|Year : 2020 | Volume
| Issue : 1 | Page : 105-107
Knowledge of yoga and its application in psychiatry
Manan Kirankumar Desai
Department of Psychiatry, CU Shah Medical College and Hospital, Surendranagar, Gujarat, India
|Date of Submission||06-Nov-2019|
|Date of Decision||17-Dec-2019|
|Date of Acceptance||31-Jan-2020|
|Date of Web Publication||30-May-2020|
Dr. Manan Kirankumar Desai
Department of Psychiatry, CU Shah Medical College and Hospital, Dudhrej Road, Surendranagar - 363 001, Gujarat
Source of Support: None, Conflict of Interest: None
Since ancient times, yoga has been conceived as plural in its composition, meanings, and practices with singularity in its objective to promote mind–body fitness. In contemporary times, hatha yoga (physical yoga) is getting further diversified into different styles. Deeper understanding of these forms of yoga reveals that certain components including ethical and moral principles, posture (asana), breathe regulation (pranayam), chanting particular sounds (mantra), introspection (pratyahar), contemplation (dharana), and meditation (dhyan) are common among these. First, yoga can induce harmony in mind–body functioning. Second, being experientially rooted, it can be adopted considerably with much ease in comparison to the existing psychological practices. Third, it has promising potential to address the mental health concerns of the people because training and taking the service of yoga is cost-effective. Fourth, it can also alleviate multiple physical, emotional, and social sufferings holistically. Gradually, demand for personalized, eclectic, and intuitive therapeutic approaches is on rise for psychiatric disorders and mental well-being.
Keywords: Mental health, psychiatry, yoga
|How to cite this article:|
Desai MK. Knowledge of yoga and its application in psychiatry. Ann Indian Psychiatry 2020;4:105-7
| Introduction|| |
In the Indian tradition, yoga was conceived as a pathway toward attainment of joy in life, freedom from sorrows, mental balance, and peace. The word roots of yoga mean “to join” in Sanskrit. Joining mind and body and individual and collective selves is the essence of this 3500-year-old ancient South Asian practice. Patanjali, who collated, coordinated, and systematized the system of yoga, declared the main objective of yoga as regulation of mind in the second aphorism of famous yoga sutra (Yogah Chitta vritti Nirodhah). Hatha yoga, a yogic tradition focusing on physical modus operandi for realizing deeper states of consciousness, emphasizes on postures, breathing patterns, energy locks, and contemplation to enhance energy and vitality. Many features and practices of yoga deal with psychological disorders and promoting psychological wellness.
As postgraduate resident doctors, we have limited understanding, skill, and experience of yoga due to the lack of knowledge or unavailability of a trained yoga therapist. In our hospital, we are prescribing yoga daily for 15–30 min verbally without expert supervision by showing printed handouts and educational videos adjuvant to pharmacotherapy for patients suffering from various psychiatric disorders such as depressive disorders, anxiety disorders, and somatic symptom disorder. We have found it to be effective in such patients. As quest and demand for nonpharmacological treatment modalities has been increasing, yoga can be used as cost-effective supportive psychotherapy. In this article, I will review relevant research on the mechanism of action, tools for self-regulation, efficacy in various psychiatric disorders, and general guidelines for yoga.
| How Does Yoga Work?|| |
Various researchers hypothesize that yoga works through positively affecting the nervous system, the cardiovascular system, and gene expression. Stimulation of the vagal nerve results in increased parasympathetic activity of the autonomic nervous system and also increases gamma-amino butyric acid activity in the brain. Similar to other forms of physical exercise, breathing and body movement has a positive impact on cardiovascular health. Studies comparing gene expression in long-term practitioners of yoga with controls suggest that yoga positively affects gene expression profiles in immune cells. Reduction in cortisol, increases in neurotropic factors (BNDF), plasma oxytocin, heart rate variability, amplitude of the cognitive event-related potential, and gray matter volume are reported in different studies. From a yogic perspective, the breath is a bridge between mind and body. The key to quieting the mind is slowing and deepening the breath. Practicing yoga helps to regain mental stability, calmness, and tranquility, primarily because of this kind of breathing. A yogic saying states that through a flexible body, we gain a flexible mind. This helps people become more patient, forgiving, and less prone to anger and sadness.
| Yoga's Tools for Self-Regulation: Ancient and Modern Interpretations|| |
The eight limbs under the following four categories referred to, herein, as “process tools” because a combination of these four categories encompasses most modern yoga classes, and most research on yoga emphasizes these particular practices:
| Ethics (Yam and Niyam)|| |
Yam refers to ethics regarding the outside world and therefore is particularly important in social contexts. It comprises nonviolence, truthfulness, nonstealing, moderation of senses, and greedlessness. Niyam refers to ethics regarding the inner world. It comprises purification or cleanliness and contentment, austerity, self-reflection, and surrender or devotion to something greater than oneself.
| Postures (Asana)|| |
In Patanjali's yoga sutras, the limb of asana is defined as steady and comfortable posture. A common premise behind modern yoga classes is that practicing various postures may help to reduce physical and emotional stress. A typical yoga class will include a series of postures targeting different parts of the body including forward and backward bends, twists, standing poses, and balancing poses.
| Breath Regulation (Pranayam)|| |
The Sanskrit word pranayam is composed of the word pran, which translates to breath as a life-sustaining force and the word ayam which translates to freedom or release. Pranayam differs from normal breathing on a number of dimensions, including the duration of the in breath, the out breath, the holding of the breath, and the ratio of these. All pranayams involve diaphragmatic breathing, mostly deep and slow in quality through the nose.
| Meditation (Pratyahar, Dharana, Dhyan, Samadhi)|| |
Sensory withdrawal (Sanskrit: pratyahar) involves techniques to minimize external distractions from sensory information, facilitating a calm mind and allowing attention to turn inward. In dharana, the practitioner aims to focus the mind on a single object of meditation such as the breath, a point on the body or an external object (e.g. candle flame) and attempts to maintain focus on that object. Gradually, the mind ceases wandering, and meditation shifts into what raja yogis consider more advanced meditative practices, dhyan, as effort to maintain focus, and an unbroken chain of awareness rests on the object of meditation. This leads to the final meditative limb, samadhi, which represents transcendent states of conscious awareness and absorption associated with a nondual subject/object distinction.
| Yoga and Psychiatric Disorders|| |
Studies have found reasonable benefit in mild depression and anxiety, even in the absence of pharmacotherapy. Studies of yoga in schizophrenia have yielded evidence of benefit as an adjunct to medications in improving positive and negative symptoms, quality of life, and sociooccupational functioning. The randomized controlled trials (RCTs) examining yoga in attention deficit hyperactivity disorder (ADHD) have demonstrated moderate–large effect sizes, comparable to other alternative therapies such as biofeedback and relaxation in ADHD. Three RCTs suggest substantial benefit for sleep complaints, although the absence of formal diagnostic and statistical manual of mental disorder (DSM) diagnoses in these studies is limiting. RCTs in cognitive disorders and eating disorders yielded conflicting results. Yoga can improve somatization and mental health status and implications for the prevention of psychosomatic symptoms in healthy individuals. Yoga practices have a place in the health-care system as a treatment for a variety of psychiatric conditions, at least as an adjunctive if not as a primary therapy.
| General Guidelines for Yoga Practice|| |
Before the practice
- Saucha means cleanliness – an important prerequisite for yogic practice. It includes cleanliness of surrounding, body, and mind
- Yogic practice should be performed in a calm and quiet atmosphere with a relaxed body and mind
- Yogic practice should be done on an empty stomach or light stomach. Consume small amounts of honey in lukewarm water if one feels weak
- Bladder and bowels should be empty before starting yogic practices
- Light and comfortable cotton clothes are preferred to facilitate easy movement of the body
- Yoga should not be performed in state of exhaustion, in a hurry or in acute stress conditions
- Yoga experts should be consulted before doing yogic practices during pregnancy and menstruation.
During the practice
- Practice sessions should start with a prayer or invocation as it creates a conductive environment to relax the mind
- Yogic practices should be performed slowly, in a relaxed manner, with awareness of the body and breath
- Do not hold the breath unless it is specially mentioned to do so during the practice
- Breathing should be always through the nostrils unless instructed otherwise
- Do not hold body tightly, or jerk the body at any point of time
- Perform the practices according to individual capacity
- It takes some time to get good results, so persistent and regular practice is very essential
- There are contraindications/limitations for each yoga practice and such should always be kept in mind
- Yoga session should end with meditation/deep silence.
- Bath may be taken only after 20–30 min of practice
- Food may be consumed only after 20–30 min of practice.
| Conclusion and Further Directives|| |
The judicial and adequate practice of yoga in selected cases of psychiatric disorders would bring us better outcome in prevention, treatment, and maintenance. It is acceptable, accessible, and cost-effective and encourages self-reliance. Resident doctors need to play an important role by integrating yoga into day-to-day practice along with pharmacotherapy and make it suitable personalized form of therapy for patients. Thus, the integration of training regarding yoga therapy in postgraduate curriculum is important.
I would like to express special thanks of gratitude to my esteemed teacher Dr. Kamlesh Patel (Professor and Head, Department of Psychiatry, CUSMC) for invaluable guidance and helping hand.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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