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Table of Contents
REVIEW ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 2  |  Page : 82-89

Addressing the psychological consequences of COVID-19 pandemic through Ayurveda: a positive approach for a positive perspective


1 Rog Nidan Department, All India Institute of Ayurveda, Sarita Vihar, New Delhi, India
2 Vikriti Vigyan Department, Faculty of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India

Date of Submission01-Mar-2021
Date of Decision23-Apr-2021
Date of Acceptance03-May-2021
Date of Web Publication28-Jun-2021

Correspondence Address:
Dr. Shalini Rai
Rog Nidan Department, All India Institute of Ayurveda, Sarita Vihar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jism.jism_17_21

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  Abstract 

Coronavirus disease (COVID-19) has challenged the medical systems worldwide due to its fast-spreading nature, with health issues emerging such as clinical presentation, the psychological impact of isolation, and post-COVID complications. It has also created an alarming situation in terms of socioeconomic crisis and resultant psychological effects, causing emotional annoyance, anger, irritability, depression, insomnia, stress, fluctuating mood, irritability, insomnia, insecurity, confusion, emotional isolation, social stigma, economic loss, inadequate resources for health care, and deficient distribution of essentials. These effects have an impact on mental health in both the general population and the frontline health-care workers (HCWS). Most of the health-care providers are vulnerable to emotional distress, given their risk of exposure to the virus for longer hours and concern about caring for their loved ones. In the current pandemic, the overall quality of life is also affected, potentiating the need of prevention from psychological distress as well as appropriate management of the disease and its sequela. Ayurveda is well known for its holistic approach toward disease prevention as well as its management through divine therapy (Daivavyapasraya Chikitsa), medicinal therapy (Yuktivyapasraya Chikitsa), and psycho-supportive therapy (Satvavajaya Chikitsa). These steps along with Medhya Rasayana and Yoga practices will help in efficient prevention and management of the psychological consequence of COVID-19. In this review, we put forward the integrative holistic modalities of Ayurveda for the prevention and management of psychological disturbances created by the current pandemic.

Keywords: Ayurveda, COVID-19, Medhya Rasayana, pandemic, psychological distress, stress, Yoga


How to cite this article:
Raahat S, Sharma M, Mandal SK, More AB, Rai S. Addressing the psychological consequences of COVID-19 pandemic through Ayurveda: a positive approach for a positive perspective. J Indian Sys Medicine 2021;9:82-9

How to cite this URL:
Raahat S, Sharma M, Mandal SK, More AB, Rai S. Addressing the psychological consequences of COVID-19 pandemic through Ayurveda: a positive approach for a positive perspective. J Indian Sys Medicine [serial online] 2021 [cited 2021 Jul 29];9:82-9. Available from: https://www.joinsysmed.com/text.asp?2021/9/2/82/319461




  Key messages: Top


The COVID-19 pandemic has created an alarming situation in terms of socioeconomic crisis and its resultant psychological distress, causing psychological symptoms, emotional disturbance, depression, stress, irritability, insomnia, posttraumatic stress symptoms, social stigma, economic loss, inadequate resources for health care, and deficient distribution of essentials. These effects have an impact on mental health in both the general population and the frontline HCWS as well as on each and every group of society. In the current pandemic, the overall quality of life is also affected, potentiating the need of prevention from psychological distress as well as appropriate management of the disease and its sequela. The holistic approach of Ayurveda toward disease prevention as well as management is well established through divine therapy (Daivavyapasraya Chikitsa), medicinal therapy (Yuktivyapasraya Chikitsa), and psycho-supportive therapy (Satvavajaya Chikitsa). Medhya rasayana and Yoga practices will help in efficient prevention and management of the psychological impact of COVID-19. In this review, we put forward the integrative holistic modalities of Ayurveda for the prevention and management of psychological disturbances created by the current pandemic.


  Introduction Top


COVID-19 is a recent pandemic threatening the world; due to mutations in viral structure and its fast-spreading nature, it is creating emergency situations and challenging the health-care system throughout the world. Compared with other pandemics, the disease is highly contagious with fast replication and is resulting in a high incidence rate and a high mortality rate. Vaccines are being developed and their use is being initiated for the general public the world over to control this crisis. Still, prevention remains the main step to prevent the spread of the disease. The adoption of control measures, such as the implementation of mass quarantine; restriction of mass gathering; closing of public places, learning institutions, and mass transit; and promoting work from home, further leads to the disruption of daily activities, social isolation, fear, loneliness, economic loss, and concern, which have a great impact on psychological health in general inhabitants as well as among HCWS.

Psychological Influence of COVID-19

COVID-19 has affected the world at large, causing negative psychological effects such as nervous tension, sleep apnea, depression, anxiety, delayed stress syndrome, and anger in the medical staff and other people. A study suggests that severe psychological distress (stress, anxiety, depression) was found in Chinese inhabitants during the COVID outbreak.[1] During the occurrence of COVID-19, a systematic review and meta-analysis carried out among the common public assessed the prevalence of stress, anxiety, and depression, respectively 29.6%, 31.9%, and 33.7%.[2] Social isolation causes increased anxiety in all age groups, which is related to feelings of an unsure future, fear of a novel and unknown pathogen.[3] Research showed that people who were frequently exposed to news regarding COVID-19 had a raised anxiety level.[4] More dangerous depressive symptoms occurred in the general population by misinformation reports about COVID-19.[5] The predominance of stress, depression, and anxiety is encountered to be high in women rather than men during the COVID-19 outbreak.[6] Research reported that the level of depression, anxiety, and stress is considerably higher in the 21–40 year age group due to a greater concern for future and economic challenges related to the current pandemic.[7] The old age group is the most vulnerable to the infection, and there is a greater impact on their mental health due to a fear of death or their being overanxious about getting the disease. A cross-sectional study conducted among adolescents during the course of COVID-19 reported 11.78% cases to be suffering from depression and 18.92% cases with anxiety.[8] The HCWs are facing many circumstances due to the emergence of the pandemic, such as pressure for working, exposure to the virus for longer hours, shortage of protective equipment (PPEs), and concern for their cherished ones, which cause psychological distress. A study on HCWs in Nepal during the COVID-19 pandemic reported that 37.3% of HCWs had symptoms of anxiety and 8% had symptoms of depression.[9] A review on psychological sequelae in quarantined and HCWs suggested that several psychological symptoms, including stress, depression, irritability, fear, stigma, and boredom, are associated with quarantine.[10] Thus, stress, anxiety, and depression (common psychological distress) are observed to be affecting all age groups and are more prevalent in the more vulnerable groups, such as HCWs, and quarantined. There is a need of an effective approach for prevention as well as appropriate management of common psychological distress.

Ayurveda Approach

Ayurveda emphasizes a whole system approach toward strengthening the body at physical as well as psychological levels to cope up with stressors, including infection, giving equal importance to somatic and mental health in each and every disease. Three modalities of therapy, that is, divine therapy (Daivavyapasraya Chikitsa), medicinal therapy (Yuktivyapasraya Chikitsa), and psycho-supportive therapy (Satvavajaya Chikitsa), are described in Ayurveda classics for the management of every disease.[11] Medicinal therapy (Yuktivyapasraya Chikitsa) is the component most utilized for health preservation and treatment and includes the usage of Rasayana and Medhya Rasayana drugs, as advocated later.

Role of Rasayana Drugs in Psychological Distress

Rasayana refers to the group of drugs in Ayurveda that, by virtue of their promotion of tissue nourishment, recover the overall health of the individual at the level of psyche as well as soma, increasing their strength and reducing the vulnerability to diseases.[12] In addition, these drugs are antioxidant, adoptogenic, and immunomodulatory; thus, they are also effective in balancing the immune response of the body.[13]Rasayana drugs have been used for ages due to their beneficial effects. The mechanism of action of these drugs on the psyche of the individuals is described in [Table 1].
Table 1: Describing the mode of action of Rasayana drugs in addressing the psychological aspects

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Role of Medhya Rasayan Drugs in Psychological Distress

Medhya Rasayana comprises Medhya, which means it is beneficial for medha (intellect), and Rasayana (rejuvenation), which will nourish the tissues, improve brain functions and health, enhance memory and immunity, and result in longevity by regular practice. Acharya Charak described a group of Medhya herbal plants in the form of kalpanas, such as Shankhpushpi (Convolvulus Pluricaulis) Kalka (whole plant paste), Mandukaparni (Centella Asiatica) Swaras (whole plant juice), Guduchi (Tinospora Cordifolia) Swaras (stem juice), and Yashtimadhu (Glycirrhiza Glabra) Churna (fine powder of root) with milk, which are known as Medhya Rasyana.[23] For psychiatric illnesses, actions of Medhya Rasayana drug involve the individuals in achieving sedation, serenity and harmony, or stimulation of activities of the brain.[24] These drugs improve Dhi (intellect), Dhriti (retention power), and Smriti (memory) by their specific action.[25] Thus, these drugs are applied as barriers as well as to cure psychopathy in both young and old age groups due to their good safety and efficacy along with their history of usage for thousands of years. This therapy requires reconsideration and proper application for the prevention and proper management of psychological distress that has occurred worldwide due to the COVID-19 crisis. The mode of action of the group of Medhya drugs is described in [Table 2].
Table 2: Describing the mode of action of Medhya Rasayan drugs in addressing the psychological aspects

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Role of Yoga in Addressing Psychological Distress

Yoga is now accepted as a holistic approach for health worldwide. The word Yoga originated from the Sanskrit root “yuj,” which means joining together.[65],[66]Yoga practices were first described in the Yoga Sutras by Patanjali.[65]Yoga-related self-care strategies are widely acceptable. Therapeutic Yoga is the implementation of Yoga practice in the management of health conditions to reduce, or alleviate structural, physiological, emotional, and spiritual pain and distress.[67] Hath Yoga is included in Yoga[68]; it is considered as Asanas and is mostly practiced in western society.[69]Yoga trains a person to relax, breathe slow, have patience, and focus on the present.[70] By yogic practices, people can achieve tranquility of mind, a sense of well-being, feeling of calm, enhanced self-esteem, competence and attention, lowered irritableness, and an optimistic outlook on life. It is reported in a study that by practicing Yoga and meditation these practices inhibit the areas that are responsible for fear, aggressiveness, and rage, and they stimulate the rewarding pleasure centers in the brain leading to a state of pleasure and contentment, which results in a reduced heart rate, respiratory rate, blood pressure, anxiety, and cardiac output in students.[67],[71],[72],[73]Yogic practices are documented to improve depression, further leading to a considerable increase in the level of serotonin and a reduction in cortisol level by decreasing the levels of monamine oxidase enzyme.[70] A number of studies on Yoga intervention have proven that it has potential beneficial effects on depression, stress, and anxiety.[74],[75],[76] A review reported that Yoga improves the variables of self-description, psychological status, and the quality of life.[77] A study proved that Yoga can be considered as monotherapy in the management of mild-to-moderate clinical depressive disorder.[74] Studies have proved that Yoga improves depression, aggressiveness, and uncertainty, along with a greater concern among psychiatric patients[78] and, thus, it could very well resolve the psychological impacts of COVID-19.

Daivavipashraya (Divine Therapy) and Satvavajaya Chikitsa (Psycho-supportive Therapy)

Divine therapy and psycho-supportive therapy are the two components of Ayurveda that address the psychological component of the individual, reinforcing their belief system toward the divine and elevating their morale to face the unseen and unknown with a positive approach. Divine therapy includes praying, mantra chanting, visiting holy deity places, and indulging in other practices that are supposed to build faith in the Almighty. The psycho-supportive therapy includes the components enumerated next.

Jnyana (knowledge)

Six types of knowledge are mentioned by Acharya Charaka; every person should have these: knowledge of self with an awareness of things and activities that are beneficial for self, knowledge of the place and family along with responsibilities toward them, knowledge of season and seasonal regimen, and knowledge of self-strength and self-capacity.[79] It is very much obvious that knowledge at such gross and subtle levels, if incorporated and practiced by people, will lead to a reduction in physical and mental diseases as well as overall crime in the society.

Vijnyana (scriptural knowledge)

This refers to gaining knowledge through books, available literature, scientific research etc. In the course of the current pandemic, people should have appropriate knowledge about the occurrence and nature of disease through scientific research on the various preventive measures, possess awareness of the WHO and AYUSH guidelines, avoid disease-related myths and fake news, seek information regarding diseases, and interact with health professionals to gain knowledge about the signs and symptoms of the disease and management strategies.

Dhairya (patience)

During the pandemic, patience should be necessarily developed as self-control of mind in individuals, as it reduces negative emotions such as stress, anger, and frustrations. It is essential for the prevention of unwholesome activities, following the rules and regulations released by authorities, having positive thoughts to maintain a positive atmosphere for family health and oneself, and having the courage to face any circumstances.

Smriti (memory)

Smriti is the recalling ability to previous events, such as what is seen, heard, read, and experienced. Smriti allows an individual to decide on the type of actions one is performing, based on the knowledge recall and understanding toward the current situation. Regarding the COVID-19 crisis, people should be aware about adopting appropriate control measures based on their knowledge of previous outbreaks such as SARS and MERS.


  Discussion Top


The COVID-19 pandemic has challenged the world due to its fast-spreading nature, with health issues emerging such as clinical presentation, the psychological impact of isolation, and post-COVID complications. It has also created an alarming situation in terms of psychological distress, causing rage, annoyance, panic, trepidation, insecurity, fluctuating mood, confusion, emotional isolation, social stigma, economic loss, inadequate resources for health care, and deficient distribution of essentials. These effects have an impact on mental health in both the general population and the frontline HCWs, though there are some differences in the patterns reported [Graph 1]. Anxiety has been reported in all categories studied, but it was found to affect HCWs more. Depression and stress were observed to a greater extent in the general population. Other studies have also reported increased levels of depression, stress, irritability, fear, anxiety, and emergence of other psychological issues. Most of the HCWs have been reported as being vulnerable to emotional distress, given their risk of exposure to the virus for longer hours and concern about caring for their loved ones, health anxiety, prolonged quarantine, fear of disease transmission, frustration, fatigue, and lack of protective equipment (PPEs). The general population was also affected psychologically due to insufficient information about the disease, financial loss, rumors, negative beliefs about vaccination, prolonged quarantine, future worries, social stigma, and care for their loved ones. In the current pandemic, the overall quality of life is also affected, potentiating the need of prevention from psychological distress as well as appropriate management of the disease and its sequela.{Figure 2}

Mental health has a great role in somatic manifestations. Observational studies suggest the predominance of depression and anxiety level found in patients having skin diseases, such as psoriasis and eczema,[80] and autoimmune disease.[81] Other studies showed that stress may affect the quality of health and cause lethality in immune-compromised disorders such as cancer[82] and HIV,[83] and it can also increase the susceptibility to infections.[84] Thus, psychological distress in terms of stress, depression, post-traumatic stress disorder (PTSD), anger, and anxiety can affect the quality of life of a comorbid person and also the general population. A positive psychological status and good mental health is essential to good-quality personal and social life, and it also affects the overall health and healing of an individual. The application of Ayurveda whole-systems approach to address this psychological consequence of COVID-19 can be a really promising step. The Rasayana and Medhya Rasayana drugs of Ayurveda, such as Ashvagandha, Amla, Mulethi, Guduchi etc., are documented to be beneficial in affecting the mental health and neurocognitive functions in Ayurveda, the scientific mechanism of which has been deciphered by contemporary medical science, as detailed in [Tables 1], [2] and [Figure 1]. The mind and the psychology are now accepted as the influencers of the immune response of the body as well as overall health and healing. The modern discoveries made in the direction of psychoneuroimmunology,[85] psychoendocrinology,[86] and psychoendoneuroimmunology[87] point toward the mind–body integration and the scientific rationale behind the whole-systems approach is accepted in Ayurveda.
Figure 1: Reversing the pathogenesis of psychological distress due to COVID crisis through pharmacological action of Rasayana and Medhya Rasayana drugs

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The usage of these Ayurveda drugs as mentioned under the umbrella of Rasayana and Medhya Rasayana and practices can be done for all healthy individuals, as they help in maintaining healthy tissues and mind. They can be specifically more useful for those who are predisposed to psychological stress, anxiety, and harsh working conditions and they are prone to develop various psychological problems. These drugs will not only address the psychological and intellectual status of the individual, but they will also help in better nourishment, and modulation of the natural immunity status of the individual by the adaptogenic effect through several reported mechanisms such as stimulation and activation of specific and nonspecific cellular immune function, increased number of natural killer cells and total white cells, and increase of antigen-specific and nonspecific immunity mediators such as immunoglobulin production or interleukin-2 levels,[88] leading to chances of reduced morbidity and mortality due to diseases such as COVID-19, meaning better survival and a positive perspective added to life without any adverse effects or dependency. The adoption of knowledge-based behavior with patience and faith in the supreme power can also be considered an effective measure in nullifying the impact of negative psychological factors and the consequent development of psychological diseases. The practice of Yoga can also be accomplished through technological advancements in the form of online Yoga practice sessions, which can be customized as per the need of the individual. Online group prayer sessions can be also an effective remedial tool to knit the community people and to address the needs and fears of the people through positive psychology and faith.


  Conclusion Top


COVID-19 has significantly negatively affected the mental health of people, so it is necessary to timely intervene and address those problems that have been recognized by the medical fraternity worldwide. Ayurveda approaches in the form of divine therapy, psycho-supportive therapy, Rasayana, Medhya Rasayana drugs, and yogic practices can be applied very effectively for managing the psychological effect of COVID-19 and other similar conditions, especially in vulnerable groups such as elderly people, HCWs, and quarantined individuals, for bringing about a positive change in their immunity status and perspective toward attaining a better life ahead.

Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.



 
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