Dr Robert London

Yoga: A Beneficial Integrative Therapy

Clinical Psychiatry News - Volume 35, Issue 12, Page 20 (December 2007)

Dr. Hans Selye's thinking was considered innovative back in the 1930s. That's when the endocrinologist developed his pioneering work on the concept of stress.

“To understand the mechanism of stress gives physicians a new approach to the treatment of illness,” he said in a Dec. 3, 1956, interview with Time magazine. “It can also give us all a new way of life.”

Dr. Selye was highly influenced by the work of physiologist Walter B. Cannon, Ph.D., who “focused on the role of the sympathetic nervous system and coined the terms ‘fight-or-flight responses’ and ‘homeostasis,’” noted Dr. Thomas C. Neylan (J. Neuropsychiatry Clin. Neurosci. 1998;10:230–1).

Today, we know that stress has an influence on physical and mental functioning. Perhaps that explains why activities aimed at eliminating stress, such as complementary and alternative medicine (CAM) approaches, are having such a huge impact on our patients.

A May 2004 report from the Centers for Disease Control and Prevention said that CAM includes at least 32 approaches (Complementary and Alternative Medicine Use Among Adults: United States, 2002).

What does this mean in terms of U.S. health care? According to the CDC report, $36-$47 billion was spent on CAM therapies in 1997, and about half of that money was spent out of pocket. Those figures surpass the amount paid out of pocket in the United States for all hospitalizations in 1997.

My own experience with CAM has been in the area of hypnosis and relaxation. Specifically, I have used the relaxation/hypnotic approach, coupled with a behavior modification of cognitive-behavioral modification technique, to develop specific strategies to treat specific problems. I've also used the hypnosis/relaxation technique as an adjunct to various behavioral techniques, including the learning, philosophizing, and action (LPA) technique I developed years ago.

I wanted to learn more about the other techniques, so I focused on yoga because so many people derive a great benefit from it.

Over the last few months, I've talked to dozens of people who have been to yoga classes, and their responses have been more or less the same: The end results seem to be a feeling of well-being, better control, and adjustment to life and its stressors.

Interestingly, the results appear to be lasting for some without the continued yoga exercises. For others, the yoga experience needs to be ongoing for the feelings of well-being to persist.

As a psychiatrist who does psychotherapy—often in an effort to achieve some of the same goals realized by veteran yoga participants—I've been puzzled by this for a while. So I called upon an expert, Astrud Castillo, a yoga instructor who teaches in New York and California, to ask what makes these yoga experiences helpful for so many people.

Ms. Castillo, who has studied and worked in India numerous times, where yoga first began centuries ago, is knowledgeable not only about the here and now, but historically as well. In India, she points out, people are asked what's going on in their lives as part of the yoga program. This kind of tailoring sounded more psychotherapeutic to me, so I decided to focus on the types of yoga popular in the United States, where breathing, posturing, and exercise lead to relaxation and a feeling of well-being.

I had several medically derived questions that involved strategies I've used for years with hypnosis and relaxation, coupled with behavior modification and cognitive therapy. I ran those ideas by Ms. Castillo and her response was a bit unexpected. She quickly assured me that she is not a doctor and does not treat illnesses (including psychiatric illnesses).

The next thing she said, which really impressed me, was that the work she does is to “quiet the mind.” What a great expression! So many of the patients my colleagues and I have seen over the years need just that (at least, initially) as they enter the office wound up in knots because of their problems.

Over and over in many ways, exercise, breathing techniques, and posturing come into the picture as does music, Ms. Castillo said as she continued to describe the yoga experience. The individual becomes so focused that peripheral thoughts and distractions disappear. As the process goes on, stress and tension seem to be released from the mind and body, and a sense of well-being follows.

I was told that yoga can take the practitioner to the outer limits of peace and understanding, and to a sense of personal freedom. Over and again, I heard from people that yoga results in a feeling of peace and tranquility, and that with these newfound feelings, a sense of self and calmness allows the practitioner to be better able to meet life on life's terms.

That's great, but I wanted a scientific or medical explanation for yoga's positive and calming effect. I turned to M. Mala Cunningham, Ph.D., founder and director of Cardiac Yoga in Charlottesville, Va., for more answers. She said that the breathing and posturing activate the parasympathetic nervous system and reduce emotional chaos and cognitive dissonance. Further, when this parasympathetic activation occurs, a decrease in cortisol levels becomes a physiologic stress reducer, said Dr. Cunningham, a counseling psychologist who also serves as president of Positive Health Solutions, a training and educational organization.

This makes sense, because current research indicates that cortisol levels are increased in highly agitated states, such as those associated with posttraumatic stress disorder.

Few of the mind-body CAM interventions are any substitute for the psychotherapeutic process, in which we actually challenge inaccurate thoughts and beliefs and offer a new perspective on the old sets of problems (certainly in cognitive therapies). Many people, however, do not need therapeutic challenges but do face stressors that lead to physical problems and emotional conflicts—probably based more on situational events than on any intrapsychic conflicts or maladjustments.

Just as hypnosis and relaxation techniques make people feel better even before I get to the strategy, many yoga techniques offer the same sense of calm. Again, perhaps those who start their day with yoga are able to get a fresh, clear vision of self and a measure of self-confidence that help protect against daily stressors.

If yoga is a stress reducer, it may need to be incorporated into medical practice in the same way that diet and exercise are now. Some diet programs and gyms, for example, give discounts when recommended by a physician. Well, perhaps a mind-body relaxing technique such as yoga also might be given a discount when medically recommended.

When I was in medical school, we had to complete a 3-hour program taught by a cultural anthropologist. Now this kind of approach is used as an example of helping medical students attain cultural sensitivity in medical schools and hospitals, as well as other types of institutions and industries.

Since stress reduction relates to better illness prevention and improved recovery from illnesses—as Dr. Selye taught us years ago—perhaps it would make sense to include yoga and other mind-body techniques in medical school education and ongoing hospital education.

Let me know your thoughts about using alternative medicine, and I will try to pass them along to my readers.

PII: S0270-6644(07)70760-9


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