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)

Introduction1) Examinations.

2) Examination Fear.

3) Satvavajaya Chikitsa.

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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

‘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

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 Bhaya-

b) 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

SampraptiNidana Sevana (Exam fear) Mano Dosha Kopa Sharirika Dosha Kopa Raja, Tama Vata, Pitta, Kapha

Hridaya Dusti 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 Fear- 1) 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 Chikitsa Satvavajaya Chikitsa

“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. Atma, Kula, Bala, Desa,

2) Vignyana.

3) Dhairya.

4) Smriti.

5) Samadhi.

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 of- a) 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 Rajas-Tamasika 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 ( Examination fear)

0

0.5

1

1.5

2

2.5

Fe.O.Los L.O.Mem Fe.O.Fal

A.T.

B.T

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

0

0.5

1

1.5

2

Pro.Sw. Fe.O.Ch. Insomn

A.T.

B.T

0

0.5

1

1.5

2

Nau.Ab.Ds Fel.Dizz Palp.

B.T.

A.T.

0

0.5

1

1.5

2

Chills Parest Shor.O.Br.

B.T.

B.T.

Effect of Satvavajaya Chikitsa Hamilton Anxiety rating Scale

Number of patients

B.T. A.T. % 0f relief

S.D. S.E. T

Value

P Value

30 32.86 18 45.23 5.89 1.52 9.76 <0.001

Effect No. of Patients Percentage

Complete remission

Marked improvement

Moderate improvement

Mild improvement

Unchanged

Overall effect of Satvavajaya Chikitsa on 30 patients of Bhaya

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 inter-dependent, 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