Anxiety affects many people. Numerous yoga techniques can be helpful for improving general mental health, including reduction of both depression and anxiety. Some techniques may be more specific for reducing either depression of anxiety. Our research has established general agreement amongst an independent panel of experienced teachers working in mental health. For reducing anxiety, there was general agreement that working with the breath, relaxation, and meditation were the most important. Postures and movement were also considered important, but less so. It is also important to be aware of practices and techniques that may make things worse for some people, and are generally better to avoid. A personalised approach is very important. Anxiety affects many people. Almost 12% of the world’s population (about 1 in 9 people) experienced a diagnosed anxiety disorder every year (WHO, 2012), and many more people experience symptoms of anxiety that may be undiagnosed. It is also well known that many people do not seek treatment, or is treatment unavailable or inadequate (Jorm et al, 2013; Reavley et al , 2013).

Although anxiety and depression are identified as independent diagnostic categories, comorbidity of depression and anxiety is well recognised and common (Kessler et al, 2015), and treatment approaches are often similar. Anti-depressants are the most common and effective medications for anxiety. Psychological treatments, including Cognitive Behavioural Therapy (CBT) also share common approaches and interventions. Many people seek mind-body-lifestyle approaches, including yoga, to help reduce their anxiety. This may include attending yoga classes or developing a personal yoga practice. Anecdotal stories of benefits are common, and some scientific research supports such claims. However, several reviews of the research all suggest that the evidence is limited, and further research is required.

For those who have already experienced the benefits of yoga for improving mental health, and reducing symptoms of depression or anxiety, no evidence is required. However, important questions remain unclear, including which particular aspects, approaches and techniques of yoga practice can be beneficial, whether any techniques can be potentially harmful, and most importantly, an understanding of individual differences. Yoga is a very broad term, which includes many different approaches and techniques. This is seen throughout the history of yoga, and certainly in the different styles of yoga in modern times. People, including yoga teachers, who have experienced benefits for themselves, will often have a desire to share those benefits with others. However, standardised approaches can be problematic, and what works for one person may not work for others. It is difficult to rely too much on another’s person’s experience, and there is little evidence to clarify questions of what works (or doesn’t) for different people. This is particularly true when working with the mind and emotions. A more personalised approach is generally more effective. Due to the lack of evidence of which particular approaches and techniques might be more effective for reducing depression and anxiety, and rather than relying on a particular person’s individual experience or preferred style, we conducted a study to gain a consensus view of a panel of independent experienced yoga teachers and researchers in the field of mental health.

This type of study uses the “Delphi method”, and aims to reach agreement amongst a majority of the panel. There was agreement that some yoga practices were beneficial for both depression and anxiety, and improving mental health in general. However, some practices were seen as more specifically beneficial for reducing anxiety, and other practices for reducing depression. There were also differences in what was generally recommended to avoid for people with depression and anxiety. The results of this study have been published, including recommended practices to include or avoid, and are available for download here (reference also provided below) The results of this study have been used to develop intervention protocol guidelines for a clinical trial. This randomized controlled trial included a sample of 101 people (initially 108) with symptoms of depression and/or anxiety, and compared the benefits of an individualized 6-week yoga intervention with a waitlist control group. Participants in both groups continued with their usual mental health treatments, and the yoga was in addition to their usual care. The control group was offered the yoga following the waitlist period. A range of mental health measures were used, including Depression Anxiety Stress Scale (DASS-21), Kessler Psychological Distress Scale (K10), Short-Form Health Survey (SF12), Scale of Positive and Negative Experience (SPANE), Flourishing Scale (FS), and Connor-Davidson Resilience Scale (CD-RISC2). There were no yoga classes in this study. The yoga intervention given to each participant included four individual 1-hr consultations/lessons over a 6-week period, with a suitably qualified yoga teacher. During these sessions, an individualized yoga practice was developed and taught to the participant, and given for him or her to do at home.

The yoga practice conformed to the consensus statement from the previous Delphi study, and was individualized for each participant according to his or her presenting symptoms, needs, abilities, goals, and circumstances (a classical approach to yoga practice known as the viniyoga of yoga, and often called yoga therapy). Each individualized yoga practice specified appropriate physical postures andmovement; breathing exercises; relaxation; mindfulness and meditation; and other aspects of yoga practice such as cultivation of positive values, thoughts and attitudes, and lifestyle factors. Some components were recommended for reducing both depression and anxiety, some were recommended to include or avoid specifically for depression or anxiety. Teacher and participant established an agreement on suitable parameters of the yoga practice, including time of day, duration, and frequency. Participants were taught their yoga practice during the sessions, and a written copy of the practice, including diagrams and instructions, was taken to assist with doing the practice at home. Depending on the participant’s feedback and the teacher’s observations at each consultation, the yoga practice may have been revised or developed over the course of the four sessions. Actual amount of yoga done, and adherence to the given practice were recorded at each subsequent session. Encouraging reminders were given to participants by phone call, SMS, or email in weeks when consultation sessions werenot conducted. Fifteen qualified yoga teachers who had specific training and experience in designing and teaching individualized yoga practices, and training in intervention protocol guidelines, provided the yoga sessions.

Results of the study showed that people who did the yoga practice had statistically significant improvements in scores of depression, anxiety (after removal of unusual outlying data), psychological distress, overall mental health, frequency of positive and negative experiences, resilience and flourishing. And, the benefits were maintained after a six-week follow-up period. The yoga practices that were done by the majority of participants included moving repetition (rather than static holding) of breath-focused gentle postures and sequences; passive relaxation postures; relaxed abdominal breathing; a longer/slower exhalation; meditation practices with a given object of focus (rather than emptiness); and formulation of a personal intention. Other components were also included in each practice, but not necessarily a main focus. The evidence shows that developing of a suitable personal yoga practice makes a significant difference in reducing depression and anxiety, and may be suitable for may be particularly beneficial in mental health care in the broader community. The results of this clinical trial have been published, and are available online here (reference also provided above)

References Jorm, A., Allen, N., Morgan, A., et al. (2013). A guide to what works for depression. (2nd ed.). Melbourne: Beyond Blue Kessler, R., Sampson, N., Berglund, P., et al. (2015). Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys. Epidemiology and Psychiatric Sciences., 24(3), 210-226. Reavley, N., Allen, N., Jorm, A., et al. (2013). A guide to what works for anxiety. (2nd ed.). Melbourne: Beyond Blue. *Please Note: The information in this article is intended for your educational use only and does not necessarily reflect the opinions of YogaMate or it's Panel of Advisors. This information it nota substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition. The above article has been supplied by YogaMate - a website sharing the depth, breadth and therapeutic application of Yoga. Check out their evidence-informed resources, locate Yoga specialists, or use their marketing and planning tools (Yoga Professionals). Learn more at www.YogaMate.org