Youth Mental Health-Anxiety: A Case for Yoga
Updated: May 31
Nearly 50% of all teenagers have complaints related to stress, anxiety and/or depression, with 37% experiencing persistent sadness or hopelessness and 19% seriously considering suicide. And that was before the COVID-19 pandemic. Researches are now reporting that mental health in youth has further deteriorated due to COVID-19 related factors such as having a family or friend die, the absence or limited availability of social supports, and economic stress(1).
Certainly, there needs to be a wide range of options for improving the mental health of youth based on their individual circumstances and a stand-alone strategy probably won’t do the trick. But should yoga be considered one of those strategies?
We think yes!
In a study led by Aurora James-Palmer, researchers (including yours truly) found that when children and adolescents practiced yoga, their symptoms of anxiety and depression were reduced(2) .In studies that assessed reduction of anxiety, 70% favored yoga whereas 40% reported fewer symptoms of depression. Unfortunately, no specifics about a “best” yoga practice could be identified.
Enter now…a case report.
A case report may not provide the best evidence for a treatment approach because it is designed for a specific individual with a particular set of circumstances. However, case reports do provide some useable data. And often, they provide the reader with details about the treatment or intervention of interest.
Let’s consider the paper by Ina Stephens entitled, “Case Report: The Use of Medical Yoga for Adolescent Mental Health”(3). Stephens describes the case of a 14 year old girl (BG) with migraine headaches and generalized anxiety disorder.
After two years of migraines that were somewhat controlled with Tylenol, Advil, Compazine and/Benadryl BG developed a complex migraine headache that included loss of sensation and movement of her right arm and leg. Her medications were adjusted by a pediatric neurologist and she was referred to a medical yoga clinic run by a university-based medical center. BG reported that she experienced a great deal of anxiety around her own medical condition as well as her family’s medical complexities, had difficulty concentrating and had a “full-blown panic attack” during school in which she developed shortness of breath, heart palpitations, and severe nausea.
At the clinic, a medical yoga prescription was developed to primarily control BG’s anxiety and help her to anticipate favorable outcomes regarding her migraines and general health. In addition to dietary recommendations, a plan for yoga including asanas/movement, pranayama/breathing, meditation/mindfulness, and svadhyaya/self-reflection was developed. The plan was based on her “diagnosis “of Anxiety & Rajasic Depression. “Rajasic depression” describes the type of depression where agitation and anxiety dominate, and is based on the Sanskrit term “raja” which is responsible for activity. On the flip side, “tamasic depression” comes from the word “tamas” which is associated with inertia. People with tamasic depression experience lethargy, fatigue and hopelessness. Different yogic practices are recommended for these two different types of depression.
Here are the practices that were recommended and performed by BG at least 4x/week. BG also reported that on many days she practiced 2x/day because they usually made her feel better.
Viloma pranayama: interrupted 3-part breathing with a 1:2 ratio of inhalation and exhalation.
“Practicing mindfulness can help to create resilience and hope, particularly important for today’s adolescent”. (3) They can include breathing methods, guided imagery, walking meditations, body scan meditations, etc. Guided meditations, available through many phone and computer applications are often the easiest to practice and can help with focus.
Self-reflection & Study
Teaching BG to recognize her emotions, “…when they actually occurred was very important and powerful. If one can understand and learn to recognize an emotion as it is occurring, one can work to alter it.” (3)
After 8 weeks, BG reported that she didn’t experience any migraines and was able to resolve a tension and stress-related headache with deep breathing exercises while at school. She also mentioned that when traveling to field hockey games she frequently noted a “tense feeling in her stomach” and that deep breathing helped her to relieve that feeling.
After 16 weeks, BG stated that she “knows when she is getting anxious and is able to calm herself down with deep breathing, so that the anxiety does not bother her or ruin her day.”
Additionally, she reported that once, she felt the beginning of migraine with a visual scotoma but that it never developed into a full migraine headache. BG is continuing to practice her medical yoga prescription almost daily.
For those reading this article all the way to the end, please don’t think that we are endorsing the above practice for all people or teenagers with anxiety and/or migraines. Rather, our intent is to highlight a paper or two that provides some support for considering yoga as a potentially safe and effective strategy for improving physical and mental health.
1 Hertz MF, Barrios LC. Adolescent mental health, COVID-19, and the value of school-community partnerships. Injury Prevention 2021;27:85-86.
2 James-Palmer A, Anderson EZ, Zucker L, Kofman Y, Daneault JF. Yoga as an Intervention for the Reduction of Symptoms of Anxiety and Depression in Children and Adolescents: A Systematic Review. Front Pediatr. 2020 Mar 13;8:78.
3 Stephens, I. Case report: The use of medical yoga for adolescent mental health. Complementary Therapies in Medicine 2019; 43:60-65.
Images from PocketYoga