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Guest Article Considerable research in Yoga as therapeutic intervention is being done abroad. We are thankful to Dr. Sat Bir Singh Khalsa to permit us to publish his PowerPoint presentation on Yoga Research which will be of interest to SM readers – Ed. Research on Yoga as a Therapeutic Intervention: Past, Present & Future Dr. Sat Bir Singh Khalsa* Brigham & Women’s Hospital Harvard Medical School Basic Elements of Yoga Practice Research on Yoga as a Therapeutic Intervention: Past, Present and Future January 14, 2013 Physical postures/exercises JBTD Research Centre Mahatma Gandhi Institute of Medical Sciences Sevagram Breathing exercises Deep Relaxation Meditation Sat Bir S. Khalsa, Ph.D. Assistant Professor of Medicine Brigham and Women’s Hospital, Harvard Medical School Director of Research, Kundalini Research Institute Research Director, Kripalu Center for Yoga and Health 3 “Yoga teaches you the techniques and awareness to stay healthy. You gain strong immune, glandular and nervous systems. This foundation gives you energy and lets you deal with the mental and spiritual facets of your life.” Reasons for Practice in a Beginners Program Yogi Bhajan From: Yoga in the real world: Motivations and patterns of use, Quilty MT, Saper R, Goldstein R, Khalsa SBS, Global Advances in Health and Medicine (in press) 2012. 4 5 -------------------------------------------------------------------------------------------------------------------------------------*Dr. Sat Bir Singh Khalsa, Ph.D. has been fully engaged in basic and clinical research on the effectiveness of yoga and meditation practices in improving physical and psychological health for over 10 years. He has also practiced yoga lifestyle for over 40 years and is a certified Kundalini Yoga instructor. He is the Director of Research for the Kundalini Research Institute, Research Director of the Kripalu Center for Yoga and Health and Assistant Professor of Medicine at Harvard Medical School at Brigham and Women's Hospital. He has been involved in efficacy studies of yoga for a number of conditions including chronic insomnia and anxiety disorders. His current studies include clinical trials of yoga for post-traumatic stress disorder and chronic stress and ongoing research funded by the Kripalu Center for Yoga and Health evaluating a yoga program within the academic curriculum of public schools to determine the benefits in mental health characteristics such as perceived stress, resilience, emotion regulation and anxiety. Dr. Khalsa routinely interacts internationally with other yoga researchers and he is actively working with the International Association of Yoga Therapists to promote the field of research on yoga therapy. For over 5 years he has also been teaching elective course at Harvard Medical School in Mind-Body Medicine. e-Mail: [email protected] SEVAMED | April 2013 Yoga Journal Survey 2012 I do yoga in my suite. Doctor’s orders. 9 19 Deep Breathing Meditation Yoga Progressive Relaxation From: Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12, 2008. 20 21 24 25 Yoga Research Das and Gastaut, 1955 Yoga Mimamsa Swami Kuvalayananda and colleagues at Kaivalyadhama Laboratory, Lonavla starting in 1924. 56 papers by Kuvalayananda from 1924-34 and 1954-73 From: Variations de l’activite electrique du cerveau, du coeur et de muscles squelettiques au cours de la meditation et de l’extase yogique [Variations in the electrical activity of the brain, heart, and skeletal muscles during yogic meditation and trance], Das N, Gastaut H, Electoencephalography and Clinical Neurophysiology, Suppl. 6:211-219, 1955. 26 SEVAMED | April 2013 29 Green & Green, 1977 Bagchi and Wenger, 1957 “…physiologically Yogic meditation represents deep relaxation of the autonomic nervous system without drowsiness or sleep …” From: Electro-physiological correlates of some Yogi exercises, Bagchi BK, Wenger MA, Electroencephalography and Clinical Neurophysiology, 7 (Suppl):132-149, 1957. 30 FMRI During Meditation From: Beyond Biofeedback, Green E, Green A, Knoll Publishing Co. Inc., 1977. 31 Long-term Meditation & Cortical Thickness From: Functional brain mapping of the relaxation response and meditation, Lazar SW, Bush G, Gollub RL, Fricchione GL, Khalsa G, Benson H, Neuroreport 11:1581-1585, 2000. 32 From: Meditation experience is associated with increased cortical thickness, Lazar SW, Kerr CE, Wasserman RH, Gray JR, Greve DN, Treadway MT, McGarvey M, Quinn BT, Dusek JA, Benson H, Rauch SL, Moore CI, Fischl B, Neuroreport 16:1893-1897, 2005. 33 Yoga, Thalamic GABA, Mood & Anxiety MBSR and Gray Matter Density L Hippocampus Posterior Cingulate Temporo-parietal Junction Cerebellum Brain regions involved in: learning and memory processes, emotion regulation, self-referential processing, and perspective taking. From: Mindfulness practice leads to increases in regional brain gray matter density, Hölzel BK, Carmody J, Vangel M, Congleton C, Yerramsetti SM, Gard T, Lazar SW, Psychiatry Research Imaging, 191:36-43, 2011. From: Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study, Streeter CC, Whitfield TH, Owen L, Rein T, Karri SK, Yakhkind A, Perlmutter R, Prescot A, Renshaw PF, Ciraulo DA, Jensen JE. Journal of Alternative and Complementary Medicine, 16:1145-52, 2010. 34 35 Yoga Meditation on Telomerase From: A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: effects on mental health, cognition, and telomerase activity, Lavretsky H, Epel ES, Siddarth P, Nazarian N, St. Cyr N, Khalsa DS, Lin J, Blackburn E, Irwin MR, International Journal of Geriatric Psychiatry, (2012). 37 SEVAMED | April 2013 38 Stress in Occupational Setting Annapurna Upanishad III-5. …this mind of mine is extremely restless’. III-6. It wanders from a cloth to a pot and thence to a big cart. The mind wanders among objects as a monkey does from tree to tree. Katha Upanishad 1-III-8. But whoso is possessed of a discriminating intellect and a restrained mind, and is ever pure, attains that goal from which he is not born again. From: Vedanta Spiritual Library http://www.celextel.org/ From: Yoga for reducing perceived stress and back pain at work, Hartfiel N, Burton C, Rycroft-Malone J, Clarke G, Havenhand J, Khalsa SB, Edwards RT, Occupational Medicine (under review). 40 Meditation and the Default Mode Network From: Mind wandering and attention during focused meditation: A fine-grained temporal analysis of fluctuating cognitive states, Hasenkamp W, Wilson-Mendenhall CD, Duncan E, Barsalou LW, Neuroimage, 59:75060, 2012. 42 dorsal anterior cingulate cortex and frontoinsular cortex lateral PFC and posterior parietal regions Attention, Stress & Mood dorsolateral prefrontal cortex default network mode regions 43 From: Short-term meditation training improves attention and self-regulation, Tang Y, Ma Y, Wang J, Fan Y, Feng S, Lu Q, Yu Q, Sui D, Rothbart MK, Fan M, Posner MI, Proceedings of the National Academy of Sciences, 104:17152–17156, 2007. 44 Yoga Meditation on Telomerase Models and Mechanisms for Yoga Therapy From: A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: effects on mental health, cognition, and telomerase activity, Lavretsky H, Epel ES, Siddarth P, Nazarian N, St. Cyr N, Khalsa DS, Lin J, Blackburn E, Irwin MR, International Journal of Geriatric Psychiatry, (2012). 45 SEVAMED | April 2013 46 Disorder Stress - + Disorder + Yoga Stress Fitness Fitness 47 48 Mechanisms in Yoga Practice Changes in GABA, ANS, HPA Axis From: Effects of Yoga on the Autonomic Nervous System, Gamma-Aminobutyric-Acid, and Allostasis in Epilepsy, Depression, and Post-traumatic Stress Disorder, Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP, Medical Hypotheses, (in press) 2012. Control of attentional networks Reduction of Default Mode Network activity Reduction of rumination and dysfunctional thoughts Induction of the psychophysiological “relaxation response” Structural brain changes in cortex and limbic system Mind-body effects, e.g. self-efficacy, belief, expectation Induction of contemplative states and self-identity changes Vagal afferent activity from pranayama and asanas Physical fitness, e.g. flexibility, endurance, respiratory Direct organ/tissue effects Subtle energy mechanisms, e.g. prana, qi 49 50 Temporal Changes in Yoga Practice Arousal Yoga Therapy Research reduction, physical/mental well-being Mind/body awareness, resilience, self-regulation Psychological / philosophical transformation 51 A Review of Yoga Therapy Research 52 Publication Source – Non-Yoga Journals http://www.ijpp.com/vol48_3/vol48_no3_spl_invt_art.pdf 53 SEVAMED | April 2013 54 Disorders – Non-Yoga Journals Chronology of Yoga Therapy Research 50 45 40 35 30 25 20 15 10 5 0 1963- 1969- 1974- 19791968 1973 1978 1983 1984- 1989- 1994- 19991988 1993 1998 2003 20042008 55 56 Yoga Treatment of Depression From: Initial evaluation of the LifeForce Yoga Program as a therapeutic intervention for depression, Bennett SM, Weintraub A, Khalsa SBS, International Journal of Yoga Therapy 18:49-57, 2008 59 Yoga for Prevention 68 SEVAMED | April 2013 Yoga in High School Students Worsening Improvement Social Stress Attitude to School Anger Resilience Negative Affect Anxiety Anger Expression 70 Qualitative Evaluation – Self-Regulation Future Directions • “… if I was stressed or angry I would then do the breathing to calm me down and I will probably continue to do this…I was less anxious about school in general...” • “Before you’re taking a test… relax and breathe and you don’t get as nervous or as tense.” • “In the beginning I didn’t like [yoga], but over time, in the middle I started to notice results… I began to like it because it started to work…” • “Friends who are doing yoga with me are kinder…if they are mad or annoyed they breathe before talking…My relationships with people are getting stronger.” New Disorders Neuroimaging Genomic Expression Specificity of Practices Cost-effectiveness Prevention Positive Psychology 71 72 73 74 Kripalu | center for yoga & health SEVAMED | April 2013