Thesis Pres- Satvavajaya Chikitsa In Bhaya W.s.r. To Fear Of Examinations.
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Satvavajaya Chikitsa In Bhaya W.S.R. To Fear of Examinations. Scholar- Dr. Mahesh C. Kundagol Guide- Dr. Narayan Prakash B. M.D. (Ayu) Co-Guide- Dr. Suhas Kumar Shetty M.D. (Ayu)
Introduction 1) Examinations. 2) Examination Fear. 3) Satvavajaya Chikitsa.
?
Aims and Objectives
AIMS AND OBJECTIVES 1)To evaluate the effect of Satvavajaya chikitsa in the management of Bhaya. 2)To evaluate the Nidana Panchaka of Bhaya 3)To provide a cost effective self assessable drugless therapy.
Historical review
VEDA PERIOD
a) Rig-Veda –Pisacha. b) Yajur-Veda – Shivasankalpa Sutra. c) Atharvana-Veda – Manasikabhavas.
SAMHITA PERIOD
Review of Bhaya ‘Bhayam Parmastrsahah’ In Bhagavad-Gita it is said that ‘The coward ness which is originated as a result of the gain of the unpleasant thing and the loss of the pleasant thing is termed the Bhaya. ( Bh.G. 16/1 Jayadmala Goendaka Comm). .
Review of Bhaya Nidana – Etiology of Bhaya. a) Prajnyaparadha. b) Vata Dosha. c) Manasika Prakriti. d) Avara Satva. c) Negative thoughts.
Types of Bhaya – (B.G.16/1) a) Pratistha Nasah Bhayab) Apamana Bhaya -. d) Vyadhi Bhaya e) Bhuta Pretadi Bhaya -Fear of ghosts, devils etc.
f) Mrityu Bhaya g) Vyaghradi Bhaya. h) Jalatraasa i) Anagata Bhaya
Poorvaroopa of Bhaya
a) Chirakari Vyadhi. b) Vata Dosha.
Roopa -
1) Vishada 2) Bhita 3) Svedavepathumaan 4) Trastha 5) Shuskashyavavakrah
Samprapti Nidana Sevana (Exam fear)
Mano Dosha Kopa Raja, Tama
Hridaya Dusti
Sharirika Dosha Kopa Vata, Pitta, Kapha
Agni Vikrit
Rasadi
Dhatudusti Hina Satva
Manovaha Srotodusti
Rasadi Sarva Srotodusti
Prolonged nidana
Manas Lakshana Uttpati
Sharira Lakshana
Uttpati
Bhayaa
Samprapti Ghataka: 1. Dosha – Manas – Raja, Tama Shareera – Vata – Prana, Udana & Vyana Pitta – Sadhaka Kapha – Tarpaka 2. Dushya –Rasadi Sarvadhatu 3. Agni – Jatharagni – Manda, Vishama 4. Srotas – Manovaha, Sarvasrotodushti 5. Srotodushti - Atipravrtti 6. Udbhava Sthana - Hrdaya
7. Sanchara Sthana - Manovaha Srotas/ Sarva Shareera 8. Adhishthana - Manovaha Srotas 9. Vyakta Sthana – Manas and Shareera 10. Sadhya Sadhyata – Krcchra Sadhya vyadhi 11. Roga Swabhava - Ashukaritva 12. Upadrava - Manovikara/ Shareera Vikara
Concept of exam fear
Causes of Exam Fear1) Negative thoughts. 2) Worrying about past performance 3) Comparison. 4)Lack of confidence. 5) Failure to organize course information.
5) Poor study habits. 6) Poor time management. 7) Lack of confidence. 8) Study environment.
Symptoms 1) Fear of loosing control or going crazy. 2) Loss of memory. 3) Fear of failure. 4) Profuse sweating. 5) Feeling of Choking. 6) Insomnia.
7) Nausea or abdominal discomfort. 8) Feeling Dizzy, unsteady, light headed or faint. 9) Palpitation, beating heart, or accelerated heart rate. 10) Chills or hot flushes. 11) Paresthesia 12) Sensation of shortness of breath or smothering.
Complications of Exam Fear 1) Failure in the exams. 2) Avoidance of exams. 3) Discontinuing of the studies. 4) Mental and physical illness. 5) Suicidal tendency.
Concept of Satvavajaya ChikitsaChikitsa Satvavajaya “Satvavajaym Punarahithebhyo Arthebhyo Mano Nigrahah.” (Ch. Su. 11/55)
Techniques of the Satvavajaya Chikitsa a) “Manaso Gnana Vignnyana Dhairya Smriti Samadibih” b) “ Dhi Dhairyatmaadi Vignynam Manodoshoushadim Param”.
1) Gnyana. 2) Vignyana. 3) Dhairya. 4) Smriti. 5) Samadhi.
Atma, Kula, Bala, Desa,
Bhaya and Satvavajaya Chikitsa 1)Rational persuasion – a) Dhairya & Ashwaasana b) Sadvrtta (good conduct) c) Dharaniya Vega .
2))Methods based on the deeper understanding
Atma Janna- who I am, what is beneficial to me Desha Janna – Society, his responsibility towards it. Kula Janna – Family and his relationship between them. Kala Janna – Season, Pathya, Apathya during this time. Bala Janna – Strength Shakti Janna – Capacity
3) Samadhi (Mental equanimity) – 1) Abridging of Indriyas Indriyani Samksipya. 2) Stilling the fickle mind (Cancalam Maanah Samksipya). 3) To fix the mind into Soul.
Methodology
For the present clinical study, a survey study was conducted in the Malnad College of Engineering Hassan for the assessment of the presence of the examination fear in students and 30 students were selected for the study who were coming under the criteria of the examination fear.
Criteria of diagnosis: The diagnosis of the examination fear in students were done on the basis of presence of the following symptoms in feared conditions. 1) Fear of loosing control or going crazy. 2) Loss of memory. 3) Fear of failure. 4) Profuse Sweating. 5) Feeling of choking.
6) Insomnia. 7) Nausea or abdominal discomfort. 8) Feeling dizzy, unsteady. Light headed, or faint. 9) Palpitation, beating of heart, or accelerated heart rate. 10) Chills or hot flushes. 11) Paresthesia. 12) Sensations of shortness of breath or smothering
Each symptoms were were given scorings as 0, 1,2,3,4, and their severity were denoted on the personal scorings as, 0 - Not present 0-12 - Mild 13-24 - Moderate. 25-36 - Severe. 37-48 - Very severe
Inclusion criteria: 1. Students of 18 to 30 years of age. 2. Students presenting with general features of fear of examination.
Exclusion criteria: 1. Students suffering from other psychiatric and organic diseases
Method of Satvavajaya Chikitsa: The Satvavajaya Chikitsa was designed depending upon the cause of the fear in the students. The students were interrogated in detail for knowing the cause of the fear, and then they were given the Satvavajaya in the for of Dhairya and Ashwaasana Chikitsa for 45 mins, in a calm and peaceful room, twice in a week for three weeks.
Assessment criteria: Assessment of the patients of the patients will be done on the basis ofa) Self assessable questions were prepared for the assessment. b) All the symptoms were given suitable score for the assessment of results. Total effect of the treatment will be considered as complete remission, marked improvement, and unchanged. c) Diagnosis and improvement in signs and symptoms of the condition according to Hamilton’s scale of anxiety.
HAMILTON ANXIETY RATING SCALE:
1)Anxious mood 2)Tension 3)Fears 4)Insomnia 5)Intellectual (Cognitive) 6)Depressed mood 7)Somatic (Muscular)
8)Somatic (Sensory) 9)Cardiovascular Symptoms 10)Respiratory symptoms 11)Gastrointestinal Symptoms 12)Genitourinary Symptoms 13)Autonomic Symptoms 14)Behavior at interview
Signs and symptoms mentioned in Hamilton scale were assessed by adopting the following scoring system: Degree of anxiety & Pathological condition Scoring None 0 Mild 1 Moderate 2 Severe 3 Severe, grossly disabling 4
OVERALL EFFECT OF THERAPY Overall effect of the therapy was assessed in terms of complete remission, marked improvement, moderate improvement, mild improvement and unchanged by adopting the following criteria: Complete remission - 100%, Marked improvement - 75 to 99 %, Moderate improvement - 51 to 74 %, Mild improvement – 25 to 50 % Un-changed - < 25 %.
Statistical analysis – For the statistical analysis of the above said parameters, paired t-test method was adopted and S.D, S.E, t and p values were calculated.
Observations and results
For the present study on examination fear a survey study was conducted in the Malnad College of Engineering at Hassan, a total of 500 students were given the questionnaire for assessing the presence of the examination fear, among them 30 students were selected for the clinical study. The demographical data of 30 patients studied are as follows
Age: All the patients selected for the study were from the age of 18, 19 and 20 years. Among them 8 patients were of 18 years (26.6%), 12 patients were of 19 years (40%), and 10 patients were of 20 years of age (33.3%). Educational Status: It is evident from the study that maximum no. of patients 26.6 % were from first Semester, followed by 40 % were from second semester and 33.3 % were from third semester B.E.
Manasika Prakriti In this study 70% of the patients were of Rajas Prakriti, 13.3%were of Tamas Prakriti and remaining 16.6% patients were of RajasTamasika Prakriti. This shows that the Rajasika Prakriti people are more prone to Bhaya. Sharira Prakriti – 73.3% patients of this study were of Vata-Pitta Prakriti, 6.6% patients were of Vata Kapha Prakriti, and 13.3% were having Pitta Kapha Prakriti.
Satva: In this study 86.6 % patients had AVARA Satva and 13.3 % had Madhyama Satva. Sara: In this study Mamsa Sara Purushas were maximum i.e. 40 % and Twak, Medo and Asthi Sara Purushas were of 20 % each. Samhanana: In this study the Madhyama Samhanana Purushas were maximum i.e. (70 %) and 23 % were of Hina and 7% were of Uttama.
Satmya – In this study maximum no. of patients was graded as Madhyama Satmya i.e. 53.3 % and Pravara were of 36.6 % and Avara Satmya people were of 10 % Agni: Here 40% patients of this study were having Visama Agni, 26.6% patients were having Manda Agni, 13.3% patients had Sama Agni and 20% of the patients had Tikshna Agni Personality: Table- Shows 73.3% of the patients were of anxious personality, while 20% were of paranoid and the remaining 6.6% were of aggressive personality
Cardinal signs and symptoms complained by 30 patients of Bhaya Cardinal signs and symptoms
No. of patients
%
Fear of loosing control
26
86.6
Loss of memory
27
90
Fear of failure
26
86.6
Profuse sweating
26
86.3
Feeling of choking
25
83.3
Insomnia
23
76.6
Nausea or abdominal discomfort
17
56.6
Feeling dizzy
24
80
Palpitation
29
96.6
Chills
29
96.6
Paresthesia
20
66.6
Shortness of breath
28
93.3
Effect of Satvavajaya Chikitsa on signs and symptoms of Bhaya 2.5 ( Examination fear) 2
1.5
A.T.
1
B.T
0.5 0 Fe.O.Los
L.O.Mem
Fe.O.Fal
Cardinal signs and symptoms
No. of patients
%
Fear of loosing control
26
86.6
Loss of memory
27
90
Fear of failure
26
86.6
Profuse sweating
26
86.3
Feeling of choking
25
83.3
Insomnia
23
76.6
Nausea or abdominal discomfort
17
56.6
Feeling dizzy
24
80
Palpitation
29
96.6
Chills
29
96.6
Paresthesia
20
66.6
Shortness of breath
28
93.3
2 1.5 A.T.
1
B.T 0.5 0 Pro.Sw .
Fe.O.Ch.
Insom n
2 1.5 B.T.
1
A.T. 0.5 0 Nau.Ab.Ds
Fe l.Dizz
Palp.
2 1.5 B.T.
1
B.T. 0.5 0 Chills
Pare s t
Shor.O.Br.
Effect of Satvavajaya Chikitsa Hamilton Anxiety rating Scale Numb B.T. er of patient s 30
A.T.
32.86 18
% 0f S.D. relief
S.E.
T P Value Value
45.23 5.89
1.52
9.76
<0.001
Overall effect of Satvavajaya Chikitsa on 30 patients of Bhaya
Effect Complete remission Marked improvement Moderate improvement Mild improvement Unchanged
No. of Patients
Percentage
Discussion 1) Bhaya is one of Manasika Vikara. In the manifestation of Bhaya, both Vata and Manas play an important role. As Vata and Manas are interdependent, so if one gets vitiated it also affects other adversely. 2) Acharya Charaka advices Ashwasana and Harshana Chikitsa for the Mnanagement of the Bhaya. So for this study Satvavajaya Chikitsa was given to 30 students who were suffering from the Fear of the Examinations
Summary and conclusion
Annexure
Introduction 1) Examinations. 2) Examination Fear. 3) Satvavajaya Chikitsa.
?
Aims and Objectives
AIMS AND OBJECTIVES 1)To evaluate the effect of Satvavajaya chikitsa in the management of Bhaya. 2)To evaluate the Nidana Panchaka of Bhaya 3)To provide a cost effective self assessable drugless therapy.
Historical review
VEDA PERIOD
a) Rig-Veda –Pisacha. b) Yajur-Veda – Shivasankalpa Sutra. c) Atharvana-Veda – Manasikabhavas.
SAMHITA PERIOD
Review of Bhaya ‘Bhayam Parmastrsahah’ In Bhagavad-Gita it is said that ‘The coward ness which is originated as a result of the gain of the unpleasant thing and the loss of the pleasant thing is termed the Bhaya. ( Bh.G. 16/1 Jayadmala Goendaka Comm). .
Review of Bhaya Nidana – Etiology of Bhaya. a) Prajnyaparadha. b) Vata Dosha. c) Manasika Prakriti. d) Avara Satva. c) Negative thoughts.
Types of Bhaya – (B.G.16/1) a) Pratistha Nasah Bhayab) Apamana Bhaya -. d) Vyadhi Bhaya e) Bhuta Pretadi Bhaya -Fear of ghosts, devils etc.
f) Mrityu Bhaya g) Vyaghradi Bhaya. h) Jalatraasa i) Anagata Bhaya
Poorvaroopa of Bhaya
a) Chirakari Vyadhi. b) Vata Dosha.
Roopa -
1) Vishada 2) Bhita 3) Svedavepathumaan 4) Trastha 5) Shuskashyavavakrah
Samprapti Nidana Sevana (Exam fear)
Mano Dosha Kopa Raja, Tama
Hridaya Dusti
Sharirika Dosha Kopa Vata, Pitta, Kapha
Agni Vikrit
Rasadi
Dhatudusti Hina Satva
Manovaha Srotodusti
Rasadi Sarva Srotodusti
Prolonged nidana
Manas Lakshana Uttpati
Sharira Lakshana
Uttpati
Bhayaa
Samprapti Ghataka: 1. Dosha – Manas – Raja, Tama Shareera – Vata – Prana, Udana & Vyana Pitta – Sadhaka Kapha – Tarpaka 2. Dushya –Rasadi Sarvadhatu 3. Agni – Jatharagni – Manda, Vishama 4. Srotas – Manovaha, Sarvasrotodushti 5. Srotodushti - Atipravrtti 6. Udbhava Sthana - Hrdaya
7. Sanchara Sthana - Manovaha Srotas/ Sarva Shareera 8. Adhishthana - Manovaha Srotas 9. Vyakta Sthana – Manas and Shareera 10. Sadhya Sadhyata – Krcchra Sadhya vyadhi 11. Roga Swabhava - Ashukaritva 12. Upadrava - Manovikara/ Shareera Vikara
Concept of exam fear
Causes of Exam Fear1) Negative thoughts. 2) Worrying about past performance 3) Comparison. 4)Lack of confidence. 5) Failure to organize course information.
5) Poor study habits. 6) Poor time management. 7) Lack of confidence. 8) Study environment.
Symptoms 1) Fear of loosing control or going crazy. 2) Loss of memory. 3) Fear of failure. 4) Profuse sweating. 5) Feeling of Choking. 6) Insomnia.
7) Nausea or abdominal discomfort. 8) Feeling Dizzy, unsteady, light headed or faint. 9) Palpitation, beating heart, or accelerated heart rate. 10) Chills or hot flushes. 11) Paresthesia 12) Sensation of shortness of breath or smothering.
Complications of Exam Fear 1) Failure in the exams. 2) Avoidance of exams. 3) Discontinuing of the studies. 4) Mental and physical illness. 5) Suicidal tendency.
Concept of Satvavajaya ChikitsaChikitsa Satvavajaya “Satvavajaym Punarahithebhyo Arthebhyo Mano Nigrahah.” (Ch. Su. 11/55)
Techniques of the Satvavajaya Chikitsa a) “Manaso Gnana Vignnyana Dhairya Smriti Samadibih” b) “ Dhi Dhairyatmaadi Vignynam Manodoshoushadim Param”.
1) Gnyana. 2) Vignyana. 3) Dhairya. 4) Smriti. 5) Samadhi.
Atma, Kula, Bala, Desa,
Bhaya and Satvavajaya Chikitsa 1)Rational persuasion – a) Dhairya & Ashwaasana b) Sadvrtta (good conduct) c) Dharaniya Vega .
2))Methods based on the deeper understanding
Atma Janna- who I am, what is beneficial to me Desha Janna – Society, his responsibility towards it. Kula Janna – Family and his relationship between them. Kala Janna – Season, Pathya, Apathya during this time. Bala Janna – Strength Shakti Janna – Capacity
3) Samadhi (Mental equanimity) – 1) Abridging of Indriyas Indriyani Samksipya. 2) Stilling the fickle mind (Cancalam Maanah Samksipya). 3) To fix the mind into Soul.
Methodology
For the present clinical study, a survey study was conducted in the Malnad College of Engineering Hassan for the assessment of the presence of the examination fear in students and 30 students were selected for the study who were coming under the criteria of the examination fear.
Criteria of diagnosis: The diagnosis of the examination fear in students were done on the basis of presence of the following symptoms in feared conditions. 1) Fear of loosing control or going crazy. 2) Loss of memory. 3) Fear of failure. 4) Profuse Sweating. 5) Feeling of choking.
6) Insomnia. 7) Nausea or abdominal discomfort. 8) Feeling dizzy, unsteady. Light headed, or faint. 9) Palpitation, beating of heart, or accelerated heart rate. 10) Chills or hot flushes. 11) Paresthesia. 12) Sensations of shortness of breath or smothering
Each symptoms were were given scorings as 0, 1,2,3,4, and their severity were denoted on the personal scorings as, 0 - Not present 0-12 - Mild 13-24 - Moderate. 25-36 - Severe. 37-48 - Very severe
Inclusion criteria: 1. Students of 18 to 30 years of age. 2. Students presenting with general features of fear of examination.
Exclusion criteria: 1. Students suffering from other psychiatric and organic diseases
Method of Satvavajaya Chikitsa: The Satvavajaya Chikitsa was designed depending upon the cause of the fear in the students. The students were interrogated in detail for knowing the cause of the fear, and then they were given the Satvavajaya in the for of Dhairya and Ashwaasana Chikitsa for 45 mins, in a calm and peaceful room, twice in a week for three weeks.
Assessment criteria: Assessment of the patients of the patients will be done on the basis ofa) Self assessable questions were prepared for the assessment. b) All the symptoms were given suitable score for the assessment of results. Total effect of the treatment will be considered as complete remission, marked improvement, and unchanged. c) Diagnosis and improvement in signs and symptoms of the condition according to Hamilton’s scale of anxiety.
HAMILTON ANXIETY RATING SCALE:
1)Anxious mood 2)Tension 3)Fears 4)Insomnia 5)Intellectual (Cognitive) 6)Depressed mood 7)Somatic (Muscular)
8)Somatic (Sensory) 9)Cardiovascular Symptoms 10)Respiratory symptoms 11)Gastrointestinal Symptoms 12)Genitourinary Symptoms 13)Autonomic Symptoms 14)Behavior at interview
Signs and symptoms mentioned in Hamilton scale were assessed by adopting the following scoring system: Degree of anxiety & Pathological condition Scoring None 0 Mild 1 Moderate 2 Severe 3 Severe, grossly disabling 4
OVERALL EFFECT OF THERAPY Overall effect of the therapy was assessed in terms of complete remission, marked improvement, moderate improvement, mild improvement and unchanged by adopting the following criteria: Complete remission - 100%, Marked improvement - 75 to 99 %, Moderate improvement - 51 to 74 %, Mild improvement – 25 to 50 % Un-changed - < 25 %.
Statistical analysis – For the statistical analysis of the above said parameters, paired t-test method was adopted and S.D, S.E, t and p values were calculated.
Observations and results
For the present study on examination fear a survey study was conducted in the Malnad College of Engineering at Hassan, a total of 500 students were given the questionnaire for assessing the presence of the examination fear, among them 30 students were selected for the clinical study. The demographical data of 30 patients studied are as follows
Age: All the patients selected for the study were from the age of 18, 19 and 20 years. Among them 8 patients were of 18 years (26.6%), 12 patients were of 19 years (40%), and 10 patients were of 20 years of age (33.3%). Educational Status: It is evident from the study that maximum no. of patients 26.6 % were from first Semester, followed by 40 % were from second semester and 33.3 % were from third semester B.E.
Manasika Prakriti In this study 70% of the patients were of Rajas Prakriti, 13.3%were of Tamas Prakriti and remaining 16.6% patients were of RajasTamasika Prakriti. This shows that the Rajasika Prakriti people are more prone to Bhaya. Sharira Prakriti – 73.3% patients of this study were of Vata-Pitta Prakriti, 6.6% patients were of Vata Kapha Prakriti, and 13.3% were having Pitta Kapha Prakriti.
Satva: In this study 86.6 % patients had AVARA Satva and 13.3 % had Madhyama Satva. Sara: In this study Mamsa Sara Purushas were maximum i.e. 40 % and Twak, Medo and Asthi Sara Purushas were of 20 % each. Samhanana: In this study the Madhyama Samhanana Purushas were maximum i.e. (70 %) and 23 % were of Hina and 7% were of Uttama.
Satmya – In this study maximum no. of patients was graded as Madhyama Satmya i.e. 53.3 % and Pravara were of 36.6 % and Avara Satmya people were of 10 % Agni: Here 40% patients of this study were having Visama Agni, 26.6% patients were having Manda Agni, 13.3% patients had Sama Agni and 20% of the patients had Tikshna Agni Personality: Table- Shows 73.3% of the patients were of anxious personality, while 20% were of paranoid and the remaining 6.6% were of aggressive personality
Cardinal signs and symptoms complained by 30 patients of Bhaya Cardinal signs and symptoms
No. of patients
%
Fear of loosing control
26
86.6
Loss of memory
27
90
Fear of failure
26
86.6
Profuse sweating
26
86.3
Feeling of choking
25
83.3
Insomnia
23
76.6
Nausea or abdominal discomfort
17
56.6
Feeling dizzy
24
80
Palpitation
29
96.6
Chills
29
96.6
Paresthesia
20
66.6
Shortness of breath
28
93.3
Effect of Satvavajaya Chikitsa on signs and symptoms of Bhaya 2.5 ( Examination fear) 2
1.5
A.T.
1
B.T
0.5 0 Fe.O.Los
L.O.Mem
Fe.O.Fal
Cardinal signs and symptoms
No. of patients
%
Fear of loosing control
26
86.6
Loss of memory
27
90
Fear of failure
26
86.6
Profuse sweating
26
86.3
Feeling of choking
25
83.3
Insomnia
23
76.6
Nausea or abdominal discomfort
17
56.6
Feeling dizzy
24
80
Palpitation
29
96.6
Chills
29
96.6
Paresthesia
20
66.6
Shortness of breath
28
93.3
2 1.5 A.T.
1
B.T 0.5 0 Pro.Sw .
Fe.O.Ch.
Insom n
2 1.5 B.T.
1
A.T. 0.5 0 Nau.Ab.Ds
Fe l.Dizz
Palp.
2 1.5 B.T.
1
B.T. 0.5 0 Chills
Pare s t
Shor.O.Br.
Effect of Satvavajaya Chikitsa Hamilton Anxiety rating Scale Numb B.T. er of patient s 30
A.T.
32.86 18
% 0f S.D. relief
S.E.
T P Value Value
45.23 5.89
1.52
9.76
<0.001
Overall effect of Satvavajaya Chikitsa on 30 patients of Bhaya
Effect Complete remission Marked improvement Moderate improvement Mild improvement Unchanged
No. of Patients
Percentage
Discussion 1) Bhaya is one of Manasika Vikara. In the manifestation of Bhaya, both Vata and Manas play an important role. As Vata and Manas are interdependent, so if one gets vitiated it also affects other adversely. 2) Acharya Charaka advices Ashwasana and Harshana Chikitsa for the Mnanagement of the Bhaya. So for this study Satvavajaya Chikitsa was given to 30 students who were suffering from the Fear of the Examinations
Summary and conclusion
Annexure
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