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EFFECT OF YOGA AND COGNITIVE BEH

EFFECT OF YOGA AND COGNITIVE BEHAVIOR THERAPIES IN ADJUSTMENT PROBLEMS

Dr Samiksha Kaur,* Dr J S Yadav**

*Psychologist, Marwari Hindu Hospital, Varanasi ,**Assistant Professor Department of Psychiatry, IMS BHU

Abstract

Aim-  To assess the effect of Yoga and cognitive behavior therapies in women suffering from adjustment problems.

Method and Procedure- the present study was prospective controlled study to explore the short term impact of life style and psychological intervention based on yoga, CBT, and stress management programmed on adjustment problem. For this purpose 30 female subjects were taken for the study from BHU and Marwari hospital Varanasi. The subjects were under treated by psychiatrist last 6 month. All patients diagnosed by psychiatrist as an adjustment problem according to ICD-10, but recovery rate was not as good as accepted. So we used structured interview Performa based on adjustment problem. Interview Performa divided in to four part biological, psychological, social, and physical problem. The out come of interview were taken on the first and last 15 days.

Result- we find out use of the Pranayam, Relaxation, Shavasan, meditation, cognitive behavior therapy, and stress management programmed there were significant improvement in the physical, biological and psychological problem like-agitation restlessness, anxiety, irritability etc.

Conclusion-present study shows that combine therapy was the best treatment for adjustment problem.

 

Introduction

 Stress is an integral part of the human condition. Different period in history have been associated with different kinds of stress. These involve largely emotional factors such as uncertainty, insecurity, relation problem, and time pressure, fear of adequacy, occupational problem and role of conflicts. ‘These states of subjective distress and emotional disturbance, usually interfering with social functioning and performance arising in the period of adaptation to a significant life changes or to the consequences of a stressful life event (including the presence or possibility of serious physical illness) The stressor may have affected the integrity of an individuals social network (through breavement of separation experience) or the wider system of social supports and values (migration or refuge status). The stressor may involve only the individual or also his or her group or community predisposition or vulnerability plays a greater role in the risk of occurrence and the shaping of the manifestation of adjustment disorder. The manifestations vary, and included depressed mood, anxiety, worry (or a mixture of there) a feeling of inability to cope, plan ahead, or continue in the present situation, and some degree of disability in the performance of daily routine may feel liable to dramatic behavior or out bursts of violence but these rarely occur.ICD-10

So stress is a common condition, a response to a physical threat or psychological distress that generates a host of chemical and hormonal reactions in the body. When the brain experiences or thinks of something stressful, these hormones will be released. When something stressful happens or thinks a stressful thought, the hypothalamus secretes an array of releasing hormones into the hypothalamic-pituitary circulatory system. A short list of diseases and conditions that have been linked to an over active stress response, besides cardio-vascular disease, include depression, anxiety states, obsessive-compulsive disorder, some types of diabetes mellitus, some autoimmune diseases, colitis, irritable bowel syndrome, reproductive problems, and suppression of the immune system.

 Many people have noted the benefits of exercise in diminishing the stress response. Yoga, too, is explained by Patanjali that the mind performs five main functions cognition, misapprehension, imagination, deep sleep and memory. In addition to this, he also observed that the obstacles to developmental clarity are: illness, mental stagnation, lack of foresight, uncertainty, fatigue, indulgence of the senses, illusions about oneself, lack of perseverance and regression. It has been recommended and studied in its relationship to stress; nonetheless, several researchers claim highly beneficial results from Yoga practice in alleviating stress and its effects. The practices recommended range from intense to moderate to relaxed asana sequences, plus pranayama and meditation. In all these approaches to dealing with stress, one common element stands out.

 The American Academy of Family Physicians and Consumer Reports suggests Yoga for stress relief 2 Dr. Susan Lark, that practicing Yoga will “provide effective relief of anxiety and stress12

Dr. Chandra Patel’ is often the first place to reveal signs of the body of a problem. Unfortunately, our upbringing often trains us to be stoic, and in our anxiety not to appear weak, we often deny signs of stress.” 14 spolasky, Dr. Kenneth R.Fox concludes; there is good evidence to demonstrate that exercise running, jogging, riding is effective as a treatment for clinical depression and anxiety.15, 13

In a study1990 review of the literature of Yoga research concludes, that Hatha yoga has potential as a useful intervention for improved physical well-being, reducing anxiety, and enhancing personality development....Hatha yoga could be a helpful adjunct to medical and psychological treatment when practiced regularly by clients on their own to improve feelings of physical health, reduce their anxiety, and enhance their self-concepts and emotional tone.” 1

In “Stress and Its Management by Yoga,” 32 K.N. Udupa outlines his research 1007 on normal, healthy subjects and on patients and him various stress disorders with a combination practice of asana, pranayama and meditation. He reported: “The patients of high blood pressure, diabetes and asthma, who came to us at an early stage, showed very good improvement. Those who came later, their drug requirement were considerably reduced after starting yogic practice.”20 another review of articles published in 1996, summarizes 21 studies on Yoga in modern medicine3. This review one more time confirms that, “Yoga therapy seems to be of great value in asthma, cardiac patients, multiple sclerosis, migraine, rheumatoid arthritis and rehabilitation.” Xix these are conditions in which stress may play a part in the course of the disease.32

A number of studies examine the physiology of the head-low position. S In both rat and human studies, Udupa found that the head-low posture reduced catecholamine (epinephrine and norepinephrine) content of the heart and the blood. It also increased stress tolerance and therefore, Udupa conjectures, may act as a tranquilizer. 35

In a study find out Yoga is assuming importance in improving mental health and quality of life in the treatment of number of psychiatric and psychosomatic disorder.27 and daily practice of Yoga reduced obesity and control dribbling,33 improvements in appetite, sleep and health26. One anther case has been found in the case of mental retardation Yoga improves the aggression, appetite, and enhances the confidence in participation among the group. Lack of studies in yoga and cognitive behavior therapy in adjustment problem we concentrate.

    

Material and Methods

The study was based on the data collected on 30 female subject’s age ranging from 20-45 years, who attended our integrated programmed, conducted in Marwari Hindu hospital Varanasi. Although initially 50 subjects were recruited for the study, due to various reasons 20 subjects could not complete the study. The subjects were neurotic patients under treated by psychiatrist last 6 month. All patients diagnosed by a psychiatrist as adjustment disorder according to ICD 10.But recovery was not good as expected. The subjects having many symptoms like anxiety, agitation, depression, sleep disturbance, poor performance, appetite etc due to family stress problem. So she couldn’t adjust No strict inclusion and exclusion criteria were used, except that the subjects were attending the integrated program.

Tools- Structured Interview Performa was used. It was based on the adjustment problem symptoms. This Performa divided in to four part, biological, psychological, physiological, and social problem generally that type of symptoms find out in family stress problem individual.

Study design

The Structured Interview Performa was assessed on the first day and last (day15) of the integrated Modification program. At the end of the study the results obtained were further analyzed.

Procedure

The program consisted of an integrated package comprising theory and practice sessions. It was administered in the form of an outpatient course, 3-4 hours each day for 13 days, and was spread over 15 days, being interrupted by a weekend break for two days. They were advised to practice the same on their own on the two off days and a good compliance of the same was reported on the subsequent day. The course was given to a group of 10-15 patients at a time. A typical day in the course started with filling the performa and introduction to one another and than started with a set of simple asanas (physical postures) and pranayama (breathing exercises) for approximately one hour followed by a break. During the break subjects listened to instrumental music, interaction with each other and had breakfast. After this short interval the next activity was a lecture and introduced the principle of Yoga and yogic technique. Although group as well as individual nutrition education was imparted, providing meals was not a part of the program. One full session was devoted to principles and practice of meditation, and two to stress management. In the session introduce about the family structure, role of family member and there relation.  Questions and unstructured discussions were encouraged. During this session two psychodrama and two family counseling programs had been given. Each day’s program ended with relaxation through either shavasana (a relaxation technique) or meditation. Autosuggestion and imagery were encouraged during relaxation to promote self-healing. The patients were given a few booklets, pen  to reinforce what was discussed in the lectures. On one of the days, the patient received individualized advice in a one to one session. This session included advice on diet, physical activity, mental relaxation, and also provided a good listener to the patient for his or her personal problems. The spouse and other members of the patient’s family were encouraged to attend the course to facilitate compliance. The protocol of the course is given in table -I, and the set of the assnas and pranayam included in the course in table -II.

Table-I Protocol of the Course

Day

List of program

1

Monday

Filling up performa, Introduction to one another

Lecture- Introduction to Yoga

Practice- Shavassana

Individualized advised-(2 patients)

2

P- Assanas & Pranayam, Break

L-Meditation

P-Meditation

I--(2 patients)

3

P- Assanas & Pranayam, Break

L-Fundamental in family Structure

P-Meditation/Shavasana

I--(2 patients)

4

P- Assanas & Pranayam, Break

L- Role and relation with family member

P-Meditation

I--(2 patients)

5

P- Assanas & Pranayam, Break

L-Adjustment Problem

P-Meditation/Shavasana

Family Counseling

 6

P- Assanas & Pranayam, Break

L- Stress Managment

P-Meditation/Shavasana

I--(2 patients)

7

Sunday

Holiday

8

P- Assanas & Pranayam, Break

L&P-Psychodrama (poor family support)

P-Meditation/Shavasana

I--(2 patients)

9

P- Assanas & Pranayam, Break

L-Yogic attitude in daily life

L-About illness & managment

P-Shavasana

10

P- Assanas & Pranayam, Break

L-Stress Management

P-Meditation/Shavasana

I--(2 patients)

11

P- Assanas & Pranayam, Break

L- Story of unemployed person & discussion

P-Meditation/Shavasana

I--(2 patients)

12

P- Assanas & Pranayam, Break

L-general discussion

P-Meditation/Shavasana

Family Counseling

13

P- Assanas & Pranayam, Break

L- Stress Management

P-Meditation/Shavasana

I--(2 patients)

14-Sunday

Holiday

15

Filling up performa

P- Assanas & Pranayam, Break

P-Meditation/Shavasana

Family Counseling

Closing Session

 

Table II- The set of asana and pranayam included in the program

 

1

Humming in meditatve posture-Vajrasana(Thunderbolt Pose), Padmasana (Lotus Pose), Sukhasana (Easy Pose)

2

Breathing Techniques-Dog breathing,Tiger breathing, Kept on chest stretching, in three position, Ankle Streching.

3

Exercises For Loosening – Warm up: starting from Head ,working towards toe,  arm rotation, Elbow movements Wrist movements Finger movements, Shoulder rotation, Waist movements, Knee rotation, Ankle rotation, Toe movements,

  4

Quick relaxation in shavasana

5

Asanas: I-Standing- Ardhakatichakrasana(lateral arc pose), Padahastasana (forward bend pose), Ardhachandrasana (backward bend pose),Vrikshasana (tree pose)

II-Sitting-Ardhamatsyendrasana (half-spinal tist pose), Paschimatanasana(back stretch pose), Konasana (angular pose)

III-Lying on stomach- Makarasana (crocodile pose), Bhujangasana (snak pose), Dhanurasana (bow pose)

IV-Lying on back- Uttitapadasana (straight leg raising), Sarvangasana (shoulder stand pose), Matsyasana (fish pose), Pavanmuktasana (ind relieving pose), Setubandhasana (bridge pose).

   6

Deep relaxation in shavasana

7

Pranayama (breathing practices)-Bhastika (rapid breathing), Bhramari (honeybee sound during expiration)

8

Quick relaxation in shavasana

  9

Humming in meditative posture – Vajrasana(Thunderbolt Pose),Padmasana (Lotus Pose),Sukhasana(Easy Pose)

Results

The score of the structured interview performa measured at the begning (day 1) and end (day 15) given in fig. 1

Table-1 Types and No. of Patients

 

Working

Non working

Total

10

20

30

 

 Table 2 Socio Economic Status

High

Middle

Low

Total

05

15

10

30

Table-3 Family Structure

Joint

Nuclear

Total

25

05

30

 

Table-4 Age Group of Patients

Age Group

No. Of Patients

20-25

03

25-30

05

31-35

08

36-40

08

41-45

06

Total

30

 

Table-5 Structured Interview Performa

 

Factors/Items

Day 1

Day15

Improvement %

Biological Items

Sleep Disturbance

25

05

80

Appetite problem

20

02

90

Decrease interest of sex

25

10

60

Psychological Items

Nervousness

30

05

83

Irritability

28

10

64

Agitation

20

05

75

Restlessness

30

08

73

Lack of interest

22

07

68

Dizziness

05

02

60

Mood Unhappy

15

05

66

Clenching of teeth

14

01

92

Weeping

15

05

66

Suicidal thought

10

02

88

Coping Strategies

28

08

71

Physical Items

Working performance poor/Laziness

28

08

71

Headache

20

10

50

Body ache

15

05

66

Social Items

Family Cooperation poor

25

10

60

 

Relation with Child& Husband Poor

20

05

75

Social Participation poor

22

08

63

 

Table-6 Age vice Distribution of SIP Day-1 and Day -15

 

Age group

Day -1

Day-15

Percentage %

20-25

28

06

78

26-30

75

22

69

31-35

112

26

76

36-40

110

39

71

41-45

92

27

65

 

At the end of the course structured interview performa score were higher than at the beginning. The data show that non working, middle socio economic status with joint family whose age group of 31-40 suffered higher family stress problem. But after the modification program of 15 days it was improved so coping strategies was good than other group.20-25 age group was gain good integrated modification program. The age group of 41-45 was less improved than other age group. In the age group improvement was only 65%.after the integrated programmed adjustment problem reduced.

Discussion

 The present study shows that measurable improvement in the structured interview performa scores occurs within 15 days as the result of an intervention that combine daily practice of asanas, pranayama relaxation techniques (shavaasana and meditation), stress management program, cognitive behavior therapy, family counseling and role of drug therapy. The present study amid to find out the combined effect of adjustment problem (family stress problem).

The intervention began each day with a set of asanas, yogic relaxation, pranayam. Prior studies have also reported beneficial effectets of yogasanas on various physiological and psychological parameters. At the end of the program all four factors positively improved. In biological factors sleep disturbance and appetite 80%- 90% improved respectively. National medical advisory committee report(8,10,22)show the muscles relaxation, breathing techniques, biofeedback modification and cognitive therapy to identify and challenge negative attitudes to the problem of sleep disturbance (Insomnia). This approach may also involve cognitive technique to reduce intrusive thoughts such as thought stopping and visualization.

Since structured interview performa psychological factor was also improved after the taken integrated modification program nervousness, clenching of teeth, suicidal thought was dramatically change. So yoga and cognitive behavior therapy and role of drug and other management were important to improvement in psychological health. The improvements in the expectation of physical problem laziness show that there was an increase in feeling of success. The study show(23,25,26) )that the therapeutic programmes on the cognitive behavior modification modal have been found to be remarkably successful in helping sufferers to cope positively with fatigue syndrome.

Headache is mostly common in the stress problem individual. In the support previous study (5,6,7 and18) find out that psychological treatment, cognitive therapy, biofeedback, and relaxation have proved to be affective as a drug treatment. The cognitive model of headache acknowledges the integral role of psychological factors in the chronic headache, because who perceives events around them negatively will tend to react with more physiological arousal will consequently more likely to developed symptoms such as headache. So the negative thoughts are common in family stress problem individual that is the cause of headache. Present study highlight that body ache was improving the 66% by the combined therapy. Cognitive behavior therapy is an effective treatment for all kind of pain( 8,19,27) egg back pain, chronic neck pain, and maladaptive pain like pain behavior include repetitive description/complaints of pain, reduced activity levels, avoidance of responsibility, reliance of pain medication and adaptation of body postures/facial expression which draw attention to the pain egg. Griming, wincing, and groaning.

When the effect of intervention on subjects in different age groups was compared, subject in the range of 20-25 and 31-35 years were found to benefit the least, these might be the woman who are least adoptable to any change. In our study social item was also improved, so this factor highlight there was a decrease in the worry and concern about the relationship of the subjects with their relationship with their respective spouse and children. And also change n the score for family cooperation and social participation. The present study suggested that the combined approaches of yoga and therapy have a favorable effect on Structured Interview Performa. And also suggest this study demonstrates that a simple and inexpensive essentially educational intervention based on yoga and therapy improves the adjustment problem.  

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20.     Ibid, p.141.

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