The Use of Yoga as an Adjunctive Treatment for Psychiatric Illness in Children and Adolescents
Kirti Saxena, M.D., Associate Professor of Psychiatry, Baylor College of Medicine/ Texas Childrens Hospital
Lex Gillan, ERYT (Experienced Registered Yoga Teacher), The Yoga Institute
Ramandeep Singh
Beenish Syed
OBJECTIVE
In recent years, the use of complementary and alternative medicine (CAM) techniques have grown both in popularity and within the research literature. The National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) explains this category of medicine as “focused on the interactions among the brain, mind, body, and behavior, and on the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health.” More parents are seeking CAM therapies due to concern of negative side-effects their children may experience from traditional pharmacological treatment. While research in CAM for medical and psychiatric illnesses is increasing, there are few studies that evaluate its use and appeal in pediatric populations, a group that is often exposed to CAM due to cultural practices, beliefs of parents, and high sensitivity to side effects of medications. The focus of CAM on mind, body, and behaviors has particular influence on adolescent populations, a period when many psychiatric disorders have age of onset, and therefore, it is beneficial to evaluate common evidence-based CAM treatments in pediatric populations. Whereas medications serve solely to control symptoms, the potential benefits of CAM techniques, such as yoga and meditation, teach behavioral and social skills, which once acquired can be used for long-term benefits with ongoing practice. The objective of this workshop is to demonstrate how yoga, along with standard treatments for mental illnesses in children and adolescents, has the potential to reduce symptom severity. There will also be a discussion regarding when it is appropriate to consider the practice of yoga and meditation for children and adolescents with psychiatric illnesses. This workshop will be conducted by a yoga practitioner with extensive years of experience and a child and adolescent psychiatrist.
METHODS
This workshop will begin with a PowerPoint presentation introducing a literature review on the effectiveness of yoga within psychiatric populations. Next, a yoga instructor with 42 years of teaching experience, will teach yoga postures, breathing practices, and meditations that have been shown to have a positive effect on mood, inattention, and impulsivity, to name a few benefits. All of the practices will be included within the class syllabus. Another certified yoga instructor will assist with the instruction. Participants will experience a potpourri of classic hatha yoga postures including standing, stretching, twisting, bending, balancing, and inversions that cultivate straight posture, suppleness of body, strength and muscle tone that help the hundred joints, nine openings, and six organs to all function optimally. The style of hatha yoga that will be taught is Vinyasa Krama (translation: a series of yoga postures focusing on specific body areas) out of the Krishnamacharya lineage. Krishnamacharya (1888-1988) is considered to be the Father of Modern Postural Yoga, having transformed the yogic landscape in the West since the 1950s. Practitioners will be exposed to how backward arching postures can open the ribcage and allow for expansion of the heart and lungs which is associated with psychic and physiological benefit, as well as how posture can affect physical presence. Following the yoga postures, attendees will be taught several different meditation practices. As we meditate, three things happen: the mind quiets, as the mind quiets concentration deepens, and with deepening concentration, there is clarity in thinking and improvement in the ability to focus. The fastest way to quiet the mind is through the breath; thus, the segue to meditation practices will be a variety of pranayama (controlled breathing) techniques. Participants will also experience how mindfulness creates a presence that quiets a discontent mind and how different ratios of breathing (in breath/out breath) can bring about both relaxing and energizing effects. The workshop will conclude with an interactive discussion of applicability in a community-based setting with limited access, affordability, and stigma against mental health therapy.
RESULTS
Four out of the ten most common CAM techniques used by children are yoga based (Birdee et al., 2009). Many studies have already examined the benefits of teaching yoga to children with various psychiatric diagnoses, including youth diagnosed with ADHD (Harrison et al., 2004), psychiatrically hospitalized adolescents with depression and adjustment disorders, children with anxiety (Stueck & Gloeckner, 2005), and adolescent females diagnosed with eating disorders (Carei et al., 2010). The evidence presented within this workshop supports the many mental health benefits gained from practicing yoga and meditation, including the areas of emotional well-being (anxiety, depression, anger, stress management, emotional regulation, self-esteem), behavior, executive functioning (academic performance and attention), interpersonal domains (peer interactions and parent-child relationships), and even physical well-being (sleep and energy). In addition, the research to date reveals the efficacy of yoga and meditation techniques with a variety of healthy and psychiatric populations. This workshop hopes to show community and academic practitioners that yoga is an acceptable adjunctive treatment to address common psychiatric symptoms of irritability, distractibility, poor communication, anxiety, and insomnia.
CONCLUSIONS
The use of CAM techniques are favorable as they are cost-effective, typically offered in group contexts, low-risk, and free of the side-effects experienced within pharmacological treatment. The general benefit of yoga for non-psychiatric and psychiatric pediatric populations alike creates potential for preventive interventions such as group yoga practice in school settings, as well as community settings like youth organizations and places of worship. The integration of yoga into local community practice will address access to care barriers such as poverty, low parental education on the need for treatment of mental illnesses, transportation problems, and excessive wait times by being an aspect of cultural competence that integrates alternative health beliefs with psychiatric treatment. It is also important for practitioners to experience and evaluate the variety of meditative practices, determining the most effective and developmentally appropriate techniques, as well as proper frequency and length of intervention for achieving optimum results. Yoga addresses affordability, accessibility, and stigma issues for patients with psychiatric illnesses. Studies have shown that yoga is efficacious as an adjunctive treatment in ADHD, depression, anxiety, and substance disorders. It is important for practitioners to understand the type of yoga classes they refer their patients to, as well as breathing and meditation techniques they can easily teach to their patients.
Lex Gillan, ERYT (Experienced Registered Yoga Teacher), The Yoga Institute
Ramandeep Singh
Beenish Syed
OBJECTIVE
In recent years, the use of complementary and alternative medicine (CAM) techniques have grown both in popularity and within the research literature. The National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) explains this category of medicine as “focused on the interactions among the brain, mind, body, and behavior, and on the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health.” More parents are seeking CAM therapies due to concern of negative side-effects their children may experience from traditional pharmacological treatment. While research in CAM for medical and psychiatric illnesses is increasing, there are few studies that evaluate its use and appeal in pediatric populations, a group that is often exposed to CAM due to cultural practices, beliefs of parents, and high sensitivity to side effects of medications. The focus of CAM on mind, body, and behaviors has particular influence on adolescent populations, a period when many psychiatric disorders have age of onset, and therefore, it is beneficial to evaluate common evidence-based CAM treatments in pediatric populations. Whereas medications serve solely to control symptoms, the potential benefits of CAM techniques, such as yoga and meditation, teach behavioral and social skills, which once acquired can be used for long-term benefits with ongoing practice. The objective of this workshop is to demonstrate how yoga, along with standard treatments for mental illnesses in children and adolescents, has the potential to reduce symptom severity. There will also be a discussion regarding when it is appropriate to consider the practice of yoga and meditation for children and adolescents with psychiatric illnesses. This workshop will be conducted by a yoga practitioner with extensive years of experience and a child and adolescent psychiatrist.
METHODS
This workshop will begin with a PowerPoint presentation introducing a literature review on the effectiveness of yoga within psychiatric populations. Next, a yoga instructor with 42 years of teaching experience, will teach yoga postures, breathing practices, and meditations that have been shown to have a positive effect on mood, inattention, and impulsivity, to name a few benefits. All of the practices will be included within the class syllabus. Another certified yoga instructor will assist with the instruction. Participants will experience a potpourri of classic hatha yoga postures including standing, stretching, twisting, bending, balancing, and inversions that cultivate straight posture, suppleness of body, strength and muscle tone that help the hundred joints, nine openings, and six organs to all function optimally. The style of hatha yoga that will be taught is Vinyasa Krama (translation: a series of yoga postures focusing on specific body areas) out of the Krishnamacharya lineage. Krishnamacharya (1888-1988) is considered to be the Father of Modern Postural Yoga, having transformed the yogic landscape in the West since the 1950s. Practitioners will be exposed to how backward arching postures can open the ribcage and allow for expansion of the heart and lungs which is associated with psychic and physiological benefit, as well as how posture can affect physical presence. Following the yoga postures, attendees will be taught several different meditation practices. As we meditate, three things happen: the mind quiets, as the mind quiets concentration deepens, and with deepening concentration, there is clarity in thinking and improvement in the ability to focus. The fastest way to quiet the mind is through the breath; thus, the segue to meditation practices will be a variety of pranayama (controlled breathing) techniques. Participants will also experience how mindfulness creates a presence that quiets a discontent mind and how different ratios of breathing (in breath/out breath) can bring about both relaxing and energizing effects. The workshop will conclude with an interactive discussion of applicability in a community-based setting with limited access, affordability, and stigma against mental health therapy.
RESULTS
Four out of the ten most common CAM techniques used by children are yoga based (Birdee et al., 2009). Many studies have already examined the benefits of teaching yoga to children with various psychiatric diagnoses, including youth diagnosed with ADHD (Harrison et al., 2004), psychiatrically hospitalized adolescents with depression and adjustment disorders, children with anxiety (Stueck & Gloeckner, 2005), and adolescent females diagnosed with eating disorders (Carei et al., 2010). The evidence presented within this workshop supports the many mental health benefits gained from practicing yoga and meditation, including the areas of emotional well-being (anxiety, depression, anger, stress management, emotional regulation, self-esteem), behavior, executive functioning (academic performance and attention), interpersonal domains (peer interactions and parent-child relationships), and even physical well-being (sleep and energy). In addition, the research to date reveals the efficacy of yoga and meditation techniques with a variety of healthy and psychiatric populations. This workshop hopes to show community and academic practitioners that yoga is an acceptable adjunctive treatment to address common psychiatric symptoms of irritability, distractibility, poor communication, anxiety, and insomnia.
CONCLUSIONS
The use of CAM techniques are favorable as they are cost-effective, typically offered in group contexts, low-risk, and free of the side-effects experienced within pharmacological treatment. The general benefit of yoga for non-psychiatric and psychiatric pediatric populations alike creates potential for preventive interventions such as group yoga practice in school settings, as well as community settings like youth organizations and places of worship. The integration of yoga into local community practice will address access to care barriers such as poverty, low parental education on the need for treatment of mental illnesses, transportation problems, and excessive wait times by being an aspect of cultural competence that integrates alternative health beliefs with psychiatric treatment. It is also important for practitioners to experience and evaluate the variety of meditative practices, determining the most effective and developmentally appropriate techniques, as well as proper frequency and length of intervention for achieving optimum results. Yoga addresses affordability, accessibility, and stigma issues for patients with psychiatric illnesses. Studies have shown that yoga is efficacious as an adjunctive treatment in ADHD, depression, anxiety, and substance disorders. It is important for practitioners to understand the type of yoga classes they refer their patients to, as well as breathing and meditation techniques they can easily teach to their patients.