Background

Post traumatic disorder is a significant health disorder resulting from the exposure to traumatic events, which can be related to the given case scenario, where Tasso, a 21 year old computer programmer went in to a post-traumatic stress disorder after witnessing a serious motor car accident. Yoga is an age old comprehensive system of practice for the physical and the mental wellbeing of people, which involves some warm –up exercises, breath work and body postures. This paper critically appraises a paper supporting to understand the perception about Yoga for managing PTSD symptoms.

There were no conflict of interest present. Jindani FA, Khalsa GF were reputed authors who have published many research papers with good impact factors, thus ensuring credible research.  Furthermore all the concepts of other authors have been included in this paper.

The aim of this paper is to understand how people with post traumatic disorder perceive the trauma sensitive Kundalini yoga program. The rationale behind this chosen topic of research is that till now there had been no studies that has investigated the experience of Yoga intervention on individuals suffering from PTSD. Hence rather than focusing on the effectiveness of the treatment, focus has been given on the perception of people regarding Yoga for PTSD treatment. There are other treatments for PTSD such as the cognitive behavioral therapy, verbal therapies and other prolonged exposure therapies that is time consuming as well as involves deterioration of the patient’s symptoms (Cramer, Anheyer, Saha & Dobos, 2018). Furthermore there are some types of exposure treatments that can evoke implicit memories or the trauma associated bodily sensation, hence re-traumatising the individual rather than resolving the trauma. Bisson, Roberts, Andrew, Cooper & Lewis (2013), have also referred Yoga to be more superior to the pharmacological therapy. Yoga had always been found to be effective for both physical and psychological health from time immemorial. Hence in order to confirm the effective ness of yoga on the physical and mental wellbeing of the patient suffering from PTSD, it is essential to assess the viewpoint of the individuals who have received Yoga training. 

Quantitative analysis has been used to record the experience of the patients. According to Lewis, (2015), qualitative research is a systematic enquiry into a social phenomenon conducted in a natural setting. These phenomena includes what and how people experience aspects of their life and how individuals behave (Teherani et al., 2015). In this paper the qualitative study is used to understand the thoughts and belief about a Yoga intervention.

Methodology

Digitally recoded telephonic interviews of about 30-60 minutes were conducted involving 40 individuals with PTSD taking part in an 8 week KY treatment program. Only the qualified participants were eligible for the interview and the PTSD was determined using the post traumatic disorder by using the Post –traumatic disorder checklist. All he participants were assigned randomly to experimental or the waitlist control group.  The benefits of using semi structured- interviews in qualitative studies is that are useful in obtaining a detailed information about the personal beliefs, experiences and opinions. The questions asked in the semi structure interview was adequate enough to record the perception of the participants.

The method of data collection and data analysis was carried out interactively by the investigator. Transcription of 40 interviews were carried out and the accuracy of the transcripts has been verified. Inductive thematic analysis has been rightly chosen for this research as in inductive method, the themes are linked strongly with the data and might bear little relation to the specific questions asked to the participants (Jindani & Khalsa, 2015). Hence the coding of the data is without trying to fix it in the researcher’s analytic preconceptions. Inductive reasoning might be limiting as it begins with single observations or an inference drawn from similar situations which possibly might not be accurate for a diverse case.  Reflecting on the interventions chosen, the interventions were designed by a leading psychologist ensuring the credibility of the interventions (Lewis, 2015). 

Three themes of interest has been revealed by the analysis of the data- Self observed changes, yoga and new awareness. These themes were further classified in to subthemes. As per the findings participants perceived changes in sectors of health and wellbeing, psychosocial integration, life style and perception of self in relation to the world. This can also be supported by Cramer, Anheyer, Saha, & Dobos, (2018), where Yoga had been found to be an effective therapeutic treatment to improve the psychiatric condition like depression and anxiety disorder. Cramer, Anheyer, Lauche & Dobos, (2017), have stated that Yoga involves aspects of relaxation and mindfulness that increase the capability to regulate emotions and even avoid the unpleasant memories, thus helping to cope up with the PTSD symptoms. Hence the result has answered the research question.

Some of the limitations of this study is that participants presenting with the PTSD symptoms might have been healthier or might have interest in other alternative approaches. Another important limitation is the small sample size and lack of active control (Lewis, 2015). A small sample size affects the reliability of a research as it might lead to high variability and may lead to bias. One of the most common bias is the non –response bias. Another limitation is the lack of a proper control group (Lewis, 2015). The presence of an active control group always helps to compare the outcomes of the intervention on the active control group receiving the standard care and the experimental group receiving the interventions. 

Data Analysis

Evidence based practice is an important aspect of nursing nowadays as it provided opportunities to the clinicians to go through and analyses several medical articles drawing the knowledge that  can be used in their nursing practice. Managing patients with post traumatic disorder can be challenging in the nursing professions and pharmacological interventions can have several side effects especially those with multiple comorbidities. This themes described in paper helps to understand about the different aspects of psychological health such as the mind- body relationship, cognitive growth, self-reflection, spirituality and how they are affected by Yoga program. Since the interventions were carried out in groups hence the group interventions had an additional collaborative effect on the interventions. This paper demonstrates how the yoga teachers had helped the participants to feel empowered and to have a control of their own healing, which can be used by the mental health nurses, nursing patients with PTSD. The future implication for this is that yoga can be used as a part of the trauma based therapies that are normally provided to the patients (Vancampfort et al., 2013).

Application of the clinical findings in to researches can be challenging from the perception of the nurses. One of the most important perceived barriers is the lack of time, provision of appropriate infrastructure and proper training. Many of the nurse are unaware of the evidence based practice and hence do not have adequate preparation for using the research findings (Bahadori, Raadabadi,  Ravangard & Mahaki, 2016). For example, clinical settings generally follow a conventional pattern to treat patients with post traumatic disorder. Inclusion of complementary therapies such as Yoga treatment requires effective nurse training, proper infrastructure in the clinical setting, funding and approval for the higher authority. Due to this reason nurses, often do not get much interest in integrating research into practice.   

Conclusion

In conclusion it can be said that the article could identify the perception of the PTSD patients about yoga treatment, which guarantees the future scope of yoga treatment in the treatment of the PTSD symptoms. The data collection method and the sampling method is appropriate, although the sample size is quite low with a risk of non-response bias. The inductive method of the data analysis also has been sufficient for classifying the findings in to appropriate themes. Furthermore, this study also would be helpful in improving the trauma related service enhancing the quality of life of people with PTSD. 

References

Bahadori, M., Raadabadi, M., Ravangard, R., & Mahaki, B. (2016). The barriers to the application of the research findings from the nurses’ perspective: A case study in a teaching hospital. Journal of education and health promotion, 5, 14. doi:10.4103/2277-9531.184553

Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev, 12. DOI: 10.1002/14651858.CD003388.pub4

Cramer, H., Anheyer, D., Lauche, R., & Dobos, G. (2017). A systematic review of yoga for major depressive disorder. Journal of affective disorders, 213, 70-77. doi: 10.1016/j.jad.2017.02.006.

Cramer, H., Anheyer, D., Saha, F. J., & Dobos, G. (2018). Yoga for posttraumatic stress disorder – a systematic review and meta-analysis. BMC psychiatry, 18(1), 72. doi:10.1186/s12888-018-1650-x

Jindani, F. A., & Khalsa, G. S. (2015). A yoga intervention program for patients suffering from symptoms of posttraumatic stress disorder: A qualitative descriptive study. Journal of Alternative and Complementary Medicine, 21(7), 401-408. doi:10.1089/acm.2014.0262  

Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), 473-475. https://doi.org/10.1177/1524839915580941

Teherani, A., Martimianakis, T., Stenfors-Hayes, T., Wadhwa, A., & Varpio, L. (2015). Choosing a Qualitative Research Approach. Journal of graduate medical education, 7(4), 669-70.

Vancampfort, D., Vansteelandt, K., Scheewe, T., Probst, M., Knapen, J., De Herdt, A., & De Hert, M. (2012). Yoga in schizophrenia: a systematic review of randomised controlled trials. Acta Psychiatrica Scandinavica, 126(1), 12-20.