Dr. James Lake is a Board-certified psychiatrist in the San Francisco Bay area and the author of four textbooks on integrative mental health care. He has served as a clinical assistant professor in the department of psychiatry at Stanford University and he founded and previously chaired the American Psychiatric Association’s Caucus on Complementary and Integrative Medicine. He recently published ten short books intended as self-care guides for managing common mental health problems, including Depression: The Integrative Mental Health Solution, which describes mindfulness and other non-pharmacologic ways to take care of depressed mood. Other books address anxiety, bipolar disorder, post-traumatic stress disorder and attention-deficit/hyperactivity disorder. You can contact Dr. Lake at his website where you can order his books, read his blogs, and find links to valuable internet resources on a broad range of alternative and integrative treatments of common mental health problems. In this contribution to the KineSophy Mindfulness Series, he presents some of the research on how mindfulness and mind-body practices influence positive mood.

Mindfulness training improves general well-being and enhances positive mood

Controlled studies and case reports show that certain mind-body practices improve general emotional well-being and enhance positive mood. Improved capacity for focused attention and reflection has been proposed as an important non-specific psychological benefit of mind-body practices. Mindfulness training includes many styles of meditation and guided imagery. Mind-body practices include taijijuan, qigong, yoga, the Hakomi body-centered method, and others. Guided imagery is widely used as a treatment of depressed mood in Western countries. The regular practice of a mind-body skill may be as beneficial as cognitive-behavioral therapy and conventional antidepressants in the management of moderately depressed mood (Murphy 1995).

Mindfulness training combined with cognitive therapy may enhance outcomes compared to cognitive therapy alone (Mason 2001). In an open trial, sixty women with post-partum depressed mood and anxiety experienced significant relief during the first four weeks following childbirth using a combined relaxation-guided imagery protocol (Rees 1995). Depressed patients who had previously been diagnosed with somatoform disorders experienced greater improvements in positive mood when guided imagery was combined with antidepressants than with conventional medications alone (Bernal 1995).

Yoga is probably beneficial in both moderate and severe depressed mood

Of the various mind-body disciplines used to obtain relief from psychiatric symptoms, more studies have been done on yoga than any other discipline (Shannahoff-Khalsa 2004). Brown has speculated that the mechanism of action of yogic breathing might be similar to vagal nerve stimulation (VNS) in that both approaches involve modulation of the balance of parasympathetic and sympathetic autonomic tone.

Yogic breathing achieves desirable changes through a variety of specific breathing exercises that differentially affect the brain stem and limbic system, while VNS relies on a weak electrical current to achieve desirable changes in brain autonomic activity that mediate improved mood or reduced anxiety. Like yogic breathing techniques, the regular practice of various yoga postures (asanas) probably results in beneficial changes in the autonomic nervous system resulting in improved cardiorespiratory performance and increased feelings of psychological well-being (Harinath 2004).

Many styles of yoga are probably beneficial in depressed mood. A particular style of yogic breathing called Sudarshan Kriya (SK) yoga has been extensively evaluated as a potential treatment of depressed mood and other mental or emotional symptoms (Shannahoff-Khalsa 1999). Moderately depressed patients improved significantly by the end of a five-week yoga class (Woolery 2004). In a group of severely depressed hospitalized patients, improvements associated with SK breathing practice were comparable to responses from conventional antidepressants and only slightly less robust than patients receiving ECT (Janakiramaiah 2000). Emerging evidence suggests that the regular practice of forms of yoga that do not include specialized breathing exercises also improve depressed mood, including hatha yoga, Omkar meditation, and Iyengar yoga.

Regular practitioners of hatha yoga and Omkar meditation also had significant increases in melatonin secretion, possibly related to increased serotonin, an established benefit of meditation (Walton 1995). In a small randomized case-control study mildly depressed practitioners of Iyengar yoga reported significant improvements in mood following semi-weekly yoga practice for five weeks (Woolery 2004). A significant limitation of studies on yoga or any mind-body practice is the absence of double-blinding, as enrolled patients are necessarily aware of engaging in specific movements or breathing exercises of a particular mind-body practice. Many depressed patients have difficulty becoming motivated to start a mind-body practice and should be gently encouraged to take classes at the start of their practice, and slowly transition to a daily self-directed program if they find it beneficial to their mood and general state of well-being.

References:

Bernal i Cercos A, Fuste i Vallverdu R, Urbieta Solana R, Montesinos Molina I. [Relaxation therapy in patients with anxiety and somatoform disorders in primary care]. [Spanish] Tratamiento de relajacion en pacientes con trastornos de ansiedad y somatoformes en atencion primaria. Atencion Primaria 1995 May 15 15:8 499-504.

Harinath, K Malhotra A, Pal, K, Prasad R, Kumar R, et al. Effects of Hatha Yoga and Omkar Meditation on Cardiorespiratory Performance, Psychologic Profile and Melatonin Secretion. JACM 10:2 2004 261-268.

Melatonin Secretion. JACM 10:2 2004 261-268. Janakiramaiah, N. et al, “Antidepressant efficacy of Sudarshan Kriya Yoga in melancholia: a randomized comparison with electroconvulsive therapy and imipramine,” J. Affect Dis 2000; 57:255-9.

Mason O, Hargreaves I. A qualitative study of mindfulness-based cognitive therapy for depression. Br J Med Psychol 2001;74(Pt 2):197-212.

Murphy GE, Carney RM, Knesevich MA, Wetzel RD, Whitworth P. Cognitive behavior therapy, relaxation training, and tricyclic antidepressant medication in the treatment of depression. Psychol Rep 1995 Oct;77(2):403-20.

Rees BL Effect of relaxation with guided imagery on anxiety, depression, and self-esteem in primiparas. Journal of Holistic Nursing 1995 Sep 13:3 255-67.

Shannahoff-Khalsa D An introduction to Kundalini Yoga meditation techniques that are specific for the treatment of psychiatric disorders. JACM 10;1:2004, 91-101.

Shannahoff-Khalsa, D.S., Ray, L.E., Levine, S., et al (1999). Randomized controlled trial of yogic meditation techniques for patients with obsessive-compulsive disorder. CNS Spectrums 4, 34-47.

Walton K, Pugh N, Gelderloos, P, Macrae P Stress reduction and preventing hypertension: preliminary support for a psychoneuroendocrine mechanism. JACM 1995; 1:263-283.

mechanism. JACM 1995; 1:263-283. Woolery A, Meyers H, Sternlieb B, Zeltzer L. A yoga intervention for young adults with elevated symptoms of depression. Alternative Therapies 10(1):60-3, 2004.

Read the other articles in the KineSophy Mindfulness Series.