Clinical Practice Guidelines for Yoga and Other Alternative Therapies for Patients with Mental Disorders

Abstract

INTRODUCTION Demand of complementary and alternative (CAM) treatments has been increasing over a period of time. Some studies have reported that up to 56% of patients with depression have used CAM methods while they have been used in other psychiatric disorders with or without conventional treatment. In ancient India and till the middle ages before British rule in India, yoga and Ayurveda were the sciences for health and disease. Modern medicine as described during British period gradually replaced these sciences in India. In other words, in olden times, yoga and Ayurveda were practiced as a way of life. Although yoga has its roots in Vedic and Upanishadic writings, it was 100 years BC that Patanjali emphasized on different aspects of yogic practices and advocated their role in day-to-day practice as well as healthy lifestyle. The scientist-sage Patanjali, in his Yoga Sutras (4), described Ashtanga Yoga meaning the eight-fold path of yoga and the way it should be practiced to live healthy lifestyle and prevent the diseases. It is thought that yoga is a spiritual science partly it is true but the latest advances have proven that we not only achieve an ideal state of psychophysiological health by practice of yoga, it helps in improving the individuals spiritual status and optimal functioning of body and mind. Yoga as a therapy has been used since 1400 BC described in Charak Samhita and has been popular in India since then. Yoga as therapy has gained its status in India and internationally after reported benefits of regular practice in stress reduction regulating of emotions improving mood, general well-being, and cognitive functioning. Utility of Pranayam has been proven in respiratory and cognitive functioning, while Yoga Asanas have their impact in physical flexibility, muscular strength, and neuromuscular performance. In health sciences, there has been a recent focus on research in Yoga therapy in various conditions including psychiatric disorders [Table 1]. In mental health, the major focus has been on research in depressive disorder and anxiety states with proven reports of its utility. Research is also being focused on posttraumatic stress disorders and substance use disorder. Some work has gone on in its utility in attention deficit disorders, autism, and obsessive–compulsive disorders. In some places, yoga therapy is being used as an adjunctive therapy. It also works as a preventive therapy where patients are having high risk for mental disorders.Table 1: Evidence base of efficacy of yoga in major depressive disorderYOGA Yoga truly means that our mind and body work together in a good harmony and we attain peace. Some authors have given the idea of harmony of mind–body and spirit together; however, the concept of spirit has not been so commonly used in modern medicine and the practice of yoga has no conflict with personal believes of individuals. The yogic practices include Pranayam which is a practice of controlling and regulating one's breath in specific described manner and meditation which is a practice of concentrating the thought on a particular figure or reciting spiritual rhymes repetitively to attain a higher level of consciousness. Asanas, the physical activity of group of muscles in specific postures and concentrating on self while reflecting on self, has also been described in yogic techniques. Yoga therapy or Yoga Chikitsa treats the individual by understanding the underlying cause of disease and prescribing specific techniques of yoga. It is indicated for individuals, families and in work place. For example, if someone is diagnosed suffering from anxiety disorders, he/she is advised Pranayam (the breathing techniques), asanas (the calming postures), and meditation or mindfulness-based techniques to change his/her lifestyle, which benefits him/her and does not cause any adverse effects. The yogic concept talks of vibrant health and emphasizes on the goal of self-realization and well-being. The Ashtanga yoga, the eight-fold path of yoga, includes: Yam (restraining self from many activities which are not approved by social norms and which lead to unhealthy lifestyle as described by yogic tradition) Niyam (observing discipline) Asanas (the physical activity of group of muscles in specific postures and concentrating on self) Pranayama (practice of controlling and regulating once breath in a specific described manner) Pratyahar (withdrawing many pleasures or habits of life) Dharna (focusing once attention at a particular thought or activity) Dhyana (concentrating the thought on a particular figure or reciting spiritual rhymes repetitively to attain a higher level of consciousness) Samadhi (a blissful state of consciousness where one attains complete tranquility and has a feeling on oneness with the cosmos). The first five ingredients are by regulating self and the external word while the last three are manipulating the internal self which Patanjali has described as Bahiranga (external) and Anta