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Full Text of: Shannahoff Khalsa: Gastroenterol Nurs, Volume 25(3).May/June 2002.126-129

Gastroenterology Nursing (C) The Society of Gastroenterology Nurses & Associates 2002.
All Rights Reserved.

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Volume 25(3) May/June 2002 pp 126-129
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Complementary Healthcare Practices: Stress Management for Gastrointestinal Disorders: The Use of Kundalini Yoga Meditation Techniques

[Departments] Shannahoff-Khalsa, David Section Editor(s): Krebs, Kathleen BS, RN

About the Department Editor: Kathleen Krebs, BS, RN, is the new editor of the Complementary Healthcare Practices column. Kathleen has received clinical training in Mind/Body Medicine from Harvard University's Mind/Body Medical Institute under the medical direction of Dr. Herbert Benson. In her role at Allegheny General Hospital's Integrated Medicine Program, Kathleen provides instruction in stress management, mind/body medicine, and healthy lifestyle strategies, and helps to integrate conventional and natural therapies for patients with acute and chronic conditions. Kathleen works with a large gastroenterology practice at Allegheny General Hospital and has been a member of SGNA since 1998.

About the Author: David Shannahoff-Khalsa is Director, The Research Group for Mind-Body Dynamics, Institute for Nonlinear Science (mail code 0402), University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0402 (e-mail dsk@ucsd.edu). Contact the author for more information about the use of Kundalini Yoga meditation techniques.

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Outline

Overview of the Techniques
Summary
References

Graphics

Table 1
Table 2
Table 3

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It is well known that stress exacerbates the symptoms of irritable bowel syndrome (IBS) and other functional gastrointestinal (GI) disorders. Drossman et al. (1999) hypothesized that functional GI disorders result from the dysregulation of "brain-gut" neuroenteric systems. They suggest the primary origin of functional GI disorders is not a disease of any GI organ or the brain, but the interaction of both. These disorders may, therefore, benefit from techniques that can alter the activities of
the central nervous system (CNS), autonomic nervous system (ANS), and enteric nervous system (ENS).

Recently, Kundalini Yoga meditation techniques (Shannahoff-Khalsa et al., 1999) have been demonstrated to have a dramatically beneficial effect on obsessive compulsive disorders (OCD), one of the most disabling of the anxiety disorders (Rapoport, 1990). OCD has a lifelong prognosis and is estimated to be the fourth most common psychiatric disorder following phobias, substance abuse, and the major depressive disorders. OCD is twice as common as schizophrenia and panic disorder (Rasmussen & Eisen,1990). OCD often begins during childhood or adolescence, has a lifetime prevalence rate of 2.5% to 5.0% (Rasmussen &
Eisen, 1990), and has proven to be refractory to traditional insight-oriented psychotherapy (Jenike, 1990). Also, 40% to 60% of patients exhibit only minimal improvement or no change with serotonin reuptake inhibitors alone (Goodman, 1992). As many as one-third are unimproved after apparently adequate drug treatment (Goodman, 1992), yielding a drug-treatment-resistant patient (Goodman, et al., 1992). In addition, medication in responders produces only a 30% to 60% symptom reduction and patients tend to remain chronically symptomatic to some degree despite the best of pharmacologic interventions (Jenike, 1992).

These OCD statistics are similar to those of IBS and other GI disorders for incidence and treatment success rates. While Kundalini Yoga meditation techniques have not yet been tested specifically for IBS or other GI disorders, they have a longstanding history over thousands of years as therapies for stress management, anxiety disorders, and a wide range of other psychiatric disorders (Shannahoff-Khalsa, 1991). The intent here is to help familiarize therapists and clinicians that may want to increase their repertoire of tools in the alternative medicine domain for the treatment of "brain-gut" disorders.

Overview of the Techniques

While there are 11 techniques in the meditation protocol specific for OCD (Shannahoff-Khalsa, 1997), including a breathing pattern specific for treating OCD (not listed below), these techniques can be employed for the stress-related exacerbation conditions of GI disorders. Several are described here. In addition to these, in the OCD-specific protocol, there is a 3-minute technique to help individuals learn to manage fears, a 5-minute technique for turning negative thoughts into positive thoughts, a technique that only requires a few breaths to help meet mental challenges, and an 11-minute technique for tranquilizing the angry mind. Whether practicing in a group or by oneself, the first technique, "tuning in" is always employed. Tuning in helps to induce a meditative state of mind and can provide the individual with the experience of being in a womb of blissful healing energy, especially when practiced beyond the minimum requirement of three repetitions (Table 1).

This technique helps to create a meditative state of mind and is always used as a precursor to the other techniques. There is no upper time limit for this technique; the longer the better.

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TABLE 1 Technique 1 "Tuning In"
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Techniques 2, Spine Flexing, and 3, Shoulder Shrug (Table 2), are also used to help induce an energized and positive state of being that can help the patient when engaging in the other techniques. These techniques increase metabolism, uplift the spirit, and induce the healthy glandular changes that give the energetic experience of vitality. These are helpful precursors to the other techniques. They help set the mood and increase metabolism.

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TABLE 2 Techniques 2 & 3 for Vitality
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Techniques 4, 5, and 6 (see Table 3) are all useful for managing anxiety, emotional stress, and mental tension-conditions that are believed to play an elementary role in the disturbance of the "brain-gut" connection. Technique 4 for reducing anxiety, stress, and mental tension is a powerful technique that induces a calm and quiet mind within minutes. It works even if you are feeling absolutely insane. In fact, in ancient times it was used to treat insanity. It can also be used to curb a restless and stressed mind and to bring an inner stillness and extraordinary experience of mental silence and well-being.

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TABLE 3 Techniques 4, 5, & 6 for Reducing Anxiety, Stress, and Mental Tension
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Technique 5 helps to alleviate emotional stress. Yogis also claim it helps rejuvenate the nervous, glandular, and
cardiovascular systems. This technique helps build respiratory capacity. The more slowly and deeply you breathe, the more relaxed you will be. Technique 6 takes about 75 seconds once learned and helps strip away any residual mental tension, especially after employing techniques 4 and 5. It can also be used independently.

Summary

Techniques in this protocol are from the system of Kundalini Yoga as taught by Yogi Bhajan (Master of Kundalini Yoga). They have a long-standing history of use for the management of stress, anxiety, and a wide variety of psychiatric and other disorders. While they have not been rigorously tested for the treatment of IBS or other functional GI disorders during modern times, they are likely to prove beneficial for helping the GI patient manage the daily stress that is often found to exacerbate and perhaps perpetuate the symptoms and conditions of the functional bowel or "brain-gut" disorders. Helping a patient to manage stress and achieve a profound sense of relaxation is likely to tend to the "brain" side of the "brain-gut" disorder, and thus help reduce these inter-system disorders.

References

1. Drossman, D.A., Creed, F.H., Olden, K.W., Svedlund, J., Toner, B.B., Whitehead, W.E. (1999). Psychological aspects of the functional gastrointestinal disorders. Gut, 45(suppl. 2), 1125-1130.

2. Goodman, W.K., McDougle, C.J., Price, L.H. (1992). Pharmacotherapy of obsessive compulsive disorder. Journal of Clinical Psychiatry, 53, 29-37. [Medline Link] [PsycINFO Link] [BIOSIS Previews Link]

3. Goodman, W.K., McDougle, C.J., Barr, L.C., Aronson, S.C., Price, L.H. (1993). Biological approaches to treatment-resistant obsessive compulsive disorder. Journal of Clinical Psychiatry, 54, 16-26. [Medline Link] [PsycINFO Link] [BIOSIS Previews Link]

4. Jenike, M.A. (1990). Psychotherapy of the patient with obsessive compulsive personality disorder. In M.A. Jenike, L. Baer, W.E. Minichiello (Eds.). Obsessive-compulsive disorders: Theory and management. St. Louis: Mosby-Year Book.

5. Jenike, M.A. (1992). Pharmacologic treatment of obsessive compulsive disorders. Psychiatric Clinics of North America, 15, 895-919. [Medline Link] [PsycINFO Link]

6. Rapoport, J.L. (1990). The waking nightmare: An overview of obsessive compulsive disorder. Journal of Clinical Psychiatry, 51, 25-28. [Medline Link] [PsycINFO Link] [BIOSIS Previews Link]

7. Rasmussen, S.A., Eisen, J.L. (1990). Epidemiology of obsessive compulsive disorder. Journal of Clinical Psychiatry, 51, 10-13. [Medline Link] [PsycINFO Link] [BIOSIS Previews Link]

8. Shannahoff-Khalsa, D.S. (1991). Stress technology medicine: A new paradigm for stress and considerations for
self-regulation. In M. Brown, G. Koob, C. Rivier (Eds.). Stress: Neurobiology and neuroendocrinology (pp. 647-686). New York: Marcel Dekker.

9. Shannahoff-Khalsa, D.S. (1997). Yogic techniques are effective in the treatment of obsessive compulsive disorders, In E. Hollander D Stein (Eds.). Obsessive-compulsive disorders: Diagnosis, etiology, and treatment (pp. 283-329). New York: Marcel Dekker.

10. Shannahoff-Khalsa, D.S., Ray, L.E., Levine, S., Gallen, C.C., Schwartz, B.J., Sidorowich, J.J. (1999). Randomized
controlled trial of yogic meditation techniques for patients with obsessive compulsive disorders. CNS Spectrums: The International Journal of Neuropsychiatric Medicine, 4( 12), 34-46.

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Accession Number: 00001610-200205000-00008
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