Growing Medical Recognition of Yoga as a Treatment for Anxiety

By Dr. Sat Bir S. Khalsa

Perceived stress and anxiety can be a normal and healthy response to life circumstances. But for some, the fast pace and uncertainty of modern society causes debilitating levels of stress and anxiety. Chronic, unmanaged stress hurts our quality of life and is responsible for an increase in health issues and disorders across the world. It is a psycho-social crisis that has been accelerated by the COVID-19 pandemic. Rates of anxiety in the U.S. have more than tripled in the second quarter, from 8.1% in 2019 to 25.5% in 2020. [1] The resulting negative emotions are not only traumatic, but also make our immune systems more vulnerable. Managing these draining emotions is difficult but doable.

Exercise, breathing techniques, relaxation and meditation have all been shown to mitigate anxiety. It is no surprise that traditional yoga — a practice that combines all four techniques — is what more people are relying on to manage their anxiety. However, yoga has not received the same level of attention from medical research. That is beginning to change. Health care professionals and researchers, like myself, are finding consensus around why yoga is such a powerful tool for regulating emotions and reducing anxiety.

Yoga as a Mind-Body Treatment

If anxiety increases, it may start to interfere with everyday activities and overall well-being and thereby meet the criteria for an anxiety disorder such as generalized anxiety disorder (GAD). Mentally, this includes pervasive day-long exaggerated worry and tension, inability to relax, difficulty concentrating, anticipation of disaster and excessive concern about life issues. Patients are unable to control this even though they realize that their anxiety is more intense than is warranted. However, many anxiety symptoms are actually physical, such as muscle tension, trembling, sweating and insomnia. Such symptoms are due to an activation of the fight or flight stress response, which prepares both the mind and body for real or imagined threats by causing significant changes in the body, mind and emotions.

Conventional medical treatments for anxiety include pharmaceuticals, which do not necessarily address the underlying causes of anxiety. Psychotherapeutic approaches, such as cognitive behavioral therapy (CBT; considered a gold standard behavioral GAD treatment), do address underlying mechanisms of anxiety in many patients, but they are not effective for all. Both approaches focus primarily on mental aspects of anxiety. Given the physical symptoms of anxiety, it follows that any successful anxiety treatment would be best if it addresses both the mind and body, which is what makes yoga such an effective option. Yoga can address both the symptoms and causes of anxiety, while strengthening the tools needed for emotional regulation.

Feelings of anxiety can quickly overwhelm us, leading to an automatic reactivity with no gap, filter or interval for response. Through practice, yoga breaks the patterns responsible for this automatic behavior. The meditation practice component of yoga works on improving self-regulation of the attention networks in your brain. As you gain more skill in the interface between your thought processes and emotion control, you simultaneously become more sensitive and less negatively reactive to your own thoughts and life situations. The physical components of yoga practice work effectively on anxiety symptoms in the body while also impacting mental functioning through the mind-body connection. Overall, these skills make it possible to have a degree of control over our emotional state and how we respond to stressful events. It’s what makes the mind-body practice of Yoga so powerful.

Evidence from the Scientific Community

Yoga’s positive impact on anxiety and anxiety disorders is supported by a growing body of research. Recent published meta-analyses (review papers summarizing statistical results from a number of previous clinical trials) of yoga for anxiety have concluded that yoga might be an effective and safe intervention for individuals with anxiety disorders or with elevated levels of anxiety. [2][3] Other researchers have found evidence to suggest that yoga for children and adolescents may also reduce anxiety — welcome news given that anxiety disorders are prevalent in younger people.[4]

Much of my own research has focused on Kundalini Yoga as a treatment for emotional and physical health. Kundalini Yoga is a traditional yoga practice that incorporates movement, postures, dynamic breathing techniques, deep relaxation, meditation and mantras. It is a yoga style focused on improving physical functioning, self-regulation of mind and body, increased mind-body awareness and enhancement of positive psychological states. These states include feelings of calm, balance, well-being, gratitude, compassion, and ultimately depth of self, transcendence, life purpose and meaning, and spirituality.

I have focused on understanding Kundalini Yoga’s efficacy in improving emotional well-being. That work has contributed to a study that showed positive benefits of a Kundalini Yoga treatment for post-traumatic stress disorder (PTSD).[5] I have also researched the potential benefit of enriching CBT with Kundalini Yoga to treat GAD.[6] The results showed statistically significant improvements in state and trait anxiety, depression, panic, sleep and quality of life, demonstrating its potential as a promising treatment for those suffering from GAD.

Following positive results of a preliminary study of Kundalini Yoga alone as a therapy for GAD,[7] our most significant research trial of Kundalini Yoga for GAD was published last August in the prestigious Journal of the American Medical Association Psychiatry. This large, rigorously conducted randomized controlled trial assigned patients with GAD to participate in a 12-week intervention of either Kundalini Yoga, CBT or a stress education control condition. Participants attended weekly group sessions and engaged in daily 20-minute home practice sessions. The results showed that Kundalini Yoga was a credible treatment. It was more effective than stress education in treating GAD, though not as effective as the CBT gold standard. Given that conventional treatments of GAD are not fully effective or easily accessible for everyone, these results are encouraging for the use of yoga as an additional treatment for anxiety and anxiety disorders. [8]

These findings are important steps toward establishing that traditional yoga (incorporating not just physical exercises but also controlled breathing, relaxation and meditation) is particularly effective at managing stress and emotion.

Practice at Home

While researchers continue to make the case to the medical establishment for yoga as treatment strategy, nothing is stopping you from using yoga as self-care. One of the many beautiful aspects of yoga is that it requires no special equipment — though a yoga mat is helpful — so there’s nothing to stop you from practicing Kundalini Yoga in your living room. Try a Kundalini sequence or meditation at home whenever you feel worried or anxious. It is always best to learn with a qualified Kundalini instructor to ensure that you are practicing properly, but there are plenty of techniques you can easily perform on your own while socially distancing during the pandemic. For a list of practices that beginners can use, visit https://www.3ho.org/kundalini-yoga/kriya/featured-kriyas.

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Editor’s note: This is a guest post by Dr. Sat Bir Singh Khalsa, Ph.D. Dr. Khalsa is the Director of Research for the Kundalini Research Institute, Research Associate at the Benson Henry Institute for Mind Body Medicine, and an Assistant Professor of Medicine at Harvard Medical School at Brigham and Women’s Hospital. His research on yoga for mental health in public schools, insomnia, anxiety disorders, and chronic stress; his Harvard e-book Your Brain on Yoga; and the medical textbook The Principles and Practice of Yoga in Health Care which he co-edited, have established him as a world-renowned yoga researcher, collaborator, author, and speaker.

^[1] https://www.washingtonpost.com/business/an-epidemic-of-depression-and-anxiety-among-young-adults/2020/08/22/dcc06c34-e43c-11ea-82d8-5e55d47e90ca_story.html

^[2] Cramer H, Lauche R, Anheyer D, Pilkington K, de Manincor M, Dobos G, Ward L. Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials. Depress Anxiety. 2018 Sep;35(9):830-843. doi: 10.1002/da.22762. Epub 2018 Apr 26. PMID: 29697885.

^[3] Hofmann SG, Andreoli G, Carpenter JK, Curtiss J. Effect of Hatha Yoga on Anxiety: A Meta-Analysis. J Evid Based Med. 2016;9(3):116-124. doi:10.1111/jebm.12204

^[4] Weaver LL, Darragh AR. Systematic Review of Yoga Interventions for Anxiety Reduction Among Children and Adolescents. Am J Occup Ther. 2015 Nov-Dec;69(6):6906180070p1-9. doi: 10.5014/ajot.2015.020115. PMID: 26565100.

^[5] Farah Jindani, Nigel Turner, Sat Bir S. Khalsa, “A Yoga Intervention for Posttraumatic Stress: A Preliminary Randomized Control Trial”, Evidence-Based Complementary and Alternative Medicine, vol. 2015, Article ID 351746, 8 pages, 2015. https://doi.org/10.1155/2015/351746

^[6] Khalsa MK, Greiner-Ferris JM, Hofmann SG, Khalsa SB. Yoga-enhanced cognitive behavioural therapy (Y-CBT) for anxiety management: a pilot study. Clin Psychol Psychother. 2015 Jul-Aug;22(4):364-71. doi: 10.1002/cpp.1902. Epub 2014 May 7. PMID: 24804619; PMCID: PMC4224639.

^[7] Gabriel MG, Curtiss J, Hofmann SG, Khalsa SBS. Kundalini Yoga for Generalized Anxiety Disorder: An Exploration of Treatment Efficacy and Possible Mechanisms. Int J Yoga Therap. 2018 Nov;28(1):97-105. doi: 10.17761/2018-00003. Epub 2018 Apr 26. PMID: 29698081.

^[8] Simon NM, Hofmann SG, Rosenfield D, et al. Efficacy of Yoga vs Cognitive Behavioral Therapy vs Stress Education for the Treatment of Generalized Anxiety Disorder: A Randomized Clinical Trial. JAMA Psychiatry. Published online August 12, 2020. doi:10.1001/jamapsychiatry.2020.2496