Critical Appraisal of Evidence on Yoga for Managing PTSD Symptoms

This paper critically appraises a paper supporting to understand the perception about Yoga for managing PTSD symptoms. The study used qualitative analysis to record the experience of the patients. The findings revealed three themes of interest - Self observed changes, yoga and new awareness.

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Title page
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HLSC122 Semester 2, 2018
Assessment 3: Critical appraisal of evidence
Word count:
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Full reference of the paper being critically appraised (using APA format)
Introduction
Post traumatic disorder is a significant health disorder resulting from the
exposure to traumatic events, which can be related to the given case scenario, where
Tasso, a 21 year old computer programmer went in to a post-traumatic stress disorder
after witnessing a serious motor car accident. Yoga is an age old comprehensive
system of practice for the physical and the mental wellbeing of people, which involves
some warm –up exercises, breath work and body postures. This paper critically
appraises a paper supporting to understand the perception about Yoga for managing
PTSD symptoms.
Body
PART A
Authorship
There were no conflict of interest present. Jindani FA, Khalsa GF were reputed authors
who have published many research papers with good impact factors, thus ensuring
credible research. Furthermore all the concepts of other authors have been included in
this paper.
Research questions
The aim of this paper is to understand how people with post traumatic disorder
perceive the trauma sensitive Kundalini yoga program. The rationale behind this chosen
topic of research is that till now there had been no studies that has investigated the
experience of Yoga intervention on individuals suffering from PTSD. Hence rather than
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focusing on the effectiveness of the treatment, focus has been given on the perception
of people regarding Yoga for PTSD treatment. There are other treatments for PTSD
such as the cognitive behavioral therapy, verbal therapies and other prolonged
exposure therapies that is time consuming as well as involves deterioration of the
patient’s symptoms (Cramer, Anheyer, Saha & Dobos, 2018). Furthermore there are
some types of exposure treatments that can evoke implicit memories or the trauma
associated bodily sensation, hence re-traumatising the individual rather than resolving
the trauma. Bisson, Roberts, Andrew, Cooper & Lewis (2013), have also referred Yoga
to be more superior to the pharmacological therapy. Yoga had always been found to be
effective for both physical and psychological health from time immemorial. Hence in
order to confirm the effective ness of yoga on the physical and mental wellbeing of the
patient suffering from PTSD, it is essential to assess the viewpoint of the individuals
who have received Yoga training.
Research design
Quantitative analysis has been used to record the experience of the patients.
According to Lewis, (2015), qualitative research is a systematic enquiry into a social
phenomenon conducted in a natural setting. These phenomena includes what and how
people experience aspects of their life and how individuals behave (Teherani et al.,
2015). In this paper the qualitative study is used to understand the thoughts and belief
about a Yoga intervention.
Research methods
Digitally recoded telephonic interviews of about 30-60 minutes were conducted
involving 40 individuals with PTSD taking part in an 8 week KY treatment program. Only
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the qualified participants were eligible for the interview and the PTSD was determined
using the post traumatic disorder by using the Post –traumatic disorder checklist. All he
participants were assigned randomly to experimental or the waitlist control group. The
benefits of using semi structured- interviews in qualitative studies is that are useful in
obtaining a detailed information about the personal beliefs, experiences and opinions.
The questions asked in the semi structure interview was adequate enough to record the
perception of the participants.
The method of data collection and data analysis was carried out interactively by
the investigator. Transcription of 40 interviews were carried out and the accuracy of the
transcripts has been verified. Inductive thematic analysis has been rightly chosen for
this research as in inductive method, the themes are linked strongly with the data and
might bear little relation to the specific questions asked to the participants (Jindani &
Khalsa, 2015). Hence the coding of the data is without trying to fix it in the researcher’s
analytic preconceptions. Inductive reasoning might be limiting as it begins with single
observations or an inference drawn from similar situations which possibly might not be
accurate for a diverse case. Reflecting on the interventions chosen, the interventions
were designed by a leading psychologist ensuring the credibility of the interventions
(Lewis, 2015).
Results
Three themes of interest has been revealed by the analysis of the data- Self
observed changes, yoga and new awareness. These themes were further classified in
to subthemes. As per the findings participants perceived changes in sectors of health
and wellbeing, psychosocial integration, life style and perception of self in relation to the
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world. This can also be supported by Cramer, Anheyer, Saha, & Dobos, (2018), where
Yoga had been found to be an effective therapeutic treatment to improve the psychiatric
condition like depression and anxiety disorder. Cramer, Anheyer, Lauche & Dobos,
(2017), have stated that Yoga involves aspects of relaxation and mindfulness that
increase the capability to regulate emotions and even avoid the unpleasant memories,
thus helping to cope up with the PTSD symptoms. Hence the result has answered the
research question.
Limitations
Some of the limitations of this study is that participants presenting with the PTSD
symptoms might have been healthier or might have interest in other alternative
approaches. Another important limitation is the small sample size and lack of active
control (Lewis, 2015). A small sample size affects the reliability of a research as it might
lead to high variability and may lead to bias. One of the most common bias is the non –
response bias. Another limitation is the lack of a proper control group (Lewis, 2015).
The presence of an active control group always helps to compare the outcomes of the
intervention on the active control group receiving the standard care and the
experimental group receiving the interventions.
PART B
Evidence based practice is an important aspect of nursing nowadays as it
provided opportunities to the clinicians to go through and analyses several medical
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articles drawing the knowledge that can be used in their nursing practice. Managing
patients with post traumatic disorder can be challenging in the nursing professions and
pharmacological interventions can have several side effects especially those with
multiple comorbidities. This themes described in paper helps to understand about the
different aspects of psychological health such as the mind- body relationship, cognitive
growth, self-reflection, spirituality and how they are affected by Yoga program. Since the
interventions were carried out in groups hence the group interventions had an additional
collaborative effect on the interventions. This paper demonstrates how the yoga
teachers had helped the participants to feel empowered and to have a control of their
own healing, which can be used by the mental health nurses, nursing patients with
PTSD. The future implication for this is that yoga can be used as a part of the trauma
based therapies that are normally provided to the patients (Vancampfort et al., 2013).
Barriers to the application of research into clinical practice?
Application of the clinical findings in to researches can be challenging from the
perception of the nurses. One of the most important perceived barriers is the lack of
time, provision of appropriate infrastructure and proper training. Many of the nurse are
unaware of the evidence based practice and hence do not have adequate preparation
for using the research findings (Bahadori, Raadabadi, Ravangard & Mahaki, 2016). For
example, clinical settings generally follow a conventional pattern to treat patients with
post traumatic disorder. Inclusion of complementary therapies such as Yoga treatment
requires effective nurse training, proper infrastructure in the clinical setting, funding and
approval for the higher authority. Due to this reason nurses, often do not get much
interest in integrating research into practice.
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Conclusion
In conclusion it can be said that the article could identify the perception of
the PTSD patients about yoga treatment, which guarantees the future scope of yoga
treatment in the treatment of the PTSD symptoms. The data collection method and the
sampling method is appropriate, although the sample size is quite low with a risk of non-
response bias. The inductive method of the data analysis also has been sufficient for
classifying the findings in to appropriate themes. Furthermore, this study also would be
helpful in improving the trauma related service enhancing the quality of life of people
with PTSD.
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References
Bahadori, M., Raadabadi, M., Ravangard, R., & Mahaki, B. (2016). The barriers to the
application of the research findings from the nurses' perspective: A case study in
a teaching hospital. Journal of education and health promotion, 5, 14.
doi:10.4103/2277-9531.184553
Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological
therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane
Database Syst Rev, 12. DOI: 10.1002/14651858.CD003388.pub4
Cramer, H., Anheyer, D., Lauche, R., & Dobos, G. (2017). A systematic review of yoga
for major depressive disorder. Journal of affective disorders, 213, 70-77. doi:
10.1016/j.jad.2017.02.006.
Cramer, H., Anheyer, D., Saha, F. J., & Dobos, G. (2018). Yoga for posttraumatic stress
disorder - a systematic review and meta-analysis. BMC psychiatry, 18(1), 72.
doi:10.1186/s12888-018-1650-x
Jindani, F. A., & Khalsa, G. S. (2015). A yoga intervention program for patients suffering
from symptoms of posttraumatic stress disorder: A qualitative descriptive study.
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doi:10.1089/acm.2014.0262
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