Brigham & Women’s Hospital Harvard Medical School · PDF fileFrom: Variations de...

Kundalini Yoga Research

December 17-18, 2012

International Kundalini Yoga Teachers Association

Winter Solstice Sadhana

Sat Bir S. Khalsa, Ph.D.

Director of Research

Kundalini Research Institute

Assistant Professor of Medicine

Harvard Medical School

Brigham & Women’s Hospital Harvard Medical School

“Yoga teaches you the

techniques and awareness

to stay healthy. You gain

strong immune, glandular

and nervous systems. This

foundation gives you

energy and lets you deal

with the mental and

spiritual facets of your life.”

Yogi Bhajan

Reasons for Practice

in a Beginners Program

From: Yoga in the real world: Motivations and patterns of use, Quilty MT, Saper R,

Goldstein R, Khalsa SBS, Global Advances in Health and Medicine (in press) 2012.

Prevalence

of Yoga Practice

Yoga Journal Survey 2012

Yoga

Meditation

Deep Breathing

From: Complementary and Alternative Medicine Use Among Adults and Children: United

States, 2007, Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report

#12, 2008.

Progressive

Relaxation

Review of

Basic

Yoga Research

Yoga Mimamsa

Swami Kuvalayananda

and colleagues at

Kaivalyadhama

Laboratory, Lonavla

starting in 1924.

56 papers by

Kuvalayananda from

1924-34 and 1954-73

Brosse, 1936

From: Documents recueillis aux

Indes sur les “Yoguis” par

l’enregistrement simultane du

pouls, de la respiration et de

l’electrocardiogramme

[Data gathered in India on a Yogi

with simultaneous registration of

the pulse, respiration, and

electrocardiogram]

Laubry C, Brosse T

La Presse Medicale 44:1601-

1604, 1936.

Das and Gastaut, 1955

From: Variations de l’activite electrique du cerveau, du coeur et de muscles squelettiques

au cours de la meditation et de l’extase yogique [Variations in the electrical activity of the

brain, heart, and skeletal muscles during yogic meditation and trance], Das N, Gastaut H,

Electoencephalography and Clinical Neurophysiology, Suppl. 6:211-219, 1955.

Bagchi and Wenger, 1957

“…physiologically

Yogic meditation

represents deep

relaxation of the

autonomic nervous

system without

drowsiness or

sleep …”

From: Electro-physiological correlates of some Yogi exercises, Bagchi BK, Wenger MA,

Electroencephalography and Clinical Neurophysiology, 7 (Suppl):132-149, 1957.

Physiology of Meditation

From: The physiology of meditation,

Wallace RK & Benson H, Scientific American 226:85, 1972.

Green & Green, 1977

From: Beyond Biofeedback, Green E, Green A, Knoll Publishing Co. Inc., 1977.

From: Stress management: A randomized study of cognitive behavioural

therapy and yoga, Granath J, Ingvarsson S, von Thiele U, Lundberg U.

Cognitive Behaviour Therapy, 35(1):3–10, 2006

Stress

Reduction

with Yoga

Perceived Stress Scale

Pre-treatment Post-treatment

Avera

ge

Sco

re

1.4

1.6

1.8

2.0

2.2

2.4

2.6

Stress Behavior Scale


Avera

ge

Sco

re

1.6

1.8

2.0

2.2

2.4

2.6

2.8

Urinary Noradrenaline


Ave

rag

e L

eve

l

200

250

300

350

Stress in Beginner Yoga Students

From: Yoga as a stress reduction technique for women, Quilty M, Khalsa SBS,

Saper R, Abstract submitted to 137th APHA Annual Meeting & Exposition, 2009.

Baseline End Program

Avera

ge S

core

PS

S

12

13

14

15

16

17

18

Perceived Stress

p < 0.0001

Long-term Meditation & Cortical Thickness

From: Meditation experience is associated with increased cortical thickness, Lazar SW, Kerr

CE, Wasserman RH, Gray JR, Greve DN, Treadway MT, McGarvey M, Quinn BT, Dusek JA,

Benson H, Rauch SL, Moore CI, Fischl B, Neuroreport 16:1893-1897, 2005.

MBSR and Gray Matter Density

From: Mindfulness practice leads to increases in regional brain gray matter density,

Hölzel BK, Carmody J, Vangel M, Congleton C, Yerramsetti SM, Gard T, Lazar SW,

Psychiatry Research Imaging, 191:36-43, 2011.

…participation in MBSR is associated with changes in gray matter

concentration in brain regions involved in learning and memory processes,

emotion regulation, self-referential processing, and perspective taking.

L Hippocampus

Posterior Cingulate

Temporo-parietal

Junction

Cerebellum

Yoga, Thalamic GABA, Mood & Anxiety

From: Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a

randomized controlled MRS study, Streeter CC, Whitfield TH, Owen L, Rein T, Karri

SK, Yakhkind A, Perlmutter R, Prescot A, Renshaw PF, Ciraulo DA, Jensen JE.

Journal of Alternative and Complementary Medicine, 16:1145-52, 2010.

Meditation

and the

DMN

From: Mind wandering

and attention during

focused meditation: A

fine-grained temporal

analysis of fluctuating

cognitive states,

Hasenkamp W,

Wilson-Mendenhall

CD, Duncan E,

Barsalou LW,

Neuroimage (in press)

2011.

dorsal anterior cingulate cortex and frontoinsular cortex

lateral PFC and posterior parietal regions

dorsolateral prefrontal cortex

default network mode regions

In our paradigm, activity in several brain regions was significantly correlated

with practice time, especially during the SHIFT phase. The cognitive processes

occurring during this phase – disengaging and re-orienting of attention – are

some of the primary cognitive skills that FA meditation trains. All correlations in

this phase were negative, signifying lower neural activity in participants with

more meditation experience. These findings may reflect an overall practice

effect whereby performance of well-learned tasks requires less neural activity,

as has been suggested previously with regard to meditation experience. Indeed

…more experienced meditators may have been faster at completing the

reorienting operations associated with the SHIFT phase.

Attention,

Stress &

Mood

From: Short-term meditation training improves attention and self-regulation, Tang Y,

Ma Y, Wang J, Fan Y, Feng S, Lu Q, Yu Q, Sui D, Rothbart MK, Fan M, Posner MI,

Proceedings of the National Academy of Sciences, 104:17152–17156, 2007.

Models and

Mechanisms for

Yoga Therapy

From: Effects of Yoga on the Autonomic Nervous System, Gamma-Aminobutyric-Acid,

and Allostasis in Epilepsy, Depression, and Post-traumatic Stress Disorder, Streeter CC,

Gerbarg PL, Saper RB, Ciraulo DA, Brown RP, Medical Hypotheses, (in press) 2012.

Changes in GABA, ANS, HPA Axis

From: Effects of Yoga on the Autonomic Nervous System, Gamma-Aminobutyric-Acid,

and Allostasis in Epilepsy, Depression, and Post-traumatic Stress Disorder, Streeter CC,

Gerbarg PL, Saper RB, Ciraulo DA, Brown RP, Medical Hypotheses, (in press) 2012.

Mechanisms in Yoga Practice Control of attentional networks

Reduction of Default Mode Network activity

Reduction of rumination and dysfunctional thoughts

Induction of the psychophysiological “relaxation response”

Structural brain changes in cortex and limbic system

Mind-body effects, e.g. self-efficacy, belief, expectation

Induction of contemplative states and self-identity changes

Vagal afferent activity from pranayama and asanas

Physical fitness, e.g. flexibility, endurance, respiratory

Direct organ/tissue effects

Subtle energy mechanisms, e.g. prana, qi

Temporal Changes in Yoga Practice

Arousal reduction, physical/mental well-being

Mind/body awareness, self-regulation, resilience

Psychological / philosophical transformation

Disorder

Stress Fitness

+

+

- - -

Yoga

Disorder

Stress Fitness

Specificity of Yoga Postures

From: Mood Changes Associated with Iyengar Yoga Practices: A Pilot Study,

Shapiro D, Cline K, International Journal of Yoga Therapy 14:35-44, 2004.

Specific poses resulted in differences in how moods were affected, with

back bends associated with greater increases in positive moods. The specific and nonspecific effects of different bodily postures and

movements on psychological processes in Yoga …deserve further study.

Sad

Imp

rove

me

nt

in S

co

re

0.0

0.1

0.2

0.3

0.4

0.5

ForwardBends

BackBends

Happy

0.0

0.1

0.2

0.3

0.4

0.5

StandingPoses

ForwardBends

BackBends

StandingPoses

From: General and Specific Cerebral Blood Flow Responses to Meditation Revealed

by Perfusion Functional MRI. Wang J, Rao H, Korczykowski M, Wintering N, Pluta J,

Jha A, Khalsa DS, Newberg AB, Unpublished preprint.

FMRI of Different Meditations

↑ Primarily forebrain areas

↑ Primarily deeper limbic &

paralimbic structures

# 2 ↑ in deeper LH limbic &

forebrain structures

+ other differences

Mind/Body and Behavioral Factors

Metabolic Syndrome Diabetes

Stress or Worldview

Dysfunctional Nutrition

Neuroendocrine Imbalance


Sleep Deprivation

Stress or Worldview



Obesity


Sleep Deprivation

Stress or Worldview



Obesity


Sleep Apnea

Sleep Deprivation

Stress or Worldview



Obesity


Sleep Apnea

Sleep Deprivation

Stress or Worldview



Yoga

Review of

Applied Yoga

Research

A Review of Yoga Therapy Research

http://www.ijpp.com/vol48_3/vol48_no3_spl_invt_art.pdf

Chronology of Yoga Therapy Research

0

5

10

15

20

25

30

35

40

45

50

1963-

1968

1969-

1973

1974-

1978

1979-

1983

1984-

1988

1989-

1993

1994-

1998

1999-

2003

2004-

2008

Disorders – Non-Yoga Journals

0 10 20 30 40 50

Psychiatric

Cardiovascular

Respiratory

Diabetes

Neurological

Musculoskeletal

Other

Future Directions

New Disorders

Neuroimaging

Genomic Expression

Specificity of Practices

Cost-effectiveness

Prevention

Positive Psychology

1. A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: effects on mental health, cognition, and telomerase activity. Lavretsky H, Epel ES,

Siddarth P, Nazarian N, Cyr NS, Khalsa DS, Lin J, Blackburn E, Irwin MR. Int J Geriatr Psychiatry. 2013 Jan;28(1):57-65.

2. Cerebral blood flow changes associated with different meditation practices and perceived depth of meditation. Wang DJ, Rao H, Korczykowski M, Wintering N, Pluta J, Khalsa

DS, Newberg AB. Psychiatry Res. 2011 Jan 30;191(1):60-7.

3. Cerebral blood flow changes during chanting meditation. Khalsa DS, Amen D, Hanks C, Money N, Newberg A. Nucl Med Commun. 2009 Dec;30(12):956-61.

4. Clinical case report: efficacy of yogic techniques in the treatment of obsessive compulsive disorders. Shannahoff-Khalsa DS, Beckett LR. Int J Neurosci. 1996 Mar;85(1-2):1-

17.

5. Effect of Breathwalk on body composition, metabolic and mood state in chronic hepatitis C patients with insulin resistance syndrome. Vázquez-Vandyck M, Roman S, Vázquez

JL, Huacuja L, Khalsa G, Troyo-Sanromán R, Panduro A. World J Gastroenterol. 2007 Dec 14;13(46):6213-8.

6. Effects of an 8-week meditation program on mood and anxiety in patients with memory loss. Moss AS, Wintering N, Roggenkamp H, Khalsa DS, Waldman MR, Monti D,

Newberg AB. J Altern Complement Med. 2012 Jan;18(1):48-53.

7. Evaluation of a residential Kundalini yoga lifestyle pilot program for addiction in India. Khalsa SB, Khalsa GS, Khalsa HK, Khalsa MK. J Ethn Subst Abuse. 2008;7(1):67-79.

8. Exaggerated heart rate oscillations during two meditation techniques. Peng CK, Mietus JE, Liu Y, Khalsa G, Douglas PS, Benson H, Goldberger AL. Int J Cardiol. 1999 Jul

31;70(2):101-7.

9. Functional brain mapping of the relaxation response and meditation. Lazar SW, Bush G, Gollub RL, Fricchione GL, Khalsa G, Benson H. Neuroreport. 2000 May

15;11(7):1581-5.

10. Functional magnetic resonance imaging of hippocampal activation during silent mantra meditation. Engström M, Pihlsgård J, Lundberg P, Söderfeldt B. J Altern Complement

Med. 2010 Dec;16(12):1253-8.

11. Genomic counter-stress changes induced by the relaxation response. Dusek JA, Otu HH, Wohlhueter AL, Bhasin M, Zerbini LF, Joseph MG, Benson H, Libermann TA. PLoS

One. 2008 Jul 2;3(7):e2576.

12. Heart rate dynamics during three forms of meditation. Peng CK, Henry IC, Mietus JE, Hausdorff JM, Khalsa G, Benson H, Goldberger AL. Int J Cardiol. 2004 May;95(1):19-27.

13. Hemodynamic observations on a yogic breathing technique claimed to help eliminate and prevent heart attacks: a pilot study. Shannahoff-Khalsa DS, Sramek BB, Kennel MB,

Jamieson SW. J Altern Complement Med. 2004 Oct;10(5):757-66.

14. Interoceptive awareness in experienced meditators. Khalsa SS, Rudrauf D, Damasio AR, Davidson RJ, Lutz A, Tranel D. Psychophysiology. 2008 Jul;45(4):671-7.

15. Meditation effects on cognitive function and cerebral blood flow in subjects with memory loss: a preliminary study. Newberg AB, Wintering N, Khalsa DS, Roggenkamp H,

Waldman MR. J Alzheimers Dis. 2010;20(2):517-26.

16. Randomized controlled trial of yogic meditation techniques for patients with obsessive-compulsive disorder. Shannahoff-Khalsa DS, Ray LE, Levine S, Gallen CC, Schwartz

BJ, Sidorowich JJ. CNS Spectr. 1999 Dec;4(12):34-47.

17. Stress management: a randomized study of cognitive behavioural therapy and yoga. Granath J, Ingvarsson S, von Thiele U, Lundberg U. Cogn Behav Ther. 2006;35(1):3-10.

18. The effects of a class in Kundalini yoga on field articulation, openness to experience and flexibility. Davis, Ilana E. ; Dissertation Abstracts International, Vol 37(1-B), Jul, 1976.

pp. 487-488.

19. The effects of Kundalini yoga on sleep disturbance. Sehgal, Sabina ; Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 68(7-B), 2008. pp.

4846.

20. Treatment of chronic insomnia with yoga: a preliminary study with sleep-wake diaries. Khalsa SB. Appl Psychophysiol Biofeedback. 2004 Dec;29(4):269-78.

21. Yoga in stroke rehabilitation: a systematic review and results of a pilot study. Lynton H, Kligler B, Shiflett S. Top Stroke Rehabil. 2007 Jul-Aug;14(4):1-8.

22. Yogic meditation reverses NF-κB and IRF-related transcriptome dynamics in leukocytes of family dementia caregivers in a randomized controlled trial. Black DS, Cole SW,

Irwin MR, Breen E, St Cyr NM, Nazarian N, Khalsa DS, Lavretsky H. Psychoneuroendocrinology. 2012 (in press).

Published Research Involving Kundalini Yoga

Cancer

Yoga Programs in Cancer Centers

Albert Einstein Comprehensive Cancer Center, Bronx, NY

Beth Israel Cancer Center, New York, NY

Cancer Center of Santa Barbara, Santa Barbara, CA

Cornucopia House Cancer Support Center, Chapell Hill, NC

Fox Chase-Temple Cancer Center, Philadelphia, PA

Fred Hutchinson Cancer Research Center, Seattle, WA

Geffen Cancer Center and Research Institute, Vero Beach, FL

Hoag Cancer Center, Newport Beach, CA

Kimmel Cancer Center at Jefferson, Philadelphia, PA

Martha Jefferson Hospital Cancer Care Center, Charlottesville, VA

Memorial Sloan-Kettering Cancer Center, New York, NY

Mercy Cancer Center, Des Moines, IA

MGH Cancer Center, Boston, MA

Saint Vincents Comprehensive Cancer Center, New York, NY

Saints Memorial Cancer Center, Lowell, MA

Southern Idaho Regional Cancer Center, Twin Falls, ID

UCLA’s Jonsson Comprehensive Cancer Center, Los Angeles, CA

UCSF Cancer Center, San Francisco, CA

University of Michigan's Comprehensive Cancer Center, Ann Arbor, MI

University of Pennsylvania Cancer Center, Philadelphia, PA

University of Texas M.D. Anderson Cancer Center, Houston, TX

Vanderbilt-Ingram Cancer Center, Nashville, TN

Yoga for Cancer

Stress

Mood – Anxiety, Depression

Immune function

Side effects of surgery

Side effects of chemotherapy

Life perspective, quality of life, well-being

Spirituality, end of life

Twelve RCTs with a total of 742 participants were included... Evidence was

found for short-term effects on global health-related quality of life, functional,

social, and spiritual well-being… Short-term effects on psychological health also

were found: anxiety, depression, perceived stress and psychological distress.

We identified 24 studies of yoga in breast cancer survivors. The outcomes assessed in

these studies are heterogeneous, although some of them are a recurrent theme, such as

fatigue (9 trials, 6 showing significantly favorable results), QOL (8 trials, all positive),

anxiety (8 studies, all positive), and depression (9 studies, 8 positive). Other less common

outcomes assessed were sleep (5 studies, 2 positive), stress, mood, mental health,

affect, spirituality, vitality, distress, pain, physical fitness, cognition, chemo-induced

nausea, and vomiting. Statistical significant or trends toward improvements were shown

for all of these outcomes in the majority of the studies reviewed here.

The effect of yoga on women with secondary arm lymphoedema from breast cancer treatment. Loudon A,

Barnett T, Piller N, Immink MA, Visentin D, Williams AD. BMC Complement Altern Med. 2012 May 28;12:66.

Feasibility of a brief yoga intervention during chemotherapy for persistent or recurrent ovarian cancer. Sohl

SJ, Danhauer SC, Schnur JB, Daly L, Suslov K, Montgomery GH. Explore (NY). 2012 May-Jun;8(3):197-8.

Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot

randomized controlled trial. Dhruva A, Miaskowski C, Abrams D, Acree M, Cooper B, Goodman S, Hecht FM.

J Altern Complement Med. 2012 May;18(5):473-9. Epub 2012 Apr 23.

Longitudinal impact of yoga on chemotherapy-related cognitive impairment and quality of life in women with

early stage breast cancer: a case series. Galantino ML, Greene L, Daniels L, Dooley B, Muscatello L,

O'Donnell L. Explore (NY). 2012 Mar-Apr;8(2):127-35.

Randomized controlled pilot trial of yoga in overweight and obese breast cancer survivors: effects on quality

of life and anthropometric measures. Littman AJ, Bertram LC, Ceballos R, Ulrich CM, Ramaprasad J,

McGregor B, McTiernan A. Support Care Cancer. 2012 Feb;20(2):267-77. Epub 2011 Jan 5.

A qualitative exploration of the impact of yoga on breast cancer survivors with aromatase inhibitor-associated

arthralgias. Galantino ML, Greene L, Archetto B, Baumgartner M, Hassall P, Murphy JK, Umstetter J, Desai

K. Explore (NY). 2012 Jan-Feb;8(1):40-7.

Predictors of adherence to an Iyengar yoga program in breast cancer survivors. Speed-Andrews AE,

Stevinson C, Belanger LJ, Mirus JJ, Courneya KS. Int J Yoga. 2012 Jan;5(1):3-9.

Yoga and NK Cell Activity in Cancer Patients

From: Effects of yoga on natural killer cell counts in early breast cancer patients

undergoing conventional treatment. Rao RM, Telles S, Nagendra HR, Nagarathna R,

Gopinath K, Srinath S, Chandrashekara C, Medical Science Monitor, 14:LE3-4, 2008.

Immune Function in Cancer Patients

NK

Cell

Perc

enta

ge

10

15

20

25

Pre-Surgery

Post-Surgery

Post-Chemotherapy

Yoga in HIV Patients

From: Evaluating a yogic breathing and meditation intervention for individuals living with

HIV/AIDS, Brazier A, Mulkins A, Verhoef M, American Journal of Health Promotion,

20:192-5, 2006.

Mental Health

Music Performance Anxiety

Ave

rag

eD

iffe

ren

ce

Sco

res

-8

-6

-4

-2

0

2

Solo Performance Anxiety

YogaLifestyle

ControlGroup

YogaOnly

* *

*

Kripalu Yoga

for Music Performance Anxiety Music Performance Anxiety

Baseline End Program

MP

AI-

A A

ve

rag

e S

co

re

40

42

44

46

48

50

52

54

8 Studies

1. A preliminary investigation of the effects of giving testimony and learning yogic

breathing techniques on battered women's feelings of depression.

Franzblau SH, et al., J Interpers Violence. 2008 Dec;23(12):1800-8.

2. Evaluation of Siddha Samadhi Yoga for anxiety and depression symptoms: a

preliminary study.

Kozasa EH, et al., Psychol Rep. 2008 Aug;103(1):271-4.

3. Wellness through a comprehensive yogic breathing program - a controlled pilot

trial.

Kjellgren A, et al., BMC Complement Altern Med. 2007 Dec 19;7:43.

4. Yoga reduces symptoms of distress in tsunami survivors in the Andaman

islands.

Telles S, et al., Evid Based Complement Alternat Med. 2007 Dec;4(4):503-9.

5. Yoga as a Complementary Treatment of Depression: Effects of Traits and

Moods on Treatment Outcome.

Shapiro D, et al., Evid Based Complement Alternat Med. 2007 Dec;4(4):493-502.

Anxiety Studies

6. A randomised comparative trial of yoga and relaxation to reduce stress and

anxiety.

Smith C, et al., Complement Ther Med. 2007 Jun;15(2):77-83.

7. Effects of a yoga lifestyle intervention on performance-related characteristics of

musicians: a preliminary study.

Khalsa SB, Cope S., Med Sci Monit. 2006 Aug;12(8):CR325-31.

8. Effect of yoga based lifestyle intervention on state and trait anxiety.

Gupta N, et al., Indian J Physiol Pharmacol. 2006 Jan-Mar;50(1):41-7.

9. Rapid stress reduction and anxiolysis among distressed women as a

consequence of a three-month intensive yoga program.

Michalsen A, et al., Med Sci Monit. 2005 Dec;11(12):CR555-561

10. Effect of Sahaj Yoga on depressive disorders.

Sharma VK, et al., Indian J Physiol Pharmacol. 2005 Oct-Dec;49(4):462-8.

11. The effects of yoga on mood in psychiatric inpatients.

Lavey R, et al., Psychiatr Rehabil J. 2005 Spring;28(4):399-402.

Anxiety Studies Continued

5 Randomized Studies

1. A preliminary investigation of the effects of giving testimony and learning yogic

breathing techniques on battered women's feelings of depression.

Franzblau SH, et al., J Interpers Violence. 2008 Dec;23(12):1800-8.

2. Sleep quality, depression state, and health status of older adults after silver

yoga exercises: Cluster randomized trial.

Chen KM, et al., Int J Nurs Stud. 2008 Oct 21.

3. Evaluation of Siddha Samadhi Yoga for anxiety and depression symptoms: a

preliminary study.

Kozasa EH, et al., Psychol Rep. 2008 Aug;103(1):271-4.

4. Meditation with yoga, group therapy with hypnosis, and psychoeducation for

long-term depressed mood: a randomized pilot trial.

Butler LD, et al., J Clin Psychol. 2008 Jul;64(7):806-20.

5. Wellness through a comprehensive yogic breathing program - a controlled pilot

trial.

Kjellgren A, et al., BMC Complement Altern Med. 2007 Dec 19;7:43.

Depression Studies

6. Yoga as a Complementary Treatment of Depression: Effects of Traits and

Moods on Treatment Outcome.

Shapiro D, et al., Evid Based Complement Alternat Med. 2007 Dec;4(4):493-502.

7. Assessing depression following two ancient Indian interventions: effects of yoga

and ayurveda on older adults in a residential home.

Krishnamurthy MN, Telles S., J Gerontol Nurs. 2007 Feb;33(2):17-23.

8. Effect of Sahaj Yoga on neuro-cognitive functions in patients suffering from

major depression.


9. Antidepressant efficacy and hormonal effects of Sudarshana Kriya Yoga (SKY)

in alcohol dependent individuals.

Vedamurthachar A, et al., J Affect Disord. 2006 Aug;94(1-3):249-53.

9. Effect of Sahaj Yoga on depressive disorders.


10. The effects of yoga on mood in psychiatric inpatients.

Lavey R, et al., Psychiatr Rehabil J. 2005 Spring;28(4):399-402.

Depression Studies Continued

Mild Depression

From: Woolery A, Myers H, Sternlieb B, Zeltzer L. A yoga intervention for young adults

with elevated symptoms of depression. Alternative Therapies in Health and Medicine

10:60-3, 2004.

Yoga Treatment of Depression

From: Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a

randomized comparison with electroconvulsive therapy (ECT) and imipramine,

Janakiramaiah N et al., Journal of Affective Disorders 57:255-259, 2000.

Depression in Battered Women

From: A preliminary investigation of the effects of giving testimony and learning yogic

breathing techniques on battered women’s feelings of depression, Franzblau SH,

Echevarria S, Smith M, Van Cantfort TE, Journal of Interpersonal Violence 23:1800-08,

2008

Beck Depression Inventory

Avera

ge B

DI

Score

0

10

20

30

40

Baseline 4 Days

TalkTalk +YogicBreath

From: Efficacy of two relaxation techniques in depression, Broota A, Dhir R, Journal

of Personality and Clinical Studies 6:83-90, 1990.


Pe

rce

nt S

ym

pto

m R

ed

uctio

n

30

40

50

60

YogaExercises Progressive

Relaxation

No-TreatmentControl

- RCT N=10, neurotic or reactive depressives on medication

- pre and post measures of treatment on 3 consecutive days

- 25’ of yogic breathing, asanas, autosuggestion, 4 techniques

From: Yoga as a complementary

treatment of sepression: Effects of

traits and moods on treatment

outcome, Shapiro D, Cook IA,

Davydov DM, Ottaviani C, Leuchter

AF, Abrams M. Evidence Based

Complementary and Alternative

Medicine 4:493–502, 2007


- Single group N=17 MDD

- 8-week 3 60-90 classes/week

- Iyengar yoga primarily postures

From: A comparative study of full and partial Sudarshan Kriya Yoga (SKY) in major

depressive disorder, Rohini V, Pandey RS, Janakiramaiah N, Gangadhar BN,

Vedamurthachar A, National Institute of Mental Health and Neuro Sciences

(NIMHANS) Journal, 18:53-57, 2000.

- RCT N=15 MDD

- SKY – yogic breathing daily 4-week 30’ daily 6/wk


From: Initial evaluation of the LifeForce Yoga Program as a therapeutic intervention for

depression, Bennett SM, Weintraub A, Khalsa SBS, International Journal of Yoga Therapy

18:49-57, 2008


- Single group study of LifeForce Yoga Program participants

- Baseline T1-N=94, 3 weeks T2-N=54, 2 months T3-N=33

From: Initial evaluation of the LifeForce Yoga Program as a therapeutic intervention for

depression, Bennett SM, Weintraub A, Khalsa SBS, International Journal of Yoga Therapy

18:49-57, 2008


Smoking Behavior

From: McIver S, O'Halloran P, McGartland M. The impact of Hatha yoga on smoking

behavior. Alternative Therapies in Health and Medicine. 10:22-3, 2004.

Alcohol Dependence

From: Raina N, Chakraborty PK, Basit MA, Samarth SN, Singh H, Evaluation of yoga

therapy in alcohol dependence syndrome. Indian Journal of Psychiatry 43(2) 2001.

Yoga for Addictions

From: Comparing Hatha yoga with dynamic group psychotherapy for enhancing

methadone maintenance treatment: a randomized clinical trial, Shaffer HJ, LaSalvia

TA, Stein JP, Alternative Therapies in Health and Medicine, 3:57-66, 1997.

BASIS-32Overall Average

Ave

rage S

core

0.0

0.5

1.0

1.5

Relation to Selfand Others

Baseline Mid-TX End-TX Followup

Ave

rage S

core

0.0

0.5

1.0

1.5

Daily Living andRole Functioning

Ave

rage S

core

0.0

1.0

2.0Depression and Anxiety

0.0

0.5

1.0

1.5

Impulsive andAddictive Behavior

0.0

0.5

1.0

1.5

Psychosis

Baseline Mid-TX End-TX Followup

0.0

0.5

1.0

Yoga

for

Substance

Abuse

From: Evaluation of a residential Kundalini Yoga lifestyle pilot program for addiction

in India, Khalsa SBS, Khalsa GS, Khalsa HK, Khalsa MK, Journal of Ethnicity in

Substance Abuse 7:67-79, 2008.

Yoga for PTSD

TotalScore

Baseline End Treatment

Score

50

55

60

65

70

75

Re-experiencingSymptoms


Score

10

12

14

16

18

20

22

AvoidanceSymptoms


Score

22

24

26

28

30

32

HyperarousalSymptoms


Score

18

19

20

21

22

23

Clinician Administered PTSD Scale (CAPS)

From: Clinical implications of neuroscience research in PTSD. van der Kolk BA,

Annals of the New York Academy of Science 1071:277-93, 2006.

Yoga for PTSD Clinician Administered PTSD Scale

To

tal C

AP

S S

co

re

0

20

40

60

80

100

120


Mantra Repetition for PTSD

From: A spiritually based group intervention for combat veterans with posttraumatic

stress disorder: feasibility study. Bormann JE, Thorp S, Wetherell JL, Golshan S.

Journal of Holistic Nursing 26:109-16, 2008

From: Yoga-Based Breath Program and Client-Centered Exposure Therapy for PTSD

& Depression in Tsunami Survivors, Descilo T, Gerbarg P, Vedamurtachar A, Nagaraja

D, Gangadhar BN, Damodaran R, Adelson B, Braslow L, Marcus S, Brown RP, Acta

Psychiatrica Scandinavica, (accepted for publication)

Mean Scores PTSD Checklist PCL-17

Yogic

Breathing for

Tsunami

Survivors

with PTSD

Schizophrenia

From: Yoga therapy as an add-on treatment in the management of patients with

schizophrenia – a randomized controlled trial. Duraiswamy G, Thirthalli J, Nagendra HR,

Gangadhar BN, Acta Psychiatric Scandinavica 116: 226–232, 2007.

Lifestyle Diseases

Metabolic Syndrome /

Endocrinology Disorders

- studies (1970–2006) of metabolic and clinical effects of yoga in DM 2

- 25 eligible studies:

15 uncontrolled trials, 6 nonrandomized controlled trials, 4 RCT’s

- “these studies suggest beneficial changes in several risk indices,

including glucose tolerance and insulin sensitivity, lipid profiles,

anthropometric characteristics, blood pressure, oxidative stress,

coagulation profiles, sympathetic activation and pulmonary function, as

well as improvement in specific clinical outcomes. Yoga may improve

risk profiles in adults with DM 2, and may have promise for the

prevention and management of cardiovascular complications…”

Yoga Mechanisms of Action on Diabetes

From: A review of yoga programs for four leading risk factors of chronic diseases. Yang

K. Evidence Based Complementary and Alternative Medicine. 4:487-91, 2007.

Psychological Changes

Direct Action:

Enhancement of organ health

Decrease in insulin resistance or glucose tolerance Indirect Action:

Decrease in stress hormones

Reduction in sympathetic dominance

Improvement in mind/body awareness

Enhanced compliance: dietary, activity, medications

Change in attitude/worldview and lifestyle behavior Adjunct Action:

Improvements in mood, well-being, sleep, quality of life

Yoga Mechanisms of Action on Diabetes

Blood Glucose

Pretreatment PosttreatmentFasting B

lood G

lucose (

mm

ole

/l)

7.0

8.0

9.0

10.0

Yoga

Control

HbA1c

Pretreatment PosttreatmentG

lycate

d H

em

oglo

bin

(P

erc

ent)

9.0

10.0

11.0

Yoga

Control

Yoga Treatment of Diabetes

From: Yoga therapy for NIDDM: a controlled trial, Monro R, Power J, Coumar A,

Nagarathna R, Dandona P, 6:66-68, 1992.

Yoga-mediated

Change

in Insulin

Sensitivity

From: Studies on the inter-

relationship between insulin

tolerance and yoga, Mukherjee

A, Banerjee S, Bandyopadhyay

SK, Mukherjee PK, Indian

Journal of Physiology and Allied

Sciences 46:110-115, 1992.

From: Role of yoga in diabetes. Sahay BK, Journal of the Associatioin of Physicians of

India, 55:121-6, 2007.

Yoga Effects Insulin Receptors

Lower Weight Gain in Yoga Practitioners

From: Yoga practice is associated with attenuated weight gain in healthy, middle-aged

mend and women, Kristal AR, Littman AJ, Benitez D, White E, Alternative Therapies in

Health and Medicine, 11:28-33, 2005.

BMI<25 BMI>25

Lifestyle Diseases

Cardiovascular System

Disorders

Stress may result in physical, biochemical, functional, and emotional body

changes. When the body experiences stress, the sympathetic nervous system

releases epinephrine into the bloodstream, increasing HR, vasoconstriction,

and systemic vascular resistance, which, in turn, increases BP and cardiac

workload. Hypothalamus activation, another physiologic stress reaction,

stimulates the posterior pituitary gland, resulting in the secretion of antidiuretic

hormone. This hormone promotes water retention, leading to increased stroke

volume, and acts as a powerful peripheral vasoconstrictor, resulting in

decreased vessel size and increased BP.

Emotional stress has the same effect on the body as physical stress and

can increase BP. Individuals encounter many different physical and emotional

stressors each day. Even the lifestyle modifications undertaken to reduce

hypertension may increase stress levels, including salt restriction, regular

exercise, and smoking and alcohol avoidance.

Monro and colleagues suggest that, by working on the mind and body to

reduce or alter stress appreciation, yoga practice breaks the cycle of

stress→hypertension→focused attention→stress.

From: The effects of yoga on hypertensive persons in Thailand, McCaffrey R, Ruknui

P, Hatthakit U, Kasetsomboon P, Holistic Nursing Practice. 19:173-80, 2005.

Rationale for Cardiovascular Pathology

Hypertension

From: Randomised controlled trial of yoga and bio-feedback in management of

hypertension, Patel C, North WR, Lancet. 1975 Jul 19;2(7925):93-5.

Hypertension

From: The effects of yoga on hypertensive persons in Thailand, McCaffrey R, Ruknui

P, Hatthakit U, Kasetsomboon P, Holistic Nursing Practice. 19:173-80, 2005.

Baroreflex Sensitivity

From: Slow breathing improves arterial baroreflex

sensitivity and decreases blood pressure in essential

hypertension, Joseph CN, Porta C, Casucci G,

Casiraghi N, Maffeis M, Rossi M, Bernardi L,

Hypertension, 46:714-8, 2005.

Reversal of

Heart Disease

From: Changes in myocardial

perfusion abnormalities by

positron emission tomography

after long-term, intense risk

factor modification, Gould KL,

Ornish D, Scherwitz L, Brown S,

Edens RP, Hess MJ, Mullani N,

Bolomey L, Dobbs F, Armstrong

WT, et al.,

Journal of the American Medical

Association, 274:894-901, 1995.

Lifestyle Diseases

Insomnia

Models of Primary Insomnia

Conditioning

Emotional Arousal

Cognitive Arousal

Physiological Arousal

Sleep in Yoga Practitioners

From: Subjective sleep quality and hormonal modulation in long-term yoga practitioners,

Vera FM, Manzaneque JM, Maldonado EF, Carranque GA, Rodriguez FM, Blanca MJ,

Morell M, Biological Psychology 81:164-8, 2009.

Yoga on Sleep in the Elderly

From: Influence of Yoga & Ayurveda on self-rated sleep in a geriatric population,

Manjunath NK, Telles S, Indian Journal of Medical Research 121:683-690, 2005.

5.5

5.7

5.9

6.1

6.3

6.5

6.7

6.9

7.1

7.3

Pretreatment Posttreatment Followup

Sle

ep

Du

rati

on

(H

ou

rs) Yoga Controls

20

25

30

35

40

45

Pretreatment Posttreatment Followup

Sle

ep

On

se

t L

ate

nc

y (

Min

)

Yoga Controls

Sle

ep O

nset Late

ncy

0

30

60

90

120

Sle

ep Q

ualit

y

1

2

3

4

5N

um

ber

of A

wa

kenin

gs

0

1

2

3

4

Tota

l S

leep T

ime

0

2

4

6

8

Tota

l W

ake T

ime

0

2

4

6

Sle

ep E

ffic

iency

0

25

50

75

100

Subject CH

Sleep Onset Latency

Baseline Wk 1-2 Wk 3-4 Wk 5-6 Wk 7-8 FollowupAvera

ge S

leep O

nset Late

ncy (

min

ute

s)

20

30

40

50

Sleep Efficiency

Baseline Wk 1-2 Wk 3-4 Wk 5-6 Wk 7-8 Followup

Avera

ge S

leep E

ffic

iency (

%)

70

75

80

85

90

Total Wake Time


Avera

ge T

ota

l W

ake T

ime (

hr)

0.8

1.0

1.2

1.4

1.6

1.8

2.0

2.2

2.4

2.6Total Sleep Time


Avera

ge T

ota

l S

leep T

ime (

hr)

5.5

6.0

6.5

7.0

7.5

Sleep Diary Data

Lifestyle Diseases

Yoga for Prevention

Majority of seriously impairing and

persistent conditions have child-

adolescent onsets and high

comorbidity

Need for treatment of largely

untreated child-adolescent

disorders

Adolescent / School Challenges

Stress (developmental, family, social, academic, societal)

Behavior (apathy, violence, social skills, bullying, absenteeism)

Mental Health (depression, anxiety, substance abuse, trauma)

Attention (ADD, ADHD)

Academics (grades, dropouts)

Physical Health (obesity, diabetes)

From: Cumulative prevalence of psychiatric

disorders by young adulthood: a prospective cohort

analysis from the Great Smoky Mountains Study,

Copeland W, Shanahan L, Costello EJ, Angold A,

Journal of the American Academy of Child and

Adolescent Psychiatry, 50:252-61, 2011.

…the striking feature

of the present data

is...how high the

rates of early

psychiatric disorders

are. Most likely, the

lifetime prevalence

of psychiatric

problems by age 21

well exceeds 80%,

suggesting that the

experience of

psychiatric illness is

nearly universal.

Yoga in Public School Research

● 12-week 1-hr Yoga Ed/Kripalu classes 2-3 times/week

● RCT, yoga vs. physical education, N ~ 100

● Qualitative interviews post-program

● Self-report pre-post mental health questionnaires

Social Stress

Attitude to School

Anger

Resilience

Negative Affect

Anxiety

Anger Expression

ImprovementWorsening

Mental Health Outcomes - Yoga

Social Stress

Attitude to School

Anger

Resilience

Negative Affect

Anxiety

Anger Expression


Mental Health Outcomes - Control

Social Stress

Attitude to School

Anger

Resilience

Negative Affect

Anxiety

Anger Expression


Yoga in High School Students

• “If you had a lot of stuff on your mind or something you

could just use some of those exercises... I just felt

calmer and stuff, if I was stressed out or angry for some

reason, I’d use that at some point. I’d do their breathing

exercises and they’d calm me down.”

• “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 or as tense.”

Qualitative Evaluation – Self-Regulation

Basics of Yoga

Therapy

Research

Access to Yoga Research

• Pubmed database

• Psychinfo database

• Althealthwatch database

• International Association of Yoga Therapists (IAYT)

• NIH Reporter database

• Clinical Trials Database – ClinicalTrials.gov

• Yoga websites

• Internet

• Kundalini Research Institute – [email protected]

http://www.ncbi.nlm.nih.gov/pubmed/

Basics of Yoga Research

Yoga Instruction or Yoga Therapy Practice • Documentation

• Followup

• Case study analysis and publication

Formal Research • Collaboration

• Human subjects research administration

• Study design: entry criteria, sample size, control group

(active/passive, assignment, blinding), outcome measures (population/disorder specific, validation, subjective/objective)

• Intervention design: consistency, fidelity, duration,

frequency, intensity, group/individual, home/institution

• Analysis, statistics, interpretation and publication

Collaboration

Why Collaborate?

- Clinical Experience and Expertise - clinical features, symptoms comorbidities of the disorder

- Research Experience and Expertise - in research on the disorder, condition, population of interest

- subject limitations, recruitment, entry criteria, outcome measures

- research design, grant and manuscript preparation

- IRB Approval - if you do not have access to an IRB

- Grant Submission - grant reviewers evaluate the strength of the research team

- collaborators can be consultants, coinvestigators or co-PI’s

Finding Collaborators

- Desirable qualities - a good reputation with expertise in the field

- published research

- grant funding history

- open to yoga or meditation

- Search published papers on the topic - Pubmed, Psychinfo - search by zip code or institution

- Search active NIH grants - NIH Reporter - search geographically over multiple years

- Search clinical trials - ClinicalTrials.gov

- Search local institution departmental websites - departmental websites often have bio’s of faculty

Human Subjects Research

- Informed consent

- Research is ethical - vulnerable populations

- coercion

- conflict of interest

- equitable subject selection/inclusion

- Research has scientific value - knowledge to be gained

- research design, analysis and statistics

- Risks and safety - risks are justifiable given the benefits

- minimization of risks and safety monitoring

- Anonymity and confidentiality - access to data by approved staff only

- appropriate data storage

Human Research Requirements

- Federal regulations in specific

circumstances

- Research and academic institution

requirement

- Research journals are starting to require

approval

- The only way to demonstrate that the

research is ethical

The Need for IRB Approval

Yoga Research

in Perspective

Why Not Do Research on Yoga?

Costly

- $2 million full study

- $700 K preliminary study

Lengthy

- full study 5 years, preliminary study 3 years

- requires replication and critical mass

Reductionist / Dualistic / Dehumanizing

Why Do Research

on Yoga?

Because a significant fraction of the population

is using it as a therapy

To promote its use by the general public

To reach populations that ordinarily do not have

access to and/or knowledge of yoga

Penetrating the Population

Two systems are in place in society that

penetrate to all levels of the population

The education system

The healthcare system

Both systems require validation of techniques

and procedures before implementation

Penetrating the Population

Dental Hygiene in Education and Healthcare

- Fully accepted in principle by these systems

- Taught & promoted in these systems

- Widespread adoption in society as a cultural norm

Mind-Body Hygiene (Yoga)

- NOT accepted in principle by these systems

- NOT taught and promoted in these systems

- Growing but narrow adoption in society as a cultural norm

What are the Barriers to Yoga Research?

Resistance from conventional scientists i.e.

the paradigm shift challenge

Reviewer Bias and

Paradigm Shift Resistance

"Requires testing within a controlled environment before it can be

used safely within a school system."

“…yoga and other techniques serve a similar role as OTC

medications do in getting relief from a cold. They temporarily relieve

symptoms, but don’t address the underlying cause. Once the

medication wears off, the symptoms (in this case a dysfunctional

amount of emotion) often return because the cause is still

there…does not contribute something that would be a practical way

to address this pressing gap in curricula, and if published, might only

send some in a relative dead end and delay progress toward finding

a better solution.”

– Reviewer, Journal of School Health




Lack of interest by scientists/researchers





Resistance from academic institutions






Suppression by the pharmaceutical industry






Suppression by the pharmaceutical industry Yoga can’t be studied with conventional

scientific methodology






Suppression by the pharmaceutical industry Yoga can’t be studied with conventional

scientific methodology

Funding

Research Funding

The Challenge of Funding

Federal Funding for Yoga Research to Date 2000-05 NCCAM $ 621,000 Yoga as a treatment for insomnia

2001-03 NCCAM $ 250,000 R21 Project: Yoga as a treatment for insomnia

2004-08 NCCAM $ 785,688 Neuroendocrine mechanisms of a yoga treatment for insomnia

2008-12 DoD $ 476,000 Evaluation of a Yoga Intervention for PTSD

2011 NCCAM $ 30,000 Yoga Therapy Research Conference

2010-15 NCCAM $1,250,000 Quantification of Outcome Measures for Mind-Body Interventions

2012-15 NIDA $ 405,000 Evaluation of Yoga for Substance Use Risk Factors

Total $3,817,688

Pending Grant 2013-18 NCCAM $2,500,000

“The Kundalini yoga intervention is not widely available or easily disseminated were yoga to be

found efficacious in the short- or long-term therapy of GAD…The type of yoga selected for the

intervention is not as widely available in the community outside of major cities as other types of

yoga.”

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