Designing and validation of a yoga-based intervention for obsessive compulsive disorder

Designing and validation of Yoga module for workers with prolonged standing

BACKGROUND

Prolonged standing is a part of several professions, which can have physical and psychosocial implications. Yoga as a mind-body therapy may be useful to prevent and manage such health issues. However, there is a lack of a standardized yoga module addressing the health issues of workers with prolonged standing.

OBJECTIVES

Thus, the present study was undertaken to design and validate a specific yoga module for the target population.

METHODS

A yoga module was prepared by reviewing yoga texts for the specific needs of the target population. This was validated for content validity for the experts on a Likert scale. 71 yoga experts validated the module. The content validity ratio (CVR) above 0.70 was considered to be valid.

RESULTS

The validated yoga module consists of joint loosening and strengthening exercises, asana, pranayama and relaxation techniques. The average CVR for the module was found to be 0.80.

CONCLUSION

The designed yoga module is found to be valid by the experts. The module needs to be assessed for feasibility and efficacy in the target population.

Effects of exercise on obsessive-compulsive disorder symptoms: a systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis assessed the efficacy of exercise in reducing OCD symptoms.

METHODS

We searched PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Scopus and grey literature until March 2022. The study was preregistered at Prospero (CRD42021283931). We included randomised controlled and pre-post trials assessing physical activity as an intervention for OCD. Risk of bias was assessed using the Cochrane ROBINS-I tool and the RoB2 tool.

RESULTS

The analysis included 6 trials (N = 92); 2 were RCTS and 4 were pre-post design studies. A random-effects meta-analysis of pre-post data identified a large reduction of OCD symptoms following exercise (g = 1.33 [95%CI 1.06-1.61]; k = 6). Exercise was also associated with significant pre-post reductions in anxiety (g = 0.71 [95%CI 0.37-1.05; k = 4) and depression (g = 0.57 [95%CI 0.26-0.89]; k = 2). Risk of bias was moderate-high in uncontrolled trials on the ROBINS-I and RCTs showed 'some concerns' on the RoB2.

CONCLUSION

Exercise was associated with a large pre-post reduction of OCD symptoms; however, few trials were of robust quality and all were at risk of bias. Further well-powered and better quality RCTs are required to assess the role of exercise as an intervention for OCD.KEY POINTSStudies exploring exercise as an adjunct therapy for OCD have small participant numbers, therefore a systematic review and meta-analysis is needed to estimate potential efficacy.Pre-post analysis shows that exercise was associated with a large reduction of OCD symptomsThe current systematic review and meta-analysis points to the potential for exercise to be beneficial for the treatment for OCD symptoms. However, more well-powered and better controlled RCTs are required to fully assess the benefit of exercise for the treatment of OCD symptoms.

Scientific yoga module for hypothyroidism: A study protocol for tele-yoga RCT

Background

Management of thyroid dysfunction has a direct effect on the quality of life and studies have recognized that hypothyroidism has become a public health challenge. Although conventional medicine is widely used, its long-term side effects are elucidated. This study aims to conduct a randomized controlled trial (RCT) through tele-mode to assess the effectiveness of the newly developed and validated "Scientific Yoga Module" as a telehealth concept for improving the quality of life in patients with hypothyroidism along with management of other symptoms as compared to the standard of care.

Method

This is a single-blinded, two-arm, parallel-group RCT in which at least a total of 120 primary hypothyroid subjects both male and female between the age group 18 to 60 will be recruited from the database of Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA). Participants will be randomly divided into a yoga intervention group (n = 60) and a waitlist control group (n = 60) as per the inclusion and exclusion criteria of the study. A tele-yoga intervention for six months will be administered and pre-interim-post data will be recorded for both groups. This protocol is designed to study the effect of Scientific Yoga Module intervention on primary assessments of SF-36 scale [health-related quality of life (HRQOL) that includes physical, mental, emotional, and social states] along with secondary assessments on the biochemical test of thyroid profile-{Triiodothyronine (T³), Thyroxine (T⁴), Thyroid Stimulating Hormones (TSH)}, Body Mass Index (BMI), Blood Pressure (BP), Fatigue Assessment Scale (FAS), Perceived Stress Scale (PSS), Gita Inventory of personality scale (GIP).

Conclusion

To the best of our knowledge, this tele-yoga RCT for hypothyroidism will be the first clinical trial to analyze the effectiveness of a "Scientific Yoga Module" imparted through tele-mode.

Yoga Module Development and Validation: A Systematic Review with Methodological Guidelines

In the past decades, more than fifty different yoga styles have been implemented in the therapeutic context to manage various diseases. Yet, not all of these yoga styles have been validated or standardized as a program. The aim of this article is to review the different methodologies used for yoga module development and to assess their quality. Three databases (PubMed, Web of Science, and Scopus) were searched using the following keywords and Boolean operators: (validation OR development OR design) AND (yoga OR mind-body) AND (module OR protocol OR program). Three thousand six hundred and seventy-one articles were enlisted, and based on the inclusion and exclusion criteria, 37 articles were narrowed down for review. Since no checklist exists to assess the quality of yoga modules, the authors designed a 23-item checklist to categorize each having low, medium, or high quality. As per the yoga module quality checklist, only 21.6% of the studies had high quality, while 75.3% of the articles had medium quality and 8.11% had low quality. A commonly used development method was literature review, while for validation, experts' scoring of the Likert scale was the preferred means. The feasibility of the module was carried out only by half of the studies. Few diseases such as cardiovascular disease, diabetes mellitus, obesity, Parkinson's disease, and obesity had more than one yoga module developed. The findings of this systematic review have shed some light on the growing need for standardized methods of yoga module development. The 23-item checklist can guide researchers in the homogeneous development strategies when designing yoga interventions in the future.

Development and Validation of Yoga Program for Patients with Type 2 Diabetes Mellitus (T2DM)

This study with aim of development and validation of a yoga program for patients with T2DM was carried in view of emerging evidence of yoga as an alternative and/or complementary treatment. Classical and contemporary yoga texts were reviewed for identification of yoga practices. After reviewing research papers and yoga texts a THREE-step yoga program, in order of increasing difficulty level for T2DM was prepared. For validation of yoga program, mixed methods approach integrating qualitative and quantitative inputs was considered. Eighteen experts over three rounds of iteration contributed toward validation of yoga program. A final set of three-step yoga program was obtained which further needs to be tested in standardized randomized controlled trials.Trial Registration With Indian Council of Medical Research: Clinical Trial Registry of India; ICMR-CTRI: Development and Validation study: CTRI/2013/11/004163.

Yoga and mental health: what every psychiatrist needs to know

Yoga was developed primarily as a tool for self-mastery and spiritual progress. However, over the past few decades, the therapeutic applications of yoga in mental healthcare have been explored with promising results. This article aims to inform psychiatrists about the clinical usefulness of yoga for mental disorders. We discuss the rationale and latest evidence base for the use of yoga in psychiatric practice, including the neurobiological mechanisms and indications and contraindications for yoga therapy. We suggest practical yoga techniques that can be used as an add-on for managing common psychiatric conditions. Finally, we discuss the setting up and running of yoga clinical services in a tertiary psychiatric hospital in India and explore what can be learnt to facilitate yoga as a therapeutic approach in the Western world.

Perspective of patients referred to Yoga center in a tertiary neuropsychiatric hospital: A cross-sectional retrospective study

BACKGROUND

Yoga has been extensively used as an alternative or complementary therapy in psychiatric disorders depending on the type and severity of the disorders. However, data related to perspective on yoga services and the benefits and adverse effects attributed to yoga by patients with major psychiatric disorders is lacking.

AIM

The aim of the study was to assess feedback of the patients who attended yoga sessions at a Yoga center in a tertiary neuropsychiatric hospital.

MATERIALS AND METHODS

This was a cross-sectional retrospective study using a specific questionnaire to get feedback from patients referred to the NIMHANS Integrated Center for Yoga, at the end of their yoga training.

RESULTS

Two hundred and one patients' data were included in this retrospective study. Most of the patients were referred by the doctors. The yoga module for schizophrenia was most commonly utilized, followed by depression. On an average, patients attended 13 sessions. Most of them practiced yoga for 1-2 weeks and had missed less than 2 sessions. The great majority of the patients reported that practicing yoga helped them. Spearman correlation analysis revealed positive associations between improvement attributed to yoga and variables affecting quality of yoga services at the center, including the quality of yoga sessions attended. Overall health and sleep improvement also positively correlated with improvement attributed to yoga. A minority of patients reported adverse effects, although these did not lead to discontinuation.

CONCLUSION

In this retrospective study of patients referred to a Yoga center in a tertiary psychiatric facility, the majority of patients with major mental disorders were able to practice yoga under supervision and reported significant improvement in symptoms with minimal adverse effects.

Therapeutic role of yoga in neuropsychological disorders

Yoga is considered a widely-used approach for health conservation and can be adopted as a treatment modality for a plethora of medical conditions, including neurological and psychological disorders. Hence, we reviewed relevant articles entailing various neurological and psychological disorders and gathered data on how yoga exerts positive impacts on patients with a diverse range of disorders, including its modulatory effects on brain bioelectrical activities, neurotransmitters, and synaptic plasticity. The role of yoga practice as an element of the treatment of several neuropsychological diseases was evaluated based on these findings.

Development, validation, and feasibility of a generic yoga-based intervention for Generalized Anxiety Disorder

CONTEXT

Evidence suggests that yoga effectively manages anxiety, but techniques are derived from different yoga schools. This paper describes the development, validation, and feasibility of a generic yoga-based intervention in patients with Generalized Anxiety Disorder (GAD).

METHODS

The first part of the study consisted of designing a generic yoga module from the traditional and contemporary yogic literature and inputs from ten experienced yoga practitioners. The content was validated using a case-vignette method from 28 yoga experts. These yoga experts rated the usefulness of the practices on a scale of 1-5 (5-extremely useful). The second part consisted of testing the feasibility of this validated generic yoga intervention in an open-label clinical trial in patients with GAD. Two weeks of ten supervised yoga sessions (SYS) were offered by a trained yoga therapist to the recruited participants and subsequently advised for home practice. A weekly booster SYS was also provided for three months after 10SYS.

RESULTS

Yoga experts (n = 28) opined that the yoga intervention would be helpful in patients with GAD with minimal modifications. All experts opined that the module was easy to teach, learn and practice. The final yoga module retained 97.7% (42 out of 43) items of the initial module. In the feasibility study, (n = 20) patients were recruited, and fifteen followed-up after one month. All patients were able to learn and practice the final yoga module within ten sessions without any significant adverse effects. The severity of anxiety reduced substantially after the ten days of SYS and this improvement was sustained for the next 4 weeks.

CONCLUSION

The designed generic yoga intervention was validated by yoga experts and found safe and feasible in patients with GAD. Patients obtained significant symptom reductions which need to be confirmed in randomized controlled trials.

Yoga therapy for Obsessive Compulsive Disorder (OCD): A case series from India

Yoga is an ancient science which has been found to be helpful in the management of several psychiatric disorders including Obsessive Compulsive Disorder (OCD). Yoga as add-on treatment in OCD may help address issues like partial response and adverse effects of medications. However, research in this area is sparse, which led us to explore it through this case series. In this case series we have described the benefits of 1 month of yoga as add-on treatment in patients with OCD. All patients were on stable doses of medications prior to and during yoga practice. Pre-post assessments for the core symptoms of obsession/compulsions as well as depressive and anxiety symptoms were done. The assessments showed significant improvement in Y-BOCS and HAM-D scores after 1 month of yoga. Yoga therapy could be an effective add-on therapy for the treatment of OCD.

A narrative review of exercise and obsessive-compulsive disorder

OBJECTIVE

Individuals with obsessive-compulsive disorder (OCD) suffer significant distress due to their condition; however, there can be multiple barriers to treatment. Even following OCD-tailored treatment, symptoms often remain. Exercise may be an effective and available approach to managing OCD, and yet, there are no specifically dedicated reviews, limiting integration into clinical practice. This study aimed to provide an overview of the literature on exercise and OCD.

METHOD

Four databases, the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and EMBASE, were systematically searched. 1534 records were screened and the reference lists of eligible articles were examined. For this review, 11 extracted studies were narratively explored.

RESULTS

Two observational and nine interventional studies were included, of which one article focused on youth and ten studies focused on adults. Physical activity likely reduces the risk of metabolic syndrome or general health conditions. Several pre-post studies demonstrated exercise's benefits for OCD symptoms, while the only randomized controlled trial showed negative findings for its efficacy in reducing obsessions and compulsions.

CONCLUSIONS

The evidence for aerobic exercise's long-term benefits for the symptoms of OCD is mixed, but remains promising. Potential mechanisms of exercise's effects and future directions for research are explored.

Effectiveness of Rajyoga meditation as an adjunct to first-line treatment in patients with obsessive compulsive disorder

BACKGROUND

Yoga is a set of mental, physical, and spiritual practices with its origin in ancient India. The renewed interest in Yoga has led to the exploration of its benefits in a variety of psychiatric disorders such as schizophrenia, depression, and anxiety disorders. There is a dearth of literature on the effect of yoga in obsessive compulsive disorder (OCD) in the Indian context.

AIM

The present study was conducted to find out the efficacy of Rajyoga meditation (RM) as an adjunct to the first-line treatment in the treatment of OCD.

MATERIALS AND METHODS

Patients with OCD (diagnosed according to Diagnostic and Statistical Manual of Mental Disorders fifth edition) were divided into two groups - (i) The meditation group (MG), which included 28 patients and (ii) The nonmeditative group (NMG), which included 22 patients. MG practiced RM protocol for 3 months duration in addition to the pharmacological treatment. The NMG continued on pharmacological management as usual. The symptomatology was assessed at baseline and 3 months using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).

RESULTS

At 3 months, both groups demonstrated improvement in symptoms. The improvement in MG was statistically significant with a change of 9.0 ± 3.16 in Y-BOCS and a 49.76 ± 9.52% reduction in symptoms. Improvement scores of NMG were also statistically significant with a change of 3.13 ± 2.59 in Y-BOCS and 18.09 ± 14.69% reduction in symptoms. MG showed significantly more improvement in Y-BOCS scores (49.76 ± 9.52) as compared to NMG (18.09 ± 14.69) using the student's paired t-test (P < 0.001).

CONCLUSION

The present study suggests that the RM is an effective adjunctive therapy to reduce obsessions and compulsions in patients with OCD.

Kundalini Yoga Meditation Versus the Relaxation Response Meditation for Treating Adults With Obsessive-Compulsive Disorder: A Randomized Clinical Trial

Background: Obsessive-compulsive disorder (OCD) is often a life-long disorder with high psychosocial impairment. Serotonin reuptake inhibitors (SRIs) are the only FDA approved drugs, and approximately 50% of patients are non-responders when using a criterion of 25% to 35% improvement with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). About 30% are non-responders to combined first-line therapies (SRIs and exposure and response prevention). Previous research (one open, one randomized clinical trial) has demonstrated that Kundalini Yoga (KY) meditation can lead to an improvement in symptoms of obsessive-compulsive severity. We expand here with a larger trial. Design: This trial compared two parallel run groups [KY vs. Relaxation Response meditation (RR)]. Patients were randomly allocated based on gender and Y-BOCS scores. They were told two different (unnamed) types of meditation would be compared, and informed if one showed greater benefits, the groups would merge for 12 months using the more effective intervention. Raters were blind in Phase One (0-4.5 months) to patient assignments, but not in Phase Two. Main Outcome Measures: Primary outcome variable, clinician-administered Y-BOCS. Secondary scales: Dimensional Yale-Brown Obsessive Compulsive Scale (clinician-administered), Profile of Mood Scales, Beck Anxiety Inventory, Beck Depression Inventory, Clinical Global Impression, Short Form 36 Health Survey. Results: Phase One: Baseline Y-BOCS scores: KY mean = 26.46 (SD 5.124; N = 24), RR mean = 26.79 (SD = 4.578; N = 24). An intent-to-treat analysis with the last observation carried forward for dropouts showed statistically greater improvement with KY compared to RR on the Y-BOCS, and statistically greater improvement on five of six secondary measures. For completers, the Y-BOCS showed 40.4% improvement for KY (N = 16), 17.9% for RR (N = 11); 31.3% in KY were judged to be in remission compared to 9.1% in RR. KY completers showed greater improvement on five of six secondary measures. At the end of Phase Two (12 months), patients, drawn from the initial groups, who elected to receive KY continued to show improvement in their Y-BOCS scores. Conclusion: KY shows promise as an add-on option for OCD patients unresponsive to first line therapies. Future studies will establish KY's relative efficacy compared to Exposure and Response Prevention and/or medications, and the most effective treatment schedule. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01833442.

Development of a yoga module targeting cardiovascular health for patients with post-myocardial left ventricular dysfunction in India

BACKGROUND

Yoga is known to contribute towards cardiovascular health. This paper describes the development of a need-based yoga program which is suitable to be integrated into the cardiac rehabilitation of post-myocardial infarction patients with left ventricular dysfunction.

MATERIALS AND METHODS

Based on the assessment of the need of the patients, literature review, and expert opinion, a yoga module was developed using the qualitative method of inquiry. The program included warm-up exercises, yogic asanas, pranayama, meditation and counseling sessions. A structured questionnaire eliciting comments on the contents was given independently to ten experts working in the field of health and yoga for validation. The final module was derived after incorporating the suggestions of the experts.

RESULTS

Using the raters' expertise in cardiology and yoga practice, the practices which constitute the module were optimized. Majority of the experts (raters) agreed with the duration of 1 h training for 1month under supervision as adequate for subsequent practice at home. There was a 0.786 inter-rater reliability estimated using the interclass coefficient (ICC) and 0.789 internal consistency of the questions, measured using Cronbach's alpha. Both values indicate "good" reliability and consistency of the yoga module.

CONCLUSION

The developed yoga module was found to be acceptable. Future randomized control trials will be necessary to validate the effectiveness of this module and if the module demonstrates to be effective by clinical studies, it may add a therapeutic option in the rehabilitation of patients with heart failure following myocardial infarction, which can be applied in the hospitals and community level.

Evidence Base of Yoga Studies on Cardiovascular Health: A Bibliometric Analysis

Noncommunicable diseases including coronary artery disease contribute to approximately 50% of global mortality. Pharmacological treatment alone may not be a panacea for such diseases since it may be associated with various other adverse effects. Hence, strategies such as Yoga involving healthy lifestyle and stress management are widely sought by the patient population.

Yoga Practice Reduces the Psychological Distress Levels of Prison Inmates

Background: Psychiatric ill-health is prevalent among prison inmates and often hampers their rehabilitation. Rehabilitation is crucial for reducing recidivistic offending. A few studies have presented evidence of the positive effect of yoga on the well-being of prison inmates. The conclusion of those previous studies that yoga is an effective method in the rehabilitation process of inmates, and deserves and requires further attention. Aims: The current study aimed to evaluate the effect of 10 weeks of yoga practice on the mental health profile, operationalized in the form of psychological distress, of inmates. Methods: One hundred and fifty-two volunteer participants (133 men; 19 women) were randomly placed in either of two groups: to participate in weekly 90-min yoga class (yoga group) or a weekly 90-min free-choice physical exercise (control group). The study period lasted for 10 weeks. Prior to and at the end of the study period the participants completed a battery of self-reported inventories, including the Brief Symptom Inventory (BSI). Results: Physical activity (including yoga) significantly reduced the inmates' levels of psychological distress. Yoga practice improved all primary symptom dimensions and its positive effect on the obsessive-compulsive, paranoid ideation, and somatization symptom dimensions of the BSI stayed significant even when comparing with the control group. Conclusions: Yoga as a form of physical activity is effective for reducing psychological distress levels in prison inmates, with specific effect on symptoms such as suspicious and fearful thoughts about losing autonomy, memory problems, difficulty in making decisions, trouble concentrating, obsessive thought, and perception of bodily dysfunction.

Development of a Trans-disciplinary Intervention Module for Adolescent Girls on Self-awareness

INTRODUCTION

Mental health promotion among adolescents has been a key area of intervention for professionals working with children and adolescents. The opinions of experts in the field of mental health have taken to frame a trans-disciplinary intervention for adolescent girls on self awareness.

AIM

To discuss the development and validation of a structured intervention by combining the knowledge from different disciplines in helping adolescents enhancing self awareness.

MATERIALS AND METHODS

Both qualitative and quantitative methodologies were followed for the development and validation of the module. First phase of the development of intervention module was the framing of intervention module after conducting in-depth interviews with experts in both mental health and yoga fields. Six experts each from mental health and yoga field were chosen for interview through convenient sampling. Validated interview guides were used for the process. The framed intervention module was given to six mental health experts and six yoga experts for content validation. The experts rated the usefulness of the intervention on a scale 0-4 (4=extremely helpful).

RESULTS

The themes derived in the interviews were importance of self awareness, autonomy of self, physical level of self understanding, self regulation of emotions and self monitoring. The interviews were consolidated to frame the intervention module consisting of eight sessions having two parts in each session. Part one of each session is activities and interactions on mental health and part two is guided instructions for body focused meditation. Sessions were finalized with rating and suggestions from the experts. The final version of the module was pilot tested and had found to have enhanced self awareness among adolescent girls.

CONCLUSION

Integration of multiple disciplines brought in novel perspectives in intervention.

Validation of yoga module for children with intellectual disabilities

BACKGROUND

Children with developmental disabilities generally experience more pain than the normal children due to chronic systemic conditions associated with their disability. Description of pain is generally difficult in children and more so in children with intellectual disabilities (IDs). Yoga has been regarded as a kind of physical activity as well as a pain management strategy. Previous studies have reported the beneficial role of yoga in enhancing physical and psychomotor abilities of IDs; however, a validated yoga module (YM) for IDs is unavailable. The present study is aimed at developing a validated YM for children with IDs.

MATERIALS AND METHODS

The content validity of YM for children with IDs was assessed by a panel of 22 experienced yoga experts. The YM for children with IDs was developed in the form of tailor-made yoga practices that were supported by classical texts and research evidence. A total of 32 practices were included in the YM, and each practice was discussed and rated as (i) not essential, (ii) useful but not essential, and (iii) essential. The content validitity ratiowas calculated using Lawshe's formula.

RESULTS

Data analysis showed that out of 32 YM practices, 31 indicated significant content validity (cutoff value: 0.42, as calculated by applying Lawshe's formula for the CVR).

CONCLUSIONS

The present study suggests that the YM for children with IDs is valid with good content validity. However, future randomized controlled trials must determine the feasibility and efficacy of the developed YM for children with IDs.