Brigham & Women’s Hospital Harvard Medical School Yoga and Anxiety Yoga Alliance Webinar April 7 & 9, 2020 Sat Bir S. Khalsa, Ph.D. Assistant Professor of Medicine, Harvard Medical School Director of Yoga Research, Yoga Alliance Director of Research, Kundalini Research Institute Editor in Chief, International Journal of Yoga Therapy Research Associate, Benson Henry Institute for Mind Body Medicine Research Affiliate, Osher Center for Integrative Medicine
Anxiety • An unpleasant feeling of worry, concern, dread • Physical, emotional, mental, behavioral components • With or without psychological stress • Should not be confused with outright fear; more of a dreaded feeling about something which appears intimidating and can be overwhelming • A normal reaction to a stressor • It may help an individual to deal with a demanding situation by prompting them to cope with it • When overwhelming and interfering with daily life it may a clinically significant anxiety disorder
Anxiety Disorders • panic disorder • obsessive-compulsive disorder (OCD) • social phobia (or social anxiety disorder) • specific phobias • generalized anxiety disorder (GAD) Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread.
Generalized Anxiety Disorder • Pervasive day-long exaggerated worry and tension • Anticipation of disaster and excessive concern about health issues, money, family problems, or work difficulties • Patients realize that their anxiety is more intense than is warranted • Can’t relax, startle easily, difficulty concentrating • Sleep disturbance • Fatigue, headaches, muscle tension & aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, breathlessness, hot flashes • diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months
Treatment of Anxiety Disorders • Pharmaceuticals • Psychotherapy; talk therapy understanding and dealing with their disorder • Cognitive-behavioral therapy; recognition and change of thought patterns and behaviors in anxiety • Mindfulness-related practices, e.g. Acceptance and Commitment Therapy (ACT), Dialectical Behavioral Therapy (DBT), yoga, meditation, etc.
Yoga Practices Postures, Breathing, Relaxation, Meditation Self-Regulation Awareness Spirituality Fitness ↑ Flexibility ↑ Attention ↑ Unitive State ↑ Stress Regulation ↑ Strength ↑ Emotion Regulation ↑ Mindfulness ↑ Transcendence ↑ Coordination/Balance ↑ Resilience ↑ Concentration ↑ Flow ↑ Respiratory Function ↑ Equanimity ↑ Cognition ↑ Transformation ↑ Self-Efficacy ↑ Self-Efficacy ↑ Meta-cognition ↑ Life Meaning/Purpose Global Human Functionality ↑ Physical & Mental Health, ↑ Physical Performance ↑ Stress & Emotion Regulation, ↑ Awareness/Mindfulness, ↑ Meta-cognition ↑ Positive Behavior, ↑ Wellbeing, ↑ Values, ↑ Life Purpose & Meaning, ↑ Spirituality
“Due to its good compliance and lack of drug interactions, yoga appears to be safe and could be encouraged to improve quality of life and, perhaps, the symptoms of stress and anxiety.” http://www.altmedrev.com/publications/17/1/21.pdf
“…yoga can serve as a therapeutic option for addressing the onset of state anxiety…doing yoga as part of a healthy lifestyle can have benefits with regard to state anxiety.”
Mood in Long Term Practitioners From: Profile of mood states and stress-related biochemical indices in long-term yoga practitioners, Yoshihara K, Hiramoto T, Sudo N, Kubo C, Biopsychosocial Medicine, 3;5:6, 2011.
Kripalu Yoga for Performance Anxiety Music Performance Anxiety Inventory for Adolescents (MPAI-A) MPAI-A Average Score 50 Control 48 46 44 Yoga 42 40 Baseline End Program From: Yoga Reduces Performance Anxiety in Adolescent Musicians, Khalsa SBS, Butzer B, Shorter SM, Reinhardt K, Cope S, Alternative Therapies in Health & Medicine, 9:34-45, 2013.
Kripalu Yoga in Harvard Physicians Anxiety 8.5 * 7.5 6.5 5.5 Pre Post Follow-up From: A Yoga-based Program Decreases Physician Burnout in Neonatologists and Obstetricians at an Academic Medical Center, Scheid, Dyer, Dusek, Khalsa, (manuscript under review).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116432/pdf/nihms788847.pdf
Yoga for Anxiety From: Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials, Cramer H, Lauche R, Anheyer D, Pilkington K, de Manincor M, Dobos G, Ward L, Depression and Anxiety, 35:830-843, 2018.
https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0204925&type=printable
https://www.handspringpublishing.com/product/principles-practice-yoga-health-care/
Y-CBT for Generalized Anxiety Disorder Trait Anxiety State Anxiety Average STAI Score Average STAI Score 60 60 p = 0.004 p < 0.002 N = 13 N = 15 55 55 50 50 45 45 40 40
Yoga for 18 Beck Anxiety Inventory Generalized Anxiety 16 Disorder N = 19 ES = 0.75 14 Score From: Kundalini Yoga for Generalized 12 Anxiety Disorder: An Exploration of 10 Treatment Efficacy and Possible Mechanisms, Gabriel MG, Curtiss J, 8 Hofmann SG, Khalsa SBS, International 6 Journal of Yoga Therapy, 28:97-105, 2018. Baseline End Treatment SCL90-R Anxiety STAI State Anxiety 1.1 46 44 1.0 N = 29 N = 34 42 ES = 0.91 ES = 0.56 0.9 40 Score Score 0.8 38 0.7 36 34 0.6 32 0.5 Baseline End Treatment Baseline End Treatment
Qualitative Evaluations – Anxiety • “If you had a lot of stuff on your mind or something you could just use some of those exercises... I just felt calmer and stuff…” • “I used breathing outside the classroom in my life to calm me down… if I was stressed or angry I would then do the breathing to calm me down and I will probably continue to do this…I was less anxious about school in general...” • “Before you’re taking a test… relax and breathe and you don’t get as nervous or as tense.” • “I felt like it was [easier] to calm myself if I was like nervous about something … or just like to deal with my stress.” From: Qualitative evaluation of a high school yoga program: Feasibility and perceived benefits, Conboy LA, Noggle JJ, Frey JL, Kudesia RS, Khalsa SBS, Explore: The Journal of Science & Healing, 9:171-180, 2013. A qualitative examination of yoga for middle school adolescents, Butzer B, LoRusso AM, Windsor R, Riley F, Frame K, Khalsa SBS, Conboy L, Advances in School Mental Health Promotion, 10:195-219, 2017.
Yoga is the stilling of the fluctuations of the mind. Patanjali “Do not dwell in the past, do not dream of the future, concentrate the mind on the present moment.” Buddha
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