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Editorial
Yoga in Psychiatry: An Examination of Concept,
Efficacy, and Safety
WHAT DO PSYCHIATRISTS MEAN WHEN Yoga Sutras, which have aphorisms on yoga. Whatever
THEY TALK ABOUT YOGA? evidence is available suggests that he lived around
100 BC. His yogic system borrows many ideas and
Yoga is an ancient Indian practice with a particular concepts from Kapila’s Sām. khya School of Philosophy.[1]
worldview and psychology. Because of its indigenous
and ancient character, yoga has perennially evoked Yoga is a Sanskrit word for union. Patañjali practically
interest in the minds of intellectual Indian researchers defines yoga as the final annihilation (Nirodha) of
and physicians. Over the last century, it has captured the all the mental states (Cittavŗtti) through progressive
interest of the Western world and has garnered millions stages to attain a steadied mind with particular types
of followers across all nations. Since June 2015, the world of graduated mental states.[2] The ultimate goal as
community has even started celebrating the International described by Patañjali is the attainment of a particular
Yoga Day. In the backdrop, with such an interest, we will spiritual mind state which is variably called Moksha and
discuss the available research and its implications for the Satcitānanda (which can be translated as salvation or
practice of psychiatry in the 21st century. union with ultimate reality).

When health‑care professionals talk about yoga, Over centuries, many systems of yoga have been
they usually discuss either its usefulness as a developed. The prominent ones which now exist are Hatha
lifestyle intervention or as a potential treatment for yoga, Mantra or Japa yoga, Surat‑Shabd yoga (also known
physical and psychological problems. The health‑care as Nam Bhakti), Kundalini yoga, Tantra yoga (popularized
community, particularly mental health community, is by Bhagawan Rajneesh/Osho), etc., Out of these, Hatha
currently interested in the physical exercises (Hatha yoga is the most popular kind in our day which has its
Yoga or Pranayama) and few ill‑defined meditative emphasis on physical exercises or asanas, while Kundalini
practices (such as Dhyana in Mantra Yoga). Hence, yoga with its Pranayama and Mantra yoga with its Dhyana
the focus is less on the mystical‑spiritual aspects of are also well practiced and popular. The particular
yoga and more on the measurable/interventional and practices such as asanas, Dhyana and Pranayama of these
physical‑psychological aspects (this specific narrower three prominent schools have claimed specific physical
aspect will be called as “Yoga therapy” in this article and psychological health benefits.[3]
to differentiate it from the broader wholesome
term – which is merely called ‑ yoga). Recent research in REVIEW OF LITERATURE
psychiatry has been in search of the empirical evidence
for the usefulness of yoga therapy as complimentary There is a lot of research literature on yoga as a therapy
or solitary therapeutic agent in psychiatric treatment. for physical and psychological problems. We will discuss
few relevant individual studies and reviews on yoga
A BRIEF CONCEPTUAL HISTORY OF YOGA therapy in psychiatric disorders.

The practice of yoga might have been present long Anxiety and depression
before it was systematized by Patañjali in his book, There are many studies[4‑6] showing improvement in
anxiety and depressive symptoms (level 3 evidence[7])

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DOI: How to cite this article: Reddy MS, Vijay SM. Yoga in psychiatry:
10.4103/0253-7176.185948 An examination of concept, eficacy, and safety. Indian J Psychol Med
2016;38:275-8.

© 2016 Indian Psychiatric Society | Published by Wolters Kluwer ‑ Medknow 275

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Reddy and Vijay: Yoga in psychiatry

which is attributable to yoga therapy, this was Research on the mechanism of action
similar to improvement due to physical exercise. Proposals have been made with regard to the mechanism
Most studies might have been done on people with of action of yoga therapy. Action on sympathetic nervous
mild‑to‑moderate anxiety or depression. Very few system and hypothalamo‑pituitary‑adrenal axis with
studies done on melancholic depression have found measurable reduction in cortisol levels[21] is the most
inferiority to electroconvulsive therapy, but not to drug common view in people with depression and anxiety
treatment.[8] Hence, yoga therapy may be used as an while others have posited increase in brain‑derived
add‑on treatment in this population. neurotrophic factor.[22] In people with schizophrenia,
an increase in oxytocin levels was observed postyoga
Eating disorders therapy, and thereby the related vagal nerve stimulation
Available studies[9,10] suggest that yoga therapy is useful is postulated as a mechanism.[23] In a study with seven
in anorexia nervosa, bulimia nervosa, and binge eating healthy elderly people, neuroimaging studies suggested
disorder. an increase in the hippocampal gray matter volume after
yoga therapy.[24] These studies are preliminary, based
Schizophrenia on small sample sizes, from single research center and
Although many studies[11,12] reported a reduction in thereby need replication.
“psychiatric symptoms” in schizophrenia with yoga
therapy as an add‑on which was also true of Tai Chi Limitations in the studies
and progressive muscle relaxation, they have not The quality of the evidence in most of the research
defined these symptoms specifically. There is limited on yoga therapy is compromised due to the high
evidence for effectiveness in anxiety and stress‑related attrition rates, small sample sizes, and short duration
symptoms in schizophrenia. Few reviews suggest of follow‑up in many studies.[5,9,14‑16,25] Absence of
moderate or no evidence for effects on social function information regarding randomization, adverse effects,
and positive and negative psychotic symptoms.[13] A and details of yoga therapy module also damages
Cochrane review[14] describes the available evidence on quality.[16,25] Some studies were also prone to selection
yoga therapy as an add‑on treatment in schizophrenia bias.[9] Generalization of findings and systematic review
as limited and weak. process was affected by varying therapy modules, study
populations, outcome variables, and the varying quality
Obsessive–compulsive disorder and attention of studies.[18,26] For better evidence, many reviews
deficit‑hyperactivity disorder suggest robust designs, larger samples, and randomized
The studies on yoga therapy for obsessive–compulsive controlled trials. However, the research scene is
disorder (OCD) are methodologically weak and they changing with attempts to construct well‑researched
report a tentative support for mindfulness meditation, therapy modules for depression[27] and for the elderly
electro‑acupuncture, and Kundalini yoga.[15] However, population.[3]
Kundalini yoga when compared to relaxation was
not found to be effective in OCD.[16] In attention ARE THERE ANY ADVERSE EFFECTS DUE
deficit‑hyperactivity disorder, available studies and TO YOGA? YES!
a Cochrane review[17] did not find any differences
between yoga therapy and standard treatment on the The knowledge of adverse effects due to any therapy
rating scales. helps us to modify the intervention and to some
extent predicts the patient compliance and the overall
Sleep disorders treatment course. Many studies on yoga therapy do
Yoga therapy has a moderate effect in sleep improvement not report on adverse effects. Adverse effects due to
in elderly.[18] While yoga therapy was recommended in yoga are popularly known, but only few are published.
restless leg syndrome, reviews have not found good Compressive myelopathy in a report was attributed to
quality evidence to support such “pseudo‑professional a yogic pose called Sirsasana (headstand).[28] Popular
recommendation.”[19] books and websites by prominent yoga practitioners and
gurus[29‑31] warn against probable disturbances associated
Parkinson’s disease and other neuropsychiatric with Kundalini awakening including depressive and
conditions anxiety symptoms, physical pain, suicidal tendencies,
Yoga therapy along with general exercise, robotic‑assisted burning sensation, and possible psychotic breakdown.
training, Tai Chi, Qi Gong and dance therapy, Dr. Bonnie Greenwell,[32] yoga practitioner and clinical
neurofeedback‑based techniques, etc., have shown a psychologist, warns that emotional upheavals with
significant effect on the quality of life, depression level, Kundalini yoga can resemble psychotic breakdowns,
and balance in patients with Parkinson’s disease.[20] wherein the person might feel unattached to reality and

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Reddy and Vijay: Yoga in psychiatry

agitated. These adverse effects should be scientifically CONCLUSION

studied and characterized for assessing the safety and
tolerability of yoga therapy. Yoga therapy might have a therapeutic potential which
can be tapped for the people with psychiatric illness.
QUESTIONS TO BE ADDRESSED IN THE Although its lifestyle benefits and usefulness as an
FUTURE RESEARCH OF YOGA add‑on therapy in mild depression and anxiety are
apparent, good quality evidence is required in psychiatric
Yoga therapy though showing tremendous potential for illnesses to come to any conclusion. The encouraging
its utility in psychiatry should be rigorously evaluated neurobiological research on the mechanisms of action
to produce generalizable, level‑1 empirical evidence. is ongoing which might give more insights about this
We place the following research questions before the therapy. Cultural and academic psychiatrists have to
scientific community for future study and discussion. probe further into the various research questions raised
• How is the effect and neurobiology of Hatha yoga and focus more on the study of adverse effects due to
exercises different from that of any other physical this intervention.
exercise or progressive muscle relaxation?
• Can (or should) we differentiate between the
beneficial effects of various Eastern spiritual M. S. Reddy, M. Starlin Vijay
practices (which have been together called
Asha Bipolar Clinic, Asha Hospital, Hyderabad,
meditative movement interventions) such as yoga,
Telangana, India.
Qi Gong, Tai Chi, mindfulness, or Zen meditation? E‑mail: drmsreddy@gmail.com
• For what specific psychiatric conditions, is the
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