Yoga and mental health: A dialogue between ancient wisdom and modern psychology

Abstract

Background:

Many yoga texts make reference to the importance of mental health and the use of specific techniques in the treatment of mental disorders. Different concepts utilized in modern psychology may not come with contemporary ideas, instead, they seem to share a common root with ancient wisdom.

Aims:

The goal of this perspective article is to correlate modern techniques used in psychology and psychiatry with yogic practices, in the treatment of mental disorders.

Materials and Methods:

The current article presented a dialogue between the yogic approach for the treatment of mental disorder and concepts used in modern psychology, such as meta-cognition, disidentification, deconditioning and interoceptive exposure.

Conclusions:

Contemplative research found out that modern interventions in psychology might not come from modern concepts after all, but share great similarity with ancient yogic knowledge, giving us the opportunity to integrate the psychological wisdom of both East and West.

INTRODUCTION

A great number of studies demonstrated that contemplative techniques like meditation and yoga have been successfully employed in the treatment of mental disorders, such as anxiety, stress, depression, and panic, whether as complementary or the main intervention.[1,2,3,4,5,6] However, the neural mechanisms through which these practices work are still uncertain. Neuroscience and psychology have different theories about this complex relationship. Notions about causes, effects, and effectiveness have been widely discussed for centuries by different philosophical systems and eastern psychology (with reflections in modern analytical psychology).

Therefore, the goal of this perspective article is to correlate modern techniques used in psychology and psychiatry with yogic practices, in the treatment of mental disorders.

ANCIENT CONCEPTS AND MODERN INTERVENTIONS: WHAT DO THE ANCIENT WISDOM OF YOGA AND MODERN PSYCHOLOGY HAVE IN COMMON?

Conflict removal and acceptance

The philosophical and psychological foundations behind these practices involve a vital component of their success, even when dealing with a purely therapeutic approach. One of the main consequences of yoga is to provide the necessary tools to help in the treatment of mental problems. But yoga says only the individual himself can do this. According to,[7] even if one is seeing a shrink or a therapist, all these professionals can do is stimulate the individual and guide him during the process of removing the mental conflicts, which he has to do by himself.

Hence, yoga is interested primarily in the practice, not words. The goal is to dig up the real cause of mental conflicts and eradicate conscious and unconscious problems. Some authors affirm that one must overcome the unhappiness associated with mental conflicts before experiencing real equanimity.[8] Actually, many people search for yoga because they have deeply rooted problems that they wish to remove. If they did not acknowledge these problems or miss something in their lives, they wouldn’t have started the practice and maybe there would not be a motivation factor in the first place.[8] In this sense, it is said that problems become positive resources that drive us to do something valuable with our lives and teach us to look at mental conflicts from a whole new different perspective. Besides,[7] says that while yoga aims at emptying our minds, it doesn’t try to fill it up with new dogmas. The ancient practice affirms that every conditioning must be removed and never replaced by new ones, and that the mind must be clear from all the problems that cause conflicts. The same author said that this is not achieved through an isolated technique or after a specific number of “sessions.” Instead, the effects of meditation seem to be better experienced when we are not practicing.[7]

According to yoga psychology, the most fundamental and recurrent mental problem is the lack of meaning. It has been said that the strongest drive in people's lives is the need to find meaning.[9] Most mental problems are caused by the simple fact that people do not add values to their lives. Everything seems superficial, meaningless, and hopelessness resulting in powerful negative emotions that can cause a real breakdown of mental functions.[8] This process has been recognized and stated: “When conscious life loses its meaning and promise, it's as if panic took over…”[9] In fact, this is how many people live; empty lives without meaning. The method of yoga, not only the physical practices but especially the entire cognitive restructuring that this ancient discipline is capable of doing, seems to help people in this sense.

Even if not recognized as a mental problem by modern psychology, this is how yoga psychology classifies conditioning. In other words, those too attached to concepts and dogmas have a mental problem. According to,[7] conditioning turns the mind into a collection of rigid and stereotyped patterns, instead of a reservoir of spontaneous ideas, representing an obstacle to real perception. This category also includes a tendency to accept ideas without personal experience. Blind susceptibility to ideas and too much attachment to preexisting ones represent a big mental problem in yoga. Moreover yoga psychology proposes a three-point approach to this problem, according to:[7]

[…]First, one should try to avoid the occurrence of these disturbances. To empty the mind of preexisting complexes and leave it open and susceptible to adverse impressions is useless. It is necessary to make the mind strong and flexible for the ups and downs of life. Second, one must drain all conscious problems. And third, one should find out and eliminate subconscious problems.

However, these ancient definitions of conditioning are different from modern concepts. Modern psychology explains that the conditioned view that occurs through classical conditioning makes an originally neutral stimulus invoke a certain response due to its combination with an elicitor.[10] For example, on a dinner table, the presence of forks and knives could be enough to make someone salivate, even before the food is served. According to the concept of operant conditioning, the visual response becomes independent from the preceding stimulus.[10] It's often reported that ancient concepts are difficult to understand from a modern psychology perspective, but traditional writings do not always communicate in a way that we are familiarized with. Consequently, this should be one of the main roles of modern research: To investigate how the ancient arrived at certain conclusions, clarify them through scientific language and replicate the results utilizing the scientific method.

The three stage process of approaching mental dysfunction described by[7] previously do not occur in sequence, but simultaneously. The stages go along as part of an integral methodology that eliminates and prevents the arising of mental conflicts. Beside these concepts, yoga psychology offers another set of tools that should be used for the removal of conflicts. One of these tools is acceptance. Yoga teaches us to deal with and accept our feelings by not comparing them with the feelings of others. It shows that we should use our own qualities to act naturally, mindfully observing the emotions, without ever suppressing them. In this approach, it is vital to accept emotions and feelings without guilt, especially when it comes to past events since many people live their lives with sorrow, regret and guilt from past actions.[7] According to,[8] if past resentments take over a person's life, they become deeply rooted in memory and hard to be removed, except through the practice of meditation.

Living in the present is also very important and an essential part of both yoga and psychotherapy. Likewise, the relationship between acceptance and change is greatly discussed in psychotherapy today. Some authors suggest that acceptance involves “experiencing events integrally and defenseless, just as they way they are.”[11] According to the authors, health professionals with empirical orientation might have contributed to the super emphasis given to eliminating negative symptoms without first accepting them. For example, a person that suffers from panic disorder develops unadaptive behavior as a way to prevent future attacks. This behavior includes drug and alcohol abuse, avoidance of relevant activities, and excessive anxiety toward bodily sensations. By accepting that panic attacks or episodes of acute anxiety occasionally occur in a limited time space without representing a real threat, the individual becomes able to experience them with tolerance, acknowledging that these are just unpleasant feelings. So, on one point modern and ancient psychologies seem to agree: The importance of acceptance in the therapeutic process. Acceptance has also been described by[12] as one of the seven fundamental practices of mindfulness meditation, a Buddhist-based meditation widely employed in medical research.

After acceptance, yoga psychology says that the next step in the process of conflict removal is meditation. The more one meditates and learns to relax, the more he allows for suppressed emotions and problems to arise, even if they generate negative responses.[8] During meditation, one should carefully observe conscious and subconscious manifestations and try to reduce the emotional response using just a contemplative posture. One should perceive and witness these manifestations without identifying with them.[7] The simple fact of becoming aware of these manifestations with a detached attitude is a powerful tool in the process of withdrawing the power that thoughts exert in our lives. However, this confrontation of mental conflicts can only be carried out during a moment of deep relaxation or meditative practice.[8]

Modern psychiatry and psychology also employ this technique and call it “ desensitization” (discussed below). It has been pointed out that the removal of mental problems is an expression since all information is permanently recorded in memory.[7] What ancient texts say is that the practice of yoga causes the emotional reaction to internal conflicts as well as the elimination of the related memory.

According to[7] all mental problems have two aspects: The object (a spider, for example) and the emotional reaction to the object (fear of spider). Therefore, when a mental problem is removed, what actually happens is the neutralization of the emotional reaction. Hence, when one manages not to respond emotionally to subconscious information, it means he was able to remove that conflict. The real cause of many fears lies in the subconscious mind, and the practice of meditation can bring them to the surface, to the conscious mind, where they can be neutralized through desensitization.[8] This method consists in: (1) Relaxation – one should be completely relaxed in his everyday life, which can be achieved through yoga practice, meditation or corpse pose (shavasana), and (2) one should imagine himself in confront with his object of fear, creating a mental image of this object. The more one practices, the less he responds emotionally to that object, reducing the fear progressively. This method should be practiced every day until no reaction is experienced. The ancient logic behind this technique is simple: People are less predisposed to react emotionally to an object of fear when confronting it during deep relaxed states.[7]

Today, systematic desensitization created by[13] is a very effective technique utilized in the process of extinction of conditioned reflexes. It consists of a set of techniques that exposes the individual to the traumatic experience. It involves three basic stages: Physical relaxation, the establishment of a hierarchy of anxiety (regarding the phobic stimulus) and counter-conditioning of relaxation as a response to the stimulus. This method of desensitization begins with the exposure to less anxiogenic elements, that is, stimuli that evoke less intense responses. Gradually, the magnitude of exposure increases until it reaches the original conditioned stimulus.[13] According to,[14] in vivo exposure is preceded by imaginary exposure, from the less to the most feared situations. Meditation, says,[3] encourages people not to remove the attention to fear, pain or negative thoughts, but instead, to make them the center of attention, admitting a noncritical attitude toward these experiences and their related cognitions, emotions, and impulses. The ability to observe these sensations without judging or criticizing them seems to reduce associated distress, just as continuous exposure to certain feelings.

The constant and controlled exposure to pain, for example, in the absence of catastrophic consequences, might lead to desensitization and gradual reduction of the associated emotional responses. In the same way, the practice of meditation and the development of meditative skills increase our ability to experience these feelings without reacting emotionally to them. In relation to the desensitization technique, modern psychology, and ancient writings describe a similar mechanism for the effects of meditation in mental disorders. The sustained and noncritical observation of anxiety-related sensations, for example, without the attempt to avoid it at any cost, is capable of significantly reducing the emotional reactivity induced by anxiety symptoms. This approach is also very similar to the interoceptive exposure strategy describe by[15] or the nonjudgmental awareness development exposed by.[3] The difference is that meditation does not include a deliberate induction of panic attack symptoms. Instead, individuals are instructed to witness these feelings as they arise.

Another technique, known as self-suggestion, has also been employed since ancient times. Today, the power of suggestion is recognized. It is so effective that people can actually heal or get sick by suggestion – the famous placebo effect. People are continuously “self-suggesting” themselves in different aversive situations. The results depend on the intensity of this suggestion. During the first stages of this practice, one should try to convince himself that the fear and the anxiety experienced are essentially unjustified.[7] According to yoga psychology, this happens initially at an intellectual level, but gradually the auto suggestion becomes deeper and stronger. Ideally, this technique should be practiced after yoga or any systematic method of relaxation. It is believed that only during periods of relaxation, the mind becomes truly receptive to suggestion.[7] Indeed, neuroimage studies show that the brain reaches a state called spontaneous concentration during yoganidra (controlled relaxation). This means that the subjects are deeply relaxed while focused in the task and controlling brain activity.[16] Based on observations of brain electrical activity (alfa and theta waves increase), the authors concluded that the relaxation response generated by yoga produces what is called a hypnagogic mental state (not awake, not rapid eye movement sleep or deep sleep). During this mental state, consciousness seems to be more open to external and internal aspects, such as self-suggestion.[16]

Deconditioning

One of the goals of the psychological processes of yoga is the removal of conditioning (basic processes formed by associations), habits (higher forms of learning), dogmas (cognitive processes), turning the individual into a more adaptive one, and open to new experiences.[7] Most individuals live an automatic life with stereotyped answers to different situations and people. But a nonrigid and clear mind has great power of perception and decision. On the other hand, a conditioned mind is able to respond according to its own unreal interpretation of the world.[8] Most conditionings are the habits of thought and action deeply rooted in the mind or fundamental processes of associations.

These ancient ideas are very similar to the modern concepts of schemas. Schemas are cognitive structures that form and give meaning to objects, situations, people, etc. Schemas are developed very early in life and help us understand the world around us. According to,[17] a schema is a cognitive structure that filters codifies and evaluates all stimuli, to which an organism is submitted. This matrix of schemas guides the individual in time and space and helps to categorize and understand experiences in a meaningful way. Schemas are formed in early childhood when the first relationships with the environment and parental figures are also being developed. Then, the schemas serve as models for processing all subsequent experience. Consequently, they become the central structures of meaning construction that self-perpetuate and remain extremely resistant to changes.[17] Likewise, one of the many tools employed by yoga is deconditioning. The yogic method teaches the individual to evaluate thoroughly his actions. When performing an action or having a thought, one should inquiry that specific behavior and its related conditioning. It is essential to realize if our conditioning is legitimate or if we’re attached to our own beliefs without real conviction or reason.[7] What the ancient writings call deconditioning (by meditation practice) is represented in modern psychology by the cognitive changes produced by some forms of psychotherapy, such as cognitive behavioral therapy. In fact, many authors noticed that meditation can lead to changes in thought and action patterns. The nonjudgmental observation of thoughts associated with pain or anxiety, says,[12] helps the individual to understand these as “thoughts only,” instead of reality, and not try to avoid them at any cost. Similarly[18] noticed that the attitude of observing and labeling one's own thoughts and feelings helps to understand that they are not precise representations of reality. For example, to be afraid does not essentially mean that the danger is imminent and to think “I’m a failure” does not make it true. Some authors suggests that the decentralized and noncritical view of one's own thoughts practiced during meditation seems to interfere with the so called ruminative patterns, typical of mental disorders such as anxiety and depression, resulting in positive cognitive changes.[19] Furthermore, this perspective (of one's own thoughts) is described as “metacognitive insight.”[20] The author also noticed that a practical advantage of acquiring these skills is that they can be practiced anytime, anywhere, including periods of remission (of the disease).

Disidentification

Yoga psychology states that disidentification helps the mind to become more resistant to external influences. However[7] says that this has nothing to do with the individual avoiding the ups and downs of life or evading from the interpersonal relationship. It means that feelings, sensations, outer activities, and roles must all be seen as something outside the individual. This way, external actions do not affect a person deeply. According to the yogic method of disidentification, one should observe life situations as if they were external. It should be, therefore, necessary to unidentify with one's own body and emotions and let the mind act as a witness, without identifying completely with these aspects. As a result, the painful events of life cannot leave such strong impressions in the mind.[7] When someone is able to separate the mind from his own center of identification (this can be achieved through meditation) he is able to reach a state of relaxed concentration in which is possible to observe his own psychological processes with complete detachment and freedom.[21]

Although yoga practice and the techniques mentioned above come from eastern culture and philosophy, which describe a particular way of behaving and perceiving the world, the references discussed here reflect another aspect of the practice, indicating its potential as an integrative practice with relevant outcomes in the field of mental health. These techniques generate a number of physical and psychological responses that can help prevent and treat different conditions, especially related to mental disorders. From this point of view, therapy can be defined as the possibility to access self-knowledge, allowing us to change what we consider dysfunctional.[8]

CONCLUSIONS

Many ancient texts of yogic philosophy and psychology make references to the importance of mental health and are full of psychological wisdom. Their rich insights can help deepen our understanding of mental health, and the practical psychological guidelines, described centuries ago, may enhance positive mental health and stabilize us in happiness. What researchers today are finding out is that modern interventions in psychology might not come from contemporary concepts after all. However, we are now in a position to integrate the rich psychological wisdom of both East and West.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.