle contraction and thus improve respiratory efficiency. It has been suggested that diaphragmatic breathing and rhythmical breathing would exert effects on the autonomic nervous system and the endocrine system which would promote mood stabilization” (Satyapriya, Nagendra, Nagarathna, & Padmalatha, 2009).

Mindfulness/ Meditation

Part of controlling the breath naturally involves some kind of intention. This is precisely where mindfulness comes into play. Several studies observe mindfulness and meditation’s effect on stress. “For those skilled Tai Chi/Yoga practitioners, they frequently achieve a meditative state of mind by adjust breathing model and bodily balance. All these features are favorable factors to help concentrate on the moment and momentarily forgetting stressful events of the daily life… While this may be the case for both Tai-Chi and Yoga, the results of the meta-analysis were more convincing for the latter” (Zou et al., 2018). Mediation is intertwined into the fabric of a yoga class via the breath. Two additional studies report that the concurrent implementation of breathing and meditation sets relaxation and serenity into motion, lowering the levels of physiological and perceived stress (Brown & Gerbarg, 2009; Shohani et al., 2018).

Physical Activity

The final intervention is physical activity and due to the yoga poses being the main component of a yoga class, all the studies had this in common. Yoga sessions incorporate sequences of several postures that can require various levels of athletic ability. The 2018 Zou et al study mentions that like other forms of exercise, when practiced regularly, yoga improves not only physical strength, but mental wellbeing. This can be attributed to the release of two pleasure hormones, serotonin and dopamine that could combat cortisol, the stress hormone (Zou et al., 2018). “As in any other modalities, there are many physiological processes linked to physical and emotional pleasure that may take place while performing Yoga, including hormonal release of serotonin and dopamine” (Zou et al., 2018). Earlier, the Schmalzl et al. two experimental study involving the breathing group and the movement group was mentioned. Though, it was determined that breathing may have been the main cause for measured lower stress levels, they “observed a reduction in perceived stress and salivary cortisol in both experimental groups” in their eight-week yoga program (Schmalzl et al., 2018). Like other forms of exercise, yoga movement brings the focus to the physical, diminishing focus on daily stressors and most likely resulting in one’s reduction of that stress.

A combination of these three yoga components is necessary for bringing forth the restorative and relaxing effects of yoga. Breath, meditation and movement all play a significant role in lowering stress measured by both biological and psychological methods.

The Afrocentric Perspective

In the spirit of the Autonomous Social Work practice at Whitney M. Young School of Social Work, there is always the component of the Afrocentric perspective to consider.

“The Afrocentric perspective recognizes the African origins of Blacks in America. It acknowledges their quest for freedom, justice, and equality. It underscores the extent to which some groups of people have promulgated laws and customs labeling African Americans as an inferior race” (Waymer, 2006).

This effort of other groups to devalue Black people through policy and basic tenets of the dominant culture is a social reality and are some of the very causes of Black people’s stress. It is known that one’s interaction with the micro, mezzo, and macro system all influence emotional health and behavior. Post-slavery in America, Black people’s interaction with the macro system has always been strained. For example, previously there were Jim Crow laws that infringed on Black people’s civil rights. Currently, discriminatory Stop and Frisk laws that profile Black drivers and pedestrians may cause more Black people to have higher levels of stress than other racial populations. These circumstances are still a reality for Black Americans.

Waymer’s article also mentions the Afrocentric perspective’s acknowledgment of Black survival tactics. This is a nod to the strengths model that a social worker practicing the Afrocentric perspective implements would implement. Knowing and considering that Black people have survived attacks on their physical, mental, spiritual well-being since their arrival in America, this would undoubtedly result in high levels of stress, anxiety, depression and consequential challenges with behavior in this population. However, where society may be more inclined to blame Black people for their disenfranchisement and stereotyped “bad behavior”, the

“Afrocentric perspective is in contrast to the deficit model which tends to be a person blame model which emphasizes pathology and a Eurocentric framework which defines and describes desirable and undesirable behaviors. The Afrocentric Perspective places emphasis on the strengths, resilience, and uniqueness of different population groups and offers service responses that respect the cultural integrity of these groups” (Waymer, 2006).

Understanding Afrocentricity is necessary for equality and understanding of all oppressed peoples regardless of race, class, religion sexual orientation and all other determinants of diversity that differ from the majority. It offers a view and foundation that can support problem solving and healing for all people (Waymer, 2006).

In this study, historical context should be considered. First, an understanding of emotional and possibly physical trauma is necessary for considering Black people for a research study. There are several instances of negative outcomes from experiments in Black American history. The Tuskegee experiment is a prime example of this. The group of Black Men involved in this study were deceived into participating, being promised hot meals and free medical services. Infected with syphilis, some were denied treatment and left to the mercy of the diseases course (Kim, 2019). In responsible experimentation, it is important to consider this and learn from the horrible mistakes of past researchers. For example, providing informed consent. The men in the Tuskegee experiment were not informed of the potential risks including anything ranging from severe sickness to death. An ethical study will provide informed consent. Another example from Black American history is that of Henrietta Lacks. She was treated at Johns Hopkins Hospital for cervical cancer and tissue from her cervix was removed without her consent. Her cells were unique and they continued to multiple even after her death. Neither Ms. Lacks nor her beneficiaries ever knew about the widespread use of the cells nor were they compensated for it (Skloot, 2011). It is important to provide proper and fair compensation for participation in the study and an ethical study will consider and implement this practice.

Yoga is not a widespread practice in the Black community. A 2018 study conducted a focus group on complementary and alternative medicines (CAMs) which includes the practice of yoga. CAMs are defined as not being part of traditional/ conventional medicine, but their usage can be coupled with them. “Evidence suggests that while CAM use is greatest in NHWs (Non-Hispanic Whites), approximately 26% of AAs (African Americans) in the United States use CAM therapies” (Tenfelde, Hatchett, & Saban, 2018). This is often due to factors such as beliefs that these practices will interfere with religious beliefs, lack of access to a studio or an instructor, or lack of education about the practices. Even though this group is a small participant in yoga and other alternative healing modalities currently, they are shown to have a strong interest in them. Typical use of these practices is often in environments where traditional medicine is unavailable. It is known that race is often a barrier to quality healthcare. It is also known that health disparities exist in the Black community such as higher rates of diabetes, heart disease, stress, depression and anxiety. This would make yoga a strong contender as an intervention in the Black community (Tenfelde, Hatchett, & Saban, 2018).

Given the history, culture and physical/ mental health vulnerabilities of African Americans, social work intervention using yoga should be implemented more. Any intervention in social work ought to include cultural competency and yoga would be no different. The practitioner should explain the purpose of yoga to ensure the client that it is not a religious practice, but a health practice for physical and mental well-being. In fact, client should be encouraged to combine aspects of their religion into their yoga practice. For example, in yoga or meditation, a social worker can suggest the use of a biblical scripture as a mantra, a phrase that is repeated between inhales and exhales. The social worker can also provide resources to visual representations of Black yoga practitioners and instructors. Similar to mental health stigmas that already exist in this community, it may take time and education to remove hesitancy. However, yoga is a potentially useful and effective intervention in social work practice in the Black community.

When examining and interpreting the findings of the study, history should be taken in consideration. With the unique challenges that Black people experience, past and present, it may impact the results of the experiment. They may be more reluctant to play the role of a subject or perhaps there may be some distrust. These valid feelings could affect the measurement of stress levels prior to and during the experiment. It is important to remain mindful of this, and to combat it from the beginning by using ethical standards in designing the study.

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