As mindfulness has exploded into a range of clinical and research settings across the world, its close relative, yoga, has followed suit. Across a range of settings, from community mental health to psychology labs at some of the top research universities, yoga is being incorporated and investigated for effectiveness as both a complementary therapy and a standalone treatment.
One particularly interesting clinical application of yoga, called Yoga-Enhanced Cognitive Behavioral Therapy (Y-CBT) has emerged to provide a targeted mind/body approach to symptom management among people struggling with anxiety disorders in Massachusetts.
The results of preliminary research have been promising; although the program was initially developed for people with anxiety, participants with depression and PTSD also experienced significant reduction in symptoms after completing the six-week program.
The Y-CBT program was developed by psychologist Manjit Khalsa, Ed.D, and clinical social worker Julie Greiner-Ferris. Both are clinicians at Riverside Community Care Outpatient Center in Upton, Massachusetts, where Greiner-Ferris serves as the program director of outpatient services.
All answers in the following interview were a collaboration between both Khalsa and Greiner-Ferris.
How did you arrive to the point of wanting to use yoga to address mental health issues? What were some of your early experiences with the therapeutic power of yoga in clinical settings?
We developed the Y-CBT model in response to a need identified by one of our psychiatrists who asked if we could create a group program for her clients with anxiety disorders (generalized anxiety disorder, panic disorder).
Her concern was that the primary coping strategy for many of her clients was to treat their symptoms with medications. She hoped that a group could potentially offer them additional strategies to manage their symptoms.
Dr. Khalsa is a long time practitioner and teacher of Kundalini Yoga. We discussed whether it would be possible to put together a group that used yoga techniques adapted to the clinic setting.
As we talked about the concept we agreed that pairing simple yoga techniques, selected specifically with Manjit’s knowledge of their effectiveness in managing the symptoms of anxiety, with techniques used in our traditional psychotherapy practice (cognitive behavioral therapy, psycho-education, etc.) could potentially have merit.
Our rationale/theory was that combining the two techniques could potentially have significant impact on both the cognitive and physical symptoms of anxiety.
We further agreed that a group model would offer the additional benefit derived from therapeutic camaraderie, shared experiences, and reduced isolation.
What does the Y-CBT intervention look like, in terms of the balance of asana practice, talk therapy, other exercises?
The group treatment model consists of six 1.5 hour sessions. Each session weaves together the three elements of group process; didactic material, cognitive restructuring strategies and Kundalini yoga/meditation and breath techniques.
Our interest was to make the model accessible to all people, regardless of their physical ability, and so, all of the yoga is done in chairs and requires relatively low physical exertion.
Each group has a unique topical focus. Topics include understanding symptoms of anxiety and panic disorder; managing the physical symptoms of anxiety; managing the cognitive symptoms of anxiety; how anxiety impacts self value/self concept; and how anxiety can impact communication and relationships.
Is Kundalini the only style of yoga that will be used in this approach? Could someone make the assumption that utilizing another style of yoga (ex. ashtanga yoga or bikram yoga) in the same capacity would produce similarly positive outcomes?
Kundalini yoga is the style of yoga that is used in Y-CBT, but many poses and breaths are common to a variety of the styles of yoga. There is much in common between the different styles of yoga and the research shows that various styles of yoga work well to produce positive physical and emotional outcomes.
We chose Kundalini Yoga as taught by Yogi Bhajan® in part because of Manjit’s training and in part because the yoga sets are said to have specific effects, such as reducing anxiety. Certain sets in the Kundalini Yoga tradition, for example, are said to strengthen the nervous and glandular systems while having a relaxing and invigorating effect.
Practiced every day, like other styles of yoga, Kundalini Yoga can be very effective at calming the mind and reducing anxiety and depression. Kundalini Yoga is also called the yoga of awareness and its goal is to help you to achieve your highest potential.
For which psychological issues is Y-CBT best suited?
The model was designed to address symptoms of Generalized Anxiety Disorder and Panic Disorder. As we developed the program, we paid very close attention to the specific physical symptoms of anxiety (heart rate, shaking, muscle tension, nausea etc) and the cognitive symptoms (rumination, worry, cognitive thought distortions, negative self talk).
Because people who struggle with anxiety experience both physical and cognitive symptoms, which trigger each other in problematic cycles, we sought to develop a model which would target both the physical and cognitive symptoms simultaneously.
In other words, symptoms of anxiety are a mind/body experience, and so we moved forward with the rationale that for most effective relief, the treatment needed to address the problem with mind/body solutions.
While we primarily targeted symptoms of generalized anxiety disorder, our research has shown that group participants with symptoms of depression and panic have also shown improvement. We believe that this is true because there is an overlap in cognitive and physical symptoms across multiple diagnoses.
For example, people who struggle with depression, often experience symptoms in line with GAD or even Panic Disorder. And self value is certainly a challenge faced by people managing depression.
Also worth noting is that the original model is designed for an adult population. An adaptation specifically for teens is well underway and will be piloted this spring/summer in both our clinic and a local group practice.
We are also looking to bring the adult model to seniors and these efforts are also underway.
Where is Y-CBT currently being used?
Y-CBT groups are being offered in multiple programs across Riverside Community Care’s large service network in eastern Massachusetts, including several Outpatient Centers, Day Treatment Programs and residential programs.
It is also being offered in a private practice setting in our area. We have also trained many clinicians from other New England organizations and it is likely that many clinicians are using the techniques with their individual clients as well.
Are there future research plans for Y-CBT? Areas for further investigation?
Our research is very promising. We have one published study, that showed significant reductions in anxiety and depression (Khalsa, Greiner-Ferris, Hoffman & Khalsa, 2015).
We have another study in process that examined the effects of Y-CBT for those who suffer with anxiety, along with other diagnoses.
Our preliminary results show that the six week Y-CBT program significantly reduced anxiety for those diagnosed with depression, anxiety and PTSD. The effect sizes for these results were in the large range. We hope to complete the writing of this article this spring and publish the results sometime later this year or early next year.
We have three current research initiatives, which are beginning this spring and will be conducted at Riverside Community Care. We have a controlled study in process, which we hope to finish in 2017. We are also about to begin testing the teen model; and, we’ve begun to contact senior centers to offer services to and research the effects of Y-CBT with the senior population who live in the community.
Is there anything more you’d like to share with readers about the model?
As far as we know, Y-CBT is the only treatment model for anxiety that combines traditional psychological techniques with yoga, and which is available in a manualized, researched and published form.
The model and the training are very clinician friendly. Y-CBT has a 22 hour training, complete with small group instruction. Soon, we plan to offer a detailed manual for group leaders, which will be available to clinicians along with a CD including the PowerPoint presentation that is used in each group. There is also a participant manual available for the Y-CBT group members.
Although designed as a group model, many of the techniques are applicable to individual practice. Y-CBT trained clinicians tell us they frequently use specific Y-CBT techniques with their clients in individual therapy.
Y-CBT is also know as YogaCBT. Their book, The YogaCBT Workbook for Anxiety, is due out in June 2017, (New Harbinger Publications.)
To find out more about Y-CBT trainings, visit the Y-CBT website: Y-CBT.com.
Yoga image available from Shutterstock