Is Yoga Beneficial for Anxiety Disorders? By our beloved teacher Kara Leutzinger

 

 

Is Yoga Beneficial for Anxiety Disorders?

May 3rd, 2019

Abstract

Yoga is the idea of bringing together, or uniting the breath with the body. Anxiety is a disabling amount of fear, possibly about a future event. Anxiety, obsessive-compulsive disorder and posttraumatic stress disorder were specifically looked at in a systematic review of the effects of yoga on mental health. Kundalini yoga was found to be one of the most beneficial types of yoga for treatment of anxiety disorders. It could possibly be from the large amount of breathing techniques used in this practice. It was hypothesized that breathing techniques are among the most useful methods used in yoga to be beneficial to those with anxiety. Findings indicate that yoga can be beneficial for those with anxiety disorders, more so than medications. However, further research is needed when looking at the effect of different types of yoga to conclude the effect on anxiety disorders.

Keywords:  yoga, mental health, anxiety, OCD, PTSD, kundalini yoga

 

Is Yoga Beneficial for Anxiety Disorders?

Introduction

I have been practicing yoga for 7 years. My affinity for the practice and the profound benefits, physically and mentally, that I have experienced led me to dive deeper into the understanding of the practice. In 2017, I started Yoga Teacher Training after 6 years of intense practice. This led me to become a yoga instructor. Mental health is a big problem in America, statistically, for every five adults there is one suffering from a mental illness (“Mental Illness,” 2017). Treatment and medication can be difficult for someone to come across, working with insurance, and finding the money to afford a therapist, or get a prescription. However, yoga is accessible to everyone. Even if it cannot necessarily cure the mental illness, for those that have been suffering for years, any sign of relief could be life changing. 

Yoga, in its most common form, is a series of asanas, the Sanskrit word for postures along with pranayama, the Sanskrit word for breath-work. Yoga in Sanskrit means “to unite.” This means that yoga works to unite the postures and the breath together as one (Varambally & Gangadhar, 2016). Some express yoga as a workout and a work-in meaning that you are exercising your body physically, but also your mind which is the work-in. Many people have the misconception that you have to be flexible to do yoga, but that is counterintuitive. The goal of yoga is not flexibility at all, but from the practice you can improve flexibility, creating space and ease in your body. Additionally, yoga has been seen to improve strength and balance, while tapping into the mind and creating “mindfulness,” or being present on the mat. 

My hypothesis is that yoga is beneficial for anxiety disorders because meditative breathing incorporated into yoga is found to activate the parasympathetic nervous system, which in turn is beneficial to lowering heart rate, calming the mind, and lowering blood pressure. Together, these factors enable stress relief and can lesson symptoms of anxiety. It is meant to be in the “rest and digest” stage, conserves energy and in turn lowers stress. The brain structures involved in anxiety occur in the limbic system (“emotional brain”), and parts of cortex. The neurotransmitters involve gamma aminobutyric acid, norepinephrine, and serotonin (Hooley, Butcher, Mineka, & Nock, 2017).

There are specific breathing techniques in yoga, each were created for a specific purpose, or have a profound benefit that they are used for. Ujjayi breath is used throughout the practice while going through the postures. It slows the breath down, helps initiate mind body connection, and helps maintain focus. It is an audible breath that mimics the sound of an ocean wave by restricting the back of the throat. This sound is soothing to the mind throughout the practice. A Three-part breath is meant to teach deeper, fuller breathing, calms the mind, and helps to stay present. The first aspect is filling up the lungs completely, then pausing along the way at abdomen, diaphragm, & chest. Alternate nostril breath is a technique used to balance the body. This practice improves focus and brings about a feeling of renewal. It is done by alternating the thumb and pinky to cover one nostril and breathe in the other. 

The definition of an anxiety-related disorder is a disabling and irrational amount of fear, often regarding a future event. The DSM-5 names many different anxiety-related disorders (Hooley, Butcher, Mineka, & Nock, 2017). This research primarily focuses on anxiety, looking specifically at post-traumatic stress disorder and obsessive-compulsive disorder, two of the three anxiety-related disorders according to the DSM-5. Post-traumatic stress disorder (PTSD) is debilitating anxiety following a traumatic event; one might re-experience the events vividly in their mind, and work to avoid anything that might trigger a reminder. War veterans are among the most affected by PTSD, and about 2.4% of the general population (Jindani, Turner, & Khalsa, 2015). Obsessive-compulsive disorder (OCD) is an anxiety disorder classified by experiences of an unwanted thought followed by repeated behavior in effort to lessen the anxious thoughts, images, or events. According to Shannahoff-Khalsa, OCD begins in childhood and goes into adulthood, with a lifetime prevalence of 2.5-5% in the population (Shannahoff-Khalsa, 2003). 

While it is important to note the impacts of yoga in clinical settings, it is also beneficial to look at the mental health of those that already do practice yoga, and what draws them to the practice. In a 2015 study, it was found that those that independently practice yoga are primarily women of higher socioeconomic status with psychosocial factors including coping and mindfulness. Yoga ties in elements of physical exercise, breath-work, concentration, spirituality, mediation, and self-knowledge. These all combined are a large component for people turning to yoga in the first place. Although women are typically displayed as yogis, there are a large number of males that practice, too. They are drawn to the more vigorous classes, but experience the same benefits, nonetheless. It was found that those who practice yoga did so in order to lower stress and help cope with life. It was found that a more frequent practice led to a better ability to handle life’s stressors. The psychosocial factors that contribute to the desire for one to begin the practice of yoga came from wanting gain social support and mindfulness. These are the characteristics found in well-established yoga practitioners. Therefore, it is important to note those who have not started practicing yoga could benefit from the powerful psychosocial effects (Park, Braun, & Siegel, 2015).

 

Methods

Anxiety

When looking at anxiety disorders, a thorough literature search study was conducted by Da Silva et. al utilizing a variety of databases: PubMed, Medline and PsycInfo. When searching the psychiatric literature, researchers used the keywords yoga and anxiety. They discovered research that was directed at a wide range of anxiety disorders. The researchers broadened the types of research they looked at, and collected articles of controlled and uncontrolled studies along with case reports, chart reviews, and retrospective analysis (Da Silva, Ravindran L., & Ravindran, A., 2009).

Post-Traumatic Stress Disorder 

            A 2012 study looked at yoga as an intervention for people affected by PTSD specifically in the military, asked eight Veterans Affairs (VA) coordinators to participate in a 30-question survey regarding the use of complementary and alternative medicine (CAM). This survey was about 30 minutes in length, assessing 32 types of CAM. They asked about the specific nature of six CAM treatments which included yoga, meditation, mindfulness, tai chi, qi gong, and massage. The questions were asked to evaluate the prevalence, background, and nature of these interventions for PTSD treatment. It was difficult to characterize these interventions because mindfulness and mediation are sometimes, but not always, seen as a part of yoga, and none of these have a specific universal definition to catch all that it implies. These surveys were mailed to the PTSD programs in the VA Healthcare System. All of the responses were read precisely, and the responses were recorded (Libby, Reddy, Pilver, & Desai, 2012).

            Another study looked at trauma and PTSD in general, and no longer focused specifically on veterans or the military. A 2015 study utilized 80 adult participants (nine females and 71 males) were included in this study ranging in ages from 18-64 years. All participants were exposed to a wide range of traumas. The study consisted of a control group of 21, and a yoga intervention group which consisted of 59 of the individuals. Each participant went through pretreatment assessment, and a final questionnaire after the yoga intervention. The yoga group participated in a 90-minute yoga session each week for 8 weeks, with encouragement to practice on their own 15 minutes a day including a YouTube video for assistance when needed at home. This was meant to teach the participants ways to calm or self-soothe, and utilize these skills for years to come (Jindani, Turner, & Khalsa, 2015). 

This research used a specific type of yoga in the study called Kundalini yoga. Kundalini yoga is specially known for its dynamic breathing techniques, synchronized with movement, and bringing about mind body awareness. Each teacher included in the study was certified as an International Kundalini Yoga Teachers Association teacher with over 10 years of experience teaching yoga, along with therapeutic mental health experience. Guided mediations were used throughout the 90-minute Kundalini class to bring awareness and serenity into their practice. As the participants stayed in the study, they answered questionnaires on how they were feeling. The questions asked were anxiety specific. Questionnaires included the Positive and Negative Affect Schedule (PANAS), 25-item Resilience Scale (RS), The 5-Facet Mindfulness Questionnaire (FFMQ), Insomnia Severity Index (ISI), Perceived Stress Scale (PSS), and Depression, Anxiety, and Stress Scale (DASS) (Jindani, Turner, & Khalsa, 2015).

Obsessive-Compulsive Disorder

            A large number of databases were searched for clinical research including websites that were specific for yoga or mental health organizations. Kirckwood et. al specifically searched the terms yoga and anxiety when searching for articles in 2005. The articles were obtained by filtering out the types of research conducted. The types of studies used were primarily randomized and nonrandomized controlled clinical trials, case studies, qualitative research, and surveys. Dissertation abstracts were not used because the methods were unknown for the most part. The participants used were those that had been suffering from an anxiety disorder according to the diagnostic criteria determined by the researchers. Various styles of yoga were used as the intervention in the study, excluding those who exclusively used meditation. Rating scales were used to measure the anxiety and the symptoms accompanying them. A clinician was also asked to comment on these studies including the relevance and practical issues (Kirkwood, Rampes, Tuffrey, Richardson, & Pilkington, 2005).

            Another study looked at a variety of mental illnesses, and were given specific techniques in yoga to treat them. A 2003 study used a detailed meditation procedure that was given to uncontrolled conditions measured in comparison with controlled meditation groups in a randomized matched-group evaluation. A two year-long study was done to look at the effect of Kundalini yoga (KY) and its meditation techniques in the treatment for OCD. The first of the trials was a small, uncontrolled trial with 5 students that scored highly on the Obsessive-Compulsive scale, all of which were previously on fluoxetine for over 5 months. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat OCD along with other psychological disorders (Shannahoff-Khalsa, 2003). 

            In 2003, Shannahoff-Khalsa conducted a study which consisted of a one year randomized blinded controlled match trial where two groups were matched based upon age, severity of anxiety, gender, and medication. The participants were told that there were two types of meditation protocols that would be compared. If one was found to be more effective, the groups would then merge for an additional year of study. Group 1 was the group that used Kundalini yoga meditation protocol, and there were 11 adults and 1 adolescent in that group. Group 2 consisted of 10 adults that went through Relaxation Response and Mindfulness Meditation techniques (Shannahoff-Khalsa, 2003).

            One of the techniques used for this OCD study was the alternate nostril breathing. Participants practiced this by sitting up with a straight spine, feeling grounded and closing the eyes, then going through the alternate nostril breathing focusing on the sound of the breath. This technique was used for a maximum of 31 minutes per day, in a time frame of 90 days. The ideal breathe cycle was about one minute, but that can be challenging for a beginner (Shannahoff-Khalsa, 2003).

 

Results

Anxiety

            In the 2009 Da Silva study, yoga was found to be superior to medication in a subgroup of patients, but when looking at specific anxiety disorders there was a gap, thus, leaving this claim undetermined. A study with different types of yoga found that those with generalized anxiety disorder using yoga alone or in conjunction with medication was found to be very beneficial. The researchers analyzed the results to find that patients with a shorter history of anxiety benefitted significantly from yoga, while those with a longer history of anxiety still had prevalent symptoms of anxiety, and continued cognitive treatment. Patients with generalized anxiety disorder (GAD) used stress reduction and relaxation in Hatha yoga. It was found that when yoga was used alone or with other therapies, varying improvements (moderate to significant) were made from symptoms of anxiety. Yoga was found to be more beneficial than no treatment at all (Da Silva, Ravindran L., & Ravindran, A., 2009). 

 

Post-traumatic Stress Disorder  

Yoga is used throughout the VA in many different forms. It was found that for those programs that did not use yoga as an intervention, it was due to a lack of trained staff or a lack of funding, and rarely from lack of veteran interest. When asked what was instructed the most by the yoga teachers, it was the pranayama (breathing), then the asanas (postures), followed by meditation. It was also mentioned there was a large variety of yoga offered including Iyenger, Kundalini, Yoga Nidra, and Ashtanga. Yoga programs were seen to have significant affects for PTSD symptoms, specifically sleep disturbances, flashbacks, and outburst as determined by the questionnaires answered, and the Chi-square tests made (Libby, Reddy, Pilver, Desai, 2012).  

When looking specifically at KY as an intervention for PTSD, specific elements of the yoga practice were seen as beneficial. The study the yoga groups to be beneficial with the specific yoga group having significantly more improvements when scored on PTSD questionnaires, self-assessments that effective screening tools in PTSD identification. Based upon the assessment results, improvements of symptoms of insomnia, resilience, anxiety, and perceived stress, were observed to be the greatest in the group with PTSD in comparison with the waitlist controlled group. There was a large range of trauma in the group, but overall KY treatment was determined to be one of the most beneficial interventions. The elements that were found most useful in reducing the symptoms were bringing about mind body awareness in order to better control thoughts and emotions, helping patients feel calmer overall. More research is needed in order to find the exact mechanisms that most strongly impacted patients in terms of the yoga used (Jindani, Turner, & Khalsa, 2015).

 

 

Obsessive-Compulsive Disorder

At the end of the Kirkwood et. al one-year study, three participants were completely free of the medication out of the five, and the other two were largely reduced on the medication. A year following four of the five were completely off the medication. It was found difficult to isolate yoga and anxiety specifically, but from what the researchers knew before, and what they discovered, it was found that yoga can be beneficial as an intervention for anxiety and OCD disorders. Using the one-minute breath rate for 31 minutes and 90 days was seen to entirely remove all obsessive-compulsive disorders (Kirkwood, Rampes, Tuffrey, Richardson, & Pilkington, 2005).

            After using the technique for OCD, referred to as obsessive compulsive disorder breath (OCDB) by Shannonhoff-Khalsa, it was found that when the breath was used for a maximum of 30 minutes for 90 days, OCD symptoms were eliminated. This information comes as self-reported data taken after the participants completed the 90 days. Although hard to perfect, the mental focus and benefits were able to be found, even among beginners (Shannhoff-Khalsa, 2003). 

 

Discussion 

            The results seen in yoga, have also been seen in exercise. Yoga has many advantages that are cost-effective, do not required medical supervision, minimal side effects, or risks, and is accessible to even those that normally might not be able to exercise. Breath control associated with yoga has been found to increase parasympathetic activity and decrease sympathetic activity. This is beneficial because those with anxiety typically experience increased heart rate, dilated blood vessels, and high blood pressure. Therefore, in addition to psychological benefits, physiological advantages are also experienced. In combination, these both work to combat side effects of anxiety. Increased self-esteem has also been observed in patients as learning a new skill can improve confidence and turn off negative thoughts that contribute to anxiety (Da Silva, Ravindran L., & Ravindran, A., 2009). 

            Stress from physical and psychological sources leads to allosteric load or excessive stress on the body overtime. Yoga-based practices can reduce this by bringing the body back to homeostasis. Allosteric load includes the autonomic nervous system which involves the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system is the “flight or fight” part of the body that acts in result of stressors, however, in anxiety-related disorders, the sympathetic nervous system is over activated. Yoga works in opposition to bring the body back to its normal, resting state. Anxiety-related disorders and many people do not use the full capacity of the lungs throughout the day. There is short and shallow breathing throughout the day, unless our attention is brought exactly to the breath. Therefore, in yoga, using the breath in its full capacity helps to lower stress by lowering the heart rate, blood pressure, and overall brain activity, bringing the attention to the breath. Although the sympathetic nervous system is meant to keep us alive, when it is overused, there can be detrimental effects to a person’s health. Yoga helps to bring homeostasis back to the body, and restore the negative effects of the sympathetic nervous system (Streeter, Gerbarg, Saper, Ciraulo, & Brown, 2012). 

One of the most used therapies in OCD is exposure and response prevention. Exposure and response prevention is using relaxation strategies while the patient is exposed to the OCD provoking situations they are struggling with. This is where yoga can be beneficial for the use of relaxation techniques. A common method of treating PTSD is cognitive behavior therapy. Cognitive behavior therapy also includes aspects of exposure and response therapy, along with, cognitive restructuring. Cognitive behavior therapy has three main components: thoughts, behavior, and emotion. An aspect of yoga is using the breath to draw attention away from any wondering thoughts. Both OCD and PTSD symptoms could be diminished by this technique. Cognitive restructuring is training the brain to identify negative thoughts and work on forming those into positive thoughts. Meditation mindfulness is a tool sometimes used in cognitive restructuring. Especially for PTSD, there are frequently barriers to care. Some of the treatments take a lot of time, require highly trained individuals that are not always available, or patients are not able to have access to the treatment based on where they are located. Today, yoga videos can be found on apps and YouTube enabling you to have access to a sequence of poses, meditation, or breathing exercises from wherever you are (Hooley, Butcher, Mineka, & Nock, 2017).

Yoga is sometimes considered in mental health services for its ability to improve heath, but there have been noticeable therapeutic effects. Therefore, yoga is used as a therapeutic strategy in holistic health compared to strictly medication that cause adverse side effects. Yoga provides many more beneficial side effects in comparison to traditional medications. Throughout this research, it was found that within multidisciplinary mental health services that have psychiatrists, doctors, nurses, psychologists, and social workers, would also benefit by introducing yoga therapists to their clinics (Varambally, & Gangadhar, 2016).

 

Conclusion 

            There were apparent findings in nearly all cases whether it was looking specifically at the types of yoga used, or the specific anxiety disorder. If anything, the research found can help facilitate more research, and better guide researchers to see what elements in each style of yoga was most beneficial to the patients. The hypothesis, yoga is beneficial for anxiety disorders because meditative breathing incorporated into yoga is found to activate the parasympathetic nervous system, which in turn is beneficial to lowering heart rate, calming the mind, and lowering blood pressure, was found to be true. Although most research was unsure about which components of the practice were most beneficial, most studies agreed that breathing techniques were primarily used. The most profound thing in the research was the abundant amount of results coming from Kundalini yoga. However, this finding makes most sense with my hypothesis because of the nature of Kundalini yoga. Kundalini yoga focuses specifically on the breath, creating energizing movements, and focusing on using the breath for every movement, every movement has a breath. It also focuses on the chakras, rooting and grounding the body, therefore, Kundalini is beneficial in its ability to calm a wondering and compulsive mind to be still, and it helps bring awareness to the thoughts that are controlling them, whether stressors or compulsive. 

  

References

Da Silva, T. L., Ravindran, L. N., & Ravindran, A. V. (2009). Yoga in the treatment of mood and anxiety disorders: A review. Asian Journal of Psychiatry2(1), 6-16. doi:10.1016/j.ajp.2008.12.002

Hooley, J. M., Butcher, J. N., Mineka, S., & Nock, M. (2017). Abnormal Psychology (Seventeenth ed.). Boston: Pearson.

Jindani, F., Turner, N., & Khalsa, S. B. S. (2015). A yoga intervention for posttraumatic stress: A preliminary randomized control trial. Evidence-Based Complementary and Alternative Medicine2015. doi:10.1155/2015/351746

Kirkwood, G., Rampes, H., Tuffrey, V., Richardson, J., & Pilkington, K. (2005). Yoga for anxiety: a systematic review of the research evidence. British journal of sports medicine39(12), 884-891. doi: 10.1136/bjsm.2005.018069 

Libby, D 

 

 

 

 

 

Is Yoga Beneficial for Anxiety Disorders?

May 3rd, 2019

Abstract

Yoga is the idea of bringing together, or uniting the breath with the body. Anxiety is a disabling amount of fear, possibly about a future event. Anxiety, obsessive-compulsive disorder and posttraumatic stress disorder were specifically looked at in a systematic review of the effects of yoga on mental health. Kundalini yoga was found to be one of the most beneficial types of yoga for treatment of anxiety disorders. It could possibly be from the large amount of breathing techniques used in this practice. It was hypothesized that breathing techniques are among the most useful methods used in yoga to be beneficial to those with anxiety. Findings indicate that yoga can be beneficial for those with anxiety disorders, more so than medications. However, further research is needed when looking at the effect of different types of yoga to conclude the effect on anxiety disorders.

Keywords:  yoga, mental health, anxiety, OCD, PTSD, kundalini yoga

 

Is Yoga Beneficial for Anxiety Disorders?

Introduction

I have been practicing yoga for 7 years. My affinity for the practice and the profound benefits, physically and mentally, that I have experienced led me to dive deeper into the understanding of the practice. In 2017, I started Yoga Teacher Training after 6 years of intense practice. This led me to become a yoga instructor. Mental health is a big problem in America, statistically, for every five adults there is one suffering from a mental illness (“Mental Illness,” 2017). Treatment and medication can be difficult for someone to come across, working with insurance, and finding the money to afford a therapist, or get a prescription. However, yoga is accessible to everyone. Even if it cannot necessarily cure the mental illness, for those that have been suffering for years, any sign of relief could be life changing. 

Yoga, in its most common form, is a series of asanas, the Sanskrit word for postures along with pranayama, the Sanskrit word for breath-work. Yoga in Sanskrit means “to unite.” This means that yoga works to unite the postures and the breath together as one (Varambally & Gangadhar, 2016). Some express yoga as a workout and a work-in meaning that you are exercising your body physically, but also your mind which is the work-in. Many people have the misconception that you have to be flexible to do yoga, but that is counterintuitive. The goal of yoga is not flexibility at all, but from the practice you can improve flexibility, creating space and ease in your body. Additionally, yoga has been seen to improve strength and balance, while tapping into the mind and creating “mindfulness,” or being present on the mat. 

My hypothesis is that yoga is beneficial for anxiety disorders because meditative breathing incorporated into yoga is found to activate the parasympathetic nervous system, which in turn is beneficial to lowering heart rate, calming the mind, and lowering blood pressure. Together, these factors enable stress relief and can lesson symptoms of anxiety. It is meant to be in the “rest and digest” stage, conserves energy and in turn lowers stress. The brain structures involved in anxiety occur in the limbic system (“emotional brain”), and parts of cortex. The neurotransmitters involve gamma aminobutyric acid, norepinephrine, and serotonin (Hooley, Butcher, Mineka, & Nock, 2017).

There are specific breathing techniques in yoga, each were created for a specific purpose, or have a profound benefit that they are used for. Ujjayi breath is used throughout the practice while going through the postures. It slows the breath down, helps initiate mind body connection, and helps maintain focus. It is an audible breath that mimics the sound of an ocean wave by restricting the back of the throat. This sound is soothing to the mind throughout the practice. A Three-part breath is meant to teach deeper, fuller breathing, calms the mind, and helps to stay present. The first aspect is filling up the lungs completely, then pausing along the way at abdomen, diaphragm, & chest. Alternate nostril breath is a technique used to balance the body. This practice improves focus and brings about a feeling of renewal. It is done by alternating the thumb and pinky to cover one nostril and breathe in the other. 

The definition of an anxiety-related disorder is a disabling and irrational amount of fear, often regarding a future event. The DSM-5 names many different anxiety-related disorders (Hooley, Butcher, Mineka, & Nock, 2017). This research primarily focuses on anxiety, looking specifically at post-traumatic stress disorder and obsessive-compulsive disorder, two of the three anxiety-related disorders according to the DSM-5. Post-traumatic stress disorder (PTSD) is debilitating anxiety following a traumatic event; one might re-experience the events vividly in their mind, and work to avoid anything that might trigger a reminder. War veterans are among the most affected by PTSD, and about 2.4% of the general population (Jindani, Turner, & Khalsa, 2015). Obsessive-compulsive disorder (OCD) is an anxiety disorder classified by experiences of an unwanted thought followed by repeated behavior in effort to lessen the anxious thoughts, images, or events. According to Shannahoff-Khalsa, OCD begins in childhood and goes into adulthood, with a lifetime prevalence of 2.5-5% in the population (Shannahoff-Khalsa, 2003). 

While it is important to note the impacts of yoga in clinical settings, it is also beneficial to look at the mental health of those that already do practice yoga, and what draws them to the practice. In a 2015 study, it was found that those that independently practice yoga are primarily women of higher socioeconomic status with psychosocial factors including coping and mindfulness. Yoga ties in elements of physical exercise, breath-work, concentration, spirituality, mediation, and self-knowledge. These all combined are a large component for people turning to yoga in the first place. Although women are typically displayed as yogis, there are a large number of males that practice, too. They are drawn to the more vigorous classes, but experience the same benefits, nonetheless. It was found that those who practice yoga did so in order to lower stress and help cope with life. It was found that a more frequent practice led to a better ability to handle life’s stressors. The psychosocial factors that contribute to the desire for one to begin the practice of yoga came from wanting gain social support and mindfulness. These are the characteristics found in well-established yoga practitioners. Therefore, it is important to note those who have not started practicing yoga could benefit from the powerful psychosocial effects (Park, Braun, & Siegel, 2015).

 

Methods

Anxiety

When looking at anxiety disorders, a thorough literature search study was conducted by Da Silva et. al utilizing a variety of databases: PubMed, Medline and PsycInfo. When searching the psychiatric literature, researchers used the keywords yoga and anxiety. They discovered research that was directed at a wide range of anxiety disorders. The researchers broadened the types of research they looked at, and collected articles of controlled and uncontrolled studies along with case reports, chart reviews, and retrospective analysis (Da Silva, Ravindran L., & Ravindran, A., 2009).

Post-Traumatic Stress Disorder 

            A 2012 study looked at yoga as an intervention for people affected by PTSD specifically in the military, asked eight Veterans Affairs (VA) coordinators to participate in a 30-question survey regarding the use of complementary and alternative medicine (CAM). This survey was about 30 minutes in length, assessing 32 types of CAM. They asked about the specific nature of six CAM treatments which included yoga, meditation, mindfulness, tai chi, qi gong, and massage. The questions were asked to evaluate the prevalence, background, and nature of these interventions for PTSD treatment. It was difficult to characterize these interventions because mindfulness and mediation are sometimes, but not always, seen as a part of yoga, and none of these have a specific universal definition to catch all that it implies. These surveys were mailed to the PTSD programs in the VA Healthcare System. All of the responses were read precisely, and the responses were recorded (Libby, Reddy, Pilver, & Desai, 2012).

            Another study looked at trauma and PTSD in general, and no longer focused specifically on veterans or the military. A 2015 study utilized 80 adult participants (nine females and 71 males) were included in this study ranging in ages from 18-64 years. All participants were exposed to a wide range of traumas. The study consisted of a control group of 21, and a yoga intervention group which consisted of 59 of the individuals. Each participant went through pretreatment assessment, and a final questionnaire after the yoga intervention. The yoga group participated in a 90-minute yoga session each week for 8 weeks, with encouragement to practice on their own 15 minutes a day including a YouTube video for assistance when needed at home. This was meant to teach the participants ways to calm or self-soothe, and utilize these skills for years to come (Jindani, Turner, & Khalsa, 2015). 

This research used a specific type of yoga in the study called Kundalini yoga. Kundalini yoga is specially known for its dynamic breathing techniques, synchronized with movement, and bringing about mind body awareness. Each teacher included in the study was certified as an International Kundalini Yoga Teachers Association teacher with over 10 years of experience teaching yoga, along with therapeutic mental health experience. Guided mediations were used throughout the 90-minute Kundalini class to bring awareness and serenity into their practice. As the participants stayed in the study, they answered questionnaires on how they were feeling. The questions asked were anxiety specific. Questionnaires included the Positive and Negative Affect Schedule (PANAS), 25-item Resilience Scale (RS), The 5-Facet Mindfulness Questionnaire (FFMQ), Insomnia Severity Index (ISI), Perceived Stress Scale (PSS), and Depression, Anxiety, and Stress Scale (DASS) (Jindani, Turner, & Khalsa, 2015).

Obsessive-Compulsive Disorder

            A large number of databases were searched for clinical research including websites that were specific for yoga or mental health organizations. Kirckwood et. al specifically searched the terms yoga and anxiety when searching for articles in 2005. The articles were obtained by filtering out the types of research conducted. The types of studies used were primarily randomized and nonrandomized controlled clinical trials, case studies, qualitative research, and surveys. Dissertation abstracts were not used because the methods were unknown for the most part. The participants used were those that had been suffering from an anxiety disorder according to the diagnostic criteria determined by the researchers. Various styles of yoga were used as the intervention in the study, excluding those who exclusively used meditation. Rating scales were used to measure the anxiety and the symptoms accompanying them. A clinician was also asked to comment on these studies including the relevance and practical issues (Kirkwood, Rampes, Tuffrey, Richardson, & Pilkington, 2005).

            Another study looked at a variety of mental illnesses, and were given specific techniques in yoga to treat them. A 2003 study used a detailed meditation procedure that was given to uncontrolled conditions measured in comparison with controlled meditation groups in a randomized matched-group evaluation. A two year-long study was done to look at the effect of Kundalini yoga (KY) and its meditation techniques in the treatment for OCD. The first of the trials was a small, uncontrolled trial with 5 students that scored highly on the Obsessive-Compulsive scale, all of which were previously on fluoxetine for over 5 months. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat OCD along with other psychological disorders (Shannahoff-Khalsa, 2003). 

            In 2003, Shannahoff-Khalsa conducted a study which consisted of a one year randomized blinded controlled match trial where two groups were matched based upon age, severity of anxiety, gender, and medication. The participants were told that there were two types of meditation protocols that would be compared. If one was found to be more effective, the groups would then merge for an additional year of study. Group 1 was the group that used Kundalini yoga meditation protocol, and there were 11 adults and 1 adolescent in that group. Group 2 consisted of 10 adults that went through Relaxation Response and Mindfulness Meditation techniques (Shannahoff-Khalsa, 2003).

            One of the techniques used for this OCD study was the alternate nostril breathing. Participants practiced this by sitting up with a straight spine, feeling grounded and closing the eyes, then going through the alternate nostril breathing focusing on the sound of the breath. This technique was used for a maximum of 31 minutes per day, in a time frame of 90 days. The ideal breathe cycle was about one minute, but that can be challenging for a beginner (Shannahoff-Khalsa, 2003).

 

Results

Anxiety

            In the 2009 Da Silva study, yoga was found to be superior to medication in a subgroup of patients, but when looking at specific anxiety disorders there was a gap, thus, leaving this claim undetermined. A study with different types of yoga found that those with generalized anxiety disorder using yoga alone or in conjunction with medication was found to be very beneficial. The researchers analyzed the results to find that patients with a shorter history of anxiety benefitted significantly from yoga, while those with a longer history of anxiety still had prevalent symptoms of anxiety, and continued cognitive treatment. Patients with generalized anxiety disorder (GAD) used stress reduction and relaxation in Hatha yoga. It was found that when yoga was used alone or with other therapies, varying improvements (moderate to significant) were made from symptoms of anxiety. Yoga was found to be more beneficial than no treatment at all (Da Silva, Ravindran L., & Ravindran, A., 2009). 

 

Post-traumatic Stress Disorder  

Yoga is used throughout the VA in many different forms. It was found that for those programs that did not use yoga as an intervention, it was due to a lack of trained staff or a lack of funding, and rarely from lack of veteran interest. When asked what was instructed the most by the yoga teachers, it was the pranayama (breathing), then the asanas (postures), followed by meditation. It was also mentioned there was a large variety of yoga offered including Iyenger, Kundalini, Yoga Nidra, and Ashtanga. Yoga programs were seen to have significant affects for PTSD symptoms, specifically sleep disturbances, flashbacks, and outburst as determined by the questionnaires answered, and the Chi-square tests made (Libby, Reddy, Pilver, Desai, 2012).  

When looking specifically at KY as an intervention for PTSD, specific elements of the yoga practice were seen as beneficial. The study the yoga groups to be beneficial with the specific yoga group having significantly more improvements when scored on PTSD questionnaires, self-assessments that effective screening tools in PTSD identification. Based upon the assessment results, improvements of symptoms of insomnia, resilience, anxiety, and perceived stress, were observed to be the greatest in the group with PTSD in comparison with the waitlist controlled group. There was a large range of trauma in the group, but overall KY treatment was determined to be one of the most beneficial interventions. The elements that were found most useful in reducing the symptoms were bringing about mind body awareness in order to better control thoughts and emotions, helping patients feel calmer overall. More research is needed in order to find the exact mechanisms that most strongly impacted patients in terms of the yoga used (Jindani, Turner, & Khalsa, 2015).

 

 

Obsessive-Compulsive Disorder

At the end of the Kirkwood et. al one-year study, three participants were completely free of the medication out of the five, and the other two were largely reduced on the medication. A year following four of the five were completely off the medication. It was found difficult to isolate yoga and anxiety specifically, but from what the researchers knew before, and what they discovered, it was found that yoga can be beneficial as an intervention for anxiety and OCD disorders. Using the one-minute breath rate for 31 minutes and 90 days was seen to entirely remove all obsessive-compulsive disorders (Kirkwood, Rampes, Tuffrey, Richardson, & Pilkington, 2005).

            After using the technique for OCD, referred to as obsessive compulsive disorder breath (OCDB) by Shannonhoff-Khalsa, it was found that when the breath was used for a maximum of 30 minutes for 90 days, OCD symptoms were eliminated. This information comes as self-reported data taken after the participants completed the 90 days. Although hard to perfect, the mental focus and benefits were able to be found, even among beginners (Shannhoff-Khalsa, 2003). 

 

Discussion 

            The results seen in yoga, have also been seen in exercise. Yoga has many advantages that are cost-effective, do not required medical supervision, minimal side effects, or risks, and is accessible to even those that normally might not be able to exercise. Breath control associated with yoga has been found to increase parasympathetic activity and decrease sympathetic activity. This is beneficial because those with anxiety typically experience increased heart rate, dilated blood vessels, and high blood pressure. Therefore, in addition to psychological benefits, physiological advantages are also experienced. In combination, these both work to combat side effects of anxiety. Increased self-esteem has also been observed in patients as learning a new skill can improve confidence and turn off negative thoughts that contribute to anxiety (Da Silva, Ravindran L., & Ravindran, A., 2009). 

            Stress from physical and psychological sources leads to allosteric load or excessive stress on the body overtime. Yoga-based practices can reduce this by bringing the body back to homeostasis. Allosteric load includes the autonomic nervous system which involves the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system is the “flight or fight” part of the body that acts in result of stressors, however, in anxiety-related disorders, the sympathetic nervous system is over activated. Yoga works in opposition to bring the body back to its normal, resting state. Anxiety-related disorders and many people do not use the full capacity of the lungs throughout the day. There is short and shallow breathing throughout the day, unless our attention is brought exactly to the breath. Therefore, in yoga, using the breath in its full capacity helps to lower stress by lowering the heart rate, blood pressure, and overall brain activity, bringing the attention to the breath. Although the sympathetic nervous system is meant to keep us alive, when it is overused, there can be detrimental effects to a person’s health. Yoga helps to bring homeostasis back to the body, and restore the negative effects of the sympathetic nervous system (Streeter, Gerbarg, Saper, Ciraulo, & Brown, 2012). 

One of the most used therapies in OCD is exposure and response prevention. Exposure and response prevention is using relaxation strategies while the patient is exposed to the OCD provoking situations they are struggling with. This is where yoga can be beneficial for the use of relaxation techniques. A common method of treating PTSD is cognitive behavior therapy. Cognitive behavior therapy also includes aspects of exposure and response therapy, along with, cognitive restructuring. Cognitive behavior therapy has three main components: thoughts, behavior, and emotion. An aspect of yoga is using the breath to draw attention away from any wondering thoughts. Both OCD and PTSD symptoms could be diminished by this technique. Cognitive restructuring is training the brain to identify negative thoughts and work on forming those into positive thoughts. Meditation mindfulness is a tool sometimes used in cognitive restructuring. Especially for PTSD, there are frequently barriers to care. Some of the treatments take a lot of time, require highly trained individuals that are not always available, or patients are not able to have access to the treatment based on where they are located. Today, yoga videos can be found on apps and YouTube enabling you to have access to a sequence of poses, meditation, or breathing exercises from wherever you are (Hooley, Butcher, Mineka, & Nock, 2017).

Yoga is sometimes considered in mental health services for its ability to improve heath, but there have been noticeable therapeutic effects. Therefore, yoga is used as a therapeutic strategy in holistic health compared to strictly medication that cause adverse side effects. Yoga provides many more beneficial side effects in comparison to traditional medications. Throughout this research, it was found that within multidisciplinary mental health services that have psychiatrists, doctors, nurses, psychologists, and social workers, would also benefit by introducing yoga therapists to their clinics (Varambally, & Gangadhar, 2016).

 

Conclusion 

            There were apparent findings in nearly all cases whether it was looking specifically at the types of yoga used, or the specific anxiety disorder. If anything, the research found can help facilitate more research, and better guide researchers to see what elements in each style of yoga was most beneficial to the patients. The hypothesis, yoga is beneficial for anxiety disorders because meditative breathing incorporated into yoga is found to activate the parasympathetic nervous system, which in turn is beneficial to lowering heart rate, calming the mind, and lowering blood pressure, was found to be true. Although most research was unsure about which components of the practice were most beneficial, most studies agreed that breathing techniques were primarily used. The most profound thing in the research was the abundant amount of results coming from Kundalini yoga. However, this finding makes most sense with my hypothesis because of the nature of Kundalini yoga. Kundalini yoga focuses specifically on the breath, creating energizing movements, and focusing on using the breath for every movement, every movement has a breath. It also focuses on the chakras, rooting and grounding the body, therefore, Kundalini is beneficial in its ability to calm a wondering and compulsive mind to be still, and it helps bring awareness to the thoughts that are controlling them, whether stressors or compulsive. 

  

References

Da Silva, T. L., Ravindran, L. N., & Ravindran, A. V. (2009). Yoga in the treatment of mood and anxiety disorders: A review. Asian Journal of Psychiatry2(1), 6-16. doi:10.1016/j.ajp.2008.12.002

Hooley, J. M., Butcher, J. N., Mineka, S., & Nock, M. (2017). Abnormal Psychology (Seventeenth ed.). Boston: Pearson.

Jindani, F., Turner, N., & Khalsa, S. B. S. (2015). A yoga intervention for posttraumatic stress: A preliminary randomized control trial. Evidence-Based Complementary and Alternative Medicine2015. doi:10.1155/2015/351746

Kirkwood, G., Rampes, H., Tuffrey, V., Richardson, J., & Pilkington, K. (2005). Yoga for anxiety: a systematic review of the research evidence. British journal of sports medicine39(12), 884-891. doi: 10.1136/bjsm.2005.018069 

Libby, D., Reddy, F., Pilver, C., & Desai, R. (2012). The use of yoga in specialized VA PTSD treatment programs. International journal of yoga therapy22(1), 79-88. doi:10.17761/ijyt.22.1.v71h07m12412k218

Mental Illness. (2017, November). Retrieved February 8, 2019, from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

Park, C. L., Braun, T., & Siegel, T. (2015). Who practices yoga? A systematic review of demographic, health-related, and psychosocial factors associated with yoga practice. Journal of behavioral medicine38(3), 460-471. doi:10.1007/s10865-015-9618-5

Shannahoff-Khalsa, D. S. (2003). Kundalini yoga meditation techniques for the treatment of obsessive-compulsive and OC spectrum disorders. Brief Treatment and Crisis Intervention3(3), 369. http://access.portico.org/stable?au=pf10g1t6rf

Streeter, C. C., Gerbarg, P. L., Saper, R. B., Ciraulo, D. A., & Brown, R. P. (2012). Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Medical hypotheses78(5), 571-579. doi:10.1016/j.mehy.2012.01.021 

Varambally, S., & Gangadhar, B. N. (2016). Current status of yoga in mental health services. International Review of Psychiatry28(3), 233-235.doi:10.3109/09540261.2016.1159950

 ., Reddy, F., Pilver, C., & Desai, R. (2012). The use of yoga in specialized VA PTSD treatment programs. International journal of yoga therapy22(1), 79-88. doi:10.17761/ijyt.22.1.v71h07m12412k218

Mental Illness. (2017, November). Retrieved February 8, 2019, from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

Park, C. L., Braun, T., & Siegel, T. (2015). Who practices yoga? A systematic review of demographic, health-related, and psychosocial factors associated with yoga practice. Journal of behavioral medicine38(3), 460-471. doi:10.1007/s10865-015-9618-5

Shannahoff-Khalsa, D. S. (2003). Kundalini yoga meditation techniques for the treatment of obsessive-compulsive and OC spectrum disorders. Brief Treatment and Crisis Intervention3(3), 369. http://access.portico.org/stable?au=pf10g1t6rf

Streeter, C. C., Gerbarg, P. L., Saper, R. B., Ciraulo, D. A., & Brown, R. P. (2012). Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Medical hypotheses78(5), 571-579. doi:10.1016/j.mehy.2012.01.021 

Varambally, S., & Gangadhar, B. N. (2016). Current status of yoga in mental health services. International Review of Psychiatry28(3), 233-235.doi:10.3109/09540261.2016.1159950

 

Lisa KanneComment