AHW Medical Research Grant Supports Study of Effects of Yoga on Grief

Grief: It’s an emotion every person inevitably experiences in their lifetime. Our emotional reactions to loss vary due to multiple factors, from our emotional regulatory abilities to the impact of the loss on our lives. After a loss, some individuals endure persistent, intense, and debilitating grief that interferes with daily life.

Prolonged grief disorder (PGD), previously called complicated grief, traumatic grief, or persistent complex bereavement disorder, is a clinically diagnosable mental health condition that presents for individuals who experience intense difficulty navigating life, more than one year after a loss in adults, or more than six months after a loss experienced by children.

In a research project made possible by a $250,000 medical research grant from Advancing a Healthier Wisconsin Endowment (AHW), a team of researchers from the Medical College of Wisconsin (MCW) is exploring how Iyengar Yoga can be used to understand PGD neurobiology better, and potentially be used to help older adults with PGD live healthier and happier lives after loss. Led by Joseph G. Goveas, MD (Psychiatry and Behavioral Medicine), the group includes:

• Keri R. Hainsworth, PhD (Anesthesiology)
• Cecilia J. Hillard, PhD (Pharmacology and Toxicology)
• Yang Wang, MD, PhD (Radiology)
• Barney Douglas Ward (Psychiatry and Behavioral Medicine)
• Abigail R. Webber, Clinical Research Coordinator I (Psychiatry and Behavior Medicine, General Research and Clinical Trials)
• Nutta-On Blair, Research Scientist I (Psychiatry, General Research and Clinical Trials)
• Linda Murphy, CIYT, Yoga Instructor
• Karen Chandler, CIYT, Yoga Instructor
• Timothy L. McAuliffe, PhD, Biostatistician (Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research)

Understanding Prolonged Grief Disorder

More than 62,000 people in Wisconsin die each year, leaving an average of five to nine people to grieve their loss. Many older adults can process and manage their grief within a normal range, returning to normal daily functioning within one year of their loss. However, 10% of older adults experience grief so debilitating and devastating that they develop PGD.

Little research and information are available about PGD and how it develops and presents in the nervous system and brain. While there is one type of treatment offered for PGD, a very intensive type of cognitive behavior therapy called prolonged grief disorder therapy, individuals suffering from PGD struggle to pursue the treatment or lack access to trained psychologists or therapists in our communities. And unlike depression or anxiety, PGD cannot be treated or improved with prescription drugs.

Unfortunately, the longer PGD patients wait for treatment, the more complex the consequences can be for their health. Dr. Goveas states, “The consequences (of waiting to treat PGD) are very detrimental and can lead to early death, poor physical and mental health, and quality of life. They’re also at an increased risk for suicide. The sooner you can treat it, the better it is to prevent complications.”

With this project, researchers hope to learn about the endocannabinoid signaling system and its critical role in regulating emotions and perhaps preventing the development of PGD. They hypothesize that, for older adults with PGD, practicing Iyengar Yoga will restore the dysregulated endocannabinoid signaling system and emotion-processing brain circuit function, resulting in improved grief symptoms and better overall health.

Yoga and Neurobiology in Prolonged Grief Disorder

In this project, funded by an AHW medical research grant, researchers sought to introduce a lifestyle intervention that could meet several criteria. First, it would need to be something that would help “calm” the brain, as grieving project participants expressed an interest in an intervention that could provide this effect. The intervention also needed to be something that older adults were physically able to do, despite varying disability levels.

Iyengar Yoga was selected because it’s a form of yoga that’s feasible for most adults. With simple poses and movements using props and aids, even older adults or those with disabilities can be accommodated well in this practice.

Dr. Goveas said, “From a scientific perspective, this type of yoga and its components (the poses, breathing exercises, and meditation) made sense because there is some evidence in the literature that shows they modulate brain circuitries that we think are linked to PGD.” Speaking to work previously done by project co-investigator Keri R. Hainsworth, PhD (Anesthesiology), Dr. Goveas said, “She found that even a simple Iyengar Yoga pose could modulate the circulating endocannabinoid concentrations.”

Researchers’ Approach to the Study

With an AHW medical research grant, researchers set out to set up two participant groups with individuals from the Froedtert and Medical College of Wisconsin Tosa Health Center and the community: participants dealing with PGD and a non-grieving control group.

The PGD participant group comprises individuals 50-90 years of age who experienced a loss more than one year prior and scored above 30 on the Inventory of Complicated Grief (ICG) scale. Individuals in the control group are also 50-90 years of age but have not experienced grief in the past five years. The PGD participants are randomized to either a ten-week Iyengar Yoga intervention or to a health education control group. The group participating in yoga attends weekly 60-minute sessions, completes weekly home-based practice, and self-reports their experience. The health education control group meets weekly for one-hour videos on health-related topics.

All participants undergo a baseline clinical assessment, blood draw, and MRI scan. They return for clinical assessments at weeks two, four, six, eight, and 10, and a repeat blood draw and brain scan where researchers measure changes in endocannabinoid and brain function measures and assess changes in their grief symptom severity.

Adjusting Plans Amid the COVID-19 Pandemic

As research began in the summer of 2021, many still felt the uncertainties brought on by the COVID-19 pandemic and navigating what activities were safe and comfortable in the environment. To accommodate the need to maintain six-foot spacing between yoga class participants and other guidelines to prevent virus spread, the researchers decided to proceed with smaller groups to start.

Abigail R. Webber, clinical research coordinator I (Psychiatry and Behavior Medicine, General Research and Clinical Trials), stated, “We wanted to maintain the ‘six feet apart’ and make everybody as comfortable as possible… it was slow moving. Lately, though, we’ve been seeing a lot of growth within the last few months. Our participants are feeling more comfortable coming into larger groups now.”

Group participation is increasing, the project is building traction, and researchers are excited to start examining initial data. “We can start looking at what the endocannabinoid measures and brain circuits look like cross-sectionally in these individuals with PGD versus those who are not grieving at this time,” said Dr. Goveas.

What’s Next for Researchers?

Researchers hope participation in this study positively impacts participants’ grief experiences. Said Webber, “As the person who started with a phone call with them (the participants), it’s neat to see the change in participants. When I first talked with some PGD participants, some felt ten weeks was a lot to ask. It’s really cool to see by the end of it, they change their opinion and enjoyed it.”

Based on the study’s findings, the researchers plan to submit additional grants to conduct more definitive studies in this area that will drive new, effective treatments for PGD.

As the project progresses and researchers continue to analyze and assess participant data, it’s encouraging to see that regardless of the outcome, study participation is making a meaningful and positive impact on individuals experiencing grief.