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The Road to Incorporating Yoga Therapy Into Healthcare: the Role of Science and Research Brigham & Women’s Hospital Harvard Medical School The Road to Incorporating Yoga Therapy Into Healthcare: The Role of Science and Research IAYT Symposium on Yoga Therapy and Research June 16, 2017 Sat Bir S. Khalsa, Ph.D. Assistant Professor of Medicine, Harvard Medical School Director of Research, Kundalini Research Institute Research Director, Kripalu Center for Yoga and Health Editor in Chief, International Journal of Yoga Therapy Research Associate, Benson Henry Institute for Mind Body Medicine Research Affiliate, Osher Center for Integrative Medicine Yoga and Yoga Therapy Yoga Alliance/Yoga Journal Survey 2016 From: http://www.yogajournal.com/yogainamericastudy/ Yoga Alliance/Yoga Journal Survey 2016 From: http://www.yogajournal.com/yogainamericastudy/ The Professional Transformation of Yoga into Mainstream Society Public Schools, Workplaces, Healthcare Ashrams, Studios, Yoga Centers, Gyms, Spas The Professional Transformation of Yoga into Mainstream Society Public Schools, Workplaces, Healthcare Research Ashrams, Studios, Yoga Centers, Gyms, Spas Rationale for Yoga in Modern Healthcare Non-communicable Diseases (NCDs) …NCDs are the leading cause of death in the world… In most middle- and high-income countries NCDs were responsible for more deaths than all other causes of death combined... Noncommunicable Diseases, Country Profiles, World Health Organization, 2011 …NCD deaths are projected to increase by 15% globally between 2010 and 2020 (to 44 million deaths). Global status report on noncommunicable diseases 2010 World Health Organization Stress Awareness Worldview The Acute Care Model • Focused on treatment and/or intentional suppression of symptoms at the expense of underlying causes and contributing factors • Dominated by a disease-focused approach rather than a patient-centered holistic approach • Highly invested in pharmaceutical, surgical and other highly technological diagnostic and treatment strategies • Incentivized to emphasize speed, high volume, and immediate symptom relief • Responsibility for healthcare is primarily on the provider • Prevention and health maintenance is not emphasized From: http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health- care-from-a-global-perspective From: Developmental origins of noncommunicable disease: population and public health implications, Hanson M, Gluckman P, American Journal of Clinical Nutrition, 94:1754S–8S, 2011. Research on Yoga for Stress, Awareness, Worldview Reasons for Practice in a Beginners Program From: Yoga in the real world: Perceptions, motivators, barriers, and patterns of use, Quilty MT, Saper RB, Goldstein R, Khalsa SBS, Global Advances in Health and Medicine, 2:44-49, 2013. Stress in Beginner Yoga Students Perceived Stress 18 17 p < 0.0001 16 15 14 13 Average Score PSS Score Average 12 Baseline End Program From: Yoga as a stress reduction technique for women, Quilty M, Khalsa SBS, Saper R, Abstract submitted to 137th APHA Annual Meeting & Exposition, 2009. Stress in Occupational Setting From: Yoga for reducing perceived stress and back pain at work, Hartfiel N, Burton C, Rycroft-Malone J, Clarke G, Havenhand J, Khalsa SB, Edwards RT, Occupational Medicine 62:606–612, 2012. Perceived Stress Stress in 20 Frontline 15 Professionals 10 N=71 from fields of 5 education, healthcare, and Baseline Post Follow-up corrections in a residential Resilience 5-day Kripalu program 92 90 88 86 84 From: Trent N, Dusek J, 82 Miraglia M, Pasalis E, Khalsa SBS, in preparation. 80 Baseline Post Follow-up Mindfulness in Yoga Practitioners Freiburg Mindfulness Inventory 95 90 85 80 75 Average Change Score Change Average Controls Marginal Moderate High Intensity of Yoga Practice From: The relationship between yoga involvement, mindfulness & psychological well-being, Gaiswinkler L, Unterrainer HF, Complementary Therapies in Medicine, 26:123-7, 2016. Positive Psychological Changes in Musicians with Kripalu Yoga Total Mindfulness Observing Awareness 10 1 Controls 3 8 0 2 6 1 4 -1 Controls 2 Controls Yoga 0 0 -2 -1 Yoga -2 Yoga -3 -4 -2 FFMQ Average Score -6 -4 -3 Observing Average Score Awareness Average Score From: Yoga Enhances Positive Psychological States in Young Adult Musicians, Butzer B, Ahmed K, Khalsa SB, Applied Psychophysiology and Biofeedback, 41, 191-2020, 2016. Total Mindfulness Kripalu Rise Score 150 Program in p = .065 the 140 Workplace 130 120 Pre-RISE Post-RISE Mindfulness Factors 35 30 25 20 From: Trent N, Dusek J, 15 Miraglia M, Pasalis E, Khalsa Observe Describe Awareness Non-Judge Non-React SBS, unpublished data. Pre-RISE Post-RISE Survey Studies in Practitioners Non-Ashram Respondents Subjective Effects Ashram Respondents Became aware of a new reality Felt a personality change Experience resulted in change in life Experience of oneness In touch with divine or spiritual 0 20 40 60 80 100 Percent with Positive Response From: Intense personal experiences: Subjective effects, interpretations, and after- effects, Wilson SR, Spencer RC, Journal of Clinical Psychology 46:565-573, 1990. Psychology of Yoga Practitioners From: Yoga experience as a predictor of psychological wellness in women over 45 years, Moliver N, Mika E, Chartrand M, Haussmann R, Khalsa S, International Journal of Yoga, 6:11-9, 2013. Self-transcendence in Yoga Practitioners Transpersonal Identification vs. Self-Differentiation 7 AY 6 Practitioners 5 p=0.000003 4 Score 3 Controls 2 1 From: Processing of proprioceptive and vestibular body signals and self-transcendence in Ashtanga yoga practitioners, Fiori F, David N, Aglioti SM, Frontiers in Human Neuroscience, 8:734, 2014. Spirituality in Yoga Practitioners Multidimensional Inventory for Religious/Spiritual Well-Being (RSWB) RSWB Total Hope Immanent 240 40 220 38 200 36 180 Average Change Score Change Average Average Change Score Change Average Controls Marginal Moderate High Controls Marginal Moderate High Experiences Connectedness of Sense and Meaning 40 41 35 40 30 39 25 38 Average Change Score Change Average Average Change Score Change Average Controls Marginal Moderate High Controls Marginal Moderate High From: The relationship between yoga involvement, mindfulness & psychological well-being, Gaiswinkler L, Unterrainer HF, Complementary Therapies in Medicine, 26:123-7, 2016. Positive Psychological Changes in Musicians with Kripalu Yoga Dispositional Flow - Total Autotelic Experience 8 1.0 6 4 0.5 Control 2 Control Average 0.0 0 Yoga -2 Yoga Difference Scores -0.5 -4 From: Yoga Enhances Positive Psychological States in Young Adult Musicians, Butzer B, Ahmed K, Khalsa SB, Applied Psychophysiology and Biofeedback, 41:191-202, 2016. Yoga Practices Postures, Breathing, Relaxation, Meditation Fitness Self-Regulation Awareness Spirituality ↑Flexibility ↑Emotion Regulation ↑Attention ↑Transcendence ↑Strength ↑Stress Regulation ↑Mindfulness ↑Unitive State ↑Coordination/Balance ↑Resilience ↑Concentration ↑Flow ↑Respiratory Function ↑Equanimity ↑Cognition ↑Transformation ↑Self-Efficacy ↑Self-Efficacy ↑Meta-cognition ↑Life Meaning/Purpose Global Human Functionality ↑Physical & Mental Health, ↑Physical, Mental, Emotional Performance, ↑Positive Behavior Change, ↑Social Responsibility, Values, Relationships, ↑Quality of Life, ↑Life Purpose & Meaning, ↑Spirituality Yoga Therapy Research Chronology of Yoga Therapy Research 250 Yoga Therapy 200 Research Publications 150 All RCT 100 50 # of Peer-Reviewed # Publicationsof Peer-Reviewed 0 67-73 74-78 79-83 84-88 89-93 94-98 99-03 04-08 09-13 5-Year Windows From: Yoga as a therapeutic intervention: A bibliometric analysis of published research studies from 1967-2013, Jeter PE, Slutsky J, Singh N, Khalsa SBS, Journal of Alternative and Complementary Medicine, 21:586-92, 2015. Yoga Research Journals Yoga Mimamsa (1924) International Journal of Yoga Therapy (1990) International Journal of Yoga (2008) Indian Journal of Ancient Medicine and Yoga (2008) Journal of Yoga and Physical Therapy (2011) International Scientific Yoga Journal SENSE (2011) International Journal of Yoga and Allied Sciences (2012) International Journal of AYUSH: Ayurveda, Yoga, Unani ,Siddha and Homeopathy (2012) Journal of Advanced Research in Ayurveda, Yoga, Unani, Siddha and Homeopathy (2014) Journal of Yoga and Physiotherapy (2016) International Journal of Advanced Ayurveda, Yoga, Unani, Siddha and Homeopathy (2016) International Journal of Yoga, Physiotherapy and Physical Education (2016) MOJ Yoga & Physical Therapy (2016) International Journal of Yoga Natural Therapy (newly founded) Yoga Therapy Research by Disorders Mental Health Cardiovascular Respiratory Musculoskeletal Cancer Diabetes Neurological Women's Health Obesity Other 10 20 30 40 50 60 70 80 90 Number of Publications From: Yoga as a therapeutic intervention: A bibliometric analysis of published research studies from 1967-2013, Jeter PE, Slutsky J, Singh N, Khalsa SBS, Journal of Alternative and Complementary Medicine, 21:586-92, 2015. • 23 chapters with theory, rationale, research & practice • ~60 chapter contributors, ~30 yoga therapist contributors “…decrease use of medications, resulting in substantial cost savings for hospitals in the care of oncology patients.” “Mind body interventions … have the potential to substantially reduce healthcare utilization at relatively low cost and thus can serve as key components in any population health and health care delivery system.” “…if all 3 interventions are constrained by resources, medical yoga treatment is the optimal choice.” Yoga for Health and Prevention Yoga Practice Associations From:
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