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Effects of Yoga on Anxiety and Autonomic Function in Panic Disorder Patients
Abstract
Introduction: Yoga is known to modify autonomic activity and improve stress coping abilities in normal and disease states including, as hypothesized, panic disorder which is characterized by episodic sympathetic hyperactivity and heightened anxiety. Methods: Panic disorder patients with / without agoraphobia were systematically randomized into study and control groups. The study group received drug therapy and did yoga ½ h / day for one month; the controls received drug therapy only. Anxiety and panic attack episodes were assessed before and after intervention, using Hamilton Anxiety Scale (HAS) and Hopkins symptom Checklist (SCL) respectively. Autonomic function was assessed by standard tests: deep breathing, lying-to-standing, handgrip, and Valsalva maneuver. Data of two groups were compared by Kruskal-Wallis test. Results: After the intervention, both the groups had reduction in HAS (control [16.00 ± 7.96 vs. 8.54 ± 4.20, p < 0.01], cases [12.17 ± 7.03 vs. 4.33 ± 2.07, p < 0.05]) and SCL (control [28.62 ± 11.10 vs. 11.23 ± 9.98, p < 0.01] and cases [21.67 ± 11.00 vs. 2.50 ± 3.89, p < 0.01]) scores though compliance seemed poor in study group. The study group had resting heart rate lowered, and less diastolic BP rise (16.00 ± 9.88 vs. 19.33 ± 4.32 mmHg, p = NS) on handgrip after the yoga as compared to controls (13.50 ± 11.35 vs. 24.38 ± 5.32 mmHg, p < 0.01). Conclusion: One month of yoga is an effective adjuvant therapy for panic disorder patients. Yoga acted by lowering tonic anxiety and sympathetic activity.
... The results demonstrate that there were significant differences in the anxiety and the QOL of the pre-test and the posttests of the yoga group. These findings align with previous research demonstrating the efficacy of various interventions for treating panic disorder, including CBT and mindfulness-based interventions (MBIs) [17][18][19][20]. ...
Background: Individuals wrestling with panic disorder (PD) know all too well its debilitating impact. Sudden, intense fear episodes disrupt lives and erode well-being. Fortunately, integrating complementary therapies like yoga with standard treatment offers a glimmer of hope for improved outcomes. Yoga's unique blend of physical postures (asanas), breathing exercises (pranayama), and meditative practices holds promise for mitigating anxiety and fostering a sense of inner peace, potentially making it a valuable tool in the fight against panic disorder.
Methods and materials: This study investigated the effect of yoga as an adjuvant to standard care for panic disorder. Sixty-four panic disorder patients of both genders previously diagnosed with panic disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were randomly assigned to the yoga group (n = 32) and the control group. The yoga group participated in integrated yoga sessions lasting 60 minutes, five days a week, for 12 weeks. Both groups received standard care. Pre- and post-intervention data were collected for HAM-A and WHOQOL-BREF.
Results: The yoga group exhibited a significant reduction in HAM-A scores (Pre: 49.13 ± 4.55, Post: 13.53 ± 5.54, p < 0.001) with a substantial effect size of 7.02. Quality of life significantly improved across all domains (physical, psychological, social, and environmental) in the yoga group (p < 0.001), demonstrating effect sizes ranging from 4.11 to 4.57. Control group participants also experienced improvements, though less pronounced. Between-group comparisons revealed significant differences in anxiety reduction (p = 0.042) and quality of life enhancement (p < 0.001), favouring the yoga group.
Conclusion: The results suggest that yoga can be a valuable complementary or alternative approach to traditional treatments for anxiety disorders.
... [9] The common psychiatric comorbidities observed were major depression and generalized anxiety disorder, [38,65] and these comorbidities were associated with more severe illness, increased severity of panic, and other anxiety symptoms. [66] The presence of agoraphobia; comorbid psychiatric disorders and stress were associated with more severe illness, increased severity of panic, and other anxiety symptoms [67] Haematological feature of increased platelet distribution width and red cell distribution width has been observed. [68] Regarding treatment, CBT was found to be effective. ...
The under‑or misdiagnosis, and symptomatic treatment of the panic disorder (PD), despite high prevalent medical illness, is common
among non‑psychiatric physicians. The non‑psychiatrist physician’s role is vital in the care of PD as most patients initially approach
general medical settings for medical help, including primary care. However, a significant proportion is undiagnosed and undergoes
either unnecessary investigation, misdiagnosed, or mismanaged even among post‑Coronary Artery Bypass Grafting patients, which
profoundly affects the patients functioning and quality of life. This article aims to provide overviews of relevant epidemiological
aspects, presenting features across medical specialties with respective diagnostic dilemmas, assessment, and management of the PD
in their general medical settings, including emergency visits. Apart from psychiatrists, this will also assist non‑psychiatrist physicians
across all medical specialties, including general practitioners, to understand, identify, and provide the first line evidence‑based
pharmacotherapy and address the unmet need of patients with PD in their day‑to‑day busy clinical practice. This paper also provides
a referral guide for non‑psychiatrist physicians to refer to psychiatrists for further management after their first‑line management.
To determine the long term effects of relaxation therapy on 24 hour ambulatory intra-arterial blood pressure in patients with mild untreated and uncomplicated hypertension.
Four week screening period followed by randomisation to receive either relaxation therapy or non-specific counselling for one year. Ambulatory intra-arterial blood pressure was measured before and after treatment.
Outpatient clinic in Amsterdam's university hospital.
35 Subjects aged 20-60 who were being treated by general practitioners for hypertension but were referred to take part in the study. At three consecutive screening visits all subjects had a diastolic blood pressure without treatment of 95-110 mm Hg. Subjects were excluded if they had damaged target organs, secondary hypertension, diabetes mellitus, a cholesterol concentration greater than 8 mmol/l, or a history of malignant hypertension.
The group allocated to relaxation therapy was trained for eight weeks (one hour a week) in muscle relaxation, yoga exercises, and stress management and continued exercising twice daily for one year with monthly visits to the clinic. The control group had the same attendance schedule but had no training and were requested just to sit and relax twice a day. All subjects were asked not to change their diet or physical activity.
Changes in ambulatory intra-arterial blood pressure after one year of relaxation therapy or non-specific counselling.
Mean urinary sodium excretion, serum concentration of cholesterol, and body weight did not change in either group. Diastolic pressures measured by sphygmomanometry were 2 and 3 mm Hg lower in subjects in the relaxation group and control group respectively at the one year follow up compared with initial readings. The mean diastolic ambulatory intra-arterial pressure during the daytime had not changed after one year in either group, but small treatment effects could not be excluded: the mean change for the relaxation group was -1 mm Hg (95% confidence interval -6 to 3.9 mm Hg) and for the control group -0.4 mm Hg (-5.3 to 4.6 mm Hg). Mean ambulatory pressure in the evening also had not changed over the year, and in both groups nighttime pressure was 5 mm Hg higher. The variability in blood pressure was the same at both measurements.
Relaxation therapy was an ineffective method of lowering 24 hour blood pressure, being no more beneficial than non-specific advice, support, and reassurance--themselves ineffective as a treatment for hypertension.
As more methadone treatment programs are funded in an attempt to curb substance abuse and HIV infection among i.v. drug users, more cost effective treatment approaches are being sought.
To investigate whether clients in outpatient methadone maintenance treatment who practice weekly Hatha yoga in a group setting experience more favorable treatment outcomes than those who receive conventional group psychodynamic therapy.
After a 5-day assessment period, 61 patients were randomly assigned to methadone maintenance enhanced by traditional group psychotherapy (ie, conventional methadone treatment) or an alternative Hatha yoga therapy (ie, alternative methadone treatment). Patients were followed for 6 months and evaluated on a variety of psychological, sociological, and biological measures. The revised Symptom Check List provided the primary psychological measures; the Addiction Severity Index provided various indices of addictive behaviors.
The evidence revealed that there were no meaningful differences between traditional psychodynamic group therapy and Hatha yoga presented in a group setting. Both treatments contributed to a treatment regimen that significantly reduced drug use and criminal activities. Psychopathology at admission was significantly related to program participation regardless of treatment group.
In addition to examining the characteristics of patients who present for treatment, this study identifies unexpected staff issues that complicate the integration of alternative and traditional treatment strategies.
Alternative methadone treatment is not more effective than conventional methadone treatment, as originally hypothesized. However, some patients may benefit more from alternative methadone treatment than conventional methadone treatment. Additional research is necessary to determine characteristics that identify patients who might benefit from alternative methadone treatment.
The objective is to estimate parameters of the natural history of panic disorder, including its prodrome, incidence, recovery and recurrence.
In 1981 the Baltimore Epidemiologic Catchment Area Study interviewed 3481 individuals probabilistically selected from the household population. During 1993-1996, 1920 of these individuals (73% of survivors) were interviewed again. Baseline and follow-up interviews included the National Institute of Mental Health Diagnostic Interview Schedule. During the follow-up, a subsample was assessed by psychiatrists using the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry (SCAN).
There were 35 new cases of panic disorder in 24,475 person years of exposure, yielding an annual incidence of 1.43 per 1000 per year. Data from the SCAN assessments suggest the incidence estimate is conservative. Incidence is greater in females and declines with age. About one-third of the new cases arise without agoraphobia, but about half have anxiety of some sort present for many years prior to meeting criteria for diagnosis. People with agoraphobia have less intense onsets but slower recoveries than those without agoraphobia.
Panic is heterogeneous in its pattern of onset and recovery. Some of the heterogeneity is associated with the presence of other anxiety over a long period of the life.
Chapter 185. Human Papillomavirus Infections.
It seems to us that the world is divided into those who read Harrison's and those who don't; it is only fair in beginning this review to acknowledge our allegiance to the former. Just as Arrowsmith and Of Human Bondage have shaped our imaginations, our view of internal medicine, perhaps inevitably, has been shaped by our allegiance to this textbook.As medical students, we read the seventh edition from cover to cover, favorite passages highlighted in yellow until, with time, the whole book seemed to fluoresce. What held us then (and still does) was the central strength of this book: the "Cardinal Manifestations of Disease" section, which now occupies 288 pages or roughly one tenth of the book. And, of course, when melancholy set in, one could find inspiration from these memorable words on page 1:No greater opportunity, responsibility, or obligation is given to an individual than that of
Incluye bibliografía e índice
A previous study of 22 medical patients with DSM-III-R-defined anxiety disorders showed clinically and statistically significant improvements in subjective and objective symptoms of anxiety and panic following an 8-week outpatient physician-referred group stress reduction intervention based on mindfulness meditation. Twenty subjects demonstrated significant reductions in Hamilton and Beck Anxiety and Depression scores postintervention and at 3-month follow-up. In this study, 3-year follow-up data were obtained and analyzed on 18 of the original 22 subjects to probe long-term effects. Repeated measures analysis showed maintenance of the gains obtained in the original study on the Hamilton [F(2,32) = 13.22; p < 0.001] and Beck [F(2,32) = 9.83; p < 0.001] anxiety scales as well as on their respective depression scales, on the Hamilton panic score, the number and severity of panic attacks, and on the Mobility Index-Accompanied and the Fear Survey. A 3-year follow-up comparison of this cohort with a larger group of subjects from the intervention who had met criteria for screening for the original study suggests generalizability of the results obtained with the smaller, more intensively studied cohort. Ongoing compliance with the meditation practice was also demonstrated in the majority of subjects at 3 years. We conclude that an intensive but time-limited group stress reduction intervention based on mindfulness meditation can have long-term beneficial effects in the treatment of people diagnosed with anxiety disorders.
Forty eight healthy volunteers who participated in the practice of yoga over a period of 4 months were assessed on Subjective Well Being Inventory (SUBI) before and after the course in order to evaluate the effect of practice of yoga on subjective feelings of well-being and quality of life. A significant improvement in 9 of the 11 factors of SUBI was observed at the end of 4 months, in these participants. The paper thus, reiterates the beneficial effects of regular practice of yoga on subjective well being.
Because panic attacks can be accompanied by surges in physiologic activation, we tested the hypothesis that panic disorder is characterized by fluctuations of physiologic variables in the absence of external triggers.
Sixteen patients with panic disorder, 15 with generalized anxiety disorder, and 19 normal control subjects were asked to sit quietly for 30 min. Electrodermal, cardiovascular, and respiratory measures were analyzed using complex demodulation to quantify variability in physiologic indices.
Both patient groups reported equally more anxiety and cardiac symptoms than control subjects, but certain other somatic symptoms, including breathlessness, were elevated only in panic disorder patients. Mean end-tidal pCO(2) and respiratory rates were lower, and tidal volume and the number of sighs were higher in panic disorder patients than control subjects. Neither cardiovascular (heart rate, arterial pressure, cardiac output), nor electrodermal instability including sighs distinguished the groups; however, tidal volume instability was greater in panic disorder than generalized anxiety disorder patients or control subjects. Several other respiratory measures (pCO(2), respiratory rate, minute volume, duty cycle) showed greater instability in both patient groups than in control subjects.
Respiration is particularly unstable in panic disorder, underlining the importance of respiratory physiology in understanding this disorder. Whether our findings represent state or trait characteristics is discussed.
We studied the symptom structure of panic attacks in 94 patients attending an outpatient psychiatric clinic. Autonomic symptoms of anxiety were reported by the majority of the panic patients. As compared with studies from the West, certain cognitive symptoms, such as fear of loss of control and depersonalization, and vestibular symptoms were endorsed by fewer panic patients. The majority of our panic patients tended to seek help initially from physicians and medical specialists. The majority of the patients also did not experience some DSM-IV symptoms as part of their panic attacks. Comorbid psychiatric conditions influenced the symptom structure of panic attacks. A higher number of agoraphobics as compared with patients with uncomplicated panic disorders had the symptoms of fear of loss of control and fainting. Our findings support the notion that the experience of panic attacks is variable and differs across cultures.
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