Hindawi Publishing Corporation

Evidence-Based Complementary and Alternative Medicine

Volume 2013, Article ID 513149, 8 pages
http://dx.doi.org/10.1155/2013/513149

Research Article
A Yoga and Compassion Meditation Program Reduces Stress in
Familial Caregivers of Alzheimer’s Disease Patients

M. A. D. Danucalov,1,2 E. H. Kozasa,1,3 K. T. Ribas,2 J. C. F. Galduróz,1 M. C. Garcia,1

I. T. N. Verreschi,4 K. C. Oliveira,4 L. Romani de Oliveira,1 and J. R. Leite1
1
Department of Psychobiology, Universidade Federal de São Paulo-UNIFESP, 925, Rua Napoleão de Barros,
04024-002 São Paulo, SP, Brazil
2
Departiment of Research, Instituto Appana Mind de Desenvolvimento Humano, 05436-020 São Paulo, SP, Brazil
3
Instituto do Cérebro, Hospital Israelita Albert Einstein, 05601-901 São Paulo, SP, Brazil
4
Department of Medicine, Division of Endocrinology, Universidade Federal de São Paulo-UNIFESP, 04023-062 São Paulo, SP, Brazil

Correspondence should be addressed to E. H. Kozasa; ehkozasa@gmail.com

Received 13 December 2012; Accepted 29 March 2013

Academic Editor: Luciano Bernardi

Copyright © 2013 M. A. D. Danucalov et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.

Familial caregivers of patients with Alzheimer’s disease exhibit reduced quality of life and increased stress levels. The aim of
this study was to investigate the effects of an 8-week yoga and compassion meditation program on the perceived stress, anxiety,
depression, and salivary cortisol levels in familial caregivers. A total of 46 volunteers were randomly assigned to participate in a
stress-reduction program for a 2-month period (yoga and compassion meditation program—YCMP group) (𝑛 = 25) or an untreated
group for the same period of time (control group) (𝑛 = 21). The levels of stress, anxiety, depression, and morning salivary cortisol of
the participants were measured before and after intervention. The groups were initially homogeneous; however, after intervention,
the groups diverged significantly. The YCMP group exhibited a reduction of the stress (𝑃 < 0.05), anxiety (𝑃 < 0.000001), and
depression (𝑃 < 0.00001) levels, as well as a reduction in the concentration of salivary cortisol (𝑃 < 0.05). Our study suggests
that an 8-week yoga and compassion meditation program may offer an effective intervention for reducing perceived stress, anxiety,
depression, and salivary cortisol in familial caregivers.

1. Introduction social exclusion, depression, emotional isolation, burnout of

personal relationships, loss of life perspectives, sleep disor-
The aging of the worldwide population has contributed to ders, and abuse of psychotropic substances [8–13]. Several
the increasing incidence of dementia-causing chronic degen- studies of Alzheimer’s disease patients and caregivers stress
erative diseases, notably Alzheimer’s disease [1]. Alzheimer’s the importance of the medical team orienting the familial
disease is the most common form of dementia and is charac- caregivers beginning in the earliest stages of disease, and
terized as a progressive brain disorder with loss of reasoning, plans for such support interventions have been suggested
memory, language skills, and the ability to maintain an inde- in the literature [14–16]. Yoga and meditation are among
pendent life [2]. The caregivers of Alzheimer’s disease patients the modalities of intervention that might be applied to this
are typically family members [3]. The physical and mental population.
burden imposed on caregivers frequently results in poor One of the most appropriate definitions of yoga is found
quality of life [4]. The physical, mental, social, and financial in documents dated approximately 2,000 years ago, namely,
burden to which caregivers are exposed to might result in an Patanjali’s Yoga sutras. One of such sutras defines yoga as
increased risk of acute myocardial infarction and death [5– follows: yoga is the restriction of the fluctuations of mind-
7]. Among the several psychosocial contexts experienced by stuff [17]. Thus, one of the aims of yoga is the development
caregivers, the following are particularly noteworthy: stress, of mindfulness; several meditation techniques exhibit similar
2 Evidence-Based Complementary and Alternative Medicine

goals. Although meditation is a component of yoga, there as the following: diagnosis of Cushing’s syndrome; ongoing
are other approaches to meditation, such as compassion treatment with corticoids per any route, including the topical
meditation, which originated in Buddhism, that are not and nasal ones in the previous 30 days; diagnosis of asthma
associated with bodily practices, as in yoga. For this reason, or chronic obstructive pulmonary diseases (COPD); use
both terms, yoga and meditation, will be used throughout the of alcohol (more than five drinks per week) or drugs of
present paper. abuse; and regular practice of yoga, meditation, or similar
Practices related with yoga and meditation have been techniques. The use of tranquilizers was not an exclusion
investigated as potential techniques for reducing stress [18– criterion, provided that the volunteers started it before the
21], anxiety [21–23], and depression [21, 23]; for improv- study and did not discontinue it during the study period. A
ing physical and mental wellbeing and several domains of total of 53 familial caregivers of Alzheimer’s disease patients
cognition [23, 24]; and for enhancing quality of life [25, were selected. Forty-six of the subjects completed all of the
26]. During these practices, the participant develops the stages of the study after random allocation into 2 groups:
ability of focused attention to the present moment, instead 25 volunteers (22 females and 3 males) participated in the
of being arrested by thoughts and ruminations [18]. This yoga and compassion meditation program (YCMP group),
mental stability seems to be related to sympathetic reduction and 21 (19 females and two males) volunteers made up the
and conversely improvement in the parasympathetic activity control group (CG), which was a nontreated group. For
contributing to stress and anxiety reductions [18–20, 27]. ethical reasons, after the end of the study, the volunteers in the
Few studies investigated the stress levels of the caregivers CG also participated in the suggested intervention. The par-
of patients with chronic diseases before and after such ticipants visited the Psychobiology Department of UNIFESP,
interventions as yoga and meditation. A pilot study applied where they were subjected to clinical examination to assess
a program known as Inner Resources as therapy to 12 women their overall health, filled in identification questionnaires,
responsible for the care of relatives with dementia. The and signed a free and informed consent form. Next, the
protocol developed by that program included meditation, volunteers filled in the psychological scales and inventories
yoga body positions and respiration techniques, and visual- and were instructed to the procedures to collect salivary
izations and repetitions of specific sounds, which are known samples to measure cortisol levels. These same assessments
as mantras. The application of specific questionnaires allowed were performed two months later in both groups.
the researchers to detect improvement in the caregivers’ state
of depression and anxiety [22]. A more recent study found 2.2. Outcome Measures. The following instruments were used
similar results upon assessing the effects of meditation on to measure the psychological aspects.
perceived stress and related indices of psychological status
in Alzheimer’s disease patients and their caregivers [27]. (a) Lipp’s Stress Symptoms Inventory for Adults (LSSI),
However, these results must be interpreted cautiously, as which has been frequently used in Brazil in recent
neither study included a control group, and the sample sizes years and categorizes stress according to a four-phase
were small in both cases. model, namely, alertness, resistance, quasiexhaustion,
In addition to the emotional stress that caregivers suffer and exhaustion according to the amount of physical
upon seeing their relative deteriorate physically and mentally, and psychological stress symptoms [28].
caregivers of patients with Alzheimer’s disease must perform (b) Beck Depression Inventory (BDI) and Beck Anxiety
physical labor. Therefore, the aim of the present study was Inventory (BAI), both comprising 21 questions des-
to investigate whether the practice of a yoga and com- cribing depression and anxiety symptoms to which
passion meditation program might alter the stress, anxiety, subjects respond on a four-point scale [29–32].
and depression levels of familial caregivers of patients with
Alzheimer’s disease, as measured on standardized question- (c) In addition, the salivary cortisol level was used as a
naires. The present study also sought to assess whether the measure of physiological stress. For that purpose, 8
intervention modified the caregivers’ morning cortisol level. samples were collected from each participant. Four
samples were collected before the intervention: two
samples were collected on 2 consecutive days, both
2. Methods immediately and 30 minutes after waking up, under
fasting conditions. Additional 4 samples were col-
2.1. Study Participants. The present study was approved by lected following the same procedures after interven-
the Research Ethics Committee of UNIFESP, Protocol no. tion. Morning was selected as the time for sample
1528/07. The study volunteers were recruited by means of collection because it corresponds to the maximum
announcements on radios and newspapers placed the Press peak of cortisol throughout the day [33–36]. As
Consultancy of UNIFESP and were also referred by the the morning cortisol level is sensitive to light—
Brazil Alzheimer’s Association (Associação Brasileira de the greater the luminosity, the higher the cortisol
Alzheimer—ABRAZ). The inclusion criteria were as follows: concentration—[35], the volunteers were oriented
older than 18 years of age, minimum educational level corre- to perform the first sample collection immediately
sponding to complete elementary education, and exhibiting upon waking up and in the dark, and the second
at least the resistance stage of stress on Lipp’s Stress Symptoms sample was collected 30 minutes later under exposure
Inventory for Adults (LSSI) [28]. The exclusion criteria were to natural light. We analyzed the results based on
Evidence-Based Complementary and Alternative Medicine 3

the average results of the first day samples, the second movement, the practitioner lies on the floor, on the
day samples, and the overall average of both days. The back. The aim of this exercise is to raise the legs,
samples were processed at the Laboratory of Steroids thighs, and hips from the floor, that is, to attain an
of the Department of Endocrinology of UNIFESP. upside-down position, while supporting the body on
The samples were centrifuged at 3,000 rpm for 5 the upper part of the back, upper arms up to the
minutes, and the supernatant was stored at −20∘ C elbows, and the back of the head. The asanas’ average
until testing, which was performed by means of duration of each movement was approximately one
radioimmunoassay (RIA). Each sample was tested and a half minutes [38, 39].
in duplicate using 100 𝜇L of supernatant without
any previous extraction [37]. An antibody (cortisol- (b) Exercises involving awareness and voluntary regula-
3-(O-carboxymethyl)-oxime-bovine) highly specific tion of breath (pranayamas) (25 min): Adhama Pra-
for cortisol (100%) but without significant cross- nayama—free, predominantly abdominal respiration.
reactivity with other steroids (<1%) was used. Bhastrika—forceful expirations through the nose
followed by passive inspirations. Ujjayi—slow and
complete inspiration, retention of the air in the
2.3. Intervention. The stress reduction program lasted 2
lungs, and slow expiration through partially closed
months, with sessions lasting 1 hour and 15 minutes, 3 times
glottis. Surya Bhedana—inspiration through the right
per week. The participants had to attend 1 live session per
nostril followed by expiration through the left nostril.
week, totaling eight live sessions, whereas the other 2 weekly
Chandra bhedana—inspiration through the left nos-
sessions (16 sessions) were performed at home with the aid
tril followed by expiration through the right nostril.
of a DVD. The program included the following traditional
Nadi Shodhana—inspiration through the left nostril,
Hatha Yoga exercises.
retention of air in the lungs, expiration through the
(a) Yoga body poses (asanas) (25 min): Sukhasana— right nostril, inspiration through the right nostril,
practitioner sits with the legs crossed and the back retention of air in the lungs, and expiration through
straight. Vajrasana—practitioner sits on the heels, the left nostril. Kapalbhati—forceful, short, and fast
keeping the legs and thighs together, and the back expiration through the nostrils followed by passive
straight. Yoga-Mudra—practitioner sits on the heels, inspiration [38, 39]. The pranayamas’ average dura-
keeping the legs and thighs together, and the back tion of each one was approximately three minutes
bent forward. Paschimottanasana—practitioner sits [40, 41] (12.5 min).
with the knees stretched, feet together, and back
bent forward. Ardha-Matsyendrasana—practitioner (c.1) Meditational practices: mindfulness meditation
sits intertwining the legs, the back straight, and twists adapted for Western psychology, originating in Bud-
the back to look behind; this movement is performed dhist meditation, involves paying sustained attention
in both directions. Shavasana—practitioner lies on to sensations, perceptions, and thoughts with suspen-
the floor, on the back, with the arms along the body, sion of judgment [18].
and the knees extended. Naukasana—practitioner lies (c.2) Compassion meditation: compassion meditation
on the floor, on the back, then raises the legs and (karuna) emphasizes the voluntary production of
trunk from the floor, and keeps this position as long compassionate feelings for all living beings based on
as it is comfortable. Bhujangasana—practitioner lies the assumption that all beings aspire to happiness and
on the floor, on the abdomen, with the palms of seek to release themselves from suffering and its
the hands on the floor, at the pectoral level. Upon causes [42, 43] (12.5 min).
the instructor’s command, the practitioner raises the
trunk gently from the floor while stretching the back.
Ardha-Shalabhasana—practitioner lies on the floor, 2.4. Statistical Analysis. To establish whether the groups were
on the abdomen, with the arms along the body, legs similar before the intervention, the chi-square (𝜒2 ) test was
together, and knees stretched. Upon the instructor’s applied to the nominal and ordinal qualitative variables, and
command, the practitioner raises one thigh from the Student’s 𝑡-test was applied to the quantitative variables. To
floor; this movement is performed on both sides. analyze the psychological (BDI and BAI) and physiological
Standing Chakrasana—practitioner stands with the (cortisol level) measurements, 2-way ANOVA was applied
feet together, raises the right arm, and bends the trunk (YCMP and CG groups) (before and after intervention)
toward the left side; this movement is performed on followed by Tukey’s test when necessary. The differences
both sides. Vrikasana—practitioner stands with the between the groups and the time-points were investigated
feet together, removes the right foot from the floor, according to their statistical significance and as was the
and places it on the internal side of the left thigh. interaction between these factors. With respect to LSSI, the
Next, he/she joins the palms of the hands in front chi-square test (𝜒2 ) was used to compare the groups before
of the chest, raises the arms above the head, and and after intervention. To assess the effect of intervention,
remains in this position, keeping the balance, as long that is, to compare the results after intervention to the ones
as it is comfortable. This movement is performed on before intervention, McNemar’s test was applied to each
both sides. Sarvangasana—at the beginning of this category of phases of stress. All of the statistical analyses
4 Evidence-Based Complementary and Alternative Medicine

were performed using software Statistica version 10.1, and the Table 1: Frequency of the distribution of the phases of stress
significance level was established as 𝑃 ≤ 0.05. manifestation among the sampled individuals according to group
before and after intervention.

3. Results Phases of stress manifestation Before After

intervention intervention
Before the intervention, both groups were statistically homo- Control group Control group
geneous with respect to the following variables: male gender Absence 0 (0) 0 (0)
(YCMP, 𝑛 = 3, 12%) (CG, 𝑛 = 2, 10%) and female gender Alert 0 (0) 0 (0)
(YCMP, 𝑛 = 22, 88%) (CG, 𝑛 = 19, 90%); educational level, Resistance 18 (86) 16 (76)
complete elementary education (YCMP, 𝑛 = 1, 4%) (CG, 𝑛 =
Quasiexhaustion 3 (14) 4 (19)
0, 0%), complete secondary education (YCMP, 𝑛 = 11, 44%)
(CG, 𝑛 = 5, 24%), and complete higher education (YCMP, Exhaustion 0 (0) 1 (5)
𝑛 = 13, 52%) (CG, 𝑛 = 16, 76%); family income (minimum YCMP group YCMP group&
wage, MW = BRL 622.00) up to five times the MW (BRL Absent 0 (0) 17 (68)∗
3,110.00) (YCMP, 𝑛 = 6) (CG, 𝑛 = 7), more than five and up Alert 0 (0) 0 (0)
to 10 times the MW (BRL 3,110.00 to BRL 6,220.00) (YCMP, Resistance 20 (80) 8 (32)∗
𝑛 = 11) (CG, 𝑛 = 6), over 10 times the MW (above BRL
Quasiexhaustion 3 (12) 0 (0)
6,220.00) (YCMP, 𝑛 = 8), (CG, 𝑛 = 8); age (YCMP, 55.5 ± 8.1
years), (CG, 53.4±8.2 years); and length of caregiving (YCMP, Exhaustion 2 (8) 0 (0)
4.2 ± 3.3 years) (CG, 5.7 ± 3.7 years). Data described as frequency (percentage); & 𝑃 < 0.05: differs from control
group, chi-square test; ∗ 𝑃 < 0.05: differs from time-point before interven-
The participants in the YCMP group reported 100% com-
tion, McNemar’s test.
mitment to the suggested program. This level of adherence YCMP: yoga and compassion meditation program.
was most likely facilitated by the relative flexibility of the
program, as the live sessions could be attended at five different
times and at three different locations in the city of São Paulo. The YCMP group exhibited a 49.4% reduction in the BAI
Further, the use of the DVD for practice at home facilitated score, whereas the CG exhibited an increase of 10% at the
the optimal rate of adherence to the protocol. same time point.
Table 1 shows the frequency of distribution of the phases Table 3 presents the salivary cortisol concentration values
of stress manifestation in both groups. Before the interven- corresponding to the average of the two measurements on
tion, the groups were statistically similar in this regard: 𝜒2 the first sampling day (day one), the average of the two
(𝑃 > 0.05). No participant in any group was in either the measurements on the second sampling day (day two), and
absent or alert stages, 86% in the CG and 80% in the the average of the four measurements performed over both
YCMP group were in the phase of resistance, 14% in the CG, days (day one and day two). The YCMP group exhibited a
and 12% in the YCMP group were in the phase of quasi- statistically significant reduction in the salivary cortisol level
exhaustion, and only 2 individuals in the YCMP group were on day two (not in day one), as well as a reduction in the
in the phase of exhaustion. However, after intervention, the average of day one + day two before and after intervention.
groups exhibited statistically significant differences: 𝜒2 (𝑃 < The differences, according to the table, are not significant in
0.05). No participant in the CG group was in either the group factor, but they are significant in time and interaction
absent or alert phase, whereas 68% of the participants in the factors. The control group did not exhibit any significant
YCMP shifted to the phase characterized by absence of stress change. Some samples had an insufficient volume of saliva
manifestations. Table 1 further demonstrates that statistically to perform cortisol analysis and were lost as a result. On the
significant diagnostic changes occurred in the YCMP group. first day of the preintervention phase for the YCMG group,
Before the intervention, 20 volunteers were in the phase of we lost 20% of the saliva samples for cortisol analysis, and on
resistance, and none of the volunteers was in the phase of the second day we lost 18%, giving an overall loss of 19%. In
absence. After the intervention, only 8 volunteers were in the the same group, in the post-intervention phase, we lost 30%,
phase of resistance, and the other 17 volunteers were in the 26% and 28% of saliva samples, respectively, for the same
phase of absence of stress: McNemar’s test (𝑃 < 0.05). Conver- reason. There were also losses in the CG: on the first day of
sely, the CG did not exhibit any statistically significant change the preintervention phase there was a loss of 11.90% of the
between the beginning and the end of intervention. samples, 14.29% on the second day, giving an overall loss of
Table 2 demonstrates that the average depression (BDI) 13.10%. In the post-intervention phase, we lost 14.29%, 28.57%
and anxiety (BAI) scores exhibited statistically significant and 21.43%, respectively.
interactions with the time point and group factors. These
interactions suggest that the groups’ profiles differed over 4. Discussion
time. Both variables exhibited a significant reduction in the
YCMP group in addition to a difference between the groups The present study sought to establish whether an interven-
after the intervention. The YCMP group exhibited a 51.2% tion using yoga and compassion meditation exercises could
reduction in the BDI score after the intervention, whereas change stress, anxiety, and depression scores and reduce the
the CG exhibited an increase of 9.5% at the same time point. salivary cortisol levels of familial caregivers of Alzheimer’s
Evidence-Based Complementary and Alternative Medicine 5

Table 2: Scores of depression and anxiety measured by BDI and BAI of familial caregivers of Alzheimer’s disease patients before and after
intervention.
Before After 𝐹time-point(1.44) 𝐹group(1.44) 𝐹inter(1.44)
BDI
Control group 14.7 (±9.5) 16.1 (±10.2) 16.5 2.0 34.7
YCMP group 16.0 (±7.8) 8.2 (±4.6)∗& 𝑃 < 0.001 𝑃 = 0.16 𝑃 < 0.000001
BAI
Control group 19.9 (±10.2) 21.9 (±10.6) 12.9 9.6 32.3
YCMP group 17.6 (±9.4) 8.7 (±5.5)∗& 𝑃 < 0.001 𝑃 < 0.001 𝑃 < 0.00001
Data are described as the mean (±standard deviation); ∗ 𝑃 < 0.001 differs from the time point before the intervention in the corresponding group—Tukey’s
test; & 𝑃 < 0.001 differs from the control group in the corresponding time point—Tukey’s test.
YCMP: yoga and compassion meditation program.

Table 3: Salivary cortisol concentration (ng/dL) of familial caregivers of Alzheimer’s disease patients before and after intervention.

Before After 𝐹time-point(1.35) 𝐹group(1.35) 𝐹inter(1.35)

Cortisol day 1
Control group 539.4 (±152.6) 531.1 (±53.7) 3.64 0.10 3.31
YCMP group 743.9 (±140.7) 404.4 (±49.5) 𝑃 = 0.06 𝑃 = 0.76 𝑃 = 0.08
Before After 𝐹time-point(1.32) 𝐹group(1.32) 𝐹inter(1.32)
Cortisol day 2
Control group 674.7 (±181.7) 673.2 (±86.3) 7.42 0.00004 7.33
YCMP group 937.6 (±171.3) 408.1 (±81.3)∗ 𝑃 < 0.05 𝑃 = 0.99 𝑃 < 0.05
Before After 𝐹time-point(1.40) 𝐹group(1.40) 𝐹inter(1.40)
Cortisol days 1 and 2
Control group 641.5 (±137.6) 568.0 (±58.03) 8.38 0.02 3.97
YCMP group 823.0 (±131.2) 424.6 (±55.3)∗ 𝑃 < 0.001 𝑃 = 0.88 𝑃 < 0.05
Data are described as the mean (±standard deviation); ∗ 𝑃 < 0.05 differs from the time point before the intervention in the corresponding group—Tukey’s test.
YCMP: yoga and compassion meditation program.

disease patients. Among the most relevant findings were the The intervention group exhibited a statistically significant
changes in the stress manifestation phases of the participants reduction in the stress and anxiety scores, thus indicating
in the YCMP group from the categories of resistance (𝑁 = that this type of intervention might be useful to reduce stress
20), quasiexhaustion (𝑁 = 3), and exhaustion (𝑁 = 2) in the healthcare professionals directly involved with patient
to absence (𝑁 = 17) and resistance (𝑁 = 8), thereby care tasks [47]. The literature includes further evidence
demonstrating the effectiveness of the intervention. The indicating that the application of these practices might be
changes exhibited by the YCMP group in the stress indices useful when applied to caregivers [22, 27], and our study
measured by LSSI suggest that our program was able to corroborates such findings.
reverse the stress-related symptoms exhibited by that group Our data demonstrate statistically significant reduction
(Table 1). in the depressive symptoms among the participants in the
Elevations in the hypothalamic pituitary adrenal (HPA) YCMP group. An emergent body of evidence points to
axis are common occurrences under conditions of chronic the possible therapeutic effects of the practice of aerobic
psychological stress and result in increased cortisol levels. or anaerobic exercises on depression [48–50]. Such exer-
Such occurrences are associated with hippocampal volume cises, meanwhile, might be either mindful or nonmind-
loss and memory impairment and might increase the risk ful physical exercises. A systematic review analyzed pos-
of dementia in older adults [44–46], eventually creating a sible therapeutic differences between these two types of
vicious circle, whereby familial caregivers of patients with exercise. The analyzed results were provided by 12 studies
Alzheimer’s disease become future patients. Kang et al. [47] that complied with the methodological criteria applied by
applied a program similar to the one used in this study the authors for inclusion in that review. According to the
and observed a statistically significant reduction in the stress authors, both mindful and nonmindful exercises proved to
and anxiety levels of 16 nursing students paired with 16 be effective in reducing depression symptoms [50]. It is
volunteers, who constituted the control group. In the study, worth noting that among other activities, the volunteers
the intervention group performed the suggested program, in our study were subjected to the practice of hatha yoga,
comprising one weekly session, with each session lasting which includes physical exercise, most of them anaero-
from one hour and a half to two hours over two months. bic, to achieve that same goal. Nevertheless, our results
6 Evidence-Based Complementary and Alternative Medicine

cannot be discussed on the grounds of the therapeutic Nevertheless, only two volunteers (both in the YCMP group)
effects of the practice of physical exercise alone because in our total sample (46 familial caregivers) were smokers.
our purpose was to subject the volunteers to a program We believed that this low number noticeably reduced the
that included mindful exercises and compassion medi- possibility of interference associated with smoking.
tation. Therefore, our results must be attributed to the pro- Comparing to previous studies with familial caregivers,
gram as such and not merely to one of its parts. In addition, [22, 27], the present study is randomized and controlled and
Kozasa et al. investigated the efficiency of a program that has a bigger sample. However, the CG had no treatment, and
included mantra meditation and pranayamas, known as it could be a limitation of the study. We suggest that similar
Siddha Samadhi Yoga, in reducing scores of anxiety and studies include an active control group which can be a stress
depression in participants with anxiety complaints. This pro- discussion group, for example. Another interesting data not
gram includes meditation exercises associated with exercises collected in this study was the impact of the caregiver’s stress
of respiration (pranayamas). A total of 22 volunteers parti- reduction on the Alzheimer’s patients.
cipated in that study, with 14 volunteers being allocated to Like mentioned in the introduction, the mental stability
the intervention group and eight to the control group. The could be related to sympathetic reduction and improvement
volunteers in the intervention group were oriented to practice in the parasympathetic activity contributing to stress and
the exercise protocol every day of the week, three times per anxiety reductions. Many other studies about the effects of
day, in 15-minute sessions. At the end of the study, as in ours, meditation practice have been indicating a number of phys-
the intervention group exhibited a significant reduction in the iological changes, such as increased GABA concentration
anxiety and depression scores compared to the control group [57], adrenalin and noradrenalin reductions [58], increased
[51]. serotonin [59] and melatonin concentrations [60], which can
A relationship between practices involving meditation be related to improvements on mood, reductions in body
and the endocrine and immune systems has been analyzed in temperature [61, 62] and increased galvanic skin resistance
the scientific literature. Witek-Janusek et al. observed a reduc- [63], may be related to stress management, and also increased
tion in cortisol concentrations and an improvement of gray matter density in brain regions related to emotional
immune system function among women diagnosed with regulation [64]. New studies with familial caregivers would
breast cancer who were subjected to the mindfulness-based evaluate more physiological parameters than presented in
stress reduction (MBSR) program compared to a control this study.
group also comprising women with breast cancer [52]. In the
present study, we chose to measure the salivary cortisol
levels as a physiological variable sensitive to the behavioral 5. Conclusions
modifications to which the volunteers were subjected. As
The results our study demonstrate are that the practice of yoga
presented in Table 3, our results indicate that the changes
and the suggested meditation techniques may represent an
exhibited by the YCMP group, with respect to the cortisol
effective intervention for caregivers of relatives with Alzheim-
levels of the samples collected on the second day and the
er’s disease to reduce their stress, anxiety, and depression
total average of the samples collected on the first and second
symptoms and to decrease their cortisol levels.
days, were higher compared to the control group. Our results
indicate that the participants in the YCMP group deve-
loped psychophysiological adaptations associated with the Acknowledgment
participation in the indicated program, although we did not
find statistically significant differences between the groups The authors thank Associação Fundo de Incentivo à Pesquisa-
in the measurements of salivary cortisol performed after the AFIP for providing financial support.
intervention.
During the study, we hypothesized that the caregivers’ References
menstrual cycle phase might interfere with the results; how-
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E in persons with memory complaints as a preventive strategy
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