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Effects of Mind Sound Resonance Technique (Yogic relaxation) on

Psychological States, Sleep Quality, and Cognitive Functions in Female
Teachers: A Randomized, Controlled Trial

Article  in  Advances in mind-body medicine · March 2017

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 ORIGINAL RESEARCH
Effects of Mind Sound Resonance Technique
(Yogic Relaxation) on Psychological States, Sleep
Quality, and Cognitive Functions in Female
Teachers: A Randomized, Controlled Trial
Manas Rao, MSc; Kashinath Metri, BAMS, MD, PhD; Nagaratna Raghuram, MBBS, MD, FRCP;
Nagendra R. Hongasandra, ME, PhD
ABSTRACT
Context • Several studies have revealed a high rate of
physical and psychological problems from stress among
schoolteachers. Yoga is one of the mind-body interventions
known to alleviate stress and effects. The mind sound
resonance technique (MSRT), a yoga-based, mindfulness
relaxation is recognized as having a positive influence on
physical and psychological health.
Objectives • The study intended to examine the effects of
an MSRT intervention for 1 mo on perceived stress,
quality of sleep, cognitive function, state and trait anxiety,
psychological distress, and fatigue among female teachers.
Design • The study was a randomized, controlled trial.
Setting • The study occurred at 2 primary schools in
Bangalore City, India.
Participants • Sixty female teachers, aged between 30 and
55 y, from the 2 schools were enrolled in the study.
Intervention • The participants were randomly divided
into an MSRT group (n = 30) and a control group (n = 30).
Participants in the MSRT group participated in MSRT for
30 min/d, 5 d/wk, for the duration of 1 mo. The participants
in the control group followed their normal daily routines.
Outcome measures • Perceived stress, sleep quality,
cognitive function, anxiety, psychological distress, fatigue,
and self-esteem were assessed using standardized assessment
tools at baseline and after 1 mo of the intervention.
Results • In the MSRT group, a significant reduction
occurred for 5 variables: (1) 47.01% for perceived stress
(P < .001), (2) 28.76% for state anxiety (P < .001),
(3) 13.35% for trait anxiety (P < .001), (4) 32.90% for
Manasa Rao, MSc, is a yoga therapist, at SVYASA University
in Bangalore, India. Kashinath Metri, BAMS, MD, PhD, is a
scholar and assistant professor at SVYASA University in
Bangalore, India. Nagaratna Raghuram, MBBS, MD, FRCP, is
chief medical officer of the Holist Health Center at SVYASA
University in Bangalore, India. Nagendra R. Hongasandra,
ME, PhD, is the chancellor of SVYASA University in
Bangalore, India.
4 ADVANCES, WINTER 2017, VOL. 31, NO. 1
psychological distress (P < .001), and (5) 44.79% for
fatigue (P < .001). A significant improvement occurred for
that group for 2 variables: (1) 44.94% for quality of sleep
(P < .001), and (2) 12.12% for self-esteem (P < .001). An
11.88% increase occurred for the group for cognitive
function, but the change was not significant (P = .111). On
the other hand, the control group showed significant
increases in 5 variables: (1) 55.56% for perceived stress
(P < .001), (2) 13.32% for state anxiety (P < .001),
(3) 21.28% for trait anxiety (P < .001), (4) 20.95% for
psychological distress (P = .103), and (5) 16.44% for
fatigue (P < .001). The group also showed significant
decreases in 3 variables: (1) 3.51% for self-esteem
(P < .001), (2) 21.39% for quality of sleep (P = .003), and
(3) 17.60% for cognitive function (P = .002). A comparison
between the 2 groups showed significant differences in
7 variables: (1) perceived stress (P < .001), (2) quality of
sleep (P < .001), (3) state anxiety (P < .001), (4) trait anxiety
(P < .001), (5) psychological distress (P = .006), (6) fatigue
(P = .005), and (7) self-esteem (P < .001). No significant
differences existed between the groups in cognitive
function (P = .083).
Conclusions • In the current study, the practice of MSRT
facilitated a reduction in the levels of stress, anxiety,
fatigue, and psychological distress. The relaxation
technique also enhanced the levels of self-esteem and
quality of sleep among female teachers working in primary
schools. (Adv Mind Body Med. 2017;31(1):4-9.)
Corresponding author: Kashinath Metri, BAMS, MD, PhD
E-mail address: kgmhetre@gmail.com
Rao—MSRT and Psychological States, Sleep, and Cognition
T
eachers play a vital role in shaping society by molding
young and impressionable minds. A tremendous
increase in the number of schools and in student
enrollment throughout the globe during the past 5 decades
has increased teachers’ responsibilities and stress levels.1,2
Recently, the number of teachers increased throughout the
world and especially in India.3
Some research has shown that a significant number of
teachers suffer from various kinds of psychological and
physical problems,4 which include voice disorders,5
psychological stress, low self-esteem,6 burnout syndrome,7 and
sleep problems.8,9 Those problems are more predominant
among female teachers, with the possible reasons being
responsibilities toward society, the school environment
(as these are added on to their household work and family
duties),10 family expectations,11 and safety issues. Women are
more prone to anxiety disorders than men,12 and hence, an
intense need exists for a novel intervention for those educators.
Yoga is an ancient science that has evolved for thousands
of years13 and, currently, it is popular as complementary and
alternative medicine. Regular practice of yoga can help in
many health-related conditions, such as asthma, diabetes,
hypertension, osteoarthritis,14 and fatigue.14 It also has been
shown to have a positive influence on several mental health
conditions such as anxiety disorder, schizophrenia,
depression, etc.15 It is a well-known stress buster,16 and it also
can alleviate the effects of stress on health.17
Research has shown that yoga can improve sleep,18
increase self-esteem,19 enhance cognitive function,20 and
encourage mindfulness. Yoga has been found to be an
effective strategy for coping with stress and improving
well-being in medical students.21
The mind sound resonance technique (MSRT) is a
mindfulness-based yoga technique consisting of recitation of
a mantra that repeatedly generates a sound resonance
throughout the body and, thereby, takes the mind to deeper
states of relaxation.21 It is a standard yoga technique, shown
to be effective in reducing pain and anxiety and improving
cognitive function.
METHODS
Participants
We made an announcement through posters regarding
the study in 2 schools of Bangalore City, India. From a total
of 84 participants willing to participate in the study, who
were screened for inclusion and exclusion criteria, 61 eligible
participants were identified. One of these could not
participate in the study due to a personal reason. Potential
participants were female teachers at 2 primary schools who
were between 30 and 55 years. The schools were located in
Bangalore City, India.
Potential participants were included in the study if they
(1) were female teachers, (2) were aged between 30 and 55 years,
(3) were willing to participate in the study, and (4) had no
previous exposure to any form of yoga practice. Potential
participants were excluded if they (1) suffered from any
Rao—MSRT and Psychological States, Sleep, and Cognition
psychological disorder, (2) had a recent history of a surgical
intervention, (3) had sleep problems or were on sleep medication,
(4) had neurological or metabolic disorders, (5) had experienced
a head injury or stroke, or (6) were pregnant.
Procedures
MRST is a mindfulness-based, yogic relaxation
technique that includes generation of an internal vibration
and resonance all over the body after chanting the
Mahamrityunjaya mantra and syllables such as A, U, M, and
OM, repeatedly. It can be practiced in a sitting or a supine
position.22,23
The intervention was carried out in a silent room at
11:00 AM to 12:00 PM in a supine posture. Regular attendance
was assessed by maintaining an attendance register, and
participants with 70% attendance were included in the
statistical analysis.
Intervention
All the subjects were given a serial number based on
alphabetical order of their names. The participants were
randomly divided into an MSRT group (n = 30) and a control
group (n = 30) using computer-based random number
generating software.22 Participants in the MSRT group
engaged in 30 minutes of MSRT 5 days per week, for
1 month. The control group followed their normal daily
routines only.
Outcome Measures
Perceived stress, sleep quality, cognitive function,
anxiety, psychological distress, fatigue, and self-esteem were
assessed using standardized assessment tools at baseline and
after 1 month of intervention.
Cohen’s Perceived Stress. Cohen’s perceived stress scale
(PSS) is valid and reliable tool to measure perceived stress.23
Perceived stress was assessed using PSS. It is the most widely
used psychological instrument for measuring the perception
of stress. It consists of 10 items.24 A higher score suggests a
greater degree of perceived stress. PSS scores are obtained by
reversing responses (eg, 0 = 4, 1 = 3, 2 = 2, 3 = 1, and 4 = 0) to
the 4 positively stated items (items 4, 5, 7, and 8) and then
summing across all scale items. A short 4-item scale can be
made from questions 2, 4, 5, and 10 of the PSS 10-item scale
Sleep Quality. The Pittsburgh sleep quality index (PSQI)
is a valid and reliable tool to assess sleep quality. The
individual self-rates each of 7 areas of sleep. Numerous
studies using the PSQI in a variety of older adult populations
internationally have validated PSQI’s high reliability.25 A
higher score suggests a greater degree of poor sleep quality.
Cognitive Function. The digit letter substitution test
(DLST)26 measures cognitive function, such as scanning
memory, psychomotor speed, and visual attention. The test
consists of a sheet of 8 rows × 12 columns of randomly
arrayed digits. The key at the top of each sheet pairs each of
the 9 digits with 9 selected letters. Individuals have to write
the corresponding letters in the empty box below each digit
ADVANCES, WINTER 2017, VOL. 31. NO. 1 5
and to substitute as many letters for digits as possible in the
test time of 90 seconds. In the current study, the test’s
supervisors timed each test on a standard stopwatch.
Anxiety. Anxiety is a feeling of fear, worry, or uneasiness,
usually generalized and unfocused as an overreaction to a
situation that is only subjectively seen as intimidating.27 Both
state and trait anxiety were assessed using Spielberg’s
State-Trait Anxiety Inventory, which is a valid instrument for
measuring anxiety in adults.28 It consists of 40 items; the first
20 (X-1) assess state anxiety and the later 20 (Y-1) assess trait
anxiety. Both the X-1 state and Y-1 trait scales comprise
20 items each and are scored on 4-point forced-choice
Likert-type response scales. Scores range from 20 to 80, with
higher scores suggesting greater levels of anxiety. Low scores
suggest mild anxiety, median scores suggest moderate
anxiety, whereas high scores suggest severe anxiety. Both
scales include direct and reverse-worded items.
Direct-worded items represent the presence of anxiety in a
statement such as, “I feel worried.” Reverse-worded items
represent the absence of anxiety in a statement such as, “I feel
secure.” The 4-point A-State intensity response scale is as
follows:
1. Not at all.
2. Somewhat.
3. Moderately so.
4. Very much so.
The 4-point A-Trait frequency response scale is as follows:
1. Almost never.
2. Sometimes.
3. Often.
4. Almost always.
Psychological Distress. Psychological distress was
measured using the general health questionnaire (GHQ-12).
GHQ-12 is the instrument most frequently used to screen for
psychological distress. The scale assesses the individual’s
experience of a particular symptom or behavior for a
specified timeframe. Each item in the scale is rated on a
4-point scale: 1 = less than usual, 2 = no more than usual,
3 = rather more than usual, and 4 = much more than usual. It
provides a total score of 12 or 36 on the basis of the scoring
method selected, with 2 methods being available: bimodal
(0-0-1-1) or Likert (0-1-2-3) scoring. A higher score suggests
a greater degree of psychological distress.29
Fatigue. Subjective fatigue was assessed using the revised
version of the Piper Fatigue Scale (PFS).30 The PFS consists of
22 items and 4 subscales: (1) behavioral/severity—6 items,
(2) affective meaning—5 items, (3) sensory—5 items, and
(4) cognitive/mood—6 items. The standardized alpha for the
entire scale is .97, indicating that some redundancy still may
exist among the items.
Adding the items contained on each specific subscale
together and dividing by the number of items on that
6 ADVANCES, WINTER 2017, VOL. 31, NO. 1
subscale determines a subscale score that remains on the
same 0-to-10 numeric scale. Should there be missing item
data, if the respondent has answered at least 75% to 80% of
the remaining items on that particular subscale, a score can
be determined by calculating the subscale mean score based
on the number of items answered and substituting that mean
value for the missing item score (mean-item substitution).
The total subscale score can then be recalculated. To calculate
the total fatigue score, add the 22 item scores together and
divide by 22 to keep the score on the same numeric 0-to-10
scale. Severity codes are as follows: 0 = none, 1–3 = mild,
4–6 = moderate, and 7–10 = severe.
Self-esteem. In sociology and psychology, self-esteem
reflects a person’s overall, subjective emotional evaluation of
his or her own worth. It is a judgment of as well as an attitude
toward the self. Self-esteem encompasses beliefs (eg, “I am
competent” or “I am worthy”) and emotions such as triumph,
despair, pride, and shame.31The study used Rosenberg’s
self-esteem scale,32 which is a 10-item scale that measures
global self-worth by determining both positive and negative
feelings about the self. All items are answered using a 4-point
Likert scale, with 1 = strongly agree, 2 = agree, 3 = disagree,
and 4 = strongly disagree. A higher score suggests a greater
degree of self-esteem.
Statistical Analysis
The data analysis was performed using SPSS version 10
(IBM, Armonk, NY, USA). The research team applied the
Shapiro-Wilk test to assess normality. The paired sample
t test and Wilcoxon’s signed-rank test were used to find
differences within a group, for normal and nonnormal data,
respectively. The independent sample t test and
Mann-Whitney U test served to identify differences between
the groups. Significance required P < .05.
RESULTS
Sixty female teachers participated in the study. No
significant differences existed in participants’ ages,
socioeconomic statuses, and educational backgrounds
between the groups (Table 1).
Table 1. Demographics
MSRT Group Control Group
Mean ± SD Mean ± SD
Variables (n = 30) (n = 30)
Age, y 43.0 ± 9.77 40.0 ± 7.32
Socioeconomic status upper middle & upper middle &
middle class middle class
Educational status, y 17.0 ± 1.5 17.3 ± 1.2
Abbreviations: MSRT, mind sound resonance technique;
SD, standard deviation.
Rao—MSRT and Psychological States, Sleep, and Cognition
Table 2. Changes From Baseline to Postintervention for the MSRT (n = 30) and Control (n = 30) Groups

MSRT Group Control Group

Baseline Postintervention Baseline Postintervention
Variables Mean ± SD Mean ± SD P Value Mean ± SD Mean ± SD P Value
Perceived stress (PSS) 21.06 ± 6.53 11.16 ± 4.30 <.001a 18.00 ± 4.80 28.00 ± 3.62 <.001a
Sleep quality (PSQL) 5.63 ± 3.31 3.10 ± 1.26 <.001a 4.86 ± 2.52 5.90 ± 1.93 .003a
Cognitive function (DLST) 51.66 ± 20.70 57.80 ± 25.19 .111 55.66 ± 17.31 45.86 ± 18.20 .002a
State anxiety 44.30 ± 12.49 31.56 ± 5.81 <.001a 43.53 ± 10.08 49.33 ± 7.61 <.001a
Trait anxiety 43.23 ± 10.86 37.46 ± 7.16 <.001a 42.76 ± 9.91 51.86 ± 7.45 <.001a
Psychological distress (GHQ) 13.80 ± 8.18 9.26 ± 6.77 <.001a 10.36 ± 5.81 12.53 ± 5.55 .10
Fatigue 93.16 ± 56.78 51.43 ± 25.33 <.001a 93.83 ± 34.34 78.40 ± 40.99 <.001a
Self-esteem 28.63 ± 4.58 32.10 ± 3.16 <.001a 27.63 ± 4.13 26.66 ± 3.41 .89
a
Significant change from preintervention to postintervention.

Abbreviations: MSRT, mind sound resonance technique; SD, standard deviation; PSS, perceived stress scale; GHQ, general
health questionnaire; PSQL, Pittsburgh sleep quality index; DLST, digit letter substitution test.

Table 3. Comparison of the MSRT (n = 30) and Control (n = 30) Groups Postintervention

MSRT Group Control Group

Baseline Postintervention Baseline Postintervention
Variables Mean ± SD Mean ± SD Mean ± SD Mean ± SD P Value
Perceived stress (PSS) 21.06 ± 6.53 11.16 ± 4.30 18.00 ± 4.80 28.00 ± 3.62 <.001a
Sleep quality (PSQL) 5.63 ± 3.31 3.10 ± 1.26 4.86 ± 2.52 5.90 ± 1.93 <.001a
Cognitive function (DLST) 51.66 ± 20.70 57.80 ± 25.19 55.66 ± 17.31 45.86 ± 18.20 .083
State anxiety 44.30 ± 12.49 31.56 ± 5.81 43.53 ± 10.08 49.33 ± 7.61 <.001a
Trait anxiety 43.23 ± 10.86 37.46 ± 7.16 42.76 ± 9.91 51.86 ± 7.45 <.001a
Psychological distress (GHQ) 13.80 ± 8.18 9.26 ± 6.77 10.36 ± 5.81 12.53 ± 5.55 .006a
Fatigue 93.16 ± 56.78 51.43 ± 25.33 93.83 ± 34.34 78.40 ± 40.99 .005a
Self-esteem 28.63 ± 4.58 32.10 ± 3.16 27.63 ± 4.13 26.66 ± 3.41 <.001a

a
Significant change from preintervention to postintervention.

Abbreviations: MRST, mind sound resonance technique; SD, standard deviation; PSS, perceived stress scale; GHQ, general
health questionnaire; PSQL, Pittsburgh sleep quality index; DLST, digit letter substitution test.

Within-group Comparisons
MSRT Group. At the completion of 1 month of MSRT
practice (Table 2), the study found significant reductions in
5 variables: (1) 47.01% for perceived stress (P < .001),
(2) 28.76% for state anxiety (P < .001), (3) 13.35% for trait
anxiety (P < .001), (4) 32.90% for psychological distress
(P < .001), and (5) 44.79% for fatigue (P < .001). The group
also showed significant improvements in 2 variables:
(1) 44.94% for quality of sleep (P < .001), and (2) 12.12% for
self-esteem (P < .001). The DLST score for cognitive function
increased 11.89%, but the change was not significant (P = .111).
Control Group. The study found significant increases
for 5 variables: (1) 55.56% for perceived stress (P < .001),
(2) 13.32% for state anxiety (P < .001), (3) 21.28% for trait
anxiety (P < .001), (4) 20.95% for psychological distress
(P = .006), and (5) 16.44 for fatigue (P < .001). The group also
showed significant decreases in 3 variables: (1) 3.51% for
self-esteem, (2) 21.40% for quality of sleep (P = .003), and
(3) 17.61% for cognitive function (P = .002).
Between-group Comparisons
When the groups were compared, the study found the
MSRT group’s results for 7 variables were significantly
different than those of the control group: (1) perceived stress
(P < .001), (2) quality of sleep (P < .001), (3) state anxiety
(P < .001), (4) trait anxiety (P < .001), (5) psychological
distress (P = .006), (6) fatigue (P = .005), and (7) self-esteem
(P < .001). No significant differences in the DLST scores for
cognitive function existed between the groups (P = .083).

Rao—MSRT and Psychological States, Sleep, and Cognition ADVANCES, WINTER 2017, VOL. 31. NO. 1 7
DISCUSSION
The aim of the present study was to determine the efficacy
of 1 month of MSRT practice on a number of variables,
including psychological states, cognitive function, sleep
quality, and fatigue in female teachers. After 1 month of the
intervention, the research team observed significant decreases
in perceived stress (P < .001), state anxiety (P < .001), trait
anxiety (P < .001), psychological distress (P < .001), and fatigue
(P = .005), together with significant improvements in sleep
quality (P < .001) and self-esteem (P < .001).
In the control group, significant increases in perceived
stress (P < .001), state anxiety (P < .001), trait anxiety
(P < .001), psychological distress (P = .006), and fatigue
(P < .001) were observed, together with significant decreases
in self-esteem (P < .001), quality of sleep (P = .003), and
cognitive function (P = .002).
The current study clearly showed that MSRT is a feasible,
cost-effective, easy-to-accomplish, nonpharmacological
intervention that teachers can use without affecting their
daily routines. It can prevent many psychological conditions,
especially excessive stress. The research team strongly
recommends implementing MSRT in school curriculums to
promote teachers’ well-being and, thus, improve the overall
school atmosphere.
A few other studies have looked into the effects of MSRT
on various psychological and physiological variables. In one
study, practice of MSRT reduced state anxiety and improved
cognitive function immediately after the intervention, for
patients with generalized anxiety disorder.33 In another study,
10 days of an MSRT intervention helped to reduce chronic
neck pain, tenderness, state and trait anxiety, blood pressure,
and pulse rate while improving neck flexion and extension as
compared with conventional physiotherapy.34 In a third
study, improvements in cognitive function were observed
immediately following an MSRT practice in patients with
type 2 diabetes mellitus.35
In the current study, the research team found results
following the MSRT that were similar to those of the previous
studies. Two of those previous studies, however, examined
MRST’s immediate effects, although the one study was a
10-day intervention. To the best of the research team’s
knowledge, the current study is the only randomized
controlled study to date with a duration for the MSRT that
was longer.
Stress is a commonly observed psychological problem in
all almost all professions; teaching is one of them. Long-
standing, chronic stress affects the physical and psychological
health of the instructor and can lead to anxiety, depression,
low self-esteem, sleep problems, hypertension, and diabetes,
among other health issues. Hence, it is important to
implement a potent intervention such as yoga.
MSRT is a mindfulness-based relaxation technique and
an effective yogic and nonpharmacological intervention that
can be practiced by anybody at any time, and it has a positive
effect on psychological well-being. Implementation of MSRT
in all demanding professions could help their professionals
8 ADVANCES, WINTER 2017, VOL. 31, NO. 1
to prevent and manage stress and its effects on health. The
technique also leads to deep relaxation, which helps in
downregulating the hypothalamus-pituitary-axis and reduces
anxiety36 and stress.37 Those results may also explain the
improvements in self-esteem and sleep quality that also have
been observed.
Teaching is a profession that was once thought to be a
routine occupation, but it has now become a very complex
one. Issues such as litigation, liability, accountability, tenure,
and unionization, together with increasingly diverse
responsibilities and fast-changing ideas, have made teaching
more stressful. The 2 most cited causes of stress are work
pressure and students’ misbehavior. A large number of
teachers find themselves unable to unwind after school, with
schoolwork obligations encroaching on personal time.38
Teachers need to focus on improving their psychological
conditions, which directly affects not only their performance
but also their quality of life, hence facilitating a congenial
atmosphere at school.
This study has several limitations such as (1) small
sample size; (2) lack of objective variables; (3) lack of proper
blinding; and (4) other possible causes of stress other than
jobs, such as family issues, relationship conflicts, and others,
were not taken into consideration.
CONCLUSIONS
Practice of MSRT can facilitate a reduction in levels of
stress, anxiety, fatigue, and psychological distress. The
relaxation technique also enhances levels of self-esteem and
the quality of sleep in female teachers working in primary
schools.
ACKNOWLEDGEMENTS
The authors acknowledge all the women in this study for their participation.
AUTHOR DISCLOSURE STATEMENT
All persons who meet authorship criteria are listed as authors, and all authors certify
that they have participated sufficiently in the work to take public responsibility for the
content, including participation in the concept, design, analysis, writing, or revision of
the manuscript. Furthermore, each author certifies that this material or similar material
has not been and will not be submitted to or published in any other publication. And
authors of this manuscript declare that we do not have any conflict of interest regarding
publication and the details mentioned in this manuscript.
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