Scientific Articles, Books, and Chapters
by Dr. Richard P. Brown, Dr. Patricia Gerbarg, and Colleagues:
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. Patricia Gerbarg
The Scientific Basis and Clinical Uses of Breath Practices.
Dr. Gerbarg explains the neurophysiology of the effects of breath practices on the autonomic nervous 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
Breath Practices for Survivor and Caregiver Stress, Depression, and Post-traumatic Stress Disorder: Connection, Co-regulation, Compassion
Patricia L. Gerbarg, Richard P. Brown, Chris C. Streeter, Martin Katzman, Monica Vermani
Open Access: OBM Integrative and Complementary Medicine July 2019, Volume 4, Issue 3, doi:10.21926/obm.icm.1903045
Special Issue: How Compassion Benefits in the Healing Process
Does compassion itself benefit the healing process or does the activation of neurophysiological processes, from which the experience of compassion arises, trigger a cascade of physical and psychological changes that support health and well-being? Exploration of the neurological substrates of compassion reveals multiple healing pathways that can be activated by mind-body practices. Furthermore, these pathways affect physical health, emotion regulation, and how we perceive and relate to others.
Physiological states affect the capacity for empathy, compassion and understanding. A state of calm alertness based on sympatho-vagal balance may support such high-level prosocial functions. Evidence suggests that polyvagal-informed mind-body practices, particularly Voluntarily Regulated Breathing Practices (VRBPs), efficiently induce such physiological states and that these same states can reduce inflammation and oxidative stress, while improving cardiovascular function, respiratory efficiency, and physical health.
Mind-body practices, such as Coherent or Resonant Breathing can balance, strengthen, and increase the adaptive flexibility of stress response systems, potentially counteracting the detrimental effects of excess stress, neglect, and trauma on emotion regulation, physical health, and the ability to experience love and compassion. Research is needed to support integration of mind-body practices into healthcare systems. The methods being used to study mind-body techniques may be further refined by considering the target symptoms, population being studied, specific parameters of each practice, and methods of teaching subjects.
The current state of global health calls for treatments that can be delivered to large populations by small numbers of healthcare providers under conditions where resources are limited. Slow gentle Coherent or Resonant Breathing and related mind-body practices are low cost, low risk, easily taught, rapidly effective, scalable, non-stigmatizing, and sustainable. At the convergence of neurophysiological research with contemplative and other mind-body practices, we marvel at the possibilities for relieving emotional and physical suffering as well as improving how we relate to one another.
Effects of Yoga on Thalamic Gamma-Aminobutyric Acid, Mood and Depression: Analysis of Two Randomized Controlled Trials
Streeter CC, Gerbarg PL, Nielsen GH, Brown RP, Jensen JE, Silveri MM
Neuropsychiatry (London) (2018) 8(3), 739–744. p- ISSN 1758-2008 e- ISSN 1758-2016
Chapter: Complementary and Integrative Psychiatry.
In American Psychiatric Association Textbook of Psychiatry 7th Edition.
Massoumi L, Gerbarg PL, Muskin PR, Naidoo U
Edited by: Roberts L.
Washington D.C., American Psychiatric Publishing (in press, 2019).
Book: Complementary and Integrative Treatments in Psychiatric Practice
Editors: Patricia L. Gerbarg, MD, Phillip R. Muskin, MD, Richard P. Brown, MD
American Psychiatric Association Publications Washington DC, 2017
For Information on All Chapters and Authors [see link to book page]
Bottiglieri T, Gerbarg PL, Brown RP. S-Adenosylmethionine, Adometionine, SAMe.
Gerbarg PL, Brown RP, Muskin PR. Complementary and Integrative Medicine, DSM-5, Clinical Decision Making.
Gerbarg PL, Brown RP. Integrating Rhodiola rosea in Practice: Clinical Cases.
Brown RP, Gerbarg PL. Breathing Techniques in Psychiatric Treatment.
Treatment of Major Depressive Disorder with Iyengar Yoga and coherent breathing: a randomized controlled dosing study
Streeter CC, Gerbarg PL, Whitfield TH, Owen L, Johnston J, Silveri MM, Gensler M, Faulkner CL, Mann C, Wixted M, Hernon AM, Nyer MB, Brown RP, Jensen JE
Altern Complement Ther. 2017 Dec 1;23(6):236-243. doi: 10.1089/act.2017.29134.ccs. PMID: 29225455
Treatment of Major Depressive Disorder with Iyengar Yoga and Coherent Breathing: A Randomized Controlled Dosing Study
Streeter CC, Gerbarg PL, Whitfield TH, Owen L, Johnson J, Silveri MM, Gensler M, Faulkner CL, Mann C, Wixted M, Hernon AM, Nyer MB, Brown RP, Jensen JE
J Altern Complement Med. 2017 Mar; 23(3):201-207. doi: 10.1089/acm.2016.0140
OBJECTIVES: The aims of this study were to assess the effects of an intervention of Iyengar yoga and coherent breathing at five breaths per minute on depressive symptoms and to determine optimal intervention yoga dosing for future studies in individuals with major depressive disorder (MDD).
METHODS: Subjects were randomized to the high-dose group (HDG) or low-dose group (LDG) for a 12-week intervention of three or two intervention classes per week, respectively. Eligible subjects were 18-64 years old with MDD, had baseline Beck Depression Inventory-II (BDI-II) scores ≥14, and were either on no antidepressant medications or on a stable dose of antidepressants for ≥3 months. The intervention included 90-min classes plus homework. Outcome measures were BDI-II scores and intervention compliance.
RESULTS: Fifteen HDG (Mage=38.4±15.1 years) and 15 LDG (Mage=34.7±10.4 years) subjects completed the intervention. BDI-II scores at screening and compliance did not differ between groups (p=0.26). BDI-II scores declined significantly from screening (24.6±1.7) to week 12 (6.0±3.8) for the HDG (-18.6±6.6; p < 0.001), and from screening (27.7±2.1) to week 12 (10.1±7.9) in the LDG (-17.7±9.3; p < 0.001). There were no significant differences between groups, based on response (i.e., >50% decrease in BDI-II scores; p=0.65) for the HDG (13/15 subjects) and LDG (11/15 subjects) or remission (i.e., number of subjects with BDI-II scores <14; p=1.00) for the HDG (14/15 subjects) and LDG (13/15 subjects) after the 12-week intervention, although a greater number of subjects in the HDG had 12-week BDI-II scores ≤10 (p=0.04).
CONCLUSIONS: During this 12-week intervention of yoga plus coherent breathing, depressive symptoms declined significantly in patients with MDD in both the HDG and LDG. Both groups showed comparable compliance and clinical improvements, with more subjects in the HDG exhibiting BDI-II scores ≤10 at week 12.
S-Adenosylmethionine (SAMe) for Neuropsychiatric Disorders: A Clinician-Oriented Review of Research
Sharma A, Gerbarg PL, Bottiglieri T, Massoumi L, Carpenter LL, Lavretsky H, Muskin PR, Brown RP, Mischoulon D, as a Work Group of the American Psychiatric Association Council on Research
J Clin Psych. 78(6):e656–e667, 2017. doi: 10.4088/JCP.16r11113.
OBJECTIVE: A systematic review on S-adenosylmethionine (SAMe) for treatment of neuropsychiatric conditions and comorbid medical conditions.
DATA SOURCES: Searches were conducted in PubMed, EMBASE, PsycINFO, Cochrane Library, CINAHL, and Google Scholar databases between July 15, 2015, and September 28, 2016, by combining search terms for SAMe (s-adenosyl methionine or s-adenosyl-l-methionine) with terms for relevant disease states (major depressive disorder, MDD, depression, perinatal depression, human immunodeficiency virus, HIV, Parkinson’s, Alzheimer’s, dementia, anxiety, schizophrenia, psychotic, 22q11.2, substance abuse, fibromyalgia, osteoarthritis, hepatitis, or cirrhosis). Additional studies were identified from prior literature. Ongoing clinical trials were identified through clinical trial registries.
STUDY SELECTION: Of the 174 records retrieved, 21 were excluded, as they were not original investigations. An additional 21 records were excluded for falling outside the scope of this review. Of the 132 studies included in this review, 115 were clinical trials and 17 were preclinical studies.
DATA EXTRACTION: A wide range of studies was included in this review to capture information that would be of interest to psychiatrists in clinical practice.
RESULTS: This review of SAMe in the treatment of major depressive disorder found promising but limited evidence of efficacy and safety to support its use as a monotherapy and as an augmentation for other antidepressants. Additionally, preliminary evidence suggests that SAMe may ameliorate symptoms in certain neurocognitive, substance use, and psychotic disorders and comorbid medical conditions.
CONCLUSIONS: S-adenosylmethionine holds promise as a treatment for multiple neuropsychiatric conditions, but the body of evidence has limitations. The encouraging findings support further study of SAMe in both psychiatric and comorbid medical illnesses.
Chapter 6 Yoga therapy for anxiety: Clinical insights. In Principles and Practice of Yoga in Health Care
Pilkington K, Gerbarg PL, Brown RP
Edited by Sat Bir Khalsa, L Cohen, T McCall, S Telles https://handspringpublishing.com/product/principles-practice-yoga-health-care/
Scotland, UK, Handspring Pub. 2017, pp. 95-114. SBN13:978-1-909141-20-9
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.
Pause menopause with Rhodiola rosea, a natural selective estrogen receptor modulator
Gerbarg PL, Brown RP
Phytomedicine. 2016; 239:763-9. PMID:26776957 DOI: 10.1016/j.phymed.2015.11.013
BACKGROUND: Menopausal women are challenged by the adverse effects of estrogen loss on energy, mood, cognitive function, and memory. These stresses are compounded by increased risks for cardiovascular disease, osteoporosis, and cancer. Known to have neuroprotective, cardio-protective, anti-oxidative and anti-carcinogenic effects, Rhodiola rosea extracts have also been shown to improve energy, mood, cognitive function and memory.
PURPOSE: We propose that R. rosea be investigated for use as a potential selective estrogen receptor modulator (SERM) in the prevention and treatment of menopause-related fatigue, stress, depression, cognitive decline, memory impairment, cardiovascular disease, osteoporosis and cancer.
METHOD: This paper briefly reviews the relationship between estrogen decline and menopause-related health risks, the molecular mechanisms underlying estrogenic effects on health, and the evidence indicating beneficial effects of R. rosea extracts on these mechanisms and health risks. Mechanisms include non-genomic and genomic effects, for example: activation of intra-cellular signal transduction pathways by binding to estrogen receptors, ERα-mediated activation of endothelial nitric oxide synthase with increased nitric oxide release; and anti-inflammatory effects, counteracting TNFα by inhibiting nuclear factor-Kappa-B (NF-KB) and protection of osteoblasts from hydrogen peroxide. A clinical case illustrating treatment of a menopausal woman with R. rosea is presented. Risks, benefits, gaps in knowledge, and future directions are discussed.
CONCLUSION: Numerous lines of evidence indicate that R. rosea should be investigated as a potential selective estrogen receptor modulator (SERM) to prevent, delay or mitigate menopause-related cognitive, psychological, cardiovascular and osteoporotic conditions.
Chapter 28. Neurobiology and neurophysiology of breath practices in psychiatric care. In Psychiatric Care of the Medical Patient
Gerbarg PL and Brown RP
Edited by David D’Addona, Barry Fogel, and Donna Greenberg
Oxford University Press, Inc., NY. 2016, pp 545-610
Chapter 13. Potential use of plant adapted to age-related disorders.
In Complementary and Integrative Therapies for Mental Health and Aging
Panossian A, Gerbarg PL
Edited by Lavretsky H, Sajatovic M, Reynolds C
Oxford University Press 2016, pp 239-256
Introduction: Adaptogens derived from plants are extracts containing metabolic regulators that enable cells and living organisms to adapt to a multitude of stressors, including heat, cold, hypoxia, chemical toxins, heavy metals, radiation, physical load, and emotional stress. Commonly recognized adaptogenic plants are Rhodiola rosea (Arctic root), Schizandra chinensis, Eleutherococcus senticosus (acanthopanax or Siberian ginseng), Panax ginseng, and Withania somnifera (ashwaganda). This chapter focuses on the first three—R. rosea, S. chinensis, and E. senticosus—which have been used for thousands of years in Europe and Asia to increase energy, endurance, sexual performance, and fertility, as well as to treat inflammation, injuries, and infections. Animal and human studies confirm that individually and in combination, these phytomedicinals improve physical and mental performance and endurance under stress. They show promising benefits in age-related disorders, including age-associated cognitive decline, memory decline, neurodegenerative disorders, hypoxia/ischemia, fatigue, cardiovascular disease, and cancer (see reviews by Gerbarg & Brown, 2013; Panossian, 2013; Panossian et al., 1999; Panossian & Wagner, 2011; Panossian & Wikman, 2009, 2010, 2014).
This chapter begins with an overview of aging and regulatory pathways as targets for anti-aging treatments. Potential benefits of adaptogens and their mechanism of action associated with key mediators of stress response and adaptation to stress will be reviewed, including the following:
• Up-regulation of transcription factor, heat shock factor HSF1, which initiates production of a molecular chaperon, heat shock protein Hsp70 (Panossian et al., 2009, 2012);
• Modulation of membrane receptors, such as glycoprotein protein coupled receptors (GPCR) and their signaling pathways (Panossian et al., 2013; Panossian et al., 2014);
• Forkhead box O (FOXO) family transcription factors, which play critical roles in the cell cycle, cell death, metabolism, and oxidative stress resistance (Wiegant et al., 2009);
• Down-regulation of apoptotic signaling protein—stress-activated protein kinase p-JNK and stress-activated increase of cortisol (Panossian et al., 2007);
• Protection against free radical reactive oxygen species (ROS) damage to cell membranes, proteins, and DNA (Boon-Niermeijer et al., 2000; Boon-Niermeijer et al., 2012; Schriner et al. 2009; Wiegant et al., 2008)
Chapter 16. Breathing Practices for Mental health and Aging. In Complementary and Integrative Therapies for Mental Health and Aging
Gerbarg PL, Brown RP.
Edited by Lavretsky H, Sajatovic M, Reynolds C
Oxford University Press 2016, pp 239-256
Introduction: Breathing Practices have been used by spiritual leaders, tribal cultures, martial artists, and health practitioners throughout the world to enhance well-being into old age. Voluntarily regulated breathing practices (VRBPs) have the potential to mitigate the effects of stress on mental and physical health, enhance mechanisms of health maintenance, and, at the same time, counteract pathophysiological processes that contribute to age-related disease progression. By studying the modes of action for RBPS, it is possible to develop specific breathing techniques to alleviate illness symptoms, support mental and physical health, and improve quality of life. Anti-aging treatments may include any preventive approach to reduce the progression of pathological processes that contribute to late-life pathology (Gems, 2014). In this sense, it is possible to consider specific breathing practices to be within the scope of anti-aging treatments.
Excess or prolonged stress has direct and indirect effects on mental health. Repeated or cumulative stressors tend to exacerbate anxiety, insomnia, depression, post-traumatic-stress disorder (PTSD), and cognitive dysfunction. tress alters sympatho-vagal balance, hypothalamic pituitary-adrenal axis (HPA) activity, energy metabolism, and inflammation. Neuroimaging studies are finding stress-related changes in neuroanatomical structures. These changes contribute to disorders of the immune, cardiovascular, gastrointestinal, neurological, and other body systems. The ensuing illnesses and their treatments (e.g., medication or surgery) can further compound the stress. The treatment of mental illness as patients age becomes more challenging, in part because, as normal homeostatic and cellular repair systems become less robust, neurodegeneration occurs, comorbid conditions develop, and patients become less able to tolerate medications.
Voluntarily regulated breathing practices (VRBPs) include deliberate, conscious alterations in respiratory rate, phases of the respiratory cycle, forcefulness of breath, and other qualities of respiration. RBPs are particularly suitable for addressing the challenges of aging because they are low in side effects, do not interact adversely with prescription medications, and exert positive effects on key components of the aging mind–body complex. Breath practices can be safely adapted for use in medically ill or frail patients, and they are affordable for those with limited means.
Psychiatric Times. 33(11):22-25, 2016
Neurobiology and neurophysiology of breath practices in psychiatric care
Gerbarg PL, Brown RP
Autonomic nervous system dysfunction is associated with most disorders seen in pediatric and adult psychiatric practice, including anxiety disorders, depression, PTSD, hostility and aggression, attention deficit disorders, and autism spectrum disorder. Increasing the underactivity of the parasympathetic branch and correcting the erratic or overactivity of the sympathetic branch can improve stress resilience and ameliorate psychological and physical symptoms.
Although prescription medications (eg, anxiolytics, antidepressants, antipsychotics) can dampen overactivity of the sympathetic nervous system (SNS), they cannot correct underactivity of the parasympathetic nervous system (PNS). Most parasympathetic pathways are contained in the vagus nerves, the 10th cranial nerves, whose extensive branches innervate all internal organs and glands. The development of measures (respiratory sinus arrhythmia, and heart rate variability) of SNS and PNS activity made it possible to assess the effects of interventions such as breathing practices on autonomic activity and to document the association between improvements in sympatho-vagal balance and reduction in psychiatric symptoms.1 The Polyvagal Theory, articulated by Stephen Porges,2 proposes that the vagal nerves are major conduits for bidirectional communication between the brain and the body.
Studies have shown that voluntarily regulated breathing practices (VRBPs) can significantly improve symptoms of anxiety disorders, trauma- and stressor-related disorders, depressive disorders, and other conditions.3VRBPs can also be used to restore feelings of meaningful connection, bonding, and love for patients who experience states of disconnection or emotional numbing—common sequelae of trauma and loss. Certain breathing practices can facilitate the psychotherapeutic process by reducing anxiety and defensiveness.4 Patients with long-standing psychological and somatic PTSD symptoms responded to VRBPs after years of no response to traditional psychotherapy and psychoanalysis.5,6Their sexual function, body perceptions, sense of self, pain syndromes, and other symptoms normalized.
Furthermore, clinicians can use VRBPs to reduce their own level of stress and to enhance empathic abilities.
The Effect of Breathing, Movement, and Meditation on Psychological and Physical Symptoms and Inflammatory Biomarkers in Inflammatory Bowel Disease: A Randomized Controlled Trial. J Inflammatory Bowel Disease
Inflammatory Bowel Disease 2015;0:1-11. 21(12):2886-96, 2015. doi: 10.1097/MIB.0000000000000568.
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
1Department of Psychiatry, New York Medical College, NY; 2Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medical College, NY, 3Columbia University Medical College
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.
Non-pharmacological treatments for ADHD in youth.
Adolescent Psychiatry. 2015, 5(4). Doi:10.2174/221067660502150430154937
Sharma A, Gerbarg PL, Brown RP.
BACKGROUND: Complementary and alternative medicine (CAM) in psychiatry or integrative psychiatry covers a wide range of biological, psychological and mind-body treatments that enhance standard medical practices and patient outcomes. While CAM approaches are popular amongst patients in their practice as well as in self-report because of their ease of use, health professionals have received limited education in these interventions and often are unaware of their patients’ use of CAM treatments.
METHOD: This overview highlights evidence-based CAM treatments for attention deficit hyperactivity disorder (ADHD) including dietary interventions, phytomedicines, mind-body practices and neurofeedback.
RESULTS: While conventional treatments are the mainstays for ADHD, there are a large number of available treatments that can be used to enhance treatment response. CONCLUSION: With improved education and further scientific and clinical research, validated integrative treatments will provide more effective, lower risk and lower cost care for patients with ADHD.
Physiological effects of mind and body practices
Telles S, Gerbarg PL, Kosasa EH.
Hindawi Publishing Corporation, BioMed Research international. 2015. Article ID 983086, 2015. doi:10.1155/2015/983086
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. Rigorous research is needed to identify effective mind-body techniques and their mechanisms of action, if they are to be integrated into mainstream medicine.
Failed studies should not be used to malign good treatments.
Gerbarg PL, Muskin PR, Bottiglieri T, Brown RP
J Clin Psych. 2014 Nov;75(11):e1328. Letter to the editor.
Breath- Body-Mind-Workshop as Adjunctive Treatment in Patients with Treatment Resistant Generalized Anxiety Disorder (GAD) with or without Comorbidity.
Katzmann MA, Vermani M, Gerbarg PL, Brown RP, et al.
Presented at American Psychiatric Association Annual Meeting, New York, May 3-7, 2014.
Multi-Component Yoga Breath Program for Vietnam Veteran Post Traumatic Stress Disorder: Randomized Controlled Trial
Janis J Carter, Patricia L Gerbarg, Richard P Brown, Robert S Ware, Christina D’Ambrosio, Leena Anand, Mihaela Dirlea, Monica Vermani and Martin A Katzman
Journal of Traumatic Stress Disorders & Treatment 2013, 2:3
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 followup 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 followup 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 intervention, and also improved significantly on the CAPS. These improvements were maintained in both groups 6 months following receipt of treatment.
CONCLUSIONS: The results indicate that multi-component interventions with yoga breath techniques may offer a valuable adjunctive treatment for veterans with PTSD.
Preface: Along Roads Less Traveled: Complementary, Alternative, and Integrative Treatments
Edited by: Philip R. Muskin, MD Patricia L. Gerbarg, MD Richard P. Brown, MD
Psychiatric Clinics of North America (2013) Vol 36: xiii–xv
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.
[Free access to full text of Preface] www.psych.theclinics.com/article/S0193-953X(13)00010-5/fulltext
Breathing practices for treatment of psychiatric and stress-related medical conditions. In Complementary and Integrative Therapies for Psychiatric Disorders
Brown, RP, Gerbarg, PL, Muench F
Edited by Phillip R. Muskin, Patricia L. Gerbarg, and Richard P. Brown.
Psychiatric Clinics of North America. March 2013, 36(1):121-140. doi: 10.1016/j.psc.2013.01.001.22.
· Neuroanatomic and brain imaging studies reveal breath-activated pathways to all major networks involved in emotion regulation, cognitive function, attention, perception, subjective awareness, and decision making.
· Specific breath practices have been shown to be beneficial in reducing symptoms of stress, anxiety, insomnia, posttraumatic stress disorder, obsessive-compulsive disorder, depression, attention deficit disorder, and schizophrenia.
· The risks of adverse reactions to breath practices can be minimized through patient assessment and by limiting the use of stimulating practices in vulnerable individuals.
· Technology-assisted breath retraining devices range from mobile phone pacing applications to physiologic biofeedback machines designed to foster therapeutic breath practices using audiovisual cues and/or physiologic feedback.
· Technology-assisted breath retraining offers alternative or adjunctive methods to clients who are interested in breathing practices.
· Ideally, initial technology-assisted breath retraining should be accompanied by in-person guided instruction and evaluation.
Phytomedicines for Prevention and Treatment of Mental Health Disorders. In Complementary and Integrative Therapies for Psychiatric Disorders
Gerbarg, PL, Brown, RP
Edited by Phillip R. Muskin, Patricia L. Gerbarg, and Richard P. Brown.
Psychiatric Clinics of North America. Mar 2013, 36(1): 37-47. doi: 10.1016/j.psc.2012.12.004
Herbal medicines supported by evidence of safety and efficacy in the treatment of anxiety, insomnia, fatigue, cognitive enhancement, mental focus, and sexual function are useful as monotherapies, multiherb combinations, and as adjuncts to prescription psychotropics. Relevant mechanisms of action and clinical guidelines for herbs in common use can assist clinicians who want to enhance treatment outcomes by integrating phytomedicinals into their treatment regimens. Research is needed to strengthen the evidence base and to expand the range of disorders that can be treated with herbal extracts. Studies of herbal genomic effects may lead to more targeted and effective treatments.
Nutrients for Prevention and Treatment of Mental Health Disorders Disorders. In Complementary and Integrative Therapies for Psychiatric Disorders
Akhondzadeh S, Brown RP, Gerbarg, PL
Edited by Phillip R. Muskin, Patricia L. Gerbarg, and Richard P. Brown
Psychiatric Clinics of North America. Mar 2013 36(1):25-36. doi: 10.1016/j.psc.2012.12.003
The choice of nutrients for review is based on clinical evidence of efficacy in neuropsychiatric disorders and biochemical effects that are neuroprotective or reparative. Vitamins, minerals, amino acids, and metabolites have been shown to augment antidepressants, improve symptoms in anxiety disorders, depression, neurodegenerative diseases, brain injury, ADHD, and schizophrenia, and to reduce medication side effects. Detection and correction of vitamin and mineral deficiencies can be essential for recovery. Generally low in adverse effects when taken in therapeutic doses, nutrients can be combined for greater benefits. Further studies are warranted to validate these promising treatments.
Treatment of Nutritional and Metabolic Disorders in Psychiatry: Integrative or Integrated?
Gerbarg PL and Brown RP
Psychiatric Times. July 11, 2013, Vol 3(7)
After decades of mind/brain-focused subspecialization, psychiatry is now reconsidering the whole person. “Integrative medicine” is being used to denote the strategic combining of standard treatments (eg, medication, psychotherapies) with evidence-based complementary and alternative approaches (eg, herbs, nutrients, acupuncture, neuro-therapy). “Integrated medicine” refers to the practice of using a multidisciplinary treatment team (physicians, psychologists, social workers, and occupational and physical therapists). The goals of both integrative and integrated care are to address the biological, psychological, and social needs of the patient.
This article highlights evidence-based treatment with herbs and nutrients with good tolerability and potential benefit when integrated into psychiatric practices. The other two articles in this Special Report are intended to refresh and update your knowledge of nutritional and metabolic disorders commonly encountered in psychiatric patients. Psychiatrists can diagnose conditions such as vitamin deficiencies, nutrient deficiencies, hypothyroidism, and obesity, and they can treat or refer patients with these ailments.
Sarris and colleagues1 have proposed that integrative mental health (a subdivision of integrative medicine) encompass mainstream mental health treatments, evidence-based complementary and alternative approaches, healthy lifestyle changes, and socio-cultural issues. The evolving concept of integrative mental health appears to encompass the goals and practices of integrated medicine.
Modern medicine is probing the biological bases of nutritional supplements and herbs to understand their therapeutic actions. Identifying active constituents and improving extraction processes will allow further development of natural combinations and synthetic analogues and consequently will expand treatment options.
Effects of yoga on cognition, psychiatric symptoms, and epigenetic changes in chronic schizophrenic patients.
Smith RC, Boules S, Maayan L, Gerbarg PL, Brown R, Visceglia E, Sershen H, Lajtha A, Auta J, Mathew M, Davis JM, Guidotti A. Presented at 14th International Schizophrenia Congress, Orlando, Florida, April 22, 2013
Effects of Yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and Post-traumatic Stress Disorder
Streeter CC, Gerbarg PL, Saper MD, Ciraulo DA, and Brown RP
Medical Hypotheses. 2012. 78(5):571-9. doi: 10.1016/j.mehy.2012.01.021
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 low 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.
International Journal of Yoga. 2012; 5(1): 57–65. doi: 10.4103/0973-6131.91716
A multicomponent Yoga-based, breath intervention program as adjunctive treatment in patients suffering from Generalized Anxiety Disorder (GAD) with or without comorbidities
Katzmann MA, Vermani M, Gerbarg PL, Brown RP, Iorio C, Davis M, Cameron C, Pawluk E, Tsirgielis D https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276935
Yoga Therapy in Practice
Mass Disasters and Mind-Body Solutions: Evidence and Field Insights
Patricia L. Gerbarg MD, Gretchen Wallace, Richard P. Brown MD
International Journal of Yoga Therapy – No. 21 (2011) 23-34
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.
[free access to full article PDF]
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
Descilo T, Vedamurtachar A, Gerbarg PL, Nagaraja D, Gangadhar BNG, Damodaran B, Adelson B, Braslow LH, Marcus M, Brown RP.
Acta Psychiatr Scand Aril 2010, 121(4):289-300. PMID: 19694633
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.
Yoga breathing, meditation, and longevity.
In Longevity, Regeneration, and optimal health, integrating Eastern and Western perspectives
Brown RP and Gerbarg PL
Ed. C. Bushness, E. Olivo, and N Theise
Annals of the New York Academy of Sciences. 2009, 1172:54-62. doi: 10.1111/j.1749-6632.2009.04394.x.
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.
Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: Part I - Neurophysiologic model
Brown RP and Gerbarg PL
J Alternative and Complementary Med. 11(1):189-201, 2005
Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part II – Clinical Applications and Guidelines
Brown RP and Gerbarg PL
J Alternative and Complementary Med. 11(4):711-717, 2005. doi: 10.1089/acm.2005.11.711
Yogic breathing is a unique method for balancing the autonomic nervous system and influencing psychologic and stress-related disorders. Part I of this series presented a neurophysiologic theory of the effects of Sudarshan Kriya Yoga (SKY). Part II will review clinical studies, our own clinical observations, and guidelines for the safe and effective use of yoga breath techniques in a wide range of clinical conditions. Although more clinical studies are needed to document the benefits of programs that combine pranayama (yogic breathing) asanas (yoga postures), and meditation, there is sufficient evidence to consider Sudarshan Kriya Yoga to be a beneficial, low-risk, low-cost adjunct to the treatment of stress, anxiety, post-traumatic stress disorder (PTSD), depression, stress-related medical illnesses, substance abuse, and rehabilitation of criminal offenders. SKY has been used as a public health intervention to alleviate PTSD in survivors of mass disasters. Yoga techniques enhance well-being, mood, attention, mental focus, and stress tolerance. Proper training by a skilled teacher and a 30-minute practice every day will maximize the benefits. Health care providers play a crucial role in encouraging patients to maintain their yoga practices.
J Psychiatr Pract. 2001 Mar;7(2):75-91
Herbs and nutrients in the treatment of depression, anxiety, insomnia, migraine, and obesity
Brown RP. Gerbarg PL
Although a multitude of pharmaceutical agents are available for the treatment of mood disorders, anxiety and insomnia, many patients have difficulty tolerating the side effects, do not respond adequately, or eventually lose their response. Many therapeutic herbs and nutrients have far fewer side effects and may provide an alternative treatment or can be used to enhance the effect of prescription medications. In the article, the authors review the quality of the evidence supporting the clinical effects of a number of commonly used types of complementary/alternative medicine (CAM) for mood disorders, anxiety, and insomnia. They review data on the use of St. John's Wort, S-adenosyl-methionine (SAM-e), B vitamins, inositol, omega-3 fatty acids, and choline for mood disorders; data on the use of kava and other herbal agents and fish extract for anxiety and insomnia; and data on valerian and melatonin for insomnia. The authors also discuss the use of CAM to treat migraines, which may be comorbid with mood and anxiety disorders, and obesity, which can occur as a side effect of psychotropic medications. They consider the data on feverfew and butterbur for migraines and on chromium picolinate and the combination of ephedrine and caffeine for obesity. The authors also review issues related to comorbid medical illness, side effects, drug interactions, dosage, and brand selection.
A Phytomedical Review of Rhodiola rosea.
Brown RP, Gerbarg PL, Ramazanov Z
Herbalgram, 56:40-62, 2002.
Rhodiola rosea L., also known as "golden root" or "roseroot" belongs to the plant family Crassulaceae.1 R. rosea grows primarily in dry sandy ground at high altitudes in the arctic areas of Europe and Asia.2 The plant reaches a height of 12 to 30 inches (70cm) and produces yellow blossoms. It is a perennial with a thick rhizome, fragrant when cut. The Greek physician, Dioscorides, first recorded medicinal applications of rodia riza in 77 C.E. in De Materia Medica.3 Linnaeus renamed it Rhodiola rosea, referring to the rose-like attar (fragrance) of the fresh cut rootstock.4
For centuries, R. rosea has been used in the traditional medicine of Russia, Scandinavia, and other countries. Between 1725 and 1960, various medicinal applications of R. rosea appeared in the scientific literature of Sweden, Norway, France, Germany, the Soviet Union, and Iceland.2,4-12 Since 1960, more than 180 pharmacological, phytochemical, and clinical studies have been published. Although R. rosea has been extensively studied as an adaptogen with various health-promoting effects, its properties remain largely unknown in the West. In part this may be due to the fact that the bulk of research has been published in Slavic and Scandinavian languages. This review provides an introduction to some of the traditional uses of R. rosea, its phytochemistry, scientific studies exploring its diverse physiological effects, and its current and future medical applications.