Yoga and mental health


In November 2012 a conference workshop entitled  Yoga, the Brain and Mental Health gathered scientists, psychologists, yoga therapists and teachers to discuss the latest research on the neurological, cognitive and emotional changes that the practice of yoga can bring about.  The London Minded Institute that specialises in the development and implementation of yoga therapy for mental health was one of the promoters of the conference.

Esther Gaytan-Fuertes spoke to Veena Ugargol, a qualified Yoga therapist, who teaches at the Minded Institute, about her research on the benefits of Yoga for stress-related mental disorders.  Esther started by asking Veena about her participation in the ‘Yoga, the Brain and Mental Health Conference’.

Veena Ugargol: Heather Mason of the London Minded Institute partnered up with Jane Ryan from Confer, who organises a lot of psychotherapy type conferences, and they decided to put together a conference that would bring together these 2 worlds, to get an understanding of the research that exists and how we can use these approaches to help people who are suffering with their mental health – anxiety, depression and people who are trying to manage symptoms of post traumatic stress disorder. These were the three areas that we were focused on and we had speakers come from all over – Dr Chris Streeter, BU School of Medicine, who has published one of the most ground breaking studies on Yoga. She looked at the effects of Yoga on one of the main Neuro transmitters in the brain – Gamma-Aminobutyric Acid  (GABA),  an inhibitory neuro transmitter which at lower levels is associated with anxiety.  After an hour of Yoga, when they imaged the brain,  there was an increase in the levels of GABA. She followed that initial study up with a study that looked at Yoga versus walking to rule out that it wasn’t just that people were moving and doing exercise. She spoke at the conference about the series of research projects that she did in that domain.

We also had Sarah Lazare who has a Lab at Harvard Medical School. She does a lot of research on meditation. We also had Patricia Goldberg and Richard Brown who are psychiatrists based in New York and they bring a lot of breath work and movement into the work that they do with some of their clients. They have built up a body of research over the last 10 or 15 years taking some of this work out to disaster hit zones – so  taking an intervention out in these very challenged situations where if there is very little, if any resource or infrastructure in place and teaching people to be able to use their breath in a way that is going to help them manage the psychological implications of what they have just been through and what they continue to go through. So they’d work with survivors of ‘9/11’, they went out and did a really fascinating project looking at the effects of breath work on post-traumatic stress disorder and that was with people who had been very badly hit in the South East Asia Tsunami in 2005. They have done work with survivors of ‘Hurricane Katrina’ so these real large-scale disasters, –  giving people the tools to help themselves. That is a very key part of this – it’s giving people the confidence to know that they have things that they can call upon.  After all, your breath is with you all the time.

Satvia Carson also attended and gave a run down of the main Yoga research studies that exist in the domain of Mental Health.

So there was a good range of speakers, we had a lot of workshops going on. I spoke specifically about anxiety and  tried to help people distil the huge amount of information they had received over a couple of days of the conference  – to help them tease out how to embed this practically. How do we use what we know to  help people with anxiety?  Also making sure that people understand that there are things that we can do that might exacerbate a situation, knowing what those things are, so that they can put together something that is really going to help that person in the long term.

I was very pleased with the turnout – there were a lot of people there, a great response, great feedback, a lot of excitement in bringing these two worlds together and a lot of recognition and acknowledgement of the value of this approach for mental health.  Given that we are in a serious situation with the state of our Mental Health in society, it could not have been better timed.

Esther Gaytan-Fuertes:  Tell me about your work with the Minded Institute, and the research you have carried out there.

Vena Ugargol

Vena Ugargol

VU: I have been a Yoga teacher since about 2008 and my teaching and practice has always been from a relaxation standpoint. I was never interested in getting ‘super flexi or bendy’. It was all about managing stress and I came across a Yoga therapy for Mental Health Training that was run by Heather Mason. When I started looking into the ins and outs of this teacher training it really felt aligned with where I was coming from with my practice and with my teaching. I was studying psychology at the time and I thought this might be a good partnership so I embarked upon that training and was very impressed by the way that Heather had brought together Yoga with Mindfulness in terms of a therapeutic intervention which has been really well researched and is pretty much established as something that is helpful for things like anxiety and depression.

She married this up with Yoga as an intervention to help people self regulate when pure mindfulness on it’s own is just too difficult to access, and as well as that  partnership of Yoga and Mindfulness she was also bringing together what we understand in terms of neuroscience and what we know can happen with brain changes when we use Yoga meditation or practice so I was blow away by how validated I felt my approach and my teaching had been and was very happy to know that there was some western scientific principles underlying at lot of this stuff. It impressed me to the point where I felt that I had to do this work –  I’d gone to that course thinking well, this might inform the way that I teach, but I left the course feeling that I really had to do this work.

During that teacher training Heather had mentioned a lot of anecdotal feedback from clients that she’d worked with in the past and I felt that it would be really helpful and necessary to try and get some evidence based data to support that anecdotal feedback that she was getting from her clients. Specifically really if we wanted to take this into organisations like the NHS, it was really about talking their language. So I approached her and asked her if she would be open to me doing some research on one mode of the approach which is the 8 week Yoga therapy for the mind course and she agreed and we partnered up with Roehampton University with Dr. Leigh Gibson, and we partnered with Satvia Carlson who is based at Harvard Medical School and knows everything there is about any Yoga research that exists at the moment. We set about designing a weightless controlled research project. We started off with about 26 people, and like any project you do get a few drop out and we ended with 22 people, 11 in each group. We had 11 of these people go straight into doing the course and the other 11 people waited, they formed the weightless control part of the research. The measures that we took were measures of anxiety and depression. We used hospital anxiety and depression scales. We also took measures of resilience, of wellbeing and of mindfulness. We had the participants complete the questionnaires, before and after they took the course and for the weightless control group, that period before the waitlist as well.

The result of that research project were very promising, We had increases in everything across the whole board except for one of the mindfulness measures which did increase, but it just didn’t hit that mark to be significant. Nevertheless we feel that it’s small numbers but that seems to be the nature of Yoga research, because if you are going to deliver a Yoga intervention it’s very nature means that it can’t be a big group, especially if it’s a mental health intervention because the size of the group can play a role in how effective it might be.

Heather and I continue to work together. I actually lecture now on her teacher training so we just had another group complete and graduate and, we will have a new group starting in February 2013, so we have about 30 people ready to start on that as well.

EF: What do you teach in Yoga Therapy? Is it a physical, mental therapy or a combination of the two?

VU:  It’s a mind body approach so I would say its more than just a physical therapy, certainly when you bring the mindfulness aspect into it as well. Probably the easiest way to explain it is that we are primarily teaching people how to self regulate  – to  recognise when they are feeling anxious or hyper aroused or very stressed out and to take some action to be able to just take the edge off of that, and to calm the nervous system. Also, likewise to recognise when there might be a sense of depression or feeling low and to be able to take some action to be able to lift the nervous system and to energise a little bit. So we are really trying to teach people to recognise what’s happening and to be able to take an observer standpoint to be able to say, ‘ this is how I am right now’ and after that to  be able to take steps to make a change, in the right way, in a helpful way. So I guess that’s the first part, probably more where the Yoga comes in because the regulation is through things like particular postures that might lift or lower the nervous system particular breath practices.

Mindfulness is inherent in yoga practice.  It’s very much about bringing you to the present moment and having awareness of what is happening here and now. It’s not impossible to practice Yoga mindlessly but I think it’s a practice that is very conducive to developing mindfulness, to really concentrating on focusing on what’s happening now. In the beginning it might be very difficult for someone who’s very, very anxious and hyper-aroused to do a practice that lifts the nervous system,  it might be too much especially for someone prone to panic attacks – it might even push them into that zone. So its about just building that tolerance to get an individual to a stage that actually they have the tolerance to do something like a lifting breath practice that might before have pushed them into panic but now they build the ability to be able to deal with it. In that sense, we are not looking at what can be managed in the here and now and what can we help in the here and now, rather we are looking at a more long term strategy – building resilience into the nervous system over the long term. It’s like exercising or building a muscle, you have to work it to its two extremes, but within its tolerance, to be able to keep it healthy and to keep it resilient. It’s the exact same thing we are doing with the nervous system so it’s not just about teaching someone who is anxious how to relax, it’s about teaching them – within their tolerance –  to be able to have their nervous system resilient enough to manage the stimulation or lift of energy and to know that they can actually regulate themselves.

When they are at that point we can start to bring in more pure mindfulness.  There is a paradox here, of course, because  inherent in mindfulness is that you are watching what’s happening but you are not trying to change it. So there’s a  tension there in what we are doing because  initially there’s a lot of regulation.  But we work to get people to the point where they can actually notice what’s happening in that pure mindfulness sense without needing to regulate, but having the confidence that they have the skills if they need to.

EG-F: Who do you think is more interested in learning about the benefits of Yoga in the treatment of mental health disorders, Health professionals or Yoga teachers?

VU: I think it’s quite interesting because for the last couple of years we’ve had an even split.  Yoga teachers  coming  to learn more about how they could focus their work to a mental health population,  and  mental health professionals who wanted to learn how they could maybe bring some breath practices into what they do, or use some postures with their clients. It seems to be shifting a little now, with  more of an interest from people like clinical psychologists. We’ve already had a number of clinical psychologists train with us and graduate. There seems to be more interest from that side of the audience, which is interesting. I think very encouraging in terms of people recognising that if we want to address things that are going on in the mind then we can actually harness what’s going on in the body as well as a resource and that there is no split between the two.

EG-F:  Is there an open-minded approach from the scientific community to this research work on Yoga and Mental Health?

VU: I think so, my opinion is obviously very subjective and based on the world that I operate in. I am surrounded by people who are probably more open to this sort of approach than not so I think it is very difficult to give an objective answer. However, my feeling is that yes, there is more interest and I think that there is definitely a recognition that what happens in the mind has an affect on the body and what happens in the body has an affect on the mind. We can draw on the interdependence between these two things and  help the body to heal the mind and visa versa, it’s a two way street. I very much think that there is a recognition of that relationship and I hear a lot of people using breath techniques and teaching people how to breathe in a way that is going to be helpful, especially in anxiety to underpin or help people with things like exposure therapy.

To answer your question I think that there is definitely more openness to mind body approaches. I think we are probably further away than I would like – I don’t expect that we will see Yoga on the NICE guidelines anytime soon, but in the future, I don’t think its impossible. I think that’s what’s important and we just need to do more research to push this forward and to be able to get this recognised as something that can be helpful to people with many different conditions, not just mental health although that is my area. I think it will happen. I don’t know when, but I’m hopeful it will be relatively soon.

EG-F: So you see a continuity in your research on the application of Yoga in Mental Health Therapy?

VU: Absolutely, I think its vital I think it’s the only way we are going to push this approach forward. I very much think that it would take the path that mindfulness did. As I say there is at least 20 years worth of research on mindfulness with many different groups of people, with different populations, in terms of things like addiction, like populations of people with Cancer and I feel that Yoga is kind of following that lead with similar kind of research projects. Things that look at psychological outcomes which are very important but also some qualitative research that looks a little deeper into the themes coming up for people when they embark upon an intervention like this. what are the ways that they feel that they are getting some sort of positivity from doing this work?  And importantly,  things like Neuro imaging studies which again give us a different level of explanation. They can tell us what is happening in the brain when we embark on some of these practices, whether it be in that moment or over a period of time, practising something every day for example. But I also think its important to stress that this really is a bringing together of Western Science and Eastern Philosophy and Eastern practice’s and its really not about undermining anyone’s experience. Its not about having to validate anyone’s experience, its about making this as accessible to as many people as possible and that’s why we need the research.

EG-F: Do you think the current popularity of your work as just another form of fitness exercise has affected the quality of Yoga teaching?

VU: I think it is a really good question but I don’t think it is something that I can answer. I think I can probably contribute to the debate, certainly.  I feel like anyone allowing their senses to drop within, rather than just being consumed with what is going on outside of them, is practicing Yoga on its most surface level. So for me, whether that is being done in a Yoga class being taught in 40 degree heat, whether its being done in a Shala in front of some temple, whether that teacher is someone dressed completely in white or full of tattoos. It’s very difficult to say ‘yes I think this teacher teaches well’ or teaches from the right place. I think you can only really know when you have experienced that teacher’s teaching. For me its really about taking on board that you are not just doing this physical practice, you’re not just trying to get flexible.

Strength is something different. I think if you can develop a sense of physical strength that can contribute to a sense of inner strength and emotional strength. It’s such a huge discipline. I think as long as people are developing that sense of confidence, developing that sense of how they want to live their lives in a way that makes sense to them and that gives them that sense of peace, to me that is Yoga – its not about following a particular series, or a particular doctrine, its really about something that’s harnessing those 8 aspects of Ashtanga Yoga – to me that is practising yoga and you don’t have to be on your mat to be practising yoga.

E-GF:  I hope this podcast has helped you to discover a new perspective of Yoga and its benefits for our health. You may find a wide selection of podcasts on very interesting topics on our website

Transcript prepared by Sheena Bateman

A list of academic research articles on yoga and mental health can be found here

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