As the mainstream media and general public pay more and more attention to the importance of mental health and mental health treatment with each passing day, there’s a renewed interest in complementary therapies such as yoga for common mental health disorders such as depression.
At Crownview Psychiatric Institute, we specialize in using the latest, cutting-edge therapies and approaches to mental health and psychiatric treatment. Examples of our innovative treatment approaches include:
The Unified Protocol for Treatment of Emotional Disorders
This protocol revolves around helping patients understand how their responses to their difficult emotions contribute to their symptoms, helping them gain perspective on those emotions, then developing productive ways to manage those responses in order to manage their symptoms. The eight modules of the Unified Protocol are effective in treating people with depressive disorders (MDD), anxiety disorders (AD), bipolar disorder (BD 1&2), posttraumatic stress disorder (PTSD), borderline personality disorder (BPD), and others.
Stellate Ganglion Block
This treatment involves injecting a local anesthetic into a cluster of nerves in the neck called the stellate ganglion, which are associated with some of the more disruptive, disturbing, and distressing symptoms associated with post-traumatic stress disorder (PTSD). After the injection, patients report symptom reduction and a sense of safety that allows them to fully participate in trauma-informed protocols such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and others.
Transcranial Magnetic Stimulation (TMS)
TMS is a non-invasive brain stimulation therapy (BST) that involves directing small electromagnetic pulses at specific brain areas in order to reduce the symptoms of mental health disorders such as treatment-resistant depression (TRD), bipolar disorder (BD), and others. Treatment occurs in an outpatient setting and does not require anesthesia. Clinicians place a small cap or coil on the patient’s scalp, and the small electromagnetic pulses stimulate brain areas associated with mood and emotion.
Ketamine and Spravato®
Ketamine and Spravato® are medications that fall under the category of psychedelic therapy. Like TMS, ketamine and Spravato® are effective for mental health disorders such as treatment-resistant depression, bipolar disorder, anxiety disorder, and post-traumatic stress disorder (PTSD). Clinicians administer ketamine in two ways: orally, as a liquid, or intravenously, as an IV drip. Spravato®, on the other hand, is self-administered with a nasal spray under the supervision of a qualified clinician. Both treatments can offer quick and lasting relief for patients who’ve attempted standard antidepressants without success.
NAD IV Therapy
This treatment involves and intravenous (IV) infusion of a chemical called nicotinamide adenine dinucleotide (NAD) in order to boost levels of vitamin B3 in the body and regulate levels of neurotransmitters in the brain. NAD IV treatment can improve mood, cognition, memory, and concentration. It can also reduce the intensity of symptoms associated with depressive disorders and anxiety disorders.
Old and New: A Mixture of Tradition and Innovation
The therapies we describe above demonstrate our commitment to innovation, but we’re also committed to traditional, evidence-based therapies such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), and others.
In addition, in our Wellness Center, we support patients with education and instruction on exercise, nutrition, and complementary therapies such as mindfulness-based meditation, acupuncture, breath work, Pilates, and elements of yoga and other holistic approaches to exercise and activity.
That’s why recent research on the impact of yoga and breathing exercises on depression and anxiety is important for us to share and discuss here in our blog. Like all our traditional and innovative treatments, the support we offer in our wellness center is also evidence-based, with a proven track record of success. And while yoga is not the core of our exercise program, we recommend yoga for all our patients interested in finding an exercise routine they can perform independently, in a way that works for them, and on a schedule that works for them.
Yoga is a powerful tool, because once a person learns the basics, those basics are theirs forever. It doesn’t take long to learn a solid, repeatable yoga routine. With a good teacher, it’s possible to learn the basics in a couple of months, and – as we mention – once you learn a person learns a yoga routine, it’s theirs to use for the long-term.
The benefits of yoga include:
Physical Benefits
Decades of evidence shows yoga increases:
- Strength
- Balance
- Flexibility
- Coordination
- Control
- Awareness
Professional athletes in all sports – from soccer to American football – embrace the practice of yoga. Countless professional sports teams incorporate yoga into their warm-up, strength, and post-game cool down routines and protocols. The professionals use yoga to boost performance and prevent injury, while regular people use yoga to get in shape, stay in shape, recovery from injuries, and make the body strong and resilient into old age. That’s another benefit of yoga: any yoga posture can be modified to meet the needs of any person, with any disability, at any age. That’s not an exaggeration. On one level, yoga is all about asking people to understand exactly where they are and what they need in that moment. In that way, yoga is a core mindfulness practice, and includes all of the benefits that mindfulness offers.
Psychological and Emotional Benefits
Scientific research confirms a regular practice of yoga can:
- Improve overall wellbeing
- Improve mood
- Reduce stress
- Boost memory
- Improve concentration
- Improve cognitive function
Studies show that yoga has a direct, positive impact on functional neurobiology. A yoga practice can increase gray matter volume in the brain, increase activity in the prefrontal cortex, and improve functional connectivity in the areas of the brain associated with mood and cognition.
The Subjective Experience: What Happens During Yoga?
During a yoga class or session, subjective benefits accrue as a result of the quality of focus involved. The mind becomes calm and centered because the correct practice of a yoga posture demands the full and undivided attention of the practitioner. While performing even a simple yoga pose, there’s no time or space to dwell on the past or worry about the future. Correct practice requires full presence and engagement in the moment. For the duration of the class or session, whether 30 minutes, 60 minutes, or longer, the issues and problems of the outside world often recede into the background, because the attention is otherwise occupied with the practice of yoga itself. For many people, the constant chatter and automatic self-talk in the brain calms down and becomes silent.
On one level, this union of body, breath, and movement acts as simple misdirection, and the practitioner emerges from a yoga class or session with a sense of calm and balance from which they can re-engage with the world with clarity, perspective, and focus. That makes yoga an easy-to-learn tool and/or coping mechanism people can use to reduce the stress associated with typical daily life.
That’s how yoga reduces stress and clears the mind: millions of people around the world can attest to this simple fact. However, yoga also has a place in formal mental health treatment as a complementary of adjunct therapy that can reduce the symptoms of mental health disorders such as depression and anxiety.
For the rest of this article, we’ll focus on a study published by the Journal of Psychiatric Practice that explores the impact of yoga on depression, anxiety, sleep, and overall wellbeing.
Yoga for Depression: About the Study
The paper “Psychological Function, Iyengar Yoga, and Coherent Breathing: A Randomized Controlled Dosing Study” discusses a component of yoga for mental health and depression treatment that many people don’t consider: the dosage.
At first blush, the words dose and yoga don’t seem to fit well together. However, when we think of yoga as a complementary therapeutic approach for treating a mental health condition like depression or anxiety, the idea of an optimal yoga dosage makes sense. Like with any medication, a provider starts a patient on a specific amount, monitors the situation, and if that amount – or dose – is effective, then they leave it as-is. If that amount of medication is not effective they often increase the amount – or dose – until it’s effective.
That’s all within well-established safety parameters, of course.
To conduct this yoga dosage experiment, researchers recruited 30 patients with a clinical diagnosis of major depressive disorder (MDD) and administered five psychological tests:
- Positivity Self-Test. This is exactly what it sound like: a two-minute self-test to determine an individual’s default level of positive mood.
- Spielberger State Anxiety Inventory. This test measures an individual’s default level of anxiety on any given day.
- Patient Health Questionnaire-9. This is a standard, well-researched, verified depression metric in common use around the world. It’s one of the most reliable and trusted tests for depression available.
- Pittsburgh Sleep Quality Index. This measures the quality, quantity, and efficiency of sleep, as well as the disturbances or problems associated with lack of sleep.
- Exercise-induced Feeling Inventory. This test measures 12 items in four categories of feeling related to exercise: revitalization, tranquility, positive engagement, and physical exhaustion. This test has become a commonly accepted method to assess the impact of exercise on emotions and overall wellbeing.
After establishing baseline levels with these psychological metrics, researchers divided the 30 patients into two groups. Each group participated in a three-month yoga protocol at different doses:
High-Dose Group (HDG)
This group completed 123 hours of therapeutic yoga training over the three-month study period. Their protocol included three 90-minute yoga classes per week, and four 30-minute yoga homework sessions per week.
Low-Dose Group (LDG)
This group completed 87 hours of therapeutic yoga training over the three-month study period. Their protocol included two 90-mimute yoga classes per week, and three 30-minute yoga homework sessions per week.
Let’s take a look at the results.
Yoga for Depression: How Much and How Often?
Researchers re-administered the five tests administered at baseline at week 4, week 8 and week 12 of the study. We’ll look at the outcomes for each metric for each time point, starting with the first check-in at 4 weeks.
4 Weeks
- Positivity: Small improvements for both groups, with the HDG showing slightly more improvement than the LDG.
- Anxiety: Small improvements for both groups, with the HDG showing slightly more improvement than the LDG.
- Depression: Small improvements for both groups, with the HDG showing slightly more improvement than the LDG.
- Sleep: Significant improvements for both groups.
- Exercise-related feelings: Improvements for both groups, with the HDG showing slightly more improvement than the LDG.
8 Weeks
- Positivity: Significant improvements for both groups, with the HDG showing more improvement than the LDG.
- Anxiety: Significant improvements for both groups, with the HDG showing more improvement than the LDG.
- Depression: Significant improvements for both groups, with the HDG showing more improvement than the LDG.
- Sleep: Significant improvements for both groups.
- Exercise-related feelings: Significant improvements for both groups, with the HDG showing more improvement than the LDG.
12 Weeks
- Positivity: Continued significant improvements for both groups, with the HDG maintaining a measurable but non-significant improvement in default positivity, compared to the LDG.
- Anxiety: Continued significant improvements for both groups, with the HDG maintaining a measurable but non-significant improvement in anxiety symptoms, compared to the LDG.
- Depression: Continued significant improvements for both groups, with the HDG maintaining a measurable but non-significant improvement in depressive symptoms, compared to the LDG.
- Sleep: Continue statistically significant improvements for both groups.
- Exercise-related feelings: Continued significant improvements for both groups, with the HDG maintaining measurably higher, but statistically non-significant increases in revitalization, tranquility, positive engagement, and physical exhaustion, compared to the LDG.
That data is important, because it shows us that yoga is a viable and effective complementary support for people with both depression and anxiety. In a relatively short period of time – one month – both low doses and high doses of yoga improved sleep. And over two and three months, participants in both groups reported significant improvements across all measures.
How This Information Helps Our Patients
We can identify three primary takeaways from this study:
- Yoga is effective in reducing symptoms of depression and anxiety in patients diagnosed with major depressive disorder (MDD).
- Yoga improved sleep in both groups within one month.
- The effects of yoga are cumulative. The high dose group showed greater improvements than the low dose group across all metrics. For both groups, improvements in all metrics increased over time.
That last observation on the cumulative nature of yoga-related improvements is crucial. The more yoga-hours a patient accrued, the greater their psychological and emotional improvements. Dr. Marisa M. Silveri of Harvard University, a lead author on the study, describes the study outcomes:
“Providing evidence-based data is helpful in getting more individuals to try yoga as a strategy for improving their health and well-being. These data are crucial for accompanying investigations of underlying neurobiology that will help elucidate ‘how’ yoga works.”
The evidence produced by this study – and the information we share in this article – can help our patients, and any patients seeking to add yoga as a complementary support for depression or anxiety treatment, by confirming that in a random-controlled trial, evidence showed that yoga can help improve symptoms significantly – and the more yoga, the better.
Starting with a dose of two classes/sessions per week – plus homework – can improve depression, anxiety, sleep, and overall wellbeing. Increasing that dose to three classes/sessions per week – plus homework – can lead to even greater improvements across all those same metrics.
Now we believe the people in our lives who’ve told us for years “more yoga is always better,” and we can tell our patients who dabble in yoga this:
Gianna Melendez
Jodie Dahl, CpHT