By Maya Shetty, BS

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Vanika Chawla, MD, FRCPC, a psychiatrist, registered yoga teacher, and member of the Stanford Lifestyle Medicine Cognitive Enhancement pillar, has dedicated her career to improving mental health treatment through innovative and holistic approaches. Her distinctive background, combining both yoga and Psychiatry, offers a unique perspective on the potential of accessible stress management interventions.

“I view yoga as a novel lens for approaching mental health – one that can concurrently complement our existing treatment models and empower providers and patients to expand their therapeutic toolbox,” says Dr. Chawla.

Dr. Chawla works alongside Douglas Noordsy, MD, Assistant Director of Stanford Lifestyle Medicine, at Stanford Medicine’s Lifestyle Psychiatry Clinic. Leveraging her unique blend of medical and yoga expertise, she focuses on innovative approaches to psychiatric care that incorporate lifestyle changes and holistic interventions into her patients’ treatment plans. In addition to her clinical work, she is actively engaged in a 300-hour Yoga Teacher Training program offered through Stanford Yoga-X, which focuses on integrating yoga into health care in an evidence-based yet holistic manner.

“I am so happy to be at Stanford because they are thinking outside the box in terms of how we can support people and enhance their mental health,” says Dr. Chawla. “It’s really cool that I found a place to work that allows me to integrate my lifelong interests in yoga and healthcare.”

Dr. Chawla’s research interests are also centered around yoga as an intervention in mental health. “Yoga is definitely a big research area that has made a lot of progress in recent years, however, significant gaps remain in the current literature,” she says. “Future research is needed to deepen our comprehension of the intricate mechanisms of how yoga affects the brain and body.”

In residency, she was involved in research projects focused on using yoga to address anxiety in children. In 2022, she was one of two recipients of the inaugural Stanford Lifestyle Medicine Seed Grants, securing a $10,000 grant to further her research in the field of Lifestyle Medicine. The project, titled ACTIVATE, seeks to create a digital tool that helps individuals with mental health disorders and make positive lifestyle changes to enhance their psychological and physical well-being.

Originally from Peterborough, Canada, Dr. Chawla completed her undergraduate studies in health sciences at McMaster University in Ontario. Here, she began exploring her interests in the mental health field. Her journey took a pivotal turn during a volunteer trip to India that exposed her to yoga as a cultural practice. This encounter sparked her fascination with the practice, leading Dr. Chawla to complete her 200-hour registered yoga teacher training the following year.

“There is so much more to yoga practice than most people realize. There is such a big psychological and social component,” says Dr. Chawla. “It’s not just the postures. There’s breathing, meditation, ethics, values, connection, and community. It’s such a broad, diverse practice and I was really blown away by that.”

She pursued her medical degree at the University of Calgary and her psychiatry residency at the University of Toronto. During her residency training, she observed parallels between psychiatry, psychology, and yoga. “I began to see how yoga could address many unmet needs in our current mental health care models, bridging gaps where medications and psychotherapy may fall short,” says Dr. Chawla. 

These interests led her to Stanford University, where she found many opportunities in the realm of lifestyle medicine and mental health. 

Looking ahead, Dr. Chawla plans to continue exploring innovative ways to improve mental health interventions through research and medical practice, including best practices for incorporating yoga into clinical care. Her vision includes working with marginalized populations, delivering culturally-informed and trauma-informed care, and ensuring that these interventions are accessible to all. To reach these goals, she plans to continue the development of digital applications like ACTIVATE to reach a broader audience.

“Yoga is a comprehensive system that includes a lot of different practices: movement, breathwork, meditation, community, and more,” says Dr. Chawla. “Because of this, it can be tailored and adapted to what people need, to help people of all backgrounds manage their stress through avenues that work best for them.”

 

By Carly Smith, BS, MPH(c)

This blog is part of the Stress Management newsletter. If you like this content, sign up here to receive our monthly newsletter!

This month, Stanford Lifestyle Medicine Assistant Director Douglas Noordsy, MD, recommends a breathwork practice called the 100-Breath Mindfulness Practice. Breathwork refers to the practice of controlling the pace of one’s breathing with the intention of steadying one’s mental, emotional, and physical condition. Mindfulness entails anchoring the mind in the present moment. Therefore, a mindful breathwork practice brings the mind into the present moment by focusing on the breath. 

Dr. Noordsy recognizes that mindfulness meditation might be intimidating for some, so he offers this breathing practice as a quick-and-easy mindfulness exercise that one can do anytime, anywhere. 

“The 100-breath practice is an excellent, portable technique for letting go of overthinking and reducing stress,” says Dr. Noordsy, head of Lifestyle Medicine Cognitive Enhancement and Professor of Psychiatry at the Stanford School of Medicine. 

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100-Breath Mindfulness Practice

1. Get in a comfortable position and start taking long, slow, deep breaths.

  • You can do this sitting cross-legged on the floor or on a meditation cushion, sitting at your desk at the office, or even while taking a walk. If it helps you focus and it’s safe to do so, you can close your eyes during the practice.

2. Breathe in through your nose and out either your nose or mouth, whichever is more comfortable. 

3. Focus all of your attention on your breath and count them from 1 to 100.

  • Inhale, “one.” Exhale, “two.” Inhale, “three.” Exhale, “four”…
  • The counting anchors your attention on your breath and in the present moment. It also curbs distraction and enhances your ability to focus. And since you are counting to 100, you can do the practice anywhere without watching the clock.

4. When you notice a thought enter your mind, bring your focus back to the practice, and count the next breath where you left off. 

  • It’s important not to judge yourself when your mind is racing. Having a busy mind is completely natural. Be gentle with yourself when thoughts arise, simply let the thoughts come and go, and return your focus back to the breath.

5. Continue this process until you reach 100 breaths.

  • The average person takes 100 breaths in about 5 minutes. 
  • If 100 breaths is too much to start with, try 25 or 50 breaths first and gradually work your way up. Remember, this is a practice, so it’s okay to start small.

6. Celebrate your body and mind for taking a moment to slow down and practice. 

How Does Breathwork Affect the Body?

The 100-Breath Mindfulness Practice, like other breathwork exercises, works to calm both the body and mind by bringing the nervous system back into a state of peace. When the body is under stress, either physical or emotional, the sympathetic nervous system takes control, which increases heart rate, hastens respiration, and floods the body with adrenaline to either fight or flee from the source of stress. This is the body’s natural response to danger, which would be helpful if being attacked by a saber-toothed tiger but not so beneficial when feeling stressed about cooking a big holiday dinner or while parsing through work emails. 

Instead, breathing exercises like the 100-Breath Mindfulness Practice, box breathing, or cyclic sighing can help shift our nervous system from the sympathetic (stressful) to the parasympathetic (peaceful) nervous system. Different organs, like the heart, lungs, and brain, constantly send each other “biofeedback” or signals that keep them operating in harmony. By slowing down breathing and directing one’s attention inwards, the diaphragm stimulates the vagus nerve, which then tells the rest of the body to relax. The breathing exercise helps to slow our heart rate down to match our relaxed breathing, leading to cardiac coherence and a tranquil state for the body and mind.

 

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By: Vanika Chawla, MD

Emerging evidence suggests that beyond its use for pleasure, sauna bathing may be linked to several health benefits including cardiovascular, neurological and metabolic benefits. A recent review by Patrick & Johnson outlines evidence of the benefits of sauna use, potential mechanisms of action, and adverse effects and contraindications.  Sauna bathing is characterized by short-term exposure to high temperatures (ranging from 113F to 212F), and there are various forms including “dry” and “wet” saunas which differ in the amount of humidity. 

 

A large study done by Laukkanen et al., examining data from over 2000 middle-aged men in Finland showed that men who used saunas two to three times a week had a 27% reduction in mortality associated with cardiovascular disease compared to those who used saunas once a week, and men who used saunas four to five times a week had a 50% reduction rate in mortality associated with cardiovascular disease. The risk of mortality from all causes was reduced by 40% in frequent sauna users compared to infrequent users! Duration of sauna use was inversely correlated with the risk of cardiovascular disease and coronary heart disease, meaning those who used saunas for longer than 19 minutes had better outcomes than those who used saunas for less than 11 minutes. Results were adjusted for factors such as socioeconomic status. 

 

Many of the physiological effects of sauna use are similar to those elicited during moderate to vigorous-intensity aerobic exercise. Studies show that aerobic exercise in combination with frequent sauna use has a synergetic effect in reducing cardiovascular and all-cause mortality. Exposure to high temperatures stresses the body and this heat exposure induces protective responses that promote cardiovascular health, such as increased heart rate, decreases in blood pressure, and improved blood flow. Heat stress may lead to improved physical fitness by increasing cardiorespiratory fitness, endurance and preserving muscle mass. During exercise the core body temperature rises and heat acclimation from the sauna optimizes the body for tolerating core body temperature elevations during future exercise, as well as supporting other cardiovascular and thermoregulatory functions that are important in fitness and exercise. pThese mechanisms contribute to muscle mass maintenance and prevent muscle loss that can occur with aging.

 

Further analysis of the data from Finland also showed that men who used saunas four to seven times a week had a 66% lower risk of developing dementia compared to those who used saunas once per week. Proposed mechanisms for improved brain health in response to sauna include heat exposure and the subsequent cardiovascular response increasing the expression of brain-derived neurotrophic factor (BDNF), which is an important factor that supports the development of new neurons in the brain, and increased blood flow to the brain. Heat shock proteins also protect against brain disease. 

 

Findings from the study also show that regular sauna users had a lower risk of developing pneumonia and sauna use may bolster the response of the immune system and promote respiratory health. 

 

Caution should be exercised for sauna use in special populations such as pregnant women and children. There are some reports of reduction in male sperm count following sauna use in a 10-person study, but measures returned to normal within 6 months of sauna use cessation. Some contraindications for sauna use include alcohol use, hypotension, recent heart attack, severe aortic stenosis, and altered or reduced sweat function (such as in certain autoimmune or neurological disorders). Proper hydration is recommended prior to and during sauna use. 

 

You may want to consider using a sauna as you cultivate a positive, healthy lifestyle. It can be pleasant and soothing on a cold winter’s day, and may reduce your risk for some upper respiratory infections. There is no clear evidence indicating whether the benefits of sauna are limited to specific climates or seasons, or whether sauna bathing during hot weather confers health benefits. 


References:

Patrick RP, Johnson TL. Sauna use as a lifestyle practice to extend healthspan. Exp Gerontol. 2021;154:111509. doi:10.1016/j.exger.2021.111509

 

Laukkanen T, Khan H, Zaccardi F, Laukkanen JA. Association between sauna bathing and fatal cardiovascular and all-cause mortality events. JAMA Intern Med. 2015;175(4):542-548. doi:10.1001/jamainternmed.2014.8187

A recent study called Treatments for Anxiety: Meditation and Escitalopram (TAME) compared an 8-week standardized evidence-based mindfulness-based intervention (mindfulness-based stress reduction, MBSR) with medication for the treatment of anxiety disorders. The study included over 200 adults with a diagnosed anxiety disorder that were assigned to either 8 weeks of the weekly MBSR course or taking a medication for anxiety called escitalopram. The MBSR course involved weekly 2.5 hour classes, 45-minuter daily home exercises, and a day-long weekend retreat during the fourth or sixth week. The classes and home exercises involved mindfulness meditation, body scans (directing attention to one part of the body at a time to increase inward awareness), and mindful movements such as stretching.  At the end of the 8 weeks, the results showed that the mindfulness program was just as effective at reducing anxiety as medication. 

By: Vanika Chawla, MD

 


Journal Reference:

  1. Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. 2023;80(1):13–21. doi:10.1001/jamapsychiatry.2022.3679

During periods of stress, many of us forgo exercising and indulge in unhealthy eating. This study provides insight into how physical acitivty can lead to stress reduction and enhance positive feelings if we are able to include exercise into our daily schedule during difficult times. The effect of physical activity lasts for hours after the session and has prolonged positive effect.

By: Sarita Khemani, MD, Head, Lifestyle Medicine Stress Pillar


Journal Reference:

  1. Schultchen D, Reichenberger J, Mittl T, Weh TRM, Smyth JM, Blechert J, Pollatos O. Bidirectional relationship of stress and affect with physical activity and healthy eating. Br J Health Psychol. 2019 May;24(2):315-333. doi: 10.1111/bjhp.12355. Epub 2019 Jan 22. PMID: 30672069; PMCID: PMC6767465.

This review article clearly highlights the importance of healthy lifestyle choices on mental health. Whole plant based diet and daily exercise have remarkable effects on our mood. In many studies, the effect has been described as equivalent to taking antidepressant medications. In addition, good sleep, daily gratitude, positive thoughts about the future, and being of service to others has also been shown to have lasting positive effects on our mental health.

By: Sarita Khemani, MD, Head, Lifestyle Medicine Stress Pillar


Journal Reference:

  1. Morton DP. Combining Lifestyle Medicine and Positive Psychology to Improve Mental Health and Emotional Well-being. Am J Lifestyle Med. 2018 Apr 18;12(5):370-374. doi: 10.1177/1559827618766482. PMID: 30283261; PMCID: PMC6146362.

The beneficial effects of yoga, meditation and mind-body health were demonstrated in this study. 38 participants took part in a 3-month yoga and meditation retreat. Various measurements were obtained pre and post retreat. Significant increase in the plasma BDNF (brain derived neurotrophic factor) level was found post retreat. BDNF promotes development, survival, and plasticity of neurons in brain areas that play important roles in learning, memory and higher cognition. In addition, increase in the CAR (cortisol awakening response) was observed in participants post retreat suggesting role in improving stress resilience. Lastly, improvement in pro and anti-inflammatory biomarkers was also seen. Now might be the time to add meditation, yoga or other mindfulness activities in our daily routine.

By: Sarita Khemani, MD, Head, Lifestyle Medicine Stress Pillar


Journal Reference:

  1. Cahn BR, Goodman MS, Peterson CT, Maturi R, Mills PJ. Yoga, Meditation and Mind-Body Health: Increased BDNF, Cortisol Awakening Response, and Altered Inflammatory Marker Expression after a 3-Month Yoga and Meditation Retreat. Front Hum Neurosci. 2017 Jun 26;11:315. doi: 10.3389/fnhum.2017.00315. Erratum in: Front Hum Neurosci. 2022 Apr 08;16:868021. PMID: 28694775; PMCID: PMC5483482.