What is Yoga Therapy?

The shortest answer

Yoga therapy addresses specific concerns or issues using the traditional practices of yoga.

The official answer

The International Association of Yoga Therapists (IAYT) uses the following short, succinct definition of yoga therapy:

“Yoga therapy is the process of empowering individuals to progress toward improved health and well-being through the application of the teachings and practices of Yoga.”

IAYT has compiled quotes from many masters of yoga that further define yoga therapy as compared to the general practice of yoga. These yoga experts use phrases that explain the distinction between yoga therapy and simply taking yoga classes.  Consider these:

  • Self-empowering
  • Adaptation
  • Specific regimens … to suit individual need
  • Particular person … particular goal
  • Holistic healing art
  • Applies yoga therapy … according to age, strength, activities

The yoga teachers’ answer

To answer the question, “What is Yoga Therapy?” we can turn to yogins and yoginis who are both yoga teachers and yoga therapists. The answer to the question is in context: it’s a difference in planning for a yoga class versus a yoga therapy session.

First, a little about the view of yoga in our culture today. There may be a general belief that yoga is what bendy, flexy women, clad in athletic wear do everyday. Many people understand that yoga involves poses and breathing practices. And by now that understanding includes knowing there are different types of yoga (super-intense to gentle and relaxing). Yoga has gained in popularity, and with that a huge variation in teachers, class styles, mission and philosophy, and the elements of a yoga class.

In general, yoga teachers will tell you they take this approach to teaching group classes: choose a theme for the class, name it, select a sequence of poses, write a short description, and maybe select a reading and put together a play list that goes along with the class theme. Private yoga classes may follow a similar process, with consideration for the client’s individual requests. The most common requests are for learning the basics, working on a particular pose, or just to have the privacy of being the only person “in class.”

By contrast, the yoga therapist starts planning a group session by unpacking the myriad elements of a particular issue. The concern might be of a physical, psychological, emotional, or spiritual nature. Issues include hypertension or developing a healthy heart, improving mobility or reducing back pain, making a deeper spiritual connection, working on a specific physical injury, and so on. And most issues that keep people from health and well-being  involve some level of stress, anxiety, and/or depression. To plan, the yoga therapist may have to study the condition, read up on research and to determine the best yogic approach (i.e, subtle clues for underlying factors). It’s not always clear, direct or obvious. Now, that’s one tall “theme” for a yoga therapy class plan!

The best answer

Yoga therapy sessions and yoga classes draw from the same yoga “toolbox.” Yoga therapy uses these tools to address a specific issue or concern. The yoga therapy practice is a work in progress, and a step-by-step progression to bring about balance.

Likewise, a very skilled yoga teacher may approach a class series in a similar vein. In fact, there are many in the yoga community that feel that ALL yoga is yoga therapy. And in the hands of a skilled yoga teacher or a yoga therapist, a carefully crafted session or class may be a true therapeutic yoga experience.

 

 

 

Global Yoga Therapy Day – August 14

The following content provided by YogaMate in conjunction with Global Yoga Therapy Day, August 14th. These articles are intended to provide a glimpse into ongoing yoga research projects. Each section addresses specific conditions that may benefit from the practices of yoga therapy.

  1. Introduction to Yoga Therapy

Meditation experience is associated with increased cortical thickness
Lazar. VERY IMPORTANT RESEARCH ON BRAIN CHANGES AND MEDITATION. Meditation is associated with increased cortical thickness, a positive indicator of brain health and function.

Benefits of Yoga (with Links to Research)
Nice infographic

Relaxation Response Can Influence Expression Of Stress-related Genes
“How could a single, nonpharmacological intervention help patients deal with disorders ranging from high blood pressure, to pain syndromes, to infertility, to rheumatoid arthritis? That question may have been answered by a study finding that eliciting the relaxation response — a physiologic state of deep rest — influences the activation patterns of genes associated with the body’s response to stress.”

Yoga and the Brain what Neuroscience can tell us
Your brain on yoga – easy physiology

Scope of Practice for Yoga Therapy
What is the scope of practice for a Yoga Therapist?  What can they do and not do? The International Association of Yoga Therapists lays this all out nicely in this chart.  Yoga Therapist renewing their certification must pass a quiz on this information.

 

  1. Chronic Pain

A Pragmatic Multicentered Randomized Controlled Trial of Yoga for Chronic Low Back Pain:  Economic Evaluation
Specialized group yoga classes are likely to be cost-effective in improving recurrent lower-back pain.

Brain Mechanisms Supporting the Modulation of Pain by Mindfulness Meditation
“After 4 days of mindfulness meditation training, meditating in the presence of noxious stimulation significantly reduced pain unpleasantness by 57% and pain intensity ratings by 40% when compared to rest.” This study also explored the impact of the practice of mindfulness meditation on brain areas associated with pain modulation.

Insular Cortex Mediates Increased Pain Tolerance in Yoga Practitioners             
Together, these findings suggest that regular and long-term yoga practice improves pain tolerance in typical North Americans by teaching different ways to deal with sensory inputs and the potential emotional reactions attached to those inputs leading to a change in insular brain anatomy and connectivity.

Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia
Recent findings have demonstrated that mindfulness meditation significantly reduces pain.” The practice of meditation activates specific brain areas known to be involved in pain modulation. In this study, mindfulness meditation provided a stronger analgesic effect than a placebo or sham meditation.

Yoga and other meditative movement therapies to reduce chronic pain
With an aging population and serious concerns regarding controlled substance abuse, the search for alternate therapies for treatment of chronic pain has gained momentum over the past 10 years. Based on this review, we conclude that it is safe to prescribe a gentle exercise program, such as yoga, as adjuvant therapy for those who suffer from chronic pain syndromes

Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial
This study shows that yoga improves health outcomes, including lowered pain intensity and decreased use of opioids, for veterans with chronic lower-back pain.

Yoga for Persistent Pain: New Findings and Directions for an Ancient Practice 
Growing body of randomized clinical trials suggests that yoga may have promise for persistent pain conditions.

  1. Anxiety

Effect of Hatha Yoga on Anxiety: A Meta-Analysis
“Treatment efficacy was positively associated with the total number of hours practiced. People with elevated levels of anxiety benefitted the most.””

Effect of mindfulness and yoga on quality of life for elementary school students and teachers: results of a randomized controlled school-based study
Data suggested benefits by both students

Relaxation Response Induces Temporal Transcriptome Changes in Energy Metabolism, Insulin Secretion and Inflammatory Pathways
Relaxation Response, anxiety and aging

The Effect of Yoga on Stress, Anxiety, and Depression in Women
52 females in study indicated that yoga reduced depression, anxiety and stress.

Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience
This paper describes ancient yoga wisdom in terms of neuroscientific topics of self-regulation and resilience

Yoga for anxiety: A systematic review and meta‐analysis of randomized controlled trials  “Yoga might be an effective and safe intervention for individuals with elevated levels of anxiety.”

Yoga for Depression and Anxiety: A Review of Published Research and Implications for Healthcare Providers.  As an affordable and relatively accessible practice with research supporting cognitive and biological mechanisms, yoga is a promising modality for depression and anxiety management. According to this review, “The current evidence base is strongest for yoga as efficacious in reducing symptoms of unipolar depression.” It outlines potential risks that may be mitigated by working with a qualified yoga therapist.

 

  1. Respiratory Disorders/Breathing

4 Ways Yoga Fosters Respiratory System Health  In general, yoga exercises can reverse changes by: 1. Improving your posture by strengthening spinal muscles. 2. Increasing movement in your chest and spine by regularly stretching your chest muscles all directions. 3. Improving the flexibility and strength of your respiratory muscles and fascia by regularly practicing a combination of well-balanced asana sequences and breath practices.

Blood Pressure and Heart Rate Variability during Yoga-Based Alternate Nostril Breathing Practice and Breath Awareness  This study showed increased vagal function (and autonomic nervous activity), accounting for lowered blood pressure and increased heart rate variability during the yogic practice of alternate-nostril breathing.

Breathing Exercises and/or Retraining Techniques in the Treatment of Asthma: Comparative Effectiveness  “Yoga breathing may improve pulmonary function in adults in addition to reducing asthma symptoms”

Breathing exercises for chronic obstructive pulmonary disease  There was a significant improvement in six‐minute walk distance after three months of yoga involving pranayama timed breathing techniques

Effects of yoga training in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis   “Yoga training has a positive effect on improving lung function and exercise capacity and could be used as an adjunct pulmonary rehabilitation program in COPD patients.”

Yoga for Asthma   “There was some evidence that yoga may improve quality of life, improve symptoms, and reduce medication usage in people with asthma.”

Acute fall and long‐term rise in oxygen saturation in response to meditation   Meditation, a key component of yoga, seems to improve efficiency of gas exchange and oxygenation. This paper concluded that, “Meditation induces favorable changes in cardiovascular and respiratory end points of clinical interest.”

 

  1. Arthritis

Yoga Benefits for Arthritis  Even the Arthritis Foundation recommends Yoga.

Yoga for Low Back Pain    Blog by yoga therapist as an introduction to Cochran’s research links embedded.

Yoga in Rheumatic Diseases  This articles summarizes key considerations for yoga in rheumatic diseases, including clear guidelines to help healthcare practitioners find qualified yoga professionals. It concludes that a growing body of evidence suggests that yoga is a safe, feasible option for many living with rheumatic conditions. Furthermore, “This holistic approach to exercise with an emphasis on mindfulness and stress reduction may also offer additional opportunities to enhance psychological well-being, reduce pain and enhance function and participation, as part of a comprehensive disease management approach.”

YOGA IN SEDENTARY ADULTS WITH ARTHRITIS: EFFECTS OF A RANDOMIZED CONTROLLED PRAGMATIC TRIAL  In this 8-year clinical trial, conducted at Johns Hopkins University, a well-rounded yoga program for those with osteoarthritis and rheumatoid arthritis improved pain by 40%. Participants also demonstrated overall improvement in arthritis symptoms, physical fitness, psychological functioning, and health-related quality of life.

Effects of an Integrated Approach of Hatha Yoga Therapy on Functional Disability, Pain, and Flexibility in Osteoarthritis of the Knee Joint: A Randomized Controlled Study  An integrated approach of hatha yoga therapy is better than therapeutic exercises

Effects of Yoga on Symptoms, Physical Function, and Psychosocial Outcomes in Adults with Osteoarthritis: A Focused Review  Yoga intervention resulted in reductions in pain, stiffness, and swelling.

Impact of Iyengar yoga on quality of life in young women with rheumatoid arthritis”  Almost half of the yoga group reported clinically meaningful symptom improvement.”

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs
Mind-body exercises are promising approaches to reduce pain, as well as to improve physical function and quality of life for individuals with knee osteoarthritis

 

  1. Trauma / PTSD

Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder SUCH AN IMPORTANT PIECE OF RESEARCH on STRESS. Yoga has far-reaching potential for the treatment of a broad array of disorders exacerbated by stress.

Meditation and Yoga for Posttraumatic Stress Disorder: A Meta-Analytic Review of Randomized Controlled Trials   This page features studies, articles, research databases, and other resources that support our work.

Mind body practices for PTSD  Mind-body practices were found to be a viable intervention to improve the constellation of PTSD symptoms such as intrusive memories, avoidance, and increased emotional arousal.”

New studies show that people suffering from posttraumatic stress disorder can find real relief with yoga.   It’s too soon to say whether yoga should replace traditional therapy as a treatment for PTSD, says trauma expert Bessel van der Kolk, a professor of psychiatry at Boston University School of Medicine. But he recommends it as a complementary practice. “Unless you befriend your body,” he says, “you cannot become well.”

Warriors at Ease Research on Yoga and Meditation   “Warriors at Ease is committed to raising awareness about how yoga and meditation can support the health and healing of service members, veterans, and their families….[read more about] evidenced-based, trauma-sensitive practices supported by research.”

Yoga as an adjunctive treatment for posttraumatic stress disorder: a randomized controlled trial.  Yoga significantly reduced PTSD symptomatology, with effect sizes comparable to well-researched psychotherapeutic and psychopharmacologic approaches. Yoga may improve the functioning of traumatized individuals by helping them to tolerate physical and sensory experiences associated with fear and helplessness and to increase emotional awareness and affect tolerance.”

Yoga, Trauma, and PTSD  Why Use Yoga for Trauma as an Adjunct Treatment for PTSD? Heather Mason will discuss this subject with us this week.

 

  1. Cardiovascular Disease

The hypotensive effect of Yoga’s breathing exercises: A systematic review   The pranayama with slower rhythms and manipulation of the nostrils, mainly with breaths by the left, present better results when compared with the other types and should be the main pranayama applied when the goal is to reduce blood pressure especially in hypertensive patients.

Effects of yoga in patients with paroxysmal atrial fibrillation – a randomized controlled study  Yoga with light movements and deep breathing may lead to improved QoL, lower blood pressure and lower heart rate in patients with PAF compared to a control group. Yoga could be a complementary treatment method to standard therapy.

Yoga as an Alternative and Complimentary Therapy for Cardiovascular Disease: A Systematic Review  This review demonstrates the clear potential yoga has as an alternative and complementary means to improve cardiovascular disease risk.

Blood Pressure Response to Meditation and Yoga: A Systematic Review and Meta-Analysis  While acknowledging the limitations of this research due to the differences in BP and the participants’ ages, meditation and yoga are demonstrated to be effective alternatives to pharmacotherapy. Given that BP decreased with the use of meditation and yoga, and this effect varied in different age groups, scientifically measured outcomes indicate that these practices are safe alternatives in some cases.

Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis This meta-analysis provides evidence for clinically important benefits of yoga on most biological cardiovascular disease risk factors, including blood pressure, respiratory rate, waist circumference, waist/hip ratio, cholesterol, triglycerides, and insulin resistance

Systematic Review of Yoga Interventions to Promote Cardiovascular Health in Older Adults.  According to this review of research on yoga and cardiovascular health, “Significant health benefits were reported, including favorable changes in blood pressure, body composition, glucose, and lipids.”

Can lifestyle changes reverse coronary heart disease?  Dean Ornish’s team has many years of research to support the efficacy of a multifaceted lifestyle program—including yoga, meditation, nutrition, and social support—in improving cardiovascular outcomes and even reversing heart disease.

 

  1. Sleep (inclusive of Insomnia)

The Connection Between Yoga and Better Sleep  Some types of yoga can be energizing (like hot yoga and vigorous vinyasa flow), which won’t help you relax as well as restorative styles of yoga like hatha and yoga nidra. A yoga therapist can help you choose the right tools.

The Effect of Yoga Therapy on Selected Psychological Variables Among Male Patients with Insomnia  We conclude that yoga is an effective treatment option for the patients with insomnia. There are no major side effects.

Yoga Can Help With Insomnia  Looking for a low-impact exercise routine with high returns for health and sleep? Try yoga.

Yoga decreases insomnia in postmenopausal women: a randomized clinical trial  This research used a specific routine. Yoga Therapists read and implement research unlike yoga instructors.

Yoga for Better Sleep  Over 55% of people who did yoga found that it helped them get better sleep.

Sleep quality, depression state, and health status of older adults after silver yoga exercises: Cluster randomized trial  “After 6 months of silver yoga exercises, the sleep quality, depression, and health status of older adults were all improved.”

Subjective Sleep Quality and hormonal modulation in long-term yoga practitioners  It can be concluded that long-term yoga practice is associated with significant psycho-biological differences, including better sleep quality as well as a modulatory action on the levels of cortisol.

Yoga and the Stress Response

Yoga and the Stress ResponseIf you thought this article would be how yoga is the “answer” to the problems of the stress response, you’d be partially correct! If you believe that one of yoga’s primary benefits is to gain control over the stress response, you’d be 100% correct. (Spoiler alert: the stress response has a corresponding condition: the relaxation response.) So, why isn’t yoga the answer to the stress response?

Let’s engage in Q and A around the concept of the stress response:

Q. To understand the stress response, let’s start with the topic experts. Who has the best current information on the relationships between the brain, the body, stress, coping, and their combined effects on trauma and stress-related diseases?
A. Top contenders and supports of yoga are Bessel Van Der Kolk, M.D. in The Body Keeps The Score, Robert M. Sapolsky in Why Zebras Don’t Get Ulcers, and his book published in 2017, Behave.

Q. What is the stress response?
A. The stress response is a host of physical and mental reactions in response to an immediate, short-term crisis, or stressor. (Picture this: The snake, a major stressor slithers into your path, and viola! You are immediately transported via the stress response, to the safety of a tree limb without so much as a thought!).

Q. The stress response is a good thing then, right?
A. Yes and No. I know, not much better than the phrase “it depends”!
Speaking for the Yes side: for acute physical emergencies it is absolutely necessary for your appropriate response to danger. The stress response is what your body does to reestablish homeostasis.
Speaking for the No side: Reacting physiologically to stressors in a chronic, constant manner is not a good thing. Much like over-stretching a rubber band, you eventually “wear out” systems in your body. When acute danger is sensed, every system in your body is designed to deliver a quick response. Your physiology can get over-stretched by constantly reacting, or even anticipating what you may consider a stressor.

Q. What are some examples of stressors?
A. Lions, tigers, and bears. The list quickly expands to include romantic, familial and social relationships, money, jobs, outward appearance, social standing and on, and on. It is anything important enough to cause you to worry, thereby expending large amounts of emotional or physical energy. It is everything that causes you to worry.

Q. Why shouldn’t you strive to completely eliminate the stress response?
A. Simply put: it is critical to your survival. Most animals (including me and you!) have survived and evolved thanks to the stress response. Stress response is what gives you the strength to get up and do what needs to be done! It powers you through adversity and challenge.

Q. What does a healthy stress response look like?
A. Tough question. It depends. Read up on the Polyvagal Theory here to entertain this question further.

Q. What role does yoga have with regard to the stress response?
A. Your body is a veritable expert at initiating the stress response. And you are the absolute master of your body, even if you don’t yet think so! Yoga may have a role in helping you initiate the relaxation response. Yoga may help you reach balance and homeostasis by developing greater awareness. Yoga teaches you to choose the appropriate response to a given situation.

Q. A few of the answers above mentioned homeostasis. What is homeostasis? A. Robert Sapolsky keeps it general when he says: “. . . different variables are maintained in homeostatic balance, the state in which all sorts of physiological measures are being kept at the optimal level. The brain, it has been noted, has evolved to seek homeostasis.” (It has been noted: the brain has evolved).

Back to our original inquiry: why isn’t yoga the answer and what is the role of yoga and the stress response? It is kind of a trick question. Yoga is not the answer because we don’t want to eliminate the stress response. We need the brain to be fully functioning and mediating the proper stress response. Yoga’s main purpose and goal is to still the fluctuations of the mind. We need to calm the mind and maintain balanced reactions to our world. As noted, the brain has evolved.

For the sake of discussion in this article, let’s use mind and brain interchangeably. As noted, and as hammered into place: the brain has evolved. It has evolved to accept messages from every organ and system in your body. Like a relay station, albeit a very sophisticated one! The current scientific evolution is proving the brain doesn’t “think” of everything, and doesn’t “control” everything. And we’re learning that most decisions are based on emotions, and not entirely on an ordered, brain-powered logic.

Yoga’s role in the stress response is to give you the experience of self-regulation. Through yoga you can learn to feel the physical effects of emotional activation. Part of that lesson comes from asana, the postures. Asana is used to activate and relax the muscles of the body as a start to the true yogic practice. Awareness of the body in asana leads to awareness of the mind in meditation. Disturbing “gut reactions” or getting the “sh*t scared out of you” actually start first in the body. A run away stress response may bypass your logic-powered brain, creating a “knee jerk reaction.” Or you may have developed habits of ignoring or stuffing your emotions. Either way, the result may be an over reactive stress response: anger, fear, or withdrawing.

Yoga may help you gain greater control over your responses to stressors. The yogic practices of right breathing, intentional movement, and mindful meditation may begin to initiate your relaxation response. Or a more active yogic practice may increase the stress response in a positive way. Yoga isn’t all about the relation response! Sometimes living a sedentary lifestyle, feeling lethargic, or having a need to increase lung capacity calls for a different approach. But that’s a topic for another article!

Where do you start with Yoga Therapy?

Your first yoga therapy session

Your first session with a yoga therapist starts with an introduction. And an inquiry. What brings you to yoga therapy? What do you hope to gain through yoga therapy?

Your first yoga therapy session at Tampa Yoga Therapy may be either a 30 minute consult or a 90 minute consult and assessment.

Either way, it’s the time to take the time. In your first yoga therapy session spend time with your yoga therapist to get all your questions answered. You may have general questions such as, “How can yoga therapy help me? What types of conditions or issues may be addressed? What kinds of yoga therapy techniques are available to me?”

Your path to health and well-being is an individual experience. Start with open communication in your first yoga therapy session. This important first conversation will help you get the most out of the therapeutic practices of yoga. Your yoga therapist can begin considering your unique situation. Understanding your needs is the first step to co-creating the best plan for you.

Use the first session with your yoga therapist to ask questions and establish your priorities for health and well-being. Your yoga therapist will be happy to share everything from general yoga therapy information, to the latest research findings to support the benefits of yoga therapy.