MANOMAYA & VIJNANAMAYA KOSHAS RELEVANT RESEARCH

Manomaya Kosha

A PubMed search of the terms “yoga” and “mental health” reveal 62 pages of studies. Suffice it to say that the research examining the efficacy of yoga-based techniques is, at this point, robust. We’ll focus here on studies that have investigated the effect of yoga-related tools on perinatal wellness.

Several studies investigated the efficacy of exercise in preventing and mitigating postpartum depression and perceived stress. Two systematic reviews in 2019 found that when compared to inactivity, exercise reduces the risk of developing depression during pregnancy and postpartum (Kołomańska-Bogucka, & Mazur-Bialy; Dipietro et al.). A 2021 systematic review explored the interplay between nutrition and physical activity, finding that both should be considered as viable non-pharmacological options in the management of postpartum maternal health. Exercise protocols improved depressive symptoms in 76 percent of the twenty-five articles reviewed (Yahya, Teng, Das & Juliana).

A 2021 study (Lewis et al.) examined the impact of both telephone-based wellness intervention, and telephone-based exercise intervention on 450 postpartum women, in comparison to usual care. Telephone intervention was utilized to remove the barriers to care. While exercise intervention “may have a protective effect on perceived stress among women at risk for postpartum depression” (p.15) it was not directly protective of depression. Arguably, telephone exercise support is not the most effective way to ensure engagement.

The wellness intervention was found to be effective in the prevention of depressive symptoms. It involved conversation with a trained health educator about “stress prevention, time management, healthy sleep, coping with fatigue, weight management, nutrition, and healthy home topics (i.e., creating a safe home for baby that could help reduce stress for the participant)” (p.8). Perhaps most importantly, “health educators provided support to the participants through active listening and empathy,” and “engaged in problem solving strategies to help reduce the impact of stressors that typically occur during the postpartum phase” (p.8). These findings reflect the power of an attuned partner in mitigating stress and depression.  

A 2019 study (Pan et al.) assessed the effectiveness of mindfulness-based programs on mental health in pregnancy and early motherhood. Participants in the intervention group received significant training in mindfulness exercises including techniques to “monitor their sensory and emotional states and cognitive processes, deepen their sensory self-awareness, and become more mindful of the process of labor and parenting” (p.5). Researchers found that the teaching and practice of mindfulness meditation significantly reduced self-perceived stress and depression.

A 2022 study evaluated the impact of mindfulness training, specifically the Mindful with Your Baby protocol, on maternal mental health and parenting (Potharst, Kuijl, Wind & Bögels). Mothers are taught to regulate stress while in the presence of baby through meditative and attentional practices. Each week of the eight-week protocol has its own theme: “(1) becoming aware of the automatic pilot, (2) mindfully observing your baby, (3) Creating space for yourself, (4) responding sensitively to your baby, (5) taking care of yourself in difficult moments, (6) closeness and distance, (7) dealing with expectations, and (8) mindful parenting, each time, beginning anew” (p.10).*

*Side Note: I see yoga therapy in each of these themes and find it extremely exciting that researchers are seeking to validate these tools in service of postpartum care. The protocol, researchers suggest, may be the answer for care providers seeking to meet the needs of new mothers struggling with depression, stress, self-compassion and parenting whose symptoms have not yet warranted referral for specialized physiological care. They share the entirety of their protocol in an earlier article published in April 2022 (Potharst, Veringa-Skiba, van Broekhuizen & Bögels), and offer formal trainings in how to administer the work. It’s well worth a read as it may provide structure for your sessions with mothers struggling to attend to the moments of motherhood, challenging and joyous alike.

Both practice and psychoeducation are offered. The results of their study suggest that the Mindful with Your Baby intervention improves “mindfulness, mindful parenting, maternal mental health, and parenting” (p.24).

A 2020 review (Traylor, Johnson, Kimmel & Manuck) of non-pharmacologic approaches examined two studies that utilized “expressive writing” in the mitigation of postpartum depression. The technique involves “personal and often emotional reflection of thoughts or memories; it focuses on detailing one’s feelings while writing with the purpose of potentially easing emotional trauma” (p.12). In both studies, the intervention groups exhibited significant decreases in depressive symptoms. While the review authors note that neither study was exceptionally robust, they do suggest that expressive writing has been found to produce positive health effects in other domains such as cancer care. I see evidence in these studies for the value of journaling, a tool I regularly suggest clients adopt.

A 2018 study (Perkins, Yorke & Fancourt) explored how group singing can facilitate recovery from symptoms of postpartum depression. The work is born from previous research that “demonstrated that making music can enhance positive emotions as well as support positive psychological functioning” (p.1). Women were randomly selected to participate in two intervention groups that met for ten weeks: singing and creative play, while a third control group maintained “usual care.” Women in the singing intervention were led in song with their babies present and encouraged to create new songs reflecting aspects of motherhood. Creative play participants engaged in play with their babies—sensory play, arts and crafts, games and song—in the group context with the intention of engaging mother while supporting momma-baby interaction.

Both intervention groups reported positive outcomes, suggesting that the group environment organized around mother-child engagement is helpful no matter the content. Those in the “singing time for mums” (p.11) group reported some important differences. Even though mothers participated with babies in tow, singing sessions emerged as a form of meditative and calming “me time.” Singing moms felt a sense of accomplishment and were able to reconnect “with a sense of self and purpose that had been lost in the transition to motherhood” (p.12). This research reflects both the parasympathetic power of the kind of breath work employed in singing, as well as the benefits of social connection.

A 2021 study identified several factors that appear to be protective against the development of postpartum emotional disorders, including “global sense of coherence, as well as a strong sense of meaningfulness, manageability, and comprehensibility” Iwanowicz-Palus, Marcewicz & Bień, 2021). Participants were assessed using The Orientation to Life Questionnaire (SOC-29), which measures ‘sense of coherence’ (SOC) also called ‘global orientation to life.’ The measure of SOC “reflects an individual’s perception of the world as predictable, manageable, and worthy of commitment” (p.5). “Postpartum patients with a strong sense of coherence demonstrate positive, child-centered attitudes. Those with poor SOC are more likely to experience anxiety and mood disorders” (p.3).

The three components of SOC could be taken straight from a yoga therapy manual: Comprehensibility: “believe in the predictability and coherence of stimuli going in from one’s external environment”; manageability: “believe in one’s ability to meet the requirements posed by these stimuli”; and meaningfulness: “an attitude of readiness to commit and make an effort” (p.5). In these three traits I see the discernment, agency, and discipline inherent to yoga philosophy and practice. What we can distill, then, is that yoga therapy can inform the development of characterological traits that are positively correlated with an emotionally healthy and stable postpartum period.

Dipietro, L., Evenson, K. R., Bloodgood, B., Sprow, K., Troiano, R. P., Piercy, K. L., Vaux-Bjerke, A., Powell, K. E., & 2018 PHYSICAL ACTIVITY GUIDELINES ADVISORY COMMITTEE* (2019). Benefits of physical activity during pregnancy and postpartum: An umbrella review. Medicine and science in sports and exercise, 51(6), 1292–1302. https://doi.org/10.1249/MSS.0000000000001941

Iwanowicz-Palus, G., Marcewicz, A., & Bień, A. (2021). Analysis of determinants of postpartum emotional disorders. BMC pregnancy and childbirth, 21(1), 517. https://doi.org/10.1186/s12884-021-03983-3

Kołomańska-Bogucka, D., & Mazur-Bialy, A. I. (2019). Physical activity and the occurrence of postnatal depression-a systematic review. Medicina (Kaunas, Lithuania), 55(9), 560. https://doi.org/10.3390/medicina55090560

Pan, W. L., Chang, C. W., Chen, S. M., & Gau, M. L. (2019). Assessing the effectiveness of mindfulness-based programs on mental health during pregnancy and early motherhood - a randomized control trial. BMC pregnancy and childbirth, 19(1), 346. https://doi.org/10.1186/s12884-019-2503-4

Perkins, R., Yorke, S., & Fancourt, D. (2018). How group singing facilitates recovery from the symptoms of postnatal depression: a comparative qualitative study. BMC psychology, 6(1), 41. https://doi.org/10.1186/s40359-018-0253-0

Potharst, E. S., Kuijl, M., Wind, D., & Bögels, S. M. (2022). Do improvements in maternal mental health predict improvements in parenting? Mechanisms of the Mindful with Your Baby Training. International journal of environmental research and public health, 19(13), 7571. https://doi.org/10.3390/ijerph19137571

Potharst, E. S., Veringa-Skiba, I., van Broekhuizen, E., & Bögels, S. M. (2022). Mindful with your baby for mothers of infants with (parental) stress in a non-clinical setting: A wait-list controlled pilot trial. BMC pregnancy and childbirth, 22(1), 298. https://doi.org/10.1186/s12884-022-04640-z

Traylor, C. S., Johnson, J. D., Kimmel, M. C., & Manuck, T. A. (2020). Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: An expert review. American journal of obstetrics & gynecology MFM, 2(4), 100229. https://doi.org/10.1016/j.ajogmf.2020.100229

Yahya, N. F. S., Teng, N. I. M. F., Das, S., & Juliana, N. (2021). Nutrition and physical activity interventions to ameliorate postpartum depression: A scoping review. Asia Pacific journal of clinical nutrition, 30(4), 662–674. https://doi.org/10.6133/apjcn.202112_30(4).0013

Vijnanamaya Kosha

Yoga On the Brain. Just like motherhood, yoga changes the brain. A 2019 systematic review (Gothe et al.) of 11 papers evaluating a range of yoga modalities found several connecting threads relevant to our work. Yoga practice is linked to changes in the “frontal cortex, hippocampus, anterior cingulate cortex and insula” and “consistent positive relationship with measures of brain structure” such as grey matter volume, density, and cortical thickness (p.116).

These changes have implications for brain function. The 2019 review reveals the following trends: the brains of yoga practitioners show less activation when performing tasks that require working memory and executive processing, meaning it takes less cognitive effort to perform tasks. While studies often demonstrate conflicting results, “the evidence still points toward yoga exerting a beneficial effect on brain function” (p. 117). The holistic practice of yoga—breath, movement, and meditation—may be protective against the age-related cognitive decline. Numerous studies revealed regular yoga practice increases activation in the Default Mode Network. Yoga practice also positively impacts the hippocampus, a member of the DMN, as well as informs the overall volume of grey matter. Specifically, function appears to be boosted in areas of the brain associated with executive function, cognitive control, response inhibition, as well as “appropriate selection and coordination of actions, and reward evaluation and decision making” (p. 117).

Yoga practitioners also appear capable of engaging in cognitive tasks while experiencing strong emotion without having to down-regulate via the emotional control center of the amygdala. Instead, yogis demonstrate “overall neurocognitive resource efficiency,” disengaging from “negative emotional information processing,” instead employing “working memory and inhibitory control tasks” (p.117). These findings suggest that a holistic yoga practice may be protective against and medicinal for the disruption to brain function in pregnancy and postpartum.

Gothe, N. P., Khan, I., Hayes, J., Erlenbach, E., & Damoiseaux, J. S. (2019). Yoga effects on brain health: A systematic review of the current literature. Brain plasticity (Amsterdam, Netherlands), 5(1), 105–122. https://doi.org/10.3233/BPL-190084