Integrating Meditative Movement for Improved Mental Health
Science supports a role for yoga, tai chi, and qigong in depression recovery.
Posted August 21, 2018
A new article just published in the Journal of Clinical Medicine supports that meditative movement, consisting of yoga, tai chi, and qigong may prove useful in the treatment of major depressive disorder (Zou). Although I will not yet divulge my personal love affair with yoga (you can read more about that here) anyone who has incorporated meditative movement as a part of their daily routine can attest to its therapeutic value. It is easy when reflecting on modern meditative practices to become disillusioned by what appears to be a faddist sport characterized by chic lululemon apparel and expensive studio memberships. However, I must admit that one of my most memorable yoga classes was on the second floor of an old beat up studio in central Manhattan earlier this year at Yoga to the People; the synchronized breath and positive energy were unrivaled, and the class was donation-based.
The popularity of yoga, in particular, as a meditative modality in recent years has risen dramatically and has quickly become one of the most sought after forms of alternative medicine practiced in the United States today, and for good reason.
However, the philosophy behind yoga is a value system rooted in the exquisite and colorful narratives of ancient India. The yamas and niyamas (ethical principles) allow for an exploration of themes focused on purity, truthfulness, and non-attachment, among others. Finding stability through suffering and sustaining peace during uncertainty are additional values offered. Specialized forms of yoga, like trauma-informed yoga, provide support for patients who struggle with post-traumatic stress disorder. While the research is arguably not yet conclusive enough to call trauma-informed yoga an evidence-based practice, I speculate that we are heading in that direction as studies become more numerous and sophisticated.
The authors performed a meta-analysis that ultimately resulted in the inclusion of 15 fair-to-high quality randomized controlled trails conducted in Germany, India, China, and the United States. Patients were allowed structured meditative movement sessions for anywhere from four to twelve weeks. Yoga was the most frequent meditative movement utilized. Some trials offered more than one meditative option, and some allowed patients the opportunity for antidepressant treatment as usual. Reported, was a statistically significant improvement in remission rate and response rate over the passive control group when meditative movements were incorporated.
What makes this an appealing study is that it is one of the first systematic reviews looking into the effects of meditative movements, specifically, on depression. The study is problematic in that it is difficult to parse out where the effect came from. For instance, if qigong was combined with tai chi and an antidepressant medication, can we really know for sure the degree to which meditative movement was a contributing factor? Also, yoga, for example, is not unimodal; kunadlini, vinyasa, and bikram yoga are all very different. The subtype of meditative movement is not specifically addressed in the authors' analysis. Finally, a statistically significant difference was not observed between the meditative movement group and the active control group; however, the fact that patients in the study appeared to find meditative movement useful, is encouraging.
I cannot help but wonder, if more studies like this are performed that support the role of meditative movement in a depression recovery model, might mental health professionals one day prescribe specific meditative modalities like yoga as an evidence-based first line treatment in lieu of an antidepressant for mild to moderate forms of depression? While it is indisputable that the current evidence recommends an antidepressant agent, psychotherapy, or a combination of both for first line treatment of depression, one of the most revered studies in psychiatry shows that only about 33 percent of patients remitted when initially presented with those options. Additionally, in clinical practice, some patients want professional help, but either their personal value system or history of medication side effects make medication adherence difficult for them. We can still help these patients. Finally, psychotherapy is useful, but it comes at a cost. Is it reasonable to recommend a patient who is depressed in the context of financial hardship to pay $100 or more per week for psychotherapy?
The ideas explored here, in support of Green Psychiatry, are intended to foster a positive mental health discourse. How do we broaden access to care? How to we meet patients where they are? How do we, as mental health care professionals, help patients maintain sustained recovery? I believe this is a beautiful time for integrative medicine as more people are committed to the improvement of our mental health. This study, examining meditative movement, provides a positive step in the right direction to broaden the way we think about mental health treatment. Meditative movement offers an alternative approach and a growing body of evidence to support recovery, with the only real potential side effect of improved health and happiness. As we continue this ongoing discussion, let us remind ourselves of the value of meditative movement in our daily quest to stay well.
Zou, Liye. et. al (August 2018). Effects of Meditative Movements on Major Depressive Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Clin. Med. 7, 195.