Beset by misconceptions and unhelpful portrayals in the media, schizophrenia is still somewhat poorly understood in wider society – even while awareness of other mental health issues is growing. For those who live with schizophrenic episodes, evidence increasingly suggests that the multifaceted benefits of yoga for schizophrenia may make it an effective technique in managing symptoms and preventing relapse.
Schizophrenia is one of the most severe mental disorders. It is defined by a combination of symptoms that either adds to a person’s experience or take away from it, and these are known as “positive” or “negative” symptoms. Positive expressions of schizophrenia include hallucinations, repetitive actions and delusions, while negative symptoms consist of anhedonia, amotivation and difficulty socialising – and those experiencing schizophrenia require significant support.
Despite not being widely studied into the early years of the 21st century (perhaps due to anxiety that meditative approaches may worsen psychosis) evidence suggests that yoga-based interventions offer potential as a safe and efficacious addition to current treatments of psychotic disorders, and can be used as an adjunct approach to improve quality of life and alleviate symptoms.
Yoga Therapy and Schizophrenia
There is no one cause of schizophrenia and no one universally effective treatment pathway for the individuals experiencing it. While antipsychotics are very effective in treating the positive symptoms of schizophrenia, they are less efficacious in the treatment of negative symptoms, and side effects include movement disorders, sleepiness and hormonal changes. A series of promising recent studies indicate that yoga is a viable option within a multidisciplinary treatment plan for schizophrenia, addressing issues that are difficult to treat with pharmaceuticals.
Learning yoga from a teacher or therapist can help people forge a sense of connection and belonging, especially if they learn in a group, which can be hugely beneficial for those who may otherwise become isolated by their mental health issues. Further to this, yogic-based practices have be shown to improve various issues seen in schizophrenia, such as cognitive deficits in neurocognition and social cognition, as well as alleviating depression and anxiety symptoms.
With an elevated risk of suicide and suicide attempts amongst sufferers, schizophrenia is a sometimes life-threatening illness which requires a holistic response that takes into account it’s social, psychological and physical impacts. Yoga could offer both a form of community support and channel through which patients can be referred to other mental health services (for instance, if someone feels that they are in danger of an acute episode), while also helping to lessen symptoms, aid in recovery and prevent relapse.
Schizophrenia: A Background
A widespread misconception regarding schizophrenia is that it refers to a “split personality”, which isn’t the case. The term schizophrenia literally means “split mind”, coined by Swiss psychiatrist Eugen Bleuler and intended to convey a disconnection between personality, thinking, memory and perception, rather than a multiple personality disorder.
People with schizophrenia often become withdrawn and lose interest in activities, socialising and their education/career, before going to on experience psychosis – ultimately finding it difficult to distinguish between their thoughts and ideas, and reality.
A person with schizophrenia may begin to hallucinate, often hearing voices or seeing things which are not there, and they may begin to feel as if their thoughts are not their own. Delusions are another key feature of schizophrenia, with people developing unlikely ideas that they hold with complete conviction – such as the belief they are being plotted against, or that their thoughts are being implanted in their minds from an outside source.
For some, hallucinations and delusions can create beliefs which (although removed from objective reality and which make it difficult to integrate into society) aren’t unpleasant to experience – for example, believing that they are in touch with benign and caring higher forces. However, many will develop ideas and experience hallucinations that are extremely distressing, and make fear and anxiety the dominating influence in their lives.
Unlike other mental health issues, schizophrenia affects both men and women equally. It also occurs in every society and culture, and most often develops in a person’s second or third decade of life. Fifty per cent of people with schizophrenia are estimated to have a history of substance abuse, perhaps due to attempts at self medication.
As is common in mental disorders, the exact cause of schizophrenia is unknown. As schizophrenia appears to run in families, it is theorised that a certain combination of genes increases vulnerability to developing this illness – something that is made extremely likely by the fact that if one identical twin develops schizophrenia, the other has a one in two chance of doing the same, even if they have been raised separately.
Other factors that have been linked to incidences of schizophrenia in those that are susceptible include drug use, (in particular, exposure to cannabis in early adolescence) stressful life events and complications in birth, such as premature labour and low birth weight.
Some question whether the diagnosis of “schizophrenia” would be more helpfully defined as a small variety of overlapping conditions which are experienced intermittently, rather than a lifelong label – which is perceived by some as an unnecessary burden. In these cases, it can be beneficial to think of a diagnosis as a tool for treating what patients are currently experiencing, rather than a definite condition or label that they will have to live with forever.
Why Use Yoga as an Adjunct Treatment for Schizophrenia?
The case for using yoga as an adjunct therapy has been growing since the first studies into this subject was conducted in the early 2000s. In an early study led H.R Nagendra (1), yoga based practices were applied in the treatment of chronic institutionalised patients with schizophrenia. The promising conclusions the researchers came to – that patients were able to learn yoga and derive some benefits in social and cognitive domains without experiencing negative side effects – led the way for further study and allayed fears of worsening certain symptoms.
A 2006 study (2) explored the effect of yoga for ninety patients with schizophrenia alongside traditional treatment, reporting greater improvements in physical and psychological functioning (as well as quality of life) in those who underwent the yoga-based intervention. Another study, which focused on outpatients receiving stable medication and reporting moderate symptoms, created a 1 month yoga module and advised participants to continue the practice at home for 3 months, while the control group took part in a standard set of exercises.
After 4 months, both groups reported improvements in negative symptoms and social functioning, with those who took part in the yoga module experiencing greater improvements than those who didn’t. (3) Following on from this, the largest study on yoga for psychosis took place, with patients divided into yoga, exercise and a wait-list control groups. Here, the yoga group was found to be five times more likely to to experience improvement in negative symptoms, while they also experienced improvements in emotional recognition, positive and negative symptoms, and social cognition. (4)
This study was later recognised by the UK’s NICE guidelines to be of good quality, recommending yoga therapy as a complementary treatment in schizophrenia.
One way in which yoga therapy is of particular benefit for those with schizophrenia is in lessening state anxiety and increasing subjective wellbeing (5), while also reducing both positive and negative symptoms and improving quality of life. (6)
As schizophrenia can contribute to feelings of anxiety and depression, and make people feel isolated, the social benefits and positive effect of patient’s wellbeing of yoga could make a tangible difference to people’s experience of life. It’s thought that these effects are achieved through a combination of activation of the mirror neuron system (and the subsequent social improvements this can involve) and an a increase in levels of oxytocin (the so-called “cuddle hormone”) in those who practice yoga (7).
With yoga, people experiencing (or who have experienced) schizophrenia should regain a sense of control over their mind and body, and find an effective self-care tool which allows them an active means through which to manage their illness. In the reduction of symptoms, greater sense of wellbeing and connection to a community, yoga can help people reintegrate into society and live a happy and fulfilled life – supported by a holistic and comprehensive treatment plan.
If you’re a yoga, health or psychology professional (or other interested party) and would like to find out more about how yoga can be used to help your clients, you can read more about the use of yoga therapy in the treatment of schizophrenia in Yoga for Mental Health by Heather Mason & Kelly Birch.
References
(1) Nagendra, H-R., Telles, S. & Naureen, K.V. (2000) An integrated approach of Yoga Therapy for the management of schizophrenia.
(2) Xie, J. Lin Y-H & Gui C-R (2006) Study on influences of yoga on quality of life for schizophrenic inpatients. Journal of Nursing, China.
(3) Duraiswamy, G. Thirthalli. J., Negendra, H-R., & Gangadhar, B.N. (2007) Yoga Therapy as an add-on treatment in the management of schizophrenia – a randomised control trial. Acta Psychiatrica Scandinavica, 166 (3), 226-232.
(4) Behere, R.V et al (2011) Effect of Yoga Therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia. Acta Psychiatrica Scandinavica, 123 (2), 147-153.
(5) Vancampfort, D. et al (2011) state anxiety, psychological stress and positive wellbeing responses to yoga and aerobic exercise in people with schizophrenia: A pilot study. Disability & Rehabilitation, 33 (8), 684 -689.
(6) Visceglia, E. & Lewis, S. (2011) Yoga therapy as an adjunctive treatment for schizophrenia: A randomised, controlled pilot study. Journal of Alternative and Complementary Medicine, 17(7), 601-607.
(7) Jayaram N., et al (2013) Effect of Yoga Therapy on plasma oxytocin levels and facial emotional recognition deficits in patients with schizophrenia. Indian Journal of Psychiatry 55 (Suppl 3), S409-S413.