People suffering from depression are looking to yoga as a complement to traditional therapies to lessen symptoms of depression, says a study presented in July at the 125th Annual Convention of the American Psychological Association.
The research focused on the acceptability and antidepressant effects of hatha yoga – the branch of yoga that emphasizes physical exercises along with meditative and breathing exercises to enhance well-being. In the study, 23 male veterans participated in twice-weekly yoga classes for eight weeks. On a one-to-10 scale, the average enjoyment rating for the yoga classes was 9.4. All participants said they would recommend the program to other veterans – but more importantly – participants with elevated depression scores before the yoga program had a significant reduction in depression symptoms after the eight weeks.
“Yoga has become increasingly popular in the West, and many new yoga practitioners cite stress-reduction and other mental health concerns as their primary reason for practicing,” said Lindsey Hopkins, PhD, of the San Francisco Veterans Affairs Medical Center. “But the empirical research on yoga lags behind its popularity as a first-line approach to mental health.”
Hatha And Heated Yoga
Another, more specific, version of hatha yoga commonly practiced in the West is Bikram yoga, also known as heated yoga. Sarah Shallit, MA, of Alliant University in San Francisco investigated Bikram yoga in 52 women, ages 25 to 45. Just more than half were assigned to participate in twice-weekly classes for eight weeks. The rest were told they were wait-listed and used as a control condition.
All participants were tested for depression levels at the beginning of the study, as well as at weeks three, six and nine. Shallit and her co-author Hopkins, found that eight weeks of Bikram yoga significantly reduced symptoms of depression compared with the control group. In the same session, Maren Nyer, PhD, and Maya Nauphal, BA, of Massachusetts General Hospital, presented data from a pilot study of 29 adults that also showed eight weeks of at least twice-weekly Bikram yoga significantly reduced symptoms of depression and improved other secondary measures including quality of life, optimism, and cognitive and physical functioning.
“The more the participants attended yoga classes, the lower were their depressive symptoms at the end of the study,” said Nyer, who currently has funding from the National Center for Complementary and Integrative Health to conduct a randomized controlled trial of Bikram yoga for individuals with depression. Nina Vollbehr, MS, of the Center for Integrative Psychiatry in the Netherlands presented data from two studies on the potential for yoga to address chronic and/or treatment-resistant depression. In the first study, 12 patients who had experienced depression for an average of 11 years participated in nine weekly yoga sessions of approximately 2.5 hours each.
The researchers measured participants’ levels of depression, anxiety, stress, rumination and worry before the yoga sessions, directly after the nine weeks and four months later. Scores for depression, anxiety and stress decreased throughout the program, a benefit that persisted four months after the training. Rumination and worry did not change immediately after the treatment, but at follow-up rumination and worry were decreased for the participants.
Yoga And Relaxation
In another study – this one involving 74 mildly depressed university students – Vollbehr and her colleagues compared yoga to a relaxation technique. Individuals received 30 minutes of live instruction on either yoga or relaxation and were asked to perform the same exercise at home for eight days using a 15-minute instructional video. While results taken immediately after the treatment showed yoga and relaxation were equally effective at reducing symptoms, two months later, the participants in the yoga group had significantly lower scores for depression, anxiety and stress than the relaxation group.
“These studies suggest that yoga-based interventions have promise for depressed mood and that they are feasible for patients with chronic, treatment-resistant depression,” said Vollbehr.
The concept of yoga as complementary or alternative mental health treatment is so promising that the U.S. military is investigating the creation of its own treatment programs. Jacob Hyde, PsyD, of the University of Denver Hopkins, noted that the research on yoga as a treatment for depression is still preliminary. “At this time, we can only recommend yoga as a complementary approach, likely most effective in conjunction with standard approaches delivered by a licensed therapist,” Hyde said. “Clearly, yoga is not a cure-all. However, based on empirical evidence, there seems to be a lot of potential.”
Yoga Reducing Back Pain
In another study also unveiled in July, researcher Dr. Erik J. Groessl and his team from the VA San Diego Healthcare System found that veterans who completed a 12-week yoga program had better scores on a disability questionnaire, improved pain intensity scores, and a decline in opioid use. That study included 150 military veterans with chronic low back pain. Groessl is a researcher with the VA San Diego Healthcare System and the University of California, San Diego School of Medicine. The study was published in the American Journal of Preventive Medicine on July 20, 2017. The study shows promise for non-drug treatment of chronic low back pain, said Groessl.
“To be able to reduce the reliance upon opioids and other medications with side effects, it is crucial to establish evidence showing mind-body practices like yoga provide benefit in both veterans and non-veterans with chronic pain,” he said.
Veterans in the study who were randomized to the yoga group attended a 12-week yoga program immediately after randomization. Comparison participants were invited to attend the yoga intervention only after six months. The 12-week yoga intervention consisted of two 60-minute, instructor-led yoga sessions per week, with home practice sessions encouraged. The intervention was based on the previously mentioned hatha yoga, which involves yoga postures and movement sequences, along with regulated breathing and mindfulness meditation. Outcomes were assessed at the baseline, six weeks, 12 weeks and six months.
Both study groups had reductions in disability scores after 12 weeks. However, notable differences emerged at the six-month assessment, with scores continuing to drop in the yoga group but increasing in the delayed-treatment group. Along with those improvements, pain intensity decreased in the yoga group at all three time periods, while the delayed-treatment group had negligible changes.
There was also a 20 percent drop in opioid pain medication use at 12 weeks in both groups as determined through self-report questionnaires and a review of medical records. Reductions in disability and pain intensity were found despite the reductions in opioid use and other medical and self-help pain treatments at six months. The trial confirms the findings of two prior randomized controlled trials with non-veterans showing that yoga is safe and can reduce pain and disability among adults with chronic low back pain.
Expanding Formal Yoga Programs
The study is one of the first to demonstrate the effectiveness of yoga specifically in military veterans, a population that faces more health challenges and may be harder to treat than non-VA populations, say the researchers. They point out that as with other non-drug treatments for chronic low back pain, yoga may not help everyone or may not completely eliminate chronic low back pain, but reduced pain and disability can often maintained long-term with ongoing yoga home practice.
The team says that given the results of their study, VA facilities nationwide may want to consider developing and expanding formal yoga programs to help veterans with back pain. Many VA facilities already do offer yoga classes, along with other complementary and integrative health programs.