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YOGA AND MEDITATION RESEARCH IN

PSYCHIATRY

Presenter: Dr Namrata Bhati


HISTORICAL ASPECTS

• Yoga is derived from Sanskrit root yuj


• Union of individual soul , atama with parmata, universal soul
• Integration of mind ,body and spirit
• Earliest written account - RIG VEDA
• 1st yoga texts dates - 2nd BC by PATANJALI
ASHTANGA/RAJA YOGA - adherence to 8 limbs to attain Samadhi
(concentrate) : quite’s one mind to unite with infinite
( Yoga Sutras of Pantajali)
History of yoga and origin and pioneer of yoga
and meditation
• Yoga-”Family of ancient spiritual practices that originated in
India
• Eastern world-path to spiritual enlightenment
• Central to Hinduism, Sikhism, Buddhism, Jainism
• Western world yoga -asana (postures) of hath yoga , fitness
exercises
• Swami Vivekanada introduced it to west in late 19th century
DEFINITION OF YOGA
• Yoga Sutras of Patanjali, :‘‘Yoga is the suppression of the
modifications of the mind’’
• Most schools of yoga incorporate elements :
Asanas (physical postures and movements) including relaxation,
Pranayama (breathing practices)
Dhyana (meditation and mindfulness)
Cultivation of positive values, thoughts and attitudes & lifestyle
factors
• Multi-dimensional intervention - tailored to needs of each
individual.
TYPES OF YOGAS
• JNANA YOGA- knowing suffices for liberation.
• BHAKTI YOGA - focused on cultivation of love and devotion toward God
• KARMA YOGA- discipline of action, based on Bhagavad gita teachings
• LAYA /KUNDALINI YOGA- focus on awakening kundalini energy
• HATHA YOGA - system of physical techniques
• BIKRAM YOGA- practiced in hot , humid environment- 40.8 C
• VINYASA YOGA – postures+breathig techniques
• ANUSARA YOGA- focus on inner self,mind, soul, most spiritual form
• Sudarshan Kriya Yoga (SKY) focuses on pranayama
• Iyengar's yoga focuses on asanas
MEDITATION
Meditation is essentially a ‘physiological state of
demonstrated, reduced metabolic activity – different
from sleep , physical and mental relaxation ,enhance
psychological balance and emotional stability ‘

(Jevning et al., 1992; Young and Taylor, 2001).


GOALS OF MEDITATION
1. Elimination/ reduction of thought processes,

2. Cessation / slowing of the internal dialogue of the mind -‘‘mental


clutter’’.

3. Thoughtless awareness /4th state of consciousness


• Sustained focused attention (concentration),
• Self-monitoring (preventing the attentional focus to wander off)
• Cognitive interference control ( inhibit interference / disruption
from unwanted thoughts/ irrelevant external events
TYPES OF MEDITATIONS
BASED ON MEDITATION TECHNIQUES
1. Concentration Meditation 5. Mindfulness Meditation
I. Zen meditation
II. Transcendental I. Deep breathing
Meditation meditation
III. Om meditation II. Body scan meditation
IV. Shine Meditation or III. Visualization
Samadhi meditation
V. Chakra Meditation IV. Mindful breathing
V. Mindful eating
2. Reflective Meditation VI. Sitting Meditation
3. Heart-Centered Meditation VII. Walking Meditation
4. Creative Meditation
HOW COULD IT BE A USEFUL
ADJUNCT TO
ACHIEVE MENTAL HEALTH?
LONG-TERM TRAIT EFFECTS OF MEDITATION
(1) Physical level: feelings of deep relaxation , stress relief;
(2) Cognitive level: enhanced concentrative attention skills, improved
self-control a, self- monitoring , ability to inhibit irrelevant interfering
external & internal activity;
(3) Emotional level: positive mood, emotional stability ,resilience to
stress ,negative life events (detachment);
(4) Psychological level: personality changes -
Enhanced overall psycho-emotional balance.
REASONS FOR GROWING INTEREST IN YOGA
• appealing to people concerned with stigma associated with
conventional mental health treatments
• recent uncertainties on the effectiveness& long-term benefits of
psychopharmacological treatments - antidepressants and
psychostimulants (Jensen et al., 2007; Kirsch et al., 2008)
• Current treatment : narrow focus of a diagnosis-treatment
approach
• Yoga : broader focus on mind-body or lifestyle interventions, for
living a healthier, happier and flourishing life
Reasons for growing interest in yoga
• Free of side effects , preferred by pregnant women
• Assist people in treatment or recovery from injury, illness or disability
• Adjunct to current treatment
• Cost effective
NEUROENDOCRINOLOGICAL CHANGES DURING
MEDITATION
 Regulatory effect on 2 axis
Hypothalamic-pituitary-adrenal (HPA) axis
 Sympathetic nervous system (SNS)
 Repeated exposure to stressors over time causes-dysregulation

Increased neurotransmitters in fronto-limbic affective


systems
Dopamine, serotonin
Melatonin : +ve immune system & antioxIdation defense system
Mood stabilisation, positive affect, stress-prevention and aging
(Young and Leyton, 2002; Neumeister, 2003; Stockmeier, 2003; Pacchierotti et al., 2001).
PERIPHERAL PHYSIOLOGICAL CHANGES DURING
MEDITATION
WAKEFUL HYPOMETABOLIC STATE
• Decreased sympathetic
• Increased parasympathetic

• Heart, respiratory , pulse rates, of SBP, oxygen metabolism,


• Urinary Vanillyl mandelic acid (VMA), increase skin resistance

• Prevents stress-related illness

( Cahn and Polich, 2006; Jevning et al., 1992; Rai et al., 1988; Young and Taylor, 2001).
Neurophysiological effects during Meditation
EEG WAVES EFFECTS

increased low frequency activation of sustained attention to internal events


theta and alpha bands left frontal Reduced anxiety
region Cahn and Polich, 2006
theta activity over left frontal regions feelings of happiness

Frontal theta activity originate from emotion processing


limbic and frontal brain regions sustained attention

• Asada et al., 1999; Deiber et al., 2007; Gevins and Smith, 2000; Rachbauer et al., 2003; Sauseng et
al., 2007).
Neurophysiological effects during Meditation
EEG WAVES EFFECTS
Increased activation in alpha sustained attention to internal events
Osaka, 1984; Gevins et al., 1997; McEvoy et al.,
power range 2000)

fronto-parietal theta bands attentional networks enforcement


reduction in the chaotic decreased task-irrelevant processes
(Aftanas & Golocheikine, 2001, 2002b, 2003)
dimensional complexity
GENETICS EFFECTS DURING YOGA

• In a study published in 2012, scientists at the University of California


at Los Angeles and Nobel Prize winner Elizabeth Blackburn found that
12 minutes of daily yoga meditation for 8 weeks
increased telomerase activity (anti ageing enzyme) by 43 percent,
suggesting an improvement in stress-induced aging.

http. hms.harvard.edu/news/harvard-yoga-scientists-find-proof-meditation-benefit
NEUROIMAGING
Study of Lou et al. (1999) using positron emission tomography (PET),
reported an increase in left prefrontal and limbic brain regions during the
abstract sense of joy compared to rest in nine practitioners of Yoga Nidra
Meditation.

Study using PET - compared Zen Buddhist Meditation of concentration on


breath to random thoughts in 11 practitioners - found increased activation in
left frontal cortex and the basal ganglia, again suggesting enhanced fronto-
striatal networks of sustained attention (Ritskes et al., 2003).

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NEUROIMAGING

Single Photon emission tomography (SPECT) in nine practitioners of a


concentrative Tibetan Buddhist Meditation who focussed on a mantra showed
enhanced frontal and thalamic metabolism after Meditation compared to a
rest scan, suggesting enhanced networks of focused concentration (Newberg,
2001)

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These findings would be in line with the ‘Neural efficiency hypothesis of skill
learning’ where the most skilled persons show less activation than less skilled
ones (Grabner et al., 2006, 2005)

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Neurophysiological changes in yoga
fMRI changes in late Vs early meditators
(Lazar et al., 2000)
dorsolateral
prefrontal

sustained
limbic & Parietal
attention &
paralimbic
autonomic cortex
regions
control

basal
ganglia
ROLE IN PSYCHIATRIC DISORDERS
Clinical effectiveness of Meditation in
psychiatric disorders
• Short and long term effects of Meditation on physiological indicators
1. Stress,
2. Personality
3. Cognitive functions,
• Functional and structural plasticity of brain regions important for
attention and emotion regulation,
• Targets : mental disorders with affective and cognitive-attentional
problems
DEPRESSION AND ANXIETY
Recent meta-analysis on antidepressant medication
raised
1. Serious concerns about its clinical efficacy (Kirsch et al.,
2008)
2. Controversial Use in Teenagers -side effects & suicide
risk (Vitiello and Swedo, 2004).
DEPRESSION AND ANXIETY
• Sahaja Yoga Meditation over 6 weeks in 24 pts with
MDD showed
(compared to a control group and a group receiving CBT)
• Reduction in symptoms of anxiety, depression and
general mental health
• Effect sizes were high, ( Cohen’s d = 1.2–2.1)
• Replication in a larger sample is needed

(Morgan, 2001).
DEPRESSION AND ANXIETY
• Sudarshan Kriya Yoga- effectiveness in patients with
depression on symptoms of anxiety and depression in a RCT

• EFFEICACY : ECT > IMIPRAMINE = MEDITATION

(Janakiramaiah et al., 2000)


DEPRESSION AND ANXIETY
• Mindfulness Meditation based CBT (MBCT) Vs Treatment as usual
(TAU)
(patients with depression with high relapse risk )

SELF-REPORTED SYMPTOMS OF DEPRESSION :

 MBCT: reduced from severe to mild levels,


 TAU: unchanged- .
(Barnhofer et al., 2007).
OBSESSIVE-COMPULSIVE DISORDER (OCD)
• Open trial of 12 months Kundalini Yoga practice, in 5 medicated
patients:
Reduction in OCD symptoms severity by 50%
(Shannahoff-Khalsa, 1997).

• Blinded RCT with 12 months of Kundalini Yoga Vs mindfulness


based Meditation:
Kundalini Yoga group improved in OCD symptoms(38%),
mood & anxiety symptoms

(Shannahoff-Khalsa et al., 1999


BINGE EATING PROBLEMS
• Mindfulness Meditation based stress-reduction(MBRS)
interventions on 18 women with binge eating problems over 6
weeks.
• MBSR treatment :
1. Decreased frequency & severity in binge eating symptoms
2. Decreased symptoms of anxiety and depression
Effects persisted 3 weeks after treatment
Effect size was large ( Cohen’s d = 2),
problem: preliminary study lacking control group.

(Kristeller et al., 2004).


ADHD
CONCERNS
• Increased rates of stimulant prescription
• Side effects ,the unknown long-term effects on brain
development of stimulants
• Waning of superiority of medication treatment over
behavioural treatments after several years - potential
sensitisation effects
(Jensen et al., 2007)
ADHD
• Significant reduction in symptoms of ADHD within 6 weeks of
sahaj yoga
• Equal results in medicated & nonmedicated patients
• The effect size was high (Cohen’s d of 1.2)
• 50% of children either stopped / reduced their medication-still
improved in symptoms.
• further explorations in larger samples of medication-naıve
children and including an active control group are required
(Harrison et al., 2004).
ADHD
• 25 adults 7 adolescents with ADHD enrolled in 8-week MCBT
1. Improvements in self reported ADHD symptoms &
2. Performance on tasks of selective attention and cognitive inhibition.
Effects sizes for symptom reduction were relatively high (Cohen’s d=
1.8)

• Lack of control group


• Used self-reported measures of ADHD symptoms,
• Influenced by placebo effects.
(Zylowska et al., 2008)
ADHD
• Sahaja Yoga Meditation-
oReduced hyperactivity via reduction of sympathetic activity
(Rai et al., 1988; Manocha et al., 2002).
o Activation of underactivated fronto-parietal attention
networks
o Improvement of cognitive functions of sustained attention,
inhibitory control & self-monitoring (Brown et al., 1984; Jha
et al., 2007; Slagter et al., 2007),

(Rubia et al., 1999, 2001, 2005, 2008, 2009; Smith et al., 2006)
SCHIZOPHRENIA
• Patients with several years of illness & stabilized pharmacological
therapy, were offered :
1. 1 month training f/b 3 months of home practices of yoga as an add-
on treatment
2. Exercise
3. Treatment as usual.
• Yoga group -Improvement in negative symptoms on PANSS and Social
Dysfunction Ratings
• Exercise group -Improved in Social Dysfunction Rating

(N Gangadhar Bangalore and Shivarama Varambally, NIMHANS , 2012)


BPAD
• Hatha yoga- powerful positive practice for bipolar disorder type 2:

• Increased Mindfulness— increased nonjudgmental focus on the


present moment—and an increased sense of calm or relaxation.
• Physical activity - reduce weight (side effects of antipsychotics and
mood stabalisers)
Self-Reported Benefits and Risks of Yoga in Individuals with Bipolar Disorder.
Journal of Psychiatric Practice
BPAD
• Problems with hatha yoga :
Extreme practices— rapid breathing, heated rooms,
or very slow and meditative practice
Heat intolerance in people taking antipsychotic
medication
Heat causing dehydration - increase the risk for
lithium toxicity
PTSD
• Yoga has been shown to have a regulatory effect on two key
neurobiological systems:
Hypothalamic-pituitary-adrenal (HPA) axis
Sympathetic nervous system (SNS)

• Repeated exposure to stressors - “hypervigilant & dysregulated”

• Downregulation benefit of yoga helps in PTSD

(Ross & Thomas, 2010)


SUBSTANCE USE
• Yogic techniques with relaxation & meditation improves -stress
anxiety, depression

• People practicing yoga refuse drug abuse-safer social network

• Increased self awareness &control –opposes learnt helpness

• Reduces use of addictive analgesic drugs for minor psychosomatic


problems

(Karel Nespor ,Twelve years of experience with yoga in psychiatry, 1991)


SUBSTANCES USE
• In-mates in a correctional facility were offered a choice between
treatment as usual and a 10 day course of Vipassana meditation
• RCT study showed the group choosing meditation showed:
• Decreases in alcohol-related problems and psychiatric
symptoms upon discharge,
• Increases in positive psychosocial outcomes

• Lack of randomization makes it difficult to draw conclusions


GERIATIC PSYCHIATRY
• Gentle activity for joints- pawan mukta asana, part 1
• Relaxation
• Enhance spiritual life
• Dopamine: increased in fronto-limbic affective systems of the brain
• Melatonin : +ve immune system & antioxydative defense system
• serotonin- mood stabalisation

(Young & Leyton, 2002; Neumeister, 2003; Stockmeier, 2003;


Pacchierotti et al., 2001)
Precipitation of psychosis by yoga and
meditation
• Meditation can actually raise dopamine levels and exacerbate
psychosis.

Studies were not RCT -more research needed to assess negative effects
of meditation for individuals with mental illness
CONCERNS IN REVIEWS FOR YOGA
• Inconsistent approach in types of yoga/meditation -based
interventions between various studies.
• Cross sectional studies - confounded by cohort effects.
• Meditation practices associated with lifestyle changes - affect
health and personality.
• Lack of Longitudinal studies
• Lack of randomized well-controlled study groups
• Small sample size-poor power of studies
• Delayed onset of effects of yoga- loss to follow up of pts
CONCERNS IN REVIEWS FOR YOGA
• Aim of meditation “experience of mystical higher states of
consciousness beyond the thinking mind” –
Not amenable to measure by scientific rationale
PROBLEMS IN PRACTICING YOGA
1. Compliance- discontinuation of yoga after discharge
2. Systems aspects- lack of family member encouragement for
adherence
3. competitiveness- overdosing causes discomfort-poor long term
compliance
4. Competent use of yoga- health status and personal diffrences
influences indications and contraindications for yogic practices
5. Delayed onset of effects of yoga – poor compliance
CONCLUSION
 Several Meditation techniques appear to have short and longterm
effects on functional and structural brain plasticity as well as on
physiological indicators of relaxation and stress relief.

 There is evidence to suggest that these effects are specific to


Meditation over and above simple relaxation effects.

 Although clinical Meditation research has mostly been conducted in


small sample sizes and poorly controlled conditions, there is some
evidence for its effectiveness in disorders of anxiety, attention and
affect.
FUTURE DIRECTIONS
Yoga as a treatment is yet to be established in standard medical care.

Work done so far in demonstrating biological changes occurring with yoga


to establish the scientific basis, though promising, is preliminary, and needs
to be expanded in the future.

A careful approach is required to match as close as possible to the existing


system which is based on allopathic understanding of body-mind dualism
and thus differs from yogic concept of body-mind interaction.

Multi-centric trials are required to examine not only the efficacy but the
effectiveness, of yoga treatment, which can then be translated to routine
medical care across the world.
REFERENCES
• "yoga.OED online” Oxford University Press. September 2015. Retrieved 9
September 2015
• Nespor K. Twelve years of experience with yoga in psychiatry.Int J Psychosom
1993;40(1-4):105-7.
• Katya Rubia, The neurobiology of Meditation and its clinical effectiveness in
psychiatric disorders, Biological Psychology, Volume 82, Issue 1, Sep 2009 pg 1-11
• Kitamura, M. (2013). Harvard yoga scientists find proof of meditation benefit.
Retrieved from http://www.bloomberg.com/news/2013-11-22/harvard-yoga-
scientists-find-proof-ofmeditation-benefit.html.
• Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, Harish MG,
Subbakrishna DK, Vedamurthachar A (2000) Antidepressant efficacy of Sudarshan
Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive
therapy (ECT) and imipramine. J Affect Disorders 57: 255-259.
REFERENCES

• Bangalore, N. G., & Varambally, S. (2012). Yoga therapy for


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