SLIDE 1 Brigham & Women’s Hospital
Harvard Medical School
Yoga and Anxiety
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
Yoga Alliance Webinar April 7 & 9, 2020
SLIDE 2
- 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
SLIDE 3
- 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.
Anxiety Disorders
SLIDE 4
- 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
Generalized Anxiety Disorder
SLIDE 5
- Pharmaceuticals
- Psychotherapy; talk therapy understanding and
dealing with their disorder
- Cognitive-behavioral therapy; recognition and change
- f thought patterns and behaviors in anxiety
- Mindfulness-related practices, e.g. Acceptance and
Commitment Therapy (ACT), Dialectical Behavioral Therapy (DBT), yoga, meditation, etc.
Treatment of Anxiety Disorders
SLIDE 6
Yoga Practices
Postures, Breathing, Relaxation, Meditation
Fitness
↑Flexibility ↑Strength ↑Coordination/Balance ↑Respiratory Function ↑Self-Efficacy
Global Human Functionality
↑Physical & Mental Health, ↑Physical Performance ↑Stress & Emotion Regulation, ↑Awareness/Mindfulness, ↑Meta-cognition ↑Positive Behavior, ↑Wellbeing, ↑Values, ↑Life Purpose & Meaning, ↑Spirituality
Self-Regulation
↑Stress Regulation ↑Emotion Regulation ↑Resilience ↑Equanimity ↑Self-Efficacy
Awareness
↑Attention ↑Mindfulness ↑Concentration ↑Cognition ↑Meta-cognition
Spirituality
↑Unitive State ↑Transcendence ↑Flow ↑Transformation ↑Life Meaning/Purpose
SLIDE 7 “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
SLIDE 8
“…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.”
SLIDE 9
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.
Mood in Long Term Practitioners
SLIDE 10
Kripalu Yoga for Performance Anxiety
Music Performance Anxiety Inventory for Adolescents (MPAI-A)
Baseline End Program
MPAI-A Average Score
40 42 44 46 48 50
Control Yoga
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.
SLIDE 11
5.5 6.5 7.5 8.5 Pre Post Follow-up
Anxiety Kripalu Yoga in Harvard Physicians
*
From: A Yoga-based Program Decreases Physician Burnout in Neonatologists and Obstetricians at an Academic Medical Center, Scheid, Dyer, Dusek, Khalsa, (manuscript under review).
SLIDE 12
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116432/pdf/nihms788847.pdf
SLIDE 13
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.
SLIDE 14
https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0204925&type=printable
SLIDE 15 https://www.handspringpublishing.com/product/principles-practice-yoga-health-care/
SLIDE 16 Trait Anxiety
Average STAI Score
40 45 50 55 60
State Anxiety
Average STAI Score
40 45 50 55 60
p = 0.004 N = 13 p < 0.002 N = 15
Y-CBT for Generalized Anxiety Disorder
SLIDE 17 Yoga for Generalized Anxiety Disorder
From: Kundalini Yoga for Generalized Anxiety Disorder: An Exploration of Treatment Efficacy and Possible Mechanisms, Gabriel MG, Curtiss J, Hofmann SG, Khalsa SBS, International Journal of Yoga Therapy, 28:97-105, 2018.
Baseline End Treatment Score
0.5 0.6 0.7 0.8 0.9 1.0 1.1
SCL90-R Anxiety
N = 34 ES = 0.56
Baseline End Treatment Score
32 34 36 38 40 42 44 46
STAI State Anxiety
N = 29 ES = 0.91
Baseline End Treatment Score
6 8 10 12 14 16 18 Beck Anxiety Inventory
N = 19 ES = 0.75
SLIDE 18
- “If you had a lot of stuff on your mind or something you could just use some
- f 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
- r 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.”
Qualitative Evaluations – Anxiety
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.
SLIDE 19
“Do not dwell in the past, do not dream of the future, concentrate the mind on the present moment.” Buddha Yoga is the stilling of the fluctuations of the mind. Patanjali
