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

ABSTRACT

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.    

INTRODUCTION: UNDERSTANDING ANXIETY & ANXIETY DISORDERS

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.   

DEFINING YOGA AS WE KNOW IT

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.

YOGA AS A COMPLEMENTARY OR ALTERNATIVE TREATMENT

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. 

BEST YOGA PRACTICES FOR ANXIETY

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.   

DISCUSSION

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.

CONCLUSION

            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. 

References

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

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.

Retrieved from: http://beyondocd.org/ocd-facts.

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

Yoga on the Wii Fit Used for Encouraging Regular Physical Activity in the Home By Jeffrey Clement

Yoga on the Wii Fit Used for Encouraging Regular Physical Activity in the Home

Yoga: Theory, Culture, and Practice

Jeffrey Clement

INTRODUCTION

The Wii Fit created by Nintendo was released over five years ago as a means for anyone to improve their basic fitness, overall health and well-being right at home. On December 1st, 2012 the Nintendo Wii Fit gaming system celebrated its fifth anniversary. The Wii Fit is perceived as an innovative system because it consists of game software that encourages participants to exercise. The main tool of the Wii console that motivates individual to exercise, strength train and improve posture and balance is the specially developed Wii Fit balance board controller (Goble, 2014). The Wii Fit is widely available commercially because it is relatively inexpensive. It is also user friendly and can be used by virtually anyone in any home. Some even consider the application and use of the Wii Fit by the elderly as an option for improving balance and preventing fatal falls (Franco et al., 2012). The Wii Fit is designed to promote balance and physical activity through interactive exercise games. Wii Fit has over forty exercise options that incorporate strength training, balance training, aerobics and yoga. Some examples of the yoga poses available on the Wii Fit are Deep Breathing, Warrior pose, Tree pose and Triangle pose (Plow, 2011). According to the American College of Sports Medicine, it is recommended that vigorous aerobic training should be performed for about twenty to sixty minutes every day. Currently, “only a few studies have tested actual energy expenditure of children and adults playing the games,” but yoga and other exercises on the Wii Fit may be an effective way to encourage regular physical activity. The general finding of the research is that “the energy requirements of playing the games are comparable to moderate exercise” (Brettler et al., 2011). Many “studies have used Wii Fit yoga games to improve participant balance” for a variety of populations and ailments. Yoga on the Wii Fit by Nintendo improves posture and general health because the yoga poses rely on static balance control. Examples of Wii Fit yoga poses that emphasize posture and balance are the Sun Salutation and Half Moon poses (Goble, 2014). Despite a broad mission of increasing regular physical fitness, the Wii Fit has generated specific interest in rehabilitation as a training device for improving posture, health and balance ability. Growing interest in Wii Fit technology is “likely due to the ubiquitous nature of poor balance and catastrophic falls, which are commonly seen in older adults and various disability conditions” (Goble, 2014). Yoga on the Wii Fit is an impeccable tool to utilize in order to improve personal fitness and balance. Yoga on the Wii Fit may have more implications in society than encouraging basic fitness for everyone, yoga on the Wii Fit may also have the potential to improve the health and well-being of disabled populations such as the elderly.

WII FIT YOGA VS. TRADITIONAL YOGA PRACTICE

               Yoga on the Wii Fit is a very different experience than doing yoga within a yoga studio. When doing yoga on the Wii Fit, participants are led by a virtual trainer on the television screen. When beginning yoga on the Wii Fit, one has the option to choose a male trainer with a male voice to be projected on the screen or a female trainer with a female voice. The selected yoga trainer demonstrates a certain body position that participant must then also achieve. Once the participant is in the posture being displayed on screen, the yoga trainer provides feedback in real-time based on calculation about the participant’s balance on the Wii Fit balance board. The participant’s “goal is to keep their body as still as possible while maintaining the yoga pose” (Goble, 2014). Another unique feature of yoga on the Wii Fit that is not present within a yoga practice at a studio is the opportunity to create an avatar, or a Mii, which looks like the participant and personifies similar motions as the participant. The movements from all the controllers translate to the movement of the Mii in the games. That is, the Wii calculates input from the controls at the participant’s hands and feet. These controllers consist of the Wiimote, Nunchuks, and the Wii Fit balance board (Brettler et al., 2011). Yoga on the Wii Fit is similar to an actual video game in the way one earns points and unlocks new levels based on the amount of time played or once proficiency is achieved (Brettler et al., 2011). 

               The chief goal of yoga on the Wii Fit is modeling the ideal movement of the virtual yoga trainer on screen. Scoring is based on a star rating system and is typically rewarded for stability. There are many exercises present on the Wii Fit that use the Wiimote and the Fit balance board. The yoga poses are supposed to improve one’s flexibility, stability, strength and breathing. In addition to yoga poses, there is the option to do other exercises such as balance games (Brettler et al., 2011). One of the most challenging yoga poses that takes many Wii Fit Credits to unlock is the Bridge pose. In the Bridge pose, the player lays on their back. Following the instructions of the yoga trainer on screen, the player then executes and maintains bridge position (Brettler et al., 2011). The first and simplest yoga pose available on the Wii Fit is the Deep Breathing exercise. While standing will flat and parallel feet on the Wii Fit board, the participant performs deep breathing with the palms on the abdomen below the belly button and while maintaining stability. The participant can monitor their stability by maintaining a red dot on screen within the yellow circle provided.  The red dot mirrors the player's real time position (Brettler et al., 2011). The Downward Facing Dog position begins on with both hands on the Wii Fit board. Then the player brings their hips up, extends their knees and arms and looks towards the floor. Similar to Deep Breathing, the player must try to maintain the red bar within the blue target area (Brettler et al., 2011). Half Moon pose is another pose where the player must standing on the Wii Fit balance board. Then they must bend from side to side with arms overhead and palms together while also maintaining stable. Again, the main goal is to maintain the red dot in yellow circle. The Sun Salutation pose, with arms extended overhead and palms together, is supposed to be performed while maintaining the red dot in the yellow circle (Brettler et al., 2011). Triangle pose, performed by standing on the Wii Fit balance board, asks the participant to rotate at the hip with the feet spread apart and parallel. Next, the participant is supposed to flex at the hips, placing and maintaining weight on front leg, bringing back arm and reaching towards the ceiling. Finally, the participant must hold this position while keeping the red bar in the blue target area. Then the triangle pose is repeated on the opposite side. Warrior is the final yoga pose that emphasizes posture and balance. The player must lean forward, placing and maintaining weight on their front leg so the red bar stays within the blue target area. This pose is also repeated on opposite side (Brettler et al., 2011). Although all of the poses available for practice on the Wii Fit are also popular in yoga classes in a yoga studio, the emphasis on balancing one’s center of pressure in a blue target area projected on a television is a vastly different experience not found in any yoga studio. 

One of the most alarming differences between yoga on the Wii Fit and traditional yoga within a studio is the direction and attention of one’s gaze. In a traditional, yoga practice, participants typically soften the gaze or focus on one steady point to find stability and center within. When practicing yoga on the Wii Fit, however, it is necessary to look at the television screen and monitor the stability of a red dot. In some poses, the body position does not allow “the players to actually see the visual information displayed on the screen. Typically, this occurs because the movement requires that they lose sight of the screen for at least part of the time” such as forward bending during Sun Salutation pose (Brettler et al., 2011). It’s also important to note the sensitivity and calibration of the Wii controls. If the Wii Fit balance board, for example, is not calibrated correctly, then the participant’s balance, focus, and proper execution of the pose may be effected. The Wiimote is more sensitive to “acceleration over movement direction or amplitude… [this] suggests that the upper extremity trajectories would prompt individuals to make rapid and potentially inaccurate movements and still be rewarded by the system” (Brettler et al., 2011). This type of error does not exist in traditional yoga practices within a studio due to the presence of an actual yoga instructor.

FITNESS

According to Nintendo, “the purpose for developing the Wii Fit was to combine fun and fitness for all ages, including such aspects of physical well-being as joint flexibility, muscle strength, and upright standing posture” (Goble, 2014). In addition, the Wii Fit system is easy to access because it is relatively inexpensive and it is highly engaging (Goble, 2014). Some of the interactive features of the Wii Fit include encouragement for participants to set health-related goals, rewards for regular use of the machine, and promotion of maintaining physical activity (Plow, 2011). The main fitness feature of yoga on the Wii Fit is the body test program. The body test program evaluates the player’s weight and balance in order to set a weight-loss or weight-gain goal (Plow, 2011). During the body test on the Wii Fit, participants stand still on the Wii Fit balance board for seven seconds while data is collected. From this data, the participant’s average center of balance “from body midline is calculated, indicating a measure of weight bearing asymmetry. Overall, this assessment is thought to provide information about body posture” (Goble, 2014). The body test on the Wii Fit helps individuals monitor their weight at home, which may be an effective strategy for promoting weight loss or weight gain. Once completed, the participant is given a score, called their Wii Fit age, which represents what age the Wii perceives they are based on their performance. This Wii Fit ages ranges from two years old to ninety nine years old. A score of forty six, for example, indicates the balance ability equal to that of the average forty six year old (Goble, 2014). Yoga on the Wii Fit includes elements of strength training, balance improvement, and aerobic endurance which are all “have been found to reduce fatigue, increase fitness levels, and improve quality of life in people” (Plow, 2011).

BALANCE

The most successful application of yoga on the Wii Fit is the improvement of balance. “No study has reported a negative impact of Wii Fit training for any measure of balance ability, and most have indicated at least some quantitative or anecdotal evidence of improvement” (Goble, 2014). The Wii Fit’s effectiveness in improving balance is due to the balance board. While using the balance board during yoga, the location of one’s center of pressure is displayed relative to the target area. Poses such as Tree pose or Warrior include this function (Franco et al., 2012). Not only do yoga poses train one’s balance, but the balance games offered on the Wii Fit project one’s center of pressure as well. Some of the fun balance games that can be accessed on the Wii Fit are Ski Jump, Tightrope, and Penguin Slide. The Wii Fit by Nintendo as claims to train coordination and endurance. This ability is attributed to the games that require combinations of accurate movements and speed in order to achieve. This patterning of the body and limbs has an effect on the cardiovascular and overall endurance. There are other games that require the body to sustain long repetitious movements for longer than there minutes of continuous exercise such as Long Run or Hula Hoop (Brettler et al., 2011). Finally, there are additional exercises available on the Wii Fit which emphasizes strength. The exercises that “require generating a group of muscles to overcome a force against gravity or resistance under a specific set additional outside resistance of circumstances" to improve muscle mass and strength.

Coinciding with an emphasis of balance is a focus on postural control. Postural control can be defined as the ability to maintain, achieve, or restore a state of balance during any posture or activity (van Diest et al., 2013). Balance is the ability to maintain an upright posture against the changing effects of gravity on the body segments, so “postural control mechanisms help a person maintain balance by ensuring that the center of gravity is maintained within the base of support” (Franco et al., 2012). On the Wii Fit by Nintendo, the most “frequently played exercises were the balance games, followed by yoga, aerobics, and strength exercises” (Plow, 2011). The Wii Fit balance board is a type of force platform (Goble, 2014). A force platform device provides accurate measures of the body’s center of pressure, which is an approximation of the body’s center of mass and balancing point. projected vertically onto the floor below. The center of pressure, or balancing point, is frequently assessed throughout the yoga poses in order approximate body sway (Goble, 2014). When standing on the Wii Fit balance board, it measures your body sway in the side to side as well as front to back “based on downward force sensor data generated at each corner of the Wii” balance board (Goble, 2014). The data provided by the balance board measuring one’s center of pressure is reliable, “evidenced by strong interclass correlations between trials of similar balance conditions” (Goble, 2014). The innovative balance board transforms one’s posture and balance because one can monitor their performance, reduce asymmetry with the visual feedback, and improve stability in yoga postures.

MOTIVATION FOR FITNESS

One appeal of yoga on the Wii Fit is that its accessibility and simplicity may motivate individuals to engage in regular physical fitness. “Interactive gaming can promote intensive task-based therapy in a manner that is motivating for the user. Widespread enthusiasm for consoles and their games prompted us to analyze the games for their rehabilitation elements related to improving balance and mobility for individuals” (Brettler et al., 2011). An encouraging attribute of yoga on the Wii Fit is that there is positive feedback linked to performance which enhances participation, motivation and engagement. For example, during all the sports games, there is cheering in the stands. Another form of positive feedback linked to success is the playing of pleasing music when a game is won. “This type of feedback may explain some of the appeal of the games. Players are also given stars or scores for their performance” (Brettler et al., 2011). Feedback is also provided in many mediums such as visual feedback as well as auditory feedback. The “abundance and redundancy [of feedback] will allow clinicians to direct patients' attention to select particular sensory information to augment their performance” (Brettler et al, 2011). The star system, another form of feedback provided by the game, is not always a completely positive response. It is possible to score one two, three or four stars as feedback. It requires substantial improvement between yoga poses to change a two star rating to a three star rating, for example (Brettler et al., 2011). All in all, Wii Fit yoga poses, as well as other exercises, are fun to play. Not only does a fun activity provide a distraction and relief from the stresses of daily life, but it also creates intrinsic motivation for individuals to engage in regular physical activity (Plow, 2011). Yoga on the Wii Fit by Nintendo was released with an intention to promote fitness for anyone at home. This specific focus on fitness, including an emphasis on balance and postural strength, makes yoga on the Wii Fit also applicable and beneficial for disabled populations without an accessible outlet for regular physical activity. It’s important to consider the Wii Fit as “beneficial in initially motivating people to engage in some type of physical activity and whether introducing variety into an existing exercise program helps promote physical activity” (Plow, 2011). Yoga on the Wii Fit is appropriate for anyome who wished to be encouraged about regular physical activity. The elderly is one population that may benefit from the encouraging promotion of regular physical activity due to long-term use of  the Wii Fit (Plow, 2011).

ELDERLY

Yoga on the Wii Fit may have extremely positive applications for the health and preventative care of elderly citizens. The elderly is “defined to include those with a chronological age of sixty five years and older. The elderly population is rapidly increasing and currently makes up twelve percent of the population” (Franco et al., 2012). It’s also important to note that “more than one third of the community-dwelling individuals aged sixty five and older falls at least once per year” (van Diest et al., 2013). For this reason, it’s imperative for seniors age sixty five or older to regularly exercise in order to maintain proper strength and balance. Some key components of fall prevention training programs for the elderly include balance, muscle strength, flexibility and endurance. The greatest effects on fall rate are seen in fall programs that “included a combination of a high dose of exercise and challenging balance exercises” (van Diest et al., 2013). The Wii Fit may be effective similar to other fall programs that highlight balance and strengthening. Older adults “enjoyed participating in Wii Fit over traditional treadmill walking and jogging” (Franco et al., 2012). Yoga on the Wii Fit is important to consider in addition to other fall programs for the elderly because the Wii Fit is fun. Because yoga and other exercises on the Wii Fit are fun and encouraging, the elderly may continue to participate in exercise or yoga training routinely (Franco et al., 2012). Yoga on the Wii Fit is similar to other “interventions that bring together several components such as strength training, resistance, balance exercises, cognitive elements and education that stimulate the older person on a broader level and prevent disability” (Molina, 2014). Some of the major risk factors for the elderly falling down are impaired or decreased mental status, side effects of medication, visual impairments, poor balance, gait impairments, and lower limb weakness. The addition of yoga and other forms of balance training could help address the risk factors of falling such as balance and gait impairments and lower limb weakness (Franco et al., 2012). The risk factors related to age that increase chances of falling down are due to changes in the musculoskeletal and neuromuscular systems of the body that impact overall balance. Some of the major changes that occur in the aging neuromuscular and musculoskeletal systems include a “loss of elasticity in the tissues, decreased bone density, and a decrease in muscle mass and strength” (Franco et al., 2012). Routine physical activity is important to combat these effects of the aging body. Therefore, Yoga on the Wii Fit may be applicable to the lifestyles of the elderly.

It is important to note that about forty to fifty percent of elderly people who fall down and are admitted to a hospital will next be admitted to a nursing home (Franco et al., 2012). According to the World Health Organization, a routine and regular physical practice is essential for older adults in order to prevent against diseases and disability. Some of the physical activities recommended by WHO include walking, cycling, household chores, games, sports or planned exercise. The use of “interactive games through virtual reality can be, therefore, considered as a form of physical activity and this way should obey recommendations related to period and length of practice, to bring the desired benefits to the health of the older person” (Molina, 2014). According to the directives of the Global Recommendations on Physical Activity for Health, it is recommend that older people practice at least one hundred and fifty minutes of moderate physical activity or at least seventy five minutes of vigorous physical activity over the course of one week (Molina, 2014). Yoga on the Wii Fit may be successful in engaging the elderly to integrate physical activity because it “involves tasks that combine physical and cognitive demands in an attractive and challenging way, interactive games may represent an option that is both viable and well-accepted by older people, thereby expanding the therapeutic strategies” (Molina, 2014). Difficulties with balance that create a high risk of falling amongst older people are a main reason why elders cannot safely remain living independently in    their homes (Franco et al., 2012). Poor postural control is one of the major risk factors for falling so this is typically the focus of training in fall prevention programs. These types of programs, however, suffer from low therapy adherence since prevention is the goal. To provide a fun and motivating training environment for the elderly, exercise programs at home such as yoga or balance games on the Wii Fit may be essential training tools (van Diest et al., 2013). However, it is important to note that the Wii Fit game was not created for the sixty and older population (Franco et al., 2012).

CONCLUSION

Yoga on the Wii Fit by Nintendo was intended to make fitness possible for anyone in any home. The applications of this technology have stretched further than the makers of the Wii Fit ever imagined. The tools that improve one’s balance and postural control have beneficial uses in the elderly population In order for older people over the age of sixty five to prevent a fatal fall, they must adopt a greater on regular exercise, balance, flexibility and strength training. Yoga on the Wii Fit is an easily accessible, very encouraging, and fun tool for achieving this type of training. Although yoga on the Wii Fit is a very different experience than doing yoga within a yoga studio, yoga on the Wii Fit is an impeccable tool to utilize in order to improve personal fitness and balance. Yoga on the Wii Fit may have more implications in society than encouraging basic fitness for everyone, yoga on the Wii Fit may also have the potential to improve the health and well-being of disabled populations such as the elderly.

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