The Classical Definition of Yoga and Modern Mental Health

Yoga has always been a practice devoted to mental health. In the Yoga sutras considered to be the original text yogic text, attributed to the scholar Patanjali, it is defined as yoga_ citta-v_tti-nirodha, which literally translates as yoga causes the cessation of wavering consciousness in the mind. Basically, this means yoga keeps the mind focused and extricates the elements of worry, doubt and restlessness helping to promote complete mental harmony. Hence, yoga perceives mental imbalance as something triggered by a mind that does not know itself. To rectify this lack of equilibrium it prescribes a process of mental development that incorporates all elements of the person. Consequently, the use of yoga in the treatment of mental health issues is not a novel idea, but rather a classical one, which, in the modern world, is infused with a current conception of the mind and body. 

In its traditional form yoga is a path of mental training that originally deemed its aspirant was seeking enlightenment and total union with god, with self, with mind and body. This is reflected in the definition of yoga, namely union, coming from the Sanskrit word yug meaning to yoke. To achieve this union a wholistic approach was advised as yoga believes all facets of the human being are interdependent. To summarize this philosophy, body, mind, and actions all affect each other and are intricate forces of joint and reciprocal creation, i.e. physical states affect mental states, mental states affect the bodily states and actions are affected by and have the capacity to affect the mind and the body. Thus, if one is to fully influence mental health the entire physical and psychological being must be cultivated. Not surprisingly yoga incorporates codes of conduct and behavioral stipulations that support well-being, in conjunction with physical movement and mental training. In this way, the yogic path to well-being harnesses the combined power of physical and mental energy to create a complete sense of well-ness and connection to all things. From a Westernized perspective one could say yoga accounts for the psychological and physiological relationship that leads to mental discord and uses this connection to remedy mental suffering through a very comprehensive approach to emotional healing.

For many this usurps the popular view of yoga as mere physical exercise and stretching and contextualizes these elements within a more elaborate system of personal development. In actuality yoga postures are only one of eight elements of a comprehensive eight-fold approach. This method is known as the eight limbs which collectively endeavor to provide deep transformation.

The Eight Limbs

1) The Yamas are ethical standards, which are meant to keep a practitioner mindful and aware of how action affects self and others. This includes such ethical standards as don't kill, don't steal, and don't think negatively of others. The Yamas are not a moral code designating right and wrong, but rather an explanation of behaviour that is believed to foster mental health and personal clarity.

2) The Niyamas are discipline and observances. This involves things such as how to take care of the body (including ablutions), studying the self, studying yogic texts, and surrendering to a higher force etc as a means to relinquish a self-centered view of the world.

These first two limbs express understanding of the importance of discipline, conduct, and perception in the role of mental health. So there is an obvious association with the Behavioural and Cognitive therapeutic schools of thought. Basically, how one acts can alter how one thinks.

3) Asana is the actual postures, which serve to aid flexibility, allow for ease in the physical body and improve general functioning of systems. This further promotes happiness, and rebalances the physiology of the body to assist in maintenance of mental health.

4) Pranayama is breath exercises that help to regulate energy and stimulate a state of alert relaxation. In the classical sense pranayama also teaches a person to control one's life force and to moderate mood through regulation of energy. In scientific terms we might say that pranayama is a breath practice designed to stimulate both the parasympathetic and sympathetic aspects of the autonomic nervous system permitting greater regulation of physiological responses to experience.

5) Pratyhara translates as withdrawal of the senses. The premise here is not to shut out the world, but rather to more deeply engage with the inner world.Yoga asserts that conflict is a repercussion of one's own mind rather than of external factors, although they may act as a stimulus. Pratyhara is both a teaching and an invitation to attend to what is happening in the mind and body, both at times of difficulty and joy. Often individuals who lack mental calm seek external gratification or distraction to avoid the world of the self when suffering arises, or alternatively seek to place blame on persons and conditions in order to abdicate responsibility, thereby hindering the self-knowledge that can lead to transformation. By drawing attention inward through Pratyhara practice, one guided to reassess situations and experience. Although this may seem above and beyond the context of a regular yoga class it need not be. By holding students in maintainable yet challenging poses for long periods of time certain escapist tendencies, mental strategies, self-judgments and doubts often arise. In this scenario students can be directed to look inward and view these thought patterns and reactions in an environment that is a safe training ground as immediate relief follows with the exiting of the pose. Here the focus is on non-judgmental awareness of sensations and mental states leading onward to self-knowledge.

6) Dharana is concentration where the mind learns to stay with one point. According to yogic philosophy it is the wavering mind that causes mental tension. Dharana is the first step in beginning to tame this pattern. For students with mental issues this can be a difficult task and must be taken slowly and lightly. Too much quiet time devoted to concentration can lead to rumination instead. However, Dharana practice can be easily integrated into a class by using balancing poses. In order to balance one must concentrate, hence, if one fails to concentrate balancing poses are quite difficult. To promote balance one must be aware of the body, focus the eyes and keep the attention on the breath. This prevents the mind from jumping about and assists in the development of concentration and mental balance.

The next two limbs are part of the greater spiritual path leading to union with god and enlightenment. Both fall outside of the realm of a regular yoga class and someone with mental issues would struggle to practice them. The other six limbs serve as preliminaries for the last two and so one who spent time sincerely working with the other steps would be able to move forward to the last two. 

7) Dhyana is a deep unwavering and focused concentration. It is basically a deep meditative state where the mind remains stable and fixed in one point. One who practices Dhyana has a mind that is malleable, and lucid.

8) Samadhi a deep meditation that offers permanent transformation and is colored with ecstatic feeling and connection to all things.

Why is Yoga Unique in Its Approach?

It should be clear from my enumeration of these eight limbs that yoga is very comprehensive in its approach towards mental health. With a deep understanding of the body and mind traditional yoga aims to support changes in body systems through breath and postures thus rebalancing bodily systems while also teaching the mind how to reflect, become clear and make better and wiser choices. For this reason I believe that yoga is wonderful complementary treatment for mild depression, anxiety and trauma. Furthermore the yogic path is a progression forwards mapped by a students own capacity to open and let go within the context of physical stretches breathing exercise that help to create pleasant feeling. This provides a cushion against the backdrop of mental tension making it just a little easier to digest. So basically yoga is like a feel good practice in the short-term that can also provide long-term relief.

How Does Yoga Actually Create a Sense of Well-Being?

Rather than espousing one particular idea I would like to offer various reflections these include the yogic perspective, the scientific or biological perspective and the psychotherapeutic perspective.

The Yogic Perspective  

According to Yogic philosophy one has a life force or energy called prana. Through yogic practice one can learn to harness this energy, strengthen this energy and allow this energy to flow in a way that perfectly aligns with universal force. Through asana, pranayama, concentration and self knowledge one is thereby able to direct prana in the correct way leading to physical strength and mental transformation. 

The Biological Model

In the West and also in India yoga has been studied from a scientific perspective in order to understand how it works within our biological idea of the person. From this viewpoint depression is seen as something more chemically and biologically based. (I would like to qualify that I believe modern science appreciates the mind body brain connection, even if these terms are debated. I don't think most would argue that thoughts affect the physiology of the body as the physiology reciprocally affects the thoughts). In this model of the person, yoga is perceived to be affective as it offers practices that are able to physiologically regulate mood.

At this point in time a number of studies have been conducted to assess yoga's ability to positively affect depressive and anxious states; however, more research certainly needs to be done. Additionally, there is no firm agreement as to exactly why yoga is affective in treating depression and anxiety, but rather various areas of research that investigate specific features indicative of depression and measure yoga's affect on these particulars. In an attempt to collaborate some of this evidence and determine if yoga base interventions are an attractive option in the treatment of depression Pilkington, Kirkwood, Rampes, and Richardson in 2005 compared various studies. Overall the group ascertained that from a physiological perspective yoga is affective due to "modulation of autonomic nervous tone and consequent reduction in sympathetic tone, activation of antagonistic neuromuscular systems, which may increase relaxation response in neuromuscular system and stimulation of limbic system" p 15  Timothy McCall M.D., the author of Yoga as Medicine complements this hypothesis when he remarks that yoga is effective in treating mental health issues because it balances and stimulates both the parasympathetic and sympathetic nervous system, which leads to a deeper relaxation response than simply stimulating the parasympathetic part of the autonomic nervous system. This is achieved through a combination of asanas and breathing techniques.

Moving to more specific affects of yoga on the physiology of the person I would like to cite four important studies. The first was conducted at Jefferson Medical College in Philadelphia in cooperation with the Yoga Research Society. Here researchers found that Cortisol levels dropped dramatically in both men and women after a one hour session of yoga. High levels of Cortisol are concomitant with stress (and depressive states) while lower levels indicate relaxation.

Secondly, a small but important study was conducted in Scandinavia by Eric Hoffman. Brain waves were measured both before and after a two hour Kriya yoga class. Hoffman found that after class each class there was a forty percent average increase in alpha and theta waves in the brain. As alpha waves are associated with relaxation and theta waves associated with unconscious memory and dreams, this alludes to greater self-awareness and mental ease. Further, Hoffman found the alpha waves increased in the left temporal lobe of the brain and concluded that a preponderance of alpha waves in the left temporal lobe of the brain is generally correlated with optimism and extroversion. Thus the yoga class appeared to increase indicators of positive mood in the brain.

Thirdly, in a study conducted at Boston University School of Medicine and Mclean Hospital, researchers found yoga may elevate GABA levels in the brain. Gamma-aminobutyric acid (GABA) is a major neurotransmitter widely distributed throughout the central nervous system (CNS). It is the most important inhibitory neurotransmitter in the brain, acting like a "brake" during times of runaway stress. Medications for anxiety, such as benzodiazepines, stimulate GABA receptors and induce relaxation and low or decreased levels of GABA in the brain is associated with several psychiatric and neurological disorders, including anxiety, depression, insomnia, and epilepsy. Studies indicate GABA can improve relaxation and enhance sleep. Using magnetic resonance spectroscopic imaging, the researchers compared the GABA levels of eight subjects prior to and after one hour of yoga, with 11 subjects who did no yoga but instead read for one hour. The researchers found a twenty-seven percent increase in GABA levels in the yoga practitioner group after their session.

Lastly, In 2007 Amy Wheeler and Linda Wilkin at California State University purposed that yoga asana based on the teaching of TKV Desikchar could influence stress level and physiological indicators of stress such as resting heart rate and breathing rate. As this study assessed students both before and after each session it was able to assess more long term affects. In other words, by looking at changes before each session researchers could assess whether benefits could carry over to the next week i.e. right before the next class. In analyzing the results of seventy-nine college students attending a class once a week for ten weeks, Wheeler and Wilkin found that students reported pre and post class changes in perceived stress and breathing rate. Alternatively heart rate was found to decrease after class, but no reported change carried on into the next week. Reflecting on an earlier study done by Telles et al in 1997, in which patients demonstrated long term changes in heart rate Wheeler and Wilkin are surprisingly critical and skeptical. Since the study done by Telles required students to practice yoga everyday for six months, Wheeler and Wilkin doubt its efficacy as it unrealistic for individuals to practice yoga so often for an extended period of time. Therefore, the pair claims the results are exaggerated. The irony here is that yoga is in fact prescribed as a daily practice; this is its very premise. Yoga is a lifestyle and regiment as important as cleaning the body. To denounce yoga's efficacy based on its own self-professed prescription is to belittle the foundations of yoga. Surely one would not make similar claims based on the necessity of taking anti-depressants everyday for six months in order to re-stabilize a person suffering from depression. Why should asana yoga or even the entire gamut of the eight limbs not be given the same 'leniency'? If yoga is to be used as a treatment should equal doses be deemed unrealistic?Technically asana yoga should be taken twice everyday: once at sunrise and once at sunset.  Unquestionably, it is hard to get students to come everyday not to mention depressed students, but if we are really to understand its full impact on mental health I believe yoga should be practiced and analyzed in the form it was intended.

Yoga is a way of living. In is not merely a cure for specific ailments but a life-long practice to keep the mind and body ever healthy and balanced. Yoga helps to restructure the way a person lives. In this way, if a person stops practicing after a short time or only practices sometimes it will not be deeply transformative. For changes to occur there needs to be enough practice to undue the regular physiological patterns and mental habits that lead to depression and anxiety. In The Mindful Brain, written by the noted neurological researcher Daniel Siegel, he claims "Experience means neural firing, which can, in some situations, promote the activation of genes, which then leads to the production of proteins that enables new synapses to form and old ones to be strengthened. Research also reveals that experience may stimulate the growth of new neurons" (p. 30). Following this line of research, yoga is in part affective because it promotes new experience and awareness. This includes new ways of thinking that promote the growth of new neurons and more healthy physiological functioning that lead support the creation of alternative neurological pathways and a divergence from old and maladaptive ones. If proper time is not allotted for this to occur nor regular practice made a part of a person's daily life, yoga will indeed be less effective. Yoga never professed to be successful in mental development and bodily changes through intermittent practice. Ironically, anti-depressants do not make such a claim either. To undo long-term habits that amount to specific neural-firing, ways of thinking, bodily cycles, breathing patterns, and basic world-views all which play a role in depression and anxious states, one must, in any treatment, be willing to invest regular and repeated time and effort. I look forward to more research which takes into account yoga's own temporal criteria and daily routine to assess its curative properties.

Psychology, Science, and Yoga 

In addition to studies, which register actual physiological changes there is also a body of research on how yoga effects mood based on subjective accounts as measured by various psychological scales.

In a study done by Woolery et al 2004 twenty-eight volunteers patients with mild depression were tested. Each patient practiced an Iyengar yoga routine of various asanas for five weeks. Results showed a significant reduction in stress on the Spielberger's STAI and the Becks Depression Inventory.

In 2004 David Shapiro, Ph.D., and Karen Cline, B.A also looked at the affect of Iyengar based yoga on mood. His hypothesis was that yoga could elevate mood and that backbends were actually able to decrease depressive mood and increase positive mood more than any other postures. Using self assessment patients were asked to mark both pre and post mood feelings. Shapiro concluded that his patients showed improved in areas of hostility depression, stress, and increase in positive feeling in general. Additionally, he concluded that back bend demonstrated the greatest affect on mood. Interestingly the level of effectiveness of backbends was correlated with the severity of negative mental states. The more intense the negative mental states the more a substantial was the noted change. 

The Psychotherapeutic Model

In the previous models yoga is deemed effective for its ability to alter mood, in the psychotherapeutic model it considered effective as it presents ground by which to transform perception. To begin with yoga is a practice that requires effort and determination on the part of the practitioner, this is in itself empowering and self-fulfilling, leading onwards to a more positive self-view. Furthermore, yoga supports an encouraging view of self as it does not ascribe psychological labels to those who are suffering. Yoga has no DSM manual or anything similar in order to diagnose mental illness. As expressed in the beginning of this paper, mental instability is merely the result of a lack understanding and clarity. Undoubtedly, personal ignorance can have varying levels of severity and take on different forms; however, all mental instability is simply a lack of cultivation, which can be rectified. Thus, a person is not bi-polar or obsessive compulsive, or defined as anything else that forges one to reify a negative sense of self. This is consistent with the Person-Centered approach to psychotherapy, where a client's own subjective experience takes precedence and not some common definition decided by a community of psychologists. In this way a person is not pigeon-holed and is seen instead as a fluid entity capable of change. Promoting this type of ideology makes a huge difference. As so many psychotherapists remind us from Rogers to Winnicott when we concretize someone's mental illness we often prevent them from flourishing and fail to offer a supportive holding environment for growth.

Offering an important complement to fluid view around mental illness is the general perception that suffering is not seen as something negative, but rather as a natural part of life. The goal of yoga is not to squash suffering in an attempt promise eternal happiness, but rather to learn how to be with difficult situations with ease. Moreover, suffering often heralds a possible transformation analogous to a person stuck in a cocoon slightly unaware that they are about to burst forth into a butterfly. If a person's mental instability is treated as a stepping stone towards greater self knowledge as opposed to an obstacle to contentment, it re-writes the entire self-narrative imbuing it with meaning and purpose. As one's happiness is a perception of conditions and a subjective extraction of what is actually happening, this modification is an effective tool in self-healing.

Further positive modes of thought forwarded by yoga include a sense of surrender to a higher purpose. Here a practitioner is not relinquishing self-responsibility, but rather cultivates a sense of acceptance rather than struggle against the normal predicaments of life. Additionally, a sense of surrender includes an experience of connection that is often lacking in the sense of isolation commonly found in depression. Such a change in view need not be spoon fed to students in yoga, but merely encountered through breath exercises. For example through during deep inhale and exhale it is common to have broad embodied feeling that leads to an experience of something greater then the self.

Surrender is often accompanied by a sense of gratitude for what one has rather than what one lacks. This helps to curb a feeling of neediness, and the outward search for external phenomenon to fill this void. When a person feels full of energy and goodness it is much easier to look clearly at life without the habitual thoughts patterns and assumptions that sabotage a feeling of well-being. In fact, through practice students gain a capacity to see thoughts and feelings in a clearer way, leading onwards towards self-modulation of thinking and letting go.  

All of these perceptual changes are part of the yogic path whether a person is practicing asana and pranayama, thus, learning how to let go through the body mind connection as in a yoga class, or attending instead to the Yamas, Niyamas and meditative aspects of the eight limbs. Hopefully, a person is practicing the whole path or at least the first six limbs as delineated above to support all aspects of the self-system. Through this combination the body, mind, and thoughts are all redirected, opened, and stretched in a way that releases tension and increases wellness and self-knowledge. 

Conclusion

As stated at the beginning of this paper yoga has always been a way to cultivate the mind. Its capacity to attain this end can be attributed to its wholistic approach to the person addressing all areas that can lead to malaise and the necessary regiment to counteract each and every aspect. This includes actions, thoughts, physical practice, and the breath, which seems to operate as an intermediate between the body and mind. The multi-tiered approach influences the physiological, psychological, emotional, and spiritual aspects of depression. In following this wholistic philosophy yoga honors all aspects of the person by seeing the psychological, spiritualist and scientific view as complementary and even integrative. It is for this reason that yoga can be equally examined from a variety of world views and prove effective by each one. In my own experience of depression nothing has ever been more effective than yoga. The practices themselves offer joyful living, promote self-worth, and a sense of completeness which I have not found by any other means. As an avid meditator, I must say that even the most wonderful of meditation practices has not provided me with the same capacity to face my woes as those found in combining mindfulness, movement, and breath. Sometimes sitting through something painful is simply too much. This is not to say that yoga is perfect or that everyone must do it as part of healing. It requires effort, and a capacity to be open to experience that not everyone is ready for. For those with deeper levels of depression this may not seem possible, yet, yoga still caters to such cases. In the first two limbs of the Yamas and Niyamas yoga realizes that just getting someone to take care of the body is part of healing. Yoga acknowledges the importance of these rituals along the path to self-understanding and self-love. Its eight limb approach is part of offering something for everyone, and everything for just one. I look forward to more comprehensive research in this field to support what yoga has been teaching for thousands of years. My wish is that through the medium of science a larger array of people will have access to the benefits of yoga practice and its profound ability.