GOT YOGA? Yoga as a Treatment Modality for Health and Wellness

Tamera Anderson-Hanna, LMHC, CAP, CRC, RYT-200

Wellness, Therapy, & Yoga, Inc.

Objectives:

Improved understanding yoga. It is more than just a physical practice.

Research on Yoga and benefits of the practice. Could it be a mini fountain of youth? What is the benefit for depression, anxiety, substance abuse and other illnesses?

Referrals - not all Yoga is the same relating to your client and or introducing them to the practice.

What is Yoga?

Yoga has been defined a the union between mind & body. In Sanskrit it means “yoke” or “unite.”

Yoga has existed for over 5,000 years.

It encompasses posture, breathing, and meditation for a goal of overall health and wellness yet we often focus or learn mostly about the physical aspects of yoga and forget there are also principles which guide the lifestyle behind yoga.

A state of being and the practice is Yoga. A Great read…Living Your Yoga by Judith Lasater.

Who Does Yoga? Marilyn Wei, M.D., J.D. published an article in Urban Source on

June 22, 2015 addressing the question.

It is estimated almost 90% of people come to yoga for improved physical health or a as form of stress management. It is suggested most if introduced to more than the physical elements of the practice will change the reason they maintain a regular yoga practice. Yoga can improve spirituality, self actualization, and an overall sense of well being.

There is also limited but growing research and evidence that yoga can not only improve health, balance, flexibility, and reduce things such as cholesterol, but it can help to reduce symptoms of depression, stress, and anxiety and can be a recognized form of treatment for many ailments.

Psycho-neuroimmunology The interaction between the nervous, endocrine, and immune

systems. The study of the connection between mental practice and internal struggles or the quality and ability to improve general health.

It is believed Yoga can help an individual cope with their mental needs once the physical demands on the body have been met, but the physical practice is believed to help create changes in the state of the body which can help individuals cope with future stressors or physical demands.

Pranayama (breath) is used to help reset the parasympathetic nervous system from fight for flight and then the mental practice can help to change and align the belief system.

Parasympathetic System is our rest and digest state and the Sympathetic System is our fight or flight response.

Image University of Michigan Medical School

The Benefits of Yoga on the Nervous System

Thomas Jefferson Medical College found when researchers measured the cortisol levels of 16 participants who participated in a 50 minute yoga session daily for seven days there was a significant decrease in cortisol levels as they believe yoga triggers the rest and digest portion of the parasympathetic nervous system. This was compared to the participants being asked to just sit quietly to read or write which produced only a minimal drop in cortisol.

Since not all yoga is relaxing such as power yoga or doing sun salutations, which triggers the sympathetic nervous system it is believed closing the session with meditation and corpse pose (savansana) will bring the body back into balance and overall individuals will feel more relaxed.

Chakras

The study of yoga includes an understanding of the energy centers or Chakras. Chakra means disk or wheel. In Eastern Body Western Mind, the Chakras are explained as an energy body which correlates to ailments which can occur as a result of blockage.

Yoga and the lifestyle behind the physical practice can assist in letting go of blockage and in theory aid in improving health. Idea that energy stored in certain area where we stress our muscles and restrict movement, breathing, etc. can influence disease. Source: Your Mind & Body Are Not Separate. May 10, 2014 by Joe Martino

The Yoga Lifestyle: The Eight Limb PathWritten in The Yoga Sutra by Patanjali around 200 A.D.

Yama: Universal morality

Niyama: Personal Observances

Asanas: Body Postures

Pranayama: Breathing Exercises and use of Prana

Pratyahara: Control of the senses

Dharana: Concentration and supporting a sense of inner peace

Dhyanya: Devotion and meditation on the divine

Samadhi: Union with the divine

Yoga is more than it appears to be.

A balanced practice can include the physical practice and lifestyle.

Yama: The attitude we have toward people and things around us. (Restraints)

Ahimsa - Compassion for all things (non-harming)

Satya - Commitment to Truthfulness (not to conflict with above).

Asteya - Non-stealing includes purpose, time, attention

Brahmacharya - Sense control – implies sensible behavior

Aparigraha - Non-hoarding, what we can use or have earned

Ahimsa – Compassion for all living things

Judgement could be one of the hardest things to overcome or to be aware of when practicing Ahimsa. This can include self judgement.

Practicing Ahimsa also means using nurturing words and actions with ourselves. Not overworking, taking breaks, eating foods which are good for our health or preparing them in a way that does not further induce heart burn, etc.

Working daily on recovery for example in a peaceful and supportive way and not putting yourself down with all or nothing thinking should you have a slip, but turning it into a prolapse and learning from it.

Ahimsa is the practice of building balance in our life. It is easier to begin the practice with yourself in mind and then it becomes easier to apply it to the world around you.

What we can learn from Ahimsa?

Irene (Aradhana) Petryszak ON June 9, 2015 in Yoga International she shared her experience with AHIMSA. Sometimes we can learn from creating space with things like bugs to overcome fear. It can translate to other fears in our life. Creatures and people can pick up on our energy and how we relate to challenges in life.

Satya – about truth and restraintslowing down, carefully considering our words so they are in harmony with non-harming. Try to avoid opinion and focus for example on observation.

Not good or bad, but share an observation or a preference. Avoid judgement or comparing feelings and beliefs. There is more than one truth? In treatment it is compared to using I statements versus the we or you should feel, think, etc., but being open to others state of being, thoughts, viewpoints.

Asteya - Non-stealing includes purpose, time, attention

How do you schedule your day, adequate sleep, time and attention toward self, children, lifestyle

balance?

Brahmacharya - Sense control – implies sensible behaviorExample not complete

abstinence but for example connecting to a spiritual self and having relationships

which are not set out to harm. Placing focus on self and not just external sources of pleasure.

Aparigraha - Non-hoarding, what we can use or have earned. Sharing of resources food, water, space, etc.

Example: take what you can use and share –free samples.

Niyamas : (Personal Observances)Attitudes which can be adopted toward life Sauca - Purity & Cleanliness. Example: Basic hygiene

Santosa - Contentment. Example gratitude be happy with what we have and accept there is purpose for

everything (Karma).

Tapas - Disciplined use of our energy. Example to heat the body to cleanse. Good use of breathing and eating

habits. Exercise in some form.

Svadhyaya - Self Study. Example Sva means self and adhyaya means inquiry or to examine. Example to be self

aware and accepting of limitations. Yoga is for self and not to

compete.

Isvarapranidhana- Celebration of the Spiritual. Whatever your belief, but that there is some

higher power guiding your life.

Santosa - Contentment Have happiness and contentment in the moment. Gratitude journals can be helpful. Avoid attachment to things or to the past. Idea and trend on Mindfulness!They say if your anxious your thinking in the future and if your depressed your focused on the past. BE HERE!

Tapas

There are yogic practices both on and off “the mat” that can hone the internal discipline of tapas. They may not be easy, but if you explore them even for just a few days, you’ll increase your capacity to apply tapas to the most challenging endeavors. 2012 Constance L. Habash

Apply exercises like doing meditation, focus on poses that you avoid, write your dream novel, change your diet, begin to search for a new job or build upon skills you can work on to improve yourself – anything that requires that inner discipline of Tapas. Doing a little bit everyday or weekly can keep the inner fire of motivation going. Schedule it for a time you know you can attend to it.

{The Practice of Svadhyaya}

Look for inspirational scriptures, readings, poems, or lectures delivered by those who seem to have acquired inner knowledge. Use these resources for contemplation of the Self. 

Begin the practice of mantra japa—repetition of a mantra in meditation. Beads in Yoga. Like I am healthy or I am loved.

Rest in the mantra for 10–20 minutes each morning or evening (or both). 

Let the silent witness, the indwelling consciousness in you, gradually awaken.

Resource: Rolf Sovik Yoga International May 2014

Ishvarapranidhana

Self Surrender: allowing another force or faith to be something more than yourself.

It may include letting go of possessions, power, attachments.

It could be compared to following the steps in A.A. to turn your life and will over to a higher power. Admitting we are powerless over certain things and are in need of guidance.

Allowing ourselves to let go of self limiting beliefs and expectations. We can be powerless and yet still be successful in a goal such as recovery.

Asana: The Physical Practice of Yoga & the Rest of the Eight Limb Path.

Meditation

Setting an intention

Breath

Disciplined or regular practice

Combining the above with the physical practice leads to a more complete form of union between body and mind to support the eight limb path.

Meditation: One conscious breath in and out is meditation. Eckhart Tolle

Meditation Versus Mindfulness

Basically meditation and mindfulness are essentially the same. Meditation originated from Buddhism and Yoga and mindfulness from the origins of psychology but both focus on relaxation, breathing, and a general mindset.

Beyond the formal definition mindfulness is coined in a way that allows individuals to realize they can be mindful anywhere at anytime. Meditation implies a more formalized sit down method of relaxation. Meditation focuses inward and mindfulness allows for a more broad focus. Meditation is something you set time aside for and mindfulness is more about cueing yourself to be in the here and now throughout the day. In theory you can do both or practice what works.

Source: What is the difference between mindfulness and meditation? Matthew Young | Feb 10, 2014 Melbourne Meditation Center & What’s Actually the Difference Between Mindfulness and Meditation? Annie Daly | Sept 12, 2014 Women’s Health

Setting an Intention

An intention is an Affirmation. An affirmation is actually every thought/self talk we have. A positive self affirmation is about focusing on improving our self talk.

Affirmation basics: having a positive or constructive purpose, focus on an area of your life where you want to be more motivated (tapas) make it in the here and now not someday I will…

Example: I am loved, I am healthy

Breathing/Pranayama

When practicing yoga your breathing is cued. On an exhale step your right foot forward etc., but there is various breathing one can practice off the mat.

Interesting fact is when practicing breathing to relax we want to decrease our rate or the client’s rate of breathing from the average 14 to 20 breaths per minute to around 5 or 6 per minute with practice to help reset any sympathetic fight or flight effects. With good cued deep breathing one can benefit from feeling more calm and having more mental clarity.

Types of breathing you can take more time to learn about include basic breath awareness, but at times any of these could be cued in a yoga class but can be used off the mat. Ujjayi breathing/Victorious breath (HA and letting it all out), Nadi breathing (alternate nostril), Kumbhaka breathing (breath retention), and Kapalabhati breathing (breath of fire) not good for stress but better for energizing.

Source: Patricia Gerbarg, M.D. Co-author of The Healing Power of the Breath.

What OHM’s got to do with it?

OHM or Om is said to be the sacred sound of life. It is used as a mantra. It reminds us we are connected to the universe around us and that it is ever changing and moving. It is in the sound of rain, the leaves when they are blowing in the wind, etc. It is often used in the beginning or ending of the physical practice of yoga as a reminder of the larger universal connection.

From a physical and psychological perspective it allows an individual to continue to relax and prepare for a meditative and relaxed state as over time it becomes a cue to the body and the practice.

Benefits of Breathing as a Fountain of Youth.

Happiness and Improved Emotional Stability

Weight Loss due to decreased stress hormones.

Better exercise stamina we use oxygen more efficiently.

Longer Life. A Harvard study has found individuals who practice deep breathing suppress chronic inflammation in their body which can be associated with cancer, Alzheimer’s, depression, heart disease, and other illnesses.

Source: Yoga Journal August 2015

Yoga on our minds: a systematic review of yoga for neuropsychiatric disorders. Psychiatry January 25, 2013. They found emerging evidence from randomized

trials to support popular beliefs about yoga for depression & sleep disorders. According to the World Health Organization 60% of patients continued to meet criteria for depression after a year of being treated with an anti-depressant. If medication can be costly and there are discouraging side effects then why not look for an alternative or supportive treatment modality which is widely available? It is believed yoga has been associated with mood changes (Phillips et all 2003) and meditation increases brain derived neurotropic factors (Xiong and Doraiswamy) in individuals with depression.

Vedamurthachar et al., 2006 demonstrated that males (mean age of 35) who were undergoing treatment for addiction and who were also depressed showed improvement in their (BDI) Beck Depression Inventory scores and there was reduction in their serum cortisol levels versus a group who did not receive yoga. Long term effects are not known, but one could propose continued yoga would have long term effects.

Yoga for Depression & Anxiety

Effects of Utilizing Yoga Nidra on reducing symptoms of depression and anxiety in a psychiatric population. University of North Texas Health Science Center. Subjects showed improvement in the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Subjects listened to yoga instruction for 20 or 40 minutes for a varied number of sessions. Yoga Nidra instructor Amy Weintraub

Yoga for Schizophrenia

Yoga has been shown to help decrease symptoms such as aggression and medication compliance was improved in groups of individuals with schizophrenia and schizoaffective disorder participating in yoga versus control groups. There was also a statistically superior difference in scores in the Positive and Negative Syndrome Scale (PANSS). Visceglia and Lewis 2011.

Two other studies have looked at the impact of yoga on schizophrenia Behere et al., 2011 and Duraiswamy et al., 2007. Overall, there was statistical improvement in function on the PANSS and neither of the two studies noted any adverse events. What has not been explored is the potential for long term yoga on a decreased need for medication, relapse rates, and hospitalizations.

Yoga for Eating Disorders

McIver et al, 2009, a group of 90 overweight or obese women with self-reported symptoms of binge eating showed improved scores on the Binge Eating Scale (BES) after 12 weeks of yoga. Generally scores went from severe to absent. The control group showed no improvement.

The next study looked at 113 women who were dissatisfied with their bodies. The group given cognitive therapy showed improvement in their scores, but not the wait list group or the group in yoga alone.

Yoga for ADHD

Haffner et al., 2006, found two randomized controlled trials that yoga was as beneficial for ADHD as biofeedback and relaxation. Overall children who practiced yoga along with receiving stimulants had the great improvement over children who did not practice yoga as a supportive treatment.

More research is needed in this area, but yoga does not appear to be detrimental and one could potentially learn yoga as a child and continue the practice long into adulthood with the added benefit for socialization if going to classes versus a home practice.

Yoga for PTSD

There are approximately 2.3 million American Veteran’s who have served in Iraq and Afghanistan. Of those, it is believed 20% suffer from PTSD among other conditions. 22 Veteran’s commit suicide daily.

Yoga appears to be having a significant impact on treatment for individuals with PTSD. Some VA clinics are now offering yoga as a complimentary support and are looking into it as a way to stop traditional treatment with medication.

CBS News, May 2015 War and Inner Peace

Research on Yoga for PTSD

Effects of Sensory-Enhanced Yoga on Symptoms of Combat Stress in Deployed Military Personnel, American Journal of Occupational Therapy, 2012.

OBJECTIVE: Examined the effects of sensory-enhanced hatha yoga on symptoms of combat stress in deployed military personnel, compared their anxiety and sensory processing with that of stateside civilians, and identified any correlations between the State-Trait Anxiety Inventory scales and the Adolescent/Adult Sensory Profile quadrants.

METHOD:

Seventy military personnel who were deployed to Iraq participated in a randomized controlled trial. Thirty-five received 3 wk (≥9 sessions) of sensory-enhanced hatha yoga, and 35 did not receive any form of yoga.

RESULTS:

Sensory-enhanced hatha yoga was effective in reducing state and trait anxiety, despite normal pretest scores. Treatment participants showed significantly greater improvement than control participants on 16 of 18 mental health and quality-of-life factors.

CONCLUSION:

The results support using sensory-enhanced hatha yoga for proactive combat stress management.

Yoga for PTSD

A pilot study at Walter Reed Medical Center found that yoga nidra (a form of deep relaxation) resulted in a reduction in symptom severity on the Posttraumatic Stress Disorder Checklist; among the symptoms reduced were insomnia, depression, anxiety, and fear (Miller, 2009; Weathers, Litz, Herman, Huska, & Keane, 1993). In their yoga pilot studies with PTSD, Carter and Byrne (2004)  found that Iyengar-style yoga asanas (poses) decreased depression but did not improve hyperarousal symptoms of PTSD until certain pranayama (breathing) techniques and meditation were added. People with PTSD have also been found to benefit from Sudarshan Kriya yoga training, a type of yoga emphasizing particular pranayama practices (Brown & Gerbarg, 2005a, 2005b).

Personal Testimony

My teacher and her previous experience.

Life is Better With Yoga: Cancer

The M.D. Anderson Cancer Center randomly assigned 163 women with breast cancer who were undergoing radiation to one of three different groups. One group participated in yoga, one in stretching, and received no extra therapy. Women who received yoga one hour a day three days a week during treatment reported having less fatigue. This was also reported in the stretching group, but cortisol levels were lower in the yoga group and suggest the yoga group learned to control their stress throughout the day.

Another study done by Ohio State University found 200 breast cancer survivors who had finished treatment in the last 3 years. One group participated in 12 weeks of yoga two times a week and one group remained on a waiting list. Inflammation in the body of the yoga group as measured by blood testing was reduced by 20%. The yoga group also reported feeling less fatigue.

October 6, 2014 American Cancer Society

Overall, Yoga appears to help improve sleep, increase flexibility, lower blood pressure, aids in alleviating feelings of depression and anxiety, decreases cortisol levels, improves metabolism, improves overall feelings of well being, helps with feelings of relaxation, decreases inflammation, and may be one key to living a longer healthier life for individuals coping with various conditions.

Types of Yoga Hatha: Can be gentle, good for those who are new to yoga or with PTSD, but

read the description for yoga 1, beginners, etc. Blend of yoga.

Bikram: Hot with a room around 105 degrees. 26 pose routine. May not be good or use caution with individuals with eating disorders.

Vinyasa: Flow and can be fast moving. Good for individuals with a short attention span.

Power: Good for Type A individuals or those with a short attention span, quick pace, push-ups, squats, etc.

Ashtanga: focus on consistent and steady breath, vigorous, good for athletes, poses advance.

Kundalini: breathing quickly with the poses, chanting. May not be good for those with anxiety who need to learn to slow down their breathing.

Yin: Poses are held for several minutes. Relaxed and focus on stretching muscles using gravity.

Restorative: Similar to Yin, but use of props rather than gravity. Good for individuals with injuries, cancer, etc.

Yoga Nidra: Meditative type of sleep/practice which helps with sleep disorders, pain management, PTSD, those recovering from illnesses.

Yoga Chart

Provided by the Huffington Post, Healthy Living July 19, 2015

Good Reads/Bibliotherapy Living Your Yoga or Eastern Body Western Mind by Judith Lasater

Yoga for Depression & Yoga Skills for Therapists by Amy Weintraub

Yoga for Emotional Balance by Bo Forbes

Yoga for Anxiety by Mary Nurrie Stearns

Overcoming Trauma through Yoga by David Emerson

Relax and Renew: Restful Yoga for Stressful Times by Judith Hanson Lasater

Chakra Balancing by Judith Anodea

Yoga for Cancer: A Guide to Managing Side Effects by Tari Prinster

The Healing Power of the Breath by Patricia Gerbarg, M.D.

Supportive Programs

Yoga Gangsters: “Connection is the Cure” Founded by Terri Cooper. The program offers yoga programming for at risk and inner city youth across the U.S. It began in South Florida, but training and volunteers are continuing to expand. You do not have to be a yoga teacher to become trained and volunteer for your community. www.Yogagangsters.org

Yoga Bear: Connects cancer patients and survivors with free local yoga classes. www.yogabear.org

Yoga for War Vets: Uses Yoga therapy to help war veterans and their families and helps connect individuals with reduced or free programming. www.Yogaforvets.org

Yoga Warriors: Offers special training for treatment of combat stress and PTSD. Approved for continuing education hours with the National Association of Social Workers. www.yogawarriors.com

Ready to practice? Questions and Discussion Points

NAMASTE