yoga and meditation reasercj in psychiatry

1. Yoga and meditation
research in psychiatry
Presenter: dr Namrata bhati
Moderator: dr nimmi

2. 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 YOGA -adherence to 8 limbs ashtanga yoga to
quite’s one mind to unite with infinite

3. History of yoga and origin and pioneer of
yoga and meditation
• Yoga-”Family of ancient spiritual practices that originated in India
• 4 main types –
• Karma yoga ,
• bhakti yoga
• jnana yoga and
• raja yoga
• Eastern world-path to spiritual enlightenment
• central to Hinduism, Sikhism, Buddhism, Jainism
• western world yoga -asana (postures) of hath yoga , fitness exercises

4. Definition of yoga
• most schools of yoga incorporate elements of
Asanas (physical postures and movements) including relaxation,
Pranayama (breathing practices), and
dhyana (meditation and mindfulness)
cultivation of positive values, thoughts and attitudes & lifestyle
factors
 multi-dimensional intervention tailored to needs of each
individual.

5. Schools of yoga
• Patanjali Yoga Sutras and focus on unification of body,
mind and spirit to promote health and well-being.
• Sudarshan Kriya Yoga (SKY) focuses almost exclusively on
pranayama,
• Iyengar's yoga focuses on asanas and
• Vinyasa yoga focus on breath-linked movement.

6. • Yoga Sutras of Patanjali, :‘‘Yoga is the suppression of the
modifications of the mind’’
• goal of Meditation :
• elimination/ reduction of thought processes,
• cessation / slowing of the internal dialogue of the mind -‘‘mental
clutter’’.
• thoughtless awareness :
• 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

7. 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).

8. • In Western psychology, 3 states of consciousness : sleep, dream
and wakefulness.
• In Eastern philosophy & Western religious & mystical traditions, ‘
‘‘higher /fourth state of consciousness’’:
• the state of ‘‘thoughtless awareness’’ (Ramamurthi, 1995).
• Elimination of incessant thinking processes
• experiencing a state of deep mental silence

9. • Mindfulness Meditation involves focussed attention on internal and
external sensory stimuli with ‘‘mindfulness’’, a specific non-
judgemental awareness of present-moment stimuli without cognitive
elaboration.

10. Schools of yoga
• Patanjali Yoga Sutras and focus on unification of body,
mind and spirit to promote health and well-being.
• Sudarshan Kriya Yoga (SKY) focuses almost exclusively on
pranayama,
• Iyengar's yoga focuses on asanas and
• Vinyasa yoga focus on breath-linked movement.

11. why 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.

12. 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

13. 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

14. NEUROENDOCRINOLOGICAL CHANGES
DURING MEDITATION
• regulatory effect on two axis
• hypothalamic-pituitary-adrenal (HPA) axis
• sympathetic nervous system (SNS)
• repeated exposure to stressors over time,
• Dysregulation of axis

15. Peripheral physiological changes during
Meditation
• WAKEFUL HYPOMETABOLIC STATE :
• decreased sympathetic nervous activity,
• increased parasympathetic activity
• heart, respiratory , pulse rates, of systolic blood pressure and
oxygen metabolism, and of urinary vanyl mandelic acid (VMA),
increases of skin resistance (Rai et al., 1988)
• Prevents stress-related illness.
(Cahn and Polich, 2006; Jevning et al., 1992; Rai et al., 1988;
Young and Taylor, 2001).

16. PERIPHERAL PHYSIOLOGICAL CHANGES DURING
MEDITATION
WAKEFUL HYPOMETABOLIC STATE
• Decreased sympathetic
• Increased parasympathetic
• heart, respiratory , pulse rates, of SBP, oxygen metabolism,
• urinary vanyl 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).

17. Neurophysiological effects during Meditation
EEG WAVES EFFECTS
increased low frequency activation of
theta and alpha bands
sustained attention to internal events
Cahn and Polich, 2006
theta activity over left frontal regions feelings of happiness
Frontal theta activity emotion processing
sustained attention
• Asada et al., 1999; Deiber et al., 2007; Gevins and Smith, 2000; Rachbauer et al., 2003; Sauseng et
al., 2007).

18. Neurophysiological effects during Meditation
EEG WAVES EFFECTS
alpha power range sustained attention to internal events
fronto-parietal theta bands reduction in
the chaotic dimensional complexity,
attentional networks enforcement
decreased task-irrelevant processes
Frontal theta activity emotion processing
sustained attention
RESULTS IN REDUCED ANXIETY
• Asada et al., 1999; Deiber et al., 2007; Gevins and Smith, 2000; Rachbauer et al., 2003; Sauseng et al., 2007).

19. Neurophysiological changes in yoga
• Functional magnetic resonance imaging (fMRI) was conducted in
a small number of five Meditators with at least 4 years of
Kundalini Yoga experience with subjects silently generated a
random list of animals and did not observe their breathing .
• There was increased activation during late versus early
Meditation in dorsolateral prefrontal and parietal cortex, limbic
and paralimbic regions (amygdala, hypothalamus, hippocampus
and anterior cingulate) and the basal ganglia (Lazar et al., 2000).
• Indicationg increased activation of brain regions that mediate
sustained attention and autonomic control.
• Given the very small subject numbers a replication in larger
samples will be necessary to corroborate the findings.

20. Neurophysiological changes in yoga
Functional magnetic resonance imaging (fMRI) changes:
Increased activation during late Vs early Meditation in:
1. dorsolateral prefrontal and parietal cortex,
2. limbic & paralimbic regions (amygdala, hypothalamus,
hippocampus and anterior cingulate)
3. basal ganglia
increased activation of brain regions mediating sustained
attention and autonomic control
(Lazar et al., 2000)

21. sustained
attention &
autonomic
control
dorsolateral
prefrontal
Parietal
cortex
basal
ganglia
limbic &
paralimbic
regions
Neurophysiological changes in yoga
fMRI changes in late Vs early meditators
(Lazar et al., 2000)

22. Long term plastic effects of Meditation on brain
structure
• Lazar et al. (2005) compared 20 Buddhist Meditators who
practised insight/ Mindfulness Meditation for an average time of
9 years to age and demographically matched controls.
• The Meditators compared to controls had significantly increased
cortical thickness in right middle and superior frontal cortex and
the insula
• Normal age-related cortical thinning is delayed in right fronto-
limbic brain regions (Lazar et al., 2005).

23. Clinical effectiveness of Meditation in
psychiatric disorders
• growing evidence for short and long term effects of Meditation on
physiological indicators of stress, personality and cognitive functions,
• on functional and structural plasticity of brain regions that are
important for attention and emotion regulation,
• mental disorders with affective and cognitive-attentional problems
are the target

24. Role of yoga and meditation in depression
and anxiety
• a recent meta-analysis on antidepressant medication has raised
serious concerns about its clinical efficacy (Kirsch et al., 2008)
• Use in Teenagers has been controversial due to side effects and
suicide risk (Vitiello and Swedo, 2004).

25. • Sahaja Yoga Meditation over 6 weeks showed a significant
reduction in the symptoms of anxiety, depression and general
mental health in 24 patients with major depression compared to
a control group and a group receiving CBT (Morgan, 2001).
• the effect sizes were high, ranging from Cohen’s d of 1.2–2.1
• replication in a larger sample is needed

26. • Sudarshan Kriya Yoga, has shown effectiveness in patients with
depression on symptoms of anxiety and depression in a randomised
controlled trial (Janakiramaiah et al., 2000)
• Meditation was as good as Imipramine, an antidepressant, but
inferior to electroconvulsive therapy

27. • A small study investigated the effect of Mindfulness Meditation
based cognitive behavioural therapy in patients with depression
with high relapse risk, randomized to either MBCT or treatment
as usual (Barnhofer et al., 2007).
• results showed that treatment with MBCT significantly reduced
self-reported symptoms of depression from severe to mild levels,
while levels of depression remained unchanged in the group that
received TAU only.

28. Meditation studies conducted in
obsessive-compulsive disorder (OCD)
• Open trial of 12 months Kundalini Yoga practice, consisting of
posture and breathing exercises, in five medicated patients
showed significant reduction in OCD symptoms and severity of
about 50% (Shannahoff-Khalsa, 1997).
• Blinded RCT with 12 months of Kundalini Yoga as the active
condition and relaxation response and mindfulness based
Meditation as active control condition (Shannahoff-Khalsa et al.,
1999).
• Only the Kundalini Yoga group improved in OCD symptoms (38%)
. mood and anxiety measures.

29. Mindfulness Meditation with binge
eating problems
• Mindfulness Meditation based stress-reduction interventions on
18 women with binge eating problems over 6 weeks.
• The MBSR treatment showed a significant improvement in binge
eating frequency and severity PLUS symptoms of anxiety and
depression after 6 weeks that persisted 3 weeks after treatment
(Kristeller et al., 2004).
• Though effect size was large (with a Cohen’s d of 2), this study
isconsidered preliminary as it lacked control group.

30. Meditation studies conducted for adhd
• The escalating stimulant prescription rates have caused growing
concern :
• Side effects ,the unknown long-term effecTS on brain
development.
• Waning of superiority of medication treatment over behavioural
treatments after several years, raising worrying questions over
potential sensitisation effects (Jensen et al., 2007).
• Sahaja Yoga Meditation helps reduce symptoms of hyperactivity
through the reduction of sympathetic activity (Rai et al., 1988;
Manocha et al., 2002).

31. • inattention and impulse control would be counteracted with
Meditation
• Meditation training induced improvement of cognitive functions
of sustained attention, inhibitory control and self-monitoring
(Brown et al., 1984; Jha et al., 2007; Slagter et al., 2007),
• Neuroimaging evidence for activation of fronto-parietal attention
networks with Sahaja Yoga Meditation
• These are under-activated in children with ADHD during tasks of
inhibitory control and attention (Rubia et al., 1999, 2001, 2005,
2008, 2009; Smith et al., 2006)

32. • Significant reduction in symptoms of ADHD within 6 weeks of
sahaj yoga
• It was equally observed in medicated and nonmedicated patients
(Harrison et al., 2004).
• The effect size was high (Cohen’s d of 1.2)
• 50% of children either stopped or reduced their medication, and
still improved in symptoms.
• further explorations in larger samples of medication-naı¨ve
children and including an active control group are required

33. • 25 adults and adolescents with ADHD were enrolled in an 8-week
MCBT
• pre–post-improvements in self reported ADHD symptoms and
performance on tasks of selective attention and cognitive
inhibition.
• The effects sizes for symptom reduction were relatively high
(Cohen’s d 1.8).
• Lack of control group and use of self-reported measures of ADHD
symptoms, could have been influenced by placebo effects.
(Zylowska et al., 2008)

34. YOGA STUDIES IN schizophrenia
• In schizophrenia patients with several years of illness and on stabilized
pharmacological therapy, one-month training followed by three
months of home practices of yoga as an add-on treatment offered
significant advantage over exercise or treatment as usual.
• Improvement in negative symptoms on PANNS and social dysfunction
ratings
was observed in yoga group and only social dysfunction rating in
exercise
group as compared to treatment only
(N Gangadhar Bangalore and Shivarama Varambally, NIMHANS , 2012)

35. Yoga studies in BPAD
• hatha yoga may be a powerful positive practice for some people with
bipolar disorder
• increased mindfulness—i.e., increased nonjudgmental focus on the
present moment—and an increased sense of calm or relaxation.
• physical activity to reduce weight (side effects of antipsychotics and
mood stabalisers)
• hatha yoga is not without risks, and, like many treatments for bipolar
disorder, should be used with care.

36. Yoga studies in BPAD
• hatha yoga is not without risks, and, like many treatments for bipolar
disorder, should be used with care.
• Extreme practices— rapid breathing, heated rooms, or very slow and
meditative practice
• heat intolerance in people taking antipsychotic medication
• Heat causing dehydration can increase the risk for lithium toxicity,

37. Yoga and meditation studies in PTSD
• Yoga has been shown to have a regulatory effect on two key
neurobiological systems:
• the hypothalamic-pituitary-adrenal (HPA) axis and
• the sympathetic nervous system (SNS)
• repeated exposure to stressors makes them “hypervigilant” and
“dysregulated
• Downregulation benefit of yoga helps in PTSD((Ross & Thomas,
2010))

38. Yoga and meditation for substances use
• problems of impulsivity, poor self-regulation, and
craving/compulsive states found in substance use disorder
• different forms of Buddhist meditation may strengthen the ability
of long-term practitioners to dampen their stress responses
• to control the automatic cascade of semantic associations and
thoughts,
• increase attentional capacity and preserve cortical integrity and
plasticity.

39. Yoga and meditation for substances use
• In-mates in a correctional facility were offered a choice between
treatment as usual and a ten-day course of Vipassana meditation
• This 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 diificult to draw conclusions

40. Precipitation of psychosis by yoga and
medittaion
• Some studies have suggested that meditation can actually raise
dopamine levels and exacerbate psychosis.
• However, these studies were not randomized, controlled trials, and,
therefore, more research is needed to assess possible negative effects
of meditation for individuals with mental illness.

41. Concerns in reviews for yoga
• considerable heterogeneity and lack of detail, rationale and
consistency of approach in the types of yoga-based interventions
between the various studies
• very difficult to draw generalizable conclusions of the benefits of yoga
and identification of effectiveness of key components of interventions.
• Crosssectional studies, however, are confounded by cohort effects.
• Meditation practices are often associated with lifestyle changes that
could also affect health and personality.
• Longitudinal studies using well-controlled study groups will be needed
to establish long-term effects on personality.

42. Concerns in research studies in yoga and
meditation
• considerable heterogeneity and lack of detail, rationale and
consistency of approach in the types of yoga-based interventions
between the various studies
• very difficult to draw generalizable conclusions of the benefits of yoga
and identification of effectiveness of key components of
interventions.

43. • Longitudinal study designs testing for structural changes before and
after years of Meditation practices or
• randomised controlled trials will be more informative an convincing
with respect to causality than cross-sectional designs, where it cannot
be excluded that brain changes are related to psychological traits or
more healthy lifestyles in people who are drawn to practice
Meditation.

44. Take home message

45. refernces
• 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.
• Van der Kolk, B. (2009). Yoga and post-traumatic stress disorder: An
interview with Bessel van der Kolk, MD. Integral Yoga Magazine, 12-13.
• Bowen S, Witkiewitz K, Dillworth TM, et al. Mindfulness meditation and
substance use in an incarcerated population. Psychol Addict Behav. 2006;
20:343–347. [PubMed: 16938074]
• Bangalore, N. G., & Varambally, S. (2012). Yoga therapy for
Schizophrenia.International Journal of Yoga, 5(2), 85–91.
http://doi.org/10.4103/0973-6131.98212

46. refernces
• Yorston G.A. Mania precipitated by meditation: a case report and
literature review. Ment Health Relig Cult. 2001;4(2):209–213.
• Walsh R, Roche L. Precipitation of acute psychotic episodes by
intensive meditation in individuals with a history of schizophrenia. Am
J Psychiatry. 1979;136(8):1085–1086. [PubMed]
• 17. Lazarus A.A. Psychiatric problems precipitated by transcendental
meditation. Psychol Rep.1976;39(2):601–602. [PubMed]

47. refernces
• Hermesh H, Shiloh R, Epstein Y, et al. Heat intolerance inpatients with
chronic schizophrenia maintained with antipsychotic drugs. Am J
Psychiatry 2000;157:1327–9.