Development, Content Validation and Pilot Study Feasibility of Heartfulness Meditation and Yoga Protocol for Anxiety

Development, Content Validation and Pilot Study Feasibility of Heartfulness Meditation and Yoga Protocol for Anxiety | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development, Content Validation and Pilot Study Feasibility of Heartfulness Meditation and Yoga Protocol for Anxiety Mansee Thakur This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3995680/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Integrating contemplative practices such as meditation and yoga may offer a comprehensive approach for the rise in mental health issues. We aimed to develop and validate a Heartfulness Meditation and Yoga protocol for individuals with low to moderate anxiety. In Phase 1, we developed the protocol from extensive literature survey using classical yoga texts and scientific studies. Phase 2 involved content validation through experts from fields related to yoga, Ayurveda, physiology, psychology, and psychiatry, by calculating the content validity ratio (CVR). Phase 3 consisted of a pilot study to check the feasibility and effectiveness of the protocol. Data were collected using Beck Anxiety Inventory (BAI), WHO-Well Being Index (WHO-WBI) and Perceived Stress Scale (PSS). The final protocol encompassed practices such meditation, relaxation, cleaning and pranayamas. In the validation phase, 40 subject experts participated, and all practices (for low and moderate anxiety) were incorporated in the final protocol, as CVR scores were >0.29. Participants from the pilot study revealed a high satisfaction rate of 90% and significant reduction in anxiety, and improved well-being. Our approach was safe, feasible and effective, making it a promising addition to conventional anxiety treatments. In future, randomized clinical trials are required. CTRI No. CTRI/2023/11/060151 Biochemical Research Methods Anxiety Validation Feasibility Heartfulness Meditation & Yoga Stress Well-being Pilot study. Introduction With the advent of industrialization in the 20th century, people across the world have faced radical socioeconomic and lifestyle changes. This modern life has caused difficulties in maintaining a fair standard of living and well-being, further leading to concerning cases of mental health around the globe. The World Health Organization (WHO) states that, India faces a mental health challenge of 2443 disability-adjusted life years (DALYs) for every 100,000 people, and the suicide rate, adjusted for age, is 21.1 per 100,000 people ( Mental Health , n.d.). Mental health is important for developing good health and well-being. Decline in mental health can affect us physically also, by leading to a number of psychosomatic diseases such as diabetes, respiratory diseases, cardiovascular diseases, and cancer(Alwan & Maclean, 2009 ). Although many mental health illnesses may be successfully treated for comparatively low-priced expenses, there still lies a wide disparity between those requiring care and those with access to it ( Mental Health , n.d.). With the recent COVID-19 pandemic these numbers increased(Pfefferbaum & North, 2020 ). In 2020, cases of anxiety and depression rose to an increasing level of 25%. This calls attention and investment in mental health all the more (Environment, 2022 ). The WHO's 2020 Mental Health Atlas states that only 25% of its members have included mental health in their healthcare systems, which means that diagnosis, treatment, and care remain inaccessible for the larger majority of 280 million depressed people across the globe. Worldwide, more than two-thirds of people having mental health issues don’t receive the care they need. As Project Hope points out, in low- and middle-income countries, up to 85% of people having mental disorders are untreated (Environment, 2022 ). Initiatives to ensure high-quality mental health care, effective treatments, and research to find novel treatments and enhance existing ones for all mental diseases, are areas that need attention. In 2019, to address this, the WHO came up with the “ WHO Special Initiative for Mental Health (2019–2023) ”. The main vision of this initiative is providing the highest standard of mental health and well-being ( Mental Health , n.d.). Anxiety is a prolonged emotional state that occurs when someone anticipates a potential threat, leading to physiological stress reactions (Daviu et al., 2019 ). The most common anxiety disorder generalized anxiety disorder (GAD) , is a chronic condition that involves uncontrollable, excessive, and often irrational worries about everyday things. Approximately, 1.9–5.1 % people are affected by GAD (Hou et al., 2017 ). Mixed anxiety and depression (MAD), is common in population below the age of 45 years (Clemente-Suárez, 2020 ). Prolonged anxiety can deteriorate our mental health by increasing our susceptibility to medical conditions such as cognitive impairments (memory loss)(Lupien et al., 2009 ), chronic diseases (Liguori et al., 2018 ), depression (Karel, 1997 ), etc. Every other individual is impacted by mental health challenges at some or the other points in their life; from the general public, to students, and healthcare professionals. Non-medicative techniques have emerged in the recent years. For instance, Heartfulness-based interventions have greatly increased in popularity and have been used to treat anxiety in recent years. Heartfulness is a type of meditative practice that enables practitioners to experience the go deep into their inner consciousness by using simple practices (Meditation, Cleaning, Prayer). This type of meditation originally called “ Sahaj Marg ” is rooted from Raja Yoga . It encompasses all the eight limbs of Ashtanga Yoga. However, it has a distinctive approach- it commences with the 6th, 7th, and 8th limbs: Dharna, Dhyana, and Samadhi . This is because by initially refining and purifying one’s consciousness, the subsequent limbs become more accessible and effective (Patel & Pollock, 2018 ). Heartfulness Meditation has three core techniques: Meditation, Cleaning, and Prayer. These techniques help to cleanse and amplify the consciousness until there is union with “ Universal Consciousness ” known by God, the Source or the Ultimate in various spiritual traditions. The fusion of meditation with cleaning and transmission purifies the consciousness by eliminating samskaras during the cleaning technique, thereby leading to an expanded consciousness. The primary aim of Heartfulness meditation is to help individuals towards attaining inner peace and expanded state of consciousness that leads to a state of permanent awareness. There are two important features of this meditative practice-the passive receptive nature of the practitioner and the technique of yogic transmission. The practitioner is made to assume throughout the meditation that the light source that is already there in their heart is drawing them inward. This assumption helps to foster receptivity and attentiveness towards the experiences unfolding from within. If there are distractions, the practitioner is asked to re-centre themselves by reasserting their focus on the light source(Patel & Pollock, 2018 ) . Apart from this, physical non-pharmacological Mind-Body interventions such as Yoga can be practiced as Yoga is a comprehensive approach that involves elements such as physical postures (asanas), controlled breathing (pranayamas) and meditation. These elements can promote physical fitness, and a harmony between the mind and body, promoting overall well-being (Salmon et al., 2009 ). A significant surge in scientific research on yoga has been seen in the recent years. As reviewed by Catherine Woodyard, 2011 , Yogic practices offer physical advantages by increasing muscle strength and flexibility, provide mental benefits by reducing stress, inflammation, anxiety, depression, and chronic pain, problems with the body’s autonomic functions and contribute to social well-being by promoting recovery from addiction and improving overall quality of life (Woodyard, 2011 ). Additionally, they enhance respiratory and cardiovascular function and promote better sleep patterns. Breathing exercises such as Deep and Slow Breathing (DSB) can also reduce anxiety in older adults (Magnon et al., 2021 ; Woodyard, 2011 ). However, the development of a proper yoga regime to treat/prevent particular diseases have been conducted by only a few researchers (K S et al., 2023; More et al., 2021 ; Naveen et al., 2013 ). Therefore, the current study was conducted to develop and validate a combined protocol of Heartfulness Meditation and Yoga practices to target patients with low and moderate anxiety. It was hypothesized that this combined protocol would yield positive results as it includes both mental and physical wellness. A pilot study was also done to determine the feasibility and efficacy of the developed protocol. Specific Aims The main aim of this research was to construct and content validate a combined protocol of Heartfulness Meditation and Yoga techniques for patients having low and moderate anxiety. The secondary aim was to check the efficacy and feasibility of this developed protocol through psychometric measures (self-administered questionnaires) pre and post-intervention. Methodology This study was divided in three phases as mentioned below- Phase 1-Development of Heartfulness Meditation and Yoga Protocol The primary focus of our study is the yogic transmission facilitated through Heartfulness meditation. However, we have incorporated yogic asanas to enhance the physical aspect of wellness as we have observed that now-a-days people are also focusing on their physical well-being. Generally, participants tend to discontinue the practice if only meditation is involved, leading to dropouts as they also prefer some physical exercises alongside meditation. people. Even AYUSH, Ministry of Health and Family Welfare, Government of India, had also initiated the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2008( Guidelines and Training Mannual on Integration of Ayurveda in NPCDCS_0.Pdf , n.d.). With respect to this, we are focussed on addressing the prevalent issue of anxiety with the help of Heartfulness meditation and yoga. Hence, Phase I started with an extensive search from a variety of sources to frame and develop our Heartfulness Meditation and Yoga protocol for anxiety. These sources included classical texts such as The Heartfulness Way (Patel & Pollock, 2018 ), yoga texts such as Asana Why & How-Kaivalyadham, Hathapradipika (Svatmarama, 2014 ), Patanjali yoga sutras (B. K. S. Iyengar, n.d.; Yoga Sutras Of Patanjali - A Summary Easy To Understand , 2023)and Gheranda Samhita (Digambarji & Gharote, 1997 ), as well as contemporary yoga-related books such as Yoga therapy series - Yogic management of diseases (Karmananda, n.d.), Suryanamaskar (Satyānanda, 2009 ), Yoga Darsana (Saraswati, 2002 ), and Light on Yoga(B. K. S. Iyengar, n.d.). Insights from the scientific literature were also obtained using search engines such as Google Scholar, and PubMed, using key words such as “Anxiety”, “Generalized Anxiety Disorder”, “Yoga”, “Meditation” and “Heartfulness” to understand the clinical features and interventions related to anxiety. By referring to these yoga texts and scientific literature, our Heartfulness Yoga certified instructor having an experience of 20 years in the field of yoga and meditation designed this protocol. Phase II- Content Validation of developed Heartfulness Meditation and Yoga Protocol In Phase II, an online questionnaire was sent to 50 subject experts via email, who had greater than five years of experience in the fields of Yoga, Ayurveda, Physiology, Psychology and Psychiatry. Experts with less than 5 years of experience in the above-mentioned fields were excluded from this research. The subject experts were first given a brief explanation about the aim and objectives of the study. The experts were then asked to rate these practices on a two-point scale with 1 indicating “Yes (essential) and 2 indicating “No (not essential)”. The content validity ratio (CVR) of each of these practices was calculated using Lawshe’s Law. Practices with a CVR of ≥ 0.29 were incorporated in the final protocol. Additional comments/suggestions given by subject experts were also included. $$CVR=(\left(Ne-\frac{N}{2}\right)÷\left(\frac{N}{2}\right))$$ where, Ne = number of experts indicating “yes (essential)” N = total number of experts Phase III- Pilot Study Feasibility and Effectiveness of Validated Heartfulness Meditation and Yoga Protocol After the protocol was content validated by the experts, the protocol was administered to participants as a pilot study to assess the feasibility of the designed and validated protocol. Feasibility and effectiveness were assessed using psychometric measures of anxiety, stress and well-being by administering questionnaires pre and post the intervention. Participants & Setting Participants with mild anxiety were recruited from the Department of Psychiatry, MGM Medical College and Hospital, Kamothe, Navi Mumbai. From these, patients who could read and write English were invited for the study. Ethical approval was taken by MGM institute of Health Sciences, Institutional Review Board Ref.No. MGMIHS/R&D/ECRHS/03/2023/186. These participants were first screened on the basis of the following inclusion and exclusion criteria- Inclusion Criteria: (i) Age 18–35 years; (ii) Participants suffering from low and moderate anxiety. Exclusion Criteria: (i) Pregnant women; (ii) Participants on medications for anxiety. The participants fulfilling the inclusion criteria and gave their consent willingly for this research were first asked to complete an online assessment for their sociodemographic characteristics and then psychometric questionnaires such as the Beck Anxiety Inventory (BAI)(Bardhoshi et al., 2016 ), Perceived Stress Scale (PSS) (Cohen et al., 1983 ) and WHO-Well Being Index (WHO-WBI) (Topp et al., 2015 ). Participants with low and moderate anxiety levels as assessed by BAI, were only included in this research. The same set of questionnaires was completed by these participants post-intervention. Participants were also requested to indicate if they were satisfied with the intervention and to comment if they faced any difficulties during the intervention period of one month. Sample Size Phase II of this research comprised conducting a validity study of the developed Heartfulness Meditation and Yoga Protocol. A sample size of n = 50 was selected for the expert validation team. For the Phase III i.e. Pilot Study Feasibility and Effectiveness of Validated Heartfulness Meditation and Yoga Protocol, a target sample size of n = 30 participants were selected. Intervention A Heartfulness certified Meditation and Yoga trainer conducted the practices mentioned in the validated protocol such as prayer, breathing techniques (pranayamas), stretching movements, asanas, and core Heartfulness techniques (Meditation, Relaxation and Cleaning) on the participants from the pilot study. They were asked to follow these practices thrice per week (online) and once a month offline with the trainer. The participants were also recommended to follow these practices in the evening daily at home on their own. Attendance was recorded for all the sessions and the participants were strictly instructed to keep their video camera “ON” during the entire session. The yoga intervention protocol relied on classical Patanjali yoga with Gheranda Samhita and Hathyogpradeepika. The certified yoga instructor led participants through a series of 14 yoga poses at an appropriate pace. Participants were advised to attain exact posture as demonstrated by the instructor and to focus on improvement in their yoga practice. The importance of attending all sessions was emphasized during the first session and throughout all subsequent sessions and participants also received regular email and text reminders to attend these sessions. This helped them to adhere to the protocol. To facilitate practice at home, the meditation and yoga instructor along with the research team, provided participants with an online link where instructors were online and participants were instructed to keep their videos ‘ON’ during the online yoga training session. The participants were first given an introductory session for three days, on Heartfulness meditation by a Heartfulness certified trainer. They were briefed about this meditative practice. In these sessions, Participants were given the following instructions- 1. Sit comfortably 2. Close your eyes 3. Focus on the source of light that is present in their heart If their focus is wandered, they were guided to gently redirect their focus back to their heart. This was conducted for 20 mins (Thimmapuram et al., 2022 ). After completing these three sessions, the participants followed the intervention protocol as mentioned below- The meditation and yoga protocol were conducted in two parts: Morning Practice (45 Minutes) Morning practice is further structured into 6 subsections: 1) Centering with Yogic prayer and Yogic breathing for 5 minutes followed by 2) Stretching and bending movements for 5 minutes which will warm up the muscles of participants for the next step and 3) Yoga Asanas for 20 minutes. A series of 14 different asanas was conducted for the participants under the guidance of Heartfulness Yoga trainers. 4)Participants were relaxed for the next 3 minutes into Shavasana with the guided Heartfulness Relaxation technique. 5)Once the participants were relaxed, they were told to sit in a comfortable posture such as Sukhasana or Vajrasana to practice 10 rounds of Anulom-Viloma Pranayama which will prepare their mind and body to enter the Meditative state. 6) The last part of the morning practice is Dhyana i.e. 5 Minutes of Heartfulness Meditation with Heartfulness Meditation Trainer/Preceptor (Thimmapuram et al., 2022 ). Evening Practice (15 Minutes) Evening practice is much simpler and consists of 5 minutes of Bhramari Pranayama and 10 minutes of rejuvenation i.e. Heartfulness Cleaning practice which is one among the characteristic practices of Heartfulness tradition (Thimmapuram et al., 2022 ). Measures General Questionnaire The experts were requested to fill an online questionnaire for basic demographic characteristics such as age, gender, professional field and years of experience in their respective professional field. The participants of the pilot scale feasibility study were also asked to complete such a questionnaire for their gender, age, height, weight and previous experience in yoga and meditation. Questionnaire for the Experts The experts included in the validity study were requested to complete a questionnaire involving all the practices (for low and moderate anxiety) designed for the Heartfulness Meditation and Yoga protocol. They had to rate these practices on a two-point scale with 1 indicating “Yes (essential) and 2 indicating “No (not essential)”. The CVR of these practices was then calculated. Psychometric Questionnaires The participants of the pilot scale feasibility study were requested to complete measures of psychometry both pre and post intervention. These questionnaires are as follows- Beck Anxiety Inventory (BAI) This scale was employed to assess anxiety levels in the study participants. This questionnaire, commonly used in clinical research for generalized anxiety, includes a four-point Likert scale, ranging from 0 (not at all) to 3 (severely) for scoring responses. Scores between 0 and 21 indicate low anxiety, 22–35 indicate moderate anxiety and 36 and above indicate high anxiety. Perceived Stress Scale (PSS) To determine an individual's level of stress perception, we used the PSS (Perceived Stress Scale) questionnaire tool. This tool tells us how people view situations in their lives as stressful. It uses a 5-point scale, with ratings ranging from 0 (meaning "never") to 4 (meaning "very often"). Low perceived stress is denoted by scores ranging from 0 to 13, moderate perceived stress corresponds to scores between 14 and 26, and high levels of perceived stress are indicated by scores in the range of 27 to 40. WHO-Well Being Index (WHO-WBI) This tool can assess the well-being of the participants. It consists of five items, that can be rated on a scale from 0 (at no time) to 5 (all the time). Scores ranging from 0 to 25 indicate the spectrum from the lowest to the highest possible lifestyle. Statistical Analysis Descriptive statistical analysis was done for sociodemographic data. The continuous variables were reported as the mean and standard deviation, whereas the categorical variables were reported as frequencies and percentages. The significant differences in scores pre and post intervention were analysed using paired t-test, using IBM-SPSS, version 25.0. Results are reported with 95% confidence intervals and p values < 0.05 are considered significant. Results Development and Content Validation of Heartfulness Meditation and Yoga Protocol With the help of classical meditation and yoga texts and literature, 27 practices were incorporated in the protocol. Out of 50 experts approached, five experts didn’t meet the exclusion criteria, three experts didn’t respond and two of them didn’t complete the questionnaire. Forty experts completed the entire questionnaire which was circulated via email. The demographic characteristics of the experts are listed in (Table 1 ). Experts from diverse fields such as Yoga, Ayurveda, Physiology with yoga expertise, Psychology, Heartfulness meditation & Yoga certified trainer and Psychiatry participated in this validation process. These experts belonged to prestigious institutes across India such as SVYASA University of Yoga, Kaivalyadhama Institute of Yoga, Yoga & Naturopathy, All India Institute of Medical Sciences (AIIMS) Raipur, Gujarat Yoga Institute, AIIMS Hyderabad, AIIMS Delhi, etc. The CVR was calculated for both-the type and duration of the practice. Out of 27 practices for low anxiety, the CVR of all the practices were > 0.6, whereas, for moderate anxiety, 24 practices had CVR > 0.6. However, all practices (low and moderate) were fixed for the final protocol as CVR was ≥ 0.29 (Ahmad et al., 2023 ). Table 1 Sociodemographic Characteristics of the Experts Sociodemographic Frequency 1. Age Mean (SD) 41.241 (11.74) Range 22–72 2. Age Groups 30 years 8 6. Profession/Field Yoga 16 Psychology, Psychiatry 09 Ayurveda with yoga expertise, Heartfulness Meditation & Yoga certified trainer, Physiology with yoga expertise 15 Based on these recommendations, the final practices included in the Heartfulness Meditation and Yoga Protocol for low and moderate anxiety are shown in (Table 2 ) and (Table 3 ) respectively. Some of the experts recommended to modify the time duration as and when needed, as it varies with experience and practice. For instance, initially it can be done for a lesser duration and then gradually, the time duration can be increased to optimal as per the patient’s response. Few of them suggested increasing the duration to 5 times a week. Table 2 Practices Approved by the Experts for Mild Anxiety Sr. No. Practices Time Prescribed CVR for the type of practice CVR for the duration of the practice Remarks 1 Centering 5mins 0.862 0.655 Retained a. Yogic Prayer 0.862 0.655 Retained b. Yogic Breathing 0.862 0.655 Retained 2 Hands Stretch up from the front 5mins 1.000 0.655 Retained a. Forward 1.000 0.655 Retained b. Lateral bending 1.000 0.655 Retained c. Twist 1.000 0.655 Retained d. Backward Bend 1.000 0.655 Retained 3 Purna Titali Asana 20mins 1.000 0.793 Retained a. Baddha Konasana 1.000 0.793 Retained b. Gomukhasana 1.000 0.793 Retained c. Paschimottanasana 1.000 0.793 Retained d. Purvottanasana 1.000 0.793 Retained e. Naukasana 1.000 0.793 Retained f. Bhujangasana 1.000 0.793 Retained g. Marjariasana 1.000 0.793 Retained h. Parvatasana 1.000 0.793 Retained i. Shashankasana 1.000 0.793 Retained j. Uttanapadasana 1.000 0.793 Retained k. Setubandhasana 1.000 0.793 Retained l. Jathara Parivartanasana 1.000 0.793 Retained m Apanasana 1.000 0.793 Retained 4 Heartfulness Relaxation in Savasana 3mins 0.931 0.724 Retained 5 Anuloma- Viloma Pranayama (10 Rounds) 7mins 1.000 1.000 Retained 6 Heartfulness Meditation 5mins 0.931 0.655 Retained 7 Bhramari Pranayama 5mins 1.000 1.000 Retained 8 Heartfulness Cleaning 10 mins 0.862 0.931 Retained Total duration 60 MINS (45 mins morning practice, 15 mins evening practice) Table 3 Practices Approved by the Experts for Moderate Anxiety Sr. No. Practices Time Prescribed CVR for the type of practice CVR for the duration of the practice Remarks 1 Centering 5mins 0.586 0.552 Retained a. Yogic Prayer 0.586 0.552 Retained b Yogic Breathing 0.586 0.552 Retained 2 Hands Stretch up from the front 5mins 0.793 0.793 Retained a Forward 0.793 0.793 Retained b Lateral bending 0.793 0.793 Retained c Twist 0.793 0.793 Retained d Backward Bend 0.793 0.793 Retained 3 Purna Titali Asana 20mins 0.862 0.759 Retained a Baddha Konasana 0.862 0.759 Retained b Gomukhasana 0.862 0.759 Retained c Paschimottanasana 0.862 0.759 Retained d Purvottanasana 0.862 0.759 Retained e Naukasana 0.862 0.759 Retained f Bhujangasana 0.862 0.759 Retained g Marjariasana 0.862 0.759 Retained h Parvatasana 0.862 0.759 Retained i Shashankasana 0.862 0.759 Retained j Uttanapadasana 0.862 0.759 Retained k Setubandhasana 0.862 0.759 Retained l Jathara Parivartanasana 0.862 0.759 Retained M Apanasana 0.862 0.759 Retained 4 Heartfulness Relaxation in Savasana 3mins 0.655 0.552 Retained 5 Anuloma- Viloma Pranayama (10 Rounds) 7mins 0.724 0.655 Retained 6 Heartfulness Meditation 5mins 0.655 0.448 Retained 7 Bhramari Pranayama 5mins 0.793 0.759 Retained 8 Heartfulness Cleaning 10 mins 0.862 0.793 Retained Total duration 60 MINS (45 mins morning practice, 15 mins evening practice) Pilot Study Feasibility and Effectiveness of Validated Heartfulness Meditation and Yoga Protocol The Heartfulness Meditation and Yoga Protocol validated by the experts was administered to participants aged between 18–35 years. 30 participants met the inclusion criteria, however only 21 participants willingly participated in the study. All 21 participants were retained till the completion of the study. The sociodemographic of the participants are listed in (Table 4 ). The average of the participants was 24.62 ± 1.568. The participants didn’t have any prior experience in yoga and meditation. Table 4 Sociodemographic Characteristics of Participants from the Pilot Scale Feasibility Study Sociodemographic Characteristics 1. Age (in years) Mean, SD 24.62, 1.568 Range 18–35 Age group- n, (%) Up to 18 3 (14.29) 19 to 25 10 (47.62) 26–35 8 (38.10) Gender -n, (%) Female 12 (57.14) Male 9 (42.86) Body Mass Index (BMI) -n, (%) Underweight 3 (14.29) Normal 10 (47.62) Overweight 2 (9.52) Obese 6 (28.57) These participants completed the structured questionnaires for psychometric analysis pre and post intervention of one month to assess the feasibility and effectiveness of the validated protocol. These measures included anxiety, perceived stress and well-being. The mean outcomes of these measures are represented in (Table 5 ). The participants did not report any adverse effects during the intervention. However, 14.29% reported difficulties in concentration. A total of 90.48% participants were satisfied with the intervention. Table 5 Mean Outcomes of Psychometric Measures of Participants before and after intervention Outcome Baseline Mean Post-Intervention Mean 95% CI (lower, upper) Anxiety 27.95 26.95 0.424, 1.576 Perceived Stress 20.90 20.52 -2.419, 3.181 Well-being 14.67 16.00 -1.553, -1.113 Discussion A wide range of mental health concerns are present in the modern life. This can have an effect on our overall well-being; including physical health. Anxiety is one among these mental health issues, which needs to be addressed. Therefore, the plan of this research was to design a protocol combining Heartfulness Meditation and Yoga protocol for patients suffering from low and moderate anxiety, with the help of classical yogic texts and scientific literature. This protocol was content validated by a panel of 40 experts from the fields of Yoga, Ayurveda, Physiology with yoga expertise, Psychology, Heartfulness Meditation & Yoga trainer, and Psychiatry, from various prestigious institutes across India. The final protocol contains prayer, breathing techniques (pranayamas), stretching movements, asanas, and core Heartfulness techniques (Meditation, Relaxation and Cleaning). The total duration of this protocol is 60 mins (45 mins morning practice, 15 mins evening practice). These practices were recommended to be carried out thrice a week (online) and once a month offline with a certified Heartfulness Meditation and Yoga trainer for 3 months. On the remaining days, the patients are advised to follow this protocol at home on their own. The aspect of meditation has been included in our protocol as even Patanjali outlines that meditation is the fundamental component in classical yoga (ashtanga yoga) (Bryant, 2015). This was also emphasized in a recent study that focused on the effect of four Mind-Body treatments- Meditation, Mediation and Yoga, Meditation and Ethical education, Yoga and Ethical Education. Each of the four therapies produced positive outcomes in terms of enhancing body awareness, emotional regulation abilities, distress tolerance, and self-compassion. Interestingly, the four groups did not exhibit any significant differences, supporting the theory that meditation could be the primary motivator (Matko et al., 2021). Researchers have emphasized solely on yogic practices to treat anxiety(Maddux et al., 2018; Sherlee & David, 2020; Upadhyay et al., 2022), or studied the effect of meditation practices alone to reduce anxiety disorders (Fazia et al., 2023; Hoge et al., 2013; Lozano Montes et al., 2021). Combined therapy of yoga and meditation have been used by only some researchers. For instance, a study showed that yoga and mindfulness intervention decreased anxiety and depression in young adolescents aged 11-14 years in the US. However, no statistically significant difference was observed (Bazzano et al., 2022). To the best of our knowledge, our study is the first integrative model combining both Heartfulness Meditation and Yoga technique to target patients with low and moderate anxiety. The participants enrolled in the pilot study reported 90.48% satisfaction rate. The outcomes of their psychometric measures also improved post intervention. These measures were anxiety, perceived stress and well-being. Anxiety can affect our mental health by causing stress which in turn can inversely affect our well-being. Therefore, along with anxiety, we also measured perceived stress and well-being in the pilot study. After the intervention of Heartfulness meditation and yoga, a significant decrease in anxiety levels was observed. A randomized control study on university students aged between 18-30 years also showed a decrease in anxiety (35.20±7.28) and perceived stress (24.25±8.18) post-intervention in the mindfulness training program as compared to the active control group (Sousa et al., 2021). Interestingly, both the baseline and post-intervention scores were higher than those observed in our study. The mean score of perceived stress in our study was 20.90±6.27, indicating moderate stress in this population. Perceived stress decreased post-intervention, but it was not statistically significant. Similar results were obtained in a study conducted on women to check the effect of a yoga intervention of 8 weeks, on heart rate variability and mood. Perceived stress, depression, and trait anxiety did not decrease with statistical significance after the intervention period (Chu et al., 2017). However, a study conducted to determine the effectiveness of mindfulness meditation using the Headspace™ app revealed a significant decrease in perceived stress after an intervention of 4-weeks (Zollars et al., 2019). Similarly, a study in Japan showed the effectiveness of yoga in participants who were healthy (H), in poor health (PH) or suffering from chronic diseases (CD). They found significant reduction (p<0.01) in perceived stress post intervention of three months in PH and CD groups, whereas the decreased scores of perceived stress was insignificant in the healthy participants (20.8±7.5), as seen in our study. Their study also showed a significant reduction in anxiety as measured by the Profile of Mood States (POMS) (Oka & Lkhagvasuren, 2021). With recent advances, newer health-related apps are being developed to monitor the mental health of individuals. One such research was carried out to develop a mobile app based on mindfulness meditation, in 2019. The well-being scores of working women increased in the intervention group to 17% in comparison to the control group to a 6% increase, after 8-weeks of intervention. The mean well-being score in the intervention group was 14.93 post-intervention (Coelhoso et al., 2019), which is lower than the mean score obtained in our study (16.00, p=0.000). This could be due to the combined effect of yoga and meditation included in our intervention protocol. Another mobile app based on Cognitive Behavioural Therapy (CBT) was developed in New Zealand to support young people during the difficult times of the COVID-19 pandemic. After the intervention of 4-weeks and a 3 month follow up, significant differences were observed for emotional (p=0.04) and mental (p=0.008) well-being, stress (p=0.001) and self-compassion (p=0.003), whereas the changes in anxiety and sleep were not significant (Thabrew et al., 2022). A study based on a yoga intervention also showed significant improvement in well-being scores based on the Subjective Well-being Inventory (SUBI), in comparison to the control group (Sharma et al., 2008). The participants of our pilot-feasibility study did not report any adverse effects during or post the intervention. These results suggest that the developed protocol is safe, easy to practice, feasible and effective. Since both physical (by Yoga) and mental (by meditation) aspects are covered in this protocol, the effectiveness of this therapy is higher, which can be further validated by randomized clinical trials. However, our study had certain limitations. First, the sample size used for the feasibility study was small. This study can be carried out with a larger population in the future. Second, this study lacked a control group, making it challenging to account for extraneous factors. Third, we used structured questionnaires to measure the outcomes, leading to the possibility of response bias. Fourth, as we conducted only a pilot study with smaller sample size and only one month of intervention period, the psychometric results were not clinically significant. The participants continued to have moderate levels of anxiety and perceived stress. Conclusion & Future Prospective Mental health poses a challenge in this fast-paced world. Recently, the use of non-pharmacological techniques has increased to address this issue. However, a limited number of studies focusing on combined mediation and yoga programs targeting specific medical conditions are available. Therefore, in this research, a combined Heartfulness Meditation and Yoga protocol was developed and content validated by 40 experts. The feasibility and efficacy of this protocol was also determined by a pilot study. This content validated protocol was found to be easy to administer, feasible and effective with a reduction in anxiety and perceived stress and an increase in the well-being of the participants, with no adverse effects. This protocol can further be clinically validated using a randomized trial in a larger sample size of patients from psychiatry departments across different hospitals. We will also use biomarkers to clinically strengthen our findings in the future, and if found effective, it can be utilized by healthcare providers to efficiently and systematically care for patients with low and moderate anxiety, in addition to their standard medicative treatment. References Ahmad, N. A., Elias, N. F., Ashaari, N., & Mohamed, H. (2023). Learning Management System Acceptance Factors for Technical and Vocational Education Training (TVET) Institutions. TEM Journal , 12 , 1156–1165. https://doi.org/10.18421/TEM122-61 Alwan, A., & Maclean, D. R. (2009). A review of non-communicable disease in low- and middle-income countries. International Health , 1 (1), 3–9. https://doi.org/10.1016/j.inhe.2009.02.003 B. K. S. Iyengar. (n.d.). Light on the Yoga Sutras of Patanjali . Retrieved December 24, 2023, from http://archive.org/details/iyengar-bks-light-on-the-yoga-sutras-of-patanjali-ocr Bardhoshi, G., Duncan, K., & Erford, B. T. (2016). Psychometric meta‐analysis of the English version of the Beck Anxiety Inventory. Journal of Counseling & Development , 94 (3), 356–373. https://doi.org/10.1002/jcad.12090 Bazzano, A. N., Sun, Y., Chavez-Gray, V., Akintimehin, T., Gustat, J., Barrera, D., & Roi, C. (2022). Effect of Yoga and Mindfulness Intervention on Symptoms of Anxiety and Depression in Young Adolescents Attending Middle School: A Pragmatic Community-Based Cluster Randomized Controlled Trial in a Racially Diverse Urban Setting. 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Improving stress management, anxiety, and mental well-being in medical students through an online Mindfulness-Based Intervention: A randomized study. Scientific Reports , 13 (1), 8214. https://doi.org/10.1038/s41598-023-35483-z Guidelines and Training Mannual on Integration of Ayurveda in NPCDCS_0.pdf . (n.d.). Retrieved December 24, 2023, from https://main.mohfw.gov.in/sites/default/files/Guidelines%20and%20Training%20Mannual%20on%20Integration%20of%20%20Ayurveda%20in%20NPCDCS_0.pdf Hoge, E. A., Bui, E., Marques, L., Metcalf, C. A., Morris, L. K., Robinaugh, D. J., Worthington, J. J., Pollack, M. H., & Simon, N. M. (2013). Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: Effects on anxiety and stress reactivity. The Journal of Clinical Psychiatry , 74 (8), 786–792. https://doi.org/10.4088/JCP.12m08083 Hou, R., Garner, M., Holmes, C., Osmond, C., Teeling, J., Lau, L., & Baldwin, D. S. (2017). Peripheral inflammatory cytokines and immune balance in Generalised Anxiety Disorder: Case-controlled study. Brain, Behavior, and Immunity , 62 , 212–218. https://doi.org/10.1016/j.bbi.2017.01.021 K S, D., K, M., Silambanan, S., Kantipudi, S. J., Sathianathan, R., & R, P. (2023). Development and Validation of Yoga Protocol for Patients with Depression. Annals of Neurosciences , 30 (2), 96–99. https://doi.org/10.1177/09727531221127766 Karel, M. J. (1997). Aging and depression: Vulnerability and stress across adulthood. Clinical Psychology Review , 17 (8), 847–879. https://doi.org/10.1016/s0272-7358(97)00053-6 Karmananda, S. (n.d.). Yogic Management of Common Diseases . Liguori, I., Russo, G., Curcio, F., Bulli, G., Aran, L., Della-Morte, D., Gargiulo, G., Testa, G., Cacciatore, F., Bonaduce, D., & Abete, P. (2018). Oxidative stress, aging, and diseases. Clinical Interventions in Aging , 13 , 757–772. https://doi.org/10.2147/CIA.S158513 Lozano Montes, L., Balakrishnan, V., & Gopalakrishnan, S. (2021). Effects of Integrated Amrita Meditation Technique on Anxiety, Depression, and Plasma Neurotransmitters on a Healthy Population: A Randomized Controlled Trial Followed by a Case-Control Study. Journal of Alternative and Complementary Medicine (New York, N.Y.) , 27 (8), 641–648. https://doi.org/10.1089/acm.2020.0238 Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nature Reviews Neuroscience , 10 (6), Article 6. https://doi.org/10.1038/nrn2639 Maddux, R. E., Daukantaité, D., & Tellhed, U. (2018). The effects of yoga on stress and psychological health among employees: An 8- and 16-week intervention study. Anxiety, Stress, and Coping , 31 (2), 121–134. https://doi.org/10.1080/10615806.2017.1405261 Magnon, V., Dutheil, F., & Vallet, G. T. (2021). Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults. Scientific Reports , 11 (1), 19267. https://doi.org/10.1038/s41598-021-98736-9 Matko, K., Sedlmeier, P., & Bringmann, H. (2021). Embodied Cognition in Meditation, Yoga, and Ethics: An Experimental Single-Case Study on Differential Effects of Four Treatments . https://doi.org/10.31234/osf.io/kvw34 Mental health . (n.d.). Retrieved December 24, 2023, from https://www.who.int/india/health-topics/mental-health More, P., Kumar, V., Usha Rani, M. R., Philip, M., Manjunatha, N., Varambally, S., & Gangadhar, B. N. (2021). Development, validation, and feasibility of a generic yoga-based intervention for Generalized Anxiety Disorder. Complementary Therapies in Medicine , 63 , 102776. https://doi.org/10.1016/j.ctim.2021.102776 Naveen, G. H., Rao, M. G., Vishal, V., Thirthalli, J., Varambally, S., & Gangadhar, B. N. (2013). Development and feasibility of yoga therapy module for out-patients with depression in India. Indian Journal of Psychiatry , 55 (Suppl 3), S350-356. https://doi.org/10.4103/0019-5545.116305 Oka, T., & Lkhagvasuren, B. (2021). Health-related benefits and adverse events associated with yoga classes among participants that are healthy, in poor health, or with chronic diseases. BioPsychoSocial Medicine , 15 (1), 17. https://doi.org/10.1186/s13030-021-00216-z Patel, K. D., & Pollock, J. (2018). The Heartfulness Way: Heart-Based Meditations for Spiritual Transformation . New Harbinger Publications. Pfefferbaum, B., & North, C. S. (2020). Mental Health and the Covid-19 Pandemic. The New England Journal of Medicine , 383 (6), 510–512. https://doi.org/10.1056/NEJMp2008017 Salmon, P., Lush, E., Jablonski, M., & Sephton, S. E. (2009). Yoga and mindfulness: Clinical aspects of an ancient mind/body practice. Cognitive and Behavioral Practice , 16 (1), 59–72. https://doi.org/10.1016/j.cbpra.2008.07.002 Saraswati, S. N. (2002). Yoga Darshan: Vision of the Yoga Upanishads . Yoga Publications Trust. Satyānanda. (2009). Surya namaskara: A technique of solar vitalization (Repr). Yoga Publications Trust. Sharma, R., Gupta, N., & Bijlani, R. L. (2008). Effect of yoga based lifestyle intervention on subjective well-being. Indian Journal of Physiology and Pharmacology , 52 (2), 123–131. Sherlee, J. I., & David, A. (2020). Effectiveness of yogic visual concentration (Trataka) on cognitive performance and anxiety among adolescents. Journal of Complementary & Integrative Medicine , 17 (3). https://doi.org/10.1515/jcim-2019-0055 Sousa, G. M. de, Lima-Araújo, G. L. de, Araújo, D. B. de, & Sousa, M. B. C. de. (2021). Brief mindfulness-based training and mindfulness trait attenuate psychological stress in university students: A randomized controlled trial. BMC Psychology , 9 (1), 21. https://doi.org/10.1186/s40359-021-00520-x Svatmarama. (2014). Hatha Yoga Pradipika with Commentary and English Translation . http://archive.org/details/hathayogapradipika Thabrew, H., Boggiss, A. L., Lim, D., Schache, K., Morunga, E., Cao, N., Cavadino, A., & Serlachius, A. S. (2022). Well-being app to support young people during the COVID-19 pandemic: Randomised controlled trial. BMJ Open , 12 (5), e058144. https://doi.org/10.1136/bmjopen-2021-058144 Thimmapuram, J., Patel, K., Madhusudhan, D. K., Deshpande, S., Bouderlique, E., Nicolai, V., & Rao, R. (2022). Health-Related Quality of Life Outcomes With Regular Yoga and Heartfulness Meditation Practice: Results From a Multinational, Cross-sectional Study. JMIR Formative Research , 6 (5), e37876. https://doi.org/10.2196/37876 Topp, C. W., Østergaard, S. D., Søndergaard, S., & Bech, P. (2015). The WHO-5 Well-Being Index: A systematic review of the literature. Psychotherapy and Psychosomatics , 84 (3), 167–176. https://doi.org/10.1159/000376585 Upadhyay, P., Narayanan, S., Khera, T., Kelly, L., Mathur, P. A., Shanker, A., Novack, L., Pérez-Robles, R., Hoffman, K. A., Sadhasivam, S. K., & Subramaniam, B. (2022). Perceived Stress, Resilience, and Wellbeing in Seasoned Isha Yoga Practitioners Compared to Matched Controls During the COVID-19 Pandemic. Frontiers in Public Health , 10 . https://www.frontiersin.org/articles/10.3389/fpubh.2022.813664 Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International Journal of Yoga , 4 (2), 49–54. https://doi.org/10.4103/0973-6131.85485 Yoga Sutras Of Patanjali—A Summary Easy To Understand . (2023, May 30). https://yogic-experience.com/yogic-knowledge/yoga-sutras-of-patanjali/ Zollars, I., Poirier, T. I., & Pailden, J. (2019). Effects of mindfulness meditation on mindfulness, mental well-being, and perceived stress. Currents in Pharmacy Teaching & Learning , 11 (10), 1022–1028. https://doi.org/10.1016/j.cptl.2019.06.005 Additional Declarations The authors declare potential competing interests as follows: no conflict of interest. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3995680","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":275312683,"identity":"66d3cadd-6a50-420a-a147-a5ea08d0a22b","order_by":0,"name":"Mansee Thakur","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYLCCxAYJEMXG/KfCBkgzNh4gSgsPUAsDz5k0kJYGwloYGxggWnjbDoMF8GrRbT97+MPDHRZy9uzNzx5Itp23W9t+GGhLjU00Li1mZ/LSJBLPSBjz8BwzNzA4dzt525lEoJZjabkNuLQcyDFjSGyTSOyRyGGTSCi7nWx2AKiFseEwbi3n3xh/AGuRf8MmcYDtXLLZ+YcEtNzIMZCA2MLDJtnQdsDO7AYhW268MYP45UyamTTDmeQEsxtAWxLw+eV8jvHHnzvq5NjbDz+TZqiwszc7n/7wwYcaG5xaMEAiWGUCscpBwJ4UxaNgFIyCUTAyAABfDmMynltd2QAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Medical Biotechnology, MGMSBS,MGMIHS, Navi Mumbai","correspondingAuthor":true,"prefix":"","firstName":"Mansee","middleName":"","lastName":"Thakur","suffix":""}],"badges":[],"createdAt":"2024-02-28 04:55:40","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-3995680/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3995680/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51786851,"identity":"69a6172b-c508-45c9-a227-186bb7a19166","added_by":"auto","created_at":"2024-02-29 03:52:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":500868,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3995680/v1/05b9c1a8-52ec-4adc-850d-1c510a7a4c6e.pdf"}],"financialInterests":"The authors declare potential competing interests as follows: no conflict of interest.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eDevelopment, Content Validation and Pilot Study Feasibility of Heartfulness Meditation and Yoga Protocol for Anxiety\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the advent of industrialization in the 20th century, people across the world have faced radical socioeconomic and lifestyle changes. This modern life has caused difficulties in maintaining a fair standard of living and well-being, further leading to concerning cases of mental health around the globe. The World Health Organization (WHO) states that, India faces a mental health challenge of 2443 disability-adjusted life years (DALYs) for every 100,000 people, and the suicide rate, adjusted for age, is 21.1 per 100,000 people (\u003cem\u003eMental Health\u003c/em\u003e, n.d.). Mental health is important for developing good health and well-being. Decline in mental health can affect us physically also, by leading to a number of psychosomatic diseases such as diabetes, respiratory diseases, cardiovascular diseases, and cancer(Alwan \u0026amp; Maclean, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Although many mental health illnesses may be successfully treated for comparatively low-priced expenses, there still lies a wide disparity between those requiring care and those with access to it (\u003cem\u003eMental Health\u003c/em\u003e, n.d.). With the recent COVID-19 pandemic these numbers increased(Pfefferbaum \u0026amp; North, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In 2020, cases of anxiety and depression rose to an increasing level of 25%. This calls attention and investment in mental health all the more (Environment, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The WHO's 2020 Mental Health Atlas states that only 25% of its members have included mental health in their healthcare systems, which means that diagnosis, treatment, and care remain inaccessible for the larger majority of 280\u0026nbsp;million depressed people across the globe. Worldwide, more than two-thirds of people having mental health issues don\u0026rsquo;t receive the care they need. As Project Hope points out, in low- and middle-income countries, up to 85% of people having mental disorders are untreated (Environment, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Initiatives to ensure high-quality mental health care, effective treatments, and research to find novel treatments and enhance existing ones for all mental diseases, are areas that need attention. In 2019, to address this, the WHO came up with the \u0026ldquo;\u003cem\u003eWHO Special Initiative for Mental Health (2019\u0026ndash;2023)\u003c/em\u003e\u0026rdquo;. The main vision of this initiative is providing the highest standard of mental health and well-being (\u003cem\u003eMental Health\u003c/em\u003e, n.d.). Anxiety is a prolonged emotional state that occurs when someone anticipates a potential threat, leading to physiological stress reactions (Daviu et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The most common anxiety disorder \u003cem\u003egeneralized anxiety disorder (GAD)\u003c/em\u003e, is a chronic condition that involves uncontrollable, excessive, and often irrational worries about everyday things. Approximately, \u003cem\u003e1.9\u0026ndash;5.1\u003c/em\u003e% people are affected by GAD (Hou et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Mixed anxiety and depression (MAD), is common in population below the age of 45 years (Clemente-Su\u0026aacute;rez, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Prolonged anxiety can deteriorate our mental health by increasing our susceptibility to medical conditions such as cognitive impairments (memory loss)(Lupien et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), chronic diseases (Liguori et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), depression (Karel, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e1997\u003c/span\u003e), etc.\u003c/p\u003e \u003cp\u003eEvery other individual is impacted by mental health challenges at some or the other points in their life; from the general public, to students, and healthcare professionals. Non-medicative techniques have emerged in the recent years. For instance, Heartfulness-based interventions have greatly increased in popularity and have been used to treat anxiety in recent years. Heartfulness is a type of meditative practice that enables practitioners to experience the go deep into their inner consciousness by using simple practices (Meditation, Cleaning, Prayer). This type of meditation originally called \u0026ldquo;\u003cem\u003eSahaj Marg\u003c/em\u003e\u0026rdquo; is rooted from \u003cem\u003eRaja Yoga\u003c/em\u003e. It encompasses all the eight limbs of Ashtanga Yoga. However, it has a distinctive approach- it commences with the 6th, 7th, and 8th limbs: \u003cem\u003eDharna, Dhyana, and Samadhi\u003c/em\u003e. This is because by initially refining and purifying one\u0026rsquo;s consciousness, the subsequent limbs become more accessible and effective (Patel \u0026amp; Pollock, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHeartfulness Meditation has three core techniques: Meditation, Cleaning, and Prayer. These techniques help to cleanse and amplify the consciousness until there is union with \u0026ldquo;\u003cem\u003eUniversal Consciousness\u003c/em\u003e\u0026rdquo; known by God, the Source or the Ultimate in various spiritual traditions. The fusion of meditation with cleaning and transmission purifies the consciousness by eliminating samskaras during the cleaning technique, thereby leading to an expanded consciousness. The primary aim of Heartfulness meditation is to help individuals towards attaining inner peace and expanded state of consciousness that leads to a state of permanent awareness. There are two important features of this meditative practice-the passive receptive nature of the practitioner and the technique of yogic transmission. The practitioner is made to assume throughout the meditation that the light source that is already there in their heart is drawing them inward. This assumption helps to foster receptivity and attentiveness towards the experiences unfolding from within. If there are distractions, the practitioner is asked to re-centre themselves by reasserting their focus on the light source(Patel \u0026amp; Pollock, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) .\u003c/p\u003e \u003cp\u003eApart from this, physical non-pharmacological Mind-Body interventions such as Yoga can be practiced as Yoga is a comprehensive approach that involves elements such as physical postures (asanas), controlled breathing (pranayamas) and meditation. These elements can promote physical fitness, and a harmony between the mind and body, promoting overall well-being (Salmon et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). A significant surge in scientific research on yoga has been seen in the recent years. As reviewed by Catherine Woodyard, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2011\u003c/span\u003e, Yogic practices offer physical advantages by increasing muscle strength and flexibility, provide mental benefits by reducing stress, inflammation, anxiety, depression, and chronic pain, problems with the body\u0026rsquo;s autonomic functions and contribute to social well-being by promoting recovery from addiction and improving overall quality of life (Woodyard, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Additionally, they enhance respiratory and cardiovascular function and promote better sleep patterns. Breathing exercises such as Deep and Slow Breathing (DSB) can also reduce anxiety in older adults (Magnon et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Woodyard, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, the development of a proper yoga regime to treat/prevent particular diseases have been conducted by only a few researchers (K S et al., 2023; More et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Naveen et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Therefore, the current study was conducted to develop and validate a combined protocol of Heartfulness Meditation and Yoga practices to target patients with low and moderate anxiety. It was hypothesized that this combined protocol would yield positive results as it includes both mental and physical wellness. A pilot study was also done to determine the feasibility and efficacy of the developed protocol.\u003c/p\u003e\n\u003ch3\u003eSpecific Aims\u003c/h3\u003e\n\u003cp\u003eThe main aim of this research was to construct and content validate a combined protocol of Heartfulness Meditation and Yoga techniques for patients having low and moderate anxiety. The secondary aim was to check the efficacy and feasibility of this developed protocol through psychometric measures (self-administered questionnaires) pre and post-intervention.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis study was divided in three phases as mentioned below-\u003c/p\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003ePhase 1-Development of Heartfulness Meditation and Yoga Protocol\u003c/h2\u003e\n \u003cp\u003eThe primary focus of our study is the yogic transmission facilitated through Heartfulness meditation. However, we have incorporated yogic asanas to enhance the physical aspect of wellness as we have observed that now-a-days people are also focusing on their physical well-being. Generally, participants tend to discontinue the practice if only meditation is involved, leading to dropouts as they also prefer some physical exercises alongside meditation. people. Even AYUSH, Ministry of Health and Family Welfare, Government of India, had also initiated the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2008(\u003cem\u003eGuidelines and Training Mannual on Integration of Ayurveda in NPCDCS_0.Pdf\u003c/em\u003e, n.d.). With respect to this, we are focussed on addressing the prevalent issue of anxiety with the help of Heartfulness meditation and yoga. Hence, Phase I started with an extensive search from a variety of sources to frame and develop our Heartfulness Meditation and Yoga protocol for anxiety. These sources included classical texts such as The Heartfulness Way (Patel \u0026amp; Pollock, \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e), yoga texts such as Asana Why \u0026amp; How-Kaivalyadham, Hathapradipika (Svatmarama, \u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e), Patanjali yoga sutras (B. K. S. Iyengar, n.d.; \u003cem\u003eYoga Sutras Of Patanjali - A Summary Easy To Understand\u003c/em\u003e, 2023)and Gheranda Samhita (Digambarji \u0026amp; Gharote, \u003cspan class=\"CitationRef\"\u003e1997\u003c/span\u003e), as well as contemporary yoga-related books such as Yoga therapy series - Yogic management of diseases (Karmananda, n.d.), Suryanamaskar (Satyānanda, \u003cspan class=\"CitationRef\"\u003e2009\u003c/span\u003e), Yoga Darsana (Saraswati, \u003cspan class=\"CitationRef\"\u003e2002\u003c/span\u003e), and Light on Yoga(B. K. S. Iyengar, n.d.). Insights from the scientific literature were also obtained using search engines such as Google Scholar, and PubMed, using key words such as \u0026ldquo;Anxiety\u0026rdquo;, \u0026ldquo;Generalized Anxiety Disorder\u0026rdquo;, \u0026ldquo;Yoga\u0026rdquo;, \u0026ldquo;Meditation\u0026rdquo; and \u0026ldquo;Heartfulness\u0026rdquo; to understand the clinical features and interventions related to anxiety. By referring to these yoga texts and scientific literature, our Heartfulness Yoga certified instructor having an experience of 20 years in the field of yoga and meditation designed this protocol.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003ePhase II- Content Validation of developed Heartfulness Meditation and Yoga Protocol\u003c/h3\u003e\n\u003cp\u003eIn Phase II, an online questionnaire was sent to 50 subject experts via email, who had greater than five years of experience in the fields of Yoga, Ayurveda, Physiology, Psychology and Psychiatry. Experts with less than 5 years of experience in the above-mentioned fields were excluded from this research. The subject experts were first given a brief explanation about the aim and objectives of the study. The experts were then asked to rate these practices on a two-point scale with 1 indicating \u0026ldquo;Yes (essential) and 2 indicating \u0026ldquo;No (not essential)\u0026rdquo;. The content validity ratio (CVR) of each of these practices was calculated using Lawshe\u0026rsquo;s Law. Practices with a CVR of \u0026ge;\u0026thinsp;0.29 were incorporated in the final protocol. Additional comments/suggestions given by subject experts were also included.\u003c/p\u003e\n\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e$$CVR=(\\left(Ne-\\frac{N}{2}\\right)\u0026divide;\\left(\\frac{N}{2}\\right))$$\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003ewhere,\u003c/p\u003e\n\u003cp\u003eNe\u0026thinsp;=\u0026thinsp;number of experts indicating \u0026ldquo;yes (essential)\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;total number of experts\u003c/p\u003e\n\u003ch3\u003ePhase III- Pilot Study Feasibility and Effectiveness of Validated Heartfulness Meditation and Yoga Protocol\u003c/h3\u003e\n\u003cp\u003eAfter the protocol was content validated by the experts, the protocol was administered to participants as a pilot study to assess the feasibility of the designed and validated protocol. Feasibility and effectiveness were assessed using psychometric measures of anxiety, stress and well-being by administering questionnaires pre and post the intervention.\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eParticipants \u0026amp; Setting\u003c/h2\u003e\n \u003cp\u003eParticipants with mild anxiety were recruited from the Department of Psychiatry, MGM Medical College and Hospital, Kamothe, Navi Mumbai. From these, patients who could read and write English were invited for the study. Ethical approval was taken by MGM institute of Health Sciences, Institutional Review Board Ref.No. MGMIHS/R\u0026amp;D/ECRHS/03/2023/186. These participants were first screened on the basis of the following inclusion and exclusion criteria-\u003c/p\u003e\n \u003cp\u003eInclusion Criteria: (i) Age 18\u0026ndash;35 years; (ii) Participants suffering from low and moderate anxiety.\u003c/p\u003e\n \u003cp\u003eExclusion Criteria: (i) Pregnant women; (ii) Participants on medications for anxiety.\u003c/p\u003e\n \u003cp\u003eThe participants fulfilling the inclusion criteria and gave their consent willingly for this research were first asked to complete an online assessment for their sociodemographic characteristics and then psychometric questionnaires such as the Beck Anxiety Inventory (BAI)(Bardhoshi et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e), Perceived Stress Scale (PSS) (Cohen et al., \u003cspan class=\"CitationRef\"\u003e1983\u003c/span\u003e) and WHO-Well Being Index (WHO-WBI) (Topp et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e). Participants with low and moderate anxiety levels as assessed by BAI, were only included in this research. The same set of questionnaires was completed by these participants post-intervention. Participants were also requested to indicate if they were satisfied with the intervention and to comment if they faced any difficulties during the intervention period of one month.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eSample Size\u003c/h2\u003e\n \u003cp\u003ePhase II of this research comprised conducting a validity study of the developed Heartfulness Meditation and Yoga Protocol. A sample size of n\u0026thinsp;=\u0026thinsp;50 was selected for the expert validation team. For the Phase III i.e. Pilot Study Feasibility and Effectiveness of Validated Heartfulness Meditation and Yoga Protocol, a target sample size of n\u0026thinsp;=\u0026thinsp;30 participants were selected.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eIntervention\u003c/h2\u003e\n \u003cp\u003eA Heartfulness certified Meditation and Yoga trainer conducted the practices mentioned in the validated protocol such as prayer, breathing techniques (pranayamas), stretching movements, asanas, and core Heartfulness techniques (Meditation, Relaxation and Cleaning) on the participants from the pilot study. They were asked to follow these practices thrice per week (online) and once a month offline with the trainer. The participants were also recommended to follow these practices in the evening daily at home on their own. Attendance was recorded for all the sessions and the participants were strictly instructed to keep their video camera \u0026ldquo;ON\u0026rdquo; during the entire session.\u003c/p\u003e\n \u003cp\u003eThe yoga intervention protocol relied on classical Patanjali yoga with Gheranda Samhita and Hathyogpradeepika. The certified yoga instructor led participants through a series of 14 yoga poses at an appropriate pace. Participants were advised to attain exact posture as demonstrated by the instructor and to focus on improvement in their yoga practice. The importance of attending all sessions was emphasized during the first session and throughout all subsequent sessions and participants also received regular email and text reminders to attend these sessions. This helped them to adhere to the protocol. To facilitate practice at home, the meditation and yoga instructor along with the research team, provided participants with an online link where instructors were online and participants were instructed to keep their videos \u0026lsquo;ON\u0026rsquo; during the online yoga training session.\u003c/p\u003e\n \u003cp\u003eThe participants were first given an introductory session for three days, on Heartfulness meditation by a Heartfulness certified trainer. They were briefed about this meditative practice. In these sessions, Participants were given the following instructions-\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e1. Sit comfortably\u003c/p\u003e\n \u003c/span\u003e \u003cspan\u003e\n \u003cp\u003e2. Close your eyes\u003c/p\u003e\n \u003c/span\u003e \u003cspan\u003e\n \u003cp\u003e3. Focus on the source of light that is present in their heart\u003c/p\u003e\n \u003c/span\u003e\n \u003cp\u003eIf their focus is wandered, they were guided to gently redirect their focus back to their heart. This was conducted for 20 mins (Thimmapuram et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eAfter completing these three sessions, the participants followed the intervention protocol as mentioned below-\u003c/p\u003e\n \u003cp\u003eThe meditation and yoga protocol were conducted in two parts:\u003c/p\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003eMorning Practice (45 Minutes)\u003c/h2\u003e\n \u003cp\u003eMorning practice is further structured into 6 subsections: 1) Centering with Yogic prayer and Yogic breathing for 5 minutes followed by 2) Stretching and bending movements for 5 minutes which will warm up the muscles of participants for the next step and 3) Yoga Asanas for 20 minutes. A series of 14 different asanas was conducted for the participants under the guidance of Heartfulness Yoga trainers. 4)Participants were relaxed for the next 3 minutes into Shavasana with the guided Heartfulness Relaxation technique. 5)Once the participants were relaxed, they were told to sit in a comfortable posture such as Sukhasana or Vajrasana to practice 10 rounds of Anulom-Viloma Pranayama which will prepare their mind and body to enter the Meditative state. 6) The last part of the morning practice is Dhyana i.e. 5 Minutes of Heartfulness Meditation with Heartfulness Meditation Trainer/Preceptor (Thimmapuram et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eEvening Practice (15 Minutes)\u003c/h2\u003e\n \u003cp\u003eEvening practice is much simpler and consists of 5 minutes of Bhramari Pranayama and 10 minutes of rejuvenation i.e. Heartfulness Cleaning practice which is one among the characteristic practices of Heartfulness tradition (Thimmapuram et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eMeasures\u003c/h2\u003e\n \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\n \u003ch2\u003eGeneral Questionnaire\u003c/h2\u003e\n \u003cp\u003eThe experts were requested to fill an online questionnaire for basic demographic characteristics such as age, gender, professional field and years of experience in their respective professional field. The participants of the pilot scale feasibility study were also asked to complete such a questionnaire for their gender, age, height, weight and previous experience in yoga and meditation.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eQuestionnaire for the Experts\u003c/h2\u003e\n \u003cp\u003eThe experts included in the validity study were requested to complete a questionnaire involving all the practices (for low and moderate anxiety) designed for the Heartfulness Meditation and Yoga protocol. They had to rate these practices on a two-point scale with 1 indicating \u0026ldquo;Yes (essential) and 2 indicating \u0026ldquo;No (not essential)\u0026rdquo;. The CVR of these practices was then calculated.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003ePsychometric Questionnaires\u003c/h2\u003e\n \u003cp\u003eThe participants of the pilot scale feasibility study were requested to complete measures of psychometry both pre and post intervention. These questionnaires are as follows-\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBeck Anxiety Inventory (BAI)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThis scale was employed to assess anxiety levels in the study participants. This questionnaire, commonly used in clinical research for generalized anxiety, includes a four-point Likert scale, ranging from 0 (not at all) to 3 (severely) for scoring responses. Scores between 0 and 21 indicate low anxiety, 22\u0026ndash;35 indicate moderate anxiety and 36 and above indicate high anxiety.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived Stress Scale (PSS)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTo determine an individual\u0026apos;s level of stress perception, we used the PSS (Perceived Stress Scale) questionnaire tool. This tool tells us how people view situations in their lives as stressful. It uses a 5-point scale, with ratings ranging from 0 (meaning \u0026quot;never\u0026quot;) to 4 (meaning \u0026quot;very often\u0026quot;). Low perceived stress is denoted by scores ranging from 0 to 13, moderate perceived stress corresponds to scores between 14 and 26, and high levels of perceived stress are indicated by scores in the range of 27 to 40.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWHO-Well Being Index (WHO-WBI)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThis tool can assess the well-being of the participants. It consists of five items, that can be rated on a scale from 0 (at no time) to 5 (all the time). Scores ranging from 0 to 25 indicate the spectrum from the lowest to the highest possible lifestyle.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n \u003cp\u003eDescriptive statistical analysis was done for sociodemographic data. The continuous variables were reported as the mean and standard deviation, whereas the categorical variables were reported as frequencies and percentages. The significant differences in scores pre and post intervention were analysed using paired t-test, using IBM-SPSS, version 25.0. Results are reported with 95% confidence intervals and p values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 are considered significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eDevelopment and Content Validation of Heartfulness Meditation and Yoga Protocol\u003c/h2\u003e \u003cp\u003eWith the help of classical meditation and yoga texts and literature, 27 practices were incorporated in the protocol. Out of 50 experts approached, five experts didn\u0026rsquo;t meet the exclusion criteria, three experts didn\u0026rsquo;t respond and two of them didn\u0026rsquo;t complete the questionnaire. Forty experts completed the entire questionnaire which was circulated via email. The demographic characteristics of the experts are listed in (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Experts from diverse fields such as Yoga, Ayurveda, Physiology with yoga expertise, Psychology, Heartfulness meditation \u0026amp; Yoga certified trainer and Psychiatry participated in this validation process. These experts belonged to prestigious institutes across India such as SVYASA University of Yoga, Kaivalyadhama Institute of Yoga, Yoga \u0026amp; Naturopathy, All India Institute of Medical Sciences (AIIMS) Raipur, Gujarat Yoga Institute, AIIMS Hyderabad, AIIMS Delhi, etc. The CVR was calculated for both-the type and duration of the practice. Out of 27 practices for low anxiety, the CVR of all the practices were \u0026gt;\u0026thinsp;0.6, whereas, for moderate anxiety, 24 practices had CVR\u0026thinsp;\u0026gt;\u0026thinsp;0.6. However, all practices (low and moderate) were fixed for the final protocol as CVR was \u0026ge;\u0026thinsp;0.29 (Ahmad et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic Characteristics of the Experts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSociodemographic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.241 (11.74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u0026ndash;72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2. Age Groups\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3. Gender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.41%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.59%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4. Years of Experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u0026ndash;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6. Profession/Field\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYoga\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychology, Psychiatry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAyurveda with yoga expertise, Heartfulness Meditation \u0026amp; Yoga certified trainer, Physiology with yoga expertise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on these recommendations, the final practices included in the Heartfulness Meditation and Yoga Protocol for low and moderate anxiety are shown in (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) respectively. Some of the experts recommended to modify the time duration as and when needed, as it varies with experience and practice. For instance, initially it can be done for a lesser duration and then gradually, the time duration can be increased to optimal as per the patient\u0026rsquo;s response. Few of them suggested increasing the duration to 5 times a week.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePractices Approved by the Experts for Mild Anxiety\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSr. No.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePractices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTime Prescribed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCVR for the type of practice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCVR for the duration of the practice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRemarks\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCentering\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e5mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYogic Prayer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eb.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYogic Breathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHands Stretch up from the front\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e5mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eb.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLateral bending\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ec.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBackward Bend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePurna Titali Asana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003e20mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaddha Konasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eb.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGomukhasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ec.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaschimottanasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePurvottanasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ee.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNaukasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBhujangasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eg.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarjariasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eh.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParvatasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ei.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShashankasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ej.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUttanapadasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ek.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSetubandhasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003el.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJathara Parivartanasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003em\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApanasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeartfulness Relaxation in Savasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.931\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnuloma- Viloma Pranayama (10 Rounds)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeartfulness Meditation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.931\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBhramari Pranayama\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeartfulness Cleaning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.931\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal duration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e60 MINS (45 mins morning practice, 15 mins evening practice)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePractices Approved by the Experts for Moderate Anxiety\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSr. No.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePractices\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTime Prescribed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCVR for the type of practice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCVR for the duration of the practice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRemarks\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCentering\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e5mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYogic Prayer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYogic Breathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHands Stretch up from the front\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e5mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eForward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLateral bending\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBackward Bend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePurna Titali Asana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"13\" rowspan=\"14\"\u003e \u003cp\u003e20mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaddha Konasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGomukhasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ec\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaschimottanasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePurvottanasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNaukasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBhujangasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarjariasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParvatasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ei\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShashankasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ej\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUttanapadasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ek\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSetubandhasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003el\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJathara Parivartanasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApanasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeartfulness Relaxation in Savasana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnuloma- Viloma Pranayama (10 Rounds)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeartfulness Meditation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBhramari Pranayama\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeartfulness Cleaning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRetained\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal duration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003e60 MINS (45 mins morning practice, 15 mins evening practice)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePilot Study Feasibility and Effectiveness of Validated Heartfulness Meditation and Yoga Protocol\u003c/h2\u003e \u003cp\u003eThe Heartfulness Meditation and Yoga Protocol validated by the experts was administered to participants aged between 18\u0026ndash;35 years. 30 participants met the inclusion criteria, however only 21 participants willingly participated in the study. All 21 participants were retained till the completion of the study. The sociodemographic of the participants are listed in (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The average of the participants was 24.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.568. The participants didn\u0026rsquo;t have any prior experience in yoga and meditation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic Characteristics of Participants from the Pilot Scale Feasibility Study\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSociodemographic Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Age (in years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean, SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.62, 1.568\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group- n, (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUp to 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (14.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19 to 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (47.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (38.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender -n, (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (57.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (42.86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBody Mass Index (BMI) -n, (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (14.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (47.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (9.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (28.57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThese participants completed the structured questionnaires for psychometric analysis pre and post intervention of one month to assess the feasibility and effectiveness of the validated protocol. These measures included anxiety, perceived stress and well-being. The mean outcomes of these measures are represented in (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The participants did not report any adverse effects during the intervention. However, 14.29% reported difficulties in concentration. A total of 90.48% participants were satisfied with the intervention.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Outcomes of Psychometric Measures of Participants before and after intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline Mean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-Intervention Mean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI (lower, upper)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.424, 1.576\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerceived Stress\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.419, 3.181\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWell-being\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.553, -1.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eA wide range of mental health concerns are present in the modern life. This can have an effect on our overall well-being; including physical health. Anxiety is one among these mental health issues, which needs to be addressed. Therefore, the plan of this research was to design a protocol combining Heartfulness Meditation and Yoga protocol for patients suffering from low and moderate anxiety, with the help of classical yogic texts and scientific literature. This protocol was\u0026nbsp;content\u0026nbsp;validated by a panel of 40 experts from the fields of Yoga, Ayurveda, Physiology with yoga expertise, Psychology, Heartfulness Meditation \u0026amp; Yoga trainer, and Psychiatry, from various prestigious institutes across India. The final protocol contains prayer, breathing techniques (pranayamas), stretching movements, asanas, and core Heartfulness techniques (Meditation, Relaxation and Cleaning). The total duration of this protocol is 60 mins (45 mins morning practice, 15 mins evening practice). These practices were recommended to be carried out thrice a week (online) and once a month offline with a certified Heartfulness Meditation and Yoga trainer for 3 months. On the remaining days, the patients are advised to follow this protocol at home on their own.\u003c/p\u003e\n\u003cp\u003eThe aspect of meditation has been included in our protocol as even Patanjali outlines that meditation is the fundamental component in classical yoga (ashtanga yoga)\u0026nbsp;(Bryant, 2015). This was also emphasized in a recent study that focused on the effect of four Mind-Body treatments-\u0026nbsp;Meditation, Mediation and Yoga, Meditation and Ethical education, Yoga and Ethical Education. Each of the four therapies produced positive outcomes in terms of enhancing body awareness, emotional regulation abilities, distress tolerance, and self-compassion. Interestingly, the four groups did not exhibit any significant differences, supporting the theory that meditation could be the primary motivator\u0026nbsp;(Matko et al., 2021).\u003c/p\u003e\n\u003cp\u003eResearchers have emphasized solely on yogic practices to treat anxiety(Maddux et al., 2018; Sherlee \u0026amp; David, 2020; Upadhyay et al., 2022), or studied the effect of meditation practices alone to reduce anxiety disorders\u0026nbsp;(Fazia et al., 2023; Hoge et al., 2013; Lozano Montes et al., 2021). Combined therapy of yoga and meditation have been used by only some researchers. For instance, a study showed that yoga and mindfulness intervention decreased anxiety and depression in young adolescents aged 11-14 years in the US. However, no statistically significant difference was observed\u0026nbsp;(Bazzano et al., 2022). To the best of our knowledge, our study is the first integrative model combining both Heartfulness Meditation and Yoga technique to target patients with low and moderate anxiety.\u003c/p\u003e\n\u003cp\u003eThe participants enrolled in the pilot study reported 90.48% satisfaction rate. The outcomes of their psychometric measures also improved post intervention.\u0026nbsp;These measures were anxiety, perceived stress and well-being.\u0026nbsp;Anxiety can affect our mental health by causing stress which in turn can inversely affect our well-being. Therefore, along with anxiety, we also measured perceived stress and well-being in the pilot study. After the intervention of Heartfulness meditation and yoga, a significant decrease in anxiety levels was observed. \u0026nbsp;A randomized control study on university students aged between 18-30 years also showed a decrease in anxiety (35.20±7.28) and perceived stress (24.25±8.18) post-intervention in the mindfulness training program as compared to the active control group\u0026nbsp;(Sousa et al., 2021). Interestingly, both the baseline and post-intervention scores were higher than those observed in our study. The mean score of perceived stress in our study was 20.90±6.27, indicating moderate stress in this population. Perceived stress decreased post-intervention, but it was not statistically significant. Similar results were obtained in a study conducted on women to check the effect of a yoga intervention of 8 weeks, on heart rate variability and mood.\u0026nbsp;Perceived stress, depression, and trait anxiety did not decrease with statistical significance after the intervention period\u0026nbsp;(Chu et al., 2017).\u0026nbsp;However, a study conducted to determine the effectiveness of mindfulness meditation using\u0026nbsp;the Headspace™ app\u0026nbsp;revealed a significant decrease in perceived stress after an intervention of 4-weeks\u0026nbsp;(Zollars et al., 2019). Similarly, a study in Japan showed the effectiveness of yoga in participants who were healthy (H), in poor health (PH) or suffering from chronic diseases (CD). They found significant reduction (p\u0026lt;0.01) in perceived stress post intervention of three months in PH and CD groups, whereas the decreased scores of perceived stress was insignificant in the healthy participants (20.8±7.5), as seen in our study. Their study also showed a significant reduction in anxiety as measured by the\u0026nbsp;Profile of Mood States (POMS)\u0026nbsp;(Oka \u0026amp; Lkhagvasuren, 2021).\u003c/p\u003e\n\u003cp\u003eWith recent advances, newer health-related apps are being developed to monitor the mental health of individuals. One such research was carried out to develop a mobile app based on mindfulness meditation, in 2019. The well-being scores of working women increased in the intervention group to 17% in comparison to the control group to a 6% increase, after 8-weeks of intervention. The mean well-being score in the intervention group was 14.93 post-intervention\u0026nbsp;(Coelhoso et al., 2019), which is lower than the mean score obtained in our study (16.00, p=0.000). This could be due to the combined effect of yoga and meditation included in our intervention protocol. Another mobile app based on Cognitive Behavioural Therapy (CBT) was developed in New Zealand to support young people during the difficult times of the COVID-19 pandemic. After the intervention of 4-weeks and a 3 month follow up, significant differences were observed for\u0026nbsp;emotional (p=0.04) and mental (p=0.008) well-being, stress (p=0.001) and self-compassion (p=0.003), whereas the changes in anxiety and sleep were not significant\u0026nbsp;(Thabrew et al., 2022). A study based on a yoga intervention also showed significant improvement in well-being scores based on the Subjective Well-being Inventory (SUBI), in comparison to the control group\u0026nbsp;(Sharma et al., 2008).\u003c/p\u003e\n\u003cp\u003eThe participants of our pilot-feasibility study did not report any adverse effects during or post the intervention. These results suggest that the developed protocol is safe, easy to practice, feasible and effective. Since both physical (by Yoga) and mental (by meditation) aspects are covered in this protocol, the effectiveness of this therapy is higher, which can be further validated by randomized clinical trials. However, our study had certain limitations. First, the sample size used for the feasibility study was small. This study can be carried out with a larger population in the future. Second, this study lacked a control group, making it challenging to account for extraneous factors. Third, we used structured questionnaires to measure the outcomes, leading to the possibility of response bias. Fourth, as we conducted only a pilot study with smaller sample size and only one month of intervention period, the psychometric results were not clinically significant. The participants continued to have moderate levels of anxiety and perceived stress.\u003c/p\u003e"},{"header":"Conclusion \u0026 Future Prospective","content":"\u003cp\u003eMental health poses a challenge in this fast-paced world. Recently, the use of non-pharmacological techniques has increased to address this issue. However, a limited number of studies focusing on combined mediation and yoga programs targeting specific medical conditions are available. Therefore, in this research, a combined Heartfulness Meditation and Yoga protocol was developed and content validated by 40 experts. The feasibility and efficacy of this protocol was also determined by a pilot study. This content validated protocol was found to be easy to administer, feasible and effective with a reduction in anxiety and perceived stress and an increase in the well-being of the participants, with no adverse effects. This protocol can further be clinically validated using a randomized trial in a larger sample size of patients from psychiatry departments across different hospitals. We will also use biomarkers to clinically strengthen our findings in the future, and if found effective, it can be utilized by healthcare providers to efficiently and systematically care for patients with low and moderate anxiety, in addition to their standard medicative treatment.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAhmad, N. A., Elias, N. F., Ashaari, N., \u0026amp; Mohamed, H. (2023). Learning Management System Acceptance Factors for Technical and Vocational Education Training (TVET) Institutions. \u003cem\u003eTEM Journal\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e, 1156\u0026ndash;1165. https://doi.org/10.18421/TEM122-61\u003c/li\u003e\n \u003cli\u003eAlwan, A., \u0026amp; Maclean, D. R. (2009). 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The WHO-5 Well-Being Index: A systematic review of the literature. \u003cem\u003ePsychotherapy and Psychosomatics\u003c/em\u003e, \u003cem\u003e84\u003c/em\u003e(3), 167\u0026ndash;176. https://doi.org/10.1159/000376585\u003c/li\u003e\n \u003cli\u003eUpadhyay, P., Narayanan, S., Khera, T., Kelly, L., Mathur, P. A., Shanker, A., Novack, L., P\u0026eacute;rez-Robles, R., Hoffman, K. A., Sadhasivam, S. K., \u0026amp; Subramaniam, B. (2022). Perceived Stress, Resilience, and Wellbeing in Seasoned Isha Yoga Practitioners Compared to Matched Controls During the COVID-19 Pandemic. \u003cem\u003eFrontiers in Public Health\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e. https://www.frontiersin.org/articles/10.3389/fpubh.2022.813664\u003c/li\u003e\n \u003cli\u003eWoodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. \u003cem\u003eInternational Journal of Yoga\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(2), 49\u0026ndash;54. https://doi.org/10.4103/0973-6131.85485\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eYoga Sutras Of Patanjali\u0026mdash;A Summary Easy To Understand\u003c/em\u003e. (2023, May 30). https://yogic-experience.com/yogic-knowledge/yoga-sutras-of-patanjali/\u003c/li\u003e\n \u003cli\u003eZollars, I., Poirier, T. I., \u0026amp; Pailden, J. (2019). Effects of mindfulness meditation on mindfulness, mental well-being, and perceived stress. \u003cem\u003eCurrents in Pharmacy Teaching \u0026amp; Learning\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(10), 1022\u0026ndash;1028. https://doi.org/10.1016/j.cptl.2019.06.005\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"MGM INSTITUTE OF HEALTH SCIENCES NAVI MUMBAI","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anxiety, Validation, Feasibility, Heartfulness Meditation \u0026 Yoga, Stress, Well-being, Pilot study.","lastPublishedDoi":"10.21203/rs.3.rs-3995680/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3995680/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntegrating contemplative practices such as meditation and yoga may offer a comprehensive approach for the rise in mental health issues. We aimed to develop and validate a Heartfulness Meditation and Yoga protocol for individuals with low to moderate anxiety. In Phase 1, we developed the protocol from extensive literature survey using classical yoga texts and scientific studies. Phase 2 involved content validation through experts from fields related to yoga, Ayurveda, physiology, psychology, and psychiatry, by calculating the content validity ratio (CVR). Phase 3 consisted of a pilot study to check the feasibility and effectiveness of the protocol. Data were collected using Beck Anxiety Inventory (BAI), WHO-Well Being Index (WHO-WBI) and Perceived Stress Scale (PSS). The final protocol encompassed practices such meditation, relaxation, cleaning and pranayamas. In the validation phase, 40 subject experts participated, and all practices (for low and moderate anxiety) were incorporated in the final protocol, as CVR scores were \u0026gt;0.29. Participants from the pilot study revealed a high satisfaction rate of 90% and significant reduction in anxiety, and improved well-being. Our approach was safe, feasible and effective, making it a promising addition to conventional anxiety treatments. In future, randomized clinical trials are required.\u003c/p\u003e\n\u003cp\u003eCTRI No. CTRI/2023/11/060151\u003c/p\u003e","manuscriptTitle":"Development, Content Validation and Pilot Study Feasibility of Heartfulness Meditation and Yoga Protocol for Anxiety","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-29 03:44:48","doi":"10.21203/rs.3.rs-3995680/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"29a9031e-3eb1-4542-8e26-447062908d96","owner":[],"postedDate":"February 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":29018780,"name":"Biochemical Research Methods"}],"tags":[],"updatedAt":"2024-02-29T03:44:48+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-29 03:44:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3995680","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3995680","identity":"rs-3995680","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}