Yoga as Therapy for Depression, Anxiety

By Jennifer Anderson

Yoga, when done properly, addresses the entire list of concerns and provides elderly practitioners the space to reflect on the meaning of their lives.

Loss accumulates as we age. We lose parents, friends, and spouses; we notice changes in our health and movement. We may worry about the future, suffer insomnia and, if we do sleep, wake up feeling depressed or anxious.

Researchers increasingly are finding that the ancient Indian practice of yoga not only can help strengthen the body and improve flexibility but also reduce feelings of anxiety and depression.

A 2006 study published in Alternative Therapies in Health and Medicine found that adults enrolled in yoga classes for six months showed "significant improvements" in mood, fatigue, and other quality-of-life indicators. 

Another study, published in 2013 in the Archives of Psychiatric Nursing, found that yoga can help adults suffering from depression regain a sense of connectedness and develop coping strategies. For this study, researchers Patricia Anne Kinser and colleagues found that while all 27 participants enrolled in either the yoga or attention-control group experienced reduced depression, yoga offered additional benefits in "decreasing ruminations."

Yogis, the people who practice yoga, are not surprised by the findings and in fact many have their own data and anecdotal evidence.

Amy Weintraub, founding director of LifeForce Yoga Healing Institute based in Tucson, Arizona, wrote several books on the topic, including Yoga for Depression: A Compassionate Guide to Relieve Suffering Through Yoga, published in 2004.

Older adults who understand and practice yoga and who also suffer loneliness through the death of a partner or friend may wake up in the mornings and practice breathing or yoga movements and feel better, Weintraub says.

"The source of loneliness or depression is still there," she says. "But they are better able to cope and to regulate their mood in response to life changes."

She explained that yoga involves more than postures. It incorporates breathing, meditation, imagery, and mantra, which she defined as a sacred verse or sound. "You see something soothing or joyful in your heart's mind, imagine the image, and draw that image to your heart with a sound like 'so hum' which means 'I am that.'"

Acknowledging an End Point
Matthew J. Taylor, a yoga and physical therapist based in Scottsdale, Arizona, and past president of the International Association of Yoga Therapists, described yoga as a "lifestyle program" and "science of living well."  He explains that yoga classes are uniquely suited for the elderly because each one, taught in the traditional way, is intended to mimic the life cycle.

While yoga emphasizes living well each day, each class ends with participants lying relaxed on the floor in what instructors often refer to as the relaxation pose but what is really supposed to be savasana, or corpse pose. "No one ever explains that because our culture is so afraid of death," he says.

"We're busy getting our faces lifted and our hair colored, trying to stay young and fit, worshipping youth," Taylor says. "We're not skilled in acknowledging that there is an end point."

The true message in yoga should be: You're going to die someday, so live your life now.

Tai chi, meditation, and other practices similar to yoga also share an emphasis on living and being awake in the moment. The difference, Taylor explains, is that yoga reminds us to be awake by reminding us that our lives will end.

For older Americans, the corpse pose is particularly beneficial. "Geriatrics realize they're coming to the last chapter," he says. They worry about loss of independence, loss of physical health, falling and fractures, and the dying process. "They want to talk about [death], but we don't do that in our culture."

Yoga, when done properly, addresses the entire list of concerns and gives elderly practitioners the space to reflect on the meaning of their lives. "It's both the practices and the philosophy," he says, "the questions of who I am and what will happen when I die."

Opening a Dialogue
Yoga is not group therapy. Instead it is a place where the instructor leads inquiry into issues concerning death and dying. In "Yoga Therapeutics: Preparation and Support for End of Life," published in 2011 in Topics in Geriatric Rehabilitation, authors Taylor and his wife, Jennifer Collins Taylor, yoga therapist and end-of-life specialist, explain that in savasana the participant is asked to lie down and do the following: Appreciate a sense of wholeness just as they are in that moment, in that body, with that current emotional and mental state and the current circumstances of life. This nonjudgmental awareness also provides an opportunity to witness their impermanence and mortality. The article goes on to indicate that gentle, supportive cues … can include the following: Allow your bones to melt into the yoga mat; imagine your entire body breathing; witness thoughts and emotions as they pass by; honor your wisdom as you connect to the universal wisdom; let joy, peace, and bliss wash over you; and single-word cues such as release, relax, guide, notice, receive, rest, dissolve, allow, open, let go, accept, honor, soften, welcome, be present, be still, connect, permit, embrace, sense, enjoy, surrender, pause, and unfold. 

Once the conversation is opened, participants may feel free to talk further out of class, with spouses or caregivers, or at least leave with a new way of thinking about those things that frighten them.

Finding a Class
Finding a yoga class that refers to the corpse pose and allows for discussions on death and dying can be difficult, Taylor says. Even though yoga has been around for thousands of years, it gained popularity in the United States just a few decades ago. 

"Yoga is very much in its infancy here," Taylor says. Geriatric yoga therapy, as a place where older adults can ponder the issues most pressing on their minds, is a vision for the future and a goal of his organization, he notes.

He recommends that geriatric patients looking for yoga therapy try the association's website, www.iayt.org, searching under the "find a member" tab for therapists. Yoga therapists who specialize in geriatric yoga require a minimum of 1,000 hours of training, which includes health and end-of-life issues.

"There isn't a lot yet," he says of therapeutic yoga options for seniors. "The movement is coming."

Connections
Barry S. Oken, MD, a professor of neurology at Oregon Health & Science University in Portland and an author of the 2006 Alternative Therapies study "Randomized, Controlled, Six-Month Trial of Yoga in Healthy Seniors: Effects on Cognition and Quality of Life," noted that in addition to the mental benefits, yoga also offers physical benefits for the elderly.

Like physical therapy, yoga builds strength and flexibility and helps improve balance, he says.  In addition, yoga brings the mind to the moment, with awareness on breathing, none of which is typical of conventional physical therapy.

For people with multiple sclerosis, lower back pain, unstable knees, and other conditions, there is adaptive yoga, sometimes with an instructor also trained in physical therapy, he says. Practicing yoga at home for at least a few minutes a day can be helpful, and there are DVDs available that can instruct people in yoga practices in their homes. But Oken also advises weekly classes, especially for the elderly who may benefit from the sense of community and socialization yoga offers.

Weintraub, likewise, endorses a classroom structure, especially for the elderly. "Yoga is about connections," she says. "We're lonely because we forget we are deeply and intimately connected to something beyond our own story." Through classes, patients can connect with their inner selves as well as others around them. 

While there are many forms of yoga, including the higher intensity vinyasa, Weintraub recommends that older adults stick with gentle yoga for strength, balance, and flexibility.  Vinyasa, she explains, is too hard on the joints, and she suggests that older adults might seek out aerobic exercise through other means such as walking, jogging, or biking. 

Weintraub advises newcomers to yoga to visit Yoga for Depression's website at http://yogafordepression.com. In addition to resources and free practices, the website also provides lists of yoga practitioners who work with patients suffering mood disorders through loss and other life changes.

— Jennifer Anderson is a freelance health and science writer based in Falls Church, Virginia.