Note: We are not permitted to give specific medical advice to individuals through this website. The information you or your doctor will need to make medical decisions about including complementary treatments in your health care plan can be found in our book, How to Use Herbs, Nutrients, and Yoga in Mental Health Care, RP Brown, PL Gerbarg, and PR Muskin (WW Norton 2009) and in our other publications (see the links to our curricula vitae under “About Us” on the home page.
Breath Master Dan Brule Interviews Dr. Pat Gerbarg:
The Neuroscience Behind Breathwork with Dr. Pat Gerbarg
Breath Teacher, Dan Brule, interviews Dr. Pat Gerbarg about the science and clinical uses of breath practices. Dr. Gerbarg explains the neurophysiology of the effects of breath practices on autonomic system, stress response, energy metabolism, inflammation, social bonding, judgement, and performance. This lively 1-hour discussion goes into depth about many questions regarding the use of mind-body practices, particularly the use of the breath.
Dan Brule is the author of Just Breathe. Master your breath for Success in Life, Love, Business and Beyond (February 2017). His website is www.breathmastery.com.
Recent Studies of the Effects of Yoga on Memory and Cognitive Function, Neuroplasticity and Functional Connectivity in Older Adults
A randomized controlled trial of Kundalini yoga in mild cognitive impairment.
Eyre HA1, Siddarth P1, Acevedo B1, Van Dyk K1, Paholpak P1, Ercoli L1, St Cyr N1, Yang H1, Khalsa DS2, Lavretsky H1. Int Psychogeriatr. 2017 Jan 16:1-11.
1Semel Institute for Neuroscience and Human Behavior, UCLA,Los Angeles,California,USA.
2Alzheimer's Research and Prevention Foundation, Tucson, Arizona,USA.
BACKGROUND: Global population aging will result in increasing rates of cognitive decline and dementia. Thus, effective, low-cost, and low side-effect interventions for the treatment and prevention of cognitive decline are urgently needed. Our study is the first to investigate the effects of Kundalini yoga (KY) training on mild cognitive impairment (MCI).
METHODS: Older participants (≥55 years of age) with MCI were randomized to either a 12-week KY intervention or memory enhancement training (MET; gold-standard, active control). Cognitive (i.e. memory and executive functioning) and mood (i.e. depression, apathy, and resilience) assessments were administered at baseline, 12 weeks and 24 weeks.
RESULTS: At baseline, 81 participants had no significant baseline group differences in clinical or demographic characteristics. At 12 weeks and 24 weeks, both KY and MET groups showed significant improvement in memory; however, only KY showed significant improvement in executive functioning. Only the KY group showed significant improvement in depressive symptoms and resilience at week 12.
CONCLUSION: KY group showed short- and long-term improvements in executive functioning as compared to MET, and broader effects on depressed mood and resilience. This observation should be confirmed in future clinical trials of yoga intervention for treatment and prevention of cognitive decline (NCT01983930).
Changes in Neural Connectivity and Memory Following a Yoga Intervention for Older Adults: A Pilot Study. Eyre HA2, Acevedo B, Yang H, Siddarth P1, Van Dyk K, Ercoli1, Leaver AM, Cyr NS, Narr K, Baune BT, Khalsa DS, Lavretsky H. J Alzheimers Dis. 2016;52(2):673-84.
BACKGROUND: No study has explored the effect of yoga on cognitive decline and resting-state functional connectivity.
OBJECTIVES: This study explored the relationship between performance on memory tests and resting-state functional connectivity before and after a yoga intervention versus active control for subjects with mild cognitive impairment (MCI).
METHODS: Participants (≥ 55 y) with MCI were randomized to receive a yoga intervention or active "gold-standard" control (i.e., memory enhancement training (MET)) for 12 weeks. Resting-state functional magnetic resonance imaging was used to map correlations between brain networks and memory performance changes over time. Default mode networks (DMN), language and superior parietal networks were chosen as networks of interest to analyze the association with changes in verbal and visuospatial memory performance.
RESULTS: Fourteen yoga and 11 MET participants completed the study. The yoga group demonstrated a statistically significant improvement in depression and visuospatial memory. We observed improved verbal memory performance correlated with increased connectivity between the DMN and frontal medial cortex, pregenual anterior cingulate cortex, right middle frontal cortex, posterior cingulate cortex, and left lateral occipital cortex. Improved verbal memory performance positively correlated with increased connectivity between the language processing network and the left inferior frontal gyrus. Improved visuospatial memory performance correlated inversely with connectivity between the superior parietal network and the medial parietal cortex.
CONCLUSION: Yoga may be as effective as MET in improving functional connectivity in relation to verbal memory performance. These findings should be confirmed in larger prospective studies.
Neurochemical and Neuroanatomical Plasticity Following Memory Training and Yoga Interventions in Older Adults with Mild Cognitive Impairment.
Yang H1, Leaver AM2, Siddarth P1, Paholpak P3, Ercoli L1, St Cyr NM1, Eyre HA4, Narr KL2, Khalsa DS5, Lavretsky H1. Front Aging Neurosci. 2016 Nov 21;8:277. 2016
ABSTRACT: Behavioral interventions are becoming increasingly popular approaches to ameliorate age-related cognitive decline, but their underlying neurobiological mechanisms and clinical efficiency have not been fully elucidated. The present study explored brain plasticity associated with two behavioral interventions, memory enhancement training (MET) and a mind-body practice (yogic meditation), in healthy seniors with mild cognitive impairment (MCI) using structural magnetic resonance imaging (s-MRI) and proton magnetic resonance spectroscopy (1H-MRS). Senior participants (age ≥55 years) with MCI were randomized to the MET or yogic meditation interventions. For both interventions, participants completed either MET training or Kundalini Yoga (KY) for 60-min sessions over 12 weeks, with 12-min daily homework assignments. Gray matter volume and metabolite concentrations in the dorsal anterior cingulate cortex (dACC) and bilateral hippocampus were measured by structural MRI and 1H-MRS at baseline and after 12 weeks of training. Metabolites measured included glutamate-glutamine (Glx), choline-containing compounds (Cho, including glycerophosphocholine and phosphocholine), gamma-aminobutyric acid (GABA), and N-acetyl aspartate and N-acetylaspartyl-glutamate (NAA-NAAG). In total, 11 participants completed MET and 14 completed yogic meditation for this study. Structural MRI analysis showed an interaction between time and group in dACC, indicating a trend towards increased gray matter volume after the MET intervention. 1H-MRS analysis showed an interaction between time and group in choline-containing compounds in bilateral hippocampus, induced by significant decreases after the MET intervention. Though preliminary, our results suggest that memory training induces structural and neurochemical plasticity in seniors with MCI. Further research is needed to determine whether mind-body interventions like yoga yield similar neuroplastic changes.
Title: Complementary and Integrative Treatments in Psychiatric Practice
American Psychiatric Association Publications Washington DC, 2017 (in press).
Editors: Patricia L. Gerbarg, MD, Phillip R. Muskin, MD, Richard P. Brown, MD
Table of Contents
Preface: Patricia L. Gerbarg, MD, Phillip R. Muskin, MD, Richard P. Brown, MD
Chapter 1. The Growth of Complementary and Integrative Medicine. Lila Massoumi
Chapter 2. Complementary and Integrative Medicine, DSM-5 and Clinical Decision Making. Patricia Gerbarg, Richard P Brown, Philip R Muskin
Chapter 3. Complementary and Integrative Medicine in Child and Adolescent Psychiatric Disorders - Nutrition, Equine Assisted Therapy, Art Therapy, and Neurofeedback. Deborah R. Simkin, Jenna Saul, Judith E. Pentz, Joel F. Lubar, Kirk D. Little and Robert W. Thatcher.
Section II. Nutrients in Psychiatric Care
Chapter 4. S-adenosyl-L-methionine, Ademetionine, SAMe. Teodoro Bottiglieri, Patricia Gerbarg, Richard P. Brown
Chapter 5. Acetyl-L-Carnitine, N-Acetylcysteine, and Inositol in the Treatment of Psychiatric and Neuropsychiatric Disorders. Sheng-Min Wang, Chi-Un Pae
Chapter 6. Single and Broad-Spectrum Micronutrient Treatments in Psychiatric Practice. Charles Popper, M.D., Bonnie J. Kaplan, Ph.D., Julia J. Rucklidge, Ph.D.
Section III Plant-Based Medicines
Chapter 7. Issues in Phytomedicine. Mark Blumenthal
Chapter 8. Adaptogens in Psychiatric practice: Rhodiola rosea, Schizandra chinensis, Eleutherococcus senticosus, Panax ginseng, Withania somnifera. Alex Panossian, Jay Amsterdam
Chapter 9. Integrating Rhodiola rosea in Clinical Practice: Clinical Cases. Patricia Gerbarg and Richard P Brown
Chapter 10. St. John’s Wort (Hypericum perforatum). Jerome Sarris
Chapter 11. Ginkgo (Ginkgo biloba). Bruce Diamond and Mary Bailey
Chapter 12. Kava (Piper methysticum). Jerome Sarris
Chapter 13. Panax ginseng and American ginseng (Panax quinquefolius). Lila Massoumi
Chapter 14. Chamomile, Lavendar, Lemon balm, Theanine. Lila Massoumi and Patricia Gerbarg
Chapter 15. Saffron, Valerian, Passion flower, Sage. Shahin Ackhondzadeh
Chapter 16. Traditional Chinese Medicine Treatments for Depression, Anxiety, and Insomnia. Wing-Fai Yeung and Ka-Fai Chung
Chapter 17. Sceletium tortuosum. DJ Stein, Nigel Gericke, Olga Gericke
Chapter 18. Bacopa monnieri. Carlos Calabrese
Section IV. Neurohormones.
Chapter 19. Melatonin. Amirhossein Modaberian Shahin
Section V. Mind-Body Practices
Chapter 20. Polyvagal Theory and the Social Engagement System: Neurophysiological Bridge between Connectedness and Health. Stephen W. Porges and C. Sue Carter
Chapter 21. Breathing Techniques in Psychiatric Treatment: Stress, Anxiety, Depression, Attention, Relationships, Trauma, Mass Disasters. Richard P Brown and Patricia L Gerbarg
Chapter 22. The Use of Yoga in Managing Posttraumatic Stress Disorder. Nilkamal Singh, Shirley Telles and Acharya Balkrishna
Chapter 23. Tai chi, Qigong, Physical Exercise. Ryan Abbott, Donald Change, Harris Eyre, Helen Lavretsky, Harris Eyre
Chapter 24. Meditation and Mindfulness in Psychiatric Practice. William Marchand
Chapter 25. Open Focus Attention Training. Lester G. Fehmi, Edward T. Kenny, Susan B. Shor
Section VI Technologies
Chapter 26. Neurofeedback Therapy in Clinical Practice. David V. Nelson and Mary Lee Este
Chapter 27. Cranial Electrotherapy Stimulation (CES) in the Psychiatric Setting. Jeffrey Marksberry, Michel Woodbury, Timothy Barclay
Chapter 28. Chapter 28. Altered Light Stimulus Changes Behavior: Integrating Visual Processing Systems in Mental Health Care. Melvin Kaplan
Chapter 29. Using Technology Based Mind-Body Tools in Clinical Practice. Heartmath, Heart Rate Variability Feedback, interactive Metronome, Phone APPS. Fred Muench
Supplemental References, Index
Neurobiology and neurophysiology of breath practices in psychiatric care. Gerbarg PL, Brown RP. Psychiatric Times. 33(11):22-25, 2016.
The Effect of Breathing, Movement, and Meditation on Psychological and Physical Symptoms and Inflammatory Biomarkers in Inflammatory Bowel Disease: A Randomized Controlled Trial. Gerbarg PL, Jacob VE, Stevens L, Bosworth BP, Chabouni F, DeFilippis EM, Warren R, ….. Christos PJ, Brown RP, Scherl EJ. J Inflammatory Bowel Disease. 2015 Dec; 21(12):2886-96.
Pause menopause with Rhodiola rosea, a natural selective estrogen receptor modulator. Gerbarg PL, Brown RP. Phytomedicine. 2016; 239:763-9.
Neurobiology and neurophysiology of breath practices in psychiatric care Chapter 28: Gerbarg PL and Brown RP. Edited by David D'Addona, Barry Fogel, and Donna Greenberg. Oxford University Press, Inc., NY. 2016, pp 545-610.
Breathing Practices for Mental health and Aging Chapter 16. Gerbarg PL, Brown RP. In Lavretsky H, Sajatovic M, Reynolds C. Complementary and Integrative Therapies for Mental Health and Aging. NY, Oxford University Press 2016, pp 239-256.
Yoga therapy for anxiety: Clinical insights. Chapter 6. Pilkington K, Gerbarg PL, Brown RP. In Principles and Practice of Yoga in Health Care. Ed. By Sat Bir Khalsa, L Cohen, T McCall, S Telles. Scotland, UK, Handspring Pub. 2017, pp. 95-114.
Integrative Treatments for Masked Anxiety and PTSD in Highly Sensitive Patients. In Evidence-Based Herbal and Nutritional Treatments for Anxiety in Psychiatric Disorders. Gerbarg PL, Brown RP. Ed. Camfield D, McIntyre E, Sarris, J. Switzerland, Springer Intl. Publishing. 2017, pp 155-168.
Patricia L. Gerbarg MD1, Vinita E. Jacob MD2, Laurie Stevens MD3, Brian P. Bosworth MD2, Fatiha Chabouni MD2, Ersilia M. DeFilippis MD2, Ryan Warren BA2, Myra Trivellas BS2, Priyanka V. Patel MS2, Colleen D. Webb RD2, Michael D. Harbus BA2, Paul J. Christos DrPH4, *Richard P. Brown MD3, *Ellen J. Scherl MD2
Background: This study evaluated effects of the Breath-Body-Mind Workshop (BBMW) (breathing, movement, and meditation) on psychological and physical symptoms and inflammatory biomarkers in inflammatory bowel disease (IBD).
Methods: Twenty-nine IBD patients from the Jill Roberts IBD Center were randomized to BBMW or an educational seminar. Beck Anxiety Inventory, Beck Depression Inventory, Brief Symptom Inventory 18, Inflammatory Bowel Disease Questionnaire, Perceived Disability Scale, Perceived Stress Questionnaire, Digestive Disease Acceptance Questionnaire, Brief Illness Perception Questionnaire, fecal calprotectin, C-reactive protein, and physiological measures were obtained at baseline and weeks 6 and 26.
Results: The BBMW group significantly improved between baseline and week 6 on Brief Symptom Inventory 18 (p=0.02), Beck Anxiety Inventory (p=0.02), and IBD Questionnaire (p=0.01), and between baseline and 26 weeks on Brief Symptom Inventory 18 (p=0.04), Beck Anxiety Inventory (P=0.03), Beck Depression Inventory (p=0.01), IBD Questionnaire (p=0.01), Perceived Disability Scale (p=0.001), and Perceived Stress Questionnaire (p=0.01) by paired t-tests. No significant changes occurred in the ES group at week 6 or 26. By week 26, median CRP values decreased significantly in the BBMW group (p=0.01 by Wilcoxon signed rank test) versus no significant change in the educational seminar group.
Conclusions: In patients with IBD, participation in the Breath-Body-Mind Workshop was associated with significant improvements in psychological and physical symptoms, quality of life, and C-reactive protein. Mind-body interventions, such as BBMW, which emphasize Voluntarily Regulated Breathing Practices, may have significant, long-lasting benefits for IBD symptoms, anxiety, depression, quality of life, and inflammation. BBMW, a promising adjunctive treatment for IBD, warrants further study.
(Inflamm Bowel Dis 2015;0:1-11)
Keywords: ulcerative colitis; Crohn’s disease; mind-body; complementary and alternative medicine (CAM), paced breathing, Qigong
Reprints: Patricia L. Gerbarg, MD (e-mail: email@example.com)
Co-senior Authors: E. J. Scherl and R. P. Brown
Hindawi Publishing Corporation, BioMed Research International, Volume 2015, Article ID 983086
Shirley Telles,1 Patricia Gerbarg,2 and Elisa H. Kozasa3.
1 Patanjali Research Foundation, Haridwar, Uttarakhand 249405, India
2New York Medical College, Valhalla, NY 10595, USA
3Hospital Israelita Albert Einstein, 05601-901 Sao Paulo, SP, Brazil
Mind-body practices originated in ancient cultures to enhance physical, mental, and spiritual wellbeing. Interest in their use in treatment stems from increasing awareness of their therapeutic potential and from the need for approaches that are cost-effective and have lower risks for adverse effects compared to pharmacological and other conventional interventions [1–3]. Rigorous research is needed to identify effective mind-body techniques and their mechanisms of action, if they are to be integrated into mainstream medicine 
Descilo T, Vedamurtachar A, Gerbarg PL, Nagaraja D, Gangadhar BN, Damodaran B, Adelson B, Braslow LH, Marcus S, Brown RP.
Effects of a yoga breath intervention alone and in combination with an exposure therapy for post-traumatic stress disorder and depression in survivors of the 2004 South-East Asia tsunami.
Acta Psychiatr Scand. Published Online 2009 Aug 19.
Effects of a yoga breath intervention alone and in combination with an exposure therapy for PTSD and depression in survivors of the 2004 South-East Asia tsunami. Objective: This study evaluated the effect of a yoga breath program alone and followed by a trauma reduction exposure technique on post-traumatic stress disorder and depression in survivors of the 2004 Asian tsunami. Method: In this non-randomized study, 183 tsunami survivors who scored 50 or above on the Post-traumatic Checklist-17 (PCL-17) were assigned by camps to one of three groups: yoga breath intervention, yoga breath intervention followed by 3-8 h of trauma reduction exposure technique or 6-week wait list. Measures for post-traumatic stress disorder (PCL-17) and depression (BDI-21) were performed at baseline and at 6, 12 and 24 weeks. Data were analyzed using anova and mixed effects regression. Results: The effect of treatment vs. control was significant at 6 weeks (F(2,178) = 279.616, P < 0.001): mean PCL-17 declined by 42.5 +/- 10.0 SD with yoga breath, 39.2 +/- 17.2 with Yoga breath + exposure and 4.6 +/- 13.2 in the control. Conclusion: Yoga breath-based interventions may help relieve psychological distress following mass disasters. PMID: 19694633 [PubMed - as supplied by publisher].
International Journal of Yoga Therapy – No. 21 (2011) 23-34
Patricia L. Gerbarg, MD1 Gretchen Wallace2 Richard P. Brown, MD3
1. New York Medical College, Valhalla, NY; 2. Global Grassroots, Hanover, NH; 3. Columbia University College of Physicians and Surgeons, New York, NY
Abstract: Treatment for the psychological consequences of mass disasters is essential to the recovery of individuals and communities. Little is known about how to provide effective mental health interventions when there are thousands of victims and little, if any, access to care. Post-disaster research and program evaluations suggest that mind-body practices can provide significant relief of anxiety, depression, posttraumatic stress, and physical ailments.
Mind-body programs are inexpensive, adaptable to different cultures and conditions, and can be taught rapidly to large numbers of people, including community leaders, to create a sustainable resource for local mental health needs. The challenges of doing research in disaster areas are illustrated using examples from field studies.
Potential risks of administering programs to vulnerable populations are discussed, with program design recommendations.The development of safe, effective, trauma-sensitive, culturally appropriate, sustainable programs requires research and collaboration among healthcare professionals, mind-body trainers, researchers, academic institutions, government agencies, and non-governmental humanitarian organizations.
Key words: mass disasters, trauma, PTSD, yoga, mind-body, stress, genocide, depression, anxiety, breathing, meditation
Correspondence: Patricia L. Gerbarg
Our world is experiencing a cascade of natural and man-made disasters—floods, earthquakes, wars, terrorism, oil spills—that leave physical, mental, emotional, and economic wounds. Most relief efforts focus resources on ensuring physical survival by providing rescue, food, water, shelter, and medical care. Yet the emotional needs of disaster survivors exist as well, surfacing days or even years later. Treatment for the psychological distress from mass disasters is crucial for preventing long-term negative outcomes such as chronic posttraumatic stress disorder (PTSD). The standard one-on-one, therapist–patient (plus medication) model of mental healthcare cannot address traumas that strike tens of thousands of people in one day.
Psychiatric Clinics of North America Vol 36 (2013) 121–140
Richard P. Brown, MDa, Patricia L. Gerbarg, MDb,*, Fred Muench, PhDc
a Department of Psychiatry, Columbia University College of Physicians and Surgeons, NY; b Department of Psychiatry, New York Medical College, Valhalla, NY 12401, USA; c Columbia University College of Physicians and Surgeons, 3 Columbus Circle, Suite 1404, New York, NY 10017,
* Corresponding author: Patricia Gerbarg, 291 Wall St., Kingston, NY 12401, USA
Psychiatr Clin N Am 36 (2013) 121–140
0193-953X/13/$ – see front matter _ 2013 Elsevier Inc. All rights reserved.
Psychiatric Clinics of North America (2013) Vol 36
Philip R. Muskin, MD Patricia L. Gerbarg, MD Richard P. Brown, MD
Psychotropic medications have revolutionized the treatment of serious mental disorders, yet in a significant number of cases, they are partially effective or ineffective. Psychotropics are necessary for many patients but they can contribute to the burden of side effects, and the cost of psychotropics contributes to the cost of health care and disposal of these medications may cause environmental pollution. Phytomedicines, nutrients, and mind-body practices tend to be less costly and to have fewer side effects. Furthermore, much of the world’s population has no access to prescription pharmaceuticals. Although psychotropics and psychotherapies will continue to be mainstays of psychiatric practice, specific combinations of herbs and nutrients can enhance the effectiveness of prescription drugs or reduce the necessary doses. Moreover, nutritional and phytomedicinal compounds can prevent or counteract various acute and long-term side effects of medications such as fatigue, Parkinsonian symptoms, akathisia, and elevated hepatic enzymes. Integrative psychiatrists are finding that mind-body practices can facilitate progress in psychotherapy. Identifying safe and effective nutrients, phytomedicines, and mind-body practices is therefore vital to better mental health care. Integrative treatments provide the clinician with additional therapeutic tools and empower the patient to participate actively in recovery.
We have invited authors to focus on treatments supported by an evidence base of significant benefits, associated with few and modest side effects. From the wide array of complementary, alternative, and integrative medicines (CAIM), we chose to include diverse points of view from experts who are well known, as well as from those whose work is not widely read by mainstream psychiatrists but who are highly regarded in their fields. The authors have been tasked with discussing the evidence base, neurophysiology, risks, benefits, and clinical applications for each treatment. Due to space limitations, commonly accepted and widely published treatments such as hypnosis and acupuncture are not included. To accommodate as much content as possible, several authors have opted to allow the publisher to post most of their reference lists online, retaining only key references with their articles.
Modern research is rediscovering and improving on the benefits of nutrients, herbs, and mind-body practices. Every culture has used local medicinal plants whose active constituents can now being analyzed. The neurophysiologic changes that underlie psychiatric disorders involve multiple mechanisms, metabolites, anatomic structures, and neuro-endocrine networks. Nutrients and herbal extracts contain bioactive substances that can scavenge free radicals, protect cellular structures, enhance mitochondrial energy transport, increase production of neurotransmitters, upregulate or downregulate genes, and replenish vital metabolites. The rationale for integrating treatments is that targeting multiple etiologic factors often results in better outcomes than targeting only one, such as a particular neurotransmitter.
The scientific measurement of psycho-neuro-immuno-hormonal and genomic changes induced by mind-body practices opens a vast domain for treatments derived from spiritual, meditative, fitness, and brain stimulation techniques. Studies are finding that mind-body interventions can activate or mute neural networks involved in emotion regulation. Such interventions act to balance stress response systems, including the autonomic nervous system and the hypothalamic-pituitary-adrenal axis. Among thousands of mind-body practices, one can discern certain common healing elements, for example, breathing practices. Initially developed prior to 5000 B.C. in India as well as in Asia, Africa, Polynesia, and the Americas, these techniques reappeared in medieval monasteries and martial arts. Today such practices are used in yoga classes and in Special Forces training. It is not surprising that such time-tested treatments show significant clinical benefits in randomized controlled trials. Developing specific mind-body programs for various psychiatric conditions and treatment settings is an appealing future direction.
Political, economic, and environmental forces are driving large-scale natural and man-made disasters. Relying solely on expensive pharmaceuticals or one-on-one therapies will not address the global epidemic of depression and posttraumatic stress disorder. Affected populations need inexpensive, accessible, safe, sustainable treatments.
The large-scale cultivation of medicinal herbs is increasing available supplies. Local teachers, care providers, clergy, and community leaders can be trained to provide and to train others in self-healing mind-body practices. Resiliency training could help at-risk communities prevent or recover from the psychological sequelae of traumatizing events. Mind-body programs could also enable members of the military to endure combat stress better and recover from service-related posttraumatic stress disorder.
Integrative psychiatry seeks to enrich mainstream mental health care with valuable treatments from global healing traditions as well as from modern laboratories in related fields, such as neurofeedback, breath pacing, and genomics. Interest, support, and research are growing, but much more is needed to strengthen the evidence base and to refine treatments for specific conditions. Educating ourselves, our peers, and our patients is essential for the safe and optimal use of CAIM approaches. This volume introduces treatments that the authors and editors deem to be worthy of consideration and future development. References provide avenues for further learning. As in any therapeutic endeavor, the journey starts with hearing what those who are experts have to say, followed by self-education and clinical experience.
Along these less traveled roads, each of us has learned and used many of these methods successfully in treating patients who were unresponsive to standard approaches.
We wish to thank the authors for contributing their knowledge and experience to this volume. Elsevier also deserves appreciation for making available to their readership material not often included in mainstream publications.
Psychiatr Clin N Am 36 (2013) xiii–xv
0193-953X/13/$ – see front matter. 2013 Published by Elsevier Inc.
J Trauma Stress Disor Treat 2013, 2:3
Janis J Carter1, Patricia L Gerbarg2, Richard P Brown3, Robert S Ware4, Christina D’Ambrosio5, Leena Anand5, Mihaela Dirlea5, Monica Vermani5,8 and Martin A Katzman5,6,7,8,9*
Objective: It is appropriate to acknowledge that despite treatment, Post Traumatic Stress Disorder (PTSD) continually debilitates many Vietnam veterans. Although therapies have been developed, remission is hard to obtain with either pharmacotherapy or psychotherapy. Evidence has suggested that some forms of yoga may reduce sympathetic overactivity and increase parasympathetic activity, thereby improving stress resilience. Sudarshan Kriya Yoga (SKY) was hypothesized in this study to be potentially useful for lessening symptom severity on the Clinician Administered PTSD Scale (CAPS) in Vietnam veterans with treatment-resistant PTSD.
Method: Fifty male Vietnam veterans with PTSD (DSM-IV) were referred to the study. Thirty-one participants meeting criteria were subsequently randomized to either the SKY intervention (adapted for veterans) group or a 6-week wait-list Control. The intervention consisted of 22 hours of guided group yoga instruction over a duration of 5 days, followed by a 2-hour group session which was held weekly for the first month and monthly thereafter for the following 5 months. Severity of PTSD symptoms was assessed at pre-intervention, 6-week post-intervention, and 6-month follow-up for both groups using the CAPS. Additional questionnaires to measure PTSD, depression, quality of life, and alcohol consumption were administered at pre-intervention, post-intervention and follow-up time frames as well.
Results: Twenty-five of the thirty-one enrolled participants completed the study, of which 14 received immediate intervention while 11 constituted the Control group. The Intervention group showed a significant decrease in CAPS scores 6 weeks following intervention completion, while the Control group had zero decline within this period. At this point, the Control group received the SKY improvements were maintained in both groups 6 months following receipt of treatment. The results indicate that multi-component interventions with yoga breath techniques may offer a valuable adjunctive treatment for veterans with PTSD.
Journal of Traumatic Stress Disorder Treatment
Medical Hypotheses 78 (2012) 571–579
C.C. Streetera, P.L. Gerbargb , R.B. Saperc, D.A. Cirauloa, R.P. Brownd
a Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
b Department of Psychiatry, New York Medical College, Vahlia, NY, United States
c Department of Family Medicine, Boston University School of Medicine, Boston, MA, United States
d Department of Psychiatry, Columbia University, College of Physicians and Surgeons, NY, United States
A theory is proposed to explain the beneﬁts of yoga practices in diverse, frequently comorbid medical conditions based on the concept that yoga practices reduce allostatic load in stress response systems such that optimal homeostasis is restored. It is hypothesized that stress induces (1) imbalance of the autonomic nervous system (ANS) with decreased parasympathetic nervous system (PNS) and increased sympathetic nervous system (SNS) activity, (2) underactivity of the gamma amino-butyric acid (GABA) system, the primary inhibitory neurotransmitter system, and (3) increased allostatic load. It is further hypothesized that yoga-based practices (4) correct underactivity of the PNS and GABA systems in part through stimulation of the vagus nerves, the main peripheral pathway of the PNS, and (5) reduce allostatic load. Depression, epilepsy, post-traumatic stress disorder (PTSD), and chronic pain exemplify medical conditions that are exacerbated by stress, have low heart rate variability (HRV) and lo GABAergic activity, respond to pharmacologic agents that increase activity of the GABA system, and show symptom improvement in response to yoga-based interventions. The observation that treatment resistant cases of epilepsy and depression respond to vagal nerve stimulation corroborates the need to correct PNS underactivity as part of a successful treatment plan in some cases. According to the proposed theory, the decreased PNS and GABAergic activity that underlies stress-related disorders can be corrected by yoga practices resulting in amelioration of disease symptoms. This has far-reaching implications for the integration of yoga-based practices in the treatment of a broad array of disorders exacerbated by stress.
2012 Elsevier Ltd. All rights reserved.
Integrating Eastern and Western Perspectives
Ed. C. Bushness, E. Olivo, and N Theise.
Richard P. Browna and Patricia L. Gerbargb
a Associate Professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA
b Assistant Professor of Clinical Psychiatry, New York Medical College, Valhalla, New York, USA
Yoga breathing is an important part of health and spiritual practices in Indo-Tibetan traditions. Considered fundamental for the development of physical well-being, meditation, awareness, and enlightenment, it is both a form of meditation in itself and a preparation for deep meditation. Yoga breathing (pranayama) can rapidly bring the mind to the present moment and reduce stress. In this paper, we review data indicating how breath work can affect longevity mechanisms in some ways that overlap with meditation and in other ways that are different from, but that synergistically enhance, the effects of meditation. We also provide clinical evidence for the use of yoga breathing in the treatment of depression, anxiety, post-traumatic stress disorder, and for victims of mass disasters. By inducing stress resilience, breath work enables us to rapidly and compassionately relieve many forms of suffering.
Brown RP and Gerbarg PL. Yoga breathing, meditation, and longevity. Annals of the New York Academy of Sciences. 2009, 1172:54-62.