The Power of Yoga in Adults with Anxiety and Stress Disorders

Introduction

Complimentary Alternative Medicine (CAM) has been indicated for the use of adjunct therapies to assist in management of acute and chronic illnesses. The 2007 National Health Interview Survey found that yoga is one of the top 10 complimentary health practices used among U.S. adults. An estimated 6 percent of adults used yoga for heath purposes in the previous 12 months (National Center for Complimentary and Alternative Medicine, 2013). The history of Yoga has evolved and traveled over time from the far Eastern countries of India to the Western countries of the United States. Since the 1960's Yoga has become more mainstream for the American culture, gaining more popularity to emerge as a 5.7 billion dollar industry in 2008, an increase of 87% from 2004 (Li & Goldsmith,2012) For over 5000 years Yoga has been implicated as a healing system of integrating balance for both body and mind. Yoga originates from India and can date back to the Indus Valley where stone carvings depicting figures in Yoga postures have been found in archaeological sites (American Yoga Association, 2006.) Yoga has been an incorporated part of some religious beliefs such as Hinduism. Similarly, yoga is not officially tied to any one particular religion, nor is it a religious practice. According to the American Yoga Association, the word Yoga means to "join or yoke together," and it brings the body and mind together into one harmonious experience (American Yoga Association, 2006). Physical posture (asana), controlled breathing (pranayama), and meditation (dhyana) surround the domain of yoga. Asana, pranayama, and dhyana are Sanskrit terminologies. Over one hundred types of Yoga exisit today to meet individual needs and intensity levels. Ashtanga yoga is one of the more classic forms of Yoga while practices such as Bikram incorporate a demanding series of 26 postures in a heated room. Despite which practice of yoga an individual takes part in the benefits out way any risk which are invariably are none. Advanced practitioners can recommend yoga to their patients as it does not interfere with any medication therapies, has a minimum cost and commitment requirements and can improve overall physical and mental well-being.

Subject and Methods

The subjects implicated for the use of this presentation include male and female adults suffering from stress and anxiety. Two of the adult disorders are listed in The Diagnostic and Statistical Manual of Mental Disorders (DSM) under Diagnostic Criteria, which classify stress and anxiety as 300.00 for Anxiety Disorder not otherwise specified, 300.02 for Generalized Anxiety Disorder, and 308.3 Acute Stress Disorder (APA,2000). Although stress and anxiety meet the diagnostic criteria according to DSM, a subject or patient does not have to meet the diagnostic criteria in order to participate in the beneficial effects of yoga.

Studies reviewed for the purpose of the poster presentation include the use of female and male adults suffering from stress and anxiety. A basic systemic literature search from the Nursing Reference Center, EBSCO, and Pubmed was performed to identify the most current, up to date literature, and evidenced based research. Randomized controlled trials, randomized comparative trials, clinical control trials, and controlled clinical trials of adults with disorders in anxiety and stress. Stress and anxiety are measurable outcomes that can be validated through use of scales such as The Hamilton Anxiety rating Scale, The Spielberger-Trait Anxiety Inventory, Perceived Stress Scale, Beck Anxiety Inventory, and The General Health Questionnaire. The scales of anxiety and stress disorders can assist any practitioner in gathering pertinent information in regards to the severity of the patients situation for individualized plan of care and referral.

Summaries of Studies/Results

Study Number 1,a randomized comparative trial of yoga by Smith et al (2007), found that yoga improved mental health in stress and anxiety while increasing physical well-being as well as sleep patterns. Number of participants in the study was 133 (22 males, 109 females) with a mean age of 44 particpants- health in conditions showed mild to moderate levels of stress (Chong, Tsunaka, Tsang, Chan, & Ming, 2011).

Study Number 2, by Kjellgren et al (2007) showed a significant decrease in degree of anxiety and stress with yoga, measurable by the Hospital Anxiety Depression Scale, Life Orientation Test, Stress and Energy Test. Number of participants in the study was 103 (25 males, 78 females) with a mean age 31.92 with no specified health conditions (Chong, Tsunaka, Tsang, Chan, & Ming, 2011).

Study Number 3, by Klatt et al (2009) demonstarted that yoga and meditation at a persons work desk each day, along with a one hour class of yoga each week decreased and lowered stress while improving sleeping patterns.

Study Number 4, in a review of comparative studies, by Ross and Thomas (2010) studied yoga with the immune system suggesting that yoga may reverse the negative impact of the immune system by increasing Immunoglobulin A and natural killer cells. They further hypothesized the link between the positive effects of yoga on the sympathetic nervous system and the hypothalmic-pituatary-adrenal axis.

Conclusion/Limitations

Yoga can be an instrumental form of therapy to reduce stress and anxiety while serving as a form of physical exercise for overall mental and physical well-being. Yoga can improve quality of life and health status with little to no pharmacological interactions and perhaps prove more cost effective than anxiolytics medication therapies. Although no current, large double blinded randomized control trials for men and women suffering from stress and anxiety exist to show quantitative/qualitative rigor in yoga practice for the proven reduction of stress and anxiety, the benefit of the practice outweigh any risks that may associated with the other forms of medicinal therapies, Yoga can be used in conjunction with medication therapies,behavioral cognitive therapies, and psychiatric therapies without contraindications. The results of yoga in reduction of stress and anxiety prove optimistic. Studies do demonstrate a substantial reduction in stress and anxiety from the baseline measurements initially performed as evidenced through questionnaires, inventory checklists, and scales. Limitations to the studies reviewed include sample size, non randomization, lack of exclusion criteria, large standard deviations and lack of control group. Other limitations to the studies include the lack of a rigorous physiological perspective to yoga to include review and measurement of cortisol levels, cytokines, c-reactive proteins to measure inflammatory markers associated with stress, anxiety, and the effects of the immune system.

Implications

Yoga can impact human health to provide overall positive effects of mental, physical, and spiritual wellness. Upon medical clearance and approval, yoga may be recommended to a patient with little commitment or out of pocket expenses to the patient. Upon recommendation a patient is required to tolerate low levels of physical demands which include stretching, concentration, and breathing. Minimal cost may be incurred to include a yoga mat, a bottle of water, and stretchable, loose fitting clothes. Some yoga classes are inclusive in gym memberships while other yoga classes are held in yoga specific studios. The style of yoga is dependent on the preferences and the needs of the patient. A patient may design their own yoga practice according to their schedule and style. If yoga can assist in the reduction of stress and anxiety in healthy individuals, the implications of yoga for use in other strenuous, biological disease processes such as immunological dysfunction, heart disease, cancer, and pain management may serve as an added benefit in holistic disease management to promote the wellness and unity of a balanced healthy body and mind.

References

American Yoga Association. (2006). Retrieved February 13, 2013, from What is yoga; http;www.americanyogaassociation.org/general.html

National Center for Complimentary and Alternative Medicine. (2012). Retrieved February 18,2013, from National Institute of Health; http;//nccam.nih.gov/video/yoga

National Center for Complementary and Alternative Medicine, (2013). Retrieved February 18.2013, from National Institute of Health

APA. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed.) Washington D.C; American Psychiatric Association

Chong, C.S.,Tsunaka, M., Tsang, H., Chan, E. P., & Ming, C. W. (2011,January/February). Effects of yoga on stress management in healthy adults; A systemic review. Alternative Therapies, 32-38.

Kjelgren, A., Bood, S., Axelsson, K., Norlander, T., & F, S. (2007). Wellness through a comprehensive yogic breathing program- a controlled pilot trial. BMC Complimentary and Alternative Medicine, 7 (43), 1-8

Klatt MD, B. J., & WB, M. (2009). Effects of low-dose mindfulness-based stress reduction on working adults. Health Education Behavior, 601-614.

Letter, H. M (2009, April). Yoga for Anxiety and Depression. Harvard Mental Health Letter, pp 4-5

Li, A W., & Goldsmith, C.-A. W. (2012). The effects of yoga on anxiety and stress. Alternative Medicine Review, 21-35

Medicine, N. C. (Director). (2012). Scientific Results of Yoga for Health and Well Being Video [Motion Picture].

Ross, A., & Thomas, S. (2010). The health benefits of yoga and exercise; a review of comparative studies. Journal of Alternative and Complimentary Medicine, 3-12.

Smith, C., Hancock, H., Blake-Mortimer, J., & Ekert, K. (2007). A randomized comparative of yoga and relaxation to reduce stress and anxiety. Complimentary Therapies in Medicine, 77-83