Wednesday, December 5, 2012

The Effectiveness of Yoga on Anxiety Disorders


The Effectiveness of Yoga on Anxiety Disorders
Katie McCarthy
Lesley University


Introduction
            Anxiety in the United States has consistently become more and more prevalent as a pathological disorder.  Its prevalence is among the highest of all psychiatric disorders in the U.S. at about 29% (Sharma & Haider, 2012).  An anxiety diagnosis is commonly a comorbidity to several other disorders (Sharma & Haider, 2012), which is the likely cause of the high rates of anxiety disorders.  Anxiety disorders are “subdivided into panic disorder, obsessive-compulsive disorder, phobias, and generalized anxiety disorder” (Li & Goldsmith, 2012, p. 22).  This research paper was originally going to focus on obsessive-compulsive disorder, but because of the lack of research available, I have broadened my topic to include anxiety disorders collectively.
            Forms of therapy used to control or treat anxiety “include hospitalization, prescription drugs, and counseling” (Sharma & Haider, 2012, p. 1).  However, there has been increasing interest in alternative and complementary forms of treatment for psychiatric disorders.  Yoga has been previously used to lower heart rate and blood pressure, thus it could be a good alternative for individuals suffering from anxiety disorders (Sharma & Haider, 2012).  In Western culture, the type of yoga used is mainly Hatha Yoga (Joshi & De Sousa, 2012), though “many of the yoga interventions used in research studies also include breathing exercises, concentration and awareness meditation” (Bonura, 2011, p. 132). 
            According to Li & Goldsmith (2012), “In America, the yoga market emerged as a 5.7 billion dollar industry in 2008” (p. 21).  Yoga’s increasing popularity and “emphasis on a spiritual connection between mind and body” (Li & Goldsmith, 2012, p. 21) makes it a reasonable treatment for mental disorders like stress and anxiety.  In an article focusing on the psychological benefits of yoga for older adults, the author notes that “yoga is free from the stigma of medical care, this yoga is particularly appealing to older adults with cultural and personal beliefs that create resistance to medical treatment, especially for psychological issues” (Bonura, 2011, p. 129).  Though this article is specific to the older adult population, it suggests that individuals in the Western society may prefer alternative forms of therapy as opposed to the more medical types of treatment.
Techniques and Interventions
            The entire point of yoga is in its practice.  Yoga, according to Sharma & Haider (2012), “is most notably specified as a mind-body therapy composed of various breathing and relaxation techniques, including meditation, postures, and phrase recitation to improve physical and mental illness” (p. 6).  There are multiple types of yoga that meet specific needs.  The practices are “intended to facilitate self-transformation at every level of functioning, with the goal of improving the overall quality of life” (Joshi & De Sousa, 2012, p. 3).  The theory behind yoga is about developing and integrating the human body, mind, and breath “to produce structural, physiological, and psychological effects” (p. 3). 
            Shannahoff-Khalsa (2003, 2004) has spent a significant amount of time studying Kundalini Yoga Meditation Techniques for individuals with obsessive-compulsive disorder and other obsessive-compulsive spectrum disorders.  In one of his articles, he discusses Kundalini Meditation and chanting techniques for OCD, phobias, learning disorders, sleep disorders, addictive disorders, depression, and grief (Shannahoff-Khalsa, 2004).  For each disorder, disease, etc., he provides specific techniques that originate from Kundalini Yoga theory.  A majority of the techniques used in two of his articles can be performed sitting in a chair (Shannahoff-Khalsa, 2003), making the techniques accessible for many different populations.  According to Russell (2008), who reviewed one of Shannahoff-Khalsa’s books, “a constant across all successful use of Kundalini Yoga Meditation was the commitment to practice by the individual” (p. 221).  In my opinion, this is the case for any yoga practice.  In order for the practice to be beneficial in any way, there needs to be some consistency and commitment.  It can be difficult to keep a practice, but it is necessary to see any long-term positive effects.  Some of Shannahoff-Khalsa’s techniques for people with OCD and anxiety include “tuning in” (p. 221), spine flexing and shoulder shrugging, and various breathing exercises.  While reading each of the techniques, I was tempted to try them.  The titles of each technique sound effective and empowering.  I wondered how effective they were or if each title was made to sound appealing and marketable.  From my own experience, though, making simple adjustments in a seated position and tuning in to a meditative state can have immediate positive effects.
            Another common form of yoga that is used for treating anxiety disorders is Sudararshan Kriya Yoga (SKY).  In the treatment of anxiety disorders, SKY breathing techniques are commonly used (Brown & Gerbarg, 2005).  Breathing is a vital part of being alive.  Four of the breathing techniques used in SKY are the Ujjayi breath, also called victorious breath or ocean breath; the Bhastrika breath, or bellows breath; Om; and Sudarshan Kriya, or proper vision by purifying action (Brown & Gerbarg, 2005).  The breath is present in every kind of yoga practice.  When it comes to anxiety, the breath may become shallow.  Therefore, breathing “may be useful for restoring a sense of control when an individual is confronted by an anxiety-inducing trigger” (Bonura, 2011, p. 130).
Research Studies
            Yoga is effective in its practice, but in order for it to gain proper recognition as an alternative therapy, research is needed.  In the United States, healthcare providers “have not endorsed yoga as an alternative therapy.  This was typified in a recent news item, published by the American Medical Association, in which yoga practice is included in a list of alternative therapies referred to as ‘unproven treatments’” (Li & Goldsmith, 2012, p. 21).  Recently, there has been more attention surrounding the effectiveness of yoga with psychiatric disorders. 
Several studies are composed of systematic reviews of research done in the past.  In a majority of the studies looked at, there is evidence of significant increases in brain GABA (gamma amino butyric acid) levels after a yoga session in experienced yoga practitioners (Joshi & De Sousa, 2012, p. 4), which helps in relieving anxiety (Sharma & Haider, 2012).  Experienced yoga practitioners also have lower mental health disturbances than short-term yoga practitioners (Joshi & De Sousa, 2012).  Across almost every study examined, researchers found that yoga intervention is really only effective in treating or lowering levels of anxiety when practice is regularly implemented for two or three months, and found that yoga intervention may be more effective with the use of an instructor as opposed to a home practice (Sharma & Haider, 2012).  Regular yoga practitioners have also been found to have lower levels of cortisol, a stress hormone, in saliva samples (Bonura, 2011).  Specific types of yoga that have been observed in the use of treating anxiety disorders include Iyengar Yoga, Sudarshan Kriya Yoga, Yoga Nidra, Hatha Yoga, and other unspecified yoga techniques (Sharma & Haider, 2012). 
Consistently, yoga has been known to decrease stress, “especially through the use of rhythmic breathing techniques, allowing its benefits to cross many cultural and regional boundaries, although its origins are in India” (Sharma & Haider, 2012, p. 6).  Yoga has been adapted in Western culture because of its universal techniques.  Yoga has a high potential for reducing stress-related symptoms, and “the National Institutes of Health recommend meditation over prescription drugs as the preferred treatment for mild hypertension in 1984” (Bonura, 2011, p. 130).  Many of the studies have been careful to conclude that the research evidence simply supports yoga as a “safe and effective method” (Joshi & De Sousa, 2012, p. 7) in treating anxiety disorders.  Each study done on the effectiveness of yoga on levels of anxiety supports the suggestion that yoga be considered as a complementary therapy (Joshi & De Sousa, 2012). 
Although there have been several studies on the benefits of yoga on anxiety disorders, there are some drawbacks.  Because the yoga practice can be difficult to measure, Yogi Bhajan says, “It may take centuries before medical science will understand” (Russell, 2008, p. 222) the effects of yoga, specifically Kundalini Yoga Meditation.  In an effort to recognize the significant benefits yoga has on anxiety and stress, Li & Goldsmith (2012) look at the research done in the past, but found that “the data regarding the usefulness of Yoga and meditation in the short-term reduction of anxiety are inconsistent” (p. 27).  They observed that the studies were weak, although the studies do hold some validity.  They noticed that many of the anxiety levels and perceived stress was measured using scores from questionnaires, some of which were created by the researchers themselves and therefore not necessarily valid (Li & Goldsmith, 2012).  In a recent study comparing the effects of yoga versus walking on anxiety and mood, “yoga intervention was associated with greater improvements in mood and decreases in anxiety…compared to the metabolically matched walking intervention” (Streeter, et. al., 2012, p. 1150), but then discusses the limitations in the study including sample size among others.  Finally, there are those who suggest that, “yoga has valuable effects, but that it does not have any unique value” (Watts, 2000, p. 73).  In other words, practicing yoga is effective in decreasing levels of anxiety, but Watts (2000) does not necessarily believe that yoga’s effectiveness is any different from other forms of treatment. 
Conclusion
            In the past few decades, yoga has become a preferred form of alternative or complementary therapy.  The Western culture is very pathologically based, and if there is a problem then there must a solution.  As a society we have taken yoga’s theory and shifted it into our own form of healing: Kundalini Yoga becomes a meditative technique as opposed to a recoiling of energy in the lower chakras is just one example of how we take the original practices and form it into something that is useful for us. 
            Yoga has been around for so long that it is hard to disregard it as effective.  However, with the many different types of yoga, it is important to know which type works best in decreasing anxiety levels.  More research needs to be done on its effectiveness in lowering levels of anxiety and increasing overall wellbeing.  I also believe more research needs to be done on specific anxiety disorders and which yoga technique is most effective.  The kind of research that needs to be done is thorough, valid research (Li & Goldsmith, 2012) that is reliable and re-testable.  However, even though these specific studies have weaknesses and limitations, they do suggest that yoga may improve anxiety symptoms and stress (Li & Goldsmith, 2012). 
            My final thoughts surround the idea of yoga being effective on its own or alongside other forms of therapy (Sharma & Haider, 2012).  This has been mentioned in several of the studies cited in this paper, but no real conclusions were made.  In some cases, participants began the study on medication and by the end were completely off medication or had decreased medication significantly.  It is unclear, though, if this is because of comorbid diagnoses or as a result of the yoga treatment.  I hope that in further research we can draw some valid conclusions that have been so evident in individual case studies over the years but do not necessarily have the empirical data to back it up.  Overall, yoga has positive and beneficial results for individuals with anxiety disorders and other stress-related symptoms.  

References
Bonura, K. B. (2011). The psychological benefits of yoga practice for older adults: Evidence and
guidelines. International Journal of Yoga Therapy, 21, 129-142.
Brown, R. P. & Gerbarg, P. L. (2005). Sudarshan Kriya yogic breathing in the treatment of
stress, anxiety, and depression: Part II—Clinical applications and guidelines. The Journal
of Alternative and Complementary Medicine, 11(4), 711-717.
Joshi, A. & De Sousa, A. (2012). Yoga in the management of anxiety disorders. Sri Lanka
Journal of Psychiatry, 3(1), 3-9.
Li, A. W. & Goldsmith, C.W. (2012). The effects of yoga on anxiety and stress. Alternative
Medicine Review, 17(1), 21-35.
Russell, T. A. (2008). Kundalini yoga meditation (KYM): Techniques specific for psychiatric
disorders, couples therapy and personal growth [Review of the book Kundalini yoga
meditation (KYM): Techniques specific for psychiatric disorders, couples therapy and
personal growth by D. S. Shannahoff-Khalsa]. Journal of Mental Health, 17(2), 221-222.
doi: 10.1080/09638230701677829
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(3), 369-382.
Shannahoff-Khalsa, D. S. (2004). An introduction to kundalini yoga meditation techniques that
are specific for the treatment of psychiatric disorders. The Journal of Alternative and
Complementary Medicine, 10(1), 91-101.
Sharma, M. & Haider, T. (2012). Yoga as an alternative and complementary therapy for patients
suffering from anxiety: A systematic review. Journal of Evidence-Based Complementary
& Alternative Medicine, 1-8. doi: 10.1177/2156587212460046
Streeter, C. C., Whitfield, T. H., Owen, L., Rein, T., Karri, S. K., Yakhkind, A., Perlmutter, R.,
Prescot, A., Renshaw, P. F., Ciraulo, D. A., & Jensen, J. E. (2012). Effects of yoga versus
walking on mood, anxiety, and brain GABA levels: A randomized controlled MRS study.
The Journal of Alternative and Complementary Medicine, 16(11), 1145-1152. doi:
10.1089/acm.2010.0007
Watts, F. (2000). Psychological research questions about yoga. Mental Health, Religion, &
Culture, 3(1), 71-83.

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