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Chapter Three
Methodology
METHODOLOGY
Methodology is of a supreme importance in any scientific inquiry, as validityand the reliability of the facts primarily depend upon the system of investigation. The present study was conducted to examine ‘Assessing the effectiveness of relaxation techniques in management of anxiety and depression’. The concept of methodology includes four aspects, namely, participants, measures, procedure and data analysis. These four aspects of overall research methodology can be taught of as forming a case for execution of present study. Additionally, the methodology provides detailed information about how the subject used for the study, the description of the participants and the measured used in the study.
One of the vital parts of the whole Methodology is the research design. A research design is a blueprint or a detailed plan as to how a research study is to be completed. That is how it would operationalize variables so that they can be measured, how to select a sample of interest to the research topic, how to collect data to be used as a basis for testing hypothesis and how to analyze the results, (Thyer, 1993). Mohsin (1984) defines a design as ‘research design contains a built-in system of checks against all factors that might affect the validity of the research outcomes’.
Present study used a mixed of between group descriptive, correlational and multivariate designs. To examine the socio-demographic characteristics of couples the descriptive statistics were used. Pearsonian Correlation was used to examine the relationship of various independent variables on the dependent variables. Multivariate design was used to examine the relationships of different variables and to explain variance in the scores on the dependent measures. The detailed description about the design and statistical analysis used in the present study has been described under the heading Statistical Analysis of Data below.
Participants
The participants for the present study consisted of 40 patients/adults. These participants drawn from Jordan. The sample was divided in terms of the variable of gender, i.e., males and females. The age range of participants was””
Measures
In order to achieve the goals of the present study, two measures were used namely i.e., Hamilton Anxiety Rating Scale (HAM-A) and Back Depression Inventory BDI-II. Demographic questionnaire prepared by the researcher was also included in the study. These measures are given in Appendix. In both the measures the Cronbach’s alpha was found satisfactory.
1. Hamilton Anxiety Rating Scale (HAM-A)
Hamilton Anxiety Rating Scale (HAM-A) was developed by Hamilton (1959). The HAM-A was one of the first rating scales developed to measure the severity of anxiety symptoms, and is still widely used in both clinical and research settings. The scale consist of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological stress) and somatic anxiety (physical complaints related to anxiety). Every item is scores from 0 (not present) to 4 (sever), with a total score range of 0-56, where less than 17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe. The HAM-A does not provide any standardized probe questions. Despite this, the reported levels of inter-rater reliability for the scale appear to be acceptable.
2. Back Depression Inventory BDI-II
The second scale of the present study was Back Depression Inventory Second Edition (BDI-II, 1996) was used. BDI-II is a 21 item self report instrument intended to assess the existence and severity of symptoms of depression as listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Forth Edition (DSM-IV; 1994). This new revised edition replaces the BDI and BDI-1A, and includes items intending to index symptoms of severe depression, which would require hospitalization.
Yoga therapy :
is a type of therapy that uses yoga postures, breathing exercises, meditation, and guided imagery to improve mental and physical health. The holistic focus of yoga therapy encourages the integration of mind, body, and spirit. Modern yoga therapy covers a broad range of therapeutic modalities, incorporating elements from both physical therapy and psychotherapy.
Issues Treated by Yoga Therapy
Yoga therapy is a growing field and scientific evidence has begun to emphasize its efficacy. It is used to treat existing mental and physical health issues, but can also be used as a self-care strategy for prevention and maintenance.
Yoga therapy is well established as a treatment for depression and anxiety. A meta-analysis cited in the Primary Care Companion for CNS Disorders found that yoga therapy also shows promise for the treatment of posttraumatic stress (PTSD) and schizophrenia. Additionally, yoga therapists have begun to develop treatment modalities to suit children with autism. The book Yoga Therapy for Children with Autism and Special Needs, written in 2013 by yoga teacher Louise Goldberg, is already considered a critical text for novice and experienced yoga therapists alike.
According to a 2012 article in Social Work Today magazine, yoga therapy is also emerging as an effective treatment for substance abuse issues. Mental health professionals point out the way yoga positively impacts the parts of the mind and body susceptible toaddiction. Studies have shown that yoga boosts the neurotransmitter GABA (gamma-aminobutyric acid), which is important because GABA levels are statistically low in people who experience substance abuse, anxiety, and depression.
Because of its concentration on mind and body integration, yoga therapy is also used to address many physical health issues. It has been effectively used to treat back pain, heart conditions, asthma, chronic fatigue, hypertension, multiple sclerosis, and side effects of chemotherapy.
Practice and Benefits of Yoga Therapy
Yoga therapy is practiced in a wide range of formats. Physical therapists, for example, often implement yoga techniques in their delivery of massage and other treatments. Yoga therapy practice can resemble physical therapy, rehabilitative therapy, and/or psychotherapy. Unlike a standard yoga class, yoga therapy sessions are typically conducted in one-on-one or small group settings. Yoga therapy can be provided as an adjunct therapy to complement other forms of treatment, or it can be used to directly treat a specific issue. Yoga techniques range from simple to advanced, and can be enjoyed by people of all ages.
Potential benefits from yoga therapy include stress reduction, psychological well-being, improved diet, and efficient functioning of bodily systems. A 2011 qualitative study from Inkanyiso: Journal of Humanities and Social Sciences examined the effects of yoga therapy on anxiety. The findings not only indicated that yoga therapy effectively reduced subjects' anxiety, but improvement across several dimensions of physical and mental health including physicality, relaxation, and mindfulness.
History of Yoga Therapy
Yoga therapy is rooted in the ancient practice of yoga, which originated thousands of years ago in India. Yoga made its way to the United States in the late 1800s, but yoga therapy emerged in a formal manner in the 1980s as the result of a study conducted by Dr. Dean Ornish. The study illustrated how the implementation of a healthy lifestyle program could reverse heart disease. Ornish’s program included therapeutic yoga and was the first of its kind to highlight the benefits of using yoga in this way. This program for treating heart disease was approved for insurance coverage in 1990 and it marked the beginning of the medical field's acceptance of yoga as a treatment option.
In 1983, the Biomedical Yoga Trust was founded to further develop and standardize the field of yoga therapy. The International Association of Yoga Therapists (IAYT) was founded in 1989 and has since hosted yoga conferences, published the Journal of the International Association of Yoga Therapists, and contributed to the creation of yoga therapy training standards. Both organizations have facilitated research to explore the extent of yoga therapy's potential.
What to Expect from Yoga Therapy
When a person decides to initiate yoga therapy, the therapist will first conduct an initial assessment. This assessment is designed to do the following:
‘ Identify health problems
‘ Assess lifestyle and physical capability
‘ Discuss reasons for seeking therapy
‘ Create a course of treatment
Once the treatment plan is established in this first consultation, the frequency of sessions is agreed upon and sessions are scheduled. From this point, therapy sessions will most likely include the following components:
‘ Breathing Exercises (Prayanama): The therapist will guide the person in therapy through a series of breathing exercises ranging from energizing breaths to balancing breaths.
‘ Physical Postures (Asana): The therapist will teach the person in treatment appropriate yoga poses that address problem areas. For example, the ‘Legs Up the Wall’ pose is used to treat things like anxiety and insomnia. In this pose, the person lays on his or her back with legs positioned up against the wall.
‘ Meditation: Relaxation and mindfulness are the focus of meditation when it is combined with yoga poses.
‘ Guided Imagery: The yoga therapist attempts to calm the body and mind by providing a guided visualization intended to bring inner peace.
‘ Homework: An important element for any yoga practice is to find a way to incorporate it into daily life. Yoga therapists provide instructions on how to use what has been learned in treatment at home.
Who Offers Yoga Therapy?
The most well-known professional title to describe a yoga therapist is Certified Yoga Therapist, credentialed as CYT. However, because the field of yoga therapy is fairly young, no official, formalized certification process exists. However, there are many organizations and education programs accredited by the IAYT that offer training and certification. Some well-respected training programs include:
‘ Integrative Yoga Therapy
‘ American Viniyoga Institute
‘ Essential Yoga Therapy
‘ Phoenix Rising Yoga Therapy
‘ YogaLife Institute
‘ Any training program accredited by the International Association of Yoga Therapists (IAYT)
Though therapists vary in education and experience, most well-trained yoga therapists have a strong knowledge base in:
‘ Yoga philosophy, techniques, and education
‘ Therapeutic yoga techniques
‘ Anatomy and physiology
‘ Diet and nutrition
‘ Basic understanding of medical care and first aid
‘ Basic understanding of business ethics
When deciding on a yoga therapist, it is important to know that there are many types. Some are yoga teachers, yogis, and gurus while others are psychotherapists, psychologists, and physical therapists. The Yoga Journal website suggests seeking out word-of-mouth referrals and yoga studio recommendations. The most crucial thing is to find a therapist who has solid experience and training, and with whom you can develop a positive therapeutic relationship.
Procedure
The questionnaire used in the present study included demographic information sheet, marital adjustment scale, emotional intelligence scale and mental health inventory. After seeking required permission from concerned authorities ''fhais national centre for mental health hospital'', then we return back to the physical records to choose our deliberate sample, then the participants were personally contacted. They were briefed about the purpose of research and questionnaire used in the study. After seeking consent of the participant a suitable time and date was fixed for data collection.
Before administering the questionnaire, the purpose of the study was again explained to the participants and they were assured that their responses will be kept confidential and will be used only for research and academic purpose only. A good rapport was build with the participants for getting correct responses. Some necessary instruction and guidelines were provided to them for properly filling the questionnaire. After this, the questionnaires were provided to them and they were requested to fill-up the questionnaire as per the instructions given in the questionnaire. It took an average of 30 minutes for the participants to complete the questionnaire. After completion of the questionnaire participants returned the questionnaire and they were thanked for their participation and cooperation.
the researcher has applied Yoga therapy on the target group for a month distributed on four days a week, in which the patients have been trained for almost an hour.
The yoga program has been applied on the group that suffered from anxiety and depression, and then the level of depression and anxiety has been measured pre and post applying the program. The program has had an important influence on elevating the level of anxiety and depression on the patients; moreover, a comparison between the target and control group has been applied which resulted in a clear difference between the two groups with respect to the intensity of anxiety and depression the researcher has found out more favorable results regarding the level of anxiety and depression with the target group.
Deep relaxation in yoga: The corpse posture
The corpse posture considered as simplest and the most difficult of all yoga postures is the corpse posture, also widely known as the dead pose. The corpse posture is an exercise in mind over matter. The only props you need are your body and mind.
The objectives of the program
The corpse posture program aims to get rid of stress and anxiety and fear and to gain experience of controlling the tension on the body and the members of the Lean and worked daily duties comfortably and be seen as positive images.
The program content:
Person starts to exercise corpse pose by doing a series of movements, here is how you do the corpse pose:
1. Lie flat on your back, with your arms stretched out and relaxed by your sides, palms up (or whatever feels most comfortable), place a small pillow under your head if you need one and another large pillow under your knees for added comfort.
2. Close your eyes.
3. Form a clear intention to relax, some people finds it helpful to picture them lying in white sand on a sunny beach.
4. Take a couple of deep breaths, lengthening exhalation.
5. Contract the muscles in your feet for a couple of seconds and then consciously relax them. Do the same with the muscles in your calves, upper legs, buttocks, abdomen, chest, back, hands, forearms, upper arms, shoulders, neck, and face.
6. Periodically scan all your muscles from your feet to your face to check that they are relaxed. You can often detect subtle tension around the eyes and the scalp muscles. Also relax your mouth and tongue.
7. Focus on the growing bodily sensation of no tension and let your breath be free.
8. At the end of the session, before opening your eyes form the intention to keep the relaxed feeling for as long as possible.
9. Open your eyes, stretch lazily, and get up slowly.
Important guidelines when implementing the program:
1. Practice 10 to 30 minutes; the longer the duration the better.
2. Training atmosphere: the atmosphere must be calm and help to relax and focus.
3. Skill needed: should lead the exercise required to be full, so to get to the overall perception of performance.
4. Proper performance must focus on the proper performance only, so as not to affect performance and repeat conceivable wrong in installing errors.
Phases of the program
It includes three phases, as follows:
Phase I: Part primer: calm and relaxation exercises (Relaxation Exercise), as follow:
Breathe deeply with closing eyes, the patient will do this movement for one time, then he/she will (sitting) constriction of the hands and feet, and total relaxation and repeat it for three time, finally will breathe deeply
Phase II: the main part: The corpse posture, the patient will lie flat on his/her back, with your arms stretched out and relaxed by your sides, palms up (or whatever feels most comfortable), place a small pillow under your head if you need one and another large pillow under your knees for added comfort and repeat it for two times, then Close his/her eyes, after that he/she will form a clear intention to relax, some people finds it helpful to picture them lying in white sand on a sunny beach for three times, then take a couple of deep breaths, lengthening exhalation for one time, after that contract the muscles in your feet for a couple of seconds and then consciously relax them. Do the same with the muscles in your calves, upper legs, buttocks, abdomen, chest, back, hands, forearms, upper arms, shoulders, neck, and face for three times, then periodically scan all your muscles from your feet to your face to check that they are relaxed. You can often detect subtle tension around the eyes and the scalp muscles. Also relax your mouth and tongue for three times, after that focus on the growing bodily sensation of no tension and let your breath be free for two times, then at the end of the session, before opening your eyes form the intention to keep the relaxed feeling for as long as possible for two times, finally he/she will open eyes, stretch lazily, and get up slowly.
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Phase III: concluding part: calm and relaxation exercises (Relaxation Exercise), as follow:
Breathe deeply with closing eyes, the patient will do this movement for one time, then he/she will (sitting) constriction of the hands and feet, and total relaxation and repeat it for three time, finally will breathe deeply