Integrated mental healthcare and vocational rehabilitation for people on sick leave with stress-related disorders: 24-month follow-up of the randomized IBBIS trial.

OBJECTIVES: Integrating vocational rehabilitation and mental healthcare has shown effects on vocational outcomes during sick leave with common mental disorders. In a previous paper, we showed that a Danish integrated healthcare and vocational rehabilitation intervention (INT) had a surprisingly negative impact on vocational outcomes compared to service as usual (SAU) at 6- and 12-month follow-up. That was also the case with a mental healthcare intervention (MHC) tested in the same study. This article reports the 24-month follow-up results of that same study. METHOD: A randomized, parallel-group, three-arm, multi-centre superiority trial was conducted to test the effectiveness of INT and MHC compared to SAU. RESULTS: In total, 631 persons were randomized. Contrary to our hypothesis, SAU showed faster return to work than both INT [hazard rate (HR) 1.39, P=0.0027] and MHC (HR 1.30, P=0.013) at 24-month follow-up. Overall, no differences were observed regarding mental health and functional level. Compared to SAU, we observed some health benefits of MHC, but not INT, at 6-month follow-up but not thereafter, and lower rates of employment at all follow-ups. Since implementation problems might explain the results of INT, we cannot conclude that INT is no better that SAU. The MHC intervention was implemented with good fidelity and did not improve return to work. CONCLUSION: This trial does not support the hypothesis that INT lead to faster return to work. However, implementation failure may explain the negative results.

Um resgate de si: itinerário terapêutico de um caso de adoecimento mental relacionado ao trabalho / Rescuing yourself: therapeutic itinerary of a case of work-related mental illness

Este artigo apresenta uma reflexão sobre o processo de reabilitação de adoecimento mental relacionado ao trabalho por meio da reconstituição do Itinerário Terapêutico de uma trabalhadora, evidenciando a importância dos serviços públicos de saúde. Mesmo diante do expressivo aumento dos casos de adoecimento mental e das evidências de relação com as condições e formas de organização do trabalho, raramente as situações laborais são consideradas nas avaliações dos serviços de saúde. Mesmo com o atual contexto de desmonte da saúde pública, existem exemplos de atuações exitosas, como a que discutimos aqui. Por meio de entrevista semidirigida com uma trabalhadora e construção do Itinerário Terapêutico, buscou-se compreender seu processo de adoecimento mental, a relação com o trabalho e o percurso de reabilitação. Os resultados demonstram a importância do entendimento do trabalho como determinante de saúde, da elaboração de projetos terapêuticos singulares e da atenção integral, revelando que a articulação em rede, o estabelecimento de vínculo e a busca pelo protagonismo do usuário são essenciais na atenção à saúde mental relacionada ao trabalho.

This article presents a reflection on the process of rehabilitation of work-related mental illness through the reconstitution of a worker's Therapeutic Itinerary, highlighting the importance of public health services. Even in the face of significant increase in cases of mental illness and evidence of a relationship with the conditions and forms of work organization, work situations are rarely considered in the assessments of health services. However, despite the current context of dismantling the public health system, there are examples of successful actions, such as the one we discussed here. Through a semi-directed interview with a worker and construction of the Therapeutic Itinerary, we sought to understand her mental illness process, the relationship with work and the path of rehabilitation. The results demonstrate the importance of understanding work as determinant of health, the development of unique therapeutic projects and comprehensive care, revealing that networking, establishing a bond and seeking the protagonism of the user are essential in work-related mental health care.

[Job Retention Process among Working People with Mental Illness: A Grounded Theory Approach].

PURPOSE: The study was conducted to explore the experiences of job retention among working people with mental illness. METHODS: The participants were members with mental illness at the S Community Mental Health Center in Gyeonggi Province and who had been working for more than six months. The data were collected through in-depth interviews with 11 participants between June 27 and August 20, 2018. The data were analyzed through Corbin and Strauss's grounded theory method. RESULTS: The core category was struggling to take root in the community as a productive member. The core phenomenon was the desire to be a productive person, and the causal condition was the willingness to change for a purposeful life. The action and interaction strategies included maintaining regular living patterns, maintaining medication, developing one's tips for self-management, and self-approval. The intervening conditions were difficulties in forming social relationships, presence of symptoms, social resources, and acceptance of one's mental illness. The consequences were restoration of family relationships, healthy pleasure through work, social inclusion, development of self-worth, and transition to an independent person. CONCLUSION: Working people with mental illness are struggling to take root in the community as a productive member. This study suggests that a holistic understanding of the job retention experience among people with mental illness is required. The findings will provide the basis for developing interventions that can improve job retention among working people with mental illness.

PERSPECTIVES: Recovery Oriented Services for Persons with Severe Mental Illness Can Focus on Meeting Needs Through Care Coordination.

BACKGROUND: The approach to care for persons with an acute illness is different from that for a person with a chronic disease. Whilst the goal of treatment for an acute illness is to cure the disease, a chronic condition has no cure as such, and hence management requires a team approach that is aimed at achieving goals that are jointly set by service users and providers. Severe and persistent mental illness (SPMI) is a chronic disease. However, in many mental health services, the approach to care for persons with SPMI is similar to those who have an acute mental illness. AIM: The aims of this paper are twofold: (i) to make an argument for recovery oriented services to focus on meeting clients' needs rather than on symptom reduction, (ii) to propose a model of service provision where clinical mental health services form a part rather than the mainstay of care for people with SPMI. RESULTS: Using examples from Australia's Partner's in Recovery initiative and other recovery literature, we start by describing how SPMI should be treated as a chronic disease that focuses on recovery. We then highlight how mental health services continue to monitor outcomes based on clinical rather than personal recovery. Next, we diagrammatically illustrate how needs can be aligned with the recovery process and illustrate how care coordination can be the hub of service delivery in a hub and spoke model. We conclude with comments on workforce requirements and costs of a needs-based recovery oriented service. DISCUSSION: In a needs based model, the role of the specialist mental health service will move from being at the centre of care to being one of the components of care and the role of the care coordinator will become central. Although, there are as yet no randomised controlled trials to show that meeting needs of persons with SPMI will significantly contribute to their recovery, preliminary studies show that it is possible. IMPLICATIONS FOR HEALTHCARE PROVISION AND USE: The role of the care coordinator becomes the hub of service provision collaborating with agencies such as family practices, specialist mental health services, legal, housing, employment, education, and community services. IMPLICATIONS FOR HEALTH POLICIES: A shift from the current model of care to a needs based approach requires a revolutionary change in the way we do business and will have to be the largest shake up of the mental health service system since deinstitutionalisation. IMPLICATIONS FOR FURTHER RESEARCH: It is a long journey from the status quo to a needs based approach. The first step would be to gather more evidence on the usefulness of addressing people's needs in achieving recovery.

Complementary and alternative medicine (CAM) in Danish residential homes for people with severe mental illness: Use and perceived benefits of CAM in relation to recovery.

BACKGROUND AND AIM: Mental health services in Denmark offer various rehabilitative treatment interventions to people with severe mental illness. Complementary and Alternative Medicine (CAM) such as National Acupuncture Detoxification Association (NADA) ear acupuncture are used as rehabilitative interventions. We investigated the use of CAM in four psychiatric residential homes, and whether CAM supports residents' rehabilitation and personal recovery. METHODS: Residents in four selected residential homes participated in a questionnaire study, which elicited information on the use of CAM offered in a residential home setting. The study was conducted from February to November 2017. Recovery scores were assessed using the Mental Health Recovery Measure (MHRM). RESULTS: Of 131 eligible respondents, 68 (52%) participated. CAM was used by 84% of the residents. NADA ear acupuncture (38%) and music therapy (37%) were the most commonly used types of CAM. CONCLUSIONS: CAM is a commonly used rehabilitative intervention and more than 50% receiving treatment with CAM believed that it has supported their recovery process.

Salutogenesis as a theoretical framework for psychosocial rehabilitation: the case of the Clubhouse model.

Purpose: This study explored whether the holistic theory of salutogenesis may be a suitable theoretical framework for the Clubhouse model of psychosocial rehabilitation, a pioneer among psychosocial rehabilitation programmes.Methods: A systematic examination of elements of the Clubhouse model, as prescribed by the Clubhouse standards, was performed within the context of the theory of salutogenesis including its basic salutogenic orientation and the main concepts of sense of coherence and resistance resources.Results: We found that several standards and practices within the Clubhouse model can be understood as applications of salutogenesis. We have hypothesized that the Clubhouse model promotes peoples' sense of coherence and mental health. However, our investigation also showed that, to enhance the recovery of Clubhouse members, more explicitly incorporating some salutogenic principles, such as "appropriate challenges" and "active adaptation as the ideal in treatment", may benefit Clubhouse practice.Conclusions: The Clubhouse model of psychosocial rehabilitation is very consistent with the salutogenic orientation and main salutogenic concepts. The present study suggests that salutogenesis may be a suitable theoretical framework for the Clubhouse model and possibly in the psychosocial rehabilitation field in general.

Stigma correlates in individuals with mental health conditions versus community members enrolled in a nationwide integrated arts-based community rehabilitation program in Israel.

Two of the most prominent challenges faced by people with mental health conditions (MHCs) are experiencing stigma and personal recovery. This study focused on the analysis of baseline data from registrants for integrated arts-based groups in a nationwide psychosocial rehabilitation program in Israel. The aim of the study was to examine the possible associations between self-stigma, personal recovery and creative self-efficacy (CSE) in people with MHCs, and the associations between public stigma, desire for social distance, familiarity with mental illness and CSE in community members. Cross-sectional data were collected by online survey software in October-November 2017 from 114 people with MHCs and 117 community members who enrolled in 15 integrated arts-based groups, and 68 people with MHCs who were not enrolled in integrated groups. The main findings suggest that individuals with MHCs who reported high self-stigma also reported a low sense of personal recovery and low CSE. The CSE of those with MHCs correlated positively with their personal recovery. Among community members, high public stigma was associated with a greater desire for social distance in women, but less contact with MHCs in men. Individuals with MHCs who had previously participated in integrated arts-based groups reported greater personal recovery than those who had not. Community members reported higher CSE and public stigma than the CSE and self-stigma of individuals with MHCs. The findings help characterise both individuals with MHCs and non-clinical community members who decide to enrol in integrated groups, as well as individuals with MHCs who chose not to enrol, enabling similar community-based programs to better identify their conditions and meet their needs. Future research should examine the contribution of integrated arts-based groups to promoting recovery and reducing stigma.

Inpatient Rehabilitation for Children and Adolescents With Diabetes in Germany Between 2006 and 2013.

INTRODUCTION: In Germany, inpatient rehabilitation is a well-established additive option in the therapeutic concept for children and adolescents with diabetes. However, its contribution in pediatric diabetes care is not known exactly. Our objective was to analyze inpatient rehabilitation in pediatric diabetes over eight years in Germany. METHODS: We requested secondary data from the German Statutory Pension Insurance Scheme to evaluate all completed inpatient rehabilitations for children and adolescents with diabetes (ICD-code E10-14) reimbursed by this institution between 2006 and 2013. For each type of diabetes, we analyzed the distribution of admissions by year, age-group, sex, nationality, and other documented diagnoses. All analyses were conducted via remote computing with IBM SPSS Version 24. RESULTS: Between 2006 and 2013, 5,403 admissions to inpatient rehabilitation for 4,746 children and adolescents with diabetes were documented. For type 1 diabetes (T1D; 88.5% of admissions), the number of yearly admissions increased from 458 in 2006 to 688 in 2013 (p=0.013), especially for age-group>5-10. The increase for type 2 diabetes (T2D) was not significant. Admissions were more frequent for girls (53.6%, p≤0.001), age>10-15 years (42.8%, p=0.001), and German nationality (98.5%). Obesity (T1D: 11.1%; T2D: 87.9%) and mental disorders (T1D: 11.6%; T2D: 27.4%) were the most frequent documented diagnoses in addition to diabetes. CONCLUSION: This study provides a comprehensive overview of inpatient rehabilitation for children and adolescents with diabetes over many years in Germany. Until 2013, inpatient rehabilitation remained important in pediatric diabetes care, especially for children with mental disorders or obesity.

[Effectiveness of Psychocardiological Care in Inpatient Rehabilitation: A Pilot Study]. / Effektivität von psychokardiologischer Versorgung in der stationären Rehabilitation ­ ein Pilotprojekt.

An integrative patient-centered care concept is increasingly demanded for treatment of cardiac patients with concomitant mental disorders. The present study aims to investigate the effect of an integrated concept of psycho-cardiac care (PK) versus a monodisciplinary cardiac (K) or psychosomatic (PSO) care. Patients were examined at baseline (T0), at the time of discharge from the rehabilitation program (T1) and after 6 month (T2). General anxiety, depression (HADS), cardiac anxiety (HAF) and quality of life (SF-12) were evaluated using computer-assisted questionnaires. A total of 93 patients were included (PK: n=37, 55.5 years SD=8.0, 43.2% female; K: n=32, 53.6 years SD=8.2, 34.4% female; PSO: n=24, 55.5 years SD=5.0, 45.8% female). Patients in the PK-group showed a significant reduction of heart-focused anxiety (HAF fear p=0.004) and a significant improvement in quality of life (SF-12 physical p=0.034) during follow-up. In contrast, these parameters remained unchanged in patients in the K- and PSO-groups. The results indicate that cardiac-patients with concomitant mental disorders benefit only from an integrated psycho-cardiac treatment concept. The findings provide first data to psycho-cardiac treatment in stationary rehabilitation and support previous clinical experiences. But further research is required to show the advantage of a psycho-cardiac concept towards monodisciplinary care.

Mindfulness Training plus Nature Exposure for Veterans with Psychiatric and Substance Use Disorders: A Model Intervention.

There is a need to develop novel complementary interventions aimed at enhancing treatment engagement and/or response for veterans with psychiatric and substance use disorders. There is evidence that both mindfulness training and nature exposure (MT/NE) may be beneficial for this population and that combining the two approaches into one intervention might result in synergistic benefit. However, to date, the MT/NE concept has not been tested. This article reports a pilot feasibility and acceptability study of MT/NE which was, in this case, provided via recreational sailing. The primary aim of this project was to develop a model intervention and evaluation process that could be used for future studies of MT/NE interventions using a variety of methods of nature exposure (e.g., hiking, skiing, mountain biking). Results indicate preliminary evidence that it is feasible to utilize MT/NE interventions for the population studied and that the MT/NE model described can serve as a template for future investigations. Further, there were significant pre- to post-intervention decreases in state anxiety, as well as increases in trait mindfulness. Three psychological instruments were identified that might be used in future studies to evaluate MT/NE outcomes. Results from this project provide a model MT/NE intervention template along with evaluation metrics for use in future studies.

MAP: A Personalized Receptive Music Therapy Intervention to Improve the Affective Well-being of Youths Hospitalized in a Mental Health Unit.

The MAP is an innovative receptive music therapy intervention derived from psychomusical relaxation methods that aims to foster the well-being and recovery of youths with mental health problems by providing them with an adaptive and effective music-assisted means to regulate their mood states. In this quasi-experimental pilot study, we assessed the mood-enhancing potential of participation in MAP sessions delivered by a music therapist in an in-patient mental health facility for children and adolescents. Using short standardized self-reported questionnaires, 20 participants aged 9-17 years old (M = 14, SD = 2.4), mainly girls (13 = 65%), rated their affective state immediately before and after two to four MAP sessions and a similar number of regular unit activity sessions used as comparison. This created a 2 × 2 (Time × Condition) single-group within-individual design. We analyzed pre-post session changes in affect using multilevel mixed models and found participation in MAP sessions to be associated with systematic reductions in self-reported general negative affect and state anxiety. These variations were of modest-to-large magnitude and significantly greater than those associated to participation in regular unit activities. While only a first step towards the validation of the MAP as an effective intervention to foster more adaptive and effective day-to-day mood regulation in youths with mental health problems, this study supports its specific potential to alleviate negative affects and provides a rare demonstration of the putative benefits of music therapy in a pediatric mental health inpatient context.

Drug treatment presentations at a treatment centre in southern Nigeria (2015-2018): Findings and implications for policy and practice.

INTRODUCTION: Recent evidence suggests that rates of drug use and abuse in Nigeria exceed the global average. There is a strong treatment demand for psychoactive drug use disorders in Nigeria; however, it is not known whether available treatment facilities are attending to the array of treatment needs. This audit compares the pattern of presentations at a tertiary facility with a community-based survey. METHODS: A review of cases (n = 212) seen at a regional drug treatment facility over a 4-year period, using local data retrieved from the Nigerian Epidemiological Network of Drug Use (NENDU) and comparison with data from the recently published national drug use survey. RESULTS: Nine out of ten clients seen were male (93.4%). About half (49.5%) of the clients used psychoactive substances for the first time between ages 10 and 19 years. Cannabis was the primary drug of use overall and also among males, while females were more likely to present with opiate abuse. Over half had a co-occurring physical or mental disorder, and a minority had received testing for hepatitis C in the past 12 months. CONCLUSION: Although patterns of drug abuse presentations were consistent with findings from a national community-based survey, there was an under-representation of females in treatment. Implications for policy development and practice are discussed.

Implementation barriers and facilitators of an integrated multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: the MULTI study IV.

BACKGROUND: Despite an increase in studies showing the efficacy of lifestyle interventions in improving the poor health outcomes for people with severe mental illness (SMI), routine implementation remains ad hoc. Recently, a multidisciplinary lifestyle enhancing treatment for inpatients with SMI (MULTI) was implemented as part of routine care at a long-term inpatient facility in the Netherlands, resulting in significant health improvements after 18 months. The current study aimed to identify barriers and facilitators of its implementation. METHODS: Determinants associated with the implementation of MULTI, related to the innovation, the users (patients, the healthcare professionals (HCPs)), and the organisational context, were assessed at the three wards that delivered MULTI. The evidence-based Measurement Instrument for Determinants of Innovations was used to assess determinants (29 items), each measured through a 5-point Likert scale and additional open-ended questions. We considered determinants to which ≥20% of the HCPs or patients responded negatively ("totally disagree/disagree", score < 3) as barriers and to which ≥80% of HCPs or patients responded positively ("agree/totally agree", score > 3) as facilitators. We included responses to open-ended questions if the topic was mentioned by ≥2 HCPs or patients. In total 50 HCPs (online questionnaire) and 46 patients (semi-structured interview) were invited to participate in the study. RESULTS: Participating HCPs (n = 42) mentioned organisational factors as the strongest barriers (e.g. organisational changes and financial resources). Patients (n = 33) mentioned the complexity of participating in MULTI as the main barrier, which could partly be due to organisational factors (e.g. lack of time for nurses to improve tailoring). The implementation was facilitated by positive attitudes of HCPs and patients towards MULTI, including their own role in it. Open responses of HCPs and patients showed strong commitment, collaboration and ownership towards MULTI. CONCLUSIONS: This is the first study analysing the implementation of a pragmatic lifestyle intervention targeting SMI inpatients in routine clinical care. Positive attitudes of both HCPs and patients towards such an approach facilitated the implementation of MULTI. We suggest that strategies addressing organisational implementation barriers are needed to further improve and maintain MULTI, to succeed in achieving positive health-related outcomes in inpatients with SMI.

[Clinical presentation and requests for support of people with HIV/AIDS seeking counselling and psychotherapy in Greece].

Despite the large progress during the last decades in the medical treatment of HIV/AIDS infection, people living with HIV nevertheless face multiple adversities at various levels of their lives. Mental disorders, in particular, are the most common comorbidities in HIV infection with negative consequences in adherence to antiretroviral medication, disease progress and overall quality of life. HIVrelated stigma, still quite intense in Greece, is one of the most debilitating factors concerning people's living with HIV mental health. The present study looked at the clinical presentation at intake and treatment requests of 191 (83% males) people living with HIV who addressed the psychological support service of the non-governmental organization 'Centre for Life' during the years 2016- 18. Data were collected through a semi-structured clinical interview and administration of adapted questionnaires (PHQ-9, BAI, CAGE), which resulted in 7 dichotomous variables related to clinical presentation and 13 dichotomous variables related to treatment requests at intake. To analyze data, we constructed frequency tables and performed chi-square tests. In the whole sample, 42.2% presented anxiety disorders, 40.3% depression, 28.8% occasional substance use, 17.5% problematic use of alcohol and 13.6% intravenous drug use. Moreover, 14% reported at least one suicide attempt in the past and 9.2% current suicidal ideation. Apart from more frequent intravenous drug use among heterosexual males and more frequent occasional/recreational drug use among men who have sex with men, no other differences related to gender, age group, sexual orientation or ethnicity were observed in the initial clinical presentation. Similarly, the most frequent treatment requests were homogenously distributed in our sample, such as depressive symptoms (58.6%), difficulties in romantic relationships (48.7%), accepting being HIV positive (42.9%), anxiety symptoms (42.4%) and issues of negative self-esteem (40.8%). The presence of clinically significant depression was found to be related to a wider range of treatment requests compared to other mental health problems. A large group of requests focused on interpersonal relationships difficulties (e.g. disclosure anxiety, social isolation, disturbed relationships with familiar persons). This indicates an important area of psychological intervention. HIV infection may affect many levels of an individual's life, including their mental health. Respectively, HIV treatment needs to adopt a more holistic approach.

Process and outcomes evaluation of a pre-academic arts program for individuals with mental health conditions: a mixed methods study protocol.

INTRODUCTION: The Garage is a multidisciplinary pre-academic arts school for people with artistic abilities who are coping with mental health conditions (MHC). The programme, supported by the National Insurance Institute and the Ministry of Health in Israel, is an innovative rehabilitation service designed to impart and enhance artistic-professional skills and socioemotional abilities to ultimately facilitate participants' integration into higher education and the job market. METHODS AND ANALYSIS: This mixed methods longitudinal study will include an embedded design in which the qualitative data are primary and the quantitative data are secondary, thus providing complementary information. The study will examine the contribution of the Garage to changes in participants' personal recovery, well-being, creative self-concept and community integration as well as possible mechanisms that may account for these changes. Qualitative data will be collected using focus groups with graduates and students (a total of ~60 participants). Quantitative data will be collected by self-report questionnaires only from students attending the programme (before, during and at the end of the academic year). Data on the graduates' integration into higher education and the job market after completing the programme will also be collected from the management team. The qualitative data will be analysed following the grounded theory approach and the quantitative data will be analysed with correlations, paired tests to examine pre-post changes and regression analyses. A merged data analysis will be conducted for data integration. ETHICS AND DISSEMINATION: The University's Human Research Ethics Committee approved the design and procedures of the study (approval #357-16). All participants will sign an informed consent form where it is clarified that participation in the study is on a voluntary basis, and anonymity and confidentiality are guaranteed. The results will be submitted for peer-reviewed journal publications, presented at conferences and disseminated to the funder and the programme's management team.

Effectiveness of art therapy with pediatric populations affected by medical health conditions: a systematic review.

Background: Visual art therapy has been widely used with children with medical health conditions within various settings. However, less is known about its effectiveness. The scope of this systematic review is to shed light on what benefit art therapy may have for ill health adjustment in youth populations. Methods: Electronic databases (Psychinfo, Medline, CINAHL, ERIC, Scopus, Embase and Child and Adolescent Studies) were searched (1806-2017). Systematic methods for study selection and data extraction were used. Results: Twelve studies (N = 404 participants, 318 in the control group; aged between 2 and 19 years old, with various medical conditions) were included. Ten studies reported significant improvements concerning at least one outcome with an overall inconclusive trend toward effectiveness. Conclusions: Visual art therapy interventions were found weak in evidence quality. However, future evidence-based research designs could show the effectiveness of these interventions in health care settings.

Interdisciplinary arts and health practice with an institutional logics perspective.

Background: Investigating the interdisciplinary relationships between stakeholders engaged in arts and health practice in the UK and Denmark, specifically with regard to institutional logics theory. The identified stakeholders: health professionals, museum educators and mental health service users. Method: Semi-structured interviews were conducted with 30 participants: health professionals, museum educators and service users. Data were collected in Denmark and the UK. A thematic approach was used to analyse the data and theoretical lenses of sociological theories, and institutional logics explored the findings. Results: The interdisciplinary work in arts and health is complex, given the different disciplines and institutions involved. Findings illustrate that institutional logics play a vital and ambiguous part in arts and health practice and that this presents a challenge for interdisciplinary working in the field. Conclusions: Awareness of the complexity of multiple logics in the arts and health field; recognising the differences between disciplines and institutions could benefit from research and practice.

Yoga: Balancing the excitation-inhibition equilibrium in psychiatric disorders.

Social behavioral disturbances are central to most psychiatric disorders. A disequilibrium within the cortical excitatory and inhibitory neurotransmitter systems underlies these deficits. Gamma-aminobutyric acid (GABA) and glutamate are the most abundant excitatory and inhibitory neurotransmitters in the brain that contribute to this equilibrium. Several contemporary therapies used in treating psychiatric disorders, regulate this GABA-glutamate balance. Yoga has been studied as an adjuvant treatment across a broad range of psychiatric disorders and is shown to have short-term therapeutic gains. Emerging evidence from recent clinical in vivo experiments suggests that yoga improves GABA-mediated cortical-inhibitory tone and enhances peripheral oxytocin levels. This is likely to have a more controlled downstream response of the hypothalamo-pituitary-adrenal system by means of reduced cortisol release and hence a blunted sympathetic response to stress. Animal and early fetal developmental studies suggest an inter-dependent role of oxytocin and GABA in regulating social behaviors. In keeping with these observations, we propose an integrated neurobiological model to study the mechanisms of therapeutic benefits with yoga. Apart from providing a neuroscientific basis for applying a traditional system of practice in the clinical setting, this model can be used as a framework for studying yoga mechanisms in future clinical trials.