| Abstract|| |
Context: Yoga-based intervention is emerging as an effective add-on therapy in the management of schizophrenia. However, many barriers make it difficult for patients to avail yoga therapy programs. One of them is motivation for yoga therapy. Ways to address the barriers are critical to employ yoga as a treatment in this population.
Aim: This study aims at exploring patients' willingness to participate in add-on yoga therapy programs on out-patient basis.
Settings and Design: The study was conducted on 100 schizophrenia patients attending psychiatry out-patient services of a tertiary care hospital.
Materials and Methods: A total of 100 schizophrenia patients (male: female = 57:43; age: 35.8 9.2 years) attending the psychiatry out-patient services of a tertiary neuropsychiatry hospital were administered a survey questionnaire.
Statistical Analysis Used: Chi-square test was used for testing the significance of proportions. P < 0.05 was taken to be significant.
Results: About 46% were aware that yoga is also one of the complementary therapies useful in schizophrenia. 32% had tried yoga in the past for some reasons, but only 31% of them were continuing yoga; commonest reasons for not continuing being lack of motivation (31%) and inability to spare time (27.6%). However, the majority (88.5%) of them were willing to take up add-on yoga therapy on out-patient basis along with their regular medical follow-up.
Conclusions: In spite of the lack of motivation to practice yoga, the majority of patients were willing to participate in add-on yoga therapy programs if given on out-patient basis along with their regular conventional medical follow-up.
Keywords: Complementary therapy; schizophrenia; yoga
|How to cite this article:|
Govindaraj R, Varambally S, Gangadhar BN. Yoga for schizophrenia: Patients' perspective. Int J Yoga 2015;8:139-41
| Introduction|| |
About 51 million people worldwide suffer from schizophrenia including 4.3-8.7 million people in India.  Even though, pharmacotherapy is the main stay of treatment, complementary therapies like yoga are widely explored for their utility in many psychiatric diseases including schizophrenia. Previous studies have shown the usefulness of yoga especially for the negative symptoms such as amotivation, and anhedonia in schizophrenia. ,, However, these very symptoms, which are addressed by yoga therapy are also a barrier for practicing yoga, as a regular practice of yoga needs motivation. Practicing yoga in a yoga center on a daily basis though effective, is not feasible for most of the patients for various reasons, mainly logistics. 
Hence, the present study was undertaken to assess the willingness of patients with schizophrenia to participate in yoga therapy programs on outpatient basis.
| Materials and Methods|| |
Sample and setting
The study was conducted in a tertiary care neuropsychiatry university teaching hospital in south India. Consecutive patients aged ≥18 years attending the psychiatry out-patient services with a diagnosis of schizophrenia were recruited. Patients who were on medications and symptomatically stable were included in the study. Informed consent was obtained from the participants.
| Questionnaire development|| |
The content of the questionnaire used for the survey were arrived at by consensus among the investigators. The questionnaires included demographic details, awareness of yoga as a complementary therapy for schizophrenia, practice of yoga in the past and experiences (if any), and willingness to participate in yoga therapy program on out-patient basis [Appendix 1].
| Data collection|| |
Consecutive patients with schizophrenia attending the outpatient services were approached. 100 consenting patients with schizophrenia were interviewed with the questionnaire [Appendix 1]. Coverage rate was 90.9% (100/110; 10 subjects did not consent).
| Analysis|| |
Data collected were scrutinized for completeness. Chi-square test was used for testing the significance of proportions. P < 0.05 was taken to be significant. SPSS version-16 (SPSS Inc. Chicago, USA) was used for analysis.
| Results|| |
The respondents' age ranged between 18 and 65 years (mean: 35.8 ± 9.2 years). The sample consisted of 57 (57%) males and 43 (43%) females. About two-fifth were literate, with the majority (32%) having a qualification of graduation and above. Most of the participants were from the urban area (63%).
More than half of the participants (58.3%) were not aware that yoga is also used as a complementary therapy for schizophrenia.
| Experience of yoga in the past|| |
About 30.2% of the respondents had tried yoga in the past for some reasons. Among those who tried, 65% of them had some positive experience with the practice of yoga. Commonest experiences were general feeling of goodness, improved biological functions such as sleep and appetite. Nobody reported positive experiences specific to their psychopathology. There were no specific adverse effects reported by any of the respondents.
Interestingly, even though the number of females who tried yoga in the past were lesser (28.6%) than their male counterparts (30.2%), majority of the females reported having positive experiences (83.3%) (P = 0.021) than the males (52.9%).
| Continuation of the yoga practice|| |
Nearly 69% of those who tried yoga in the past were not continuing their yoga practices. Among those who are continuing their yoga practices 17.2% were doing so regularly, 6.9% weekly and 6.9% irregularly.
Common reasons for not continuing the yoga practices were lack of motivation (31%) and inability to spare time (27.6%). Only a few (13.8%) mentioned about side-effects of drugs like drowsiness as a cause for difficulty in continuing the practices. The remaining declined to give their reasons (27.6%).
| Willingness to participate on out-patient basis|| |
About 89% of the respondents were willing to participate in an out-patient-based add-on yoga therapy program. 92.9% of females were willing to participate compared to 85.2% of males. Majority of those who were willing (65.9%) preferred their yoga sessions to be clubbed along with their regular medical follow-up once a month (P = 0.03) and 34.1% of the willing respondents were ready to spare time exclusively for yoga alone apart from their regular medical follow-up, preferring weekly or fortnightly yoga sessions.
Most of the unwilling respondents cited no reasons for their declining to participate in yoga therapy with a few stating lack of motivation and time as a reason.
| Discussion|| |
In the present study, nearly 90% of the patients with schizophrenia reported that they can participate in add-on yoga therapy programs, when they were given the options of choosing out-patient-based yoga therapy sessions weekly, fortnightly or monthly as per their convenience. Logistic reasons like long distance travel and financial problems which were found to be the main barriers for participating in yoga therapy programs according to a previous study in the same setting  did not become significant factors in this study as patients were given convenient options such as weekly, fortnightly and monthly sessions instead of a fixed daily basis regimen.
Interestingly, the willingness to take part in yoga therapy programs was more among females as also the positive experiences among those women who did yoga in the past, which suggest females get more spiritual related experiences compared to males. This is in line with the findings of previous studies. 
However the question of how to make the patients sustain what they learn at the yoga center weekly, fortnightly or monthly at home until they come for next follow-up remains unanswered. Along with such out-patient-based yoga therapy programs, which are more pragmatic, future studies can be directed toward making more patient friendly yoga modules to overcome the problem of lack of motivation. Involving care givers along with the patients more actively or arrangements for group yoga sessions in the community set up could be one of the possible solutions for these issues.
| References|| |
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NIMHANS Integrated Centre for Yoga, National Institute of Mental Health and Neuro Sciences, Ayush Block, Hosur Road, Bengaluru - 560 029, Karnataka
Source of Support: None, Conflict of Interest: None