Monday, May 3, 2010

yoga and obsessive-compulsive disorder

Yoga and Obsessive-Compulsive Disorder

Megan Langelier

Yoga: Theory, Culture and Practice

April 5th, 2010

Professor Laura Douglass

Yoga has been shown to help many with relaxation and mind clarity, and is now being adapted as treatment for many different disorders. This paper is about the impact of yoga on people with obsessive-compulsive disorder. The techniques of Kundalini yoga have been proven to dramatically lower the scores on Yale-Brown Obsessive Compulsive Scale (Y-BOCS) tests given to those with obsessive-compulsive disorder. Yoga techniques are shown to not only help long term symptoms, but they also help as an immediate treatment for many.

Introduction

Obsessive-compulsive disorder (OCD) is an anxiety disorder that affects millions of people worldwide. It is the fourth most common psychiatric disorder, affecting about one in every fifty people, or 3.3 million adults in America (Health, 2010). There have been different methods of treating obsessive-compulsive disorder. Some of these methods include psychopharmacologic and cognitive-behavioral therapy; both of these methods require multiple meetings with a psychologist or psychiatrist, and the treatment can be expensive. David S. Shannahoff-Khalsa introduced yoga as a possible method for treating OCD in 1991. Since then, there have been several studies conducted on yoga as a treatment for anxiety disorders, specifically OCD (Shannahoff-Khalsa, 2003). A study was done and reported by Michalsen with women and anxiety, in which “women who participated in the yoga training demonstrated significant reductions in perceived stress, anxiety, fatigue and depression as well as increased will-being and vigor” (Field, 2009, p.63-64). “Conditions such as mixed anxiety and depressive disorder, generalized anxiety disorder, phobias, obsessive compulsive disorder, and panic disorder make up over 86% of neurotic disorders found” (Kirkwood, Rampes, Tuffrey, Richardson, & Pilkington, 2005, p.884). Yoga has been shown to be effective as a way to treat the many different psychological disorders, one being the obsessive-compulsive disorder, along with quickly alleviating the symptoms of those who try it.

What is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder is an anxiety disorder in which one has “unwanted, persistent, intrusive thoughts and impulses as well as repetitive actions intended to suppress them” (Barlow, 2005, G-10). The average age of onset for the disorder begins around age 19 (Health, 2010). Barlow states that, “It is not uncommon for someone with OCD to experience severe generalized anxiety, recurrent panic attacks, debilitating avoidance, and major depression” (Barlow, 2005, p.159). Since OCD may cause other disorders, it is heartbreaking to think about; and even harder to imagine, having this disorder. It can be debilitating on multiple levels, for it affects a person mentally, emotionally, physically and socially. A case study found in Barlow’s text about OCD tells about a young man named Richard who stopped taking care of himself because his rituals crippled him when he showered, shaved and washed. He would rarely leave his room. He could only eat certain foods because all other foods were considered contaminated (p.159). According to the DSM-IV, “obsessions and compulsions cause marked distress, are time consuming (take more than one hour per day), or significantly interfere with the person’s normal routine” (Barlow, 2005, p.160). Many who have OCD believe that something terrible will happen to them or their loved ones if they do not complete their rituals. Frequently seen compulsions consist of checking and rechecking locks, washing one’s hands, and walking in a certain pattern. Often, those with OCD cannot give a reason why they do what they do, but they feel compelled to do it.

How is OCD Viewed in Different Parts of the World?

Obsessive-compulsive disorder affects people of all different cultures. Some affected by OCD show specific cultural ties, such as ties to a culture’s religion. For example, “the religious connotation of obsessive compulsive disorder in Muslim culture is denoted by the term weswas, which refers to the devil as well as obsessions” (Pallanti, 2008, p.170). This shows that depending on where in the world one is, the disorder has different levels of acceptance and understanding. In America, there is a vast amount of research and information about the disorder, and thus there is a higher level of acceptance, but in Muslim cultures, OCD is linked with evil. Barlow discusses in his text how other cultures conceptualize OCD by stating:

“In Arabic countries, obsessive-compulsive disorder is easily recognizable, although as always cultural beliefs and concerns influence the content of the obsessions and the nature of the compulsions. In Saudi Arabia and Egypt, obsessions are primarily related to religious practices, specifically the Muslim emphasis on cleanliness. Contamination themes are also highly prevalent in India” (161).

Based upon that quote, one can think about how yoga would be able to help someone with OCD, for when they are practicing the poses, they are not consistently washing their hands, which is often done to avoid contamination.

Traditional Treatment of OCD

Obsessive-compulsive disorder treatments in the West include cognitive-behavioral therapy (CBT), psychopharmacology, and psychosurgery. Cognitive-behavioral therapy is a psychotherapeutic approach that focuses on goal-oriented, systematic procedures (Barlow, 2005). For someone with obsessive-compulsive disorder, this might involve someone making a list of alternative ways of getting ready in the morning. Instead of checking the mirror 4 times, washing one’s hands 6 times and brushing one’s teeth three times, they would write a list stating that they would do each thing one time less than normally until they get down to a regular ritual. Psychopharmacology refers to medication given to someone with a psychological disorder. In OCD, the most effective medications have been those that “inhibit the reuptake of serotonin, such as clomippramine or the SSRIs” (Barlow, 2005, p.162). The problem with using medication to treat OCD is that symptoms often present themselves again after discontinuing the medication (Shannahoff-Khalsa, 2004). Both of these treatments “lack as remedies for quick relief” (Shannahoff-Khalsa, 2003, p.370). Psychosurgery is neurological surgery for a disorder when all other remedies are not working (Barlow, 2005). For OCD, “most of [the] extremely severe cases who had failed to respond at all to either drug or psychological treatment [had] a very specific surgical lesion to the cingulated bundle” (Barlow, 2005, p.162). This shows how in Western culture, often if one cannot fix the problem with traditional measures, such as medication or traditional therapies, an invasive procedure is completed to try to repair the issue.

What is Kundalini Yoga?

Yoga was developed in India in approximately 3000 BC, the word yoga meaning “to yoke” or “to join together” in Sanskrit (Field, 2009). The western interest in yoga began sometime 150 years ago (Muskin, 2000). Writers such as Ralph Waldo Emerson and Henry David Thoreau were inspired by the Bhagavad Gita and began to share their interest in yogic philosophy (Muskin, 2000). In recent years, the popularity of yoga has increased, along with the number of studies completed about yoga. “Harvard cardiologist Herbert Benson, showed that meditation and breathing techniques for relaxation could have the opposite effect of stress, reducing blood pressure and other indicators” (Dupler, & Frey, 2005, pp.5). Kundalini yoga has been kept private for many years, and only in recent times has it been taught to the public. Yogi Bhajan, a master of Kundalini yoga, brought this style of yoga to the West in December of 1968 (Shannahoff-Khalsa, 2004). Since, he “has taught nearly 5,000 different meditation techniques, of which many have been taught that were known by yogis to be specific for distinct psychiatric disorders” (Shannahoff-Khalsa, 2004, p.91). Kundalini refers to untapped energy at the base of the spine, which can be drawn up through the body to awake each of the seven chakras (Trivieri, 2001). When one attends a Kundalini yoga class, it begins with a chant, followed by a warm-up to stretch the spine, followed by different asana poses which are done together with specific breaths which intensify the poses, then the class ends with a mediation (Muskin, 2005).

Kundalini Yoga for Obsessive-Compulsive Disorder

A Kundalini yoga class for someone who has obsessive-compulsive disorder has specific poses, which have been linked to helping with the disorder. Since someone who has the disorder may feel uncomfortable doing the poses standing, all the poses can be completed while sitting (Shannahoff-Khalsa, 2004). There are eight primary poses one completes, and three additional poses that one can add into their practice if they wish. The technique begins with bringing oneself into a meditative state. Shannahoff-Khalsa goes into great description for each of the poses, telling at what angle the hands should be at, and how much pressure one should be applying to hands and feet. This is helpful for those with obsessive-compulsive disorder, for they often need things to be described in great detail in order to know they are completing things the correct way. The second part of the practice includes spine flexing in order to stretch one’s spine for as long as desired, resting for a minute or two upon completion. Next, one performs shoulder shrugs for two minutes. The next part includes a meditation, which is a “technique for reducing anxiety, stress, and mental tension” (Shannahoff-Khalsa, 2004, p.375). This meditation differs from a more common mediation, for one focuses vision on their nose, opens the mouth, presses the tip of the tongue to the upper palate and breathes continuously through the nose for three to five minutes. The next technique involves holding the hands two inches apart in front of the heart, while tensing the body for ten seconds and letting the pressure go for up to fifteen minutes. This is another technique for reducing anxiety, stress and mental tension. After, one pulls their upper lip down while focusing on the tip of the nose in an attempt to move their nose, while holding their arms up. Shannahoff-Khalsa states that “this short exercise is claimed to be so effective that, if done correctly, it can relieve the most tense person” (2004, p.376). The next technique involves pushing on one’s navel and is done to manage fear. The eighth technique is specific for OCD and deals with yogic breath for obsessive-compulsive disorder. One blocks off the right nostril and one inhales slowly through the left nostril, holds the breath, and exhales through the same nostril. “Yogic experiments claim that 90 days of 31 minute per day, using the perfect rate of one breath per minute with fifteen seconds per phase, will completely eliminate all OC disorders” (Shannahoff-Khalsa, 2004, p.376). There are more techniques that one can add onto this, but these are the main eight.

Case Studies

Shannahoff-Khalsa completed two studies on the relationship of obsessive-compulsive disorder and yoga. One study was done in an uncontrolled trial, where five out of eight patients completed twelve months of practicing Kundalini yoga. The mean improvement for those in this case study was a 55.6% improvement on the Yale-Brown Obsessive-Compulsive Scale, also referred to as the Y-BOCS (Shannahoff-Khalsa, 2003). Before using the different Kundalini yoga techniques, those who participated in the study were “previously stabilized with fluoxetine (20-40 mg) for greater than three months prior to the start of the study” (Shannahoff-Khalsa, 2003, p.370). After doing yogic techniques, three out of the five participants who completed the study were completely medication free and the other two decreased their dosage by fifty percent (Shannahoff-Khalsa, 2003). This shows that yoga does help for most that try it; the degree to which it helps varies between individuals. Those who did not complete the study did not end their participation because there were not results, but due to pregnancy, scheduling conflicts and fibromyalgia (Shannahoff-Khalsa, 2003). This lead Shannahoff-Khalsa to complete a larger trial after such promising results on his first study.

The second study was done with a larger population, and compared the Kundalini yoga techniques against relaxation and meditative techniques. The trials were done with eleven adults and one teenager in one group and ten adults in the other, each with Y-BOCS scores that were around 23 out of 40, which is considered a moderate level (Shannahoff-Khalsa, 2004). “Seven adults in each group completed three months of therapy. Group 1 (Kundalini yoga) demonstrated greater and statistically significant improvements on the Y-BOCS” (Shannahoff-Khalsa, 2004, p.93). Since the first group had such success with the yogic practice, they had the second group practice yoga instead of doing purely relaxation and meditative techniques, to which the group’s Y-BOCS scores improved 44%. This shows that practicing yoga is most effective. Although both of the studies completed have been included extremely small samples, it is hopeful to see promising research to help those with obsessive-compulsive disorder that does not involve drug usage or surgery.

Testimonial

David Shannahoff-Khalsa included in one of his articles an experience a young woman in her twenties had when practicing Kundalini yoga. She stated, “The very first session that I had with David altered my experience of anxiety, so much that the rushing thoughts that seemed so constantly harrowing before had dissipated to a state of calm and relaxation” (2004, p.372). For those with obsessive-compulsive disorder, it is often hard to find peace when the obsessions are constantly present. She goes on to tell, “the OCD disappeared completely and the results again lasted for the remainder of the day” (p.372). She was then prescribed Prozac and said that the drug made her, “so completely anxious and depressed simultaneously, that I began to harm myself, by self-mutilating my arm” and “had a severely diminished interest in eating” (p.373). The girl stated that she “started losing weight and my mother began to question whether I was also becoming anorexic” (p.373). This shows how having obsessive-compulsive disorder is often comorbid with other disorders, whether it is depression to the point of self-mutilation or eating disorders. Hope was found for this case though, for she goes on to explain that, “on the first meeting, everything became manageable again. At this time I also gave up use of medication. The yoga put me in a state of balance, and gave me peace of mind… This all happened within a week of meeting with David and continuing to practice” (p.373). A specific testimonial such as this shows not only the scientific backing of the use of yoga as a treatment for obsessive-compulsive disorder, but it also can provide hope for those who may be in a similar situation as this young woman.

Conclusion

Yoga as a treatment for obsessive-compulsive disorder is showing very promising results. More studies with a great number of participants need to be completed in order to have more conclusive results. Based upon the case studies that have been completed, paired with testimonials given from people who do practice Kundalini yoga daily as their form of treatment, one may safely suggest this as an option to friends and loved ones they may know who have obsessive-compulsive disorder.


References

Barlow, D. H. (2005). Abnormal psychology: an integrative approach. Belmont, CA: Thomson

Wadsworth.

Dupler, D., & Frey, R. F. (2005). Yoga. (2005). The Gale encyclopedia of alternative medicine. Detroit, CO: Gale.

Field, T. (2009). Complementary and alternative therapies research. Washington, DC: American Psychological Association.

Health, G. (2010, April 28). Obsessive-compulsive disorder. Retrieved from http://www.wrongdiagnosis.com/o/obsessive_compulsive_disorder/stats.htm

Kirkwood, G., Rampes, H., Tuffey, V., Richardson, J., & Pilkington, K. (2005). Yoga for anxiety: a systematic review of the research evidence. British Journal of Sports Medicine, 39(12), 884-891.

Muskin, P. R. (2000). Complementary and alternative medicine and psychiatry. Washington

D.C.: American Psychiatric Press.

Pallanti, S. (2008). Transcultural observations of obsessive-compulsive disorder. American

Journal of Psychiatry, 165(2), 169-170.

Shannahoff-Khalsa, D. S. (2003). Kundalini yoga meditation techniques for the treatment of

obsessive-compulsive and oc spectrum disorders. Brief Treatment and Crisis Intervention, 3, 369-382.

Shannahoff-Khalsa, D. S. (2004). The Journal of alternative and complementary medicine. The

Journal of Alternative and Complementary Medicine, 10(1), 91-101.

Trivieri, L. (2001). The American holistic medical association guide to holistic health: healing

therapies for optimal wellness. New York, NY: John Wiley & Sons, Inc.

4 comments:

  1. Megan,

    I thought that your paper on yoga and OCD was very interesting. I liked how you gave a significant amount of background information including information about OCD, Kundalini yoga in particular, and the way Muslims treat people with OCD. One thing you said in your paper that really stuck with me was, "This shows how in western culture, often if one cannot fix the problem with traditional measures, such as medication or traditional therapies, an invasive procedure is completed to try to repair the issue." I think that this quote effectively sums up the difference between the western and eastern cultures when it comes to healing. The other point in your paper I found very interesting was that yoga was more effective for people with OCD than simple meditation and relaxation. I assumed that it would be the other way around.

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  2. This article was laid out very nicely. I thought that it was smart of the author to describe OCD and how different cultures view this disease first before getting into how yoga can help treat it. In a lot of the articles, the authors just delved right into yoga as treatment for the disease rather than explaining the disease and yoga separately. It is important to describe the disease and how it affects the body to give the reader some background information.
    Including a testimonial in the article also led me to believe that Kundalini yoga could really be an answer to OCD. Using a story about a real person instead of just case studies of anonymous "numbers" really helps the reader relate to what's going on in the article. Hearing a person's story is very effective in getting the message across and that was the case while reading this essay. I thought that the way this article was laid out was very effective and covered almost all questions that could've otherwise arisen.

    -Liz Affa

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  3. Yoga teaches practitioners that we are not our thoughts, we are not our beliefs, we are not our self-concepts. We are not what others think we are, we are not our bodies, etc. In anxiety, thoughts are overwhelming. Our realities can be based on what we think alone, and when thoughts are delusional and obsessive, reality is just that. Yoga and meditation has significantly improved my quality of life through this realization alone. I can really see how the philosophy of yoga and its embodiment through the asanas has the potential as a supplemental tool in treating obsessive compulsive disorder. Great paper, Megan.

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