The critical importance of mind body medicine as regards - treatment gap of 80-96pc for mental illness - proved benefit - can be administered by non medical professionals - safe and efficetive

1. Symposium on
Mind-Body Medicine
Sanjay Phadke, Arun Marwale
Vani Kulhalli, Nischol Raval
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2. Mental Health care
gap to the extent of
96 %
Time to think !
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3. Origin of Mind-Body Medicine
Research on TM (Transcendental Meditation)
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5. Mind-Body Medicine
The science of stress and impact of stress
management and resiliency on patients
and their clinical care to enhance:
• Treatment outcomes
• Prevention
• Quality of life
• Our (healthcare professional’s) own
self-care
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6. MBM established application in..
Migraines
Psoriasis
Neuropathy
Depression
Addiction
MS
Arrhythmia
Autoimmune
disorders
Nausea
Hair loss
Fatigue
IBS
Obesity
Parkinson’s
Cancer
PTSD/TBI
Infertility
CVD
Crohn’s disease
Chronic pain/
fibromyalgia
Panic
Anorexia
Hives
Jaw pain/TMJ
Stuttering
Diabetes
Impotence/low libido
GERD
HTN
Hot flashes
Tinnitus
Asthma
IBD
ADHD
Memory loss
Anxiety
Insomnia
Palpitations
Seizures
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7. Mind-Body Dichotomy and
Treatment biases
‘Mind’ bias of psychiatry - psychiatry applied
psychological methods in addition to
pharmacotherapy, but missed out on embracing
‘mind-body methods’ like Yoga & Meditation and
‘body methods’ like exercise and nutrition
‘Body’ bias of medicine – similarly needs to
move beyond the ‘diet & exercise for weight
reduction’ paradigm – positive psychology, Yoga
& Meditation are beneficial in good measure for
medical conditions too
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8. MBM - Concept
Mind-Body interventions conceptually
different from other therapies as they are
‘self-administered’ and have ‘systemic’
action
Several outcome studies have helped
create the evidence base
Process research has been helpful to
understand the mechanisms of action
(including our own work)
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9. Stress research & PNIE
Psycho-Neuro-Immune-Endocrinology
Lab evidence for Mind-body connect comes
from PNIE research in the context of stress
Also ample clinical evidence about
positive psychology, Yoga &
Meditation, exercise & nutrition
in psychiatric and medical
disorders
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10. Stress research milestones
1911 - ANS response to stress - Walter Canon
“The mechanical factors of digestion”
1920s Psychosomatic medicine Franz Alexander
1947 Immune alterations in psychotic patients
1950s Cortisol HPA decreased proliferation of
immune cells Stress GAS Hans Selye
1964 Soloman Psychoimmunology “Emotions,
immunity, and disease…”
1975 Psycho-Neuro-Immunology Robert Ader
Ader & Cohen – ‘taste’ signal affecting immune
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11. Interesting “Common cold” experiment
1991 New England Journal of Medicine
“Psychological stress and susceptibility to
common cold” by Cohen et al
About 400 subjects (with controls), given
intranasal common respiratory viruses
Those with higher psychological stress
developed infection
NEJM 1991; 325: 606-12
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12. Developments in Stress Biology
Understanding the ‘Systems’ dynamics
Health - Allostatic load - Disease
Stress tries to destabilize system
Allostatic load - extra energy to maintain stability
Healthy state
Ordered system
Allostatic load
disordered state
Disease & disordered state

13. 1980-90,Goldberger - cardiac dynamics
HRV (Heart Rate Variability) Research
Variability* is stability
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14. Biorhythms, Environment-Organism
Interaction is the key to stress biology
Sleep-wake diurnal rhythm
Cortisol rhythm
ANS rhythm: Sympathetic and
parasympathetic modulation
changes
TH1–TH2 immune responses
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15. Clockworks: molecular biology
Each cell has its own clock and several clock
genes are involved
Master clock – SCN in brain synchronizes all
the clocks
SCN messages through ANS and
Hypothalamus Pituitary Adrenal
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Dumbelll et al. Frontiers in
Endocrinology, 2016, Vol 7

16. Indian Contribution
Lab research:
Neurochemistry (Cortisol, BDNF,
Oxytocin)
Brain Imaging
Autonomic Nervous System
Clinical studies:
Schizophrenia, Depression, etc
Diabetes, Hypertension, etc
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17. Drop in Cortisol was correlated with increase
in BDNF: Yoga in depression
2/21/2019 Neuroscience of Yoga
Naveen et al., Int Rev Psy 2016
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18. BDNF levels are low in depression & rise after treatment
Regular practice of Yoga ‘normalises’ plasma BDNF levels
2/21/2019
Depression, Neuroplasticity &Yoga (practiced >50days; ‘regular’)
p<0.05
Neuroscience of Yoga 18

19. The ‘cuddle hormone’ oxytocin is elevated by
Yoga in schizophrenia
Jayaram et al Ind J Psychiatry 2013
2/21/2019 Neuroscience of Yoga 19

20. Pre-Yoga Post-Yoga
Significantly increased activation in Left Ventral Pre-Motor
Cortex following Yoga in subjects (N=36) during the contrast
dynamic pincer grasp condition minus static control
(Left [S4-D2] t=2.50; p=0.018)
Mirror Neuron Activation Paradigm:
fNIRS Results
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21. Compared to REST, OM Chanting produced deactivation of limbic structures,
anterior cingulum (B), hippocampi (C), insula (D), parahippocampi (E) and, thalami
(F). Control ‘chanting’: no effect (A)
International Journal of Yoga Vol. 4 Jan-
Jun-2011
Antidepressant mechanisms of Yoga
Vagal hypothesis (similar to VNS): Effect of OM chanting on
limbic cortex
212/21/2019 Neuroscience of Yoga

22. The stress of imprisonment lowers immunity
that recovers upon freedom
Phadke Leena et al
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23. Modulating the ANS - Yoga HRV studies
Phadke Leena et al
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24. Direct comparison of Yogasanas with
aerobic exercise: calorimetry and HRV
Phadke Leena et al
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26. Modified asanas & aerobic exercise in
Yoga naïve subjects, Leena Phadke et al

27. Differential Modulation of ANS during different
Yoga-asanas: understanding the ‘process’
Leena Phadke, Sanjay Phadke, Reinhard Bogle,
S.N.Bhavsar, K.M. Dandare, Nitin Patki
LF HF LF HF LF HF
Effort and posture dependent graded vagal
withdrawal/augmentation and modulation of
baroreflex activity- resilience development
T S R A V P Si Sa

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EEG, and EMG during Yogasana
Phadke Leena et al, 2013-

29. Yoga Biomechanics
DEVELOPMENT AND RELIABILITY OF A SCALE FOR
ASSESSMENT OF MUSCLE
CONTRACTION/RELAXATION DURING YOGASANA
Sanjay S. Phadke MD DPM1,2, Leena S.
Phadke MD3 Reinhard Bogle Dipl. Päd.1,4, S.B.
Sarmukaddam, PhD1.
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30. Yoga in Parkinson’s Disease
Simple Self-Paced Yoga-asana Learning and
Home Practice Improves QOL and Cognitive
Functioning in Parkinson’s Disease: A Pilot Study
Rahul Kulkarni, Sanjay Phadke, Vrushali Belekar,
Manjusha Vehale
Center for Brain and Spine Disorders
Deenanath Mangeshkar Hospital & Research Center, Pune
10th World Congress for Neurorehabilitation
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31. International Symposium on Neuroscience of
Yoga: From Yoga For Health To Yoga For
Wisdom, 2016
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32. International Symposium on Integrating
Yoga and Medicine: Developing Evidence
Based Guidelines, Pune 2017
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33. Neuroscience of Yoga
Courses and Workshops for Yoga Teachers
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34. Fundamental process in Yoga
through the lens of neuroscience
Intentional action on different planes
Observe the action/feedback (awareness)*
Use the feedback to improvise the action
Long-loop - ‘piloting’
Habit suppression and
new learning
Reorganization and
emergence of new patterns
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36. Our Concept of MBM
Self-regulation for health – from allostatic
load to attainment of stability & comfort
Introception, Metacognition, Attention and
Arousal control, ‘Flow’, Contemplation
Yoga & Meditation, Positive Psychology,
exercise & nutrition
Integrated with medical
treatment
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37. Dr. Raval will present review of exercise
and nutrition in psychiatric disorders
Dr. Kulhalli will present review of Yoga &
Meditation in psychiatric disorders
Dr. Marwale will present in brief MBM in
medical disorders, and opportunities &
practical considerations about
implementation of MBM
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“Insanity:
Doing the same thing
over and over again
and expecting different results.”
Albert Einstein

39. Thank You
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