Effects of yoga on impulsivity in patients with and without mental disorders: a systematic review.

BACKGROUND: Yoga can be used as a complementary intervention to conventional treatments, whether pharmacological or non-pharmacological. Sustained practice of yoga can generate a series of benefits for individuals' quality of life and improve their physical fitness. OBJECTIVE: To investigate the potential effects of yoga as an adjunct intervention in conditions involving impulse control issues, such as attention deficit hyperactivity disorder (ADHD), borderline personality disorder, bipolar affective disorder, and substance use disorders. METHODS: We performed a systematic review of placebo-controlled, randomized trials of yoga in patients with impulsivity. PubMed, Web of Science, and Science Direct databases were searched for trials published up to January, 2023. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. RESULTS: Out of 277 database results, 6 RCT were included in this systematic review. To assess the level of attention and impulsiveness, the following scales were analyzed: Barratt Impulsiveness, UPPS-P Impulsive Behavior scale, Conners' Continuous Performance Test IIª and Conners' Parent Rating Scale-Revised: Long. CONCLUSIONS: Yoga didn't have a significant improvement in impulsivity when compared to placebo. There are many tools to assess impulsivity, but they mean different concepts and domains consisting in a weakness on comparison of yoga effects. PROSPERO REGISTRATION: CRD42023389088.

Know thyself (Jnana Yoga): Psychotherapeutic insights from the east.

Humans have asked themselves the question "who am I" from ancient times. Vedic, upanishadic and buddhist philosophers have pointed out over millennia the illusive nature of the individual self, and posit either a no-self, or a universal Self. Vedantic scholars also posit the illusory nature of the universe (Maya) and suggest that the only reality is the knower (Brahman), a view resonating with modern concepts in quantum theory. On the other hand, western philosophers, notably influenced by the Cartesian dualism, have pursued an individualist view of the self. Recent psychological literature is convergent with eastern views and emphasizes the importance of understanding the self, metacognition and mindful practices to understand the mind and its afflictions. Several recent western psychotherapeutic models resonate with, and may have been motivated, at least in part, by ancient eastern philosophy and spiritual practices. More work is needed to develop and implement psychotherapeutic approaches using eastern insights, and to empirically test their effectiveness.

An Integrated Yoga and Cognitive Behavioral Therapy Intervention for Managing Excessive Use of Internet among the Youth: A Case Series.

Background: Internet addiction is a behavioral problem that is managed by pharmacological and nonpharmacological methods. The nonpharmacological methods focus on enhancing skills for healthy use of technology and promoting mindfulness and mental relaxation. Yoga therapy is an effective tool to reduce psychological stress and promote self-regulation and mindfulness. Thus, present work focused on developing an integrated yoga and cognitive behavioral therapy intervention (Y-CBT) for the management of excessive use of technology amongst adolescents and young adult students. Methods: Feasibility of the Y-CBT program was tested by implementing 10 sessions of yoga and 6 sessions of CBT program for 2 weeks by certified Yoga therapist and psychologist, respectively. This was followed by online booster sessions once a week, and post assessments were conducted at 12 weeks. A total of 4 college-going students with the excessive use of technology were recruited from tertiary specialty service for promotion of healthy use of technology. Each participant was assessed using short-version of internet addiction test (s-IAT), Smartphone Addiction Scale-Short Version, Kessler's Psychological distress scale for baseline, and follow-up assessment after completion of the program. Results: The Y-CBT program was found feasible and useful in reducing internet use, smart phone use, and psychological distress. There were no reported side-effects. A trend was observed for increase compliance toward treatment at follow-up. Future studies should explore this further with robust methodology.

Immediate Effect of Nada Yoga Meditation on Energy Levels and Alignment of Seven Chakras as Assessed by Electro-photonic Imaging: A Randomized Controlled Crossover Pilot Study.

Context: Nada Yoga is a branch of yoga philosophy that means "union through sound." The practice involves the resonance of energy centers in the body through specific sound frequencies. These subtle effects of yogic sound resonance on the subtle energy systems of the body have not been assessed before. Objective: To investigate the immediate effect of Nada Yoga meditation on the energy levels and alignment of the seven chakras in healthy volunteers. Design: Randomized controlled crossover design. Setting: Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India. Participants: 15 healthy volunteers (5 males and 10 females) with a mean age of 28.40 ± 5.63 were randomized to one of the two groups: group A (n = 8) and group B (n = 7). Intervention: On day 1, group A performed 45 minutes of Nada Yoga meditation (NYM) and group B performed 45 minutes of supine rest (SR). On day 2, the interventions were interchanged for the group. Outcome Measures: The assessment was done using the electro-photonic imaging (EPI) technique just before and immediately after each session on both days. Results: There was a significant increase in muladhara chakra energy (P = .012), manipura chakra energy (P = .008), anahata chakra energy (P = .011), vishuddha chakra energy (P = .001), and index energy (average chakra energy) (P = .001) after a 45-minute Nada Yoga meditation session as compared to the supine rest session.

Composition of yoga-philosophy based mental traits (Gunas) in major psychiatric disorders: A trans-diagnostic approach.

Yoga philosophy includes the theory of Tri-guna (three mental traits): sattva (signifies a tendency to 'goodness'), rajas (tendency towards 'activity'), and tamas (tendency towards "inertia"). This cross-sectional study aimed to understand the differences in the expression of gunas in patients suffering from major psychiatric disorders (n = 113, 40 females) and age-gender-education-matched healthy controls (HCs; n = 113, 40 females). Patients were diagnosed by a psychiatrist using DSM 5 criteria and suffered from the following disorders: depression (n = 30), schizophrenia (SCZ; n = 28), obsessive-compulsive disorder (OCD; n = 23), anxiety (n = 16), and bipolar affective disorder (BPAD; n = 16). Tri-gunas were assessed using a validated tool (Vedic Personality Inventory) and symptoms were assessed using standard scales as per the diagnosis. Multi-variate analysis of variance (MANOVA) was used to assess the differences in guna scores between HCs and patients, and between patients with different diagnoses. A two-tailed Pearson correlation was performed between the gunas and psychometric scales. Results revealed that HCs had significantly higher sattva traits as compared to patients (except those with OCD). Each psychiatric diagnosis also showed a specific guna configuration: (1) Anxiety disorders and OCD: High sattva-rajas, low tamas; (2) Depression: High sattva-tamas, low rajas; (3) Psychotic disorders (SCZ/BPAD): High tamo-rajas, low sattva. Significant positive correlations were observed between rajas traits and anxiety/OC/positive psychotic symptoms, negative psychotic symptoms and tamas traits, and sattva traits and OC symptoms. This finding has clinical implications, both to develop ways of predicting outcomes of psychiatric disorders, as well as to develop psycho-therapeutic and lifestyle interventions targeting the gunas.

Impact of workplace yoga on pain measures, mental health, sleep quality, and quality of life in female teachers with chronic musculoskeletal pain: A randomized controlled study.

BACKGROUND: Chronic pain conditions such as low back pain, knee pain and cervical pain are highly prevalent among female teachers. Chronic pain significantly affects the mental health, sleep and quality of life among teachers. OBJECTIVE: This study is intended to investigate the impact of a workplace yoga intervention on musculoskeletal pain, anxiety, depression, sleep, and quality of life (QoL) among female teachers who had chronic musculoskeletal pain. METHOD: Fifty female teachers aged between 25-55 years with chronic musculoskeletal pain were randomized to either the yoga group (n = 25) or the control group (n = 25). The yoga group received a 60-minute structured Integrated Yoga intervention (IY) four days a week for six consecutive weeks at school. The control group received no intervention. OUTCOME MEASURES: Pain intensity, anxiety, depression, stress, fatigue, self-compassion, sleep quality, and quality of life were assessed at the baseline and six weeks. RESULTS: A significant (p < 0.05) reduction in pain intensity and pain disability in the yoga group was observed after 6-week compared to baseline. Anxiety, depression, stress, sleep scores and fatigues also improved in the yoga group after six weeks. The control group showed no change. Post score comparison showed a significant difference between the groups for all the measures. CONCLUSION: Workplace yoga intervention is found to be effective in improving pain, pain disability, mental health, sleep quality among female teachers with chronic musculoskeletal pain. This study strongly recommends yoga for the prevention of work-related health issues and for the promotion of wellbeing among teachers.

Applications of Gas Discharge Visualization Imaging in Health and Disease: A Systematic Review.

Context: Gas discharge visualization (GDV) works on the principle of the Kirlian effect. It's a noninvasive, quick, and safe biometric tool to investigate the psychophysiological state of an individual, with the potential to identify deviations from the healthy functioning of humans at early stages. Objective: The study intended to systematically document the scientific evidence pertaining to the use of GDV devices in human health and disease conditions. Design: The research team performed a systematic search for studies on GDV on research databases such as Google Scholar, PubMed, and PsychINFO, using the following inclusion criteria: (1) experimental studies dealing with a GDV device, (2) studies dealing with human participants related to health and disease, and (3) studies published in the English language. The study excluded: (1) review articles, (2) case studies, (3) letter to editors, (4) studies with unclear methodology, and (5) studies published before the year 2000. Setting: The study took place in the Department of Integrative Medicine at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru, India. Results: After filtering, the research team obtained 108 publications that dealt with the application of a GDV device in human participants. Based on the selection criteria, 42 studies were included in the review. These 42 studies included eight randomized controlled trials (RCTs), five nonrandomized controlled studies, 17 cross-sectional studies, 10 single-group pre-post studies, and two correlational studies. Conclusions: More studies with a robust methodology are needed to make definitive conclusions. The literature reveals that the GDV technique has the potential to provide early diagnosis and screening, especially in disorders of the endocrine and immune systems. It might also be used to assess wellness in healthy subjects and monitor the effects of interventions, such as yoga-including pranayama and meditation, acupuncture, qigong, music therapy, and massage on the human energy system. Future studies should focus on the validation of GDV imaging in clinical settings.

Yoga and Integrative Healthcare: Lessons from the National Institute of Mental Health and Neurosciences (NIMHANS) in India.

Background: There is growing evidence and increasing interest for systemic integration of medicine (synergistic and evidence-based combination of different systems along with conventional biomedicine). The National Institute of Mental Health and Neurosciences (NIMHANS), an Institute of National Importance and a tertiary mental and neurological healthcare hospital situated in Bengaluru, India, has established one such integrative model. The present manuscript traces the history and describes the important steps followed in this integrative approach. Methodology: The NIMHANS model followed a stage-wise two-step approach: (1) First stage - Starting with Integration of Yoga: The process began more than a decade ago, with integrating yoga into a clinical department (rather than an exclusive research-based approach) of the institute which had relatively high clinical service load (For example, Department of Psychiatry in NIMHANS). Yoga was gradually formalized into academic and clinical activities (outpatient and inpatient services) by appointing a Yoga faculty with a medical background with an MD/PhD in Yoga. The research was primarily directed by the clinical observations of patients receiving yoga therapy. (2) Second stage: Adding an appropriate and compatible discipline from Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) system (Ayurveda in this case): The center for yoga gradually evolved into the Department of Integrative Medicine with the appointment of faculty from the Ayurveda stream. In this model, specialists from each discipline provide clinical inputs after simultaneous consultation with the patient through systemic integration in clinical, academic, and research domains rather than mere co-location of AYUSH services with mainstream medicine. Conclusion: The NIMHANS model of integration suggests the application of yoga into mainstream clinical service as the first step toward integration. Yoga should be added as a formalized clinical discipline with systemic integration. Gradually, other feasible systems of traditional medicine from AYUSH can be integrated at a later stage in a step-by-step manner based on clinical practice and evidence.

Integrative Approach Improves Fall Risk and Postural Stability in Spinocerebellar Ataxia-2 - A Case Report.

Spinocerebellar ataxias (SCAs) comprise a large heterogeneous group of autosomal dominant cerebellar ataxias. Despite availability of various conventional treatments, reducing disability and improving the quality of life is a challenge in this condition. In the present case report, based on the clinical symptoms and site of pathology, an Ayurveda-based diagnosis of kaphavruta vayana and kaphavruta udana was considered. Therapeutic measures such as rookshana (drying therapy), vatahara (measures to pacifying vata), balya (strengthening), and brimhana (nourishing) regimens were adopted along with oral medications and specific yoga practices. The objective of the treatment was to improve stability, posture, and balance. After 10 weeks of integrative treatment, a demonstrable improvement was observed in scale for assessment and rating of ataxia Scale for the Assessment and Rating of Ataxia (SARA), fall risk, and limit of stability (using computerized dynamic posturography). Hence, an integrated Ayurveda and Yoga-based lifestyle regimen may serve as a useful adjuvant in improving fall risk and limit of stability in patients with SCAs.

Integrative Medicine Enhances Motor and Sensory Recovery in Guillain-Barre Syndrome - A Case Study.

Guillain-Barre syndrome (GBS) is a heterogenous group of immune-mediated conditions affecting peripheral nerves. About 40% of patients treated with standard dosage of plasma exchange or intravenous immunoglobulins do not improve in the first 4 weeks following treatment. Add-on treatment from traditional medical approaches such as Yoga therapy and Ayurveda are increasingly being sought for rehabilitation of patients with chronic neurological disorders. The current case study reports the clinical utility of adjunct Yoga and Ayurveda treatment in the treatment of residual symptoms of GBS.

Yoga Module Development and Validation: A Systematic Review with Methodological Guidelines.

In the past decades, more than fifty different yoga styles have been implemented in the therapeutic context to manage various diseases. Yet, not all of these yoga styles have been validated or standardized as a program. The aim of this article is to review the different methodologies used for yoga module development and to assess their quality. Three databases (PubMed, Web of Science, and Scopus) were searched using the following keywords and Boolean operators: (validation OR development OR design) AND (yoga OR mind-body) AND (module OR protocol OR program). Three thousand six hundred and seventy-one articles were enlisted, and based on the inclusion and exclusion criteria, 37 articles were narrowed down for review. Since no checklist exists to assess the quality of yoga modules, the authors designed a 23-item checklist to categorize each having low, medium, or high quality. As per the yoga module quality checklist, only 21.6% of the studies had high quality, while 75.3% of the articles had medium quality and 8.11% had low quality. A commonly used development method was literature review, while for validation, experts' scoring of the Likert scale was the preferred means. The feasibility of the module was carried out only by half of the studies. Few diseases such as cardiovascular disease, diabetes mellitus, obesity, Parkinson's disease, and obesity had more than one yoga module developed. The findings of this systematic review have shed some light on the growing need for standardized methods of yoga module development. The 23-item checklist can guide researchers in the homogeneous development strategies when designing yoga interventions in the future.

Role of Ayurveda and Yoga-Based lifestyle in the COVID-19 pandemic - A narrative review.

The COVID-19 pandemic has posed an immense challenge to health care systems around the globe in terms of limited health care facilities and proven medical therapeutics to address the symptoms of the infection. The current health care strategies are primarily focused on either the pathogen or the environmental factors. However, efforts towards strengthening the host immunity are important from public health perspective to prevent the spread of infection and downregulate the potency of the infectious agent. While a vaccine can induce specific immunity in the host, non-specific ways of improving overall host immunity are needed as well. This scenario has paved the way for the use of traditional Indian therapies such as Ayurveda and Yoga. This review aims at collating available evidence on Ayurveda, Yoga, and COVID-19. Further, it draws inferences from recent studies on Yoga and Ayurveda on immunity, respiratory health, and mental health respectively to approximate its probable role in prophylaxis and as an add-on management option for the current pandemic.

Yoga as an Adjunct for Management of Opioid Dependence Syndrome: A Nine-Month Follow-Up Case Report.

Opioid dependence syndrome (ODS) is a chronic relapsing remitting condition associated with significant impairment and mortality risk. Opioid substitution therapy is used worldwide, but long-term retention rates are low and there is risk of misuse and diversion. Yoga practice can improve quality of life, reduce chronic pain, and enhance endogenous opioids (beta-endorphins). We describe a case of ODS where yoga was added to the conventional management and who was followed up for 9 months. Assessments were done for clinical symptoms, urine drug screening, plasma beta-endorphins, and Buprenorphine dosage. We observed an improvement in his clinical symptoms and reduction in the requirements for Buprenorphine. A slight increase in basal plasma beta-endorphin levels was also observed at the 9-month follow-up (from 2.02 pmol/L at baseline to 6.51 pmol/L).

Effect of yoga on depression in hypothyroidism: A pilot study.

BACKGROUND: The prevalence of hypothyroidism among Indian women is 15.8%. Depression is frequently reported in hypothyroidism. Yoga is an effective intervention for depression. However, the influence of yoga on depression in patients with hypothyroidism has not been studied. AIM: The present study investigated the effect of a 3-month integrated yoga intervention (3-IY) on depression, lipid indices, and serum thyroid-stimulating hormone (sTSH) levels among female patients having hypothyroidism, and mild-to-moderate depression. METHOD: The present single-arm pre-post design study was conducted in thirty-eight women (average age 34.2 ± 4.7 years). Participants received a 3-IY comprising asanas, pranayama, and relaxation techniques for 60 min daily (5 days a week). Depression, sTSH, lipid profile indices, Body Mass Index (BMI), fatigue, anxiety, and stress were assessed at baseline and after 12 weeks. Thyroid medication was kept constant during the study period. Data were analysed using R Studio software. RESULT: A significant (P < 0.05) reduction in depression (58%), sTSH (37%), BMI (6%), fatigue (64%), anxiety (57%), lipid profile indices (HLD increased significanty), and stress (55%) levels was observed after 3 months, compared with the corresponding baseline levels. CONCLUSION: The 3-IY is useful for reducing depression, dyslipidemia, and sTSH in women with hypothyroidism and depression. Further studies with a larger sample size and a robust research design using objective variables must be conducted to strengthen the study findings.

Generic Yoga Modules for Clinical and Research Settings-Need of the Hour.

Yoga-based interventions offer significant promise in healthcare. However, meta-analyses of various yoga trials suggest that comparisons of trials are either not possible or difficult due to heterogeneity in therapeutic yoga interventions. Also, in view of emerging evidence for the role of therapeutic yoga, it is important to identify the specificity and validity of various yoga components being used in different trials. Efforts in this direction will be fruitful only if a systematic approach is adopted to develop yoga programs for various ailments. In this article, we emphasize the need for a "generic yoga" concept for designing a therapeutic yoga program for particular health issues, with the objectives of promoting scientific growth of therapeutic applications of yoga and widespread application of standardized therapeutic yoga programs within a biomedical framework. This generic therapeutic yoga will essentially highlight the development-validation process of uncopyrighted yoga programs; their components, benefits, and possible side-effects; and requirement for need-based modifications.

Development, Validation, and Feasibility Testing of a Yoga Module for Opioid Use Disorder.

CONTEXT: Opioid use disorder (OUD) involves excessive use of opioids-such as heroin, morphine, fentanyl, codeine, oxycodone, and hydrocodone-leading to major health, social, and economic consequences. Yoga lifestyle interventions have been found to be useful as adjunct therapies in management of substance use disorders and chronic pain conditions. OBJECTIVE: The research team intended to develop, validate, and test for feasibility a yoga program for OUD patients that could reduce opiate withdrawal symptoms-such as pain, fatigue, low mood, anxiety and sleep disturbances-and cravings associated with drugs. DESIGN: The research team first performed a literature review of traditional and contemporary yoga texts, such as Hatha Yoga Pradipika and Light on Yoga, as well as modern scientific literature in the following search engines-Google Scholar, PubMed, and PsychInfo, using the keywords yoga, pranayama, hatha yoga, relaxation. meditation, substance use, addiction, impulsivity, craving, sleep quality, and fatigue. Using the information obtained, the team developed a yoga program and designed a pilot study that used the program. SETTING: The study took place in the Department of Integrative Medicine at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore, India. PARTICIPANTS: Participants in the pilot study were 8 inpatients, 6 males and 2 females, who were on opioid agonist treatment (buprenorphine) for OUD. INTERVENTION: The intervention was the yoga program previously validated by the research team. In the pilot study, participants were taught a one-hour, yoga-based intervention, with sessions occurring once per day, for 10 sessions. OUTCOME MEASURES: For validation, 13 experts scored the yoga program that the research team had developed and gave suggestions for each yogic practice for use during the acute phase of withdrawal and the maintenance phase respectively. A content validity ratio (CVR) was calculated from their scoring, and the research team made changes to the program base on the scoring and suggestions. For the pilot study, assessments occurred at baseline and postintervention. The participants' yoga performance was rated by the yoga trainer on a yoga performance assessment scale (YPA). Other measurements included: (1) the Clinical Opiate Withdrawal Scale (COWS), (2) the Hamilton's anxiety rating scale (HAM-A), (3) the Hamilton's depression rating scale (HAM-D), (4) buprenorphine dosage, (5) the Clinical Global Impression Severity (CGI-S) scale, (6) a visual analog scale (VAS) for pain, (7) sleep quality (latency and duration), and (8) the module's safety. RESULTS: Four practices were removed from the program due to CVR scores below the cutoff, and one practice was found not to be feasible (Kapalabhati). Two categories of yoga modules emerged: (1) for the acute symptomatic phase (40 minutes) and (2) for the maintenance phase (one hour). Practices were added or excluded based on the phase. CONCLUSIONS: The yoga module that was developed for reducing withdrawal symptoms and cravings in OUD patients was found to be safe, feasible, and potentially useful as an adjunct therapy to conventional treatment.

Heavy Metals in Indian Traditional Systems of Medicine: A Systematic Scoping Review and Recommendations for Integrative Medicine Practice.

Introduction: Ayurveda and Siddha are two important components of the traditional Indian medicine (TIM). The regulatory mechanisms have been insufficient, and heavy metal toxicity with TIM preparations continues to be a public health nuisance, putting integrated medicine practice in jeopardy. The current study was undertaken to review the potential health hazards of the heavy metal content in the TIM and formulate patient-safety recommendations for integrative medical practice. Materials and Methods: Systematic MEDLINE searches were performed using a combination of relevant MeSH terms and keywords, and case report/series of Ayurveda or Siddha-induced heavy metal toxicity, published in the previous two decades, were included. Risk of bias was assessed with the tool by Murad et al. Results: A total of 220 cases (51 case reports and 14 case series) were found (lead, n = 156; arsenic, n = 11; mercury, n = 47; thallium, n = 1; gold, n = 1; combination of heavy metals, n = 4) after screening for the inclusion and exclusion criteria. Among them, 169 (76.8%) had a low risk of bias, 113 (out of 135 [83.7%] analyzed) contained higher-than-permissible heavy metal content in the drug samples, and the majority showed elevated biological levels of the heavy metals in the body. Conclusion: The heavy metals in TIM are often the result of adulteration or improper manufacturing and prescribing practices, despite national and international guidelines recommending quality standards and protocols for preparing and dispensing TIM. We thus propose multipronged approaches and provide recommendations at various levels, including individual, institutional, national policy decisions essential to establish patient safety of TIM.