tudy of Digital media as a risk factor in Mental Adjustment Disorders (MAD) of Young Adults w.s.r to Sattvavajaya Chikitsa (Rational Emotive Behavior Therapy) Introduction Digital media such as You Tube, Podcast, Web Series, Digital arts, and Social media etc. has become a intrinsic part to our daily routine. Social media sites such as Instagram, Facebook, and Twitter have penetrated deeply into the life of young adults. Instagram has 1158 million active users’ word wide, with 62.70 % of users added 18- 34 years and 120 million active users in India as of October 2020. Deterioration in mental condition is the most common side effects derive from excessive use of digital media. According to W.H.O, the prevalence of mental health problem is increasing at a rate of 13% per year. In 2019, 1 in every 8 people, or 970 million people around the world was living with mental disorders the most common. Negative comments, self comparison, cyber bullying, number of likes, views, FOMO (Fear of missing out), may activates physiological stress response in user ultimately leads to Mental Adjustment Disorders. The symptom associated with Mental Adjustment Disorder such as mood change, sleeping problems, delusions, excessive anger, suicidal tendency etc interferes in normal life of young adults and distracts them from their life goals. In Ayurveda, pragyaparadh is the origin of all the diseases. Even knowing the harmful effects of excessive use of digital media young adults get attracted towards it, hence leads to Pragyapradh. Sattvavajaya Chikitsha has the pschyco- spiritual approach and, it is exclusively meant for mind. Rational Emotive Behavior Therapy as Sattvavajaya Chikitsha is a type of Cognitive Behavioral Therapy. A core concept of REBT is the ABC model. It is an action-oriented approach that’s focused on helping people deal with irrational beliefs and learn how to manage their emotions, thoughts and behavior in a healthier, more realistic way. Current scenario, there is insufficiency in mental health treatment; REBT can be a low-cost treatment option in MAD for young adults. In this study an attempt is made to assess the REBT as Sattvavajaya Chikitsha in the condition of MAD in which digital media is a risk factor.
Objectives 1. To study role of pragyaparadh in leading to Mental Adjustment Disorder( MAD). 2. To study the digital media as a risk factor in MAD in young adult. 3. To analyze the impact of REBT as Sattvavajaya Chikitsha in MAD. 4. To improve the mental condition in digital dependent young adults.
Material and methods IEC approval: Before trial this clinical study will be placed in IEC for approval. The study is categorized in two steps Step 1 Conceptual study In this step, the literature is reviewed, analysis of Ayurveda samhitas and modern text references are to be done. Step 2 Clinical study (Upashayatmaka Study) Type of study: Longitudinal study with survey. Study design: It is an open labelled single arm uncontrolled clinical study. Study population: 200 random subjects, active user in digital media. Sample size: Sample will be drawn out of 200 subjects having mild, moderate sign and symptom of Mental Adjustment Disorder after screening by questionnaire. The current and lifetime prevalence of any psychiatric disorder in Chhattisgarh was 11.64% and 14.05%, respectively [7]. At an absolute precision of 2% and level of confidence of 95%, the estimated sample size is approximately 30 by using sample size calculator on website Study steps: i. 200 young adults subject irrespective of sex and religion who are active users in digital media will be selected randomly for clinical study from this institute only. ii. Digital media survey questionnaire and scale (HDRS, HARS, YMRS, EDDS, FQ) questionnaire will be asked to fill by subjects. iii. Evaluation and scoring of questionnaires will be done. Out of 200, subjects having mild to moderate sign and symptom of Mental Adjustment Disorders (MAD) will be selected for clinical study. iv. A written consent will be taken in prescribed proforma before clinical study. v. CRF will be fill according to information given by patient. vi. The REBT will be given in the interval of 15 days for 2 months and the result will be assessed on the basis of change in subjective and objective parameters. vii. At last, conclusion will be drawn on the effect of REBT in MAD in which digital media is a risk factor. Proforma: The patients will be interview with the help of predesigned proforma i.e. case record form (CRF) followed by clinical examination and necessary investigation. The CRF included data of name, age, sex, residence, academic session, family history, history of past illness, Srotas examination including Manovaha srotas, Asthavidha & Dasavidha parikshya, Physical & systematic examination. Questionnaire Including subject detail, digital media definition, Digital media survey questionnaire, five scale (HDRS, HDAS, YMRS, EDDS, FQ) questionnaire. Trial Duration 2 Months. Inclusion criteria a. Individual of 17- 25 years of age. b. Individual will be selected from this institute only. c. Individual who are active user of digital media. d. Individual having mild, moderate sign and symptom of MAD. e. Individual who are concern and unaware of mental health. Exclusion criteria a. Individual having below 17 years and above 25 years of age. b. Individual who are not active in digital media. c. Individual affected from severe disorder such as Tuberculosis, Cancer, Heart disease, Epilepsy etc. d. Individual who will not come for regular follow up. Criteria for selection of patient : a. Subjective criteria Subjects will be selected on the basis of score on five scales – i. Hamilton Depression Rating Scale (HDRS): 0–7 : the normal range (or in clinical remission), 20 : indicating at least moderate severity (usually required for entry into a clinical trial) ii. Hamilton Anxiety Rating Scale (HARS): <17 : mild severity 18-24 : mild to moderate severity 25-30: moderate to severe. iii. Young Mania Rating Scale (YMRS): Less or equal to 12 : resubmission 13-19 : minimal symptom 20-25 : mild mania 26-37 : moderate mania 38-60 : severe mania iv. Eating Disorder Diagnostic Scale (EDDS): The grading will be asses by using software calculate by QxMD on Website v. Fear Questionnaire (FQ) Four scores are obtained from the Fear Questionnaire: Main Phobia Level of Avoidance: Item 1 (score range 0 to 8) Total Phobia Score: Sum of items 2 to 16 (score range 0 to 120) Agoraphobia subscale (items 5, 6, 8, 12, & 15) (score range 0 to 40) Blood injury phobia subscale (items 2, 4, 10, 13, & 16) (score range 0 to 40) Social phobia subscale (items 3, 7, 9, 11, & 14) (score range 0 to 40) Global Phobia Rating: Item 18 (score range 0 to 8) Associated Anxiety and Depression: Sum of items 19 to 24 (score range 0 to 40 ) As per above scale scoring, Performa will be prepared and subject will be selected for clinical study. b. Objective criteria Following parameters will be studied before and after clinical study Body weight (in Kilograms) Eye power (in Dioptre) Blood pressure (in mm Hg ) Time spent on digital media (in Hrs) C.B.C. - Hb%, RBC, TLC, DLC, etc. Criteria of Assessment The clinical study will be performing in interval of 15 days for 2 month in each patient. The objective and subjective parameters will be assess before and after of the therapy. The change will be assess on the basis of score on HDRS, HARS,YMRS, EDDS, FQ scale and change in body weight, eye power, blood pressure, time spent on digital media, C.B.C report Statistical Test: The observed data will be collected and collated systematically. For statistical analysis of subjective parameters Wilcoxon signed rank test will be used. After 60 days of trial the effect of therapy after 60 days of trial will assess by applying student’s paired “t” test for comparing before and after the treatment. Implication and future scope This clinical study approaches to minimize the symptoms of Mental Adjustment Disorders through Rational Emotive Behavior Therapy as Sattvavajaya Chikitsha. In current scenario, there is rapid increase in number of digital media users and insufficiency in mental health treatment, REBT can be a low cost treatment option in MAD for young adults. The conclusion drawn will be beneficial for students to prevent their normal mental health condition through digital media especially social media uses and the result from clinical trial of REBT will be useful in future for treating Mental Adjustment Disorder (MAD) patients.
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