Complementary Therapies in Medicine 61 (2021) 102772

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Complementary Therapies in Medicine

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Development and validation of Yoga Module for Anger Management

in adolescents
Alaka Mani TL a, *, Omkar SN b, 1, Manoj K. Sharma c, Astha Choukse d, Nagendra HR e, 2
a
Yoga and Counselling Professional, Life Skills Trainer, Life-Style Couch, Adolescent Health Couch, India
b
Dept of Aerospace Eng., Indian Institute of Science, Bangalore, India
c
Dept of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, India
d
Yoga Professional, India
e
Founder and Chancellor of a World Renowned Yoga University, India

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Development of anger management programs and in particular, yoga module for anger management
Yoga Module has not been well researched. Being a complex emotion, anger poses serious challenges in developing a
Anger management comprehensive anger management program. While various theories of anger are dealt in modern psychology,
Adolescent
several anger management techniques are set forth in Indian traditional texts. Yoga, which is considered as a
School
holistic and integrated approach is explored in this study to develop and validate a school-based yoga program
for anger management in adolescence.
Materials and methods: Integrated Approach to Yoga Therapy (IAYT) principles and literary review formed the
basis for deriving the concepts of anger management. The methodology includes construction of the yoga
module, validation of the module by 22 experts followed by a pilot non-randomised control study (n-50) to assess
feasibility and initial effectiveness. Content Validity Ratio (CVR) and paired t-test were employed to analyse the
experts’ rating and pilot-study data respectively.
Results: Emergence of IAYT based yoga program for anger management. Based on CVR ratio, 16 out of 18 yogic
techniques qualified for the final module. The pilot study revealed viability of the module and its recognition as
an anger management program. Significant reduction of anger scores in yoga group substantiates initial effec­
tiveness of the module.
Conclusion: The developed and validated yoga module for anger management is recognised as a well-accepted
and effective yoga program for anger management in adolescents.

1. Introduction activation of parasympathetic activity with release of acetylcholine

neurotransmitter.5
Anger and its manifestations among adolescents have drawn global Considering the adverse effects and the long-term consequences of
concern. Anger is a difficult construct to understand, assess and to anger, researchers and clinicians have prescribed a variety of interven­
conceive coping strategies.1,2 Furthermore, anger issues and conduct tion programs for anger management. Cognitive-behavioural and skills-
disorders among adolescents and youth are on rise in India.3 based approaches are widely studied and empirically validated treat­
Anger is marked by a profound chemical and electrical activity ments for anger in adolescents.2,6 Recent years have witnessed the use of
simultaneously occurring at the hypothalamic-pituitary-adrenal (HPA) mindfulness, yoga, and other healing techniques to manage emotional
axis.4 Arousal of anger is marked by release of noradrenaline (nor-epi­ dyscontrol or affective states.7–9 School-based yoga programs that has
nephrine) hormone that results in a sudden surge of energy and gathered special interest among researchers, promote healthy behav­
increased sympathetic activity. Anger arousal is counteracted by iours at societal level by focusing on prevention of negative patterns

* Corresponding author.
E-mail addresses: [email protected] (A.M. TL), [email protected] (O. SN), [email protected] (M.K. Sharma), [email protected] (A. Choukse),
[email protected] (N. HR).
1
www.yogaomkar.com.
2
www.svyasa.org.

https://doi.org/10.1016/j.ctim.2021.102772
Received 3 September 2020; Received in revised form 20 August 2021; Accepted 25 August 2021
Available online 8 September 2021
0965-2299/© 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
A.M. TL et al. Complementary Therapies in Medicine 61 (2021) 102772

during adolescent transition.10–14 4) Vijnanamaya Kosha – Lectures, Counselling, Satsang (company of

Yoga is an umbrella term used for any physical, psychological and good people) and Jnana Yoga (in-depth study of a subject) sharpens
spiritual activity that originated from ancient texts to enhance quality of the intellect. All these provide right knowledge and eradicate igno­
life. Yoga is broadly classified as Bhakti Yoga (Yoga of devotion), Jnana rance. Helps to understand realities of life.
Yoga (Yoga of knowledge), Raja Yoga (Yoga of mental mastery) and 5) Anandamaya Kosha - Karma Yoga (selfless service) leads to a state of
Karma Yoga (Yoga of action).15 Among these, Raja Yoga or Patanjali blissful silence with awareness, perfect poise, and freedom of choice
Yoga is more popular and researched. This form of yoga comprises of 8 where the mind is not troubled by stressful thoughts and fears.
limbs called Yama (social conducts), Niyama (individual adherences),
Asana (postures), Pranayama (breathing techniques), Pratyahara (con­ Anchored in this theory, an attempt is made to develop an integrated
trol of senses), Dharana (focusing), Dhyana (meditation) and Samadhi and holistic yoga module for anger management by deriving the concept
(contemplation). Adherence to first two limbs (Yama and Niyama) is of anger management from the traditional texts as detailed below.
essential to tread the path of yogic way of life. Yama comprises of five According to ancient texts, anger is an innate emotion and has its
essential social conducts called ahimsa (non-violence), satya (truthful­ origin in manomaya kosha. It is experienced throughout the body and
ness), asteya (non-stealing), brahmacharya (living in moderation) and causes disruption in all dimensions of existence (koshas). Anger triggers
aparigraha (non-possessiveness). Niyama also comprises of five essential sympathetic arousal causing various physiological changes in the body
qualities such as shoucha (purity), santosha (contentment), tapas (aus­ (annamaya kosha). It alters the breathing pattern (pranamaya kosha)
terity), swadhyaya (self-awareness) and Iswara pranidhana (let go of and leads to momentary memory loss (manomaya kosha). Further it
ego). Both Yama and Niyama play a vital role in establishing self-control destroys the power of discrimination (vijnanamaya kosha) and distances
of emotions and judicial use of intellect. one from being at bliss (anandamaya kosha).
The tenets of yoga emphasise on establishing harmony between the Among the several traditional texts, Patanjali Yoga Sutras (PYS),
physical body, breath and mind.16,17 In yogic parlance, human existence Yoga Vasista, Bhagavad-Gita (BG) and Upanishads have illustrated
is an amalgamation of five sheaths described as the physical body, many anger management techniques. Yama –Niyama concepts of PYS
breath, emotions, intellect, and blissfulness. This theory of human ex­ provide a strong base to overcome anger. Yoga Vasista offers evidences
istence is called pancha-kosha model and is explained in detail in the for mind–body inter-connectedness in defining, diagnosing and treating
ancient text called Taittiriya Upanishad. The Brahmananda Valli and illnesses of all kinds. BG explains the origin of anger, its consequences,
Brugu Valli sections of this text, also define human existence as a and management techniques spread across in various verses. To mention
composition of 5 koshas (sheaths) called Annamaya kosha (gross a few, Yoga Vasista talks about sublimation of thoughts (mana pra­
sheath), Pranamaya kosha (energy sheath), Manomaya kosha shamana), PYS suggests distraction (pratipaksha bhavana), physical
(emotional sheath), Vijnanamaya kosha (intellectual sheath) & Anan­ activity (asanas), regulating the breath (pranayama) etc. BG promotes
damaya kosha (bliss sheath).18 developing virtues such as ahimsa, forgiveness, and patience as a rem­
Holistic and integrated approach is to consider suitable yogic prac­ edy for anger.
tices from different forms of yoga to establish health and wellbeing at all Although it is seen that yoga is effective in schools for nurturing
the five sheaths. This approach is also well correlated with the definition mental health, available studies suffer from several limitations
of health declared by World Health Organisation (WHO). According to regarding study design, methodology, standardization yoga module,
WHO, health is the state of complete wellbeing at physical, psycholog­ sample size, absence of control group, etc. Review studies on yoga in
ical, social and spiritual domains and not merely the absence of disease schools calls for standardisation of yoga module.12,21
and infirmity. Considering the dearth in studies pertaining to yoga modules for
Considering the vastness of the Yogic science, experts have derived a anger management, this study aims at developing an integrated and
comprehensive approach called Integrated Approach to Yoga Therapy holistic yoga program for anger management suitable to school envi­
(IAYT) or Integrated Yoga Module (IYM). Anchored in the concept of ronment. Holistic and integrative approach is established by considering
pancha-kosha, IYM is a prescription of yogic techniques derived from all the yogic practices suited to all layers of existence and also considering
major forms of yoga, to address specific health conditions. A study based major forms of yoga such as Raja Yoga, Bhakti Yoga and Jnana Yoga.
on qualitative evidence, decoded IAYT module to prescribe a framework
of yogic practices for different koshas as detailed below.19,20 2. Material and methods

1) Annamaya Kosha – Asanas (Yogic Postures), Loosening Exercises, The purpose of the study is to develop a yoga module for anger
Kriyas (cleansing techniques) and Yogic Diet predominantly work on management for secondary school children. The scope of the study in­
Annamaya Kosha. A stable and comfortable asana engages musculo- cludes a) construction of the module based on IAYT principle and lit­
skeletal system in a systematic way. Asanas also provide stimulation erary review, b) validation of the module by experts, and c) through the
and deep relaxation to internal organs by thoroughly massaging pilot study, assessing the feasibility of the module and also check its
them. Sage Patanjali states that the mind becomes tranquilled and initial effectiveness. It is a school-based yoga program designed to be
expanded in a natural effortless way by practicing Asanas. He further taught in secondary schools. This study was approved by Institutional
claims that the dualities of the mind cease to exist by practicing Ethics Committee of S-VYASA Yoga University. Clinical trial registry was
Asanas. Loosening exercises strengthens the muscles, reduces joint not done as it was not mandatory at the time of study and the scope of
stiffness and increases physical stamina. Kriyas have many hidden the work was more theoretical.
benefits in addition to purifying the body. Balanced diet helps to The study relies on scriptural evidences for deriving various anger
maintain internal harmony in the body and mind. management techniques and contemporary yoga books for selecting
2) Pranamaya Kosha – Breathing exercises increases bodily awareness, relevant yogic practices for anger management. Strict adherence to
corrects breathing pattern, clears the lungs and increases lung ca­ modern scientific module development procedures and processes was
pacity. Pranayamas help to slow down breath rate and restore ensured during construction and validation of the module.
autonomic balance thereby calming the mind. It promotes free flow The study methodology comprises of three processes. They are
of energy in the body thereby makes the mind ready for higher construction of a yoga module, validation of the module by experts, and
practices. a pilot study administering the module in a non-randomised control
3) Manomaya Kosha – Meditations, Devotional Sessions and Bhakti trial.
Yoga engage the mind to promote emotional regulation and Initially a framework of 18 yogic techniques was prepared providing
emotional culture. justification for each technique. Evidences for justification of the yogic

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A.M. TL et al. Complementary Therapies in Medicine 61 (2021) 102772

techniques were drawn from the contemporary books on yoga.22–30 In psychologists) partially filled the forms excluding the asana and
general, yogic techniques that activate parasympathetic activities and breathing part as they stated that they don’t have expertise in these
promote balance of sympathetic and parasympathetic activities were aspects. Remaining eight experts did not provide their rating item-wise
chosen. These include asanas that promote concentration, attention, and but responded saying that everything is OK and it is an excellent
balance; pranayamas that promote calmness and tranquillity; medita­ attempt. For the purpose of calculation, only technique-wise provided
tion that promotes emotional mastery. Under the premise of Jnana yoga, responses were considered.
a few aspects of Yama, Niyama, Pratyahara and also physiology and Out of 18 practices in the framework, 12 practices were validated by
psychology of anger are discussed. 8 experts and 6 practices were validated by 14 experts. As per the
This framework was prepared in a tabular form providing columns Lawshe’s CVR ratio, the minimum value (qualifying value) for 8 experts
for validation using Likert scale of 0–4 with 0 being necessary, 1 a little is 0.75, and for 14 experts is 0.51. CVR was calculated for all the prac­
useful, 2 moderately useful, 3 essential 4 extremely essential. Provision tices which are presented in Table 1 below.
were made to provide overall comments, suggestions and also to review Seven techniques have scored CVR 1.0 indicating total agreement. 11
the module in terms of it’s techniques with CVR ≥ 0.75 reviewed by 8 experts, and 5 techniques
with CVR ≥ 0.51 reviewed by 14 experts, qualified for inclusion in the
a) relevance - whether the technique significantly works for anger module. Techniques (with asterisk mark in Table 1) namely krida yoga
b) specificity - whether the technique is precise for anger; (CVR = 0.50) and screening of movies (CVR = 0.14) were excluded.
c) sensitivity - whether the technique is sensitive enough to be prac­ Experts have expressed their apprehension about screening of movies
ticed by children (both girls and boys) in school setting; and and conducting krida yoga in the class room in the 30-minutes slot.
d) evidence - whether the justification provided is adequate for its use. Even though experts who gave an overall OK comment and did not
provide item-wise rating were excluded, it is worth mentioning that they
The framework was sent to 26 experts (6 yoga practitioners and have validated all the techniques in total agreement. In general, these
therapists, 4 yoga professors, 4 yoga research scholars, 10 psychologists, responses were excellent.
and 2 adolescent counselling experts). A detailed note on the purpose of The pre and post data of pilot study is anlysed using paired t-test to
this study was also sent along with the framework in printed form for examine the effectiveness of the yoga module. For the purpose of sta­
local experts and in electronic form for outstation and overseas experts. tistical testing, α level was set at 5 %. Normality test was not carried out
Experts were requested to respond immediately but not later than 30 as it was a pilot work and randomisation at children level was not done.
days. Most of the experts were Ph.D. holders with more than 10–15 years Results are tabulated in Table 2 below.
of experience and are veterans in their field. Results indicate significant reduction of anger scores in the yoga
Content rationality of the module was calculated using Lawshe’s group. An increase, though not significant is observed in control group.
Content Validity Ratio (CVR), which is a method for measuring the level Table 2 also reveal a big difference in baseline data which renders the
of agreement of an item among experts in the panel. The more the ex­ results non conclusive. However, p value 0.000 of yoga group moder­
perts agree on an item, the greater the level of content validity for that ately substantiates the initial effectiveness.
item.31 Subjective feedback from the students during practice was excellent.
A yoga module was constructed using techniques that were qualified The module was well accepted and children found it very convenient
in expert validation. It was broadly classified into 1) Opening and and comfortable to practice. Oral feedback from the teachers was that
closing prayers 2) Postures and breathing techniques 3) Meditations 4)
Knowledge points, and 5) Home practice.
The developed module was administered in a non-randomised con­ Table 1
trol study (pilot study) carried out in a secondary school. The school had Yogic Techniques with CVR as per Lawshe formula.
two sections (divisions/ classrooms/groups) of 8th grade students i.e. Yogic techniques ne N N/ ne CVR
Section A and Section B with around 30 children in each section. Among 2 -N/2
them, 28 children in Section A and 22 children in Section B consented for
Techniques reviewed by 8 experts
the study and met inclusion and exclusion criterion. Using lottery 1 Dynamic practice of asanas in sequence - 7 8 4 3 0.75
method, one section was considered as the yoga group and the other Shashankasana, Bhujangasana,
section as the waitlist control group. Randomisation at the children level Adhomukha swanasana
2 Triyak Tadasana 7 8 4 3 0.75
could not be done as it was disturbing the school’s internal set-up. Yoga
3 Ostrich Pose 7 8 4 3 0.75
sessions were conducted during the academic hours in the slots (free 4 Vrikshasana, veerabhadrasana-3, 7 8 4 3 0.75
periods) allotted by the school. Control group students attended regular Natarajasana
classes. Yoga sessions were conducted for four months with two sessions 5 Paschimottanasana 7 8 4 3 0.75
of 30 min each per week. 6 Suryanamaskara 8 8 4 4 1.0
7 Conscious Breathing 8 8 4 4 1.0
Anger assessment was done using a validated Adolescent Anger
8 Abdominal breathing 8 8 4 4 1.0
Assessment Scale. This 23-item self-reporting scale assesses anger at 9 Alternate Nostril Breathing 7 8 4 3 0.75
behavioural, verbal, and mental domains in adolescents and enjoys high 10 Brahmari 7 8 4 3 0.75
reliability scores with Alpha coefficient (α-0.804) and test-retest reli­ 11 Yogic Concepts (Ahimsa, Brahmacharya, 8 8 4 4 1.0
Santosha, Swadhyaya, Iswara
ability (r-0.835). Anger scales tend to have limitations of culture spec­
Pranidhana, Pratyahara)
ificity and sensitivity as the words used to describe anger have variety of 12 Krida Yoga 6 8 4 2 0.5*
meanings in different cultures.32,33 This is the first of its kind anger scale Techniques reviewed by 14 experts
developed in India34 and is found to be in par with the popular and 13 Meditation 12 14 7 5 0.71
widely used STAXI-2A anger assessment Scale which is of western 14 Physiology & Psychology of Anger 14 14 7 7 1.0
15 Screening of Movies 7 14 7 0 0.14
origin.
*
16 Food and Anger 14 14 7 7 1.0
2.1. Analysis and results 17 Stories on Anger 14 14 7 7 1.0
18 Home work 13 14 7 6 0.88
The framework that was sent to experts for their rating is placed as ne = number of experts indicating ‘essential and extremely essential’ (3 or 4 in
Appendix A. Out of twenty-six, four experts did not respond. Eight ex­ 0–4 Likert scale), N = Total number of experts, CVR = Content validity ratio.
perts provided their ratings for all the items. Six experts (mostly *
Excluded in final module.

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A.M. TL et al. Complementary Therapies in Medicine 61 (2021) 102772

Table 2 3. Discussion
Results of intervention study.
Category Groups pre-mean post-mean p-value The study documented development and validation of an integrative
yoga module for anger management among healthy students in a school
Yoga Group (n = 28) 51.50 45.07 .000
School (n = 50)
Control Group (n = 22) 46.82 47.23 .585 setting. Anchored in IAYT concept, the module was very well received
by the students. Excellent CVR scores, pilot study results and feedback
from the subjects confirm the validity and feasibility of the yoga module.
children were active, energetic and attentive in the class after the yoga The pilot study also records significant reduction of anger scores in the
sessions. As a part of homework, children were asked to practice 12 yoga group which provides reasonable evidences for initial effectiveness
surya namaskaras every day at home which led the students’ family of the module.
members also to start practicing yoga. The current study is considered as a maiden step to develop a holistic
The conclusive result of the study is the emergence of the Yoga and integrative module based on IAYT for anger management. The
module after expert validation and pilot study. The framework of the strength of the module is that it comprises of specific techniques to
module is detailed below in Table 3. address the issues of anger at physical, psychological, and social do­
mains. Utmost care was taken while designing the module to aptly suit to
Table 3 the school environment.
Summarised Integrated Yoga Module for Anger Management. The novelty of this study is in developing the framework by
providing justification and seeking both subjective and objective vali­
Sl Technique Description
No
dation of experts. The framework developed was validated by multi-
disciplinary experts, which is first of its kind. The experts included
Opening Prayer, sitting Bhagavad-Gita Chapter 2 verse 62 and 63.
experienced and veteran Yoga Practitioners, Yoga Scientists, Yoga
position, (2 min) The verses are "dhyayato vishayaanpumsaha
sangasteshoopajaayate| sangaat sanjaayate Therapists, Psychologist, and Counselling Professionals. Sixteen out of
kaamaha kaamaat krodhobhijaayate|| 18 yogic techniques suggested in the framework received high scores of
krodhaadbhavati sammohah sammohaat CVR in expert validation confirming high content validity of the module.
smritivibhramaha| smritibhramshaad
Uniqueness of the study also lies in emphasising on Yama–Niyama
1 Prayer should be chanted buddinaasho buddhinaashaat pranashyati||”,
followed by explaining the Meaning: Looking at something, an interest concept as well as considering physiology and psychology of anger
meaning. develops, which leads to attachment then the under the premise of Jnana Yoga and incorporating it in a planned
desire to have it. From the desire, anger manner. Novelty of the program also lies in driving the yogic concepts
arises. Anger leads to mesmerisation which through stories and lectures immediately after asana and pranayama
leads to loss of memory which leads to loss of
practice. An observation is that the dynamic practice of 10–15 min of
decision making ability. With that, one ruins.
Surya namaskar 6–12 rounds + any 2 Asanas helped children to counter their fatigue and burn a few calories.
prescribed asanas practice in each session They seemed to be in a calm state of mind after practicing Asanas and
(Shashankasana, Bhujangasana, Adhomukha Pranayamas. Children were more attentive and focused throughout the
swanasana, Ostrich Pose Vrikshasana,
Asanas, standing position, session. The concept driven through lectures and stories were very well
2 veerabhadrasana-3, Natarajasana, Triyak
(10 min)
Tadasana, Paschimottanasana); each asana
understood by the students. It also helped them to internalise the con­
should be done twice. Repetition of asanas in cepts better.
subsequent sessions one after the other In the current study, the framework that was prepared for expert
depending on their learning validation appeared to be having too many dimensions to evaluate. The
Any one of the prescribed breathing
fragmentation of sensitivity, relevance, significance, evidence etc. also
Breathing practice, sitting technique each session (Conscious Breathing,
3
position, (5 min) Abdominal breathing, Alternate Nostril did not receive good response. The response was almost same for all the
Breathing, Brahmari) features. This may be due to many of the experts resorting to providing
Any one of the prescribed four guided short an overall comment. This complexity could be considered as a limitation
Meditation, sitting position meditations in each session Meditations
4 and future studies may consider simplifying the aspects for validation.
(8 min) include Awareness, Sublimation, Distraction
to opposite emotion, Developing Virtues
Secondly, the significant reduction in the anger scores in the yoga group
Any one concept is driven in each session failed to provide strong evidences for effectiveness of the module
either through story or lecture. Concepts because of weak methodology. As it was a pilot study, sample size
include Ahimsa (non-violence), calculation, normality, and significance tests were not done a priori
Brahmacharya (moderation), Santosha
Jana Yoga (knowledge which could be considered as a limitation. Further, subject wise ran­
(contentment), Swadhyaya (Self-awareness),
5 points), sitting position,
Iswara Pranidhana (dropping of ego), domisation was not done and hence could not explain the baseline dif­
(3 min)
Mindful eating, Pratyahara (controlling the ference observed. However, testing of baseline difference is debated in a
senses). Story telling on anger and its couple of studies.35,36
management. Basic physiology and The developed module has been used in a separate study to assess
psychology of anger.
Bhagavad-Gita, Chapter 3, verse 37 - "Kaama
anger among 187 children. The design of this non-randomised control
esha krodha esha rajoguna samudhbhavaha| study is similar to the pilot study of current research work. The study
Closing Prayer, sitting
mahaashano mahaapaapmaa viddhyenamiha was conducted in two schools and each school had a yoga and control
6 vairinam ||" Meaning: Desire and Anger are group. Yoga intervention was provided for 4 months with two sessions
position (2 min)
same. It arises from the Rajasic nature. Anger
per week. Yoga group had 114 (71+ 43) children and control group had
is most sinful and heinous character. It is said
to be biggest enemy of man. 73 (38+ 35) children.37The study showed significant reduction of anger
Children are asked to practice minimum 12 scores in yoga group. In addition to confirming efficacy of the module,
rounds of Surya Namaskara everyday the study also substantiates module’s standardisation and
morning. Children can be asked to maintain a generalisation.
log book of the following: 1) wake up time &
7 Home Practice going to bed time; 2) No. of times got angry,
Very few studies on developing and validating yoga modules are
brief about the situation, with whom; 3) available. Common aspects followed in these studies are 1) reviewing
Screen time (TV watching time); 4) foods yoga texts (Literary review), 2) validation by yoga experts and 3)
eaten details; 5) No. of Surya Namaskara administration of the module in a small sample size.
done on that day
A study developing yoga module for depression reports validation of

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A.M. TL et al. Complementary Therapies in Medicine 61 (2021) 102772

the module by 9 experts and pilot intervention study with 7 patients.38 children in the control group did not return the data sheets.
Another yoga module developed for Parkinson disease carried out only Sample size calculation could not be done for considering the num­
validation by 20 experts. Twenty one out of 28 techniques scored ber of experts. Number of expert in previous studies varied from 5 to 26
required CVR ratio in this study.39 A study developing an IAYT Yoga and had experts only from yoga field. The current study considered 26
module for obesity in adolescents developed the module based on lit­ experts in total from interdisciplinary fields like yoga, psychology, ed­
erary review and was validated by 16 yoga experts. This module consists ucation etc. Four of the experts did not respond and eight experts did not
of 43 techniques.40 Another study developing yoga module for children provide item-wise rating. Hence, only responses of 14 experts were
with visual impairment developed the module based on traditional texts, considered for calculation. Further, out of 18 practices in the frame­
followed by validation by 25 yoga experts and pilot administration with work, 12 practices were validated by 8 experts and 6 practices were
9 children.41 validated by 14 experts. Future studies may consider streamlining this
The highlights of the current study are 1) detailed literary review of process in a more effective way.
Indian traditional texts for deriving concepts of anger management, 2)
yoga books referred for selection of yogic practices are placed as refer­ 4. Conclusion
ences 3) provided justification and evidences for each of the techniques
chosen in the module, 4) inter-disciplinary experts were chosen for Holistic and integrative approach employed by considering Pancha
validation of the module, 5) field study was conducted with a reasonably Kosha concept and IAYT principle in developing yoga module for anger
good sample size, and 6) an attempt to combine the best of East (Indian management provided adequate basis to achieve content validity.
traditional concepts of anger management) with the best of West Validation from multi-disciplinary experts greatly supported the
(modern scientific research processes and practices). integrative approach. The pilot study provided satisfactory evidence for
There are a couple of yoga studies that assessed anger along with standardisation of the module.
other parameters in adolescents. These studies have used yoga modules Yoga program for anger management is feasible in school environ­
based on Kripalu Yoga,42 Yoga Ed program,11 and IAYT.43 Though they ment and the techniques were very well accepted by students.
have found effectiveness of yoga in reduction of anger scores, there is no The developed yoga module is recognized as a very useful program
mention of validation of the yoga module in any of these studies. for anger management among adolescents.
A few studies have reported benefits of specific yogic techniques.
Studies on Suryanamaskara report multiple benefits such as activation of
80 % of the musculoskeletal system, enhanced executive functions, Declaration of Competing Interest
improved attention and concentration and also inducement of peace and
calmness44,45 Brahmari pranayama helps in activating the higher limbic The authors report no declarations of interest.
activities and harmonizing the hypothalamic functions.46 The medita­
tions are known to produce changes in the limbic lobes of brain and Acknowledgement
influence the expression of anger and also produce calmness.47
The waitlist control group in the pilot study did not perform any The current study is part of a project on anger in adolescents for
specific activity during the period of study which could also be consid­ which financial assistance is provided by Sri. Venkateswara Vedic Uni­
ered as a limitation. Secondly, a data sheet (dairy) was provided to all versity, Tirupati. The authors acknowledge the support of the funding
the children to fill. Children did not respond well for this and most of the institution.

Appendix A. Framework of yogic techniques – sent to experts for validation

Sl Yogic Technique Details and Justification 1 2 3 4 5

no

1-relevance, 2-specificity, 3-sensitivity, 4-evidence, 5-overall comments

Dynamic practice of these asanas in
Provides gentle movement, flexion and extension to all major joints - head to toe
sequence
Enhanced blood flow throughout the body
Induces cycle of relaxation and activation
1
Shashankasana, Bhujangasana, Bhujangasana – has balancing effect on some hormones, keep the spine supple
Adhomukha swanasana, Shashankasana – regulates the functioning of adrenal glands and good for anger
Strengthens the nerves and muscles of arms and legs.
(ref : book ‘Yoga Education for children’ by Bihar School of Yoga)
Lateral bending and lateral balancing posture.
2 Triyak Tadasana Simple movement in coronal plane as opposed to sagittal plane movements in the previous step
(ref : book ‘Yoga Education for children’ by Bihar School of Yoga)
3 Ostrich Pose Develops balance, attention and concentration
balancing postures
Enhance focusing, strengthen the lower extremities,
Vrikshasana, veerabhadrasana-3,
4 Awareness of sensory input perception
Natarajasana
Balancing enhances concentration / attention. (anger is associated with restlessness or lack of attention
and concentration)
5 Paschimottanasana Good for strengthening lower extremities, Thymus gland activation
Mind-body-breath coordination;
80 % of the musculoskeletal system gets activation, sub maximum pressure on joints
(Ref: SNO paper)
6 Suryanamaskara
Positive outlook; improved memory, concentration and attention; induces peace and calmness; promotes
well-being; enhances depth of perception
(Ref: Book - Dynamic Suryanamaskar-Krzysztof Stec)
7 Conscious Breathing Awareness of breathing
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Helps to calm down.

Easy and simple way to practice – be in the present
Upper Chest breathing is observed with anger
abdominal breathing is the natural breathing pattern
8 Abdominal breathing Requires less energy than chest or upper lunch breathing
Oxygen/Carbon dioxide exchange is greater during this type of breathing
(Ref: Yoga Education for Children, Bihar School of Yoga; page 265, vol 1)
Balances the sympathetic and parasympathetic tone ;
Flow of prana in Ida and Pingala nadis is equalized
9 Alternate Nostril Breathing
Regulating breathing helps in calming down the mind. Mind stabilises when breath is steady
(Ref: Hata Yoga Pradeepika 2-2)
Activates the higher limbic activities – anger is generated at lower limbic but coping is done at higher
limbic region
10 Brahmari
Harmonises the hypothalamic functions by which entire mind-body complex gets benefits
(Ref: book Power of Pranayama, Dr. Renu Mahtani)
Short guided-meditations comprised of three parts a) Preparation b) One of the four Anger Management
Techniques and c) Conclusion.
Preparation process includes adopting a sitting meditative posture, bringing the mind-body-breath
awareness by observing the posture and breathing. The concluding process includes observing silence,
making a resolve. The middle part includes one of the four anger management techniques as detailed
below:
Prajna (awareness) – Thinking and feeling of anger by evoking, intensifying and defusing the anger
emotion. This helps children to become aware of their anger emotion, physiological and psychological
11 Meditation
changes that occur during anger.
Manaprashamana (sublimation) – Art of sublimation of anger thoughts. The process involves evoking
anger emotion and then reducing the speed by slowing down the thought process.
Pratipaksha Bhavana (shifting of emotions) – It is a process of experiencing opposite emotions one after
the other. This helps in swiftly shifting the mind to an opposite emotion.
Sadguna (developing positive virtue): Forgiveness is one of the positive virtues that turn away the anger
emotion. This process involves calling or re-living an instance once with anger driven response and
recalling it again with forgiveness driven response
Definition of anger
Stimulus and Response theory
12 Physiology & Psychology of Anger SNS and PSNS
What happens when you are angry
Manifestations
Anger consequences
Anger Management
13 Screening of Movies
Philosophers who emphasised Non-violence (Krishna, Gandhi, Vivekananda etc.)
Health consequences of Anger
Ahimsa (Nonviolence)
Do not cause physical or mental suffering to anyone
Do not hurt others for whatsoever reason
Do not blame anything and hate anybody
Be gentle in your speech - speak good and pleasant things
Be polite in your behaviour
Be kind to everyone
14 Yogic Concepts
Brahmacharya (moderation)
Do not do anything in excess – watching TV, sleeping, playing, eating etc.
Do not get addicted to electronic gadgets
Do not get into bad habits – smoking, alcohol, drugs etc.
Judge what is good for you and do only that
Know your limits
Live in moderation
Santosha (Contentment)
Be satisfied with what you have
Love yourself
Enjoy doing things without focusing too much on the results
Do not feel bad for what you don’t have
Don’t feel jealous
Do not get attracted towards crafty advertisements
Swadhyaya (Self Awareness)
Know your strengths and weaknesses
Be self-motivated
Have an inclination to understand the mind, consciousness, our existence and the whole creation
Do not get fooled by false information / wrong knowledge
Do not learn anything that brings down your personality
Iswara Pranidana (Giving up the Ego)
Develop humility
Treat everyone as equal
Learn to surrender
Do good and forget it
Do not argue
Don’t have rigid thoughts
Do not boast
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Pratyahara (withdrawal of senses)

Controlling the sensory inputs
Focus on what you are doing
Do not get disturbed /distracted by other things
(Ref : Book – SURYA by Dr. SN Omkar,)
Food types (rajasic, tamasic and satvic)
15 Food and Anger What, when, how, how much, where to eat
MINDFUL EATING
Stories on anger can be narrated to students to make them understand the concept of anger. Briefing and
debriefing the moral of story is essential to reinforce the concept. 3 stories are listed below:
Story of a boy hitting the nail on a tree every time when he got angry. Moral : Anger comes and goes
leaving a permanent scar
16 Stories on Anger
Story of smashed fingers: Enraged father punishing his son for making a scratch on the car. Moral: Anger
has no limits. Anger leads to inappropriate and harmful actions. Anger leads to temporary memory loss.
Story of Vivekananda as a student in Law College in UK. Interaction between him and Mr. Peters. Moral -
Anger is not a solution to any problem. Keeping mind calm helps one to take better decisions.
17 Krida Yoga A computer game on anger management will be developed and used if time permits.
Asana Practice : Daily practice of Surya Namaskara – minimum 12 rounds
Dairy writing – Children can be asked to maintain a log book of the following: 1) wake up time & going to
18 Home Work bed time; 2) No. of times got angry, brief about the situation, with whom; 3) Screen time (TV watching
time); 4) foods eaten details; 5) Good thing of the day & Bad thing of the day and 6) No. of Surya
Namaskara done on that day

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