Stress Yoga and Cortisol

Many studies have documented that yoga can have an array of psychological, physiological and physical health benefits for healthy individuals as well as those coping with disease (e.g., Morgan, Irwin, Chung and Wang, 2014; Sengupta, 2012). However, the mechanism through which these yoga-induced health benefits occur is less clear. One possible pathway linking yoga with positive health outcomes is through stress reduction, or reducing one’s reactivity during stressful circumstances. This is a plausible mechanism, given that there is a robust connection between experiencing stressors and adverse health outcomes (e.g., McEwen, 1998; Sapolsky, 2004). This association between stressors and health could be due in part to stress-induced changes in important physiological systems, including the stress hormone cortisol. If yoga enables people to better cope with the stressors they face, this could lead to less stress-induced physiological activation (e.g., less of an increase in cortisol), which in turn could impact health.

The stress hormone cortisol may be a prime candidate as a physiological mediator of the yoga-health association, based on evidence that certain types of stressors can increase cortisol, and the regulation of this hormone in turn can impact health. The prototypical context where cortisol can be activated is in response to a physical threat, such as when survival or safety is threatened; cortisol can mobilize energy resources to effectively respond to the short-term metabolic demands of the threat (e.g., fighting or fleeing). There is increasing evidence that cortisol can also be activated in response to social threat, such as situations in which one feels rejected or evaluated by others (e.g., Dickerson & Kemeny, 2004). For example, in our studies in which participants are randomly assigned to deliver a speech along in a room (non-social context) or in front of an evaluative audience (social context), only the social evaluative stressor elicits a cortisol response (e.g., Dickerson, Mycek & Zaldivar, 2008; Woody, Hooker, Zoccola, & Dickerson, 2018). These and other studies have demonstrated that cortisol is very attuned to the social context and is triggered when we feel evaluated, rejected or devalued; given that we may encounter many such social stressors in daily life, we may be exposed to many situations that could elicit cortisol reactivity. If the cortisol response is frequently activated or fails to shut off after the end of a stressor, this could lead to over-exposure to cortisol and dysregulation in this system. Specifically, cortisol dysregulation has been associated with suppression of aspects of the immune system, damage to neurons (e.g., in the hippocampus), and the development and exacerbation of different disease states. Therefore, it is important to try to identify ways in which we might be able to “quiet” or better regulate the cortisol response, and therefore mitigate these negative effects on health. 

Yoga may be one method to regulate the cortisol response – yoga could shift cortisol trajectories to stressors, which in turn could in turn lead to improvements health outcomes. This could happen through stress reactivity – yoga could alter the way we respond psychologically and physiologically to stressors (e.g., less cortisol reactivity). The reduction of cortisol reactivity to stressors through yoga could confer health benefits.

There is growing support for the premise that yoga could reduce cortisol reactivity to stressors. The basic methodology of these studies is that participants are randomly assigned to participate in a yoga intervention or a control condition, and then subsequently go through a stressor in the laboratory (e.g., difficult cognitive task, delivering a speech). Cortisol is assessed before and after the stressor. This design allows a test of whether yoga leads to differences in stress reactivity.

Benvenutti et al. (2017) had 24 participants complete a yoga session (30 minutes of video-instructed Hatha yoga) or a control session (watching TV) on different days. Following both the yoga and control sessions, the participants then completed a standardized laboratory stressor and cortisol reactivity was assessed. Another study (Gothe, Keswani & McAuley, 2016) recruited 118 sedentary adults, who were randomly assigned to participate in either an 8-week yoga intervention (3 hatha yoga classes per week) or a control group (3 classes per week of stretching exercises). They then completed a challenging cognitive task. Both studies found that the yoga condition had less cortisol reactivity to a laboratory stressor than the control condition; in other words, a single yoga session or regular yoga practice reduced cortisol responses to a subsequent stressor.

Another study assessed cortisol reactivity to a laboratory stressor (speech and math task), then randomly assigned 52 female participants to a yoga intervention (2 Bikram yoga classes per week for 8 weeks) or a waitlist control; then stress reactivity was re-assessed (Hopkins et al., 2016). There was not a significant effect overall between the yoga and control groups in terms of cortisol reactivity following the intervention; however, those who showed exaggerated cortisol reactivity initially showed greater reductions in cortisol when assigned to the yoga condition. In other words, yoga reduced cortisol reactivity among the initial “high reactors.”

Taken together, these methodologically rigorous studies suggest that yoga may lead to reduced cortisol reactivity to stressors. However, more research should be done to replicate and extend these findings, as important questions remain. For example, the psychological mechanism of these effects has yet to be delineated. After yoga, do individuals appraise the stressor differently, or respond with different emotions – and does this in turn affect cortisol reactivity? Understanding how yoga may lead to cognitive or affective shifts which in turn shape physiology will be an important next step. Additionally, the “critical ingredient” of the yoga practice that translates into reductions in physiological reactivity will need to be unpacked. These studies examined Bikram and Hatha yoga – but the intensity, frequency and style of yoga that most effectively leads to substantive stress reductions has yet to be empirically tested. Practices of different intensities, duration, and orientation may have different physiological consequences. Further, other research has found similar results with mindfulness meditation – for example, cortisol reactivity has been reduced (e.g., Creswell, Pacilio, Lindsay, & Brown, 2014) or better regulated (Manigault, Woody, Zoccola, & Dickerson, 2018) among those randomly assigned to a mindfulness meditation intervention or who are high on trait mindfulness. Therefore, studies that compare meditation, yoga, and other mind-body interventions (e.g., tai chi) could elucidate common and distinct pathways through which these two practices could influence physiological reactivity and health.

In sum, there is consistent evidence that yoga may serve as a stress-buffer – leading to better regulation of cortisol reactivity to stressors. This provides empirical evidence for a phenomenon many yogis have intrinsically understood – what happens “on the mat” can have an effect on how one responds to “off the mat” stressful experiences. Yoga has the potential to improve health outcomes via the regulation of stress-responsive systems; the next phase of research is needed to usher in a greater understanding of yoga’s benefits and the mechanisms through which they may occur.

RERFERENCES CITED

Benvenutti, M. J., Alves, E. D., Michael, S., Ding, D., Stamatakis, M., & Edwards, K. M. (2017). A single session of hatha yoga improves stress reactivity and recover after an acute psychological stress task: A counterbalanced, randomized crossover trial in healthy individuals. Complementary Therapies in Medicine, 35, 120-126. 

Creswell, J. D., Pacilio, L. E., Lindsay, E. K., & Brown, K. W. (2014). Brief mindfulness training alters psychological and neuroendocrine responses to social evaluative stress. Psychoneuroendocrinology, 44, 1-12.

Dickerson, S. S., & Kemeny, M. E.  (2004).  Acute stressors and cortisol responses: A theoretical integration and synthesis of laboratory research.  Psychological Bulletin, 130(3), 355-391.

Dickerson, S. S., Mycek, P. J., & Zaldivar, F. (2008).  Social evaluation – but not mere social presence – elicits cortisol responses to a laboratory stressor task.   Health Psychology, 27(1), 116-121.

Gothe, N. P., Keswani, R. K., & McAuley, E. (2016). Yoga practice improves executive function by attenuating stress levels. Biological Psychology, 121, 109-116.

Hopkins, L. B., Medina, J. L., Baird, S. O., Rosenfield, D., Powers, M. B., & Smits, J. A. J. (2016). Heated hatha yoga to target cortisol reactivity to stress and affective eating in women at risk for obesity-related illnesses: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 84(6), 558-564.

Manigault, A. W., Woody, A., Zoccola, P. M., & Dickerson, S. S. (2018). Education is associated with the magnitude of cortisol responses to psychosocial stress in college students. International Journal of Behavioral Medicine, 1-8.

McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840, 33-44.

Morgan, N., Irwin, M. R., Chung, M., & Wang, C. (2014). The effects of mind-body therapies on the immune system: Meta-analysis. PLOS One, 9, e100903.

Sengupta, P. (2012). Health impacts of yoga and pranayama: A state-of-the-art review. International Journal of Preventative Medicine, 3(7), 444-458.

Sapolsky, R. M. (2004). Why Zebras Don’t Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Disease, and Coping. New York: Holt and Company.

Woody, A., Hooker, E.D., Zoccola, P.M. & Dickerson, S. S. (2018). Social-evaluative threat, cognitive load, and the cortisol and cardiovascular stress response. Psychoneuroendocrinology, 97, 149-155.

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Sally Dickerson, Ph.D., is a professor of psychology. Her research and teaching focus on how the body responds to stressful circumstances. She also is a yoga teacher (RYT-200) and yoga therapy student at Prema Yoga Institute.

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Meditating with Mantras and Mudras in Therapeutic Yoga

Some of the most famous images in yoga are of a silver-haired and wrinkled B.K.S. Iyengar in an advanced posture just a few years before his death well into his nineties, or a pink lipstick-wearing Tao Porchon-Lynch displaying increAfter practicing yoga over a long enough period of time, most of us encounter its more nuanced components that don’t necessarily fall into the category of asana or pranayama. These types of practices are especially of interest to yoga therapists, as they tap into the more subtle forms of using yoga for healing.

In meditation, we sometimes make use of mantras and/or mudras. Mantras are words or phrases that can be repeated aloud or to oneself with the rhythm of the breath, and mudras are the use of the hands to focus the brain. While most yoga practitioners have had some exposure to these concepts, as yoga therapists, we can go a step deeper to understand why they are used and how they can support healing.

What makes mantras and mudras of such interest to yoga therapists is how they tap into the parts of the body that can be most effective for promoting healing. The Homunculus Diagram shows the human body in proportion to the amount of nerve endings in each part. For this reason, when offering a yoga chikitsa, yoga therapists pay special attention to the parts of the body with the greatest number of nerve endings because of their efficacy to support healing – the face, lips and mouth (mantras) and the hands and fingers (mudras).

Thus, mantras and mudras help link physical actions to the functioning of the mind. Especially for active students, those who find meditation challenging, or those who are pitta vitiated, Ayurvedically-speaking, mantras and mudras can be a highly effective point through which to access meditation.

Mantras

Mantras have transcended the yoga community and are commonly cited as ways to enhance performance and in self-help circles. We repeat these words or short phrases to manifest an outcome or send out an intention, reminiscent of a prayer.

In yoga, mantras are chanted or repeated silently. When chanted or spoken aloud, we activate the healing capacities of connecting the brain to the mouth, lips and tongue. Even if repeated silently, mantras can help focus the mind during meditation.

Some common mantras include:

• Kirtan kriya – Four syllables, sa ta na ma, meaning birth, life death and rebirth – make up this classic mantra. The Kirtan kriya can be highly effective in focusing the mind during meditation when it is repeated over and over in a melodic way.

• Peace mantras – Om shanti shanti shanti is a common mantra used to call in peace, often heard at the end of a yoga class or to conclude a longer chant. Another mantra for peace can be more personal, such as breathing in “I am at peace,” and repeating it on the exhale. If “at peace” does not resonate with you, you can substitute another state of being to help bring a sense of ease to the mind and body.

• Devotional mantras – Mantras can also be used to chant devotion to a belief system or deity. One of the most common devotional mantras is the Gaytri mantra, which Sri Swami Satchidananda translates as “Let us meditate on Isvara [God] and His Glory who has created the Universe, who is fit to be worshipped, who is the remover of all sins and ignorance. May he enlighten our intellect." 

Mudras

Given the concentration of nerve endings in the hands and fingers, using them in meditation is said to be the most effective body-based yoga style to improve brain function. It also makes mudras one of the most accessible forms of asana, given the undeniably physical aspect of the practice. If you’re working with a client in a hospital setting, or if you’re working to introduce a more physical practice, mudras can be a great way to ease into asana.

Some common mudras

• Anjali mudra -- The most common mudra most of us are familiar with is Anjali mudra, or bringing the hands to a prayer position at the center of the chest. This is a devotional position meant to bring awareness to the heart’s center and can be found within many other asanas.

• Dhyana mudra – Place the non-dominant hand in the lap, face-up, with the dominant hand resting face-up on top of it. This is a powerful mantra for promoting healing and balance, by symbolically cradling our yang side and allowing it to rest.

Once you’ve introduced mantas or mudras to a yoga therapy client, the next step is putting them together.

• Mala beads – Chanting or repeating a mantra 108 times as you hold a mala is one of the most classical examples of devotion. Hold the mala in your right hand, draped over your middle finger. Using the thumb, touch one bead, silently or out loud speak your mantra, and slide your thumb to the next bead, being sure to skip over the large guru bead. At PYI, we chant “aham Prema” 108 times to honor the divine love inherent to our lineage.

• The Kirtan kriya – Once you’ve learned sa ta na ma, you can add the hands. On sa, lightly touch the thumb to the index finger, bring the thumb to the top of the middle finger for ta, the fourth finger for na, and the pinky finger for ma. Repeat.

Mantras and mudras are well known in yoga, but it’s their therapeutic effects where they really stand out. Ultimately, mantras and mudras are simple and highly accessible tools to deepen a therapeutic yoga experience.

LINKS:

https://www.intuitiveflow.com/the-magic-of-the-hand-mudras/

https://www.youtube.com/watch?v=nwRoHC83wx0&feature=youtu.be

https://www.yogiapproved.com/om/mantras-explained-use/

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Hannah Slocum Darcy is a yoga teacher and a student at Prema Yoga Institute. She specializes in accessibility and adaptive practice for many life stages and scenarios.

Poses, Props and Modifications for a Lifelong Yoga Practice

Some of the most famous images in yoga are of a silver-haired and wrinkled B.K.S. Iyengar in an advanced posture just a few years before his death well into his nineties, or a pink lipstick-wearing Tao Porchon-Lynch displaying incredible feats of flexibility before she passed away earlier this year at 101. While most of us see these images and shake our heads, lamenting our own muscle flexibility lost and aches gained over the past decade, they teach us a great deal about the practice itself.

Yoga, as most of us know, was not intended as purely a physical exercise, but rather a holistic practice comprised of eight limbs, culminating in samadhi. In this way, yoga lends itself to being accessible through the many stages of life and the necessary modifications that result. While many forms of exercise and sports can be so physically demanding that they either frequently lead to injury or are difficult or unsafe to practice as we enter a new life stage such as pregnancy, injury, illness or old age, yoga asana – and especially therapeutic variations – has a response to each of these. 

Here are some common poses, props and modifications to address some of the most common challenges that arise in the course of adulthood and ways to leverage the asana practice as a healing mechanism.

Chair yoga – Whether due to challenges with balance, restricted movement, or for clients just beginning a yoga practice, chair yoga is a starting point. So many common asana poses – twists, Warrior series, triangle, backbends, forward folds and more – can be modified to be done from a chair, whether seated or standing behind it and using it for support. All you need is a firm, steady folding chair. You can start to build strength in the chair and then eventually explore poses without using it.

Walls – As we age, the risk of falls increases. The National Council on Aging reports that one in four Americans over the age of 65 will fall each year, often resulting in the need to be treated in the emergency room. Thus, cultivating balance is critical. For clients who struggle to maintain balance, whether because of vertigo or ageing, the best modification is to find the steadiest prop possible and use that for practice – think the wall or floor. These props do not move no matter what, so should be used in poses that can challenge the balance. Think keeping the big toe on the floor during tree pose, or leaning back into a wall for triangle pose.

Yoga for low back pain – Low back pain is the second leading cause of missed work, second only to the common cold. Nearly all of us have awoken at one point or another with a stiff or sore lower back, not knowing what to do about it. The tricky part about low back pain is that its causes are many, and its treatments are just as diverse. Certain causes, like a ruptured disc, ask us not to forward fold, while others, such as sciatica, call for spinal twists. The key, if you are experiencing low back pain, is to visit a physician who can order tests and examine you to assign a proper diagnosis to your pain, and from there, you can work with a yoga therapist to ease your symptoms. Dr. Loren Fishman is a great resource on yoga for low back pain and has contributed greatly to the field of therapeutic yoga through his work.

Patience – Over time, the connective tissues that hold together our muscles and bone structure can dry up and become brittle. A key practice to maintain flexibility, which helps enable pain-free movement in the body and prevent common injuries, is yin yoga. Yin involves holding stretches for three to five minutes, getting deep into the connective tissue, to keep it healthy and supple. Interestingly enough, yin does not require deep flexibility to begin with, but rather asks us to stretch only to about half of our full capacity and utilize props to keep each pose supported, making it a sustainable practice for varying stages of fitness. That’s why you’ll be encouraged to bend your knees slightly in a yin-style forward fold or to back out of the most intense version of a posture to achieve lasting results over time.

These are just a few of the most common challenges we face as we age, and ways to modify, support, and explore them in the yoga practice. Finding a skilled yoga therapist to work with can help you find more ways to adapt your asana practice to your changing needs as you age.

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Hannah Slocum Darcy is a yoga teacher and a student at Prema Yoga Institute. She specializes in accessibility and adaptive practice for many life stages and scenarios.