Kundalini Yoga Research
December 17-18, 2012
International Kundalini Yoga Teachers Association
Winter Solstice Sadhana
Sat Bir S. Khalsa, Ph.D.
Director of Research
Kundalini Research Institute
Assistant Professor of Medicine
Harvard Medical School
Brigham & Women’s Hospital Harvard Medical School
“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.”
Yogi Bhajan
Reasons for Practice
in a Beginners Program
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.
Prevalence
of Yoga Practice
Yoga Journal Survey 2012
Yoga
Meditation
Deep Breathing
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.
Progressive
Relaxation
Review of
Basic
Yoga Research
Yoga Mimamsa
Swami Kuvalayananda
and colleagues at
Kaivalyadhama
Laboratory, Lonavla
starting in 1924.
56 papers by
Kuvalayananda from
1924-34 and 1954-73
Brosse, 1936
From: Documents recueillis aux
Indes sur les “Yoguis” par
l’enregistrement simultane du
pouls, de la respiration et de
l’electrocardiogramme
[Data gathered in India on a Yogi
with simultaneous registration of
the pulse, respiration, and
electrocardiogram]
Laubry C, Brosse T
La Presse Medicale 44:1601-
1604, 1936.
Das and Gastaut, 1955
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.
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.
Physiology of Meditation
From: The physiology of meditation,
Wallace RK & Benson H, Scientific American 226:85, 1972.
Green & Green, 1977
From: Beyond Biofeedback, Green E, Green A, Knoll Publishing Co. Inc., 1977.
From: Stress management: A randomized study of cognitive behavioural
therapy and yoga, Granath J, Ingvarsson S, von Thiele U, Lundberg U.
Cognitive Behaviour Therapy, 35(1):3–10, 2006
Stress
Reduction
with Yoga
Perceived Stress Scale
Pre-treatment Post-treatment
Avera
ge
Sco
re
1.4
1.6
1.8
2.0
2.2
2.4
2.6
Stress Behavior Scale
Pre-treatment Post-treatment
Avera
ge
Sco
re
1.6
1.8
2.0
2.2
2.4
2.6
2.8
Urinary Noradrenaline
Pre-treatment Post-treatment
Ave
rag
e L
eve
l
200
250
300
350
Stress in Beginner Yoga Students
From: Yoga as a stress reduction technique for women, Quilty M, Khalsa SBS,
Saper R, Abstract submitted to 137th APHA Annual Meeting & Exposition, 2009.
Baseline End Program
Avera
ge S
core
PS
S
12
13
14
15
16
17
18
Perceived Stress
p < 0.0001
Long-term Meditation & Cortical Thickness
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.
MBSR and Gray Matter Density
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.
…participation in MBSR is associated with changes in gray matter
concentration in brain regions involved in learning and memory processes,
emotion regulation, self-referential processing, and perspective taking.
L Hippocampus
Posterior Cingulate
Temporo-parietal
Junction
Cerebellum
Yoga, Thalamic GABA, Mood & Anxiety
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.
Meditation
and the
DMN
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 (in press)
2011.
dorsal anterior cingulate cortex and frontoinsular cortex
lateral PFC and posterior parietal regions
dorsolateral prefrontal cortex
default network mode regions
In our paradigm, activity in several brain regions was significantly correlated
with practice time, especially during the SHIFT phase. The cognitive processes
occurring during this phase – disengaging and re-orienting of attention – are
some of the primary cognitive skills that FA meditation trains. All correlations in
this phase were negative, signifying lower neural activity in participants with
more meditation experience. These findings may reflect an overall practice
effect whereby performance of well-learned tasks requires less neural activity,
as has been suggested previously with regard to meditation experience. Indeed
…more experienced meditators may have been faster at completing the
reorienting operations associated with the SHIFT phase.
Attention,
Stress &
Mood
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.
Models and
Mechanisms for
Yoga Therapy
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.
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.
Mechanisms in Yoga Practice 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
Temporal Changes in Yoga Practice
Arousal reduction, physical/mental well-being
Mind/body awareness, self-regulation, resilience
Psychological / philosophical transformation
Disorder
Stress Fitness
+
+
- - -
Yoga
Disorder
Stress Fitness
Specificity of Yoga Postures
From: Mood Changes Associated with Iyengar Yoga Practices: A Pilot Study,
Shapiro D, Cline K, International Journal of Yoga Therapy 14:35-44, 2004.
Specific poses resulted in differences in how moods were affected, with
back bends associated with greater increases in positive moods. The specific and nonspecific effects of different bodily postures and
movements on psychological processes in Yoga …deserve further study.
Sad
Imp
rove
me
nt
in S
co
re
0.0
0.1
0.2
0.3
0.4
0.5
ForwardBends
BackBends
Happy
0.0
0.1
0.2
0.3
0.4
0.5
StandingPoses
ForwardBends
BackBends
StandingPoses
From: General and Specific Cerebral Blood Flow Responses to Meditation Revealed
by Perfusion Functional MRI. Wang J, Rao H, Korczykowski M, Wintering N, Pluta J,
Jha A, Khalsa DS, Newberg AB, Unpublished preprint.
FMRI of Different Meditations
↑ Primarily forebrain areas
↑ Primarily deeper limbic &
paralimbic structures
# 2 ↑ in deeper LH limbic &
forebrain structures
+ other differences
Mind/Body and Behavioral Factors
Metabolic Syndrome Diabetes
Stress or Worldview
Dysfunctional Nutrition
Neuroendocrine Imbalance
Metabolic Syndrome Diabetes
Sleep Deprivation
Stress or Worldview
Dysfunctional Nutrition
Neuroendocrine Imbalance
Obesity
Metabolic Syndrome Diabetes
Sleep Deprivation
Stress or Worldview
Dysfunctional Nutrition
Neuroendocrine Imbalance
Obesity
Metabolic Syndrome Diabetes
Sleep Apnea
Sleep Deprivation
Stress or Worldview
Dysfunctional Nutrition
Neuroendocrine Imbalance
Obesity
Metabolic Syndrome Diabetes
Sleep Apnea
Sleep Deprivation
Stress or Worldview
Dysfunctional Nutrition
Neuroendocrine Imbalance
Yoga
Review of
Applied Yoga
Research
A Review of Yoga Therapy Research
http://www.ijpp.com/vol48_3/vol48_no3_spl_invt_art.pdf
Chronology of Yoga Therapy Research
0
5
10
15
20
25
30
35
40
45
50
1963-
1968
1969-
1973
1974-
1978
1979-
1983
1984-
1988
1989-
1993
1994-
1998
1999-
2003
2004-
2008
Disorders – Non-Yoga Journals
0 10 20 30 40 50
Psychiatric
Cardiovascular
Respiratory
Diabetes
Neurological
Musculoskeletal
Other
Future Directions
New Disorders
Neuroimaging
Genomic Expression
Specificity of Practices
Cost-effectiveness
Prevention
Positive Psychology
1. 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, Cyr NS, Khalsa DS, Lin J, Blackburn E, Irwin MR. Int J Geriatr Psychiatry. 2013 Jan;28(1):57-65.
2. Cerebral blood flow changes associated with different meditation practices and perceived depth of meditation. Wang DJ, Rao H, Korczykowski M, Wintering N, Pluta J, Khalsa
DS, Newberg AB. Psychiatry Res. 2011 Jan 30;191(1):60-7.
3. Cerebral blood flow changes during chanting meditation. Khalsa DS, Amen D, Hanks C, Money N, Newberg A. Nucl Med Commun. 2009 Dec;30(12):956-61.
4. Clinical case report: efficacy of yogic techniques in the treatment of obsessive compulsive disorders. Shannahoff-Khalsa DS, Beckett LR. Int J Neurosci. 1996 Mar;85(1-2):1-
17.
5. Effect of Breathwalk on body composition, metabolic and mood state in chronic hepatitis C patients with insulin resistance syndrome. Vázquez-Vandyck M, Roman S, Vázquez
JL, Huacuja L, Khalsa G, Troyo-Sanromán R, Panduro A. World J Gastroenterol. 2007 Dec 14;13(46):6213-8.
6. Effects of an 8-week meditation program on mood and anxiety in patients with memory loss. Moss AS, Wintering N, Roggenkamp H, Khalsa DS, Waldman MR, Monti D,
Newberg AB. J Altern Complement Med. 2012 Jan;18(1):48-53.
7. Evaluation of a residential Kundalini yoga lifestyle pilot program for addiction in India. Khalsa SB, Khalsa GS, Khalsa HK, Khalsa MK. J Ethn Subst Abuse. 2008;7(1):67-79.
8. Exaggerated heart rate oscillations during two meditation techniques. Peng CK, Mietus JE, Liu Y, Khalsa G, Douglas PS, Benson H, Goldberger AL. Int J Cardiol. 1999 Jul
31;70(2):101-7.
9. Functional brain mapping of the relaxation response and meditation. Lazar SW, Bush G, Gollub RL, Fricchione GL, Khalsa G, Benson H. Neuroreport. 2000 May
15;11(7):1581-5.
10. Functional magnetic resonance imaging of hippocampal activation during silent mantra meditation. Engström M, Pihlsgård J, Lundberg P, Söderfeldt B. J Altern Complement
Med. 2010 Dec;16(12):1253-8.
11. Genomic counter-stress changes induced by the relaxation response. Dusek JA, Otu HH, Wohlhueter AL, Bhasin M, Zerbini LF, Joseph MG, Benson H, Libermann TA. PLoS
One. 2008 Jul 2;3(7):e2576.
12. Heart rate dynamics during three forms of meditation. Peng CK, Henry IC, Mietus JE, Hausdorff JM, Khalsa G, Benson H, Goldberger AL. Int J Cardiol. 2004 May;95(1):19-27.
13. Hemodynamic observations on a yogic breathing technique claimed to help eliminate and prevent heart attacks: a pilot study. Shannahoff-Khalsa DS, Sramek BB, Kennel MB,
Jamieson SW. J Altern Complement Med. 2004 Oct;10(5):757-66.
14. Interoceptive awareness in experienced meditators. Khalsa SS, Rudrauf D, Damasio AR, Davidson RJ, Lutz A, Tranel D. Psychophysiology. 2008 Jul;45(4):671-7.
15. Meditation effects on cognitive function and cerebral blood flow in subjects with memory loss: a preliminary study. Newberg AB, Wintering N, Khalsa DS, Roggenkamp H,
Waldman MR. J Alzheimers Dis. 2010;20(2):517-26.
16. Randomized controlled trial of yogic meditation techniques for patients with obsessive-compulsive disorder. Shannahoff-Khalsa DS, Ray LE, Levine S, Gallen CC, Schwartz
BJ, Sidorowich JJ. CNS Spectr. 1999 Dec;4(12):34-47.
17. Stress management: a randomized study of cognitive behavioural therapy and yoga. Granath J, Ingvarsson S, von Thiele U, Lundberg U. Cogn Behav Ther. 2006;35(1):3-10.
18. The effects of a class in Kundalini yoga on field articulation, openness to experience and flexibility. Davis, Ilana E. ; Dissertation Abstracts International, Vol 37(1-B), Jul, 1976.
pp. 487-488.
19. The effects of Kundalini yoga on sleep disturbance. Sehgal, Sabina ; Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 68(7-B), 2008. pp.
4846.
20. Treatment of chronic insomnia with yoga: a preliminary study with sleep-wake diaries. Khalsa SB. Appl Psychophysiol Biofeedback. 2004 Dec;29(4):269-78.
21. Yoga in stroke rehabilitation: a systematic review and results of a pilot study. Lynton H, Kligler B, Shiflett S. Top Stroke Rehabil. 2007 Jul-Aug;14(4):1-8.
22. Yogic meditation reverses NF-κB and IRF-related transcriptome dynamics in leukocytes of family dementia caregivers in a randomized controlled trial. Black DS, Cole SW,
Irwin MR, Breen E, St Cyr NM, Nazarian N, Khalsa DS, Lavretsky H. Psychoneuroendocrinology. 2012 (in press).
Published Research Involving Kundalini Yoga
Cancer
Yoga Programs in Cancer Centers
Albert Einstein Comprehensive Cancer Center, Bronx, NY
Beth Israel Cancer Center, New York, NY
Cancer Center of Santa Barbara, Santa Barbara, CA
Cornucopia House Cancer Support Center, Chapell Hill, NC
Fox Chase-Temple Cancer Center, Philadelphia, PA
Fred Hutchinson Cancer Research Center, Seattle, WA
Geffen Cancer Center and Research Institute, Vero Beach, FL
Hoag Cancer Center, Newport Beach, CA
Kimmel Cancer Center at Jefferson, Philadelphia, PA
Martha Jefferson Hospital Cancer Care Center, Charlottesville, VA
Memorial Sloan-Kettering Cancer Center, New York, NY
Mercy Cancer Center, Des Moines, IA
MGH Cancer Center, Boston, MA
Saint Vincents Comprehensive Cancer Center, New York, NY
Saints Memorial Cancer Center, Lowell, MA
Southern Idaho Regional Cancer Center, Twin Falls, ID
UCLA’s Jonsson Comprehensive Cancer Center, Los Angeles, CA
UCSF Cancer Center, San Francisco, CA
University of Michigan's Comprehensive Cancer Center, Ann Arbor, MI
University of Pennsylvania Cancer Center, Philadelphia, PA
University of Texas M.D. Anderson Cancer Center, Houston, TX
Vanderbilt-Ingram Cancer Center, Nashville, TN
Yoga for Cancer
Stress
Mood – Anxiety, Depression
Immune function
Side effects of surgery
Side effects of chemotherapy
Life perspective, quality of life, well-being
Spirituality, end of life
Twelve RCTs with a total of 742 participants were included... Evidence was
found for short-term effects on global health-related quality of life, functional,
social, and spiritual well-being… Short-term effects on psychological health also
were found: anxiety, depression, perceived stress and psychological distress.
We identified 24 studies of yoga in breast cancer survivors. The outcomes assessed in
these studies are heterogeneous, although some of them are a recurrent theme, such as
fatigue (9 trials, 6 showing significantly favorable results), QOL (8 trials, all positive),
anxiety (8 studies, all positive), and depression (9 studies, 8 positive). Other less common
outcomes assessed were sleep (5 studies, 2 positive), stress, mood, mental health,
affect, spirituality, vitality, distress, pain, physical fitness, cognition, chemo-induced
nausea, and vomiting. Statistical significant or trends toward improvements were shown
for all of these outcomes in the majority of the studies reviewed here.
The effect of yoga on women with secondary arm lymphoedema from breast cancer treatment. Loudon A,
Barnett T, Piller N, Immink MA, Visentin D, Williams AD. BMC Complement Altern Med. 2012 May 28;12:66.
Feasibility of a brief yoga intervention during chemotherapy for persistent or recurrent ovarian cancer. Sohl
SJ, Danhauer SC, Schnur JB, Daly L, Suslov K, Montgomery GH. Explore (NY). 2012 May-Jun;8(3):197-8.
Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot
randomized controlled trial. Dhruva A, Miaskowski C, Abrams D, Acree M, Cooper B, Goodman S, Hecht FM.
J Altern Complement Med. 2012 May;18(5):473-9. Epub 2012 Apr 23.
Longitudinal impact of yoga on chemotherapy-related cognitive impairment and quality of life in women with
early stage breast cancer: a case series. Galantino ML, Greene L, Daniels L, Dooley B, Muscatello L,
O'Donnell L. Explore (NY). 2012 Mar-Apr;8(2):127-35.
Randomized controlled pilot trial of yoga in overweight and obese breast cancer survivors: effects on quality
of life and anthropometric measures. Littman AJ, Bertram LC, Ceballos R, Ulrich CM, Ramaprasad J,
McGregor B, McTiernan A. Support Care Cancer. 2012 Feb;20(2):267-77. Epub 2011 Jan 5.
A qualitative exploration of the impact of yoga on breast cancer survivors with aromatase inhibitor-associated
arthralgias. Galantino ML, Greene L, Archetto B, Baumgartner M, Hassall P, Murphy JK, Umstetter J, Desai
K. Explore (NY). 2012 Jan-Feb;8(1):40-7.
Predictors of adherence to an Iyengar yoga program in breast cancer survivors. Speed-Andrews AE,
Stevinson C, Belanger LJ, Mirus JJ, Courneya KS. Int J Yoga. 2012 Jan;5(1):3-9.
Yoga and NK Cell Activity in Cancer Patients
From: Effects of yoga on natural killer cell counts in early breast cancer patients
undergoing conventional treatment. Rao RM, Telles S, Nagendra HR, Nagarathna R,
Gopinath K, Srinath S, Chandrashekara C, Medical Science Monitor, 14:LE3-4, 2008.
Immune Function in Cancer Patients
NK
Cell
Perc
enta
ge
10
15
20
25
Pre-Surgery
Post-Surgery
Post-Chemotherapy
Yoga in HIV Patients
From: Evaluating a yogic breathing and meditation intervention for individuals living with
HIV/AIDS, Brazier A, Mulkins A, Verhoef M, American Journal of Health Promotion,
20:192-5, 2006.
Mental Health
Music Performance Anxiety
Ave
rag
eD
iffe
ren
ce
Sco
res
-8
-6
-4
-2
0
2
Solo Performance Anxiety
YogaLifestyle
ControlGroup
YogaOnly
* *
*
Kripalu Yoga
for Music Performance Anxiety Music Performance Anxiety
Baseline End Program
MP
AI-
A A
ve
rag
e S
co
re
40
42
44
46
48
50
52
54
8 Studies
1. A preliminary investigation of the effects of giving testimony and learning yogic
breathing techniques on battered women's feelings of depression.
Franzblau SH, et al., J Interpers Violence. 2008 Dec;23(12):1800-8.
2. Evaluation of Siddha Samadhi Yoga for anxiety and depression symptoms: a
preliminary study.
Kozasa EH, et al., Psychol Rep. 2008 Aug;103(1):271-4.
3. Wellness through a comprehensive yogic breathing program - a controlled pilot
trial.
Kjellgren A, et al., BMC Complement Altern Med. 2007 Dec 19;7:43.
4. Yoga reduces symptoms of distress in tsunami survivors in the Andaman
islands.
Telles S, et al., Evid Based Complement Alternat Med. 2007 Dec;4(4):503-9.
5. Yoga as a Complementary Treatment of Depression: Effects of Traits and
Moods on Treatment Outcome.
Shapiro D, et al., Evid Based Complement Alternat Med. 2007 Dec;4(4):493-502.
Anxiety Studies
6. A randomised comparative trial of yoga and relaxation to reduce stress and
anxiety.
Smith C, et al., Complement Ther Med. 2007 Jun;15(2):77-83.
7. Effects of a yoga lifestyle intervention on performance-related characteristics of
musicians: a preliminary study.
Khalsa SB, Cope S., Med Sci Monit. 2006 Aug;12(8):CR325-31.
8. Effect of yoga based lifestyle intervention on state and trait anxiety.
Gupta N, et al., Indian J Physiol Pharmacol. 2006 Jan-Mar;50(1):41-7.
9. Rapid stress reduction and anxiolysis among distressed women as a
consequence of a three-month intensive yoga program.
Michalsen A, et al., Med Sci Monit. 2005 Dec;11(12):CR555-561
10. Effect of Sahaj Yoga on depressive disorders.
Sharma VK, et al., Indian J Physiol Pharmacol. 2005 Oct-Dec;49(4):462-8.
11. The effects of yoga on mood in psychiatric inpatients.
Lavey R, et al., Psychiatr Rehabil J. 2005 Spring;28(4):399-402.
Anxiety Studies Continued
5 Randomized Studies
1. A preliminary investigation of the effects of giving testimony and learning yogic
breathing techniques on battered women's feelings of depression.
Franzblau SH, et al., J Interpers Violence. 2008 Dec;23(12):1800-8.
2. Sleep quality, depression state, and health status of older adults after silver
yoga exercises: Cluster randomized trial.
Chen KM, et al., Int J Nurs Stud. 2008 Oct 21.
3. Evaluation of Siddha Samadhi Yoga for anxiety and depression symptoms: a
preliminary study.
Kozasa EH, et al., Psychol Rep. 2008 Aug;103(1):271-4.
4. Meditation with yoga, group therapy with hypnosis, and psychoeducation for
long-term depressed mood: a randomized pilot trial.
Butler LD, et al., J Clin Psychol. 2008 Jul;64(7):806-20.
5. Wellness through a comprehensive yogic breathing program - a controlled pilot
trial.
Kjellgren A, et al., BMC Complement Altern Med. 2007 Dec 19;7:43.
Depression Studies
6. Yoga as a Complementary Treatment of Depression: Effects of Traits and
Moods on Treatment Outcome.
Shapiro D, et al., Evid Based Complement Alternat Med. 2007 Dec;4(4):493-502.
7. Assessing depression following two ancient Indian interventions: effects of yoga
and ayurveda on older adults in a residential home.
Krishnamurthy MN, Telles S., J Gerontol Nurs. 2007 Feb;33(2):17-23.
8. Effect of Sahaj Yoga on neuro-cognitive functions in patients suffering from
major depression.
Sharma VK, et al., Indian J Physiol Pharmacol. 2006 Oct-Dec;50(4):375-83.
9. Antidepressant efficacy and hormonal effects of Sudarshana Kriya Yoga (SKY)
in alcohol dependent individuals.
Vedamurthachar A, et al., J Affect Disord. 2006 Aug;94(1-3):249-53.
9. Effect of Sahaj Yoga on depressive disorders.
Sharma VK, et al., Indian J Physiol Pharmacol. 2005 Oct-Dec;49(4):462-8.
10. The effects of yoga on mood in psychiatric inpatients.
Lavey R, et al., Psychiatr Rehabil J. 2005 Spring;28(4):399-402.
Depression Studies Continued
Mild Depression
From: Woolery A, Myers H, Sternlieb B, Zeltzer L. A yoga intervention for young adults
with elevated symptoms of depression. Alternative Therapies in Health and Medicine
10:60-3, 2004.
Yoga Treatment of Depression
From: Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a
randomized comparison with electroconvulsive therapy (ECT) and imipramine,
Janakiramaiah N et al., Journal of Affective Disorders 57:255-259, 2000.
Depression in Battered Women
From: A preliminary investigation of the effects of giving testimony and learning yogic
breathing techniques on battered women’s feelings of depression, Franzblau SH,
Echevarria S, Smith M, Van Cantfort TE, Journal of Interpersonal Violence 23:1800-08,
2008
Beck Depression Inventory
Avera
ge B
DI
Score
0
10
20
30
40
Baseline 4 Days
TalkTalk +YogicBreath
From: Efficacy of two relaxation techniques in depression, Broota A, Dhir R, Journal
of Personality and Clinical Studies 6:83-90, 1990.
Yoga Treatment of Depression
Pe
rce
nt S
ym
pto
m R
ed
uctio
n
30
40
50
60
YogaExercises Progressive
Relaxation
No-TreatmentControl
- RCT N=10, neurotic or reactive depressives on medication
- pre and post measures of treatment on 3 consecutive days
- 25’ of yogic breathing, asanas, autosuggestion, 4 techniques
From: Yoga as a complementary
treatment of sepression: Effects of
traits and moods on treatment
outcome, Shapiro D, Cook IA,
Davydov DM, Ottaviani C, Leuchter
AF, Abrams M. Evidence Based
Complementary and Alternative
Medicine 4:493–502, 2007
Yoga Treatment of Depression
- Single group N=17 MDD
- 8-week 3 60-90 classes/week
- Iyengar yoga primarily postures
From: A comparative study of full and partial Sudarshan Kriya Yoga (SKY) in major
depressive disorder, Rohini V, Pandey RS, Janakiramaiah N, Gangadhar BN,
Vedamurthachar A, National Institute of Mental Health and Neuro Sciences
(NIMHANS) Journal, 18:53-57, 2000.
- RCT N=15 MDD
- SKY – yogic breathing daily 4-week 30’ daily 6/wk
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
Yoga Treatment of Depression
- Single group study of LifeForce Yoga Program participants
- Baseline T1-N=94, 3 weeks T2-N=54, 2 months T3-N=33
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
Yoga Treatment of Depression
Smoking Behavior
From: McIver S, O'Halloran P, McGartland M. The impact of Hatha yoga on smoking
behavior. Alternative Therapies in Health and Medicine. 10:22-3, 2004.
Alcohol Dependence
From: Raina N, Chakraborty PK, Basit MA, Samarth SN, Singh H, Evaluation of yoga
therapy in alcohol dependence syndrome. Indian Journal of Psychiatry 43(2) 2001.
Yoga for Addictions
From: Comparing Hatha yoga with dynamic group psychotherapy for enhancing
methadone maintenance treatment: a randomized clinical trial, Shaffer HJ, LaSalvia
TA, Stein JP, Alternative Therapies in Health and Medicine, 3:57-66, 1997.
BASIS-32Overall Average
Ave
rage S
core
0.0
0.5
1.0
1.5
Relation to Selfand Others
Baseline Mid-TX End-TX Followup
Ave
rage S
core
0.0
0.5
1.0
1.5
Daily Living andRole Functioning
Ave
rage S
core
0.0
1.0
2.0Depression and Anxiety
0.0
0.5
1.0
1.5
Impulsive andAddictive Behavior
0.0
0.5
1.0
1.5
Psychosis
Baseline Mid-TX End-TX Followup
0.0
0.5
1.0
Yoga
for
Substance
Abuse
From: Evaluation of a residential Kundalini Yoga lifestyle pilot program for addiction
in India, Khalsa SBS, Khalsa GS, Khalsa HK, Khalsa MK, Journal of Ethnicity in
Substance Abuse 7:67-79, 2008.
Yoga for PTSD
TotalScore
Baseline End Treatment
Score
50
55
60
65
70
75
Re-experiencingSymptoms
Baseline End Treatment
Score
10
12
14
16
18
20
22
AvoidanceSymptoms
Baseline End Treatment
Score
22
24
26
28
30
32
HyperarousalSymptoms
Baseline End Treatment
Score
18
19
20
21
22
23
Clinician Administered PTSD Scale (CAPS)
From: Clinical implications of neuroscience research in PTSD. van der Kolk BA,
Annals of the New York Academy of Science 1071:277-93, 2006.
Yoga for PTSD Clinician Administered PTSD Scale
To
tal C
AP
S S
co
re
0
20
40
60
80
100
120
Baseline End Treatment
Mantra Repetition for PTSD
From: A spiritually based group intervention for combat veterans with posttraumatic
stress disorder: feasibility study. Bormann JE, Thorp S, Wetherell JL, Golshan S.
Journal of Holistic Nursing 26:109-16, 2008
From: Yoga-Based Breath Program and Client-Centered Exposure Therapy for PTSD
& Depression in Tsunami Survivors, Descilo T, Gerbarg P, Vedamurtachar A, Nagaraja
D, Gangadhar BN, Damodaran R, Adelson B, Braslow L, Marcus S, Brown RP, Acta
Psychiatrica Scandinavica, (accepted for publication)
Mean Scores PTSD Checklist PCL-17
Yogic
Breathing for
Tsunami
Survivors
with PTSD
Schizophrenia
From: Yoga therapy as an add-on treatment in the management of patients with
schizophrenia – a randomized controlled trial. Duraiswamy G, Thirthalli J, Nagendra HR,
Gangadhar BN, Acta Psychiatric Scandinavica 116: 226–232, 2007.
Lifestyle Diseases
Metabolic Syndrome /
Endocrinology Disorders
- studies (1970–2006) of metabolic and clinical effects of yoga in DM 2
- 25 eligible studies:
15 uncontrolled trials, 6 nonrandomized controlled trials, 4 RCT’s
- “these studies suggest beneficial changes in several risk indices,
including glucose tolerance and insulin sensitivity, lipid profiles,
anthropometric characteristics, blood pressure, oxidative stress,
coagulation profiles, sympathetic activation and pulmonary function, as
well as improvement in specific clinical outcomes. Yoga may improve
risk profiles in adults with DM 2, and may have promise for the
prevention and management of cardiovascular complications…”
Yoga Mechanisms of Action on Diabetes
From: A review of yoga programs for four leading risk factors of chronic diseases. Yang
K. Evidence Based Complementary and Alternative Medicine. 4:487-91, 2007.
Psychological Changes
Direct Action:
Enhancement of organ health
Decrease in insulin resistance or glucose tolerance Indirect Action:
Decrease in stress hormones
Reduction in sympathetic dominance
Improvement in mind/body awareness
Enhanced compliance: dietary, activity, medications
Change in attitude/worldview and lifestyle behavior Adjunct Action:
Improvements in mood, well-being, sleep, quality of life
Yoga Mechanisms of Action on Diabetes
Blood Glucose
Pretreatment PosttreatmentFasting B
lood G
lucose (
mm
ole
/l)
7.0
8.0
9.0
10.0
Yoga
Control
HbA1c
Pretreatment PosttreatmentG
lycate
d H
em
oglo
bin
(P
erc
ent)
9.0
10.0
11.0
Yoga
Control
Yoga Treatment of Diabetes
From: Yoga therapy for NIDDM: a controlled trial, Monro R, Power J, Coumar A,
Nagarathna R, Dandona P, 6:66-68, 1992.
Yoga-mediated
Change
in Insulin
Sensitivity
From: Studies on the inter-
relationship between insulin
tolerance and yoga, Mukherjee
A, Banerjee S, Bandyopadhyay
SK, Mukherjee PK, Indian
Journal of Physiology and Allied
Sciences 46:110-115, 1992.
From: Role of yoga in diabetes. Sahay BK, Journal of the Associatioin of Physicians of
India, 55:121-6, 2007.
Yoga Effects Insulin Receptors
Lower Weight Gain in Yoga Practitioners
From: Yoga practice is associated with attenuated weight gain in healthy, middle-aged
mend and women, Kristal AR, Littman AJ, Benitez D, White E, Alternative Therapies in
Health and Medicine, 11:28-33, 2005.
BMI<25 BMI>25
Lifestyle Diseases
Cardiovascular System
Disorders
Stress may result in physical, biochemical, functional, and emotional body
changes. When the body experiences stress, the sympathetic nervous system
releases epinephrine into the bloodstream, increasing HR, vasoconstriction,
and systemic vascular resistance, which, in turn, increases BP and cardiac
workload. Hypothalamus activation, another physiologic stress reaction,
stimulates the posterior pituitary gland, resulting in the secretion of antidiuretic
hormone. This hormone promotes water retention, leading to increased stroke
volume, and acts as a powerful peripheral vasoconstrictor, resulting in
decreased vessel size and increased BP.
Emotional stress has the same effect on the body as physical stress and
can increase BP. Individuals encounter many different physical and emotional
stressors each day. Even the lifestyle modifications undertaken to reduce
hypertension may increase stress levels, including salt restriction, regular
exercise, and smoking and alcohol avoidance.
Monro and colleagues suggest that, by working on the mind and body to
reduce or alter stress appreciation, yoga practice breaks the cycle of
stress→hypertension→focused attention→stress.
From: The effects of yoga on hypertensive persons in Thailand, McCaffrey R, Ruknui
P, Hatthakit U, Kasetsomboon P, Holistic Nursing Practice. 19:173-80, 2005.
Rationale for Cardiovascular Pathology
Hypertension
From: Randomised controlled trial of yoga and bio-feedback in management of
hypertension, Patel C, North WR, Lancet. 1975 Jul 19;2(7925):93-5.
Hypertension
From: The effects of yoga on hypertensive persons in Thailand, McCaffrey R, Ruknui
P, Hatthakit U, Kasetsomboon P, Holistic Nursing Practice. 19:173-80, 2005.
Baroreflex Sensitivity
From: Slow breathing improves arterial baroreflex
sensitivity and decreases blood pressure in essential
hypertension, Joseph CN, Porta C, Casucci G,
Casiraghi N, Maffeis M, Rossi M, Bernardi L,
Hypertension, 46:714-8, 2005.
Reversal of
Heart Disease
From: Changes in myocardial
perfusion abnormalities by
positron emission tomography
after long-term, intense risk
factor modification, Gould KL,
Ornish D, Scherwitz L, Brown S,
Edens RP, Hess MJ, Mullani N,
Bolomey L, Dobbs F, Armstrong
WT, et al.,
Journal of the American Medical
Association, 274:894-901, 1995.
Lifestyle Diseases
Insomnia
Models of Primary Insomnia
Conditioning
Emotional Arousal
Cognitive Arousal
Physiological Arousal
Sleep in Yoga Practitioners
From: Subjective sleep quality and hormonal modulation in long-term yoga practitioners,
Vera FM, Manzaneque JM, Maldonado EF, Carranque GA, Rodriguez FM, Blanca MJ,
Morell M, Biological Psychology 81:164-8, 2009.
Yoga on Sleep in the Elderly
From: Influence of Yoga & Ayurveda on self-rated sleep in a geriatric population,
Manjunath NK, Telles S, Indian Journal of Medical Research 121:683-690, 2005.
5.5
5.7
5.9
6.1
6.3
6.5
6.7
6.9
7.1
7.3
Pretreatment Posttreatment Followup
Sle
ep
Du
rati
on
(H
ou
rs) Yoga Controls
20
25
30
35
40
45
Pretreatment Posttreatment Followup
Sle
ep
On
se
t L
ate
nc
y (
Min
)
Yoga Controls
Sle
ep O
nset Late
ncy
0
30
60
90
120
Sle
ep Q
ualit
y
1
2
3
4
5N
um
ber
of A
wa
kenin
gs
0
1
2
3
4
Tota
l S
leep T
ime
0
2
4
6
8
Tota
l W
ake T
ime
0
2
4
6
Sle
ep E
ffic
iency
0
25
50
75
100
Subject CH
Sleep Onset Latency
Baseline Wk 1-2 Wk 3-4 Wk 5-6 Wk 7-8 FollowupAvera
ge S
leep O
nset Late
ncy (
min
ute
s)
20
30
40
50
Sleep Efficiency
Baseline Wk 1-2 Wk 3-4 Wk 5-6 Wk 7-8 Followup
Avera
ge S
leep E
ffic
iency (
%)
70
75
80
85
90
Total Wake Time
Baseline Wk 1-2 Wk 3-4 Wk 5-6 Wk 7-8 Followup
Avera
ge T
ota
l W
ake T
ime (
hr)
0.8
1.0
1.2
1.4
1.6
1.8
2.0
2.2
2.4
2.6Total Sleep Time
Baseline Wk 1-2 Wk 3-4 Wk 5-6 Wk 7-8 Followup
Avera
ge T
ota
l S
leep T
ime (
hr)
5.5
6.0
6.5
7.0
7.5
Sleep Diary Data
Lifestyle Diseases
Yoga for Prevention
Majority of seriously impairing and
persistent conditions have child-
adolescent onsets and high
comorbidity
Need for treatment of largely
untreated child-adolescent
disorders
Adolescent / School Challenges
Stress (developmental, family, social, academic, societal)
Behavior (apathy, violence, social skills, bullying, absenteeism)
Mental Health (depression, anxiety, substance abuse, trauma)
Attention (ADD, ADHD)
Academics (grades, dropouts)
Physical Health (obesity, diabetes)
From: Cumulative prevalence of psychiatric
disorders by young adulthood: a prospective cohort
analysis from the Great Smoky Mountains Study,
Copeland W, Shanahan L, Costello EJ, Angold A,
Journal of the American Academy of Child and
Adolescent Psychiatry, 50:252-61, 2011.
…the striking feature
of the present data
is...how high the
rates of early
psychiatric disorders
are. Most likely, the
lifetime prevalence
of psychiatric
problems by age 21
well exceeds 80%,
suggesting that the
experience of
psychiatric illness is
nearly universal.
Yoga in Public School Research
● 12-week 1-hr Yoga Ed/Kripalu classes 2-3 times/week
● RCT, yoga vs. physical education, N ~ 100
● Qualitative interviews post-program
● Self-report pre-post mental health questionnaires
Social Stress
Attitude to School
Anger
Resilience
Negative Affect
Anxiety
Anger Expression
ImprovementWorsening
Mental Health Outcomes - Yoga
Social Stress
Attitude to School
Anger
Resilience
Negative Affect
Anxiety
Anger Expression
ImprovementWorsening
Mental Health Outcomes - Control
Social Stress
Attitude to School
Anger
Resilience
Negative Affect
Anxiety
Anger Expression
ImprovementWorsening
Yoga in High School Students
• “If you had a lot of stuff on your mind or something you
could just use some of those exercises... I just felt
calmer and stuff, if I was stressed out or angry for some
reason, I’d use that at some point. I’d do their breathing
exercises and they’d calm me down.”
• “I used breathing outside the classroom in my life to
calm me down… 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.”
Qualitative Evaluation – Self-Regulation
Basics of Yoga
Therapy
Research
Access to Yoga Research
• Pubmed database
• Psychinfo database
• Althealthwatch database
• International Association of Yoga Therapists (IAYT)
• NIH Reporter database
• Clinical Trials Database – ClinicalTrials.gov
• Yoga websites
• Internet
• Kundalini Research Institute – [email protected]
http://www.ncbi.nlm.nih.gov/pubmed/
Basics of Yoga Research
Yoga Instruction or Yoga Therapy Practice • Documentation
• Followup
• Case study analysis and publication
Formal Research • Collaboration
• Human subjects research administration
• Study design: entry criteria, sample size, control group
(active/passive, assignment, blinding), outcome measures (population/disorder specific, validation, subjective/objective)
• Intervention design: consistency, fidelity, duration,
frequency, intensity, group/individual, home/institution
• Analysis, statistics, interpretation and publication
Collaboration
Why Collaborate?
- Clinical Experience and Expertise - clinical features, symptoms comorbidities of the disorder
- Research Experience and Expertise - in research on the disorder, condition, population of interest
- subject limitations, recruitment, entry criteria, outcome measures
- research design, grant and manuscript preparation
- IRB Approval - if you do not have access to an IRB
- Grant Submission - grant reviewers evaluate the strength of the research team
- collaborators can be consultants, coinvestigators or co-PI’s
Finding Collaborators
- Desirable qualities - a good reputation with expertise in the field
- published research
- grant funding history
- open to yoga or meditation
- Search published papers on the topic - Pubmed, Psychinfo - search by zip code or institution
- Search active NIH grants - NIH Reporter - search geographically over multiple years
- Search clinical trials - ClinicalTrials.gov
- Search local institution departmental websites - departmental websites often have bio’s of faculty
Human Subjects Research
- Informed consent
- Research is ethical - vulnerable populations
- coercion
- conflict of interest
- equitable subject selection/inclusion
- Research has scientific value - knowledge to be gained
- research design, analysis and statistics
- Risks and safety - risks are justifiable given the benefits
- minimization of risks and safety monitoring
- Anonymity and confidentiality - access to data by approved staff only
- appropriate data storage
Human Research Requirements
- Federal regulations in specific
circumstances
- Research and academic institution
requirement
- Research journals are starting to require
approval
- The only way to demonstrate that the
research is ethical
The Need for IRB Approval
Yoga Research
in Perspective
Why Not Do Research on Yoga?
Costly
- $2 million full study
- $700 K preliminary study
Lengthy
- full study 5 years, preliminary study 3 years
- requires replication and critical mass
Reductionist / Dualistic / Dehumanizing
Why Do Research
on Yoga?
Because a significant fraction of the population
is using it as a therapy
To promote its use by the general public
To reach populations that ordinarily do not have
access to and/or knowledge of yoga
Penetrating the Population
Two systems are in place in society that
penetrate to all levels of the population
The education system
The healthcare system
Both systems require validation of techniques
and procedures before implementation
Penetrating the Population
Dental Hygiene in Education and Healthcare
- Fully accepted in principle by these systems
- Taught & promoted in these systems
- Widespread adoption in society as a cultural norm
Mind-Body Hygiene (Yoga)
- NOT accepted in principle by these systems
- NOT taught and promoted in these systems
- Growing but narrow adoption in society as a cultural norm
What are the Barriers to Yoga Research?
Resistance from conventional scientists i.e.
the paradigm shift challenge
Reviewer Bias and
Paradigm Shift Resistance
"Requires testing within a controlled environment before it can be
used safely within a school system."
“…yoga and other techniques serve a similar role as OTC
medications do in getting relief from a cold. They temporarily relieve
symptoms, but don’t address the underlying cause. Once the
medication wears off, the symptoms (in this case a dysfunctional
amount of emotion) often return because the cause is still
there…does not contribute something that would be a practical way
to address this pressing gap in curricula, and if published, might only
send some in a relative dead end and delay progress toward finding
a better solution.”
– Reviewer, Journal of School Health
What are the Barriers to Yoga Research?
Resistance from conventional scientists i.e.
the paradigm shift challenge
Lack of interest by scientists/researchers
What are the Barriers to Yoga Research?
Resistance from conventional scientists i.e.
the paradigm shift challenge
Lack of interest by scientists/researchers
Resistance from academic institutions
What are the Barriers to Yoga Research?
Resistance from conventional scientists i.e.
the paradigm shift challenge
Lack of interest by scientists/researchers
Resistance from academic institutions
Suppression by the pharmaceutical industry
What are the Barriers to Yoga Research?
Resistance from conventional scientists i.e.
the paradigm shift challenge
Lack of interest by scientists/researchers
Resistance from academic institutions
Suppression by the pharmaceutical industry Yoga can’t be studied with conventional
scientific methodology
What are the Barriers to Yoga Research?
Resistance from conventional scientists i.e.
the paradigm shift challenge
Lack of interest by scientists/researchers
Resistance from academic institutions
Suppression by the pharmaceutical industry Yoga can’t be studied with conventional
scientific methodology
Funding
Research Funding
The Challenge of Funding
Federal Funding for Yoga Research to Date 2000-05 NCCAM $ 621,000 Yoga as a treatment for insomnia
2001-03 NCCAM $ 250,000 R21 Project: Yoga as a treatment for insomnia
2004-08 NCCAM $ 785,688 Neuroendocrine mechanisms of a yoga treatment for insomnia
2008-12 DoD $ 476,000 Evaluation of a Yoga Intervention for PTSD
2011 NCCAM $ 30,000 Yoga Therapy Research Conference
2010-15 NCCAM $1,250,000 Quantification of Outcome Measures for Mind-Body Interventions
2012-15 NIDA $ 405,000 Evaluation of Yoga for Substance Use Risk Factors
Total $3,817,688
Pending Grant 2013-18 NCCAM $2,500,000
“The Kundalini yoga intervention is not widely available or easily disseminated were yoga to be
found efficacious in the short- or long-term therapy of GAD…The type of yoga selected for the
intervention is not as widely available in the community outside of major cities as other types of
yoga.”