1 13CHAPTER 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 hea ...

1. 1
13CHAPTER 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

2. 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

3. 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

4. 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 concentra tion,
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 speci fically,

5. 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 meditativestate 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

6. 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 experime ntal 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

7. 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).

8. 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

9. 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

10. 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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