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Yoga for Behavioral Therapy

This blog is in response to the hopeful article “How Yoga and Breathing Help the Brain Unwind” that is in high circulation in the yoga therapy community. To summarize the Psychology Today article, a study was recently shared showing that the neurotransmitter GABA, which suppresses the stress response, increases with yoga and breathing techniques. The study included individuals with depression, anxiety, PTSD and substance abuse.  In the very least, this is one more evidence based study that yoga and breathing techniques should be integrated into treatment plans. The real power of the study remains to be seen, however, as it is suggested that yoga and breathing techniques could potentially be used as a stand alone therapy for behavioral diagnoses that involve imbalance in the autonomic nervous system.

So that is the gist of the landmark news… but…the article is shared with a cautious reminder of the importance of choosing  yoga and breathing practices that are appropriate for the individual. Sadly, what prompted me to write this is that in the same week I read the study (not just the article in Psychology Today, but the actual study because I’m geeky about good news), I heard another disheartening story about someone who was ‘prescribed’ yoga for pain care, and reported that the yoga increased the pain and caused emotional distress.  If yoga or any of it’s facets, such as meditation or pranayama, have been recommended to you by a doctor or mental health expert to help treat PTSD, substance abuse, depression, anxiety or MDD (a combination of the two), or chronic pain, seek out a yoga therapist or teacher with the appropriate training. Unfortunately, medical professionals often put yoga under one big umbrella. Unwittingly, their advice can send someone to a class that is physically exhausting or overwhelming (sympathetic arousal). All yoga heals, but yoga to heal requires the proper guidance and a willingness to do the work.

Yoga is an accessible practice. There is no reason to participate in what I think of as the American version of super-sized, fast-paced upside-down asana if it does not relieve suffering.  There are many different traditions, styles and teachers; the postures are not a requirement for healing. A translation of Yoga Sutra 1.3 summarizes the use of yoga for behavioral health: “In a state of yoga (or wholeness as I call it), the different preconceptions and products of the imagination that can prevent or distort understanding are controlled, reduced or eliminated.” Yoga recognizes that relieving suffering is different than finding joy. Relief is a cold fist finding a warm hand to hold it.  It is small steps up a mountain, sometimes with blisters, but we don’t need to climb alone.

My initial purpose in taking up yoga was to manage anxiety and panic attacks. Some questions I learned to ask myself when seeking out new teachers or classes:
Does the teacher empower me?
Am I practicing loving-kindness yoga or trauma yoga?
Do I feel safe?
Can I just be myself?
Does this practice help to change my perspective?
Am I challenged and can I successfully meet some of the challenges?
Can I let go of self-judgement?
Am I appreciated?
What knowledge am I gaining?

If we choose asana (physical postures) we hold poses to leave the mind and enter the body. In this way, yoga helps us to cultivate our somatic or felt sense where we notice bodily sensations and stay present in them.  We shift from thinking (except and reject) to awareness (observation); or from the head to the heart.  This can be an entirely new experience in itself.  When we understand that our behavior is a blend of instinct, emotion and knowledge, witness consciousness wrapped in love enables us to feel pain and still go forward, staying focused. Eventually, as our bodies remember what relaxation is (parasympathetic system- that GABA creator,) it gets easier to stay in alignment. Our intuitive bodies remember their natural state.  We get the green light even when the difficult stuff comes. It takes time to fix ourselves, but in addition to having confidence in our care givers, we have the tools built into our bodies to help.

Yogi’s like to use the term enlightenment to describe a feeling of wholeness.  My favorite explanation of enlightenment comes from Judith Lasater: “One way to view enlightenment is a radical shift in perspective. Nothing outside you has changed…you have changed, and rather paradoxically, you have not changed, but have become what you already are.”

Namaste, Megan

PS – This is a photo of a parhelion or sun dog as it is commonly called. Parhelion means “beside the sun” in Greek and forms as a result of the sun refracting through hexagonal ice crystals . When I saw this the other morning, it reminded me that just as the sun can bend the light, my mind is like a prism that can bend my own Light to make it a bit brighter.

Helping Clients Overcome Challenges

Helping Clients Overcome Practice Challenges through Somatic Space

This article was originally published by the International Association of Yoga Therapists, Yoga Therapy Today, Winter 2018, Yoga Therapy in Practice, www.iayt.org 

Increased interoceptive awareness—the deep knowledge of what’s occurring in the physical body, the soma—can be a negative experience for some. Notwithstanding the long-term benefits clients gain through heightened self-awareness, we yoga therapists may find ourselves needing to help clients navigate uncomfortable sensations and emotions that arise from yogic inquiry. Yoga, perhaps initially perceived as a purely physical activity, can move students through the three psychic layers of the gunas (qualities). I use somatic yoga and the pancha kosha (five-sheaths) model to guide people toward sattva (balance); here I offer practical ideas to help others to do the same.

When muscles fail to perform, it is not necessarily because they are strong or weak. Muscle inhibition occurs in athletes and armchair quarterbacks alike. The ability to control muscles comes partly from nervous system communication. Somatic Yoga was developed to increase communication among the nervous system, brain, and pranic body. My eyes opened to the benefits of a regular Somatic Yoga practice as a result of experiencing chronic pain in the sacroiliac joint (nervous system), post-concussion syndrome (brain), and energy-body consciousness (pranic body).

I liken the journey through the somatic space to Joseph Campbell’s The Hero’s Journey; separation, initiation, and return. In yogic terms, The Hero’s Journey translates as the gunas, or subtle basic components of life. Tamas (often translated as “darkness”) is the road of separation—appearing wide and easy, it represents ignorance and inertia. Innumerable people are breathing a lackluster survival breath and walking the black road of tamas without even knowing it. Perhaps they cannot or chose not to be present in the body. Often in the depths of physical or mental despair, they receive the call to action. Rajas (passion) is the winding, uphill road of action/initiation.

Yoga practices, particularly Somatic Yoga, in my experience, can delicately guide clients through rajas when they feel agitated (or, for some, when they feel anything at all) and when they face off with the things they fear the most—the kleshas (obstacles). Students who view this awareness as a negative may be scared, sad, angry, or in denial. They may discontinue the practice and go back to tamas because it is safe and familiar. Initially, rajas requires surrender. With guidance and regular practice, rajas is where we start to see we have control of our lives. Tamas is the victim mentality. The discomfort of rajas is where you learn to love yourSelf, dragons and all, to get to the purity of the sattvic state. Yogic philosophy doesn’t see the journey as acquiring a new strength, as Campbell does; rather, in Somatic Yoga the superpower is something that was always there. Remembering and returning to awareness of the Self is the steady state of sattva.

 

Demystify the Somatic Space

A starting point for somatic inquiry may be to take the mystery out of movement with a brief overview of the nervous system. The somatic system, or voluntary nervous system, includes both sensory and motor neurons, allowing communication to flow freely to and from the muscles, sensory organs, and skin. What we call muscle memory is really one of the jobs of the nervous system. Habitual movement, aging, and trauma (conditioned reflexes) can cause the nervous system to “forget” how to move with fluidity and freedom. We should explain to our students that both physical and emotional trauma can result in the inability to feel ourselves. Psychological trauma is held in the brain, but we also hold trauma in the body in the form of unconscious contractions. Despite being voluntary, much of our somatic movement takes place below the level of conscious awareness; the fact that this does not always have to be so is a tremendous asset that we can use to empower our students.

How do you guide those who encounter difficulty doing what on the surface appears to be a simple practice? Let the goal be to stay present. Teach them that they have the tools within themselves to heal; they need only to listen to their bodies. When physical or mental challenges arise, normalize movement and emotional response. Give such clients veto power. “Veto” means “I forbid” in Latin and can be absolute or limited.

Working with a sensation scale rather than a pain scale teaches clients that it is safe to be present in their bodies, even in discomfort. The body communicates through sensation. Discuss pain as a complex communicator that is about structure and emotional response, much of which is attached to previous experience and fear. Don’t make the scale all about difficulty. Encourage them to remember the sensation of pleasure: massage, eating something delicious, petting a furry friend, sexual satisfaction, or a simple hug. The traditional ayurvedic techniques of garshana (gentle dry-brushing of the skin) or abhyanga (warm oil massage) can be intimate gateways to reintroduce the nervous system to the sensation of pleasure through the skin.

What happens when a student discovers structural imbalance or an inability to feel a muscle? For instance, when working with the quadratus lumborum, a client may feel an immediate muscle response on one side of the back and think the muscle doesn’t exist on the other. Similarly, Somatic Yoga is a recommended postpartum practice to reconnect to the pelvic floor and transversus abdominis, but these muscles may be difficult to locate kinetically. Guide the students to bringing their awareness into the area with the intention to visualize it; visual aids such as a photograph of a particular muscle and thoughtfully placed props can accentuate cognitive connection. In the case of movement disorders where there is an inability to move or movement cannot be controlled, guide clients to imagine the experience of the movement.

Give people ample time to “mind their Ps”: pause, present, precious perception. Allow them to experience how much sensation can exist in stillness. When doing asymmetrical movements, take a full minute of inactivity between the two sides. The mind loves to entertain contrast in the body. The first side can communicate the experience to the brain to prepare the second side for the movement. Learn from the experience but don’t anticipate how the second side will respond. When both sides of the body are done, pause again, noticing the similarities and differences.

Ask clients to describe recurring and unfamiliar sensations as fantastically as they can and to label perceptions as something other than “good,” “bad,” or “okay.” Remind them occasionally that you are the DJ choosing the song, but they control the volume knob of bodily sensation.

Work within the Kosha Model

What door would enable a client to enter the body: spanda, shakti or grace?

Spanda: Annamaya Kosha

Spanda is play and spontaneous expression of aliveness! Let the practice be “sloppy yoga.” This often works with those who are more physically oriented, like to overdo movements, and have difficulty stepping away from the bigger, stronger, faster philosophy. Sitting too much, rigidity, and habitual movement patterns are what get us into trouble in the first place, so play! One approach is to ask students to invoke their inner child and do the practice as if just learning to move. Suggest they give themselves permission to approach the movements like their favorite animal would. Ask them to continually notice when bodily sensations move, increase, dull, or subside.

Even when the practice is familiar, invoke the beginner’s mind; don’t just go through the motions. The practice may at times appear uneventful, but fascinating things are happening at the subtle-
body level. Enthusiastically encourage curiosity and amazement. Freedom of expression in the body inspires creative thinking. If it adds to the creative pulse, somatic yoga can be a breath-centered practice. The inhalation deepens the student’s experience of expansion and elongation; the exhalation allows release. As Carl Jung said, “The creation of something new is not accomplished by the intellect but by the play instinct acting from inner necessity.”

Shakti: Pranamaya Kosha

The vital force of prana shakti makes itself tangible though the breath. This approach is for those who are more devotional, spiritual, or who enjoy meditation. A healthy dose of skepticism works, and yoga nidra can be used to develop conscious awareness of the pranic body. A goal of yoga therapy is to create energy and distribute it to all parts of the body. It can be valuable to offer your client a simplified explanation of the subtle body that may include nadis (energetic channels), chakras, vayus (“winds,” or functions of prana), and/or marma points. When the students can sense where their breath originates or can connect to their spiritual heart, they are ready to explore the power of creating energy through awareness and intention. Explain that pain can be thought of as congested energy. Ask them to breathe into the body, noticing where they feel tension or discomfort. Then on the next inhale, breathe into the tension; exhale the energy out. If a specific point in the body needs healing or release, the student can use all their senses to create an active image in their mind and fill the particular part of their body with the image.

As prana is experienced on the subtle level as touch, placement of hands can result in clearer communication. This is different from manual manipulation, which may fall outside the scope of your practice and can be interpreted by the students as “doing it wrong,” “not doing enough,” or that you are fixing them. Use your hands to teach them to use their own hands as feelers for the nervous system, transmitting their own life force from their heart (the seat of prana) through their hands. When finished, have them ask the subtle body if it has any messages.

Grace: Manomaya Kosha

One aspect of grace is the ability to surrender all limiting beliefs and previous experiences. Make the practice about self-acceptance over self-improvement. This is best received by those who feel more emotional, those who present with low self-esteem, or those for whom healing needs to triumph over curing. Two influential words are “allow” and “trust.” You may also want them to start by creating an affirmation or sankalpa (heartfelt intention) and to keep repeating it. Teach them to let go of self-judgment. In a society that rewards “perfection,” teach that it is okay to make mistakes! Stay away from language that leads to what the movement should look or feel like. Offer the understanding that the senses are intended to bring joy. Explain imagery as the language of the mind: it listens to what is outside us through our senses, then speaks in images that can turn into words. We decide to attach a positive or negative association to the words, and therein lies the difference between pain and suffering.

Hold Space: Vijnanamaya Kosha

Always hold space for your clients. We hold sacred space for them by asking for their highest good and offering unconditional love. The greatest gift we give our students is to teach them to cultivate that same sacred space for themselves outside the safety of our guidance and to continually stay present and objective when experiencing signals within the body. Witnessing consciousness of self and experiencing this awakening through yoga gives the client a glimpse of the illumination of pure consciousness.

Sukha: Anandamaya Kosha

Yoga teaches that we need to have sweetness (sukha) in our lives to bring us closer to our Source—bliss. Recognize and praise the joy of small successes with your students. A benefit of a traditional asana practice is that we purposely challenge ourselves, stress the physical body, and consciously watch the mind’s response. In Somatic Yoga, we undo by underdoing; there is personal accountability in recognizing and doing only what makes us feel good. The more we experience joy, the more it becomes our natural state of being.

Somatic Yoga is highly adaptable and achievable, but needs to be structured for the individual. Yoga therapy clients have often tried several modalities before they find you. They are familiar with the failure of checking out mentally and the unfulfilled expectation that someone else would “fix” them. Start with a thorough and thoughtful intake, which may hint at the client’s current level of self-awareness. The intake should include a discussion of any history of physical or emotional trauma, even when the trauma does not have any obvious correlation to the issue the client is presenting with. Ascertain the mental and spiritual state of your client using the qualities of the three gunas. Let the client do the talking with words and body language. To the best of your ability, give the client a voice in creating their yoga therapy plan. Continually adjust the plan based on feedback. Using the kosha model, ask them what door they are most comfortable with: the body, the breath, or the mind. As the client gradually increases her or his awareness of internal body sensations in your presence and in the rest of life, the practice is no longer about overcoming pain or dis-ease, and joy can be developed in the purity of the sattvic state.

Peace and Light,

Megan

Access a printable PDF copy of the article here: YTT_Winter 2018_MacCarthy