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| Cactus by Melina Meza |
Q: I've got a question for Baxter (as one of his former teacher training students and budding yoga teacher): Are there any studies showing that individuals with mental disorders such as depression or schizophrenia should not meditate because it may worsen their condition or otherwise?
A: My students are always spurring me to look more deeply at what I know about yoga and its safe application for so many conditions! And this question opened up a new world of work on yoga and psychological issues to me. I had previously taken a wonderful workshop that Patricia Walden and Timothy McCall did at Yoga Journal Conference many years ago, in which they recommended yoga as a helpful adjunct to the treatment of depression and anxiety. Nina reminded me today as we talked about their work that Patricia did mention cautions on the appropriate use of certain yoga poses and meditation as they related to those two particular conditions. But I was unaware as to whether there existed studies on this.
On the positive side, Timothy lists multiple studies on his 75 Conditions Yoga Helps listthat show yoga having benefits for anxiety and depression. But as I began to do some research, I immediately came across several online meditation sites that warned about certain contraindications. I also found a review article that looked at existing research on meditation and mental illness, which had some recommendations based on their discoveries. Today I’ll summarize some of what I discovered and give you a few links if you’d like to read more yourself.
The good news is that there were no strict or absolute contraindications for introducing meditation to students with mental illness, especially if the teacher is truly experienced with the meditation technique being taught, has a clear understanding of the student’s mental illness, and has given the student proper preparations for the actual meditation being taught. However, having a clear understanding of the student’s depression or schizophrenia may be way beyond the scope of practice of most yoga teachers or yoga therapists, so as a teacher, you might want to collaborate with the student’s therapist to make sure the student is stable enough to tolerate or benefit from learning meditation. And if you are a practitioner with a mental disorder who wants to learn meditation, check in with your therapist first and then try to find a very experienced meditation instructor.
According to The Spiritual Competency Resource:
“There are conditions and situations when meditation is contra-indicated. A useful rule of thumb is that meditation should be used with caution whenever there are concerns regarding reality testing, ego boundaries, lack of empathy, or rigid over-control. For example, when treating a schizophrenic patient with active psychotic symptoms, it may be inadvisable to include meditation as a component of treatment, as reality testing may be impaired.”
A 1979 study Precipitation of acute psychoticepisodes by intensive meditation in individuals with a history of schizophrenia looked at the worsening of patients’ schizophrenia when meditation was introduced, whereas a 1986 study A holistic program for chronic schizophrenic patients demonstrated the safe introduction of meditation as part of a holistic program for schizophrenic patients in a state mental hospital setting. So, as with so many things related to yoga, it depends on many factors as to the safety of introducing meditation to this population.
I also discovered an anxiety condition that I was previously unaware of previously (although I did get hints of this when Richard Miller, PhD added a newer component to his yoga nidra practices for PTSD students that had them establish a “safe space” mentally that they could go to during their yoga nidra if they suddenly became anxious or had a panic attack). The condition, called “relaxation-induced anxiety,” is one in which someone who is unaccustomed to the deep relaxation that often accompanies meditation finds the resulting physiological release and attention to internal sensations, perceptions, and images, to be a source of fearful anxiety-producing apprehension. It turns out this kind of anxiety can happen with just about any relaxation technique, so that includes not only yoga nidra but also simple Savasana or a restorative yoga practice. Being aware of condition seems like a great idea for any yoga teacher who offers such practices to their public students. A 1983 study Relaxation-induced anxiety in a subclinical sample of chronically anxious subjects that looked at 30 chronically anxious patients who were given a progressive relaxation practice found that 17% of the participants had an increase in anxiety during the session.
“relaxation-induced anxiety and panic; paradoxical increases in tension; less motivation in life; boredom; pain; impaired reality testing; confusion and disorientation; feeling 'spaced out'; depression; increased negativity; being more judgmental; feeling addicted to meditation; uncomfortable kinesthetic sensations; mild dissociation; feelings of guilt; psychosis-like symptoms; grandiosity; elation; destructive behavior; suicidal feelings; defenselessness; fear; anger; apprehension; and despair.”
The authors point out that many of these side effects are also symptoms that patients with neurosis might have had the symptoms before trying meditation, so it may be a question of the chicken or the egg. And once again, they warn about the state of the research:
“Research into meditation is mixed, and of poor quality. Most of the studies are methodologically flawed, with insufficient number of cases, lack of standardized diagnostic procedures and being limited to non-psychiatric populations.”
I think the take-home here is that we have some evidence that meditation techniques can be helpful for some people with conditions like depression and even schizophrenia, but maybe not for others who are more unstable and fragile. It would seem prudent for anyone with significant symptoms of any mental illness to be working with a good psychologist and maybe a psychiatrist if medications are required. So yoga teachers and therapists should consider forming working relationships with mental health professionals to best serve their students with mental health issues. And if you are a student with mental health problems who experiences significant anxiety, agitation or depression while meditating, please let your teacher know as he or she may be able to offer you an alternative practice (Nina will have some recommendations on Monday).
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