Anti-anxiety efficacy of Sudarshan Kriya Yoga in general anxiety disorder: A multicomponent, yoga based, breath intervention program for patients suffering from generalized anxiety disorder with or without comorbidities
Introduction
An estimated third of the total European population suffers from mental disorders (Wittchen and Jacobi, 2005). Among these, depression and anxiety are two of the most common psychiatric disorders affecting adults, young adults and adolescents of both sexes (Da Silva et al., 2009, Alonso et al., 2004, Cassano and Fava, 2002, Wittchen et al., 1999, Wittchen et al., 2002b, Wittchen and Jacobi, 2005, Wittchen et al., 2010). Psychiatric disorders are the prominent cost of disability adjusted life years world-wide (Balasubramaniam et al., 2012). The personal, social and occupational functions of an individual, as well as their physical health, can be dramatically affected by these disorders, which, in turn, produce a negative impact on society, in terms of both the elevated cost of health care resources, and the subsequent reduction in worker productivity (Frye et al., 2006, Wittchen and Jacobi, 2005, Wang et al., 2009).
Regarding treatment strategies, recent studies have revealed an issue of particular relevance concerning the difference in access and propensity to psychiatric care in relation to gender. Women result as demonstrating a higher propensity to acknowledge psychological discomfort, and subsequently, to request aid, given that they are primarily affected by internalization-related disturbances (Depression and Anxiety). On the contrary, men result as being much more likely to repress their psychological discomfort, and are characterized by a general refusal to ask for assistance, opting, instead, to isolate themselves, given that they are primarily affected by externalization-related disturbances (antisocial behavior, drug addiction, etc.) (Eaton et al., 2012). To this regard, in order to facilitate equal access and compliance to psychiatric care for both genders, it is necessary to develop strategies in communication, diagnosis and care specifically designed for the different needs and characteristics of male and female psychological disorders.
Furthermore, in order to achieve effective, long-term results in therapeutic treatment, it is also essential to take into account the tendency of mood and anxiety disorders to be not only chronic and highly comorbid, but by their very nature, prone to exacerbate other forms of psychiatric illnesses (Andrews et al., 2002, Wittchen et al., 1998, Wittchen and Jacobi, 2005).
Generalized Anxiety Disorder (GAD), has the potential to cause serious interference with a person's daily life (Wittchen, 2002a, Wittchen and Jacobi, 2005). By definition, GAD is characterized by excessive anxiety and worry that lasts for at least six months and is associated with three or more of the following symptoms: restlessness, becoming easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance. Excessive and uncontrollable worrying is a core feature of GAD, often concerning the individual's health and that of their significant others, their personal finances and their future (American Psychiatric Association, 1994). This disorder also exhibits a high degree of chronicity, with women more likely to be diagnosed than men (Wittchen et al., 2002b). It is often complicated by a high prevalence (45–91%) of comorbidity with other psychiatric and/or medical conditions including panic disorders and major depressive disorders (Massion et al., 1993, Olfson et al., 1997, Wittchen and Jacobi, 2005) as well as a variety of cardiovascular, gastrointestinal and respiratory diseases (Wittchen et al., 2002b). Relapse rates are fairly high for people suffering with GAD with two thirds of patients suffering a recurrence within one-year (Brawman-Mintzer and Lydiard, 1996).
Current pharmacotherapeutic options for GAD include antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRI), e.g. venlafaxine, O-desmethyl-venlafaxine, duloxetine, milnacipran, buspirone, hydroxyzine, and benzodiazepines, low-dose anti-psychotics, and pregabalin (Ballenger, 1991; Montgomery, 2006). Nevertheless, all pharmacological treatments for GAD can cause troublesome side effects, including nausea, sexual dysfunction, and weight gain for the antidepressants (Kennedy et al., 1999, Kennedy et al., 2001), and anterograde memory impairment, sedation and the risk of dependence with benzodiazepines; therefore, they are not recommended for long-term use (Michelini et al., 1996). Response to these treatments tends to be highly variable, ranging from 40% to 70% (Baldwin and Nair, 2005, Gelenberg et al., 2000, Pollack et al., 2001, Rickels et al., 1993). Furthermore, limits in terms of efficacy and tolerability often result in poor patient adherence to medication and thus, long-term remission is often difficult to achieve (Katzman et al., 2008). On average, only a third of GAD patients achieve remission within a year of follow-up, while patients who do achieve an initial response often relapse (Andrews et al., 2000).
Depressive disorder is another well-known chronic, recurrent and disabling mental disease with high direct and indirect costs to society in both western and eastern cultures (Hwu et al., 1996, Cassano and Fava, 2002, Lu. et al., 2008). Depressive disorder is also associated with a considerable disability burden in terms of number of work days lost (Wittchen and Jacobi, 2005). Although a large number of novel antidepressants have been introduced over the past few decades, at least 40% of depressed patients show only partial or no response to initial or even multiple antidepressant medication (Fava and Davidson, 1996, Golden et al., 2002). Thus, novel, effective therapies for anxiety and depression are currently needed.
Sudarshan Kriya Yoga (SKY) is a comprehensive program derived from yoga that includes bodily postures, powerful breathing exercises, meditation, and cognitive/behavioral procedures. From the biomedical point of view, it is a set of techniques with demonstrable effects on brain function (Meti and Desiraju, 1984, Meti and Raju, 1993). Previous studies have suggested that SKY is an effective tool in relieving clinical and non-clinical anxiety and depression. There is sufficient evidence to consider SKY to be a beneficial, low-risk, low-cost adjunct to the treatment of stress, anxiety and depression (Brown and Gerbarg, 2005, Katzman et al., 2012, Zope and Zope, 2013). Thus SKY represents a potentially valuable adjunct to standard pharmacotherapy in patients with GAD or treatment-resistant GAD patients, and warrants further investigation. The objective of the current study was to evaluate the possible efficacy of SKY in relieving anxiety and depression symptoms, at the same time improving the general psychological condition of a population of Caucasian adult outpatients.
Section snippets
Patients
The study was made up of 69 consenting outpatient adults (between 25 and 64 years) with a primary diagnosis of DSM-IV Mood and/or Anxiety disorders (American Psychiatric Association, 1994). Thirty-nine consenting outpatients presented a primary diagnosis of DSM-IV Anxiety disorders, 18 consenting outpatients presented a primary diagnosis of DSM-IV Mood disorder (patients with major depression, dysthymic disorder, or other depressive disorders) with 12 patients presenting both diagnoses. The 39
Results
Hamilton Rating Scale for Anxiety HRSA's scores significantly decreased from baseline to subsequent time points: F (2.224, 122.315)=18.959 (p<0.001) [F (2.281, 152.808)=25.763 p<0.001], and with a moderate effect size (Cohen's d=0,66) [d=0,74]. The main effect of the use of medication to the Anxiety scores is not significant F (1, 55)=0.628, (p=0.432) [F (1, 67)=0.309, p=0.580], nor was the effect of medication consumption to the scores recorded in different time points of the survey F (2.224,
Discussion
The statistical analyses employed in this study have verified that the implementation of SKY therapy in a scientifically controlled, medical environment significantly reduces levels of Anxiety and Depression in patients suffering from these disorders, as measured by five different psychological scales, across four main groups (Depression pharmaceutically treated/Not treated, Anxiety pharmaceutically treated/Not treated). The reduction in the scores achieved resulted as being particularly
Conclusion
In conclusion, the introduction of SKY Treatment has successfully induced a significant reduction in Anxiety and Depression symptoms in the patients participating in our study. Considering the strong demand for the improvement in patients’ quality of life, as well as the need to reduce the negative impact on the work-force and to decrease the public costs generated by Anxiety and Depression, this study provides extensive evidence to warrant further studies on the efficacy of the SKY Procedure
Confilct of interest
The authors declare no conflict of interest.
Role of funding
The authors declare that study has not been funded.
Acknowledgment
The authors thank the patients who participated in the study. The authors also thank Professor Sandro Levi for kindly reviewing early versions of this article, in particular statistical analysis. The authors thank Kendall Katze for reviewing the English version of the article and Dr. Luiz Felipe Nevola Teixeira for the organization of paragraphs. The authors also thank Dr. Emanuele Proverbio for informatic support.
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