SamatvamJune How Yoga Can Help Treat Mental Disorders

Transcription

1 SamatvamJune 2015 How Yoga Can Help Treat Mental Disorders

2 Samatvam 01 EDITORIAL Yoga and the brain NIMHANS at the frontier The message Samatvam Yoga Uchyate (Equilibrium is Yoga) is a part of the NIMHANS' logo. True to this, the Institute has a proud tradition of research into the effects of yoga on the brain and nervous system since the last four decades, and has also been a pioneer in using yoga-based interventions as a therapeutic modality for neuropsychiatric disorders. The yoga research conducted at NIMHANS has been multidisciplinary, involving basic science, paraclinical, and clinical departments. To help realize the potential of yoga for both service and research in patients suffering from neuropsychiatric disorders, the NIMHANS Integrated Centre for Yoga Mental Health and Neurosciences was set up in 2007 in collaboration with the Morarji Desai National Institute of Yoga, New Delhi (an autonomous institute under the Dept. of AYUSH, Govt. of India). The Centre was successful in integrating yoga into service delivery and research at NIMHANS, and conducted ground-breaking research on the efficacy and biological mechanisms of yoga in disorders such as schizophrenia, depression, and cognitive impairment in the elderly. The work of the centre has been published in more than 20 peer-reviewed research articles in national and international journals, and has received global recognition. The Centre was successful in integrating yoga into service delivery and research at NIMHANS, and conducted ground-breaking research on the efficacy and biological mechanisms of yoga in disorders such as schizophrenia, depression, and cognitive impairment in the elderly. The NIMHANS Integrated Centre for Yoga was established in July 2014 and is currently engaged in continued service, research, and educational programs at the interface of yoga and neuropsychiatry. Collaborative research by medical and yoga researchers is the way forward to place yoga on a sound scientific footing as an evidence-based therapeutic intervention, and institutes like NIMHANS must lead the way. I am happy that the NIMHANS Integrated Centre for Yoga and the White Swan Foundation are bringing out a special edition of the Samatvam magazine on the occasion of the first International Day of Yoga. I congratulate the team on the good work and wish them all the best for future endeavours. Dr. P Satish Chandra Director and Vice-Chancellor, NIMHANS World Yoga Day More than 300 people participated in the yoga session organized by the NIMHANS Integrated Centre for Yoga, to celebrate the International Day of Yoga on 21 June 2015

3 The Science Behind Yoga Dr. Ramajayam G Samatvam 02 Yoga has been in existence in the form of art and also as an experiential science for thousands of years. However, serious objective scientific exploration started only in the last few years. To tap all the potential benefits of yoga and make it appealing to humanity, studying it thoroughly like any other science is as essential as portraying it in its most artistic form. Patanjali s systematic approach The eight limbs of yoga, as framed by Patanjali, are evidence of the systematic approach yoga follows, at par with other mainstream sciences. Yama, niyama, asana, pranayama, prathyahara, dharana, dhyana and samadhi are the eight limbs of yoga. Yama and niyama are for behavioral modification, asana and pranayama for physical conditioning, prathyahara and dharana for mental focus and dhyana and samadhi for self-realization. We can see that Patanjali has given interventions in multiple ways, covering different levels of human existence with the common goal of mind control. Though the systematic way of approaching a subject, which forms the core of any science, is evident in the eight limbs itself, exploring exactly how yoga works has been elusive for the scientific community for many practical reasons. Despite the challenges, researchers have now begun to gather objective scientific evidence that will give yoga a concrete scientific backing. Researchers have found that yoga can: Reset the homeostatic set point The human body functions in a highly coordinated manner. Every cell functions within a range of normality, allowing for some adjustments when there is a change in its surroundings. Some tissues have a lower level of controlling capacity and some have a high level. When certain functions such as hormonal secretion take place, there is feedback generated between these two levels of tissues. This feedback is used to maintain the range of normality and stability of cell functioning. This process that maintains the stability of the human body's internal environment in response to surrounding changes is known as homeostasis. Erratic lifestyles can cause instability in this process and it can be fixed with regular practice of yoga. People are becoming increasingly stressed nowadays and yoga can be a good antidote. Modulate stress People are becoming increasingly stressed nowadays and yoga can be a good antidote. The neuro-endocrine system has inbuilt mechanisms to fight stress. However, when used for a long term without setting a strategy to manage stress, it gets exhausted. This leads to negative consequences such as increased stress hormones that have adverse effects on the entire human system. Yoga primarily works at this core level of eradicating stress and hence relaxes the whole body and mind. This systematic way of giving rest to the cells has a profound effect on our perception of stress and hence its management. Fine-tune the autonomic nervous system The autonomic nervous system has two parts: the sympathetic nervous system and the parasympathetic nervous system. The sympathetic system is responsible for the 'fight-orflight' response of the body, while the parasympathetic system is responsible for activities when the body is at rest such as digestion and sexual arousal. They are complementary systems which work in harmony to maintain a healthy state. However, when the sympathetic system is overused, this balance is upset, resulting in illness. Yoga helps in restoring the balance between the two types of the autonomic nervous system thereby boosting overall health. Enhance the quality of life Yoga has subtle positive effects on several aspects of our life. These benefits can be experienced by a person practicing yoga but may not be measured by scientific tools. Inner peace, contentment, happiness and self awareness are some of the aspects on which yoga has a positive effect. These positive experiences are not only a foundation for healthy living but also beneficial for people approaching the end of their life (cancer, chronically ill, bed-ridden patients), as it provides an anchor for them to hold on to something positive. As a result of these effects on the various body mechanisms, here are some of the direct benefits that yoga provides: decreased blood pressure decreased heart rate better oxygen utilization improved digestion reduced toxic substance formation better immune system better neuro-muscular coordination better hormonal balance It is evident that the core principles of yoga - relaxed body, slow and steady breath, and calm mind - help us experience all the above mentioned benefits. Dr Ramajayam G is a PhD Scholar in yoga, at NIMHANS, Bangalore

4 How Yoga Can Help Treat Mental Disorders Dr Shivarama Varambally Samatvam 03 Yoga as an intervention in psychiatric disorders is not a recent concept, as doctors have been recommending yoga-based interventions for stressrelated disorders since a long time. However, there has been a renaissance in the last two decades, in terms of a scientific approach and modern research methods to the study of yoga-based interventions. Yoga practice is known to improve a person's physical and mental functioning. In psychiatry, yoga-based interventions have been successfully used both as a standalone and a supportive treatment of disorders such as depression, anxiety, and insomnia. Yoga has also been beneficial as a complementary treatment for psychiatric conditions such as schizophrenia, Attention Deficit Hyperactivity Disorder (ADHD) in children, and cognitive impairment in the elderly. Yoga practice is known to improve a person's physical and mental functioning. Yoga practice has led to improved cognitive performance in persons with depression, better emotion recognition abilities in persons with schizophrenia, and improved memory, sleep and quality of life in elderly persons with mild memory impairment. Regular practice of yoga causes a reduction in the 'stress hormone' cortisol, increase in the cuddle hormone oxytocin and increase in markers of brain plasticity such as Brain Derived Neurotrophic Factor (BDNF). It helps prevent degeneration of brain cells, or even an increase of brain volume in areas related to memory (hippocampus), especially in the elderly A neuro-imaging study on healthy persons showed that chanting Om reduced brain activation in areas related to emotional control, suggesting that it has the potential to calm emotional disturbances. Yoga asanas and their possible effects on bodily conditions Yogic practice Quality Viparitakarini mudra Suryabhedana Pranayama Pascimottanasana Stops/slows down/ reverses aging and cognitive decline Matsyendrasana Matsyendrasana Matsyasana Bhujangasana Helps fight all types of diseases Kapalabhati Pranayama Paschimottasana Improves overall health Matsyendrasana Pascimottasana Viparitakarini mudra Bhujangasana Improves metabolism Suryabhedana Pranayama Bhastrika Pranayama

5 Samatvam 04 Nadisuddhi Pranayama Savasana Tadasana (Tree pose) Adhomukha Shavasana (Dog pose) Virabhadrasana (Warrior pose) Vajrasana (Thunderbolt pose) Simhasana (Lion pose) Ardha-Matsendrasana (Half-spinal stretching pose) Yogamudra Maarjaalasana (cat-pose) Dhanurasana (Downward-facing bow pose) Nadishuddhi Bhraamari (Bee breath) Cleanses the nadi (finer channels which carry life force, i.e, Prana) Wards off stress, strain, fatigue and brings mental calmness For, diminished memory, thinking and concentration For depressed mood, easy fatigability/loss of energy For depressed mood For depressed mood, diminished memory, thinking and concentration, anorexia, weight loss/gain & constipation, hypersomnia For depressed mood, diminished memory, thinking and concentration For anorexia, weight loss/gain & constipation For depressed mood, decreased sexual desire/functioning For easy fatigability/loss of energy, psychomotor agitation For anorexia, weight loss/gain and constipation For depressed mood, diminished memory, thinking and concentration, depressive ideation For psychomotor agitation, easy fatigability The above references highlight the benefits of yoga-based interventions to treat psychiatric disorders. However, there are several challenges for adapting yoga in clinical practice. One of these is the significant variability in the yoga practices taught and followed by different schools of yoga. In addition, there is difficulty in correlating the benefits of yoga practices as described in traditional yoga literature to specific disorders as defined by modern medical diagnostic systems. Staunch yoga practitioners and experts define it to be a holistic and spiritual lifestyle and are not in favor of creating specific yoga modules for specific mental health problems. However, evidence-based modern medical science demands scientific proof in terms of 'randomized controlled trials' of a specific yoga module or package for a specific disorder. This mandates cooperative research by clinicians and yoga experts to make the optimum benefits of yoga available to the maximum number of people. Staunch yoga practitioners and experts define it to be a holistic and spiritual lifestyle The NIMHANS Integrated Centre for Yoga has made several efforts in this direction wherein psychiatrists and neuroscientists have collaborated with yoga experts from Swami Vivekananda Yoga Anusandhana Samsthanam (SVYASA) and Morarji Desai National Institute of Yoga, New Delhi (an institution under the Department of AYUSH, Govt. of India). This has led to the development and validation of some specific yoga modules for disorders such as depression, cognitive impairment in the elderly, and schizophrenia. This is just the beginning of a much-needed intensive program that will integrate different streams of medicine for the benefit of patients suffering from neuropsychiatric disorders. Dr Shivarama Varambally is a consultant at the NIMHANS Integrated Centre for Yoga, and additional professor of psychiatry at NIMHANS, Bangalore References: 1- Hariprasad VR, Varambally S, Varambally PT, Thirthalli J, Basavaraddi IV, Gangadhar BN. Designing, validation and feasability of a yoga-based intervention for elderly. Indian J Psychiatry 2013; 55: Naveen GH, Rao MG, Vishal V, Thirthalli J, Varambally S, Gangadhar BN. Development and feasibility of yoga therapy module for out-patients with depression in India. Indian J Psychiatry 2013;55:350-6

6 Yoga for the World Dr. BN Gangadhar Samatvam 05 In his speech at the United Nations General Assembly on 27 Sept 2014, Hon Prime Minister Narendra Modi called for an International Yoga Day. Twelve weeks later, the UN declared that 21 June be dedicated as International Day of Yoga. The celebration of this day is a matter of pride for all of us. The word 'yoga' has its origins from the word 'yuj', which means 'unite'. In a way, yoga has united all the countries that voted for it at the UN. 21 June is the summer solstice (longest day of the year) to the majority of the population that lives in the northern hemisphere. Hence, this day was selected as International Yoga Day. The date, therefore, symbolizes enlightenment, the effect of yoga. Six thousand years ago, yoga originated as a spiritual lifestyle in our country. Yoga is a means to unite the body and mind; thought and action; and to create internal harmony. It also leads one from ignorance to a higher understanding and awareness. In the spiritual sense, it unites the personal consciousness with the cosmic one. Many people practice yoga rigorously with dedication, to achieve this spiritual consciousness. Today, most people see yoga as a set of postures and a few breathing practices, while some others consider yoga a form of meditation. Either of these is completely true. Yoga is a holistic lifestyle with many principles. Asanas and pranayamas form the physical part of the practice. This practice is also an effortful inner journey of the consciousness, which, as it progresses, becomes effortless and leads to bliss: the final union of the conscious with the supreme. The process is multidimensional. Practiced together with mindfulness at all stages, yoga brings about the best outcomes. In the field of medical science, several studies indicate the physical benefits of yoga. Scientists have studied the nervous system extensively, and have observed that there is a structural, functional, and chemical change in the brain of people who practice yoga regularly. Through this practice, the brain becomes highly functional, the autonomic system stabilizes, and the sympathetic and parasympathetic systems become harmonious. This, in turn, has effects on other organs as well. As a consequence, yoga practitioners experience a high degree of psychological wellbeing, and demonstrate increased competence in their skills. Research on the heart and its functions have testified the benefits of yoga. Regular practice leads to decrease in blood pressure and heart rate. The rhythm of the heartbeat becomes healthier as measured by a parameter called as heart rate variability. Respiratory rate becomes slower. The internal organs function predictably. Several endocrine organs become steady. Yoga, therefore, harmonizes the functions of different body systems. And what about the mind? Yogavasishta, describes yoga as manah prashamanopayah. This means yoga improves the health of the mind. Some years later, the Bhagavad Gita too described yoga as samatvam, meaning harmony in mind. Patanjali, who can be credited for simplifying yoga from its abstract philosophy to practical and comprehensive steps, states yogahchittavrittinirodhah as the first aphorism in his teachings. This means that yoga makes the mind more stable. Clearly, yoga has a profound effect on the mind, bringing it to a state of positive health. No wonder, the regular practice of yoga creates a state of tranquility and wellbeing in people. Is yoga merely an alternative to exercise? At our clinic, nearly every person who is unwilling to practice yoga says that they are exercising enough and don t need it. This is a myth because yoga is not the same as any other form of exercise. Yoga must be practiced with slowness and steadiness. Each movement should be slow and synchronized, accompanied by appropriate breathing technique. The posture itself needs to be held effortlessly. Asana is described as sthiram sukham meaning steady and relaxed. At all stages of performing the asanas, the practitioner is expected to be mindful. Yogasana, therefore, is inherently different from exercise, and there is enough evidence to support this statement. Yoga, as mentioned earlier has other components too. The eight limbs of yoga that Patanjali describes are the yama, niyama, asana, pranayama, pratyahara, dharana, dhyana and samadhi. One can experience holistic benefits by practicing yoga regularly, when compared to the benefits of other forms of exercise. As we celebrate International Day of Yoga, let us remember that yoga has the potential to help us be more restful, mindful, and keep us all united. The department of AYUSH has released a simple set of yoga practices to help us all. Let us make yoga our lifestyle, and achieve a healthier mind and healthier body. Dr. BN Gangadhar, Dean, Behavioural Sciences; Professor of Psychiatry, Officerin-charge, NICY, NIMHANS

7 Increasing Gray Matter In Your Brain Naturally! SriRanjitha Jeurkar Samatvam 06 Most of us are aware of the physical benefits of practicing yoga yoga helps build a stronger, more flexible body, greater endurance and overall physical wellbeing. This can lead to the misconception that yoga is just another form of exercise. However, yoga was originally intended to train the mind (or the brain) and it is only over the last few centuries that the physical aspect of yoga has received greater emphasis. Experts say that yoga practices include meditation and other mindfulness techniques used to train the mind. Patanjali meant yoga to be a tonic for the mind; the aim of practicing yoga is to gain mastery over the mind. Yoga offers several physical benefits as a by-product of the practices, but it is also very good for the brain. It reduces stress, improves concentration, increases gray matter and creates new neural pathways; it can also help in the management of disorders like depression and schizophrenia, says Dr Shivarama Varambally, additional professor, department of psychiatry, NIMHANS. Can my brain benefit from yoga? It is commonly known that yoga is effective in reducing stress and reducing age-related degeneration. It can also improve your memory and sharpen your cognitive abilities. It improves the supply of blood to your brain, minimizing the chances of a stroke, especially among persons with disorders like diabetes, blood pressure and high cholesterol. Yoga can help you bring down your heartbeat to a healthier rate, enabling you to stay calm and rational in difficult situations. It also enhances your ability to stay focused with a task for longer periods of time. How long does it take for the effects to be visible? Even a single session of practice can lead to changes in the brain. The improvement to your mental wellbeing are visible within the first one week; you are likely to feel better and calmer, stay more confident about handling things, and experience lower levels of stress. Within a few weeks, you may notice that you are grasping things more quickly, have a sharper memory and have improved concentration and focus. Experts say that yoga can have optimum long-term impact when practiced for at least three days a week, for at least six months at a stretch. You can plan your yoga practice to focus on mindfulness and the breath to achieve maximum cognitive benefit. Reducing stress and anxiety By balancing the parts of the nervous system that control our rest and action mechanisms, yoga helps to reduce stress and anxiety. The central nervous system is made of two parts: the sympathetic system and the parasympathetic system. The parasympathetic system guides our mind and body into action, causing us to fight or flee in danger situations. The sympathetic system helps us slow down by reducing the heart rate, calm down and be in a relaxed state. A balance between the functioning of these two systems helps us function normally. Our modern lifestyle, with its stress and over-stimulation, activates the sympathetic system and creates an imbalance between the two. Practicing yoga regularly activates the parasympathetic system, which regulates the breathing, heart rate, and reduces stress and anxiety levels. Improving memory, thinking sharper Did you know that practicing yoga regularly can help increase the grey matter in your brain? The hippocampus, or the part of the brain that is critical for memory and cognitive abilities, shrinks as we grow older; this is why we tend to forget things, or slow down intellectually as we age. A study conducted by NIMHANS across old age homes in Bangalore monitored the effects of yoga on the brains of residents, after they practiced yoga for six months. The researchers found that regular practice of yoga reversed the effects of aging, and enhanced the size of the hippocampus. They concluded that practicing yoga can be very beneficial among those with mild cognitive impairment, a condition that precedes the onset of dementia and other old-age related brain disorders, and prevent them from occurring. Healing the brain The brain is an organ that has a remarkable ability to heal itself. A person with a brain injury or trauma may lose some abilities for a period of time, during which the brain is able to repair the injured part, or move the functioning into another. The Brain Derived Neurotropic Factor (BDNF) is a marker of the brain s plasticity, or ability to heal itself. The higher a person s BDNF, the greater the brain s ability to heal itself. Persons with depression or bipolar disorder have lowered levels of BDNF. They also have higher levels of cortisol (the stress hormone). When they are treated with medications for depression, the depression may get better, and the BDNF levels also increase, but once they stop the medication, the person remains at a risk of relapse as the stress and cortisol levels may remain elevated. A study at the NIMHANS Integrated

8 Centre for Yoga showed that when patients with depression practiced yoga with or without medication, their BDNF levels normalized and the cortisol levels came down. This suggests that the stress came down, and therefore minimizes the chances of relapse. Reducing negative emotions Chanting Om for at least five minutes can help reduce the flow of blood to the part of the brain that is involved in negative emotions like anger, stress, jealousy or disgust. In a functional MRI study conducted at NIMHANS, laypersons (with no expertise in yoga) were asked to chant Om for five minutes, and chant another phrase for five minutes, under control conditions. The scans showed decreased blood flow to the parts of the brain that control emotion while chanting Om, when compared to another phrase. This suggests that the different forms of chanting prescribed in various mindfulness techniques (yoga or mindfulness meditation) can help manage negative emotions when practiced regularly. Improving recognition of facial emotions Among people with schizophrenia, yoga has been proven to increase the brain s ability to register facial emotions. Persons with schizophrenia have been shown to have Facial Emotion Recognition Deficits, which makes it challenging for them to make sense of facial expressions and interpret them in terms of emotions. For instance, a person with schizophrenia may misunderstand neutral or even positive facial emotions as anger or fear. A study conducted at NIMHANS has shown that practicing yoga can help a person with schizophrenia overcome these deficits caused by the illness. A group of persons with schizophrenia were shown videos and still images of trained actors enacting different emotions. Participants experienced difficulty in mapping the expression to the emotion being acted out. After practicing yoga for at least three times a week for three months,, they showed a significant improvement in this ability. This is possibly linked to the blood flow changes in the brain as explained above, and also increase in blood levels of a hormone called oxytocin (the bonding hormone), which is important in promoting bonding between mothers and infants. It is also known to promote social behaviours by facilitating connection, relaxation and trust. SriRanjitha Jeurkar is with the White Swan Foundation References 1- Hariprasad VR, Varambally S, Shivakumar V, Kalmady SV, Venkatasubramanian G, Gangadhar BN. Yoga increases the volume of the hippocampus in elderly subjects. Indian J Psychiatry 2013; 55: GH, Thirthalli J, Rao MG, Varambally S, Christopher R, Gangadhar BN. Positive therapeutic and neurotrophic effects of yoga in depression: A comparative study. Indian J Psychiatry 2013; 55: Effect of yoga therapy on plasma oxytocin and facial emotion regulation deficits in patients of schizophrenia: Jayaram et al, IJP, 2013 Link: NIMHANS Integrated Centre for Yoga: The Team Published by The NIMHANS Integrated Centre for Yoga, in collaboration with White Swan Foundation for Mental Health ( Contact Details: NIMHANS Integrated Centre for Yoga, AYUSH Block, NIMHANS, Bangalore Website: yoga.nimhans@gmail.com Sitting L to R: Dr. Muralidharan K, Dr. Naren P. Rao, Dr. BN Gangadhar, Dr. Shivarama Varambally, Dr. G. Venkatasubramanian Standing L to R: C Gowthami, Dr. Sneha J. Karmani, Shubha Bhat G.S., Kavitha R, Dr. Vinod Kumar