Science of Yoga as a tool for Anxiety Management
These are times of high anxiety. Efforts to control the pandemic have resulted in uncertainty about the long-term impacts on the economy, on public health, and on society. In a previous post, we discussed anxiety and anxiety disorders, offering guidance as to whether what one is feeling is merely elevated anxiety levels or whether it’s a medical condition.
That distinction remains important as we now examine the scientific evidence for yoga as a method to combat anxiety. One reason the distinction is important is that individuals with severe anxiety disorders may need some prior treatment in order to have sufficient focus, mental energy, and confidence to successfully begin a practice. Another reason is that the findings to date differ between the two groups.
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It should be noted that while studies of yoga as a therapeutic tool have been on the rise in recent years,
it’s a relatively new area of inquiry for science. That’s important because science is a cumulative endeavor. Scientists remain skeptical until an overwhelming and consistent body of evidence has accumulated. For the non-scientist, this means that one should not use a study or two as definitive proof on which to base a decision to, or not to, practice yoga (or do / not do anything else in life.) It’s also worth noting that the scientific approach isn’t the only means of evaluating the usefulness of a yogic practice. While yoga was not developed as a therapeutic tool, for centuries it was many people’s only available means to bring peace to their minds. This post should not be seen as an attempt to override other grounds for judgement of yoga such as personal experience or recommendations from others. Instead, it’s a snapshot of the current state of evidence on the subject.
Ultimately, you’ll find that your own experience is the most relevant source of evidence when it comes to what enhances your own well-being.
A 2016 analysis conducted by scholars at Boston University of seventeen studies found support for hatha yoga as treatment for anxiety, particularly for those with elevated levels of anxiety [Hofmann, et. al.] The bulk of the findings investigating yoga as a means to reduce anxiety among those who are not afflicted with a disorder seem to be in line with the Boston University meta-analysis. [Meta-analyses (called literature reviews in some fields) are papers that report the findings of a number of separate individual studies. Many of the papers cited in this post are of that variety because our goal is to try to show the overarching picture.]
Results regarding the use of yoga as a treatment for those with an anxiety disorder present a picture that is less clear, showing little or no benefit in some studies. For example, Cramer, et.al.  found no evidence that yoga was a successful treatment for those diagnosed using the strict criteria of the DSM. [However, there was evidence of benefit for those without a diagnosable condition, as well as for those diagnosed using other criteria.] Another meta-analysis indicated that there was reason to believe that yoga was of benefit as a complementary practice for those suffering from disorders [Saeed, et. al.] It’s important to note what question is being answered by these studies, and what is meant by showing “no benefit.” We’ll discuss what it means in the next paragraph as we clarify what yoga as a complementary versus an alternative therapy means. For now, suffice it to say, it doesn’t mean there is a recommendation against the practice of yoga.
When looking at a practice as a treatment for a mental disorder, it’s important to consider whether research is considering it as an alternative or as a complementary practice. Most papers look at yoga as a complement to the usual therapy (medicine, psychotherapy, cognitive behavioral therapy [CBT], etc.) In such cases, the question that is most often being asked is whether yoga offers an added benefit — above and beyond the conventional treatment (i.e. medication or therapy.) Showing no benefit doesn’t mean that no one benefited. It means that in the group under study, on average, there was no additional benefit observed.
In some cases, you’ll see yoga investigated as the primary treatment (i.e. an alternative to the mainstream treatment, sometimes referred to as a monotherapy because it’s the solitary therapeutic tool being used.) In such cases, the question of interest is whether yoga was as successful as (or more successful than) the conventional treatment. The idea being that if one is going to pursue only one mode of therapy, one wants it to be the one that shows the most promise of being successful. There are studies that have found yoga promising as the primary therapy. For example, researchers from Brazil found preliminary evidence that yoga was effective as a monotherapy for those suffering from Panic Disorder [Vorkapic & Rangé.]
There’s a lot of room for furthur study,
and a number of reasons mixed results occur. Researchers point out that there are several issues that would be useful to have clarity about in order to design better studies. Some researchers point out that there is limited information about the mechanism by which yoga helps manage stress and anxiety. It is known that many yogic practices help support rest and digest functions (i.e. the parasympathetic nervous system response.) But there is a great deal that remains unclear. Studies such as the 2008 University of Utah paper showing reduced reactiveness in the brain to pain stimuli in yoga practitioners are just starting to offer insight into how yoga increases calm [Smith, et. al.]
There are also technical questions that remain unanswered that make it hard to build a study, such as what is the ideal duration and frequency of practice. [And over what timeframe — individuals who’ve been practicing for months might reasonably show different results than those after a couple weeks.] It’s likely that the wide-ranging results are at least in part a result of radically different regimes under study — i.e. the practices used and the amount of practice time. Saeed, et. al. reported on a study that found one 60-minute practice a week showed positive benefit — but a typical practice would be more frequent than that and might offer more robust results. Some studies featured integrated practices using asana, pranayama, meditation, and other practices (e.g. yoga nidra,) while other studies focused on a narrow form of practice. While both types of study have value, it can make for some apples to oranges comparisons.
There is also a wide divergence among those being studied, which might also contribute to varied results. Some studies draw from a broad population, while others focus on a narrow subgroup of interest. In the citations section, there are two examples of papers more narrowly focused, one that studied elderly participants [Klainin-Yobas, et. al.] and another that only investigated women [Parthasarathy, et. al.] Of course, there are often good reasons for being interested in narrowed groups of interest, but it explains why it’s important to look carefully at what is being studied when one sees studies that suggest different results.
The results of studies of yoga for anxiety tend to suggest a benefit is to be had. While results may be muddled, the inexorable march of science will — over time — offer us clearer insights.
Scientific studies offer a reason to believe that yoga can benefit those experiencing heightened anxiety. Of course, individuals respond differently to various practices, and so you may find it beneficial to mindfully experiment with a variety of types of practices such as asana (postural yoga), breathwork (pranayama), relaxation practices (e.g. yoga nidra), and meditation. Though often a balanced or integrated practice that includes various forms of activity provides the best result.
Scientific evidence supporting yoga as means to treat anxiety disorders is less firmly established. If you believe you might have an anxiety disorder, it’s a good idea to seek the help of a mental health professional. Then, discuss your practice with them. As yoga is a safe practice for most individuals when guided by an experienced teacher, one may benefit from it as a complementary practice, at least.
Until next time, be well.
Cramer H, Lauche R, Anheyer D, et al. 2018. Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials. Depress Anxiety. 35(9):830‐843. doi:10.1002/da.22762
Hofmann SG, Andreoli G, Carpenter JK, Curtiss J. 2016. Effect of hatha yoga on anxiety: a meta-analysis [published online ahead of print May 20, 2016]. J Evid Based Med. https://onlinelibrary.wiley.com/doi/abs/10.1111/jebm.12204. Accessed May 22, 2020.
Klainin-Yobas P, Oo WN, Suzanne Yew PY, Lau Y. 2015. Effects of relaxation interventions on depression and anxiety among older adults: a systematic review. Aging Ment Health. 19(12):1043‐1055. doi:10.1080/13607863.2014.997191
Parthasarathy S, Jaiganesh K, Duraisamy. 2014. Effect of integrated yoga module on selected psychological variables among women with anxiety problem. West Indian Med J. 63(1):78–80
Saeed SA, Cunningham K, Bloch RM. 2019. Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation. Am Fam Physician. 99(10):620‐627.
Sengupta, Pallav. 2012. Health Impacts of Yoga and Pranayama: A State-of-the-Art Review. International journal of preventive medicine . 3(7), 444–458.
Smith C, Hancock H, Blake-Mortimer J, Eckert K. 2008. A randomized comparative trial of yoga and relaxation to reduce stress and anxiety. Complement Ther Med. 15:77–83.
Vorkapic CF, Rangé B. 2014. Reducing the symptomatology of panic disorder: the effects of a yoga program alone and in combination with cognitive-behavioral therapy. Front Psychiatry. 5:177.
1. “The Diagnostic and Statistical Manual of Mental Disorders” is a guide to mental health issues and diagnostic criteria put out by the American Psychiatric Association.