Yoga and Mental Health: A Review

Abstract

The need for effective population mental health promotion approaches is urgent as mental health concerns are escalating globally and current allopathic treatment regimens are insufficient to bring people towards the state of mental well-being (citation). Successfully alleviating stress has the potential to promote wellbeing and prevent illness. Worldwide, yoga is gaining popularity as an accessible, acceptable and cost-effective practice for mind and body. People are turning to yoga for mental health improvement because of preferences for: self-treatment as opposed to clinical intervention; perceived greater efficacy than medication; fewer side effects; lack of response to medication. Yoga has minimal side effects and is cost-effective in comparison with pharmacological treatments and psychotherapy. Yoga’s added benefit is that it improves physical fitness and encourages self-reliance. In this brief article we discuss the evidence for yoga as a form of mental health promotion, illness prevention and treatment for depression.

Full text

Yoga and Mental Health: A Review
Farah M Shroff * and Mani Asgarpour
Department of Family Practice and the School of Population and Public Health, The University of British Columbia, Canada
*Corresponding author: Farah M Shroff, Department of Family Practice and the School of Population and Public Health, The University of British Columbia, Canada,
Tel: +6046823269; E-mail: farah.shroff@ubc.ca
Received date: April 21, 2016; Accepted date: March 10, 2017; Published date: March 16, 2017
Copyright: © 2017 Shroff FM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
The need for effective population mental health promotion approaches is urgent as mental health concerns are
escalating globally and current allopathic treatment regimens are insufficient to bring people towards the state of
mental well-being (citation). Successfully alleviating stress has the potential to promote wellbeing and prevent
illness. Worldwide, yoga is gaining popularity as an accessible, acceptable and cost-effective practice for mind and
body. People are turning to yoga for mental health improvement because of preferences for: self-treatment as
opposed to clinical intervention; perceived greater efficacy than medication; fewer side effects; lack of response to
medication. Yoga has minimal side effects and is cost-effective in comparison with pharmacological treatments and
psychotherapy. Yoga’s added benefit is that it improves physical fitness and encourages self-reliance. In this brief
article we discuss the evidence for yoga as a form of mental health promotion, illness prevention and treatment for
depression.
Keywords: Mental wellbeing; Quality of life; Yoga; Depression;
Mental health promotion
Introduction
By 2020, the World Health Organization predicts that depression
will be the second largest contributor to the global disease burden,
aer ischemic heart disease (cite). Anxiety is also being diagnosed at a
greater rate than it was in the past. Despite these increases in diagnosis,
treatment regimens typically include pharmaceutical therapies that are
not sucient to prevent further illness or promote mental well-being.
Eectively addressing mental health concerns entails a comprehensive
approach that addresses the root of the problem(s) [1-3].
In this paper, we provide evidence for yoga as a form of health
promotion, illness prevention and treatment for depression and other
mental health imbalances. Like other therapies, yoga is not a complete
solution to mental health concerns. In conjunction with other
approaches, yoga has great potential to lead people towards greater
mental well-being.
What is Yoga?
e eight limbed path of yoga includes: Yama (moral codes),
niyama (self-discipline), asana (postures), pranyama (breath practices
promoting life force), pratyahara (sensory transcendence), dharana
(concentration), dhyana (meditation), samadhi (state of bliss). e
word roots of yoga mean “to join” in Sanskrit. Joining mind and body,
and individual and collective selves is the essence of this ancient South
Asian practice [4]. Yogic philosophy posits that every life form is
interconnected and united [5]. “Yoga exists in the world because
everything is linked” [6].
Yoga’s greatest aim is to create compassion within and a deep sense
of unity and oneness with all forms of life [7]. Yoga is an individual
activity that has social implications. ose who regularly participate in
yoga typically interact with the world in calmer and more reasonable
ways. More positive social interactions and relationships are one of the
ripple eects of individual yoga practice. Accessible or complementary
yoga classes oer low income people the opportunity to experience the
benets of inner peace and healthier body. When practices such as
yoga are accessible to all, larger eects are possible. Without overstating
the impacts, potential consequences of large scale population mental
well-being initiatives such as this are less violence in society, less
addiction, greater ability to be authentic with one and others.
Literature Review of Mental Health and Yoga Methods
We found approximately 30 review articles and 300 separate studies
in the area of yoga and mental health in the peer-reviewed medical
literature. Because this is a relatively new area of research, it is dicult
to compare one study to the next partly because of sample size
variation, dierences in trial length, and variances in the kind of yoga.
Some studies tested Iyengar (primarily asanas) while others tested
Sudarshan kriya (patterned pranayam exercises, moving from slow and
calming to rapid and stimulating, followed by emotional self-
expression in a supine position), savasana (deep relaxation), Sahaja
yoga (a type of meditation), or pranayam. Varying time periods, from
2 week to 6 months of yogic interventions, also made studies dicult
to compare and contrast. Overall, studies of yoga and mental health
would improve from greater methodological rigor, particularly better
randomization [8].
A brief summary of peer-reviewed literature on yoga and
mental health
As the Patanjali Sutras notes: “Yoga is the practice of quieting the
mind” [9]. Positive mental health is “a state of well-being in which
every individual realizes his or her own abilities, can cope with the
normal stresses of life, can work productively and fruitfully, and is able
to make a contribution to his or her community [10]”. We searched for
articles that examined yoga as a form of promoting mental wellbeing
for healthy people. However most of the literature in this area focuses
Journal of Physiotherapy & Physical
Rehabilitation Shroff and Asgarpour, Physiother Rehabil 2017, 2:1
DOI: 10.4172/2573-0312.1000132
Mini Review OMICS International
Physiother Rehabil, an open access journal
ISSN:2573-0312
Volume 2 • Issue 1 • 1000132

on improving quality of life for people with cancer and other
aictions. e literature on mental health and yoga is biased towards
individualized mental health imbalances in a similar way as literature
in physical health is biased towards individualized disease.
We found approximately 30 review articles (2002-2014) on yoga as a
treatment for various mental health disorders, including Major
Depressive Disorder (MDD), Anxiety Disorders, Obsessive
Compulsive Disorder (OCD), Schizophrenia and others. e most
signicant results were for yoga as treatment for depression. More
research is required for conclusive evidence-based recommendations;
so far, peer-reviewed literature appears promising for yoga as mental
health promotion and treatment particularly for depression.
Studies of yoga’s eects on quality of life and depression
Yoga has been shown to enhance quality of life in people who are
healthy and ill. A review study found that yoga is as eective or better
than exercise at improving a variety of mental and physical health
measures such as stress, quality of life, mood states, heart rate
variability, pulmonary function and so on [11]. A meta-analysis
concluded that because weight gain and toxicity are side eects of
various pharmacotherapies, yoga may be an eective and less toxic
auxiliary treatment for severe mental illness [12]. In one study yoga
improved subjective wellbeing, mental health and executive
functioning within prison populations [13]. Yoga improved the quality
of life of pregnant women in various studies and enhanced their
interpersonal relationships [14]. Studies over the past 15 years have
shown that yoga can improve psychological health during breast
cancer treatment [15], as well as health-related quality of life in
antipsychotic-stabilized patients [16].
In the treatment of mild to moderate MDD, promising results
indicate that yoga may be applied as a monotherapy [3]. Level Two
evidence supports the use of yoga as an adjunctive therapy [17].
Multiple studies conclude that: a) Yoga is better than no treatment in
improving mild to moderate depressive symptoms in MDD [18]; b)
Yoga is equally as eective as TCAs (tricyclic antidepressants) in severe
MDD [19]; c) Yoga in combination with anti-depressants is better than
anti-depressants alone for depressive symptoms [20].
Patients’ Experiences with Yoga
Connectedness and shared experience with others
“e shared experience was important for coping shared
consciousness was there, when everyone was there together it makes
you feel a feeling of connectedness of everything. You walk out of there
feeling in touch with the condition of others, not just what’s going on
with me, but what’s going on with everything, which is very reassuring.
When you’re in a depressed state, you feel very alone but feeling whole
and part of a whole is where the value is really is.”
Coping with stress and ruminations
“I feel good about myself more oen than before the yoga. I learned
to focus on the positive, instead of what I did wrong, didn’t do, or can’t
do anything about anyway.”
Empowerment and competence
“It gives me motivation to try other things that I might not have
tried before it gave me a sense that ‘I can do it, I can do this for myself.”
How Does Yoga Work?
e mechanisms that make yoga a seemingly eective health
promotion, disease prevention, treatment, rehabilitation, and palliation
intervention are not entirely understood. Various researchers
hypothesize that yoga works through positively aecting the nervous
system, the cardiovascular system and gene expression. Stimulation of
the vagal nerve results in increased parasympathetic activity of the
autonomic nervous system and also increases GABA (a
neurotransmitter) activity in the brain [21]. Similar to other forms of
physical exercise, breathing and body movement has a positive impact
on cardiovascular health. Studies comparing gene expression in long
term practitioners of yoga with controls suggest that yoga positively
aects gene expression proles in immune cells [22].
From a yogic perspective, the breath is a bridge between mind and
body. Slow diaphragmatic breathing is common to almost all forms of
yoga. e key to quieting the mind is slowing and deepening the
breath. Practicing yoga helps to regain mental stability, calmness, and
tranquility, primarily because of this kind of breathing. Practitioners
are able to connect internally through this stillness and silence.
Virtually all yogic practices, including asana (postures), pranyam (life
force practices), dhyana (meditation), encourage quietness and
listening within. Being kinder and gentler to oneself and others is part
of the practice on and o the mat.
A yogic saying states that through a exible body we gain a exible
mind. is helps people become more patient, forgiving, less prone to
anger and sadness. Additionally, yoga brings practitioners “home” to
their natural selves, partially through an imitation of nature. Many of
the asanas imitate animals and plants such as tree pose, dog pose, cat
pose, snake pose, and others [23].
e nal part of a yoga class is savasana, corpse pose, in which
people lie down with their arms and legs open in deep rest. It is oen
the most popular part of the class, partly because it comes aer the
body has been moving and working. Ayurvedic physicians recommend
savasana to almost all their patients as a remedy to modern society’s
hectic pace of living. Savasana combines deep breathing with
systematic relaxation of each body part. While some people may fall
asleep during savasana, the intent is to maintain consciousness while
most of the body is resting. e sense of expansion and soness helps
to release attachment to material concerns. While we don’t tend to
discuss this outside of India, the symbolism of savasana as a corpse is
based partly on the notion that the corpse is in complete peace. Within
Indian philosophy death is part of a cycle of life and re-birth. By
allowing the mind and body to imitate death, letting go of all worries
and attachments becomes possible.
Moreover, yoga encourages practitioners to experience an open
heart. Many yogic philosophers consider the entire practice to be about
metaphorically connecting to our hearts. Within the chakra system, the
heart lies in the middle of the seven chakras. Asanas such as arda
chakrasana (back bend), kapotasana (pigeon pose), and ustrasana
(camel pose) encourage the expansion of the center of the chest which
is the location of the anahata chakra, the yogic heart center.
Visualizations and pranyams in yoga also encourage open heartedness.
e eect is oen less judgment, greater acceptance of self and others
and a more relax approach to life.
Citation: Shroff FM, Asgarpour M (2017) Yoga and Mental Health: A Review. Physiother Rehabil 2: 132. doi:10.4172/2573-0312.1000132
Page 2 of 3
Physiother Rehabil, an open access journal
ISSN:2573-0312
Volume 2 • Issue 1 • 1000132

Conclusions
e practice of yoga shows promise for promoting better population
mental health. It is acceptable, accessible, cost-eective and encourages
self-reliance. Yoga is an individual health promoting practice that can
be done in groups and supported by communities. Like other holistic
practices such as tai chi, qigong, meditation and so forth, it includes a
community component. Practicing yoga together, in workplaces,
schools and other group settings have shown to promote population
mental health [24]. While yoga does not address the social
determinants of mental illness it does promote a greater sense of inner
peace for those who partake.
It appears that deep slow breathing in combination with movement
and other aspects of yoga are at the heart of yoga’s ability to bring
people a greater sense of tranquility. It meets the triple aim of
improving health, improving care and reducing cost. A recent article
questions whether sucient evidence exists for family physicians to
recommend yoga to their patients. e evidence-based answer: “Yes,
yoga can reduce symptoms of anxiety and depression (strength of
recommendation [SOR]: B, systematic reviews of randomized
controlled trials [RCTs] with signicant heterogeneity). Across
multiple RCTs using varied yoga interventions and diverse study
populations, yoga typically improves overall symptom scores for
anxiety and depression by about 40%, both by itself and as an
adjunctive treatment. It produces no reported harmful side eects.” In
some cases yoga is taught for free such as yoga clubs in India and other
countries. While it may not be for everyone, through a disciplined
approach most people with or without mental health imbalances may
feel more mental ease and relaxation through the practice of yoga.
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Citation: Shroff FM, Asgarpour M (2017) Yoga and Mental Health: A Review. Physiother Rehabil 2: 132. doi:10.4172/2573-0312.1000132
Page 3 of 3
Physiother Rehabil, an open access journal
ISSN:2573-0312
Volume 2 • Issue 1 • 1000132