Yogis have long practised yoga for mental transformation, above all to calm the mind. In fact, in the yoga sutras – one of the fundamental and oldest yogic texts – it is declared that ‘Yoga citta vritti nirodhah’ – ‘Yoga stills the mind’. That yoga might offer a way of treating psychological problems is in the West a recent notion. But it is one that is attracting great interest in the wake of new discoveries about the role of the autonomic nervous system and certain neuropeptides (small protein-like molecules in the brain that are used by neurons to communicate with each other) in promoting psychological wellbeing. Increasingly, the benefits of yoga are being explored by practitioners and psychology researchers. For some, yoga is even being seen as a treatment for mental illness.

Professor Sat Bir Khalsa, Director of the Kripalu Center for Yoga and Health, and Assistant Professor of Medicine at Harvard Medical School, has been involved in yoga practice and instruction for over 35 years and has been researching it for over 10 years. He is currently investigating the treatment of primary insomnia with yoga and meditation techniques. He is also interested in the potential effectiveness of these techniques to treat insomnia that is related to other conditions, such as depression, anxiety and fibromyalgia, and other sleep disorders. Yoga, he says, is increasingly being used alongside medical and psychiatric treatments for a range of mental health conditions, including chronic stress, anxiety and insomnia; there is a growing body of evidence to support its effectiveness in both treatment and prevention.

Increasingly, yoga is recognised as a holistic approach that works on several psycho-physiological levels. Next month, November 2012, international experts are gathering in London at a conference that will bring together yoga and mental health professionals to discuss the latest research findings into the neurobiology of yoga and how it can benefit our mental health and wellbeing.

Affect regulation
For practitioners of integrated medicine, the potential of yoga to promote our physical wellbeing and steady the mind is understood principally via the concept of affect regulation. The ability to manage one’s feelings, especially when under pressure, is part of healthy child development. However, the strains that are placed on individuals in societies where attachment relationships are frequently disrupted or insecure – where basic securities can rarely be taken for granted – mean that emotional disruption is increasingly endemic. Effective and accessible solutions for the resulting mild anxiety, depression and shame are needed and yoga may be an emerging prescription.

Specialists in the field of neurobiology emphasise the interpersonal nature of our capacity to self-regulate – that we learn to recognise and manage our feelings from a caring parent, who provides safety at times of turmoil. This, over time, becomes an internalised ability that enables us to self-soothe adaptively in response to the challenges of life. The biological mechanisms of this process are becoming increasingly well understood through advances in attachment theory and neuroscience, which in particular demonstrate that the development of the emotionally sensitive right brain is dependent on the quality of interaction between the infant and their closest parent figure.

Most psychological practitioners are familiar with the workings of the autonomic nervous system and the negative impact of trauma or disturbed attachment relationships on that feedback loop. Trauma work now frequently focuses on establishing the client’s ability to stay within a ‘window of tolerance’^{1, 2} between the two polar extremes of dissociation/withdrawal and the fight/flight response. The role of the caring other in maintaining this homeostasis is essential. Indeed, ‘affect regulation therapy’ is a new discipline. As one of its innovators, Dr Allan Schore of the UCLA David Geffen School of Medicine, says: ‘In an interpersonal neurobiological model of psychotherapeutic expertise for working with early-forming relational trauma, our conception of clinical expert is shifting from one who offers insight-oriented interpretations in order to make the unconscious conscious to one who optimally processes and regulates the patient’s unconsciously communicated bodily-based affective states, in order to facilitate development of the unconscious mind itself.’

Yoga for trauma
Interestingly, trauma psychiatrist and Director of The Trauma Center in Boston, Dr Bessel van der Kolk has so fully embraced yoga as a treatment for post-traumatic stress disorder (PTSD) that the centre now offers training in trauma-sensitive yoga instruction. They have offered yoga classes to thousands of PTSD sufferers, from survivors of rape and childhood incest to Gulf war veterans. Their confidence in this approach is based on a ground-breaking two-year study, funded by the USA National Institute of Health and completed in 2011. This study showed that trauma-sensitive yoga was more effective than dialectical behaviour therapy in reducing PTSD symptomology. The randomised controlled trial compared the benefits of eight 75-minute sessions of gentle Hatha yoga with dialectical behaviour therapy (DBT) for a group of 16 female trauma survivors. After eight weeks, the eight yoga participants showed greater improvements in all dimensions of PTSD and in their physical vitality and body attunement than did the eight women in the comparison DBT group. Although the study sample was too small to produce statistically significant results, it does suggest that yoga can positively affect self-regulation and decrease hyperarousal, and that these effects are comparable, if not better than those achieved through DBT, which is commonly used to treat PTSD.³

How then might yoga work as a therapy for emotional dysregulation? Using an alternative paradigm, based on Eastern spiritual practices, it appears to achieve its effects through the yoga positions and focused breathing, which enable the person to divert their attention from an upsetting state to a point of inner emotional stability. As Mira Mehta, a leading teacher of yoga, explains on her website:⁴ ‘Yoga is the control of the mind with the goal of spiritual peace. It is founded on ethical conduct and calm-inducing mental habits. Physical practice begins with postures which train the body-mind complex. The next step is breath control, a direct means of controlling the mind. Linked with this is the control of the sense organs. Yoga philosophy underpins these practices, giving them perspective and depth. Meditative states, the culmination of yoga, are the fruit of practice arising from stilling the senses and concentrating the mind.’ Here, the other ‘regulating’ person is replaced by the ability to self-induce nervous system stability through yoga techniques.

Current understandings of the interaction between psychological processes and the various branches of the nervous system demonstrate how the body and the mind talk to each other through signalling pathways – a dynamic that can be controlled by yogic or meditative breathing exercises. Such practices are thought to have a direct neurobiological link into the immune and cardiovascular systems. It has been speculated that PTSD may be a primitive defence system;⁵ Stephen Porges of the Brain-Body Center University of Illinois at Chicago has found that meditative activities are associated with the down-regulation of defensive responses to threat.⁶

Neurophysiology
Unsurprisingly, psychologists, researchers and yoga experts have begun turning their attention specifically to the benefits of yoga for mental health and wellbeing. New and exciting research findings are being published on the effectiveness of yoga to treat mental disorders such as schizophrenia, PTSD, insomnia, anxiety, ADHD and depression. A search on Google Scholar for academic articles published since January 2012 under the term ‘yoga and mental health’ throws up 2,720 results.

One leading figure in this development is yoga teacher and psychotherapist Heather Mason, who has set up a training institute called Yoga Therapy for the Mind. Her approach grew out of her own experience of working with people with depression and anxiety. After years of personal yoga and academic study in both Buddhist psychology and neuroscience, she has developed an approach that blends yoga practices with psychotherapy and neurobiology. A possible key to the effectiveness of yoga on the mind is the relatively recent discovery of neuroplasticity, which underpins sustained psychological transformation. ‘Part of our work,’ Mason explains, ‘is to understand how to positively promote this plasticity. We want to see if we can isolate factors that give rise to brain change and to see how specific yoga practice may achieve this. Essentially, we need to understand how the practice of yoga through its various mechanisms, such as controlled breathing, stretching, coordinated physical movement, enhanced cardiac output and mindfulness, combine to enhance brain functioning and promote positive mental health.’

Heather Mason is not alone in the quest for evidence to substantiate the benefits of yoga for the mind. Research projects in several universities – for example, Harvard, Boston University and the University of Bangalore – are now publicly funded, suggesting that yoga is being perceived by the medical research establishment as a potentially worthwhile treatment for a range of psychological issues. At the November conference, scientific researchers, including Dr Chris Streeter, Dr Sara Lazar and Professor Sat Bir Khalsa, and those with an interest in meditation and affect regulation, including Dr Pat Gerbarg, Dr Richard Brown and Dr Alan Watkins, will be presenting their findings alongside psychotherapists and psychologists who seek an integrated, mind–body approach to working with mental distress.

Dr Sara Lazar, a keynote speaker at the November conference and Instructor in Psychology at Harvard Medical School, has been practising yoga and mindfulness meditation since 1994. She is researching the neural mechanisms underlying the beneficial effects of yoga and meditation for people with a mental illness and for healthy individuals. One focus of her work is determining how yoga and meditation influence brain structure, and how these changes in turn influence behaviour. She explains: ‘We use neuroimaging techniques to study neurological, cognitive and emotional changes associated with the practice of meditation and yoga. We also incorporate measures of peripheral physiology (breathing, heartbeat) in order to understand how meditation practice influences the brain–body interaction and we use MRI to study the neural underpinnings of yoga and meditation.’ Lazar has produced data showing how yoga and meditation influence neural function and structure. These changes, she argues, lead to long-term improvements in physical and psychological health and wellbeing.

Dr Pat Gerbarg and Dr Dick Brown, both from the US, are exploring how yoga breathing can correct a wide range of disorders: autonomic nervous system imbalances, over-activity of stress responses and dysfunctions in emotion regulatory systems and inhibitory neurotransmitters. They believe that, by changing breathing patterns, we can alter the interoceptive messages from the body to the brain where they can influence key neuro-anatomic regions involved in trauma processing, emotion regulation and recovery. ‘Through these pathways,’ Gerbarg says, ‘we can see how specific breathing practices can alleviate symptoms of post-traumatic stress disorder such as anxiety, insomnia, intrusive memories, over-reactions, distorted body perceptions, disconnectedness and loss of meaning.’

Drilling down into the neurophysiology of the matter, Dr Chris Streeter, Associate Professor of Psychiatry and Neurology at Boston University School of Medicine, is researching the effects of yoga-based practices on brain gamma amino-butyric acid (GABA), the primary inhibitory neurotransmitter of mood and heart rate variability. Her studies use magnetic resonance spectroscopy to document increases in brain GABA levels and improved mood in association with yoga practice. ‘Yoga practices correct decreased parasympathetic nervous system activity and also correct under-activity of the gamma amino-butyric acid (GABA) system – the primary inhibitory neurotransmitter system,’ she argues.

These studies are attracting worldwide attention and reflect a new development that crosses psychology, psychotherapy and physiology disciplines – to offer a therapy that can combine a caring, interpersonal relationship with the teaching of self-regulating practices; one that purposefully enhances neuroplasticity and enables the individual to continue the work outside the therapy room. As the ancient wisdom of the yoga would describe it: we are rooted in the body when the mind focuses and settles.

‘Yoga, the brain and mental health’ takes place in London on 2–4 November 2012. For more information and to book a place, visit www.confer.uk.com

Jane Ryan is Director of Confer, an organisation specialising in conferences for mental health workers. She originally trained as an attachment-based psychotherapist and is the editor of two books: How Does Psychotherapy Work? (Karnac, 2006) and Tales of Psychotherapy (Karnac, 2007).

1. Siegel DJ. The developing mind: how relationships and the brain interact to shape who we are. New York: Guilford Press, 1999.
2. Ogden P, Minton K, Pain C, Siegel DJ, van der Kolk B. Trauma and the body: a sensorimotor approach to psychotherapy. London: WW Norton, 2006.
3. Emerson D, Sharma R, Chaudhry S, Turner J. Trauma-sensitive yoga: principles, practice and research. International Journal of Yoga Therapy 2009; 19: 123–128.
4. See www.yogicpath.com.
5. Porges S. The polyvagal theory. Biological Psychology 2007; 74 (2): 116–143.
6. Personal communication with the author.