Yoga and Mental Health importance in life.ppt

Yoga and mental health

1. EQUILIBRIUM OF THE
PSYCHE: UNVEILING THE
ROLE OF YOGA THERAPY IN
MENTAL HEALTH
RESTORATION
BY
DR. NARESH KALAKOTA
MD PSYCHIATRY
SENIOR RESIDENT(TOMCH&RC)

2. OUTLINE
INTRODUCTION TO YOGA.
YOGA FOR DEPRESSION.
YOGA FOR ANXIETY DISORDERS.
YOGA FOR SCHIZOPHRENIA
YOGA FOR MCI.
NEUROBIOLOGY OF YOGA.
LIMITATIONS OF YOGA.

5. Panchakoshamodel (TaittiriyaUpanishad)

6. •Yoga vashishthaclassifies diseases into two types
1.Adhijavyadhi-due to internal cause(Stress borne diseases in
manomayakosha)
2.Anadhijavyadhi-due to external cause (external injuries and
infections in annamayakosha)

7. Panchamahabhutasand Doshas: Fundamental regulatory principles of
the body, mind, and behavior
7
Dynamic, related to
movement of the body,
motility in various body
systems
Digestion,
biotransformation of the
digested food, and
metabolism
Structure and integrity of
the tissue, mucous
secretions, adipose and
lubricating fluids

9. Four pathways of yoga (Bhagavad gita).
•Jnana yoga(path of knowledge),
•Raja yoga(path of practice),
•Karma yoga(path of action),
•Bhakti yoga(path of devotion).

10. TRIGUNAS
The dominance of each gunaresults in characteristic behavior patterns and describes a personality type.
SATTVIC (enthusiasm in performing his duties being indifferent to result of the action , they prefer sattvicfood
which is juicy, sweet, and nourishing in nature)
RAJAS(intense ambition and relentless desires, with the anticipation of fruits of their actions, they prefer rajasic
food that is spicy, sour, salty, hot)
TAMAS (lethargic, stubborn, deluded and revengeful in their actions, they tend to give up all their duties, they
prefer food that is cold, lacks freshness, tasteless, and unhygienic)

11. Exercise YOGA
Heart Rate Increases Decreases
Respiratory Rate Increases Decreases
Blood Pressure Increases Decreases
B.M.R Increases Decreases
SNS ACTIVATION IN EXERCISE AND PNS IN YOGA
RamajayamGovindaraj, Sneha Karmani, ShivaramaVarambally& B.N. Gangadhar (2016): Yoga and physical exercise –
a review and comparison, International Review of Psychiatry, DOI: 10.3109/09540261.2016.1160878

12. Yoga Based Management of Depression
•OM chanting (stimulation of auricular branch of vagus).
•Shavasana, tratakaare useful for symptoms like easy Fatigability
•Depression patients requires rajasic and sattvic food, and must avoid
tamasic foods.
•Humming sound “AAA” during day time.
•Bhramaripranayama helps in Quality of sleep for insomnia.

13. •Suryanamaskara: 4 cycles per day and increase once
in two weeks to reach 12 cycles per day by a month
•Back-bending poses: hold posture 30-40 seconds
Bhujangasana, ardha-chakrasana.
•Bhastrika20 times for 2 minutes and repeat thrice,
kapalabhati60/min twice, Rt Nostril breathing (surya
bhedana) slow for 5 min, OM chanting 3 min.
13

14. •Canadian Network for Mood and Anxiety Treatments (CANMAT) for
the management of MDD in adults (2016) -yoga as a adjunctive
therapy for mild-to moderate depression.
•significant reduction in HDRS scores
•Increase in brain-derived neurotrophic factor (BDNF) levels.
•A significant reduction in serum cortisol

17. Effect of yoga on depressive symptoms
•19 studies were included in the review (1080 participants) and 13 studies
were included in the meta-analysis (632 participants).
•Yoga showed greater reductions in depressive symptoms.
•Greater reductions in depressive symptoms were associated with higher
frequency of yoga sessions per week
Brinsley J, SchuchF, Lederman O, Girard D, SmoutM, ImminkMA, Stubbs B, Firth J, Davison K, Rosenbaum S.
Effects of yoga on depressive symptoms in people with mental disorders: a systematic review and meta-analysis.
Br J Sports Med. 2021 Sep;55(17):992-1000. doi: 10.1136/bjsports-2019-101242. Epub2020 May 18. PMID:
32423912.

18. •Twelve RCTs with 619 participants were included
yoga could be considered an adjuvant
treatment option for patients with depressive
disorders

19. YOGA FOR ANXIETY
•Anxiety is called as
chittaudvega(restless state of mind).
•charakamentioned it as
manasavikara.

20. Yoga for anxiety disorder
•Slow deep breathing & longer exhalations
•Hands in and out, tiger breathing.
•Sheetalipranayama 9-10 rounds
•Left nostril breathing.
•Bhramaripranayama 3 minutes
•Shavasana with slow breathing
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21. 21
Slow deep breathing,
Hands in and out breathing

22. Yoga for PTSD
•Ardhakatichakrasana, Pavanamuktasana,
Trikonasana, trataka.
•Breathing 1:4:2; Inspire:Hold:Expirethese can be for
10-12 min.
•Shavasana at bedtime.
Tightening and relaxing in muscles head to toe in
parts
22

23. PTSD
23
Trataka

24. Yoga for posttraumatic stress disorder –a systematic review and
meta-analysis. Cramer et al. BMC Psychiatry (2018) 18:72
Seven RCTs (N = 284)
24
Yoga significantly better than no treatment

25. Yoga for OCD
•Left nostril breathing, loud OM chanting
•Breathing slow in shavasana
•Avoid long breath holding.
25

26. Yoga for Schizophrenia & other Psychoses
•Simple warming exercises for 5 min before yoga
•Sun salutations,
•Bhastrika,
•alternate nostril breaths
One of the treatment guidelines (NICE) in 2014 included yoga
as an add-on treatment in the management of psychosis
26

27. Higher Percentage of Schizophrenia patients were improved at
4 months after Yoga as regards Social Functioning
27
Varamballyet al Ind J Psychiatr2012

28. Yoga significantly improves social cognition in schizophrenia (RCT)
Govindarajet al, Asian J psychiatry, 2021 Aug;62:102731
social cognition composite score
(SCCS), SANS
6 weeks of yoga therapy
28

29. Yoga for Mild Cognitive Impairment
•Short sessions with Bhramaripranayama
•Left nostril breathing
•Slow kapalabhati(20/min for 3 min)
•OM Chanting
•Tratakakriya for 3-5 minutes
29

30. Neurobiological aspects

31. OM chanting –limbic deactivation
31

32. OM Chanting and limbic deactivation
•A sensation of vibration is experienced during audible
‘OM’ chanting. This has the potential for vagusnerve
stimulation through its auricular branches.
•Using functional Magnetic Resonance Imaging (fMRI), the
neurohemodynamiccorrelates of audible ‘OM’ chanting
were examined in right-handed healthy volunteers, the
‘OM’ chanting condition was compared with pronunciation
of “ssss”.

33. •In this study, significant deactivation was observed bilaterally
during ‘OM’ chanting in comparison to the resting brain state in
bilateral anterior cingulate, parahippocampalgyri, and
hippocampi. The right amygdala too demonstrated significant
deactivation.
•No significant activation was observed during ‘OM’ chanting.
•In contrast, neither activation nor deactivation occurred in these
brain regions during the comparative task –namely the ‘ssss’
pronunciation condition.

34. •The neurohemodynamiccorrelates of ‘OM’ chanting indicate limbic deactivation.
As similar observations have been recorded with vagusnerve stimulation
treatment used in depression and epilepsy.
•Effective ‘OM’ chanting is associated with the experience of vibration sensation
around the ears. It is expected that such a sensation is also transmitted through
the auricular branch of the vagusnerve, therefore it is hypothesized that like
transcutaneous VNS, ‘OM’ chanting too produces limbic deactivation

35. KapalabhatiEnhanced Pre-frontal Activation in Healthy Subjects
(Bhargav et al, 2014)

36. •Frontal hemodynamic responses to high frequency yoga
breathing technique, Kapalabhati(KB), were compared
between patients of schizophrenia, healthy subjects using
functional near-infrared spectroscopy.
•A chest pressure transducer was used to monitor the frequency
and intensity of the practice objectively.
•The frontal hemodynamic response in terms of the oxygenated
hemoglobin (oxyHb), deoxygenated hemoglobin (deoxyHb) was
tapped for 5 min before, 1 min during, and for 5 min after KB.

37. •Within group comparison showed that the increase in bilateral
oxyHbfrom the baseline was highly significant in healthy
controls during KB, whereas schizophrenia patients did not
show any significant changes in the same on both the sides.
•Comparison between the groups showed that schizophrenia
patients have reduced bilateral pre-frontal activation, during KB
as compared to healthy controls.

38. Yoga in mental health -Major findings in clinical
neuroscience from NIMHANS
Disorder Clinical finding Biological correlate
Depression Improvement in symptoms and
cognitive functions
Decrease in Serum Cortisol &
Increase in plasma BDNF
Schizophrenia Improvement in symptoms as well as
functioning and social cognition
Increased oxytocin & Mirror
Neuron Activity, improved
‘connectivity’ of brain networks
Cognitive
impairment in the
elderly
Improvement in cognitive function,
sleep, quality of life
Increasein hippocampal gray
matter volume
Other psychiatric
disorders: opioid
dependence
Improvement in symptoms Increasein plasma beta-
endorphins

39. Structural neuroplastic effects (increase in grey matter) in the
hippocampus after Yoga practice of 6 months in healthy elderly
Hariprasadet al, Ind J Psy2013
n=7

40. Effect of Regular Yoga Practice on Brain
Review of 34 neuro-imaging studies:
(a) increased grey matter volume in the insulaand hippocampus;
(b) increased activation of prefrontal cortical regions;
(c) functional connectivity changes in the default mode network
(Van Aalst, 2020)

41. Heart rate variability and yoga
•Bhramaripranayama effect on HRV parameters.
•Sample 520(260+260) adolescents.
•Practiseof 5days a week for six months
•control group continued with their daily routine without any intervention.
•After 6 months of yoga breathing,
•the time domain parameters of HRV showed significant improvement towards the
parasympathetic domain.
•Frequency domain parameters also showed the same direction of changes.
•In contrast, control group showed a trend towards a sympathetic domain.
Conclusion-positive shift in autonomic modulation towards parasympathetic predominance
after 6 months of yoga practice among apparently healthy adolescents.
KuppusamyM, KamaldeenD, PitaniR, AmaldasJ, Ramasamy P, Shanmugam P, Vijayakumar V. Effects of yoga breathing practice on heart rate
variability in healthy adolescents: a randomized controlled trial. IntegrMed Res. 2020 Mar;9(1):28-32. doi: 10.1016/j.imr.2020.01.006. Epub2020 Jan 20.
PMID: 32025489; PMCID: PMC6997567.
Vinay AV, Venkatesh D, AmbarishV. Impact of short-term practice of yoga on heart rate variability. Int J Yoga. 2016 Jan-Jun;9(1):62-6. doi: 10.4103/0973-
6131.171714. PMID: 26865773; PMCID: PMC4728961.

42. Yoga and heart rate variability: A comprehensive review
of the literature
A total of 59 studies were reviewed involving a total of 2358 participants.
The reviewed studies suggest that yoga can affect cardiac autonomic regulation with increased HRV
and vagal dominance during yoga practices.
Regular yoga practitioners were also found to have increased vagal tone at rest compared to non-
yoga practitioners.
Tyagi A, Cohen M. Yoga and heart rate variability: A comprehensive review of the literature. Int J Yoga. 2016 Jul-
Dec;9(2):97-113. doi: 10.4103/0973-6131.183712. PMID: 27512317; PMCID: PMC4959333.

43. Conditions where Yoga practices to be avoided
•Migraine and other headaches-kapalbhatiand bhastrika
•Moderate to severe depression-pratyahara.
•Schizophrenia –pratyahara, vipassana meditation.
•BPAD-A balance must be achieved by keeping the person engaged
with dynamic change of practices from one to another, interspersed
with brief periods of relaxation in shavasana (corpse pose).
•Epilepsy-kapalbhati, bhastrika, jyotitrataka.

44. •Most common injuries in yoga are with asanas.
•Neurological and vascular injuries (sirsasana, sarvangasana, halasana),
and ligament injuries but these are rare when practiced under
supervision.

45. REFERENCES
Bhargav H, George S, VaramballyS. Yoga and mental health: what every psychiatrist needs to
know.BJPsychAdvances. 2023;29(1):44-55. doi:10.1192/bja.2022.22
Tyagi A, Cohen M. Yoga and heart rate variability: A comprehensive review of the literature. Int J Yoga. 2016 Jul-
Dec;9(2):97-113. doi: 10.4103/0973-6131.183712. PMID: 27512317; PMCID: PMC4959333.
KuppusamyM, KamaldeenD, PitaniR, AmaldasJ, Ramasamy P, Shanmugam P, Vijayakumar V.
Effects of yoga breathing practice on heart rate variability in healthy adolescents: a randomized
controlled trial. IntegrMed Res. 2020 Mar;9(1):28-32. doi: 10.1016/j.imr.2020.01.006. Epub2020 Jan
20. PMID: 32025489; PMCID: PMC6997567.
Vinay AV, Venkatesh D, AmbarishV. Impact of short-term practice of yoga on heart rate variability. Int
J Yoga. 2016 Jan-Jun;9(1):62-6. doi: 10.4103/0973-6131.171714. PMID: 26865773; PMCID:
PMC4728961
van Aalst J, CeccariniJ, DemyttenaereK, SunaertS, Van LaereK. What Has Neuroimaging Taught
Us on the Neurobiology of Yoga? A Review. Front IntegrNeurosci. 2020 Jul 8;14:34. doi:
10.3389/fnint.2020.00034. PMID: 32733213; PMCID: PMC7362763.
Bhargav H, Nagendra HR, Gangadhar BN, NagarathnaR. Frontal hemodynamic responses to high frequency yoga
breathing in schizophrenia: a functional near-infrared spectroscopy study. Front Psychiatry. 2014 Mar 24;5:29. doi:
10.3389/fpsyt.2014.00029. PMID: 24715879; PMCID: PMC3970016.

46. GovindarajR, Naik SS, Mehta UM, Sharma M, VaramballyS, Gangadhar BN. Yoga therapy
for social cognition in schizophrenia: An experimental medicine-based randomized
controlled trial. Asian J Psychiatr. 2021 Aug;62:102731. doi: 10.1016/j.ajp.2021.102731.
Epub2021 Jun 1. PMID: 34098192.
HariprasadVR, VaramballyS, ShivakumarV, KalmadySV, Venkatasubramanian G, Gangadhar BN. Yoga
increases the volume of the hippocampus in elderly subjects. Indian J Psychiatry. 2013 Jul;55(Suppl 3):S394-6.
doi: 10.4103/0019-5545.116309. PMID: 24049206; PMCID: PMC3768219.
Kalyani BG, Venkatasubramanian G, ArasappaR, Rao NP, KalmadySV, BehereRV, Rao H, Vasudev MK,
Gangadhar BN. Neurohemodynamiccorrelates of 'OM' chanting: A pilot functional magnetic resonance imaging
study. Int J Yoga. 2011 Jan;4(1):3-6. doi: 10.4103/0973-6131.78171. PMID: 21654968; PMCID: PMC3099099.
Cramer H, AnheyerD, Saha FJ, DobosG. Yoga for posttraumatic stress disorder -a
systematic review and meta-analysis. BMC Psychiatry. 2018 Mar 22;18(1):72. doi:
10.1186/s12888-018-1650-x. PMID: 29566652; PMCID: PMC5863799.
RamajayamGovindaraj, Sneha Karmani, ShivaramaVarambally& B.N. Gangadhar (2016):
Yoga and physical exercise –a review and comparison, International Review of Psychiatry,
DOI: 10.3109/09540261.2016.1160878

48. Cortical silent period (CSP) in msecrecorded at 120% (n=12) & 140% (n=10) RMT.
Blind independent raters(ICC=0.91). Longer CSP at 140% than at 120%.
Post yoga CSP longer than pre yoga at 140% (t=3.1, df=9, p=0.013) & not at 120%
50.7 50.3
70.9
87.5
PRE YOGA POST YOGA
Cortical Silent period (msec)
longer after Yoga
120% RMT 140% RMT
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49. Depression & Role of GABA in Yoga
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(Jakharet al, Brain Stimul. 2019 November 01; 12(6): 1597–1599)

50. Serum total and free BDNF levels
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50
There was a significant decrease in the free BDNF/ total BDNF ratio after
yoga therapy (Aditi, Unpublished PhD Dissertation, 2022)
Serum baseline t BDNF levels
Aditi Thesis-unpublished data (2021)

51. Default Mode
Network (DMN)
Beta=0.72
t=2.16
p=0.04
↑ Self-monitoring
↓ Mind-wandering
LME Group x Time Adjusted for Age, Sex, Duration of Illness, Head Motion and Scanner
Effect of Yoga Therapy in Schizophrenia: Resting State Functional MRI
Network coherence (overall voxel coherence within-network)
Larger values
reflecting greater
coherence over time
was found in DMN
for yoga (N=10) vs
control (N=16) from
BL to F1 (1 month)
Low High
coherence
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