When people think of evidence-based treatments for depression and anxiety, the first thing that may come to mind is psychotherapy such as cognitive-behavior therapy or pharmacology, including antidepressant medications. Concerns about the effectiveness of psychotherapy, the side-effects of medications, and a variety of other reasons, lead some consumers to an interest in alternative or adjunctive (or additional) treatment options.
Yoga in Treatment
One such treatment that researchers and clinicians are exploring is yoga to help people cope with and recover from anxiety or depression. Yoga is appealing to many people, and it is widely practiced in a variety of forms across the United States and around the world. It may be a way to promote mental and physical health and well-being, more than just a tool to treat disorder and disease, which is typical of most psychotherapy and pharmacological treatments.
A growing body of research suggests that interventions incorporating yoga in a variety of forms, such as Kundalini yoga1 and trauma-focused hatha yoga2,3, may be helpful in reducing anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms,1-3 when used in conjunction with ongoing psychotherapy and medication. Research studies also suggest that yoga is effective at boosting physical health, as beneficial as many other common forms of exercise4-6.
Yoga Intervention
Much of this research examines yoga interventions that are delivered predominantly in groups and with variable lengths4. A team of researchers wanted to see if the effect on symptoms of anxiety and depression is similar in individualized and personal yoga sessions7.
Researchers examined this question in a group of 101 adults experiencing mild to severe anxiety or depression. Participants were assigned to either the control group in treatment as usual (continuing any outpatient psychotherapy and medication management and placement on a waiting list for the yoga intervention) or the yoga group, who received a six-week individualized yoga intervention in addition to their psychotherapy or medication-based treatment. Participants were not eligible if they already had a stable yoga practice at least once a week for the last three months.
Unique and Personal
What makes this study unique is that the yoga intervention was personalized for every participant. It included four individual consultations or lessons over a six-week period with a qualified yoga teacher. During these sessions, each participant learned a personalized yoga practice, which included a series of assignments to practice at home. With the support of the teacher, each yoga practice was designed to address a client’s own symptoms, needs, goals for treatment, and life circumstances.
Most practices included physical postures, breathing exercises, mindfulness, relaxation, and meditation. The teacher and the participant agreed on a length of practice that made the most personal sense. Most individuals practiced at home for 25 to 30 minutes about five times a week, having received a written copy of the practice, including diagrams and instructions for assistance. In addition, each yoga practice could be revised over the course of the four sessions if a participant’s needs or goals shifted.
The yoga components used in this study were based on prior research that identified the most important parts of yoga practices thought to address psychological symptoms of anxiety and depression8.
Positive Changes
Overall results were very promising. They suggested that the yoga intervention in addition to treatment as usual was more effective in reducing symptoms of depression, when compared with treatment as usual. The yoga intervention was also effective in reducing general psychological distress and improving overall self-reported mental health, positive experiences, and a sense of flourishing and resilience.
However, the effect of the yoga intervention on anxiety was not statistically significant, so this may warrant further attention and analysis. The effect of the yoga intervention was maintained at a six-week follow-up assessment, but there were no significant differences in perceived physical health between the yoga group and the control group after the intervention or at the follow-up point. This may be due to the personalized nature of the yoga practices, which were specifically designed to address anxiety and depression, as opposed to increasing physical strength and endurance.
Abundant Benefits
This study highlights that yoga could also be used along with conventional treatments for anxiety and depression, which can be adapted for specific personal physical concerns and preferences. It also highlights that yoga may have additional benefits beyond reducing symptoms; it may enhance an individual’s sense of resilience and flourishing while experiencing anxiety or depression.
However, researchers also note that yoga interventions have many components, such as relaxation, meditation and mindfulness, and physical postures, so it is unclear if one or a combination of these components is driving the positive change demonstrated in this study. It is hopeful that yoga as an adjunctive treatment for anxiety and depression will continue to be studied to develop and refine options for those seeking additional and alternative modes of treatment.
Sources
1. Khalsa, M. K., Greiner-Ferris, J. M., Hofmann, S. G., & Khalsa, S. S. (2015). Yoga-enhanced cognitive behavioural therapy (Y-CBT) for anxiety management: A pilot study. Clinical Psychology & Psychotherapy, 22(4), 364-371. doi:10.1002/cpp.190
2. Rhodes, A., Spinazzola, J., & van der Kolk, B. (2016). Yoga for adult women with chronic PTSD: A long-term follow-up study. The Journal of Alternative And Complementary Medicine, 22(3), 189-196. doi:10.1089/acm.2014.0407
3. van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., & Spinazzola, J. (2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. The Journal of Clinical Psychiatry, 75(6), e559-e565. doi:10.4088/JCP.13m08561
4. Desveaux, L., Lee, A., Goldstein, R., & Brooks, D. (2015). Yoga in the management of chronic disease: A systematic review and meta-analysis. Medical Care, 53(7), 653-661. doi:10.1097/MLR.0000000000000372
5. Ross A., Thomas, S. (2010). The health benefits of yoga and exercise: A review of comparison studies. The Journal of Alternative and Complementary Medicine, 16:3-12.
6. Govindaraj, R., Karmani, S., Varambally, S., & Gangadhar, B. N. (2016). Yoga and physical exercise—A review and comparison. International Review of Psychiatry, 28(3), 242-253. doi:10.3109/09540261.2016.1160878
7. de Manincor, M., Bensoussan, A., Smith, C. A., Barr, K., Schweickle, M., Donoghoe, L., Bourchier, S., & Fahey, P. (2016). Individualized yoga for reducing depression and anxiety, and improving wellbeing: A randomized controlled trial. Depression and Anxiety, 33(9), 816-828. doi:10.1002/da.22502
8. de Manincor, M., Bensoussan A., Smith, C.A. (2015). Establishing key components of yoga interventions for anxiety and depression and improving well-being: a delphi method study. BMC Complementary Alternative Medicine 15(1) 1-5.
Sarah Krill Williston is a PhD Candidate in the Roemer lab at the University of Massachusetts Boston. Sarah’s research primarily focuses on developing strategies to increase mental health literacy and reduce mental health stigma, to empower individuals to more effectively seek evidence-based mental health care for anxiety and trauma-related disorders. In addition, Sarah’s clinical interests include providing evidenced-based treatments (primarily CBT, ABBT) to individuals with mood, anxiety and trauma-related disorders, with a particular interest in working with military families, active duty service members, and veterans.
