Review on Role of Yoga in Chittodvega w.s.r. to Generalized Anxiety Disorder

Introduction

Anxiety phenomenon is as old as the humanity. Among all anxiety disorders generalized anxiety disorders are the most common occurring mental illness with prevalence rate of 5-6% globally [1]. An anxiety state may be defined in terms of intensity of the subjective feeling of tension, apprehension, nervousness and worry that are experienced by individual at a particular moment and by heightened activity of the autonomic nervous system that accompanies these feelings. Generalized Anxiety Disorder is characterized by at least 6 months of persistent and excessive anxiety and worry. People with symptoms of GAD always tend to expect failure and can’t stop worrying and this worry is often unrealistic or out of proportion for the situation. So, daily life becomes a constant state of worry. It is more frequent anxiety disorder in primary care, being present in 22% of primary care patients who complain of anxiety problems. Women are more susceptible for GAD as compare to men. GAD may lead to insomnia, Social isolation, impaired quality life Gastrointestinal problems, drug and alcohol use disorder. Chittodvega seems to be well suited to anxiety disorders. Aetiology of Chittodvega clearly shows a state of mental anxiety. To make a space in this highly competitive world, man is approaching to the Raja and Tama Prakopaka Ahara - Vihara and hence living very stressful life. It all leads to disturbance of Vatadi Doshas which in turns is responsible for production of an abnormal state of both body & mind.

Pathophysiology

The exact mechanism is not entirely known. Nor- adrenergic, serotonergic, and other neurotransmitter systems appear to play a role in the body’s response to stress. The serotonin and noradrenergic systems are the common pathways involved in anxiety [3].

Diagnostic Criteria [4]

Patients will be diagnosed on the basis of signs and symptoms of generalized anxiety disorder (DSM-V criteria). 1. Excessive anxiety and worry (apprehensive expectations) occurring more days than not for atleast 6 months, about a no. of events or activities (such as work or school performance). 2. The individual finds it difficult to control the worry. 3. The anxiety and worry are associated with three (or more) of the following six symptoms (with atleast some symptoms having been present for more days than not for the past 6 months) :

• Restlessness or feeling keyed up or on edge.
• Being easily fatigued
• Difficulty concentrating or mind going blank.
• Irritability
• Muscle tension
• Sleep disturbance (difficulty in falling or staying sleep or restless, unsatisfying) 4. The anxiety, worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. 5. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). 6. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in post-traumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

Ayurvedic Review

Chittodvega is considered as a perfect word for highlighting the state of anxiety. A separate description of Chittodvega is not given in Ayurvedic Samhitas. The term Chittodvega is mentioned by Acharya Charaka in Vimana Sthana, in context of Manas Dosha Vikara [5].

Samprapti

Udvega Avastha of Manasa, or an agitated state of mind, indicates elevated Rajas, or quality of mind, and this is what sets apart Chittodvega as a Manovikara. The pathophysiology of Chittodvega is mostly determined by the vitiation of Vata and Rajas. It is believed that mental trauma, or Manoabhighata, is what sets off mental illnesses. Furthermore, triglycerides are essential for the disease’s expression. Fear, sadness, and confusion are among the signs of aggravated Vata, which can cause mental disorder. Among the five types of Pitta, Sadhaka Pitta is linked to accomplishments, excitement, memory, and intelligence. Its vitiation causes mental disorders of all the types of Kapha, Chittodvega is the outcome of Tarpaka Kapha vitiation. Vata Prakopa Lakshanas are associated with excess thinking, impatience, palpitations, and other anxiety symptoms; Pitta Prakopa is associated with disturbed bowel habits, fear, anger, and other similar symptoms. Taking into account the dhatus associated with the illness, Ati chinta, or overthinking, is a contributing component to Rasa Dhatu Dushti, which again presents with physical and mental symptoms.

Management

A combination of pharmacologic and psychotherapeutic interventions is most effective in GAD, but complete symptomatic relief is rare. Clinical trials have shown that anxiolytic drugs alone have limited long-term efficacy. Moreover, they often have adverse side effects including dependency, drowsiness, impaired cognition and memory and sexual dysfunction. Consequently, clinical community has begun to consider alternative old and new approaches targeting anxiety problems and to examine the merits of combined and tailored somatic and psychological treatments.

In Ayurveda Acharya Charaka explains three types of therapies of physical and mental disorders-

• Daivavyapashraya Chikitsa (Divine or spiritual Therapy)
• Yuktivyapashrya Chikitsa (Rational or Physical Therapy)
• Sattvavajaya Chikitsa (Mental Therapy) Yuktivyapashraya Chikitsa is further divided into Dravyabhuta (Bhesaja Chikitsa) and Adravyabhuta Chikitsa. The Adravyabhuta Chikitsa includes treatment with different Upayas [7]. Yoga Chikitsa can be considered as Adravyabhuta Chikitsa which may also aid in Sattvavajaya.

Review on Yoga

Manas are located between Shirah and Talu [8]. The power of all Indriyas is derived from Manas. The cause of different modes of functioning of the intellect is Chitta [9]. Chitta is an aspect of Manas. Because of its ability to discriminate between Karya and Akarya and Shubha and Ashubha, it is spoken as Buddhi. Hathayoga Pradipika holds that Manas is the Master of Indriyas and Vayu is the master of Manas. Yoga reduces stress and anxiety by improving autonomic functions via triggering neuro-hormonal mechanisms that suppress sympathetic activity through down regulation of the hypothalamic–pituitary–adrenal (HPA) axis [10]. Different type of Yoga may produce beneficial effects on Chittodvega in the following way.

Discussion

Anxiety disorders have been implicated as the cause of many chronic disease and decreased quality of life, even with pharmacologic treatment. Yoga is a promising method for anxiety disorder. However more studies are needed to check out the individual role of Yoga and anxiety disorder. Yoga arouses awareness and cultivates mindfulness. It includes focusing on the breath, bodily sensation and movements due to which individuals developes a deep mind body connection. This heightened arousal and awareness of mind facilitates recognition and acceptance of anxious thoughts and emotions, leading to their effective medicine. The current dissertation study is entitled as “Randomized comparative clinical evaluation of efficacy of Brahmi Taila Nasya and Yoga module in Chittodvega (GAD). The one of the main objectives of the study is to find the individual efficacy of Yoga in Anxiety disorder.

Conclusion

From the above discussion we can conclude that Yoga plays an important role in maintaining the balance between mind and body. It can produce significant effects alone or in the form of integrative medicine along with Ayurveda in case of Chittodvega (GAD).