Cure Talk’s Conversation With Dr. Satbir Khalsa, Director Of Research, Kundalini Research Institute

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Dr. Satbir Khalsa

Dr. Khalsa is the Director of Research for the Kundalini Research Institute, Research Director of the Kripalu Center for Yoga and Health and an Assistant Professor of Medicine at Harvard Medical School at Brigham and Women’s Hospital. For over 10 years he has been conducting research on the efficacy of yoga and meditation practices, including evaluation of yoga for insomnia, addiction, back pain, depression, anxiety disorders, post-traumatic stress disorder, chronic stress and mental health in public schools. He has also practiced a yoga lifestyle for over 35 years, is a Kundalini Yoga instructor, and directs an elective course at Harvard Medical School in Mind-Body Medicine.

On behalf of Cure Talk, I had the honor of interviewing Dr. Khalsa and it was truly an awesome experience.

Hope you enjoy the interview,

Q: I see that you are exploring effects of yoga in sleep disorders and PTSD. Can you explain your research?

SK: We have conducted clinical trials of a yoga treatment for chronic insomnia, one of these was a single group preliminary study (see: http://www.ncbi.nlm.nih.gov/pubmed/15707256) and another a yet-to-be published randomized controlled trial. Research studies have indicated that yoga is very effective in reducing physiological and psychological arousal. It is well known that chronic insomnia involves both physiological and psychological arousal. In our clinical trials, we investigated a simple daily treatment of a set of Kundalini Yoga practices for insomnia which individuals could do by themselves at home. It involved 45 minutes of yoga practice daily for 8 weeks. We found that intensity of insomnia was reduced following 8 weeks of treatment period.

We are also completing a trial of a Kripalu Yoga intervention in patients with post-traumatic stress disorder (PTSD). PTSD is another condition which has evidence for the involvement of both psychological and physiological arousal. In this trial conducted mostly in military veterans, our preliminary data has shown that 10 weeks of yoga treatment yielded significant improvement in PTSD severity

Q: Can you simplify ‘relaxation response’ for our readers?

SK: Researcher Dr. Herbert Benson has studied effects of meditation-based practices on physiology and in particular on the stress response systems. His research has demonstrated that contemplative-based practices such as yoga, tai chi and meditation induce a characteristic psychophysiogical response that he has called the relaxation response. This response is characterized by a decrease in stress activation and an experience of reduced arousal and positive well-being. This phenomenon is exactly opposite to stress activation or fight or flight response, in which there is an increase in stress activation with elevated adrenalin, sympathetic activity, stress hormones, arousal. The basic characteristic of these contemplative/meditative practices involves the control of mental attention and the cultivation of awareness and mindfulness, which is essentially the opposite of rumination or mind wandering.

Q: There has been some recent press regarding how Yoga can hurt the body. What is your opinion on this?

SK: The article in the NY times that has been widely publicized entitled ‘Yoga can wreck your body’, focuses on the prevalence of injuries that can occur in yoga practice. The answer to the question of whether you can get injured while practicing yoga, is simply yes. One can certainly findyoga teachers who are not well-qualified and there are many people who practice yoga aggressively and inappropriately or without considering their preexisting medical conditions or physical limitations. With the growing popularity of yoga, this will lead to an increasing number of reported injuries.

The issue that I object to with the article is that it does not discuss the most important issue which is relative risk. There is an inherent risk in every human activity. For example, people taking a walk outside are at a risk of being hit by a car and being killed. The number of people/pedestrians killed while walking is in thousands (over 4,000 in 2009; see: http://www-nrd.nhtsa.dot.gov/Pubs/811394.pdf) and therefore the relative risk of taking a walk is much much greater than the relative risk involved in getting injured by practicing yoga. It would be ridiculous if we were to publish an article entitled ‘Walking can kill you’. Walking is considered benign and safe and everyone walks. So, the point here is that relative risk of injuring yourself through yoga practice is relatively low in comparison to other everyday human activities.

Q: What are some tips you would suggest to someone with insomnia so that they can avail benefit of Yoga?

SK: There are many approaches to dealing with insomnia which fall into the category of behavioral treatments. These have been well-researched scientifically and have been demonstrated to be good for insomnia as well as have long-term beneficial effects. These behavioral techniques vary in the way they approach insomnia. Some of these techniques evaluate the effects of conditioning, some of them evaluate dysfunctional thoughts and thinking, and sleep-related behaviors during both daytime and at night. These practices have been packaged into a clinical therapy called Cognitive Behavioral Therapy for insomnia. This would be a prudent first choice for treatment for most individuals.

Relaxation practice is included within behavioral treatment approaches and have efficacy for chronic insomnia and I think that yoga fits in very well as an excellent relaxation technique. I suggest anyone with insomnia, to first consult an insomnia specialist in cognitive behavioral therapy for insomnia. As well, I believe it would be beneficial to also practice a yoga style which is more contemplative-based and incorporates all the important components of traditional yoga, not just postures alone, but also with breathing techniques as well as meditation and relaxation techniques. Regular practice of yoga on a daily basis for three or more days a week, along with behavioral treatments would likely improve sleep quality or patterns. If the patient does not find relief, he/she always has the option of consulting a physician for a prescription for sleeping pills.

Q: What in your view is the charm of Yoga, which has fuelled its meteoric rise across borders?

SK: Our society and culture has no existing technique for maintaining mental health. Our modern lifestyle is stress inducing with constant activity and high demand, fueled by round the clock access to the internet, cell phones and television. Without behavioral skills to allow individuals to effectively cope with stress, there is distress, burnout and the risk for developing mood impairment and stress-related diseases. Yoga and other mind-body contemplative practices are behavioral skills that can manage stress. Because these practices are not inherent to modern western society, individuals will often only be able to find out about these practices by word of mouth. Because it is effective, people practice it; they find it beneficial and tell their friends and as a consequence more and more people practice yoga.

Q: How long have you been practicing Yoga? Is there any sequence of poses or a style of Yoga that you would recommend?

SK: I have been practicing yoga for more than 40 years. Much of this time, I have been a yoga instructor as well. I have also been living in a yoga community of instructors and practitioners of an organization dedicated to the teaching and practice of yoga.

There are hundreds of yoga poses, and sequences of poses. So, it would depend on your interests. Different postures have different aspects attributed to them. For example, some yoga poses and meditation techniques are purported to be good for depression, some good for anxiety, some for mood enhancement, some for arthritis, some for back pain, and so on. Different types of practices have different benefits for various body functions.

Q: What are the 3 seminal studies or researches that have been important in establishing clinical effects of Yoga over the last 30 years?

SK: There have been many studies conducted using yoga as a therapeutic intervention. Historically, and to the best of my knowledge, yoga was never originally a therapy or a system of medicine. It was and is a set of practices primarily developed for spiritual advancement. Practice of yoga enhances physiological and psychological functioning of the body. By practicing meditation and breathing techniques as well as the postures, the body and mind come to a more optimal state of health. This is why yoga began to be used as therapy. This therapeutic use of yoga did not become popular until the beginning of the 20^th century. In the past 20 to 30 years, yoga has grown as a treatment option and several scientific studies, researches, and papers are being conducted using yoga as a therapy for a variety of medical conditions. For example, yoga is being used in cancer patients, not to cure the disease, but to help cancer patients cope with anxiety, depression, and stress related to a life threatening disease.

Q: Do you anticipate yoga to be a health insurance supported therapy going forward?

SK: I think eventually it will be supported with insurance to some degree. In fact, recently a yoga-based treatment program evaluated by Dr. Dean Ornish, for Reversing Heart Disease, led to Medicare supporting yoga for heart disease. I think this is just the beginning. Many more healthcare companies will come to realize the benefits of prevention in the practice of yoga. Yoga practice is very beneficial in reducing risk factors associated with number of major diseases like hypertension, heart disease etc. Therefore, it is in the interests of healthcare companies to recognize the potential preventive benefits of yoga practice as a cost effective measure.

We thank Dr. Khalsa for helping us in the editing process of the manuscript.