Interview: Yoga and mental health

Yoga can be prescribed as therapy, along with medication and psychotherapy, for treating various mental disorders

Research in the past decade has produced enough evidence to prove that yoga is beneficial as an add-on treatment for various types of mental illnesses. Patrecia Preetham from White Swan Foundation spoke to Dr Shivarama Varambally, additional professor of psychiatry at NIMHANS. Here are the edited excerpts.

How is yoga beneficial for treating mental illness?

For the past few years, we have done quite a bit of work in this area. For people with fairly severe mental illness, yoga can be quite beneficial as an add-on to the medicines that they are already taking, but in a few cases, yoga can be a medicine in itself. We have had people who refused to take medication and were looking for alternative methods of treatment. With such people, we have had a good success rate with yoga as a sole treatment option. The percentage of such people though, is on the lower side. Most people practice yoga as an add-on treatment to their existing treatment strategies such as medication, psychotherapy and other treatments.

Yoga has produced significant benefits as a treatment in a few disorders such as depression, schizophrenia, anxiety, and attention deficit hyperactivity disorder.

Is there any scientific report or data that supports the fact that yoga is beneficial as a complementary therapy for mental illness?

There is quite a bit of evidence in terms of publication as well as meta-analytic reviews, which basically give a better idea because they take a lot of data and combine it in a meaningful form. Individual studies are difficult because single studies may not give the evidence required for people who want to know whether it works, or how well it works. So in the last 10 years, maybe, there is quite a bit of evidence, both from India and from abroad, for yoga as a complementary treatment for disorders such as schizophrenia and depression. Much of the research work has been conducted in our own institution, NIMHANS, where we have actually published more than 25 research papers in various national and international journals, to show that yoga works well as a complementary treatment for various disorders in mental illness. Most of it is available on the internet for free. I would refer to a recent supplement of the Indian Journal of Psychiatry: July-September 2013 edition, which gives quite a good example of how yoga can be a complementary therapy for multiple mental disorders.

Yoga is a practice of Indian origin. Why has it not been promoted as a therapy for so long?

It is a very interesting question and this question is asked in many forums. There are two issues we need to look at here. One: If you ask many yoga teachers or people who practice in yoga schools, they don't consider yoga as a therapy in that sense. They insist that yoga is a lifestyle which has to be lived and not looking at yoga with any specific benefits for any illness. Rather, they look at a way of helping the individual reach his or her goal, which could be salvation, mental health, or physical health. Yoga as a therapy is a fairly recent construct, maybe in the last two or three decades. Before that yoga was looked at as a purely lifestyle activity. That is one major issue from the yoga point of view.

The other issue of course is the difficulties inherent in looking at yoga as a therapy because most journals ask for what is called as a randomized control trial, which is a methodology suitable for testing medication. In this trial, one person is given the target medicine and another person is given a very similar looking pill that does not have the active ingredient.

Now yoga as you all know, cannot be done like that because the person who is doing yoga cannot be blinded to the fact that he is doing yoga. So, you cannot say that this person does not know he is doing yoga whereas in medication that is very easy to do. This is one big problem we are trying to overcome by using various methods to convince the scientific community that yoga is a very effective therapy. Hence, this is the reason I think yoga is not being looked at as a therapy the way it should be.

Will practicing yoga help in alleviating mental illness in its early stages (for example, early stages of depression, anxiety disorder, OCD).

Yoga as a treatment as I said earlier, is still being looked at as a preliminary kind of evidence. Now whether yoga works early or late, we have to look into the genesis of psychiatric disorders itself. We also very well know that in most psychiatric disorders, the earlier the treatment is started, the better the prognosis or the outcome for the individual. This is fairly well established evidence in most psychiatric disorders including schizophrenia, depression, and OCD. Now if yoga works, theoretically, it should work better in the early stages. Now, this has not been proven yet, but going by the logic, it should. If you look at the other way how does yoga work, that's a very important and interesting question that scientists around the world are now trying to answer. We believe that it basically helps the innate repair mechanism of the human brain to do its job more efficiently. In other words, it helps the body repair itself. Here I am talking specifically of the brain. So even this logic we see that the earlier it is started in the course of the illness, the more effective it should be.

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