J. Behav.7%~. & Exp. Psychiat.Vol. 5, pp. 157-160.PergamonPress,1974.Printedin Great Bntam.

YOGA MEDITATION AND FLOODING IN THE

TREATMENT OF ANXIETY NEUROSIS

MICHEL GIRODO*

University of Ottawa

Summary-Nine patients diagnosed as anxiety neurotic had their anxiety symptoms

morritored by an anxiety symptom questionnaire before practising yoga meditation
at each training session. After approximately 4 months of practice, five patients im-
proved significantly and the other four failed to show any appreciable decline in anxiety
symptoms. These four then engaged in imaginal flooding, in the course of which
anxiety decrement occurred. Analysis of patient characteristics suggested that yoga
meditation was beneficial for patients with a short history of illness and that flooding
was effective in those with a long history. There was questionnaire data to suggest
that the former patients had higher cognitive symptom scores.

DESENSITIZATION is designed to break anxiety the treatment of the failures by a technique

habits related to precursor stimuli (Wolpe, that combined flooding with relaxation.
1958). It involves the isolation of the particular
internal or external stimulus events that trigger
the anxiety. Usually, the anxiety is inhibited by METHOD
active muscle relaxation. Recently yoga medi- Patients and assessment
tation has also been found to be successful in Nine patients (seven malts, two females)
producing relaxed states. A technique known diagnosed as anxiety neurotic ranged in age
as Transcendental Meditation (TM)?, defined from 18 to 42, and between 5 and 71 months
as “turning the attention inwards towards the in length of illness,
subtler levels of a thought until the mind An “Anxiety Symptom Questionnaire” (ASQ)
transcends the experience of the subtle state of was devised for the purpose of measuring
the thought and arrives at the source of the changes in a variety of anxiety symptom groups.
thought” (Mahesh Yogi, 1969, p. 470), has This questionnaire consists of 15 21-point
been found to reduce significantly cardiac out- scales designed to cover generally the symp-
put. heart rate, and respiration (Wallace, 1970). toms associated with anxiety neurosis as
In one report (Boudreau, 1972), TM was suc- described by Pitts (1971) and is grouped into
cessful in alleviating symptoms associated with three symptom clusters, as presented by Buss
claustrophobia in one case, and excessive (1966). Under cognitive symptoms, patients
perspiration on another. The present paper indicate their degree of (a) apprehension and
reports on the effects of practising yoga medi- worry, and (b) distractibility and forgetfulness,
tation in a relatively undifferentiated homo- on separate scales ranging from “NOT AT
geneous group of anxiety neurotics, and on ALL” at one end to “VERY MUCH” at the
*Kequests for reprints should be addressed to Michel Girodo, The Faculty of Psychology, University of
Ottawa, 1245 Kilborn Avenue, Otitawa, Canada.
TThe Students International Meditation Society (1015 Gayley Ave., Los Angeles, Calif.) considers that only
the meditation technique as taught by their teachers should be considered at TM. For the purposes of this
paper, this distinction is noted and reported as a meditation technique similar to TM.

57
 158 MICHEL GIRODO
other. On similar 21-point Fcales, affecfive
symptoms indicate the degree to which they
are (a) restless and irritable and (b) depressed.
Somatic symptoms are assessed by asking
patients to indicate the extent to which they
have had each of the following 11 symptoms
and their degree of severity: (a) fluttering or
throbbing of the heart, (b) difficult or labourzd
breathing, (c) trembling of muscles, (d) sensa-
tion of tingling, crawling or burning of the
skin, (e) feelings of weakness, (f) chest pains,
(g) sensations of faintness or dizziness, (h)
headache, (i) sweating or perspiration, (j) dry
mouth, (k) aches, cramps or intestinal distress.
The first two sessions, a week apart, were de-
voted to recording the patient’s responses to
the questions with reference to the preceding
week.
Since there are individual differences in the
pattern of autonomic reactivity (Lacey, 1950),
the three subscales were tabulated separately
and the three resulting means were averaged in
order to obtain a composite index of severity
of anxiety symptoms. Table 1 shows the pre-
therapy scores for the nine patients. The
stability of these score;: before treatment,
determined over a range of 7-10 days in terms
of a Pearson’s r was 0.81.
TREATMENT
At the third session, each patient was given
extensive instructions on a meditation tech-
nique similar to TM. He was told to expect
calm, relaxation, peacefulness and tranquility
to result from the regular practice of this
technique. All patients were given the same
“sound” to attend to, the word “RAMA”.
They were asked passively and quietly to attend
to that sound while they were seated, with eyes
closed, in a quiet room free from distractiorls.
They were told to make no effort to concen-
trate on the word, but merely to “passively
attend to it”. Furthermore, if other thoughts
entered the mind, they were not to attend to
these but to “return quietly to the sound”.
After the demonstration and practice of the
technique, they were told to practise it twice a
day for 20 min, morning and afternoon. They
were not instructed to use TM when in anxiety
provoking situations nor to Imagine anxiety
scenes when practising it.
The patients were seen every 7-14 days. At
these subsequent sessions, they described how
they were carrying out the exercise, and how
they felt during and after it, and were encour-
aged to continue with regular practice. At each
session they again completed the ASQ, based
on how they had felt since the last session.
It became apparent after an average of eight
sessions that some patients were benefiting from
the practice of the meditation, and others not.
This is illustrated in Fig. l(a). Five patients
showed marked reduction in anxiety symptom-
atology on the ASQ index by the eighth session,
and the remaining four showed no appreciable
decline (d = 3.05; P = 0.01). At this point, it
was decided to apply a different treatment to
those who were not responding to meditation
effects. They were taught relaxation (Wolpe,
1958), and, while relaxed, were asked to “imag-
ine the worst thing that could happen to you” in
a variety of interpersonal situations such as at
work, at a party, on a bus, at a hockey game,
or alone. One patient reported that the worst
thing that could happen at work would be to
have to correct a subordinate who did not
know his job. The anxiety in this case had to
do with getting angry at the subordinate-a
fear of asserting himself and expressing his
frustrations with him. Another patient reported
that the worst thing that could happen to her
would be to be caught in a crowd and not be
able to get enough air or get out of the crowd.
A third patient focussed on his relationship
with his neighbour, expressing fear of occasions
when he became angry and could not express
his anger. In this flooding therapy, most patients
were una’ble to express feelings, and reported
great anxiety when asked to imagine them-
selves screaming or expressing anger. The
scenes were rehearsed in fantasy repeatedly
until the patient could imagine them without
feeling anxious. These sessions lasted approxi-
 YOGA MEDITATION AND FLOODING-DESENSITIZATION THERAPY 159

SESSIONS SESSIONS

a b
FIG 1.(a) Mean ASQ scores on pretest days and subsequent sessions for five successful (dark) and four
unsuccessful (light) responders to yoga meditation; (b) mean ASQ for the latter four during flooding
compared with the other five continuing meditation.

mately 75 min. Sessions took place every
7-10 days.
While patients eventually reported decreas-
ing anxiety after approximately 30 min of ihe
flooding, they would become quite emotionally
drained and exhausted. All continued to com-
plete the ASQ before each session.
Figure I(b) presents the mean ASQ scores
obtained from the patients over the 6-8
months of treatment as well as from a 6-month
mailed follow-up questionnaire. The data for
the “meditation only” patients from sessions
13-17 came from replies mailed every 2 weeks.
Mean ASQ scores for the four flooding
patients began to decline soon after the initia-
tion of the flooding sessions. The follow-ups
indicate that the changes were stable.
In order to examine why five of the nine
patients responded to the meditation exercises
and why four benefited only after “fantasy
flooding” was applied, a closer look at the data
provided in Table 1 was made. In terms of
length of illness, ihere was a significant differ-
ence between those whose anxiety symptoms
declined as a result of meditation practice
(14.2 months) and those who failed to benefit
(44.2 months). On the average, the two groups
did not differ with respect to severity of affec-
tive or somatic symptoms; however, those who
did not respond to meditation exercises reported
at the initial interviews a mean cognitive
symptom severity of 9 ‘5 while the five who
responded to meditation reported a mean of
16.4 on the same cognitive scales (t = 7.11;
P = 0001).
The results suggest that transcendental
meditation may be of benefit in reducing
anxiety symptoms in those patients who are

TABLE 1.AGE,SEX,LENGTHOF ILLNESS,ANDMEAN PRE-TEST

ASQ SCORES FORTHE 9 PATIENTS INTHE INVESTIGATION

Anxiety symptom Patients

questionnaire 1 2 3 4 5 6 7 8 9
Age 26 29 40 38 37 42
sex M::F:FMMM
Length of illness (months) 16 20 18 5 12 28 71 43 35
Somatic 18 16 20 18 16 17 19 17 15
Aflective 11 14 13 15 15 14 18 16 20
Cognitive 16 17 12 18 19 10 8 11 9
Mean ASQ scores 15.0 15.6 15.0 17.0 16.6 13.6 15.0 14.6 14.6
160 MICHEL GIRODO

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