A Yogic Perspective of Mental Health and Anxiety

Exerpts from a paper written exploring the efficacy of using yoga as a treatment for anxiety disorders.

It is well established that yoga supports one’s emotional, spiritual, and physical wellbeing. Yoga is a 5,000 year old practice that was formed in India (Jaina, 2021). It involves physical postures, breathing techniques, and meditation. It is considered an efficient way to ease the mind (More et al., 2021). Yoga can also be described as a ‘life system’ that explains the basic tenets of life and the absolute “truth” of life (Akdeniz & Kaştan, 2023). In the past decade, research on treating mental health disorders, including anxiety disorders, with adjunctive yoga interventions has grown exponentially (Martínez-Calderon et. al., 2023).

Yogic philosophy considers three concepts that apply to the development of mental health disorders (More et al., 2021). One of these concepts is yoga vashishta, which maintains that emotional imbalances, known as adhi, are the root of all disease. The emotional imbalances affect the body’s subtle energy, or, vital life force, which then affects the physical body, or, vyadhi. Another concept, derived from the Bhagavad Gita, is the understanding that thoughts form emotions, which affect one’s psychological state. Generalized Anxiety Disorder is an example of how repeated and uncontrollable thoughts affect one’s psychological state. The uncontrollable thoughts lead to excessive physiological activity that habituate in the affected person’s psychological state.

Finally, the concept of our existence amongst five different levels, known as Pancha kosha, informs our understanding of the needs of each individual. The Pancha kosha holds that we are made up of five sheaths, which both influence and are influenced by each other. These sheaths are annamaya kosha (physical level), pranamaya kosha (energetic level), manomaya kosha (emotional level), vijnanamaya kosha (intellectual level) and anandamaya kosha (blissful level). This explains how anxiety symptoms that might originate in the mind can affect the body, and vice versa. This concept also explains that any intervention applied at one level will affect the person on other levels as well, therefore informing a yoga practice that encompasses a holistic approach, inclusive of multiple forms of yoga shapes and sequences.

Literature Review

This literature review focuses on six articles that explored using a yoga intervention to treat or manage anxiety disorders and/or symptoms. The studies reviewed differed in the amount of times the yoga intervention was practiced, the type of yoga practiced, the length of the session, and the length of the study as a whole. A total of 744 participants were studied, some participating in control groups and some participating in yoga groups. Additionally, 1420 participants were included in the systematic review, however, the number of participants that were involved in the anxiety groups in particular was undisclosed (depressive disorders were also included in this study).

The studies used qualitative and quantitative research methods consisting of questionnaires (Jaina, 2021; Akdeniz & Kaştan, 2023), self-report study assessments (Danhauer, 2022), case study designs (Akdeniz & Kaştan, 2023), individual and focus group interviews, participant observation, and anxiety scales (Rani et al., 2012), and literature reviews and semi-structured interviews (Martínez-Calderon et al., 2023; More et. al., 2021). Participants were recruited through self-interest at a secondary school (Jaina, 2021), yoga institution (Akdeniz & Kaştan, 2023), outpatient clinics (More et. al., 2021; Rani et al., 2012), flyers, mailings, and newspaper advertisements (Danhauer et. al., 2022).

All six studies concluded that yoga can have a positive effect on the management of anxiety symptoms (Akdeniz & Kaştan, 2023; Danhauer et. al., 2022; Jaina, 2021; Martínez-Calderon et al., 2023; More et. al., 2021; & Rani et al., 2012). The studies explored using yoga as a treatment modality for multiple types of anxiety, including generalized anxiety disorder, exam anxiety in younger populations, late-life worry in older populations, and anxiety symptoms in women with menstrual disorders. This indicates that the yoga intervention was supportive for people experiencing anxiety symptoms regardless of the particular type of anxiety experienced. Yoga interventions involved asana (physical postures), meditation, mindfulness, breathing techniques, relaxation techniques, affirmations, and yoga nidra. The variety of yoga practices indicates that the type of yoga one practices is inconsequential, as improvement in symptoms was seen regardless of the specific type of yoga that was practiced. The frequency of the yoga sessions ranged from two-seven days per week and the studies lasted between two weeks to two years, indicating that a wide range of lengths of yoga interventions can be supportive in the treatment of anxiety disorders.

Additional benefits were noted. Jaina (2021) found that the yoga group improved exam-related anxiety, an increased effect on mindfulness, a positive influence on attention span, and improved memory. Danhauer et al. (2022) found reduced depressive symptoms and fatigue with a yoga intervention and highlighted that yoga interventions performed as well as the gold standard, Cognitive Behavioral Therapy (CBT). This study emphasized the importance of these findings, as older populations prefer not to use medications. Similarly, More et al. (2021) emphasized the risk of unwanted side effects and dependence associated with pharmacological methods for treating anxiety disorders, highlighting the need for alternative treatment modalities. Additionally, Martínez-Calderon et al. (2023) noted that yoga appears to be a beneficial strategy for assisting patients in enhancing their emotional well-being following a diagnosis of medical conditions frequently marked by an uncertain and unpredictable progression. Danhauer et al. (2022) and Akdeniz & Kaştan (2023) found that a yoga intervention reduced pain, however, Danhauer et al. (2022) noted that the CBT group had a higher improvement in pain symptoms than did the yoga group.

Akdeniz & Kaştan (2023) also noted improvements in flexibility, spiritual well being, sleep, personality, self esteem, stress-management, and emotional affect. They further suggest that starting yoga practice young and engaging in long-term practice will reduce the physical limitations associated with yoga practice. More et al. (2021) emphasized that starting the intervention with beginner-friendly practices and then moving on to more experienced-level practices in later weeks of the intervention was supportive for the accessibility and implementation of the routine.

More at al. (2021) did note that participants struggled to maintain the practice at home, and mentioned that the lengthiness of the intervention may have contributed to this challenge. Another challenge was noted by Rani et al. (2012), which found that the yoga nidra intervention was only supportive for participants suffering from mild-to-moderate anxiety symptoms, as it was ineffective for participants with severe anxiety symptoms.

The studies listed several strengths and limitations. Strengths included the randomized nature of the trails (Danhauer et. al., 2022; Martínez-Calderon et al., 2023) and multiple exploratory measures (Danhauer et. al., 2022). Limitations included small participant sizes (Akdeniz & Kaştan, 2023; Rani et al., 2012), participants being selected only from one institution (Akdeniz & Kaştan, 2023; Rani et al., 2012), participants being mostly white females (Danhauer et. al., 2022) or of mainly Western culture (Martínez-Calderon et al., 2023), and more clarity needed when describing methodologies (More et al., 2021).

References

Akdeniz, Ş., & Kaştan, Ö. (2023). Perceived benefit of yoga among adults who have practiced yoga for a long time: A qualitative study. BioPsychoSocial Medicine, 17(19), 1-10. https://doi.org/10.1186/s13030-023-00276-3

Danhauer, S. C., Miller, M. E., Jasmin, D., Anderson, A., Gena, H., & Brenes, G. A. (2022). A randomized preference trial comparing cognitive-behavioral therapy and yoga for the treatment of late-life worry: Examination of impact on depression, generalized anxiety, fatigue, pain, social participation, and physical function. Global Advances in Health and Medicine, 11, 1-10. doi:https://doi.org/10.1177/2164957X221100405

Jaina, D. (2021). Impact of yoga intervention on exam anxiety, mindfulness, attention & memory in school going children. Delhi Business Review, 22(2), 85-90. doi:https://doi.org/10.51768/dbr.v22i2.222202109

Martínez-Calderon, J., Casuso-Holgado, M. J., Muñoz-Fernandez, M. J., Garcia-Muñoz, C., & Heredia-Rizo, A. M. (2023). Yoga-based interventions may reduce anxiety symptoms in anxiety disorders and depression symptoms in depressive disorders: A systematic review with meta-analysis and meta-regression. British Journal of Sports Medicine, 0, 1-9. https://doi.org/10.1136/bjsports-2022-106497

More, P., Kumar, V., Rani, MR.U., Philip, M., Manjunatha, N., Varambally, S., & Gangadhar, B. (2021). Development, validation, and feasibility of a generic yoga-based intervention for generalized anxiety disorder. Complementary Therapies in Medicine, 63, 1-10. https://doi.org/10.1016/j.ctim.2021.102776

Rani, K., Tiwari, S., Singh, U., Singh, I., & Srivastava, N. (2012). Yoga nidra as a complementary treatment of anxiety and depressive symptoms in patients with menstrual disorder. International Journal of Yoga, 5(1), 52-56. doi:https://doi.org/10.4103/0973-6131.91715

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