Intervention(s)
A Yoga-Cognitive behavioural therapy program manual was developed by two of the researchers in collaboration with two experts (one in CBT and the other in Yoga). In developing the manual, CBT strategies were blended with after-session Yoga exercises. The CBT sessions were based on using the “ABCDE” model (Antecedent/Activating event, Beliefs, Consequences, Disputing, and Effective new philosophy) to identify, assess, revalidate and change unhelpful absolutistic and irrational beliefs associated with work experiences. The major aims of Y-CBT were to 1) use ABCDE group therapeutic model (CBT) in “disputing” – challenging and questioning teachers’ work-related irrational and dysfunctional beliefs and to replace them with rather helpful and functional beliefs [84] 2); use yoga to reduce the physiological symptoms of stress and helping the participants oust of the vicious circle of negative thoughts through Yoga “Victory Meditation,” affirmations and physical exercises.[55] This framework helped provide a targeted mind/body approach to stress perceptions, reactions, and symptoms.
The ABCDE formed the basis of explaining the relationships links between activating
(A) events associated with teaching children with ASD, dysfunctional thoughts, beliefs or cognitions arising from those events (B); the emotional and behavioral consequences of the beliefs (C) [84] Then, disputation techniques (D) are used to eliminate the maladaptive, dysfunctional, and self-limiting beliefs and cognitions. [84, 85, 86] Disputation involves challenging and comparing the maladaptive thoughts with more adaptive ones. Ellis [87] theorized that the best way to counter irrational beliefs is by considering realistic and logical ones. Hence as participants become aware of and counteract their dysfunctional beliefs, they come up with more effective world-views (E). This ABCDE model as used in earlier studies formed the basis of activities throughout the intervention (See table 1).
Yoga complementary approaches involved after-session physical/posture exercise and meditation practices. The interaction between cognitions, emotions, and physical symptoms were highlighted and skills were taught to reduce the incongruity between sensation and perception. Traditional Yoga (asanas, breathing exercises, and meditation) exercises were used in maintaining physical, mental, and emotional well-being. The traditional Yoga used in this study was appropriate for beginners, given that it is mild and does not demand too much effort. The Yoga intervention was meant to help participants understand and appreciate the interplay between their bodily sensations and emotional feelings. Ten different asanas posses were used, which are Tadasana (Mountain pose); Vrikshasana (Tree Pose); Adho Mukho Svanasana (Downward Facing Dog Pose); Trikonasana (Triangle Pose); Kursiasana(Chair Pose); Naukasana (Boat Pose); Bhujangasana (Cobra Pose); Paschimottanasana; Child's Pose and Sukhasna. [88]
Breathing exercises focused on basic Breath Awareness; Ujjayi Pranayama (Victorious Breath or Ocean Breath); Kapalabhati Pranayama (Breath of Fire or Skull-Shining Breath); Kumbhaka Pranayama (Breath Retention), Nadi Shodhana Pranayama (Alternate-Nostril Breathing). Meditation involved getting quiet, calm, and focused; mind slows down, relaxation, and staying positive by focusing on something that brings you peace to mind as well as choosing to shed go all the negative thoughts that interfere with health. Meditation also helps you become more mindful of your mind and body.
Hence, in Y-CBT we designed a 12 weeks module of CBT accompanied by traditional yoga exercises as discussed above. Each session of the module includes information, exercises, worksheets, images, examples, homework exercises, and template for progress feedback.