Are these yoga techniques compatible with all therapeutic modalities?
Regardless of the modality of psychotherapy you are practicing, these tools will help you develop a stronger therapeutic relationship with your client. As most therapists know, it’s not the modality that makes a difference for the most part. Rather, the most important element of a positive outcome in therapy is the quality of the therapeutic relationship.
When you’re teaching these techniques to your client, you’re practicing with your client, creating a sense of connection, and giving them tools that they can use on their own—tools for not only self-regulation, but self-empowerment.
Research among people who are depressed has shown that when self-efficacy goes up, depression goes down. So if you give a client a tool for self-empowerment, that process can strengthen the connection between the two of you.
Can you expand a bit more about how the therapeutic relationship is enhanced through the use of yoga in sessions?
When you offer a yogic tool or skill, you are creating a sacred space; a kind of safe container. You’re doing something that allows you and your client to experience something together that clears away the constrictions and tensions in the mind, body, and spirit.
In doing so, the oxytocin and prolactin — the feel good hormones — are elevated. So you, the clinician, are going to feel more connected and your client is going to feel more connected, both to you and to a sense of themselves. They are going to feel more connected with what might be true about themselves beneath the story or beneath the mood.
Through these practices, you give the client a moment, a glimpse, a window through the story with which they’ve come in. You give them a glimpse through the dark mood or the anxious mood, and even if just for a moment, you give them a sense of hope that they are more than that story and that mood.
In that moment, the client experiences a sense of connection to themselves as being whole and healed. They may have touched some very deep, dark material, and may have had some insight that was painful, but they leave the session knowing that they now have the tools to find their way into a larger space–a space where they are deeply and intimately connected to their true nature, their wholeness, something bigger than the pain with which they arrived.
Can you talk a little bit about the slumped over posture, the psoas muscle, the trembling that often occurs when doing yoga postures, and how this is all connected with depression and anxiety?
The posture associated with depression is kind of a compression, in which the shoulders are slumped over and the belly is dormant. When we begin a yoga practice, through breathing practice and also posture, we’re increasing lung capacity, we’re opening the lungs.
What happens in depression, anxiety, and trauma, is that the psoas muscle — the only muscle that goes from the front of the body to the back, and the top to the bottom — constricts, it clenches, and when that happens, that impacts the diaphragm in such a way that the diaphragm is now constricted.
A constricted diaphragm is one of the reasons why we aren’t able to breathe deeply. So when we do the heart opening postures and the breathing practices, we are able to relax the psoas, to deepen the breath, and to counter the effect of trauma.
Somatic psychotherapy modalities, developed by people like Peter Levine and Pat Ogden, are based on getting the body to tremble at the psoas muscle. When the body trembles, there’s often a release of constriction in the psoas that is a release of that holding pattern that trauma and loss have structured in the body.
Because this occurs in the body, the release can come without the story attached, so people can ultimately feel lighter, brighter, less constricted, less gripped by this trauma story simply because they’ve had release through the psoas.
The benefits of deep breath are often taken for granted, but what are the benefits? What is the function of breathing deeply and how does it affect our mental health?
Diaphragmatic breathing, or being able to breathe to the bottom of the lungs, has a calming effect on the autonomic nervous system. The breathing practices that we teach in yoga stimulate the vagus nerve, which then deactivates the sympathetic nervous system so that the parasympathetic system takes over. That’s the calming, cooling, rest and digest side of the nervous system.
Deep breathing practices also create an increase in heart rate variability, which is the balance and the ease in which we go from sympathetic activity to parasympathetic, both of which are needed. If we were only in the parasympathetic, we’d be couch potatoes. If we were only in the sympathetic, we’d be hyper-aroused all the time, anxious, and our responses would be trigger responses that are not necessarily appropriate to the situation.
Mindfulness meditation and mindfulness-based exercises have become extremely popular and the research has supported this growth. When it comes to meditation without an element of breath work, is there something missing?
Yes. The problem with instructing only mindfulness with someone who has a lot of rumination and negative self-talk is that when you’re watching the breath and the negative thoughts arise, unless that patient has already developed the skill of witnessing and not being caught up in her thoughts, she is likely to spiral into a darker place as she sits in meditation.
These yoga tools, things like pranayama and mudra, give the mind a bone. They anchor it with a technique that allows the mind to focus and draws the senses in. These practices are a more effective portal into meditation for someone with a mood disorder than the technique of simply watching the breath.
In the popular press, mindfulness is shown to work so well with depression and anxiety and it does. But mindfulness-based stress reduction (MBSR), the specific modality that is used in many of these studies, is not just mindfulness meditation. It includes yoga, and it includes a body scan.
So in fact, when you hear that mindfulness is effective, you’re not just seeing results of mindfulness meditation, but also body scan and yoga.
For therapists who wish to incorporate yoga practices into their clinical work, how necessary is it for them to have their own personal practice?
A therapist doesn’t need to necessarily take a 200-hour teacher training to introduce yogic strategies or skills to clients in sessions, but just reading a book may not be enough. I would suggest workshops or trainings that are specific for those who work in medical/clinical settings and that give them clinical applications of yoga skills, as well as practice facilitating those skills in a supervised setting.
In such a training, a mental health professional can learn the subtleties of language in introducing the practices, how to effectively monitor the client and how to help the client develop a home practice, tailored to help them self-regulate and manage mood.
There are also safety precautions — there are certain practices that are appropriate in a yoga studio setting that are not appropriate in a clinical setting. We need to be careful that clients don’t leave the session too revved up or overstimulated or so meditative that it might not be safe to drive home.