By Christine Saari, M.A., E-RYT, C-IAYT
Do you have a health condition that is chronic and seems to have no solution? Have you been to multiple doctors without receiving a satisfactory diagnosis that could explain your symptoms? Are you desperate for relief, and frustrated by the recommendation you reduce your stress? Is your ability to function day-to-day and enjoy life diminished by the debilitating nature of your symptoms?
If so, you are not alone.
More and more people are exhausting all the available medical options, only to receive a recommendation to reduce their stress. Often this leaves people feeling even more stressed and uncertain about where to go for help. They may feel intimidated by going to a public yoga class, or uncertain they can follow along with the group due to their condition.
Read on to discover how yoga therapy is emerging as an evidence-based complementary health care option to empower people to reduce, manage, or even transform their relationship to stress, even finding relief from stubborn health conditions with no obvious medical explanation.
Learn how yoga therapists work with their clients individually to create a holistic plan for stress reduction and better health, supporting clients every step of the way toward relief.
What is a psychosomatic condition?
You may have been told your symptoms are psychosomatic. Or maybe you are a mental health clinician looking to support your clients in their quest to find relief from somatic symptoms that are related to high levels of stress.
What does “psychosomatic” mean? It means your symptoms could be stress-related. Maybe your doctor has already recommended you try yoga for stress relief.
Psychosomatic conditions, also known as somatoform disorders, are defined by the American Psychiatric Association as a group of disorders in which individuals experience physical symptoms that are not fully explained by a medical condition, but are believed to be caused or aggravated by psychological factors such as stress, anxiety, or emotional conflicts1.
Research has shown that psychosomatic conditions are associated with a range of physiological and psychological factors. For example, stress is known to activate the hypothalamic-pituitary-adrenal (HPA) axis, which can lead to changes in the immune system, inflammation, and other physiological processes that may contribute to the development or exacerbation of physical symptoms2. Psychological factors such as negative affect and maladaptive coping strategies have also been found to be associated with increased risk of developing psychosomatic conditions3.
Psychosomatic disorder is characterized by a patient’s fixation on seeking a medical, rather than psychological, explanation for the symptoms at hand. Patients often seek frequent medical care from a variety of healthcare providers without receiving a satisfactory medical diagnosis. Patients may experience distress, anxiety, depression, anger or irritability because they believe their medical needs are not being properly addressed4.
Psychosomatic Disorder Diagnosis
It is important to recognize that not all physical symptoms without obvious medical cause are psychosomatic in nature. For a psychosomatic disorder diagnosis, a patient must also present with psychological symptoms including the following three criteria:5
- One or more somatic symptoms that are distressing or result in significant disruption of daily life;
- Excessive thoughts, feelings or behaviors related to somatic symptoms or associated health concerns;
- Though different symptoms may come and go, the state of being symptomatic lasts at least six months.
Common psychosomatic symptoms
Psychosomatic conditions could be more common than typically thought. It is generally recognized in the medical and mental health fields that psychosomatic conditions are often underdiagnosed or misdiagnosed as other physical or mental health conditions, leading to a lack of appropriate treatment and management. This is partially due to the wide variety of symptoms that can be considered psychosomatic, or “due to stress.”
The most common psychosomatic symptoms include muscle or joint pain, fatigue, insomnia, hypertension, trouble breathing, headaches, rash, and gastrointestinal issues such as stomach pain, ulcers, indigestion, diarrhea and constipation.
A more extensive list includes the following symptoms:6
Pain-related symptoms:
- Joint pain
- Stomach cramps
- Ulcers
- Headaches
- Back pain
- Chest pain
- Pain in the arms or legs
Additional symptoms may include:
- Fatigue
- Insomnia
- Shortness of breath
- Indigestion
- Diarrhea
- Constipation
- Hypertension
- Rapid heart rate
- Muscle spasms
- Weakness
- Loss of voice
- Difficulty moving
- Dizziness
- Numbness or tingling
Misconceptions about psychosomatic conditions
A common misconception about psychosomatic conditions is that the symptoms are imaginary or made up, or hypochondriacal in nature. In fact, psychosomatic symptoms are very real and do require medical treatment like any other illness.
If you or your client suffers from a psychosomatic condition, you already know how debilitating it can be to suffer from symptoms that prevent your or your client’s participation in the activities of daily life.
Another misconception about psychosomatic conditions is that they only affect adults. With stress on the rise due to the lasting social and academic effects of Covid shut-downs, as well as the social pressures unique to the youngest generation, psychosomatic symptoms are on the rise in children and youth.7
Psychosomatic conditions in children can affect school attendance and performance.8 Supporting children and youth with these conditions is a major cause of distress for parents as well, because their child is suffering from symptoms seemingly without cause or cure.
Common causes of psychosomatic conditions
It is not currently known why someone might develop a particular psychosomatic condition. However, several factors have been correlated with the development of these conditions, including emotional or psychological stress, co-occurring mental health conditions, past traumatic experiences, personality traits, hypochondria, and cultural and societal factors.9,10
Stress
Stressful life events, such as the death of a loved one, divorce, a chaotic lifestyle, financial difficulties, or work-related stress, can trigger physical symptoms. This is because stress can affect the body’s immune system, hormones, and nervous system. Co-occurring psychological conditions such as substance abuse, depression, anxiety, or personality disorders may also play a role.11
Trauma
Traumatic experiences such as physical, emotional, or sexual abuse, can lead to the development of psychosomatic conditions as well. When a person experiences trauma, their nervous system can become dysregulated, and this can lead to the development of psychosomatic symptoms.
The nervous system has two main branches – the sympathetic nervous system and the parasympathetic nervous system. These two branches work together to regulate the body’s response to stress and to maintain balance, or homeostasis, in the body.
When a person experiences trauma, their sympathetic nervous system may become overactive, leading to an increased “fight or flight” response. This response can cause a range of physical symptoms, such as increased heart rate, elevated blood pressure, rapid breathing, and muscle tension. Over time, chronic activation of the sympathetic nervous system can lead to a range of health problems, including cardiovascular disease, chronic pain, and digestive issues.
On the other hand, the parasympathetic nervous system is responsible for promoting relaxation and restoring balance in the body. When a person experiences trauma, their parasympathetic nervous system may become underactive, making it difficult to regulate emotions and physiological responses. This can contribute to chronic stress and a range of physical symptoms, such as fatigue, headaches, and difficulty sleeping.
Understanding these physiological changes is important in understanding how traumatic experiences can potentially be a root cause of psychosomatic conditions.
Other Potential Causes
Other causes of psychosomatic conditions relate to certain personality traits, such as perfectionism and obsessive-compulsive tendencies.12 People with hypochondria tendencies may overly focus on physical symptoms that others might consider to be minor due to anxiety.
Finally, cultural or societal factors may play a role in psychosomatic conditions due to the prevalence of mental health stigmas. In some cultures, physical symptoms may be more acceptable than psychological symptoms. This may lead to people expressing emotional distress through physical symptoms.
Psychosomatic symptoms can take many forms, and it is not yet understood why a person might develop particular symptoms, even when taking into account these additional risk factors.
The most important thing to remember is that psychosomatic conditions are real, and people suffering with psychosomatic symptoms deserve support and care in accessing integrative health options to help them get relief.
Mainstream treatments for chronic psychosomatic symptoms
Diagnosis of a psychosomatic condition requires ruling out other physical causes of the symptoms through medical testing and examinations. Treatment of psychosomatic conditions typically involves a combination of medical and psychological interventions.
This may include medications to manage physical symptoms, cognitive-behavioral therapy to address underlying psychological factors, and stress management techniques such as mindfulness and relaxation exercises.13 They may be advised to take steps to reduce their stress levels. Patients are also advised to maintain regular care with their primary care provider.
But what if talk therapy is not enough?
Are there any other options for people with these conditions to find relief?
Yoga therapy as an evidence-based approach for psychosomatic conditions
The answer is a resounding yes!
One might even say that yoga therapists specialize in working with psychosomatic conditions.
Yogic therapy is emerging as a viable evidence-based approach to complementary health care for people with psychosomatic conditions. A 2020 study by Mehta et al. provides compelling evidence of the effectiveness of yoga therapy in improving psycho-physiological states in patients with psychosomatic diseases.14 The study found that yoga intervention led to a significant improvement in psychological well-being, quality of life, and reduction in symptoms of anxiety, depression, and stress in patients with psychosomatic diseases. These findings are consistent with other studies that have shown the benefits of yoga therapy in improving mental health outcomes.
In addition to improving psychological well-being, yoga therapy also has physical benefits that can contribute to the overall well-being of patients with psychosomatic conditions. Yogic breathwork, in particular, has been shown to have positive effects on the autonomic nervous system, which is involved in regulating physiological processes such as heart rate, blood pressure, and respiration. A 2013 study by Sharma et al. found that both fast and slow pranayama practice improved cognitive function in healthy volunteers.15
Another study by Telles et al. in 2017 found that yoga intervention led to a significant improvement in heart rate variability, which is an indicator of the health of the autonomic nervous system, in flood survivors with posttraumatic stress disorder.16
Yoga Therapy as Complementary Health Care
Overall, the evidence suggests that yoga therapy is a viable complementary health care option for people with psychosomatic conditions.
The benefits of yoga therapy extend beyond the physical to the psychological, making it an ideal treatment option for conditions that are influenced by psychological factors. The integration of yoga therapy with conventional medical treatment can lead to a more comprehensive approach to treating psychosomatic conditions, which can improve overall outcomes for patients.
The rise of yoga pranayama as an alternative to mindfulness-based therapy for psychosomatic conditions
Until recently, mindfulness-based therapy has been the primary complementary therapy for stress reduction for patients diagnosed with psychosomatic disorder.17 This is because mindfulness meditation is now well-established as an evidence-based therapeutic technique.
However, that may soon shift.
Yogic pranayama and breathwork are now having a limelight moment in the mental health community. A pivotal recent study in January of 2023 by Balban et al. shows that Yogic breathwork is more effective than mindfulness meditation at improving mood and reducing stress.18 The study concluded that Yogic breathwork featuring a longer exhalation than inhalation demonstrated better efficacy for stress reduction than mindfulness meditation, box breathing, and hyperventilation.
These findings have major implications for psychologists and psychiatrists employing mindfulness-based therapies for clients with psychosomatic disorders, because stress reduction is such a key component in providing treatment.
As many have formerly done with mindfulness-based therapy,19 mental health clinicians may choose to focus their continuing education on acquiring clinical Yogic breathwork skills. Clinicians may also choose to partner with Yogic breathwork specialists, including certified yoga therapists.
As more and more mental health clinicians begin to partner with yoga therapists and focus their continuing education on acquiring the skills necessary to employ Yogic breathwork-based stress reduction therapy, clinical evidence is expected to continue to demonstrate the efficacy of this approach.
It is anticipated that among mental health practitioners working with clients with psychosomatic disorders, yogic pranayama will become a standard approach for managing stress.
Yoga therapy methods for working with clients with psychosomatic conditions
Yoga therapists work with clients with psychosomatic conditions using a holistic methodology. This process involves using a yoga therapy framework to determine which practices can best help the client. These frameworks are based on tenets drawn from traditional practices, yoga philosophy, and Ayurvedic medicine.
The frameworks are used to assess a client for various systemic imbalances, and to determine which practices are most appropriate and effective for the individual’s symptoms and personal circumstances. When teaching practices, emphasis is placed on ease of adopting the therapy and likelihood of compliance.
Yoga therapy is informed by the latest medical research in neuroscience, physiology, kinesiology, anatomy, and psychology. Evidence-based interventions for stress reduction and nervous system management are common features of many of the yoga therapy protocols used when addressing psychosomatic symptoms.
Techniques for working with psychosomatic conditions may include Yogic breathwork to promote parasympathetic nervous system function, but not always. Co-occurring conditions such as trauma or OCD may indicate use of other techniques such as somatic work or mantra meditation.
Yoga therapists work with people as individuals, taking the full range of health considerations into account when developing a plan.
Yoga therapy is therefore highly individualized.
For example, a client presenting with headaches and depression will usually be prescribed a different practice regimen than a client presenting with stomach pain and ruminating thoughts. These areas represent different types of imbalances, and are therefore treated differently. Even two clients with the same complaint of stomach pain and ruminating thoughts may receive different practice regimens according to their subjective experiences and preferences.
In fact, a client’s subjective experience of the practice is more important than any predetermined protocol when delivering a desired balancing effect.
The highly individualized nature of yoga therapy contributes to its efficacy. Efficacy is measured clinically by tracking metrics when addressing a client’s suffering from symptoms. This means that the client is in control.
Taking control of one’s health is often a welcome change for people who feel frustrated with the medical options available to them.
Yoga therapy offers relief from psychosomatic symptoms
People who use yoga therapy to find relief from psychosomatic symptoms may feel more in control of their health and well-being. They may feel a greater sense of connection between their emotional and physical health, and have a deeper understanding of how their thoughts and emotions can impact their physical symptoms. This can lead to improved self-awareness and a greater sense of empowerment to manage their health.
Additionally, finding relief from a psychosomatic condition can have a significant positive impact on a person’s quality of life. Clients often feel less burdened by physical symptoms and have more energy and motivation to engage in activities they enjoy.
Many also experience improved relationships and social connections, as they are better able to participate in social activities and engage with others without the limitations imposed by their physical symptoms.
Overall, finding relief from a psychosomatic condition through yoga therapy can be a transformative experience for an individual, leading to improved physical, emotional, and social well-being.
Yoga therapy recommended by doctors and mental health clinicians
If you or a loved one suffers from a chronic condition that you may believe is psychosomatic, talk to your doctor about trying yoga therapy.
More and more doctors are recommending yoga therapy for psychosomatic conditions. That’s because, like mindfulness-based therapy, yoga therapy is emerging as an evidence-based complementary therapy for use with stress-related disorders and psychosomatic conditions.
As awareness of the efficacy of Yogic breathwork for stress reduction increases, more and more mental health clinicians are expected to join doctors in referring their clients with psychosomatic conditions for yoga therapy.
How Do I Find A Yoga Therapist?
If you feel like you or your loved one are out of viable health options, consider asking a doctor or mental health provider about yoga therapy. Find a certified yoga therapist near you through organizations like Yoga Therapy Associates or the International Association of Yoga Therapists.
It’s never too late to take control of your health.
References
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
- Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychological Bulletin, 130(4), 601-630. https://doi.org/10.1037/0033-2909.130.4.601
- Gierk, B., Kohlmann, S., Kroenke, K., Spangenberg, L., Zenger, M., Brähler, E., & Löwe, B. (2015). The somatic symptom scale-8 (SSS-8): A brief measure of somatic symptom burden. Journal of the American Medical Association Internal Medicine, 175(5), 848-855. https://doi.org/10.1001/jamainternmed.2015.1210
- Levenson, J. L. (2017). Psychosomatic disorders. In The Merck Manual Professional Edition. Retrieved from https://www.merckmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/psychosomatic-disorders
- American Psychiatric Association. DSM (2013).
- Kroenke, K. (2003). Patients presenting with somatic complaints: Epidemiology, psychiatric comorbidity and management. International Journal of Methods in Psychiatric Research, 12(1), 34-43. https://doi.org/10.1002/mpr.141
- Stewart, S. E. (2019). Psychosomatic disorders in children and adolescents. The Medical Clinics of North America, 103(4), 725-737. https://doi.org/10.1016/j.mcna.2019.02.006
- Mallorquí-Bagué, N., Bulbena Vilarrasa, A., Martin-Andreu, S., & Jiménez-Murcia, S. (2018). Pediatric somatic symptom disorders. Current Psychiatry Reports, 20(11), 101. https://doi.org/10.1007/s11920-018-0968-0
- Kroenke, K. , 34-43.
- Kirmayer, L. J., & Robbins, J. M. (1996). Three forms of somatization in primary care: Prevalence, co-occurrence, and sociodemographic characteristics. Journal of Nervous and Mental Disease, 184(12), 697-704. https://doi.org/10.1097/00005053-199612000-00002
- Kroenke, K., 34-43.
- Rief, W., Martin, A., Rauh, E., & Zech, T. (2006). Fear of negative evaluation and the development of hypochondriacal concerns: A longitudinal study in primary care. Journal of Psychosomatic Research, 61(5), 719-725. https://doi.org/10.1016/j.jpsychores.2006.05.007
- Mayo Clinic. (2020). Psychosomatic illness. https://www.mayoclinic.org/diseases-conditions/somatoform-disorders/symptoms-causes/syc-20377777
- Mehta, R. K., Khera, S., Dara, P., & Chaturvedi, S. K. (2020). Effect of yoga intervention on psycho-physiological states in patients suffering from psychosomatic diseases: A randomized controlled trial. Journal of Psychosomatic Research, 131, 109962. https://doi.org/10.1016/j.jpsychores.2020.109962
- Sharma, V. K., Trakroo, M., Subramaniam, V., & Rajajeyakumar, M. (2013). Effect of fast and slow pranayama practice on cognitive functions in healthy volunteers. Journal of Clinical and Diagnostic Research, 7(10), 2133-2136. https://doi.org/10.7860/JCDR/2013/6435.3428
- Telles, S., Singh, N., Joshi, M., & Balkrishna, A. (2017). Posttraumatic stress symptoms and heart rate variability in Bihar flood survivors following yoga: A randomized controlled study. BMC Psychiatry, 17(1), 363. https://doi.org/10.1186/s12888-017-1537-x
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