YOGA AND BREATHWORK PRACTICES AS AN ADJUNCT TREATMENT FOR DEPRESSION
Depression is a serious mental health condition that affects millions of people worldwide. Major depressive disorder (MDD) is a type of depression that is characterised by persistent feelings of sadness, hopelessness and a lack of interest in activities that were once enjoyable. Traditional treatment options for MDD include therapy, medication, and a combination of both. However, alternative therapies, such as Yoga and coherent breathwork, are also gaining attention as potential treatment options.
A couple of notable studies in recent years have specifically looked at the impact of Yoga and breathwork on MDD, both led by pioneering researchers in this field, Dr Patricia Gerbarg, Assistant Clinical Professor in Psychiatry, New York Medical College, and co-founder of the Body-Breath-Mind Foundation, and Christ Streeter MD, Associate Professor of Psychiatry at Boston University Chobanian & Avedisian School of Medicine. Treatment of Major Depressive Disorder with Iyengar Yoga and Coherent Breathing: A Randomized Controlled Dosing Study, was published in 2017 in the Journal of Alternative and Complementary Medicine; and A randomized controlled dosing study of Iyengar yoga and coherent breathing for the treatment of major depressive disorder: Impact on suicidal ideation and safety findings was published in 2018 in the journal Complementary Therapies in Medicine.
To give some background, Iyengar Yoga is a specific form of Yoga developing in the mid-20th century that emphasises very precise anatomical alignment in the body postures. It is known for its use of props, such as blankets, blocks and straps, to help students support their bodies to achieve the positions. Coherent or balanced breathing is taught through many Eastern spiritual practices and involves breathing at a rate of about 5-6 breaths per minute with equal length inhales and exhales – 5 counts on the inhale, 5 counts on the exhale. Many of us breathe too rapidly, which keeps our nervous system in an activated state, raising heart rate and blood pressure and making us more susceptible ot anxiety. Coherent breathing slows everything down, balancing nervous system function and having a systemic calming effect on our entire body-mind. Interestingly, studies have found that monks and other meditators naturally settle into this breathing pattern during their meditative practice.
One of the most worrying symptoms of depression is suicidal ideation (SI). the above studies of individuals with MDD found that a Yoga intervention, which included Iyengar Yoga and coherent breathing, resulted in significant reductions in suicidal ideation by reducing reported levels of stress and anxiety, and increasing feelings of wellbeing. During the 2018 study, 8 out of 9 participants experienced resolution of SI, with only mild side effects that were primarily musculoskeletal in nature - normal if practicing postural Yoga for the first time. A limitation of both these studies is their small sample sizes (the number of people that took part), however, they were designed to provide some preliminary data concerning the safety and efficacy of this kind of intervention with those living with MDD, to explore whether further and bigger trials would be warranted. Gerbarg and Streeter have done further research to uncover the physiological mechanisms that may be at work at the molecular level in terms of beneficial effects of body-breath-mind practices, in particular looking at the impact of these practices of levels of a neurotransmitter called gamma-aminobutyric acid (GABA), which plays an important role in calming the activity of our sympathetic nervous system (activating, fight or flight) and regulating our mood.
It's important to note that while Iyengar Yoga may be helpful in treating MDD and reducing suicidal ideation, it is important for individuals with MDD to consult with a mental health professional to discuss treatment options. Additionally, while Yoga is generally considered safe, it can be contraindicated for some individuals with certain physical or mental health conditions, so it is important to speak to a a doctor and/or qualified Yoga teacher to determine if Iyengar Yoga is appropriate.
For example, with its emphasis on very strict and precise alignment of the body and intensive use of straps and other props, it has the potential to be triggering for someone who is living with the effects of trauma, especially relational trauma in which they may have been victims of coercive behaviour. In trauma sensitive Yoga, it is more important to offer people choice and agency in their practice, and to let them know that everything is optional, so that they can gently explore their bodies with curiosity and re-befriend them, rather than forcing them into shapes that may not feel good. The ‘method’ section of the studies does however note that the Iyengar practice was adapted for these cohorts.
