Effect of Shirodhara and Yoga Nidra in Generalised Anxiety Disorder: A Single Case Study

S. Navarange; V. Wasnik; S. Jain

doi:http://dx.doi.org/10.21760/jaims.8.3.35

Effect of Shirodhara and Yoga Nidra in Generalised Anxiety Disorder: A Single Case Study

Navarange S.^1*, Wasnik V.², Jain S.³

DOI: http://dx.doi.org/10.21760/jaims.8.3.35

^1* S. Navarange, 2nd Year Post Graduate Scholar, Department of Swasthavritta and Yoga, Government Ayurveda College, Nagpur, Maharashtra, India.

² V. Wasnik, Associate Professor, Department of Swasthavritta and Yoga, Government Ayurveda College, Nagpur, Maharashtra, India.

³ S. Jain, HOD and Associate Professor, Department of Swasthavritta and Yoga, Government Ayurveda College, Nagpur, Maharashtra, India.

Introduction: There is tremendous increase in the psychological disorders like anxiety, depression and stress due to various factors like social distancing, lockdowns, poor socioeconomic conditions. Among these, generalised anxiety disorder (GAD) has become an alarming situation in the country. The present study was undertaken to assess the efficacy of Shirodhara and Yognidra. Aims and Objectives: To assess the effect of Jatamansi Siddha Taila Shirodhara and Yognidra in Anxiety. Material and Methods: The patient was provided with the Jatamansi Siddha Taila Shirodhara as well as Yog Nidra in Anxiety. The assessment criteria used for the evaluation was Hamilton Anxiety Rating Scale (HARS) with a global score of 56. Result: During the 14 days of treatment patient reported relief in his symptoms. After 2 month here was a significant reduction in all the symptoms and the score reduced drastically from 35 to 19. Discussion: Warm liquids used in the Shirodhara procedure cause increased infiltration of blood in scalp region thus relaxing muscle and nerve endings. Shirodhara causes tranquility of mind and induces natural sleep by prolonged and continuous pressure. Yoga Nidra is the science of relaxation which enables to enter into the realms of the subconscious mind, thereby releasing and relaxing mental tensions and establishing harmony in all facts of life. Conclusion: In the present case, the treatment showed significant relief and was found very effective in Anxiety.

Keywords: Shirodhara, Yoga Nidra, Generalised Anxiety Disorder, Ayurveda, Case Report

Corresponding Author	How to Cite this Article	To Browse
S. Navarange, 2nd Year Post Graduate Scholar, Department of Swasthavritta and Yoga, Government Ayurveda College, Nagpur, Maharashtra, India. Email:	S. Navarange, V. Wasnik, S. Jain, Effect of Shirodhara and Yoga Nidra in Generalised Anxiety Disorder: A Single Case Study. J Ayu Int Med Sci. 2022;8(3):183-187. Available From https://jaims.in/jaims/article/view/2357

Introduction

Anxiety is understood as the state of apprehension or uneasiness arising due to the anticipation of insecurity or assault. It is pathological when it is unreasonable, exaggerated, recurrent, and causing significant psycho-physiological distress. Generalized anxiety disorder (GAD), a common variant of anxiety disorders, has a 2 - 5% prevalence in the general population (Baxter et al., 2013).^[1] Generalized Anxiety Disorder is characterized by excessive or unrealistic anxiety about two or more aspects of life (work, social relationships, financial matters, etc.), often accompanied by symptoms such as palpitations, shortness of breath, or other somatic symptoms. About 5.8% in India and 4% globally are said to be suffering from GAD at some point in their life.^[2] Anxiety is an extremely common problem, affecting approximately 23.4 percent of females and 14.3 percent of males. In fact, it is the most common mental disorder worldwide. Data from the National Institute of Mental Health suggest that around 31 percent of adults can expect to experience some type of anxiety disorder in their lifetime.^[3]

A balanced state of Dosha, Agni, Dhatu, Mala, Manas, Atma, and Indriya is considered to be healthy.^[4] From an Ayurvedic perspective, anxiety is an imbalance in the Vata Dosha. Vata is the “air” principle. It is light, dry, and mobile. An imbalance of Vata, mentally, is associated with an overabundance of lightness or movement, erratic thoughts, worries, obsession, confusion, and difficulty focusing. Vata imbalance is also associated with a hyper-excitable nervous system and trouble sleeping. If you’ve ever heard someone say they feel “ungrounded,” that’s a classic description of Vata imbalance. It’s too much energy in the mind, not enough at the feet.

Thus, when Vata is disturbed, you feel ungrounded, disconnected from the earth. To treat anxiety/Vata imbalance, you have to stabilize your energy, calm the nervous system, relax the mind, release obsessive thoughts, connect to your body and to the earth, and ultimately surrender to the flow of the Universe.^[5]

Shirodhara (Shiro means head and Dhara means flow) involves gentle pouring of a medicated liquid upon the forehead. It is traditionally used to treat variety of conditions related to cognition,

sleep and anxiety. Continuous pouring of Shirodhara on fore-head for a specific period has tranquilizing effect & regulates rhythm Mana & Prana Vayu it also induces Sleep.

A process of Murdhni Taila, in which a suitable Taila and other substances such as Ghritas, Takra, Ikshu Rasa, Kashaya, Ksheera etc. is continuously poured on the forehead and then allowed to flow over the scalp in a specific rhythm, is called Shirodhara.^[6,7]

The author of Hatha Yoga Pradipika, great Yogi Swatmarama, classifies Yog Nidra as the state of Turiya; means the all expansive and encompassing ‘fourth dimension’, in which Shakti neither contracts nor expands, but is in union with Shiva or supreme consciousness.^[8]

Yoga Nidra, or Yogic sleep as it is commonly known, is an immensely powerful meditation technique, and one of the easiest Yoga practices to develop and maintain. While the practitioner rests comfortably in Savasana (corpse pose), this systematic meditation takes you through the Pancha Maya Kosha (five layers of self), leaving you with a sense of wholeness.

In the present modern lifestyle, where Psychological and Psychosomatic problems are on the on the rise, the technique of Yog Nidra may serve as a real boon for mankind.^[9] The present case study is aimed to see the positive effects of Shirodhara and Yog Nidra in an anxiety-diagnosed patient.

Case Report

A 51 years old married woman with middle socioeconomic background residing in Nagpur, Maharashtra presented in the Swasthavritta and Yog outpatient department (OPD no.-11098) on 18/08/2021 with the following complaints since last 1 year:

1. Increase in worrying tendencies and negative thoughts

2. Irritability and restlessness

3. Fear of being left alone

4. Feeling of weakness

5. Tremors of hand

6. Insomnia

7. Loss of interest in work and social gathering

Personal history: General condition (G.C) - moderate, Appetite - decreased, Diet - only veg, Bowel - normal but sometimes constipation, Urine - normal, Thirst - normal, Sleep - insomnia, Habits - 5-6 times tea in a day and Occupation - housewife.

General examination: The patient was conscious, well-oriented, and spoke normally. There was the absence of pallor, icterus, clubbing, and cyanosis. Bp - 120/70 mm hg, PR - 70/ min, Height - 162 cm, Weight - 62 kg, and BMI - 23.6 kg/m².

Diagnosis and Evaluation: The evaluation of the patient’s condition was done by the following psychological test:

Hamilton anxiety rating scale HARS (hamilton, 1959).^[10] – the patient denoted major anxiety with a score of 35 out of 56.

Interventions: After the written informed consent, the patient was treated with the proper Shirodhara technique and Yognidra.

SN	Intervention	Time	Duration of treatment
1.	Shirodhara	45 minutes	21 days
2.	Yoga Nidra	30 minutes (2 times/day)	60 days

The assessment was done using HARS, before treatment and follow-ups were taken on the 30^th and 60^th day to check for relapse if any.

Observation

Table 1: Assessment of symptoms - HARS (Hamilton Anxiety Rating Scale)

Note: 0 = Not present, 1 = Mild, 2 = Moderate, 3 = Severe, 4 = Very severe

SN	Parameter	Before Treatment	After 1 Month of follow-up	After 2 Month of follow-up
1.	Anxious Mood	4	2	2
2.	Tension	4	3	2
3.	Fears	3	2	2
4.	Insomnia	3	2	1
5.	Intellectual	3	3	1
6.	Depressed Mood	4	3	3
7.	Somatic (Muscular)	0	0	0
8.	Somatic (Sensory)	2	2	1
9.	Cardiovascular Symptoms	2	2	1
10.	Respiratory Symptoms	2	2	1
11.	Gastrointestinal Symptoms	1	1	1
12.	Genitourinary Symptoms	2	1	1
13.	Autonomic Symptoms	2	2	1
14.	Behavior at Interview	3	2	2
	Total	35	27	19

Result

After 21 days of Shirodhara, significant improvement was observed in the clinical condition of the patient. Psychological symptoms like negative thoughts, irritability, and insomnia were drastically reduced by 21 days. There was a marked reduction in the score of the HARS scale (table 1) after one month. After about 2 months of intervention, most of the symptoms subsided.

Discussion

Anxiety disorder is a common morbidity found as an independent or secondary condition. GAD has anxiety as the predominant feature reflecting through various physical and psychological domains.

Vayu is the driving force of all the activities of the body and mind. Vayu is said to be a Tantra (formula) which runs the Yantra (machine) called as Shareera (body). Pitta's, Kapha, the tissues of the body, the waste excreta of the body, all are dependent on Vata (Vayu). If Vayu is functioning properly all these elements are in equilibrium and if Vayu is disturbed, it further disturbs other elements of the body and causes wide array of diseases.

The key for well being is in having the Vayu (life force and energy) in our body in control.

Shirodhara will have the Vayu in our body in control. Shiridhara by Jatamnasi Siddha Taila have a tremendous effect on controlling Vayu. It controls, pacifies and expels the morbid Vayu. Chakrapani has already clarified that Prana located in the Shiras is nothing but different types of Vayu. Shirodhara has a relaxing effect on brain and the whole nervous system and hence releases the stress and anxiety stagnant in the cheif controlling station of our body. Shiro Dhara procedures relaxes & revitalizes the central nervous system, balances the brain and hormonal functions and thus regularizes and relaxes all the functions of the body. The stress in each and every cell and passage of the body is removed. It has a soothing effect on the endocrine system.

Shirodhara has shown its anti-anxiety, antihypertensive and sleep inducing effects in few studies (Vinjamury et al., 2014; Nakanekar et al., 2015; Sriranjni, 2009).^[11]

Physiological responses of shirodhara procedure are found to reduce the sympathetic tone thereby decreasing the cardiac activity and increasing α and θ wave activity in brain (Uebaba et al., 2008; Xu et al., 2008).^[12]

Mode of action of Shirodhara

SN	Intervention	Karmukta
1.	Taila Dhara	Mana - Sthairyakar, Balya, Nidra, Medhya
2.	Jatamansi	Tikta, Madhur, Kashaya Rasa, Sheet Virya, Katu Vipaka, Medhya, Bhutaghna (Manasdoshahar), Tridoshaghna.[13]

Yoga Nidra is the science of relaxation which enables to enter into the realms of the subconscious mind, thereby releasing and relaxing mental tensions and establishing harmony in all facts of life.

Thus, it is found that Yog Nidra increases the parasympathetic activity thereby resulting in increase in the vagal tone and alteration in neurotransmission and helps in release anxiety, stress.^[14]

One important observation made in the study is about the sustainable effects of Shirodhara and Yognidra upon the symptoms of anxiety. As it was observed through the changes in the HAR-Scale.

Conclusion

It can be concluded that the Shirodhara by Jatamansi Siddha Taila and Yog Nidra can significantly improve the mental condition of patients with Generalized Anxiety Disorder. No serious adverse effects were noted. Further studies need to be conducted on larger population using advanced assessment tools to reproduce similar results so that it can be prescribed as a scientifically approved modality in GAD and related mental disorders.

Reference

1. Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013;43:897-910.

2. Craske MG, Stein MB. "Anxiety". The Lancet [inter-net]. (2016 Jun 24) [Cited on 2020 Mar 12]; 388 (10063):3048– 3059. Available from: DOI: 10.1016/S0140 6736(16)30381-6.

3. https://chopra.com/articles/an-ayurvedic-approach-to-anxiety

4. Sushruta. Sushruta Samhita. Acharya YT, editor. Varanasi: Chaukambha Surabharati Prakashan; 2012. p. 75.

5. https://chopra.com/articles/an-ayurvedic-approach-to-anxiety

6. Ashtang hridaya, Arundatta, Hemadri commentary, by Dr Anna Moreswara Kunte, Krsna Ramchandra Sastri Navare, Edited by Bhisagacharya Harisastri Paradakara Vaidya, Introduction by Prof. P. V. Sharma, Reprint Tenth Edition 2014, Chaukhamba Orientalia, Varanasi, Pp : 956, Pg no : 301, Sutrasthana, Ch : 22. Sloka no: 24.

7. Ashtang hridaya, Arundatta, Hemadri commentary, by Dr Anna Moreswara Kunte, Krsna Ramchandra Sastri Navare, Edited by Bhisagacharya Harisastri Paradakara Vaidya, Introduction by Prof. P. V. Sharma, Reprint Tenth Edition 2014, Chaukhamba Orientalia, Varanasi, Pp : 956, Pg no : 301, Sutrasthana, Ch : 22. Sloka no: 24.

8. Swatmarama; Hatha Yoga Pradipika; Chapter 4 verses 49.

9. Bhushan Siddhartha Mar, Yoga Nidra and its advantages and application; Yoga (Bihar School of Yoga, Munger), 2001.

10. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol, 1959; 32: 50–55

11. Nakanekar A, Bhople S, Gulhane H, Rathod S, Gulhane J, Bonde P. An ayurvedic approach in the management of Guillain-Barre syndrome: A case study. Anc Sci Life. 2015;35:52-57.

12. Otto M. Teaching Slides: CBT for Anxiety and Depressive Disorders. Available at: http://www.adaa.org/resources-professionals/teaching-slides (accessed on 1st October 2016).

13. Chunekar, K. C. (Editor). Bhavaprakasha Nighantu. Karpooradi Varga; Verse No. 89; Varanasi: Chaukhamba Bharati Academy; 2002;240.

14. Balasubramaniam M, Telles S, Doraiswamy PM. Yoga on our minds: A systematic review of yoga for neuropsychiatric disorders. Front Psychiatry. 2012;3:117

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2023-01-28	2023-01-31	2023-02-07	2023-02-14	2023-02-21
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Generalised Anxiety Disorder

Journal of Ayurveda and Integrated Medical Sciences

Effect of Shirodhara and Yoga Nidra in Generalised Anxiety Disorder: A Single Case Study

Navarange S.1*, Wasnik V.2, Jain S.3

Introduction

Case Report

Observation

Result

Discussion

Conclusion

Reference

Navarange S.^1*, Wasnik V.², Jain S.³