Post-traumatic stress disorder (PTSD) remains a hidden epidemic in India. Despite a seemingly low prevalence rate of 0.2 % reported in India, compared to a global average of 3.9 %-5.6 %, studies indicate that many cases might go undetected due to numerous social barriers [2], [3]. These include societal indifference, fear of being stigmatized, and a pervasive distrust of mental health professionals [4], [5], which collectively hinder seeking effective care and treatment for PTSD [6]. Studies show retention rates ranging from 60 % to 72 %, suggesting dropout rates range from 28 % to 40 % [7]. Given these obstacles, a critical question arises: if the full extent of the problem is hidden and ignored, how can it be adequately addressed in public health policies and interventions? What are the implications for those suffering from PTSD in the meantime? We propose to bridge the stigma-associated gap in PTSD-specific intervention by systematically developing and validating a Tele-Yoga Module (TYM) within a community setting. Designed for home-based, self-paced practice, TYM minimizes the fear of judgment linked to conventional clinical environments and fosters a sense of safety and autonomy. By reducing social exposure and offering a culturally sensitive, non-intrusive alternative, TYM facilitates access to mental health care while mitigating stigma-related barriers.

PTSD can result from exposure to any traumatic event, with war being the most prevalent source. A meta-analysis estimated a global point prevalence of 26.51 % for PTSD among war veterans across 43 countries with a history of war spanning 30 years, and among them, 55.26 % also suffered from major depression [8]. While wars are dramatic causes, more pervasive yet less apparent sources include daily domestic violence and other inevitable traumatic events. In India, the issue of PTSD is further compounded by various social and cultural factors that discourage individuals from seeking help. Domestic violence is a significant contributor to PTSD in India, with reported prevalence rates as high as 28 % following such trauma [9]. Furthermore, data from the National Crime Records Bureau (2023) indicate that crimes against women, which often lead to PTSD [10], have been increasing at an annual rate of 4.6 %. Most of these cases remain undiagnosed and unreported, highlighting an urgent need to bridge this significant gap in mental health care.

Fear of stigmatization is another important factor that discourages PTSD sufferers from seeking help. When the source of trauma is familial or close community members, the societal backlash and the stigma associated with mental health issues can be overpowering [11]. Research suggests that self-stigma, where victims internalize societal prejudices, leads to decreased self-esteem and worsens PTSD symptoms, making the prospect of seeking help even more intimidating [12]. Failure to address PTSD can have profound long-term consequences on social harmony. The lasting psychological impact of trauma impairs an individual's social functioning, leading to dysfunction across social institutions [13]. Therefore, understanding and intervening in the social dynamics surrounding PTSD is crucial for both individual recovery and community well-being.

In response to the barriers presented by standard in-person therapy settings, telemedicine has emerged as a viable alternative, providing PTSD sufferers with access to treatments in the privacy and comfort of their own homes. The evidence shows the effectiveness of telehealth intervention for PTSD was the same as in-person interventions [14], [15], [16]. Tele-yoga enables the delivery of yoga programs remotely, overcoming geographic and stigma-related barriers while maintaining the effectiveness of conventional yoga practices [17]. Studies have shown that tele-yoga can significantly alleviate symptoms of common mental health disorders and improve overall well-being, providing a safe, cost-effective, and accessible option [18], [19], [20], especially for individuals who might otherwise avoid traditional treatment settings due to stigma or fear.

Teaching yoga through tele-mode has its own challenges. In India, to guide practitioners in this tele-yoga landscape, the Central Council for Research in Yoga and Naturopathy (CCRYN) released an advisory on tele-yoga services in 2020 [21]. It outlines various modalities for delivering yoga, such as general practices, targeted training, and therapeutic sessions through secure, interactive platforms. It addresses ethical and legal considerations, ensuring remote yoga services maintain confidentiality and professionalism. This approach adapts traditional yoga to meet diverse needs, including those with limited mobility or in remote areas [17], [22].

While only two studies have been reported earlier [23], [24], one where online yoga was delivered through recorded video lessons to women with PTSD due to stillbirth, and another where online yoga was delivered via live stream to veteran women with PTSD—there is a need to develop a comprehensive yoga module that specifically addresses the emerging concerns around delivering yoga through online modes. Our study addresses this significant gap in the PTSD care ecosystem by leveraging the potential of tele-yoga. Through a structured development and validation process, we aim to provide an accessible, stigma-free avenue for improving mental health outcomes among PTSD sufferers, promoting recovery through structured, supportive practices that can be adapted for individual needs.