Yoga and the Mind: Can Yoga Reduce Symptoms of Major Psychiatric Disorders?

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story did not discuss costs. Yoga is relatively cheap (roughly $10 to $20 per class in the Northeast city where one of our reviewers lives) compared with other forms of treatment, but it isn’t covered by insurance. So the costs can still add up, especially for those with limited incomes who are already paying for other medical care.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story’s description of benefits is unacceptably vague. It reports that the yoga has “positive effects on mild depression and sleep problems, and it improves the symptoms of psychiatric disorders like schizophrenia and ADHD among patients using medication.”

But which symptoms or outcomes specifically does yoga improve? And by how much? Which of the dozens forms of yoga out there should patients look for? These key details are not provided. And without them the story is far less useful than it could be for people trying to make decisions about their treatment.

And if the journal article on which the story is based didn’t make this clear – or if the scientists’ methods were questionable – then the entire basis for the story itself is questionable.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

While it’s not an invasive treatment and seems to be safe for most people, yoga can cause harm. The story, however, doesn’t address this possibility or state whether the studies included in the review assessed potential adverse effects of treatment.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story does make some attempt to assess the quality of the evidence, noting specifically that “the vast majority of studies looking at the benefits of yoga are all small studies.”  The story goes on to caution that yoga isn’t a replacement for medication, and that “we still need to do further, large-scale studies before we are ready to conclude  that people with mental illnesses can turn to yoga as a first-line treatment.”

Welcome as these caveats are, we don’t think they are enough to convey just how preliminary this evidence is, and just how far we still are from knowing whether yoga is truly an effective treatment. For example, while the story notes that the review included 16 studies overall, it doesn’t explain that there were only a handful of studies looking at each particular condition (4 studies of depression, 3 for schizophrenia, and only 2 for ADHD). Moreover, most of these studies suffered from important limitations beyond their small size. These limitations were catalogued in detail in the study’s discussion section, and deserved greater attention in the story. Following are some examples:

• Many studies included in the review compared people taking yoga to patients on a wait list receiving no therapeutic contact. This makes it difficult to tell whether the benefits attributed to yoga are due to the yoga per se or merely the increased attention these patients received from instructors/caregivers, which the wait-list patients did not receive.
• Many studies didn’t specify how frequently the yoga was performed.
• Patients in most of the studies had milder forms of disease; it’s unclear if the benefits would extend to patients with more serious symptoms, which tend to be harder to treat.
• The studies might be biased by lack of blinding (i.e. patients and researchers knew which patients were in the active treatment group). Although patients in a yoga study can’t be blinded in the same way that they can in a pill study, the researchers assessing symptoms can be blinded (i.e. they don’t have to know whether the patients are taking yoga or in the control group). However, most studies in the analysis never addressed this question.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

Researchers tend to be optimistic about the treatments they are studying, and the study author quoted in this story is no different. That’s why it’s always a good idea to include an objective perspective from an independent expert — something this story regrettably lacked.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story suggests that yoga would be an attractive alternative to psychiatric medications, but it doesn’t mention that psychotherapy is a well-validated and effective nonpharmacologic treatment for many of the disorders discussed in the story. And other major categories of treatment for people with some of the disorders discussed include a range of medications, a range of self-help strategies, and for some conditions, somatic treatments such as transcranial magnetic stimulation.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

Yoga classes are widely available, but there is no standardized curriculum. So it’s not clear if classes at the local community center will provide the same benefits observed in these studies. The story should have addressed this uncertainty.