|Year : 2011 | Volume
| Issue : 2 | Page : 97-102
Six-month trial of Yoga Nidra in menstrual disorder patients: Effects on somatoform symptoms
Khushbu Rani1, SC Tiwari2, Uma Singh3, GG Agrawal4, Neena Srivastava1
1 Department of Physiology, CSM Medical University, Lucknow, Uttar Pradesh, India
2 Department of Geriatric Mental Health, CSM Medical University, Lucknow, Uttar Pradesh, India
3 Department of Obstetrics and Gynecology, CSM Medical University, Lucknow, Uttar Pradesh, India
4 Department of Statistics, Lucknow University, Lucknow, Uttar Pradesh, India
|Date of Web Publication||16-Oct-2012|
Department of Physiology, CSM Medical University, Lucknow, Uttar Pradesh
Source of Support: Ministry of health and family welfare, scheme for extra mural research (EMR) in Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH), New Delhi., Conflict of Interest: None
| Abstract|| |
Background: Yoga Nidra is a successful therapy for both recent and long-standing psychological disturbances of all kinds especially depression and high anxiety level and neurotic patterns. Objective: The purpose of the present work, therefore, was to conduct a preliminary randomized study of Yoga Nidra as a treatment in the patients of menstrual disorders with somatoform symptoms. Materials and Methods: Patients were recruited from Department of Obstetrics and Gynecology, CSM Medical University (erstwhile KGMU) Lucknow, Uttar Pradesh, India. One hundred and fifty female patients with menstrual disorders were randomly divided in to two groups 1- Intervention group: 75 subjects (Yoga Nidra intervention and medication) 2- control group: 75 subjects (without Yoga Nidra intervention only medication). Schedule for clinical assessment in neuropsychiatry tool was used. Results: There was significant improvement in pain symptoms (P<0.006), gastrointestinal symptoms (P<0.04), cardiovascular symptoms (P<0.02) and urogenital symptoms (P<0.005) after 6 months of Yoga Nidra therapy in Intervention group in comparison to control group. Conclusion: Yoga Nidra appears to be a promising intervention for psychosomatic problems. It is cost-effective and easy to implement. The results indicate that somatoform symptoms in patients with menstrual disorder can be decreased by learning and applying a program based on Yogic intervention (Yoga Nidra).
Keywords: Menstrual disorders, somatoform symptoms, Yoga Nidra
|How to cite this article:|
Rani K, Tiwari S C, Singh U, Agrawal G G, Srivastava N. Six-month trial of Yoga Nidra in menstrual disorder patients: Effects on somatoform symptoms. Ind Psychiatry J 2011;20:97-102
Women's problems, especially gynecological problems like menstrual problems, are neglected in our society. Menstrual problems can be because of gynecological disorders, hormonal imbalance as well as psychosomatic diseases.
There are several types of menstrual cycle related problems such as irregular periods that affect frequency of menstruation like polymenorrhea (frequent periods - with intervals of 21 days or less), oligomenorrhea (infrequent menstrual periods- Interval exceeds 35 days in between menstruation), amenorrhea (absence of periods for more than 60 days in a woman of reproductive age: physiologically occurring during pregnancy and breastfeeding).
In addition, these are pain-related problems during menses such as dysmenorrhea (dysmenorrhea, cramps or painful menstruation: menstrual periods that are accompanied by either sharp, intermittent pain or dull, aching pain, usually in the pelvis or lower abdomen) and irregular periods that affect quantity of menstruation which are hypomenorrhea (a diminution of the flow or a shortening of the duration of menstruation), menorrhagia (an abnormally heavy and or prolonged menstrual period).  Many females also complain of pain, anxiety, depression, fatigue, vomiting during menstrual cycle throughout their reproductive life.
Somatoform disorder, also known as Briquet's syndrome (named after Paul Briquet), or Brissaud-Marie syndrome More Details (named after Édouard Brissaud and Pierre Marie), is a mental disorder characterized by physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause.  Somatization disorder in the general population is estimated to be 0.2-2 in women and 0.2 in men. Women with somatization disorder outnumber men 5-20 times. Somatoform disorder is a commonly associated with other mental disorders, including major depressive disorder, personality disorders, generalized anxiety disorder and phobias. Somatization is where mental factors such as stress cause physical symptoms. 
No one knows exactly why symptoms of somatoform disorder appear. In some cases, there may be a problem with the nerve impulses that send signals of pain, pressure and other unpleasant sensations to the brain. The different relaxation techniques often lead to specific psychological and physiological changes termed as relaxation response.  Yoga Nidra is one of such effective technique, not only for physical or mental relaxation but also for preparing the mind for yogic discipline. Yoga Nidra has widespread application in the management of diseases of all kinds, and promises to play a far greater role in the future as its potential becomes fully recognized by doctors, psychologists and healers. Yoga Nidra has been termed 'sleepless sleep' because we learn to enter the state between sleep and wakefulness without loss of awareness  however; studies have not been done to examine the effect of Yoga Nidra on psychological symptoms associated with menstrual irregularities.
Present study was planned to assess the effect of Yoga Nidra on somatoform disorder in patients with menstrual problems.
| Materials and Methods|| |
Study design and setting
We conducted a randomized controlled trial for women (Menstrual irregularities) with psychological problems. Subjects were randomly assigned to a standardized 6-month protocol of Yoga Nidra classes. We used computer-generated permuted randomization. Small paper chits written either case or control were placed in opaque, sequentially numbered envelopes prepared by a biostatistician who had no contact with participants. The study was approved by the ethical committee at CSMMU U.P (erstwhile KGMU) Lucknow.
A total of 150 female subjects were included suffering from menstrual irregularities. Subjects with menstrual irregularities were diagnosed by senior consultant in the Department of Obstetrics and Gynecology, C.S.M. Medical University Uttar Pradesh, Lucknow, India. Participants were aged between 18 and 45 years with current menstrual irregularities persisting for >6 months. Interested individuals were initially screened for eligibility by senior consultant after oral informed consent was obtained and using inclusion and exclusion criteria. According to inclusion and exclusion criteria, eligible subjects were invited to take up yoga classes. At the first meeting, written informed consent was obtained and their socio economic history and menstrual history was recorded.
Women more than 18 years of age having menstrual irregularities, (pathological amenorrhea, dysmenorrhea, oligomenorrhea, polymenorrhea, hypomenorrhea, menorrhagia and metrorrhagia) were included.
Women having known gynecological neoplasm requiring surgery, pregnancy, pelvic inflammatory disease (PID) and uncooperative subjects were excluded.
The socio demographic data, details of personal history and menstrual history (last menstrual period, duration of menstrual cycle, amount of bleeding and dysmenorrhea) and pervious treatments such as physical therapy and yoga therapy were inquired and recorded. A total of 150 subjects were included and were randomly assigned into two groups: 1. Intervention group of 75 subjects (Yoga Nidra intervention and medication) and 2. Control group of 75 subjects (only medication, without Yoga Nidra intervention). The data collector was blind unaware about patients' inclusion in intervention or control groups. Medroxy progesterone, norethistrone, ethinyl estrodiol, levonorgestrol, tranexemic acid, ethamsylate medicines were prescribed to the patients by the consultants as and where required. Out of 150 subjects, 10 subjects from Intervention group and 14 subjects from Control group were dropped out because they did not turn up for the second follow-up. Out of 24 drop-out patients, 16 patients could not follow the time schedule and 8 patients did not feel better so they were not willing after 1 week. Baseline assessments of all the subjects were carried out. A final assessment was done at the end of the treatment period (6 month) with the test tool, SCAN rating scale.
The outcome was assessed using following measures:
In this study rating was made on 0 (zero) and 1 (one), 0 means absence of symptom and 1 means presence of symptom. Scores at the time of initial assessment and subsequent follow-ups were compared.
- Proforma for socio demographic and personal history details
- Schedule for clinical assessment in neuropsychiatry (SCAN)  : The psychiatric interview was conducted with the SCAN; version 2.1 based clinical interviews were conducted to assess somatoform symptoms of the subjects. The SCAN based clinical interview was used to inquire about 76 physical symptoms in seven symptom groups.
Yoga Nidra intervention
The Yoga Nidra intervention used was developed by Swami Satyananda Saraswati, School of Yoga, Munger, Bihar, India. One Yoga instructor was selected by an expert panel for this study. The final protocol (yoga classes) consisted of 35-minute /day, five days in week intervention with Yoga Nidra in the department of physiology CSMMU, Lucknow, U.P., India for 6 months. Yoga Nidra is a deep relaxation technique  (Appendix-1).
The differences in pre- and post-treatment scores were used for the analysis. This was done to take into account the imbalances, if any, at the baseline characteristics of the subjects. Independent sample 't' test (parametric test) was used to compare the differences in scores , between the two groups (yoga vs. non-yoga group). Statistical analysis was done using GraphPad inStat version 3.05 software Inc., Year 2000.
| Results|| |
In the present study, Intervention and Control groups were compared by Independent sample't' test (parametric test) on all measures at socioeconomic demographic profile and baseline characteristics, there were no significant differences. Socio economic demographic profile is shows in [Table 1] and baseline characteristics of Intervention and control groups are shows in [Table 2]. Independent sample't' test was used to examine group differences on these measures was a cut-off of P<0.05 of the present study.
[Table 3] shows comparison of Mean Difference in score Mean with SD of pre-treatment and post-treatment values of psychological variables. We found significant changes in pain symptoms (P<0.006), gastrointestinal symptoms (P<0.04), cardiovascular symptoms (P<0.02) and urogenital symptoms (P<0.005) in Intervention group after the 6 th month of yogic intervention with comparison to control group. Although, the improvement on neurological, autonomic and skin and glands symptoms did not show a significant difference, yet in Intervention group there was improvement in these parameters also when compared with the control group.
|Table 3: Comparison of differences in pre- and post-treatment values of psychological variables in intervention and control groups|
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[Table 4] and [Table 5] are showing changes in the baseline and post intervention in menstrual symptoms of Intervention and Control groups but more changes in Intervention group as compassion to the Control group.
| Discussion|| |
In the present study, two groups were well matched for age, socio economic status and there were no significant differences. The results suggest that the aspects of somatoform symptoms measured in this study improved in Intervention group. Those who were the participants of Intervention group (Yoga Nidra) started feeling better and were relieved somatoform symptoms as then compared with the Control group.
The current study, suggests that in patients with menstrual irregularities, Yoga Nidra not only has utility as a possible therapeutic strategy, but also may be a method for improving headache, giddiness, nervousness and irritability. Yoga Nidra probably relieves pain by stimulating the pituitary gland to release its own potent pain-suppressing compounds. Research studies have uncovered the existence of endogenous morphine-like brain hormones, termed endorphins and encephalin. These natural substances appear to be produced by the pituitary gland under conditions of extreme stress and prolonged, intractable pain and are secreted into the cerebrospinal fluid which surrounds and supports the entire central nervous system. Through Yoga Nidra powerful stimulus can be given to the pituitary gland to release these hormones so that need for external painkillers is not there. 
In the Intervention group which practiced Yoga Nidra for 6 months, there was significant decrease in their degree of pain symptoms (according to the SCAN) and observed a significant change during the treatment period. The ability of Yoga Nidra to control pain was investigated in a study, in which the need for analgesic medication was eliminated, or markedly reduced, among the 54 participants in the study. Two-third of them suffered from headache or migraine. The remainders suffered from a verity of conditions characterized by long term or intermittent pain, including gastrointestinal pain, shoulder and neck pain and lower back pain. At follow-up after 6 weeks of Yoga Nidra therapy, patients reported an average of 81 effective pain relief  and Yoga Nidra have also been used successfully in the management of chronic arthritic pain. 
There was a significant improvement in gastrointestinal symptoms. These findings are consistent; researchers reported that in a smaller sample of young adults, where positive effects of yoga were found on general well-being. Mind--body methods such as yoga, with its reliance on deep relaxed abdominal breathing and attention to comfort, may disrupt chronic patterns of functional disability, anxiety and maladaptive coping, which subsequently could reduce overall levels of gastrointestinal symptoms  in another study performed on adolescents, researchers observed that yoga group reported lower levels of functional disability, less use of emotion-focused avoidance and lower anxiety following the intervention than adolescents in the control group. When the pre- and post-intervention data for the two groups were combined, adolescents had significantly lower scores for gastrointestinal symptoms and emotion--focused avoidance following the yoga intervention. Adolescents found the yoga to be helpful and indicated they would continue to use it to manage their IBS.  Present study, also reports significant improvement of cardiovascular symptoms. Yoga Nidra has emerged as an effective preventive, alleviative and curative technique in the management of degenerative and ischemic heart disease. Researchers have found that Yoga Nidra significantly lowered levels of serum cholesterol in cardiac patients.  Other studies have reported yoga training is associated with a significant increase of cardiac vagal modulation. Since this method is easy to apply with no side effects, it could be a suitable intervention in cardiac rehabilitation programs. 
The practice of Yoga Nidra throughout urogenital problems helps to create the most favorable conditions for intrauterine growth and development. Yoga Nidra has also been prescribed for the relief of pain associated with dysmenorrhea (disturbance of the menstrual cycle) and excessive levels of premenstrual tension. Authors concluded that yogic relaxation training should be prescribed more frequently as an adjunct or alternative to conventional drug therapy for menstrual dysfunction and pain.  Another Australian study involving young women reported that they suffered 'very severe' pain during menstruation and spent one to several days in bed each month as a result. These women were given individual interviews and a series of relaxation sessions using a technique similar to Yoga Nidra. Results were most successful, with all subjects reporting a reduction in tension, pain and time in bed. Six months after stopping the relaxation therapy more than half reported that they were still having pain-free periods and they showed an improved attitude to menstruation in general. 
Yoga Nidra can be used in stressful situations to become relaxed and for better management of stress. They experienced that Yoga program helped in decreasing backache, pain in arms and legs, headaches, nausea, irregular menstruation and dysmenorrhea. They felt happy and satisfied. Increased experience of altered states of consciousness (ASC) during Sudarshan Kriya and related Practice. Experience of (ASC) has been associated with deep relaxation and stress release.  Yoga Nidra also increased the consciousness associated with deep relaxation which reduces the mental and physical problems.
| Conclusions|| |
Yoga Nidra appears to be a promising intervention for psychosomatic problems. It is cost-effective and easy to implement. The results indicate that somatoform symptoms in patients with menstrual disorder can be decreased by learning and applying a program based on Yogic intervention (Yoga Nidra).
| Acknowledgment|| |
We are very thankful to entire Yoga team and faculty of Department of Physiology, Geriatric mental health, obstetrics and gynecology. The authors wish to acknowledge the financial support of Department of AYUSH ministry of health and family welfare Government of India.
Instructions for Yoga Nidra were given in the following manner:
- Preparation: Get ready for Yoga Nidra. Lie down on your back on the floor and adopt the pose called shavasana. In this position the body should be straight from head to toe, the legs slightly apart and the arms a little away from the body, with the palms of the hands turned upwards. During Yoga Nidra there should be no physical movement (patient closes her eyes and keeps them closed until is told to open) (pause). Take deep breath and as you breathe out, feel the cares and worries of the day flow out of you. In the practice which follows, you are going to develop the feeling of relaxation in the body. During Yoga Nidra, you are functioning on the levels of hearing and awareness, and the only important thing is to follow the voice of the instructor (pause)
- Relaxation: Now brings about a feeling of inner relaxation in the whole body; concentrate on the body and become aware of the importance of complete stillness (pause). Develop awareness of your body from the top of the head to the tips of the toes and mentally repeat the mantra O--o--o--m--m--m. Experience complete stillness and complete awareness of the whole body again repeat O--o--o--m--m--m (pause)
- Resolve: At this moment you should resolve yourself. The resolve will have to be very simple; it should be short, positive statement in simple language stated three times with awareness, feeling and emphasis. The resolve you make during Yoga Nidra is bound to come true in your life (pause)
- Rotation of consciousness: We now begin rotation of consciousness, rotation of awareness by taking a trip through the different parts of the body (pause) as quickly as possible the awareness is to go from part to part. Repeat the part in your mind and simultaneously become aware of that part of the body. Become aware of the right side, left side, back, front, and major parts (pause)
- Breathing: Become aware of your breath. Feel the flow of your breath in and out of your lungs (pause) counting breaths with navel, chest, throat and nostril awareness; each 27 to 1
- Image visualization: Stop counting and leave your breaths; we now come to visualization. A number of different things will be named and you should try to develop a vision of them on all levels of feelings, awareness, emotions, imagination, as best you can
- Resolve: Now this is time to repeat your resolve. Repeat the same resolve that you made at the beginning of the practice, do not change it, repeat the resolve three times with full awareness and feeling (pause)
- Finish: Relax all efforts, draw your mind outside and become aware of your breath (pause), become aware of the natural breath, awareness of the whole body and awareness of breathing (pause). Your body is lying totally relaxed on the floor you are breathing quietly and slowly. Develop awareness of your body from the top of the head to the tips of the toes and say mentally in your mind O--o--o--m--m--m (pause). Please take your time, do not hurry. Start moving your body. When you are sure that you are wide awake, sit up slowly and open your eyes. The practice of Yoga Nidra is now complete. 
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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