Motivation and emotion/Book/2018/Yoga and mood disorders

Overview


Yoga, according to Wikipedia, is is a group of physical, mental, and spiritual practices or disciplines which originated in ancient India, around 5000 BCE (McCall, 2014). Another way of putting the description of yoga into words is that it is a system created for greater physical and mental clarity with a goal to transcend the limited concepts of self we have acquired through society (Douglass, 2007), and even to attain enlightenment.

Yoga and emotion present a strong, significant relationship, showing that regular practice improves physical and emotional well-being. As will be explained throughout this page, yoga has great outcomes anatomically, but it is highly important to understand the origins of the practice of yoga and the many aspects of it, and use that to appropriately guide our individual practice.

For the purpose of this book chapter, the word 'yoga' will be used to encompass the "original" yoga as well as the modern, physical postures (asanas), breathing exercises and techniques (pranayama) and meditation as these are the forms of yoga used throughout the studies that will be mentioned.

Biological effects of yoga


Conditions of stress create imbalances in the autonomic nervous system, which comprises the sympathetic nervous system and the parasympathetic nervous system (Streeter, Gerbarg, Saper, Ciraulo & Brown, 2012). Stress decreases activity in the parasympathetic nervous system, which is commonly known to be responsible for the "rest and digest" functions in the body, and increased activity in the sympathetic nervous system, which in turn is known for its "fight or flight" reactions (Streeter et al., 2012).

Ujjayi breath is a type of yogic breathing technique employed in practice, usually done hand in hand with asana practice. Many forms of yogic breathing have shown significant positive cardiovascular and respiratory outcomes, among them ujjayi breath showing the greatest improvement (Mason et al., 2013).

Breathing exercise to activate the parasympathetic nervous system Regardless of where you are or what you are doing, this is a breathing exercise that you can use to relax your body and bring your mind back to the present moment.

Close your eyes if that is comfortable to you. Consciously release tension from your shoulders, your arms, your stomach, your legs and your feet. Relax your forehead, your eyelids, your nose, cheeks, lips and chin. Unclench your jaw and release your tongue from the roof of your mouth. Let go of all tension that no longer serves you. Now bring your awareness to your breathing. We're going to breathe in for a certain count, hold for one and breathe out for double the breath in. Breathe in for 3 counts, hold for 1, and breathe out for 6. Now breathe in for 4 counts, hold for 1 and breathe out for 8. Repeat the same pattern, or increase the counts it if it feels right. Continue doing so as long as needed; the parasympathetic nervous system will activate and your mind will bring you back to the here-and-now.

The GABA (gamma-aminobutyric acid) system is crucial in the brain for regulating emotion and threat perception as well as stress reactivity (Streeter et al., 2012; Streeter et al., 2010). Numerous studies have concluded that yoga regulated levels of GABA in the brain, leading to improved mood (Streeter et al., 2012; Streeter et al., 2010)

Does yoga increase GABA system activity or is it exercise in general? Streeter and colleagues (2010) created a study to understand whether it was yoga specifically that increased the GABA system activity, or if it was exercise in general. The researchers found that, compared to walking, yoga results in a greater increase in the parasympathetic nervous system, there were increased thalamic GABA levels, which in turn are associated with a reduction of anxiety and better mood.

Major Depressive Disorder
Criteria for Major Depressive Disorder includes experiencing a depressed mood for more than 2 weeks, anhedonia, changes in weight, appetite and energy levels, psychomotor retardation and agitation, diminished cognitive ability and suicidal ideation (American Psychiatric Association, 2013). According to the DSM-5, these symptoms cause significant distress in a person's social, occupational and general functioning life (APA, 2013).

Stress has been found to heighten symptoms in certain disorders, including depression, as it is associated an increased allostatic load, an underactive parasympathetic nervous system and with low levels of GABA activity (Streeter et al., 2012; Streeter et al., 2010). Yoga has shown therapeutic effects in this sense as it has proven to increase activity in both the parasympathetic nervous system and the GABA system (Streeter et al., 2012; Streeter et al., 2010). The effect of yoga on mood is immediate, this was confirmed in a study assessing mood states in patients with depression before and after a yoga class, showing significant reductions for depression, neurotic symptoms, anger and anxiety (Shapiro et al., 2007). In addition to mood improvement, executive functioning has also been shown to be enhanced with the practice of yoga. In addition to conventional anti-depressants, yoga can significantly improve verbal working memory, attention span and visuo-motor speeds (Sharma, Mondal, Goswami & Gandhi, 2006).

Bipolar Disorder
Bipolar Disorders encompass Bipolar I, Bipolar II and Cyclothymia. According to the DSM-5, bipolar I criteria consists of one or more episodes of mania, and a major depressive episode may be present. Bipolar II criteria consists of at least one major depressive episode, at least one episode of hypomania and a manic episode has never occurred. Cyclothymia is a more chronic, but less severe version of Bipolar I and II.

Surprisingly, there is little to no research on the impact of yoga on bipolar disorders (Da Silva, Ravindran & Ravindran, 2009). There is a study that looked at the impact of a mindfulness-based cognitive therapy (MCBT) in patients with bipolar and unipolar disorder with a history of suicidal ideation or behaviour. This study found that MCBT results in significant effects in terms of reducing anxiety as well as depressive symptoms in patients with bipolar disorder (Williams et al., 2008). This is one relatively small study that only recruited people with suicidal ideation or behaviour, while informative, cannot be relied on on its own or generalised to this topic of yoga's effect on bipolar.

Other illnesses
Aside from mood disorders, yoga has also demonstrated strong benefits for other DSM-5 classified mental disorders. Yoga interventions have shown decrease in anxiety; which has also been mentioned in studies looking at patients with bipolar and depression (Shapiro et al., 2007; Streeter et al., 2010; Williams et al., 2008; Woodyard, 2011). In terms of eating disorders, lower body dissatisfaction, lower drive for thinness, decrease in bulimic behaviours and decrease in preoccupation over food were associated with yoga interventions (Klein & Cook-Cottone, 2013).

Implementation
A recent study supported the use of an online yoga program, tailored to treat mood disorders, as an effective intervention in decreasing the negative effect of mood disorders (Uebelacker, et al, 2018).

Yoga is seen as a promising intervention for depressive disorder as it is low on cost and easy to implement (Shapiro et al., 2007), it is seen as highly effective alongside mainstream treatment, but hasn't yet been proven to be a curative treatment on its own (Büssing, Michalsen, Khalsa, Telles & Sherman, 2012).

Distraction hypothesis
The distraction hypothesis states that exercise distracts the mind from negative thoughts and feelings, and when distracted from such intrusive sentiments, there is a reduction in anxiety (Peluso & Andrade, 2005). During exercise, people tend to switch their attention to the present moment, their physiological state (Craft 2005), which is especially true in yoga, where the conscious mind is brought to the awareness of the body.

Flow theory
A holistic sensation is felt when an act is carried out with complete focus and intrinsic enjoyment, it is a state of absolute concentration, enjoyment and low self-awareness (Csikszentmihalyi & LeFevre, 1989; Ullén et al., 2012, Teng, 2011). This sensation and state of being is defined as flow. Flow occurs when performing an enjoyable, yet slightly challenging activity (Ullén et al., 2012) and can be strongly related to yoga in different ways. Firstly, the word "flow" is one that is regularly used in the practice of yoga as yoga does not try to force, but let happen as is. Yoga practice can be as challenging as one decides to make it; it is completely up to the individual how difficult the practice is. Finally, it is a time of low self-awareness as the intention of yoga is to release any sense of ego and be the purest form one can be.

Case Study

Allegra is a 19 year old that has struggled with major depression for as long as she can remember. She has been prescribed a wide array of medication over the years, with nothing helping long-term. She joined a gym as she heard that exercise has been proven to alleviate symptoms, and found that they offered yoga, so she decided to try out a class. The teacher made Allegra feel very at ease as she repeated that yoga wasn't about the poses or the flexibility, and Allegra found herself losing herself in the flow of the class. She wasn't focused on what she couldn't do - instead she just allowed her body to move in a way that felt good. Allegra has been hooked ever since, and has found that whenever she finishes yoga she feels very relaxed, in a better mood and as though she has a clear mind. Allegra, through conversing with her teacher, gradually learnt more and more about the roots of yoga, which drew her into the practice and the lifestyle. Although Allegra acknowledges that her depression hasn't disappeared, she continues to follow her journey with yoga and its teachings and feels as though she is coming to peace with who she is more and more as time passes.

Further research is needed to focus on theories directly related to yoga and emotion, rather than general exercise.





Conclusion
If you were to experience a yoga class today in the western world, you would find that the majority of people attend for the health benefits, including strength and flexibility. The physical level of asana alone is not yoga and will do little to develop spiritual growth.

Vast amounts of research have shown the benefits of yoga on disorders, especially in the field of depression and anxiety. The practice of yoga, which includes yoga poses, breathing techniques, meditation and chanting, among others, has proved to positively impact the parasympathetic nervous system and the GABA system in the brain, which result in improved moods and reduced anxiety. The change in mood states are immediate when practicing yoga, and it is an easily implemented and cost effective way to aid treatment for multiple disorders. Although proved to be highly effective, it is not yet proved to be a curative treatment on its own, without other more conventional and mainstream treatments, such as therapy and antidepressants. More research is needed in the area of bipolar disorders, but other research also shows strong effects of yoga on other DSM-5 disorders.

Finally, although this chapter has outlined to many anatomical benefits of yoga, it is important to note that yoga holds the core value that a soul has no bad; it is divine as it is and does not need to be fixed or changed. In today's age there is a strong emphasis on needing to change, fix, improve and understand. When approaching the practice of yoga, these limiting beliefs are not of service.

"The soul always knows what to do to heal itself. The challenge is to silence the mind."

- Caroline Myss