Integrative Yoga Therapy for Mental Health

Today, yoga is practiced by more people worldwide than it was in the nineteenth century, especially as a medical approach and a way to assist in potentially healing different health problems. Yoga is a productive way for people to achieve mental health, relieve stress and live a more fulfilling life. The COVID-19 pandemic has created a sense of panic and fear, which has translated in various ways amongst individuals. Integrative yoga therapy has become more of a medical approach as people seek more natural and practical methods to solve depression and anxiety. Yoga teaches an individual to focus more on the parasympathetic system; through yoga, one will focus more on accepting circumstances rather than fleeing or fighting back. The deep breathing practice enables one to develop mindfulness, thus calming the nervous system and, in turn, enhancing mental wellbeing. Science and research have proven the positive effect of integrative yoga on health when used in medical approach. This paper discusses the three major phases of the yoga process, i.e., physical postures, the phase of recognition of the psychophysical effects, and the spiritual phase. Journal of Yoga, Physical Therapy and Rehabilitation Raval A, et al. Yoga Phys Ther Rehabil. 6: 1086. www.doi.org/10.29011/2577-0756.001086 www.gavinpublishers.com


Introduction
Yoga is one of the many types of complementary and integrative medicine approaches. The practice of yoga brings together the mental and physical disciplines that have been proven to help balance the physical, mental, psychological, emotional, and spiritual wellbeing of the body. That is, yoga is a mind and wholebody practice. Various styles of yoga combine physical postures, breathing techniques, and meditation to mental and physical wellbeing. Regular practice of yoga can promote endurance, strength, calmness, flexibility, and the wellbeing of an individual. Yoga is known as an ancient practice that has gained popularity through the years, as more and more people take alternative ways to deal with personal mental and physical health issues [1]. Yoga helps shed the stress, reconnects with one's body and relieves the tension and mental strain.
Perhaps one of the biggest takeaways from these years, i.e., 2020 till now, would be the relevance of mental health and the scrutiny yoga has faced previously. The COVID-19 pandemic that led to the interruption of the whole global enterprises, creating a sense of panic and fear. These created feelings that translated in various ways amongst individuals. Anxiety was the top issue for mental health during the pandemic [2]. While some anxiety that can occur daily is essential and helps in critical decision making, a substantial amount of consistent anxiety can be detrimental to one's health. Mental health issues, like depression and/or anxiety, amongst many others are all in the mind and have no effect on the person's physical vessel i.e., the body, is a misconception. The body is the biggest tell-tell sign for mental issues. It is known as somatic symptom wherein parts of one's body experience pain caused by anxiety, stress or depression. This uncertain time with nothing but speculation on the coming months created an urgency in finding methods to curb individual mental issues. Yoga, meditation, and mindfulness were three ways a person was able to self-manage themselves to ensure mental wellbeing. Yoga has been prevalent in India and now, globally for centuries. Practicing different positions (asana) in a smooth flow to allow better flow of blood in the body and to relieve anxiety without having to rationalize the process is a great starting point. The body can relax itself during the process. showed the correlation between anxiety (stress) and pain tolerance [3]. They found the group of individuals who were experienced yogis had a much higher pain tolerance than the otherwise control group of healthy volunteers. Many doctors have started recommending yoga as a self-managing tool for patients to regulate their mind and body [3].
Meditation practices like pranayama, wherein one focuses on breathing and attempting to empty the mind, is known to help regulate blood, create a sense of calm in oneself and be present in the moment [4]. Mindfulness is a state of being. It is the conscious choice of an individual being aware of surroundings and utilizing all senses, i.e., touch, smell, sight, taste and hearing. Being mindful allows a person to truly cherish and acknowledge surroundings and be grateful for the life that currently exists, rather than fixating on what could be. All three practices provide a gateway for people to be in the here and now and live in the moment. These practices during COVID allow one to not dwell on the past, not worry about the future, but instead focus on the immediate surroundings and self. Yoga gives the body the feeling of relaxation and calmness as well as relieves any anxious feelings and doubts.
When one practices yoga regularly, the individual will be mentally refreshed and rejuvenated to a higher level. Yoga creates a calmness and a more relaxed condition, since it helps the body release tension. Yoga works on the principles of body connection, helping synchronize and harmonize all aspects fully and making the body more active and relaxed than before. Yoga teaches to focus more on the parasympathetic system. Through yoga, the focus is more on accepting circumstances rather than fleeing or fighting back. The deep breathing practice, associated with yoga, enables the development of mindfulness, thus calming the nervous system and, in turn, enhancing mental wellbeing.
Integrative yoga is not just a practice for the mind and body but is also a medical approach to solving many of the problems in the body. It gives an individual more strength and determination to fight diseases and stay positive in the hardest of situations. Integrative yoga, through the years, has developed and evolved to become a method of medication and a potential way to solve multiple health complications in patients. In the modern world, many physicians refer patients to integrative yoga in attempts to help them solve their health complications and mental illness. Integrative yoga today helps people achieve mental health. Physical health, and the ability to go through stressing events without affecting their mental wellbeing. The practice of yoga also helps people to understand how to manage stress and how to avoid being controlled by events and circumstances, thus integrative yoga is a way to staying fit, healthy, and alert [5].  Figure 1 shows the process of the practitioner of Integrative type yoga advances through various levels. During the first phase of practice, one performs various physical exercises through asanas and recognizes the effects of performing on various changes in physical system (body). During the second phase, which includes change of diet (often resulting in restricting it to vegetarian diet), practitioner experiences psychophysical effects. Sometimes a practitioner experiences difficulties due to sudden change in diet and ends the practice. It is recommended that in such cases the practitioner should consult with a dietician and adjust accordingly instead of terminating. In the third phase the practitioner may decide to share his experience with novices and act as a teacher. As one continues to practice the spiritual enlightenment phase begins.

Background
For a long time, yoga has been used to relax the body and relieve the mind of stress and depression. More and more people today are suffering from depression to being suicidal and avoiding any social interactions [6,7]. The high rates of depression are also serious mental issues in the United States [8,9]. These studies showed that around 9% of the total population suffers from depression in the United States alone. This percentage does assist in explaining higher suicide rates and the ever-increasing crime rates, as people search for things to bring them peace of mind. More and more, people have turned to alternative medicine approaches to relieve their stress. One of the most common alternative approaches to medication is integrative yoga. According to [6], yoga is a broad term that refers to the practice of specific physical, mental, and spiritual discipline. Yoga targets the relaxation of the body, peace of mind and relief of any negative feelings and thoughts to help the body heal itself [10]. Through integrative yoga, the body gains more freedom with the ability to fight off infections and diseases, since the mind, hence, the body's systems, are at peace. Based on all the four studies discussed above, incorporating yoga and mindfulness-based practice into individual's lives can positively affect the body and mind in various, positive ways.
From the age 18 to 35 ages, yoga was a way of life comprised of mental, physical, and spiritual attributes to achieve different targets. Some people practiced yoga to achieve holism, while others practiced to achieve meaningfulness or excellence and completeness in all aspects of human functioning. Integrative yoga has continuously been used to help the body recover and stay healthy, especially when a person feels depressed or overwhelmed by emotions. Integrative yoga involves a fueling and energizing process that gives the individual a balance between personality and the wellbeing of the mind [11]. Social, psychological, spiritual, and moral coordination through the practice can be achieved. Yoga seeks to balance all body aspects, to bring everyone to the state of total coordination and understanding, avoiding scenarios, such as stress and mental issues. That is, yoga creates a level of calmness, eliminating any possibilities of overthinking issues that take away the person's peace of mind.
In today's modern world, emotion regulation and control are aspects gaining more and more interest. Adolescent studies [12] are steadily increasing over the years, and most of them focus on regulating and controlling emotions. Emotion regulation is the process of monitoring, evaluating, and modifying emotional reactions, especially their intensive and temporal features. Several scenarios in the body influence emotion regulation, including neurophysiological, physical, cognitive, behavioral, and social systems [10]. All these systems can also be positively influenced by integrative yoga, consequently influencing the state of the body and mind. Therefore, integrative yoga is an approach to deal with emotion regulation, which has affected millions and millions of people in the 21st century [13]. An ever-growing need exists to use integrative yoga today as a medical approach. Integrative medicine is an approach to wellness that combines: Conventional (traditional Western) medicine, which includes drugs, surgery and lifestyle changes. Complementary medicine, therapies that are not part of traditional Western medicine. Care may include chiropractic therapy, yoga, meditation and more The higher intensity and integrative yoga practice has great health benefits in the short and long run. The benefits of integrative yoga have become more and more evident to the general population, especially with the commercialization of integrative yoga [14]. Integrative yoga is gaining accreditation and popularity as it forges its way into the mainstream of the United States of America. Different people choose to practice yoga for various purposes and reasons. Some choose yoga for practice, others for their mental health, while others have it recommended by their physicians as a medical approach. Some people are attracted to yoga for weight loss, health promotion, and health maintenance [15]. Other individuals seek the benefits of yoga on a deeper level, desiring personal wellness and the yogic virtues of selfacceptance, mindfulness, and noncompetitive spirit. Yoga has also been utilized as a route to allow people to prevent, reduce, and control diseases and other associated factors. Integrative yoga is also used in rehabilitating an injury or trying to recover from long illness or a state of mental disability.
Today, stress contributes almost 80% of all diseases and illness in the world. Stress is the leading cause of suicide, blood pressure cases, and heart attacks, especially amongst the elderly [16,17]. Through comprehensive reviews and study, integrative yoga has been confirmed to minimize and control levels of stress amongst the people who regularly practice yoga [18]. Most people today do not believe or understand the problems associated with stress and how these problems affect physical health. (Cartwright et al. 2020) [19] recently concluded most people still did not understand the importance and the health benefits of integrative yoga. More and more people are falling victim of stressful illnesses and mental health problems today. Integrative yoga can be used to Volume  help people cope better with stress and avoid falling into depression [19]. Yoga can also help people develop healthy habits and methods to assist in a positive mental state.  Figure 2 illustrates the mental benefits of yoga, where an individual's mental health is a foundation of general wellbeing with proper functioning of the body and immune system. Mental health is a critical part of wellbeing and staying healthy, fit, and disease-free. Mental health is more just than being free from a certain mental condition. Being mentally healthy is the ability to think critically, understand feelings, learn, and perceive other people's reactions [6]. Therefore, mental health is a combination of the physical, psychological, cultural, social, spiritual, and emotional state of the body. The entire state and the wellbeing of the body decide mental health and how the mind reacts to different situations. The emotional and physical health of the body is inextricably linked, with one affecting the other more directly. The peak of mental health entails the ability to avoid mental illness and the ability to maintain the overall wellbeing and happiness of an individual.

Yoga and mental health
According to the National Alliance on Mental Illness, nearly one in every five individuals in the United States of America has a mental illness. As a result of NIMI (National Alliance on Mental Illness), 4.5% of the entire American population suffers from a mental disorder or a severe psychiatric disorder that affects their ability to function properly and be healthy. Mental illness is becoming a global problem, affecting more and more people worldwide than ever before [1]. The problem of mental illness could be associated with different scenarios and problems affecting people from across the globe. For instance, poverty, diseases, war, pandemics, and the lack of basic needs are the leading causes of mental illness. Depression, addiction to drugs and the inability to critically and healthy. process one's thoughts leads to mental instability and illness [12]. Most people today have problems where no solution exists, in their perspective, resulting in depression affecting personal mental health in the long run. Yoga today is recognized by certain physical postures. Through the practice of these postures, one learns how to focus awareness inwards, helping the body relax, leading to better focus/concentration. Thus, the body is prepared for meditation. The mind is relieved of any stress and excess thoughts that may lead to depression or mental illness. The posture also helps the body develop muscular strength, balance, and flexibility and stimulates the relaxation response, which allows the immune and the endocrine systems [12]. Also, the postures help create a deeper awareness of how the individual's body moves and feels. This awareness is finally transmitted to all other aspects of the body and life [20]. More and more practice of yoga gives more awareness of thoughts and how to control these thoughts to avoid falling into depression effectively. The yoga practice also trains an individual to avoid overthinking, paying little attention to stresscausing thoughts. Through integrative yoga, the person becomes more aware of who they are and better self-expression. Integrative yoga, also, helps improve focus and concentration [11]. Soon, this concentration and focus are present in the person's life to assist in finding peace and clarity of mind, clearing the mind of any distractions like stress, depression, frustration, fear, and anxiety.
For many years now, yoga has been used as a practice for mental development and to expand one's consciousness and enlightenment. Yoga has been proven to promote mental health and help people achieve a great state of their mind through meditation and focus their minds on better and healthier issues [21]. Yoga practice is a way to achieve better health, peace of Volume 7; Issue: 01 Yoga Phys Ther Rehabil, an open access journal ISSN: 2577-0756 mind, and control of emotions to avoid causing harm to yourself. Those individuals, who practice yoga, create more opportunities to avoid aspects of depression and anxiety.
Yoga eliminates issues like depression, and post-traumatic stress disorder, making the mind healthier and fit to face problems. According to yoga researchers and medical scientists, yoga and meditation can mitigate common mental health disorders like anxiety and depression [12]. Yoga relieves the mind of excessive thoughts, making one free from their negative thoughts and, as a result promoting mental health.
Mental illness and issues have become a concern across the world, especially amongst the young people. The second most group of individuals affected by mental issues are parents and people trying to make "ends" meet. Financial problems are the leading cause of mental illness and depression. The world is unforgiving, especially to the poor and those that lack a way to provide for their basic needs [22,23]. Mental illness and depression are also amongst the leading cause of death worldwide [23]. Integrative yoga has proven to help individuals fighting depression and mental health issues [22]. When people practice yoga, they understand how to stay calm, avoid overthinking issues, and find alternative solutions to the problems they have. Yoga also gives people the ability to meditate and calmly go through the thoughts in their minds to avoid stressing.

Depression and Yoga
Practicing yoga involves the discipline of mental, spiritual, and physical practice to achieve peace of mind, soul, and body. One estimation is that over 350 million in the world have some of the depression [24]. Depression is so common today, some states have defined it as a critical condition that needs national intervention [25]. Depression affects one's state of mind and life, as well Depression may result from multiple factors, including genetic, biological, and even environmental. The formal treatment of depression consists of psychotherapy, taking antidepressants, or attending counseling sessions. Most people, however, lack access to any of these solutions, leading to depression affecting their lives and their daily activities in the long run [12].
Over the last decade, researchers have studied the effectiveness of mind and body interventions ,such as yoga as an alternative treatment for depression. The use of yoga can help bring the body and mind to peace [26]. Yoga helps the individual live and focus their energy on more positive things. The limbs of yoga include physical postures, breathing regulation techniques, and meditation [27]. The different types of yoga include alignmentoriented yoga, fitness yoga, flow yoga, hot yoga, specialty yoga, and spiritual-oriented yoga. Yoga involves the ability and willingness to focus an individual's energy and body to more calming and fulfilling events, hopefully avoiding any negative energy and stressing thoughts. Breathing regulation techniques trains the mind and body on how to focus on the positive life situations and issues, while neglecting the negative energy. Meditation has the ability to only focus on the things that bring peace to an individual.
Livingston et al. 2018 [12] studied thirty-eight participants to determine yoga practice's effectiveness on depression and mental health. The practice of yoga showed effectiveness in reducing participants' stress levels and depression [12]. The minimum yoga practice had positive effects on individuals who were stressed or under some form of mental distress. The practice of relaxation, silence and concentration helped these individuals focus their thoughts on more positive thoughts and events in their lives. As a result, they discarded the negative thoughts that might have led to depression, mental illness and stress [1]. Focusing energy, thoughts and body relieved the body of depression, achieved a greater feeling of satisfaction, which can lead to calmness, avoiding many destructive thoughts.

Yoga as Holistic Therapy
Integrative yoga includes a precise combination of yoga postures, breathing, and meditation that could be key to unlocking some of the most crucial health benefits. Those who carry the burden of chronic disease can experience relative ease through regular yoga practice. The healing ability of yoga can allow the prevention, alleviation and recover of chronic diseases naturally. Integrative yoga can improve both visible and invisible cues of pain, suffering, and limitations which plague quality of life [28]. The restorative, rejuvenating, and relaxing nature of yoga has led to its increased usage in treating multiple common disorders. Integrative yoga has been proven to improve optimism, immunity, and self-acceptance while also minimizing fear, anxiety, and irritability.
Integrative yoga improves relaxation and the ability of the mind to focus, improving on the ability to sleep soundly and improving the symptoms of insomnia. In general, integrative yoga leads to a healthier body image, self-confidence, and mindfulness. Yoga also helps individuals abandon addictive behaviors and avoid falling into addictive habits [29]. Yoga practice has also led to pain relief and increased range of motion for individuals with musculoskeletal disorders including osteoarthritis, carpal tunnel syndrome, and chronic back pain. Integrative yoga is, therefore, a medical approach that can help individuals recover from different problems and issues that arise.

The benefit of yoga in children
Today, more and more children are suffering from anxiety, fear, and depression due to the modern way of life. Children no longer participate in physical activities and social interactions that could help their mental development. Instead, most of them prefer Volume 7; Issue: 01 Yoga Phys Ther Rehabil, an open access journal ISSN: 2577-0756 sedentary video games and spending their time on the internet with social media. These specific behaviors result in the development of anti-social characteristics and children keeping to themselves instead of associating [27]. The pressure to perform academically is also potentially delaying the children's cognitive development today, leading to mental illness and depression. Another reason behind the children's mental health issues today is insufficient sleep [30]. Mental health problems amongst children today are on the rise, Integrative and therapeutic yoga have a productive influence on helping children cope with stress and anxiety [30]. Yoga engages not only the body, but also the mind in promoting a child's general well-being. In children, yoga can be both a healing practice and a way to help them develop better social relations and a way of life. Practicing yoga opens their mind to the many possibilities of life, keeping them away from screens and video games [31]. The psychological and educational outcomes of yoga practice in this specific population are multiple, helping each child cope with life's difficulties today, hopefully. Integrative yoga should be included in the school curriculum as it has proven to help children's mental growth and well-being.

Discussion
Anxiety is a mental health disorder characterized by fear, worry, and strong feelings of insecurity [31]. Panic attacks, obsessive-compulsive disorder, and post-traumatic disorder are the most prevalent anxiety attacks today. Most people suffering from anxiety disorder try to keep away from the issues or situations that expose them to these anxieties. Anxiety is a normal way of the body trying to respond to stress [27], however, anxiety will disrupt one's normal activities and function and life healthily. Integrative yoga is an alternative medical process to addressing anxiety issues outside of the standard medical treatment options. Yoga helps an individual stay calm even in the most stressful situations. The yoga practice gives an individual control over what is going on and the ability to get a solution instead of overthinking circumstances. Yoga therapy also provides additional support to assist those individuals suffering from anxiety regulate their stress response, enhance resilience, and better manage their anxiety. Clinical practice today is implementing yoga as a treatment for anxiety.
Depression results from mood disorders and feelings of sadness, loss, rage, withdrawal, or constant denial. The rates of depression amongst the population today are way high due to circumstances, health conditions, poverty and living in denial. According to the Center for Disease Control and Preventions, almost 10% of all American adults had depression in any given two-week period between 2018 and 2020 [31].
Apart from the regular medical approach and treatment of depression, integrative yoga could also help people dealing with depression. More and more studies have been completed to establish the relationship between yoga and depression. According to the Harvard Mental Health Center, yoga has a significant positive influence on depression [17]. Integrative yoga can reduce the impact of stress, help with anxiety and depression, assist in relaxation and meditation, and improve the body's overall energy [32]. The problems caused by depression could potentially be solved through yoga postures exercises and mind control. The effects of depression-like lack of concentration and trouble sleeping can benefit from yoga therapy.  Figure 3 shows health benefits of yoga related to various aspects related to human body. Today, many people use yoga for various benefits and positive health impacts. In fact, yoga helps relieve mental and emotional problems, including depression and anxiety. Yoga can also help relieve some conditions, such as low back pain and muscle stiffness. Yoga can relieve an individual of chronic or long-term pain, improve their overall health and wellbeing [33]. Yoga has multiple more physical benefits to the body that have been confirmed by scientific research in different studies like health benefit. Yoga has multiple benefits, like increasing the body's flexibility and muscle strength and tone. Yoga also helps the body improve respiration, energy, and vitality. Maintaining a body's balanced metabolism can also be affected through the regular practice of yoga postures [31]. Weight reduction and cardio and circulatory health can be improved through regular yoga postures, keeping individuals healthy and free of mental illness. Through the practice of integrative yoga, one can help significantly improve their athletic performance. The practice of yoga has effectively implemented positive health benefits, assisting individuals in coping with varying medical complications and situations [34,35]. Occasionally, the medical world has adopted the practice of yoga as a supplemental way to advise and treat patients. When used with medical treatment, yoga helps solve different health and psychological problems.

Limitations of Yoga Practice
Today, integrative yoga is becoming more than just a trend with more and more people adopting the meditative approaches and techniques The all-encompassing nature of yoga has the tendency to draw in widespread appeal. The very first critique of integrative yoga is whether the benefits attributed to this specific yoga are real. Barriers may exist that prevent people from practicing yoga, since the effects of yoga are also unknown to many people citing and associating unrelated problems with the practice of yoga. Most people with medical issues only practice yoga when they must or when they have a problem that integrative yoga practices can intervene and alleviate. People do not understand the fact that integrative yoga should a routine part and way of life, so they can achieve the best results in their mental, physical, and emotional health.
The issue of people today relying more on medical approaches and medications, whether prescribed or over-thecounter, rather than healthy practices and simple living challenges the concept of integrative yoga. People do not want to get too involved in solving their individual problems. Many would rather choose the easy way out, taking and medications to cure even the simplest of problems. The fact that people do not believe in the health benefits of integrative yoga makes it almost impossible for physicians and medical personnel to convince their patients to try yoga. Unless people understand the benefits and the medical help from integrative yoga, it is difficult to make integrative yoga a medical practice across the globe.

Conclusion
The people, who practice yoga, often have the feeling of peace and relaxation. Research and studies show yoga helps with mental issues and emotion regulation. The increased heart rate variability resulting from yoga practice benefits the nervous system, leading to potentially reduced stress and trauma. With the increased rates of mental disorders, integrative treatment and practices are becoming more and more common as strategies to help those suffering from the diseases. Yoga practice can be positively used as an integrative treatment for psychological and physical problems. Yoga, also, trains the mind on how to accept emotions and control how the body reacts to different situations. Yoga does help one understand and develop insights on problems, thus, developing better ways to live better and more satisfied.