key: cord-263777-9rehacfy
authors: Ransing, Ramdas; Pinto da Costa, Mariana; Adiukwu, Frances; Grandinetti, Paolo; Schuh Teixeira, Andre Luiz; Kilic, Ozge; Soler-Vidal, Joan; Ramalho, Rodrigo
title: Yoga for COVID-19 and Natural Disaster Related Mental health Issues: Challenges and Perspectives
date: 2020-08-27
journal: Asian J Psychiatr
DOI: 10.1016/j.ajp.2020.102386
sha: 
doc_id: 263777
cord_uid: 9rehacfy

nan

The COVID-19 pandemic has placed the world at risk of an increased incidence of mental disorders (e.g., anxiety, fear, post-traumatic stress disorder) Smith et al., 2020; Tandon, 2020) . Though prevention and management of these conditions are imperative, delivery of evidence-based in person psychotherapeutic interventions (e.g., CBT) has hampered due to lockdown, physical distancing, and overburdened health care systems. The provision of these interventions via telecommunication has its limitations, like the digital divide in lowmiddle income countries, lack of adequate training in telepsychiatry in many countries , and lack of access to a telephone connection (Malathesh et al., 2020) .

Consequently, the burden of mental illness may remain unaddressed for specific populations if unprovided with viable alternatives.

Some countries have to be ready to deal with the double risk presented by both COVID-19 and natural disasters. For example, Fiji and Bangladesh and India have in May 2020 faced the consequences of Cyclones Harold and Amphan, respectively. Natural disasters have shown to have a significant impact on mental health (Durrani et al., 2019) . Unfortunately, natural disasters further increase the difficulties for people to access mental health care including digital. This dual risk presented by COVID-19 and the possibility of natural disasters reinforces the need to identify and provide viable alternatives to the one of telecare. Ideally, any suggested option should be evidence-based, self-reliant, feasible, acceptable, appropriate, and non-dependent on access to telecommunications.

In this letter, we explore the potential utility of Yoga as such an alternative. In 2014, the United Nations proclaimed 21 st June as the International Day of Yoga. 'Yoga' is a Sanskrit word that translated as 'to join' or 'to unite,' symbolizing the union of body and consciousness. It is a multi-component discipline that includes three forms of practice, namely postures and physical exercises (Asana), breathing regulation techniques (Pranayama), and meditation-based (control J o u r n a l P r e -p r o o f of attention, dissociating oneself from the disturbing thought) activities. The World Health Organization (WHO) describes Yoga as a valuable tool, one that increases physical activity, mental wellbeing, and decreases non-communicable diseases. The positive physical or psychological outcome of yoga intervention has hypothesized to be a result of complex pathways involving relaxation, physical flexibility, breathing exercise, coping strategies, acceptance, and self-efficacy (Büssing et al., 2012) .

Yoga has been proposed as a non-pharmacological intervention for mental issues (e.g., stress, fear) and disorders, either alone or in combination with other interventions. For example, significant improvement in people with post-traumatic stress disorder has reported following yoga interventions (Büssing et al., 2012) . Also, it has been found effective in reducing perceived stress, reducing fatigue in patients with cancer, improving blood sugar regulation in diabetes mellitus, diastolic blood pressure, symptoms of menopause, chronic bronchitis, and asthma (Büssing et al., 2012) . Yoga can enhance emotional control, and to improve self-efficacy, selfconfidence, and overall quality of life.

We searched two databases, PubMed and Scopus till 23 rd May 2020, for publications (available in English) about the potential role of Yoga in both the COVID-19 pandemic and natural disasters. To our surprise, no studies were exploring the potential role of Yoga as an intervention for mental disorders during COVID-19, and there were only five studies on the role of Yoga as a potential supportive intervention in disaster settings (Table 1) (Descilo et al., 2010; Durrani et al., 2019; Telles et al., 2010 Telles et al., , 2007 Thordardottir et al., 2014) . These studies were single centric conducted across three countries (India = 3, USA=1, Iceland=1) covering four disaster settings (tsunami =2, hurricane =1, earthquake =1, and flood=1). Yoga was found a beneficial, cost-effective, and feasible intervention in all except one study. But, these findings 

Components:

• Physical activities of mild to moderate intensity. 

Effects of Yoga on Mental and Physical Health: A Short Summary of Reviews

Effects of a yoga breath intervention alone and in combination with an exposure therapy for post-traumatic stress disorder and depression in survivors of the 2004 South-East Asia tsunami

The Effects of Yoga in Helping Cancer Patients and Caregivers Manage the Stress of a Natural Disaster: A Brief Report on Hurricane Harvey

Response to: Rethinking online mental health services in China during the COVID-19 epidemic

COVID-19 effect on mental health: patients and workforce

Correlates of symptoms of anxiety and depression and mental wellbeing associated with COVID-19: a crosssectional study of UK-based respondents

The COVID-19 pandemic

Yoga reduces symptoms of distress in tsunami survivors in the andaman islands

Post traumatic stress symptoms and heart rate variability in Bihar flood survivors following yoga: a randomized controlled study

Effects of yoga practice on stress-related symptoms in the aftermath of an earthquake: A community-based controlled trial

: an increase in selfrated anxiety.Neither group showed changes in heart rate variability or breath rate Small sample size, Small effect size, Short duration of follow up, All male participants (Telles et al., 2007) Tsunami, India 
