Dr Pratik Surandashe, MD Psychiatry, Consultant Psychiatrist, Apex Group Of Hospitals, Borivali, talks about the relevance of yoga in holistic management of mental disorders and promote emotional well-being
Yoga means ‘union’. It implies the union of mind and the body. It has been part of the ancient Indian wisdom and has been practised since many millennia. It’s a way of life that transcends religions, socio-economic strata, creed or gender. There are four paths of yoga, namely, karma yoga (active path), Jnana Yoga (philosophical path), Bhakti Yoga (devotional path) and Raja Yoga (scientific path). From the above, Raja Yoga is the most popular path taken by many to achieve mental well-being. Raja Yoga employs eight steps:
1. Yama- Right moral conduct
2. Niyama- Self Discipline, contentment
3. Asana- Postural exercises
4. Pranayama- Control of breathing
5. Pratyahara-Control of senses
6. Dharana- Concentration
7. Dhyana-Meditation
8. Samadhi- the super-conscious state
The Indian sage Patanjali mentioned in his first yoga sutra (or aphorism) that “yoga is the restraint of mental modification”. It is no surprise that many mental health professionals are advising their patients to practice yoga. In India, path-breaking studies are being done to know the effects of yoga on various psychiatric illnesses. Sudarshan Kriya Yoga, Pranayama, Sahajyoga and Asanas are being used effectively either as the primary treatment modality or as an adjunct to pharmacological treatments in various mental health disorders.
Yoga is culturally acceptable, needs minimal supervision, is largely free of side effects when practised properly and last but not the least, it gives the patient a sense of control over their illness. These distinctive qualities of yoga contribute to its universal appeal.
Looking at the case of Mrs A, a 35-year-old housewife who had come to our hospital complaining of sad mood, loss of pleasure in life, easy fatigability, poor appetite and poor sleep quality from months. After the results of her thorough physical and laboratory examination came out to be normal, she was finally advised to seek psychiatric help. Mrs A was diagnosed with major depressive disorder. She complained that she couldn’t carry out her day to day responsibilities. She also reported that she has stopped meeting her friends and felt guilty for no apparent reason. Mrs A consented to treatment and was treated with antidepressant medication.
Within a period of two weeks, she reported an improvement in her mood and appetite. She also underwent counselling and regular follow-ups showed significant improvement in most of her symptoms which was further endorsed by objective measurements. However, intermittently, Mrs A would still complain about feeling low and having poor sleep. She especially complained of not feeling fresh upon waking up in the morning. So as a part of lifestyle modification, she was advised yoga practice.
She consulted a yoga practitioner and started practising pranayama, meditation and asanas. Gradually her sleep improved and Mrs A experienced a near-complete improvement in her symptoms. This shows that yoga can be used as a treatment modality in conjunction with medications and counselling, especially for residual symptoms persisting despite adequate treatment.
Today there is ample evidence to suggest that yoga improves the levels of Serotonin and Brain Derived Neurotrophic Factor (BDNF) which are low in patients suffering from depression. It also attenuates the over-active hypothalamo-pituitary-adrenal axis in patients of depression and provides relief from fatigue and being chronically stressed out.
In another case, Mr B, a 29-year-old male working as a finance executive in a multinational company, suffered from repeated episodes of feeling nervous and “being on the edge”. He would get palpitations, breathlessness, sweaty palms and dry mouth before making presentations to seniors or when facing difficult work projects. He came to our hospital seeking help to manage his anxiety. Mr B reported a very stressful work environment and was interested in trying out yoga to mitigate his problems. We trained him in relaxation and breathing exercises. He was advised to keep practising the breathing exercises even at work. After some time, he reported that he was able to handle the stressful situations at work more successfully with the combination of yoga and medications.
Yoga reduces stress by releasing GABA, a chemical which produces a relaxed state of mind. It influences the autonomic nervous system to reduce the sympathetic arousal that produced anxiety symptoms. Ashtanga Yoga also employs mindfulness in its practice of asanas and pranayamas. Mindfulness means ‘staying in the present’. A person who worries about the future is anxious and thus, yoga keeps the person focussed on the ‘now’.
Along with depression and anxiety, yoga is proven to improve cognition in patients with schizophrenia. It improves negative symptoms like avolition, anhedonia, asociality. It helps by releasing oxytocin, a hormone which improves bonding with others. Apart from the patients, yoga also helps their caregivers by reducing their stress levels.
Sudarshan Kriya Yoga also helps people with alcohol addiction. It reduces symptoms of depression occurring during alcohol withdrawal and also in the long-term treatment. Depression is a common comorbidity in alcohol addiction and is a risk factor for relapse after treatment. Fortunately, the practice of yoga reduces the chances of relapse.
Children with Attention Deficit Hyperactivity Disorder (ADHD) also benefit from yoga. Practising yoga in addition to pharmacological treatment has been known to improve inattention in many children with ADHD. It can be effectively done in the evening after school hours as a fun activity along with other family members.
Yoga is helpful to all age groups. When practised by senior citizens it improves sleeping disorders like insomnia. It promotes a sense of well-being and enhances the quality of life in the geriatric population.
The ancient wisdom of yoga is now being recognized as a relevant tool even in the practice of modern medicine. It is slowly becoming a mainstream modality for holistic care of patients and will soon be indispensable.