Monday, December 8, 2014

Yoga and OCD























Yoga and Obsessive Compulsive Disorder
Briana Karman
Lesley University
12/3/14





















Introduction

Obsessive Compulsive Disorder is a mental condition that affects approximately 3.3 million people in the United states alone. The Center for Addiction and Mental Health reports that OCD affects approximately 1 adult in 40, affecting men and women at an equal rate. About two-thirds of people with OCD develop the condition as adolescents or young adults (Hall, 2014). OCD  can be very debilitating, affecting peoples daily lives, jobs, and relationships. OCD is treated mostly through pharmaceutical drugs, but there has been more alternative research done to show that forms of yoga can be more effective compared to medications.

What is Obsessive Compulsive Disorder? 

OCD is an anxiety disorder that is characterized by unreasonable fears or thoughts, which is the obsessive part, that lead to repetitive behaviors, which are the compulsions. Obsessions are recurrent and persistent thoughts, impulses, images, or doubts that are intrusive or inappropriate and that cause anxiety or distress. Usually those suffering from the disorder try to ignore or suppress their obsessions or neutralize them with other compulsive thoughts or actions. Compulsions are repetitive behaviors, including mental acts, that a person performs in response to an obsession they are having (Pallanti, 2008). Around “80% of individuals who develop OCD show signs of the disorder in childhood, although the disorder usually develops fully in adulthood. Also, OCD is more common among people of higher education, IQ, and socioeconomic status” (Ulbricht, 2012).  According to Sigmund Freud, OCD develops in the anal stage of development which is when children are in the toilet training stage of life. Freud’s theory would back up the research of OCD showing signs and beginning during childhood.


OCD Cross-Culturally 

OCD has been studied in many different cultures and the symptoms of OCD often take on characteristics of the clients culture. For example, a correlation between compulsive ablution, poor insight, and religious rituals has been reported among Egyptian Muslims. If a certain culture practices certain rituals, it can be that those with OCD fixate on the specific rituals. In some cultures, it is thought that obsessive-compulsive traits can be manifested as “magical thinking,” a common mental technique for asserting control over the world through rituals. Magical thinking, an ancestor of science in most cultures, cognitively represents the concept of thought-action fusion. Japan’s isolation is reflected in its unique cultural institutions, which rely on highly ritualized ceremonies to regulate aggression in social interactions. It has been said that the Japanese have made courtesy a religion, as concern regarding negative social evaluation is much stronger in Japan than in Western cultures Despite these well-known cultural differences, the symptoms of obsessive-compulsive disorder in Japan are remarkably similar to those in other cultures. The information shows that even if someone is from a different culture, OCD looks similar cross-culturally, even if the symptoms are a bit different, like fixating on rituals. In an article about transcultural observations about OCD, the results suggest that obsessive-compulsive disorder is more deeply embedded in common neurobiology than in cultural differences (Pallanti, 2008). 
Another article suggests that the role of religious upbringing has been evident in the phenomenology of OCD in Egypt. There is a strong “emphasis on religious rituals and the warding-off of blasphemous thoughts through repeated religious phrases could explain the high prevalence of religious obsessions and repeating compulsions among our Egyptian sample” ( Okasha, 2004). This is true even if the participants in the study were not practicing their religious duties. Muslims make up most of the Egyptian population and are required to pray five times a day. Each prayer has to do with a ritual cleansing, which involves washing several parts of the body in a specific order, each three times. There is a strong emphasis on cleanliness or ritual purity which is the compulsive part to the rituals. “Other evidence of the religious connotation inherent in OCD in Muslim culture lies in the term weswas. This term is used in reference to the devil and, at the same time, is used as a name for obsessions” (Okasha, 2004). This all would seem like very extreme behavior in most places especially in the United States, and someone would assume that the person practicing this routine would have OCD. Even religious rituals can increase obsessive-compulsive behaviors. The rest of the population in Egypt is made up of Christians, who had similar obsessions surrounding religion, however there was a difference in what the specific rituals were. 
A study performed in India found that only 0.6% of the population suffered from OCD, compared to the 2-3% rate reported in the European and North American studies. The study compared 200 “obsessionals” with 200 controls and reported a high rate of family history of obsessional illness and premorbid obsessional personality. Another interesting fact about this article was that “increased levels of serum immunoglobulins were found in OCD subjects as compared to normal controls, with specific reference to IgG. The IgG levels were high even after clinical improvement. The authors speculated that the immunological abnormality could be a marker of vulnerability to OCD” (Khanna, 2010). It is very interesting to me that people with a lower immune response typically are more vulnerable to OCD. It makes sense because if someones body isn’t as healthy as it could be, that would also influence the state of mind since the mind and body are connected. It was proven in this study that obsessions were less frequent compared to compulsions. “Obsessions of harm, religion, and impersonal images were commonly reported. Washing, praying, touching, counting and spitting were the common compulsions”(Khanna, 2010). Both studies from India and Egypt show that there is a large religious component. The different cultures (Egypt and India) both are showing very similar results with OCD, especially around religion, and saying that their results are similar to most cultures.


Yoga as a Treatment for OCD

There is lots of research that proves yoga to be a powerful treatment for OCD. A study by the Dev Sanskriti University in Haridwar, India, found that a combination of yoga, pranayama, and chanting is an effective way to help OCD symptoms. The “study had sixty patients with OCD and they practiced twenty minutes of yoga per day. Ten minutes of pranayama and ten minutes of chanting the Gayatri mantra, which is a vedic sanskrit verse. The study found that after 45 sessions, the patients OCD symptoms were reduced” (Unknown Author, 2012). This holistic approach is based off of psychology and yoga.
Yogi Bhajan is a master of Kundalini yoga. He learned a Kundalini yoga breathing technique specific for the treatment of OCD. OCD can be very difficult to treat, However, Kundalini yoga can be used for temporary relief as well as long-term relief. “Two year-long clinical trials have been conducted to test the efficacy of Kundalini yoga meditation techniques for the treatment of OCD. The first trial was an open uncontrolled pilot and the second was a randomized controlled trial. The first trial was conducted in an attempt to test a technique that was claimed by yogis to be specific for the treatment of OCD (Shannahoff-Khalsa, 1991). The second trial was conducted to include a comparison meditation group using the well-studied Relaxation Response technique along with mindfulness meditation” (Shannahoff-Khalsa, 2004). The Kundalini participants exhibited improvements on their Y-BOCS scores. The authors concluded that Kundalini yoga holds great promise in treating OCD (Shannahoff-Khalsa, 2004). Kundalini yoga strives to raise “dormant energy” through sequences that combine physical exercises, meditation and structured breathing techniques. “Citing Yogi Bhajan, who introduced Kundalini yoga to the West in 1969, Shannahoff-Khalsa wrote that practicing this technique for a maximum of 31 minutes a day for 90 days, at a rate of one breath per minute, will eliminate obsessive-compulsive behaviors” (Hall, 2014).
People must tune into their inner selves before the start of a Kundalini yoga practice which helps them get into a mindful state. “A mantra is chanted out loud in a 11/2 breath cycle. Inhale first through the nose and chant Ong Namo with an equal em- phasis on the Ong and the Namo. Then immediately follow with a half-breath inhalation through the mouth and chant Guru Dev Namo with approximately equal emphasis on each word. The practitioner should experience the vibrations that these sounds create on the upper palate and throughout the cranium while letting the mind be carried by the sounds.Spine flexing for vitality is the second technique. The mental focus is kept on the sound of the breath while listening to the fluid movement of the inhalation and exhalation. Begin the technique slowly while loosening up the spine. Eventually, a rapid movement can be achieved with practice, reaching a rate of 1–2 times per second for the entire movement.Shoulder shrugs for vitality: technique 3 in the OCD Kundalini yoga protocol
While keeping the spine straight, rest the hands on the knees if sitting in a cross- legged position  or with hands on the thighs if on a chair. In-hale and raise the shoulders up toward the ears, then exhale, letting them down. All breathing is only through the nose. Eyes should be kept closed and focused at the third eye. Mentally listen to the sound of the inhalation and exhalation.
A secure plug can also be used for the right nostril. Inhale slowly and deeply through the left nostril, hold in long, ex- hale out slowly and completely through the same nostril only (left nostril), hold out long. The mental focus should be on the sound of the breath” These descriptive techniques of Kundalini yoga come from Shannahoff-Khalsa’s article “An Introduction to Kundalini Yoga Meditation Techniques That Are Specific for the Treatment of Psychiatric Disorders” (Shannahoff-Khalsa, 2004).
Along with Shannahoff-Khalsa’s research, “Researchers at UCLA developed a yoga breathing technique which reportedly reduced some forms of OCD by 70% or more. The technique involves closing off the right nostril and breathing through the left (both inhalation and exhalation) for approximately 30 minutes per day. The positive effects were seen over six to twelve months of daily practice”(Komor). The results with yogic practice is very promising. Yoga is prescribed additionally to medication because there are no side effects. Our Mind is very strong and can control our body and certain outcomes, which means people must want to help themselves get better. The “yogic method teaches one to train the mind. The truth is – we all have fears and intrusive thoughts. Therapeutic forms of Yoga teach us to prioritize and eliminate intrusive thoughts” (Unknown Author, Yoga for Obsessive Compulsive Disorder). If we have the tools to change our thought patterns, we can take better control of our minds. Kundalini yoga is beneficial because instead of sitting in silent meditation, people are focused on breathing and other practices where your mind needs to be focused in order to succeed, which limits the intrusive and obsessive thoughts.

Personal Experience with OCD and Treatments

Some of the most popular treatments for OCD are antidepressants and behavioral therapy. I know from personal experience that medication can lessen the symptoms of OCD, but it never makes it completely vanish or gets to the root of the problem. Therapy can help to an extent, but I believe for myself that the strongest way to reduce symptoms is to try and retrain my brain through meditative yoga practices. Another complicated part about medication is that it can stop working and people become dependent on it. If I were to come off my low dose of medication right now, my symptoms would most likely resurface immediately. I have started on a low dose of medication and then have to increase the dose after a period of time because it stops working. It is said that “OCD is classified as an anxiety disorder, but its rate of symptomatic response to medication is much slower than other anxiety-related disorders. In addition, “40%–60% of patients exhibit only minimal improvement or no change with serotonin re-uptake inhibitors alone. Discontinuation of pharmacologic treatment is, however, almost always associated with a complete relapse” (Shannahoff-Khalsa, 2004). Pharmaceutical drugs are not the best solution, because if the drugs disappeared people would have limited ways to cope with their OCD. 
Practicing retraining your brain and thoughts through meditation, on top or without medication, could give people a higher chance of getting rid of symptoms. I know for me personally, since I started yoga and yogic breathing, it has helped me tremendously with my OCD. practicing yoga forces you to be in the present moment concentrating on your body and breath, instead of my mind drifting off to my obsessive thought patterns. Paying attention to the present moment, which is crucial while practicing yoga, helps me the most with my OCD symptoms.

Conclusion

  For the most part, OCD looks the same no matter what culture you are in. The obsessions and compulsions can be different depending on culture, but the illness has the same roots no matter what culture. It is interesting to see how treatments can vary throughout the world and how successful the practice of yoga can be as a treatment for OCD. The yogic meditations reduce anxiety in people, which lowers their compulsions. From my own personal experience and from the research, it is proven that yoga is a more effective treatment for OCD compared to medications. More studies have to be done, but the studies that have been completed this far show lots of potential and promise to use yoga as a serious treatment method for OCD.


Resources: 


Author Unknown, (2012, December 30). Yoga can tackle psychological disorders. Retrieved from: http://zeenews.india.com


Hall, S, (2014, February 7). Kundalini Yoga for OCD. Retrieved from: http:// www.livestrong.com/  


Khanna, S., Rao, N., Reddy, J. (2010). An overview of Indian research in obsessive compulsive disorder. Indian Journal of Psychiatry, 52(1). doi: 10.4103/0019-5545.69233


Komor, C. Comprehensive Treatment for Primarily Obsessional OCD. Retrieved on November 29, 2014 from: http://www.ocdrecoverycenters.com

Okasha, A, (2004, April 15). OCD in Egyptian Adolescents: The Effect of Culture and Religion. Retrieved From: http://www.psychiatrictimes.com 


Pallanti, S. (2008). Transcultural Observations of Obsessive-Compulsive Disorder. The American Journal of Psychiatry,165(2). doi:10.1176/appi.ajp.2007.07111815.




Shannahoff-Khalsa, D. (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), pp. 91–101. www.web.a.ebscohost.com


Smith, P, (2011). Obsessive Compulsive Disorder OCD. Retrieved from: http:// www.balancingbrainchemistry.co.uk 


Sirnivasan, (2011). Review of Kundalini Yoga Meditation for Complex Psychiatric Disorders. Journal of Alternative and Complementary Medicine, 17(9), pp. 875-876. doi: 10.1089/acm.2011.0401



Ulbricht, C, (2012, May 15). Alternative Therapies for OCD. Retrieved from: http://www.psychologytoday.com


Yoga for Obsessive Compulsive Disorder. Retrieved November 29, 2014, from: http:// www.wellnessyoga.cz

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