Effect of Yoga on Anxiety

Keywords

Yoga; Anxiety.

Introduction

Complementary and alternative medicine (CAM) is often referred to as integrative medicine (Institute of Medicine [6]). The word Integrative, makes one think of a holistic approach in the nursing practice. Hence, holistic in the sense of caring for the whole person which include the bio psychosocial aspect of a person. It is important when treating a client psychiatrically to investigate the genetic component, temperament and environment of such person. CAM adheres to those three factors respectively, but emphasizes the psychosocial aspect a great deal. Knowing that CAM is reasonably new in the western hemisphere, in order to fully understand its philosophical approach, a thorough literature research was completed searching PubMed, Cochrane, Medline, Elsevier, Psych Info as well as some psychiatric textbooks. Over 10 articles were selected with the keywords yoga and anxiety, since it is the treatment modality selected for the improvement of anxiety disorder for the purpose of this paper. However, many of these articles did not mention solely the effective of yoga on anxiety, but other mental health disorders, such as depression and mood disorders. These articles were then saved on Zotero, a free software available to collect, save, share and cite research articles. The articles depicted the efficacy of yoga in regards to anxiety and mood disturbance such as depression. Among them one specific article even includes details not only the effect of yoga on the mood, but heart rate as described [4]. Each articles were reviewed in relation to yoga and its effectiveness to mental health disorder especially anxiety.

It was evident that such treatment modality has been adapted in the Western hemisphere for over three decades with positive effectiveness.

CAM puts clients first and at the center of care. It stresses prevention and focuses on the clients’ physical, mental and spiritual needs [6]. As mentioned before, many of the approaches of CAM are originated from non-Western cultural tradition since they are fairly new to us. The movement toward the use of CAM in the Western health care is relatively new, but clients are becoming receptive to such philosophy by changes in dominant scientific theory and belief [11]. The philosophy of this treatment modality is geared at complete healing as providers pay close attention to the client as a whole, mind, body and spirit including the lifestyle of clients with their choice of treatment. Interesting finding with CAM is that clients are able to advocate on their own modality of care they prefer. 40% or more of Americans treat themselves with CAM without professional supervision, often without disclosing it to their psychiatrist or primary care provider. Therefore is imperative for providers to inquire about interest in CAM therapy or if they have already engaged in a specific CAM treatment modality. It is notably important to know these facts in order prevent any risk factors to the clients’ health.

As mentioned earlier, this paper will develop the importance of yoga as one of the several CAM therapies available up-to-date. The United States have embraced CAM so much so that the National Institutes of Health (NIH) created the National Center for Complementary and Alternative Medicine (NCCAM) in 1998 [8].

In order to incorporate CAM into Western health care practice, providers had to change their way of thinking in respect to clients’ belief. Providers had to understand the importance of integrated alternative care into their practice, a perception that has not been a traditional approach to the western healthcare [10]. CAM is being adapted for various and significant mental health problem, such as depression, substance abuse treatment and neurocognitive disorders [5]. Anxiety disorder is one disorder that CAM has been proven to be an effective treatment modality for. Among the ten most common CAM treatment modalities adapted by adults in the United States (US) Yoga is ranked number six [1]. Given Yoga as number six CAM therapy most used in the US, the followings are in this order: natural products as number one, deep breathing as number two, meditation as number three, chiroplastic & osteopathic as number four, massage as number five, diet-based therapy as number seven, progression relaxation as number eight, guided imagery as number nine and homeopathic treatment as number ten [1]. It is vital that providers familiarize themselves with the population or community they are serving before suggesting a CAM therapy, because the belief system of these consumers can affect treatment adherence to certain CAM. In 2014, a colleague completed study proven that Yoga has been effective for the treatment of hypertension. She was invited to present such finding to a group of a community of Christian denomination, however the attendance turn out was a failure. They did not show up for the presentation, due to the belief that Yoga is not a divine approach. CAM can be controversial.

Familiarize ourselves with the population belief system is important in order to offer or provide the most effective and acceptable CAM therapy.

Anxiety disorders are the most common form of psychiatric disorders in the US. They affect up to 40 million adults, or 18% of the population aged 18 andolder [7]. Anxiety disorders are comorbid with depression at a rate of 60% [9]. Given such alarming statistics about anxiety disorders, providers must educate themselves about different alternative treatment modalities, such as yoga to better serve their clients. Yoga is a relaxation technique that helps a client creates a balance within the core of the bodily structure in the quest of becoming in tuned with oneself. It usually includes a number of physical postures, meditation and breathing techniques. While the goal of yoga historically has been to create a spiritual state of unity, it is also practiced to produce physical and emotional well being. Research suggests that yoga can improve anxiety [13].

Studies have shown that yoga can have positive benefits for people with several types of mental health conditions, such as including depression, ADHD, anxiety, schizophrenia and PTSD [3]. For the purpose of this paper we will only talk about its effect on anxiety. When people in treatment acquire tools like yoga for reducing anxiety, they are better able to tolerate the painful memories and emotions that arise during therapy sessions as well as in their outside daily life [3]. Integrating such treatment modality within one’s practice should be encouraged especially for clients suffering from anxiety disorders.

Yoga has been shown to be effective in alleviating symptoms of anxiety in healthy volunteers and psychiatric populations [2]. This evidence in effectiveness of yoga as an alternative treatment for anxiety can help alleviate healthcare cost both for the clients and the healthcare system as a whole. People with anxiety disorders frequently seek health care services for relief of physical symptoms, at a cost of approximately $22 billion per year [7]. Yoga has received considerable attention for its therapeutic benefits over the past few decades [12]. Including yoga in the treatment plan can help reducethe healthcare cost. For example, as a member of a yoga course the member course rate is between $100 to $150 range and clients are at liberty to stop at anytime if they feel that the techniques are not effective, which in turn will help them save and control their financial funds. If the psychiatric nursing provider is not certified in the practice of yoga, it is important to refer the client to a known, reliable and respectable certified yoga instructor. It is important to do so because although yoga is a relaxation technique, there are some contraindications that providers must be aware of the client wellbeing before referring clients for this type of CAM therapy. Because rapid yoga breathing can lower serum lithium levels, people being treated with lithium alone should not attempt it [3]. Clients’ education regarding yoga should be thoroughly explained to the client if the treatment will be initiated by the provider in combination with his/her conventional treatment plan. If the client started their quest with yoga on their own, it is also important to inquire from the client if he or she understands the efficacy and the contraindication of such treatment modality.

Pregnancy, uncontrolled hypertension, a recent heart attack or serious heart disease, seizure disorders, migraine headaches, chronic obstructive pulmonary disorder (COPD), asthma, and physical injuries are all contraindications for rapid orforceful yoga breathing. They recommend slow, gentle yoga breathing practices as being both safe and effective [3]. The evidence is clear and precise that yoga is one of the CAM therapies most explored by clients in the US. Its relevance into the psychiatric nursing practice is of priority and it will be integrated and promoted into future practice as a psychiatric nurse practitioner.