Post-traumatic Stress Disorder (PTSD) is a debilitating and persistent result of traumatic events [1]. A traumatic incident might be a single occurrence or a series of occurrences. As a result, symptoms, and behaviors such as repeated re-experiencing of the trauma or flashbacks of the incident, avoidance of any reminders of the painful idea, talk, or location, numbing of happy feelings, social disengagement, and elevated autonomic arousal develop [2]. PTSD is a severe public health issue, with a global incidence of up to 6.1% [3]. One in every five adult critical care survivors may experience PTSD symptoms, with a high relapse rate of one year after discharge [4]. With continuing conflicts, natural disasters, interpersonal violence, and other traumatic occurrences, it is estimated that over 70% of the world's population has been exposed to at least one traumatic experience in their lifetime [5].

Previous research showed that many cases of PTSD are not diagnosed [6] and even in those diagnosed, not all seek treatment [7], [8] as avoidance is one of the core symptoms of PTSD. Concerns about stigmatization, lack of social acknowledgment, poor health care infrastructure, the lack of training institutions, shame, rejection, low mental health literacy, lack of knowledge, treatment-related doubts, fear of negative social consequences, limited resources and time are identified as potential barriers to receiving clinical treatment [9]. With regards to the therapeutic approach, the first-line treatments of PTSD include Cognitive Behavioural Therapy (CBT), Cognitive Therapy, and Exposure Therapy [10], [11]. A review study however suggested that more than half of PTSD cases might be unresponsive to CBT [12]. To add on, a meta-analysis on PTSD indicated poor effect sizes for pharmacological treatments for PTSD in comparison to other psychological treatments [13].

Increasingly, researchers are investigating the use of complementary therapy for treating PTSD. Complementary therapies used to treat PTSD include acupuncture, mindfulness-based stress reduction, meditation, yoga, deep-breathing exercises and guided imagery. Reviews of the literature on complementary therapy found support for the beneficial effects of such interventions on symptoms of PTSD; however, their findings were limited by the paucity of well-designed trials [14].

Yoga has emerged as a mind-body approach for dealing with the challenges associated with the PTSD patient population [15]. Yoga is a holistic multi-dimensional system of health and well-being that focuses on the mind and its functions, with multi-component mind-body practices, including i) asana- physical postures and movement; ii) pranayama- breathing exercises; iii) relaxation; iv) mindfulness and meditation; and v) yogic counseling. It is a multi-dimensional intervention that can be tailored to the needs of each individual [16]. Tele-Yoga (TY) refers to the delivery of yoga practices through the means of virtual video platforms. It has the advantage compared to traditional face-to-face practices in the need to travel and attend yoga classes. Although the delivery of yoga via tele-mode has not been widely evaluated, limited studies on the treatment of mental health issues such as PTSD via telehealth indicate that it is broadly accepted, effective, and more cost-effective than in-person interventions. Tele mode of therapy deliverance can be expected to remove most of the barriers hampering the treatment of PTSD [17], [18].

The Indian concept of understanding the biological and psychological aspects has been explained. One is rooted in Ayurveda viz. Tridoshas [19] and the other in yoga’s Samkhya philosophy which talks about trigunas i.e. Sattva, Rajas, and Tamas [20]. The tridoshas comprising of Vata, Pitta and Kapha explain both biological and psychological aspects while trigunas explain intrinsic human behavior. Correlations have been specifically made between tridoshas and mental health such as anxiety, depression, and aggressive & intrusive behavior [21]. Likewise, the influence of trigunas on mental health disorders like GAD and PTSD is also emerging [22]. The present study intends to assess PTSD individuals on the basis of the Indian concepts of trigunas and tridoshas for the PTSD yoga module development.

Though scientific evidence shows that yoga-based interventions for PTSD are efficient in ameliorating PTSD symptoms, there was significant heterogeneity in the yoga interventions used in these studies combined with low-quality evidence and a high dropout rate [15], [22]. Existing PTSD yoga studies use different yoga modules which may be supported with or even without the author’s logical explanations for the use of particular practices. There is a need for a standardized yoga module for PTSD, which can be followed [23]. In the context of accessibility to PTSD patients, especially those in remote areas, the role of telemedicine is found to be significant, although the issue of internet connectivity in rural is debatable. Keeping view of these observations, a standardized TY module for PTSD patients’ needs to be developed. This will be done with the support of literature review, evidence-based research, and experts’ validation of the module.