Sunday, December 14, 2014

Yoga as an Alternative or Complementary Therapy in Treating Anxiety

Yoga as an Alternative or Complementary Therapy in Treating Anxiety

Daniela Velasco
Lesley University
Professor Douglass
Yoga: Theory, Culture, & Practice
December 3, 2014

This paper will examine the benefits of yoga as a complementary or alternative component of therapy for individuals suffering from anxiety and anxiety disorders. It is clear that yoga has been adopted worldwide for several reasons including self-care, to increase flexibility and physical activity and also as another form of therapy for a variety of psychiatric disorders such as anxiety, depressive disorders, and phobias. This paper will explore how different elements of yoga benefit as a complementary or alternative therapy for individuals with anxiety, as well as the best kinds of yoga to help treat this specific disorder.    
Recent studies have found that anxiety disorders are one of the most common psychiatric disorders in the U.S. (Bandelow, et al., 2014). In order to understand the etiology of anxiety disorders, it is extremely important to know about all of the contributing factors “that can dramatically affect the emotional consequences of traumatic and stressful life events [which] often [implicate] in the origins of anxiety disorders” (Mineka & Zinbarg, 2006, p. 11). For instance, individuals with generalized anxiety disorder (GAD) have been characterized by excessive worrisome about a series of events or activities for at least six months and the experience of worry is extremely difficult to control (Mineka & Zinbarg, 2006). This level of emotion usually arises from unpredictable or uncontrollable events which has a huge influence on the development of GAD (Mineka & Zinbarg, 2006). Essentially, individuals who experience anxiety – a defining feature in the DSM V, find worry to be particularly unenjoyable because they think of all the bad outcomes that may occur in a given situation which leads to negative intrusive thoughts and actually increases their anxiety (Mineka & Zinbarg, 2006).
    Anxiety’s prevalence is about 29% higher than all other psychiatric disorders in the U.S. (Sharma & Haider, 2012). Anxiety disorders are categorized into “panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety disorder, and generalized anxiety disorder” (Li & Goldsmith, 2012, p. 22). Mineka & Zinbarg’s article also addressed emotional factors that go into each of these different anxiety disorders such as excessive fear for extended periods of time (2006). Unfortunately, about 18% of Americans are affected by intense fear over an extended period of time in a given year (Li & Goldsmith, 2012). Furthermore, “they often arise in combination with other anxiety disorders, major depression, somatoform disorders, and addictive disorders” (Bandelow, et al., 2014, p. 473). Research by Li and Goldsmith found that, according to the U.S. National Institute of Mental Health, anxiety disorders are treated by pharmaceutical therapy, which “consists of benzodiazepines, beta-blockers, monoamine oxidase inhibitors, and antidepressants.” (2012, p. 22). Other forms of therapy used to treat anxiety disorders include counseling and hospitalization (Sharma & Haider, 2012). However, recent studies have been focused on finding effective alternative or complementary forms of treatments for different psychiatric disorders, including yoga and anxiety disorders.   
It is inevitable that yoga has an infinite number of definitions worldwide. However, the practice and word itself originated from India (Joshi & De Sousa, 2012). The word yoga comes from the Sanskrit root word “Yuj” which means to control or unite (Joshi & De Sousa, 2012). Yoga as a practice integrates physical and mental aspects of an individual through breathing techniques (pranayamas), postures (asanas), strengthening exercises (sithilikarana vyayama), and meditation (dhyana), (Li & Goldsmith, 2012). This scientific scheme was “designed to facilitate development and integration of the human body, mind, and breath to produce structural, physiological, and psychological effects” (Joshi & De Sousa, 2012, p. 3). The physiological effects include a strong and flexible body that is free of pain and a clear and calm mind (Joshi & De Sousa, 2012). In addition, the psychological effects that arise from a yoga practice facilitates “self transformation at every level of functioning, with the goal of improving the overall quality of life” (Joshi & De Sousa, 2012, p. 3).  
Yoga has been practiced for over 5,000 years in Eastern culture, but it has gained popularity in Western culture fairly recently (Li & Goldsmith, 2012). In the U.S., “the yoga market emerged as a 5.7 billion dollar industry in 2008, increase of 87% from 2004” (Li & Goldsmith, 2012, p. 21). The significant growth in yoga practice is associated in the treatment of mental and physical disorders such as bronchitis, chronic pain, and symptoms of menopause (Li & Goldsmith, 2012). Although there a several different kinds of yoga, the most popular one practiced in the U.S. is Hatha yoga, which incorporates asanas, pranayamas, and meditation to influence the physical and mental wellbeing of an individual (Li & Goldsmith, 2012). Hatha yoga is subdivided “into Iyengar, Kundalini, Bikram, Ananda, Vivnoya, and Anusara styles” (Li & Goldsmith, 2012, p. 21). For most people in the U.S. today, yoga is defined as a way to stay fit, strong, and flexible through different yoga practices. In eastern cultures, yoga is passageway to connect to your mind and body spiritually to reach eternal bliss and awareness of the self. Overtime, however, each culture has adopted each other’s views to enhance the overall yoga experience in order to meet each individual’s beliefs and needs.
In 2002, approximately 15.2 Americans adopted some form of yoga practice for health purposes (Li & Goldsmith, 2012). However, a news article published by the American Medical Association stated yoga practice as alternative therapy to be “unproven treatments” due to the invalidity in previous studies conducted (Li & Goldsmith, 2012). However, studies have found that the neurobiology of yoga can increase the gamma amino butyric acid (GABA), system activity in individuals with anxiety (Streeter, et al., 2010). Reduced activity in GABA systems has been found in mood disorders, anxiety disorders, and epilepsy (Street, et al., 2010). Furthermore, the physical symptoms of anxiety including a racing heart, sweating, tremors, palpitations, dry mouth, increased blood pressure, avoidance behavior and restlessness can slowly disappear through yoga as treatment for anxiety (Joshi & De Sousa, 2012). Previous studies demonstrated a 27% increase in GABA levels after a 60-minute yoga session, which was obtained utilizing magnetic resonance spectroscopy (MRS), (Streeter, et al., 2010).
According to Sharma and Haider’s research conducted to determine the effectiveness of yoga, with or without utilizing pharmaceutical therapy to treat anxiety disorders, between 2010 and 2012, 19 out of 27 studies showed a significant decrease in individuals with anxiety through yoga (2012). Moreover, two specific studies looked at efficacy of yoga and anxiety based on age alone. The first group was of 15 elderly aged 65-75 years old and the second group was 10 young adults aged 20-30 years old and they each practiced yoga for about 90 minutes 1 or 2 times a week for a month. The results of this study demonstrated “a statistically significant reduction in trait and state anxiety levels” (Sharma & Haider, 2012, p. 21). Therefore, it has been proven that yoga is being used as an alternative or complementary therapy because it does have physiological and psychological effects on the body such as lower blood pressure or heart rate, and increasing relaxation through awareness of the mind and body as one. 
It is clear that there are numerous yoga practices worldwide, but certain yoga types have been associated with better results in treating anxiety. For instance, Sahaja yoga meditation consists “of silent affirmations and breathing techniques [that] assist an individual to achieve a state of mental silence in which the entire attention is on the present moment and one is free from unnecessary mental activity” (Chung et al., 2012, p. 589). Individuals who practiced Sahaja yoga meditation treatment had a significant anxiety reduction (Chung et al., 2012). Furthermore, even children with deficit-hyperactivity disorder showed improvements in anxiety and self-esteem through Sahaja yoga meditation (Chung et al., 2012). Another study conducted by Eastman-Mueller et al., examined iRest yoga-nidra among college students to understand its effectiveness in reducing stress and anxiety (2013). iRest yoga-nidra involves yoga asanas to increase awareness of the body, pranayamas to enhance breathing and energy, and mindfulness meditation to increase awareness of emotions and thoughts (Eastman-Mueller et al., 2013). The results of this study demonstrated that iRest yoga-nidra intervention did, in fact decrease depressive symptoms, which helped reduce stress and worry – a large factor in anxiety disorders (Eastman-Mueller, et al., 2013).
Another yoga practice that benefits individuals with anxiety and anxiety disorders is known as Sudasharn Kriya Yoga (SKY). SKY breathing techniques includes Ujjayi or “Victorious Breath”, Bhastrika or “Bellows Breath”, Om chants 3 times with increased exhalations, and lastly Sudarshan Kriya or “Proper Vision by Purifying Action” (Brown & Gerbarg, 2005). These breathing techniques are extremely helpful in treating anxiety since often there is a loss of the control of the breath and SKY techniques restore that sense of control (Brown & Gerbarg, 2005). In addition, studies by Shannahof-Khalsa focused on Kundalini Yoga meditation psychiatric disorders such as obsessive-compulsive disorders; classified as an anxiety disorders, phobias, major depressive disorders and sleep disorders (2004). Essentially, Kundalini yoga meditation techniques have specific elements that reduce anxiety symptoms because it can “produce both quick temporary relief as well as long-term improvement and remission” (Shannahof-Khalsa, 2004, p. 92). Majority of Kundalini yoga meditation techniques required to be in a seated position on a chair with spine straight or on the floor with legs crossed in a comfortable position that allows “tuning in” into a meditative state (Shannahof-Khalsa, 2004). This meditative state “gives the experience of being in a ‘womb of healing energy’” (Shannahof-Khalsa, 2004, p. 93).
I found that there are several different yoga practices that are extremely beneficial in reducing symptoms of anxiety, which leads to an overall anxiety reduction in individuals. Each yoga practice has a different targeted goal and utilizes different elements of yoga to accomplish a relaxed, meditative state, pranayamas or innate energy that increases awareness of the mind, body, and spirit which benefits the overall wellbeing, mood, attention, mental focus and stress tolerance (Brown & Gerbarg, 2005). Although, it is important to keep in mind that yoga is in its practice and it requires consistency, commitment, and a positive attitude.   
It is without a question, that yoga has been found effective in treating psychological disorders such as anxiety. In fact, yoga as an alternative or complementary therapy is beneficial for individuals who suffer with anxiety who were unable to get treatment due to “high cost of most therapies, drug side effects, or physical ailments” (Sharma & Haider, 2012, p. 15). In addition, the elements involved in yoga promotes slow and deep breathing and increases oxygenation to relax the mind and the body (Sharma & Haider, 2012). It is a safe and effective practice that can even be done at home to reduce anxiety symptoms (Joshi & De Sousa, 2012). In my personal opinion, I recommend yoga to all individuals but even more to those suffering from stress, depression, muscle pain or tension, etc. because I understand how effective yoga is overall and it does not have any negative implications either.
On the contrary, there have been several limitations in research studies around yoga and psychological disorders. Some studies had errors in self-reporting such as inability to recollect practice duration and technique, as well as misdiagnosis of anxiety and anxiety variations among individuals making it difficult to assess the efficacy of yoga in treating anxiety disorder (Sharma & Haider, 2012). In addition, researchers have used different populations with different health issues and/or mental disorders which also makes it hard to compare and draw conclusions based on their data (Li & Goldsmith, 2012). Yoga as a practice is difficult to measure which is why further research is still needed in understanding its effectiveness among treating anxiety as an alternative or complementary therapy.
            Over the past few decades, yoga has been commonly practiced as a complementary component or alternative form of therapy.  In Western culture, however, there is the belief that if there is a problem, a solution is necessary. For instance, if we get flu-like symptoms, we immediately call our doctor to find out what exactly is wrong with us. However, yoga has existed for more than 5,000 years and it is hard to disregard it as effective (Li & Goldsmith, 2012).  Also, after learning the different purposes of the many different types of yoga, it is fundamental to find a yoga practice that works best in decreasing anxiety levels within a specific individual, since each experiences it differently. Based on this research, I believe yoga is still significantly effective on its own or as a complementary form of therapy. However, is it necessary to do further research to determine what specific yoga practices are most beneficial for individuals with anxiety. I also think it is also important to learn what practices may implicate symptoms of anxiety as well. Overall, yoga has positive and beneficial results for individuals with anxiety disorders and other stress-related symptoms and although research is still needed to support this theory, we should not disregard yoga practices as an alternative or complementary therapy. 

Bandelow, B., Lichte, T., Rudolf, S., Wiltink, J., & Beutel, M. E. (2014). The Diagnosis of and Treatment Recommendations for Anxiety Disorders. Deutsches Aerzteblatt International, 111(27/28), 473-III. doi:10.3238/arztebl.2014.0473
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. Journal of Alternative And Complementary Medicine (New York, N.Y.), 11(4), 711-717.
Chung, S., Brooks, M. M., Rai, M., Balk, J. L., & Rai, S. (2012). Effect of Sahaja yoga meditation on quality of life, anxiety, and blood pressure control. Journal of Alternative And Complementary Medicine (New York, N.Y.), 18(6), 589-596. doi:10.1089/acm.2011.0038
Eastman-Mueller, H., Wilson, T., Jung, A., Kimura, A., & Tarrant, J. (2013). iRest yoga-nidra on the college campus: changes in stress, depression, worry, and mindfulness. International Journal Of Yoga Therapy, (23), 15-24.
Joshi, A. & De Sousa, A. (2012). Yoga in the management of anxiety disorders. Sri LankaJournal 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.
Mineka, S., & Zinbarg, R. (2006). A contemporary learning theory perspective on the etiology of anxiety disorders: it's not what you thought it was. The American Psychologist, 61(1), 10-26.
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., & ... Jensen, J. E. (2010). Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. Journal of Alternative And Complementary Medicine (New York, N.Y.), 16(11), 1145-1152. doi:10.1089/acm.2010.0007


  1. If you are still interested in this topic you might want to read Amy Weintraub's book, Yoga for Depression which includes good information on anxiety as well as depression. she also has a program for yoga teachers called LifeForce Yoga, which trains teachers to use yoga for anxiety and depression. Just thought you'd like to know....

  2. Very true! Yoga can treat anxiety, it really helps in controlling our weight and helps in refresh yourself. I was very much interested in starting doing yoga then I called up my friend who shared with me best yoga video links. Now I am doing workout daily for at least 2 hours.