SciencefortheYogaTherapist Therapy and Depression

By Stephanie M. Shorter for the yoga therapy client, catalyzed by lating one's experience), acting with the trusting relationship with the yoga ther- awareness, nonjudging of inner experi- apist. As has been explored in this column ence, and nonreactivity to inner experi- sing the tools of yoga therapy for 4 depression can effectively address before, the sense of social safety created ence. This questionnaire has been shown Uthe entire person—all of the by the yoga therapist gets registered by to be a psychometrically sound measuring koshas 11 —through a complex intervention the vagus nerves to boost the parasympa- instrument. In a nutshell, that means that addressing multiple biopsychosocial fac- thetic response. In other words, there is a the questionnaire itself has been put to tors. In other words, it is a textbook case tangible physiological reality of “holding the test—rigorously quantified to show of the mind-body connection at work. The space” for clients and their transformation, that it is measuring things consistently health research literature increasingly and it is in these moments of parasympa- (reliability) and measuring what it is sup- shows the implausibility of thinking of thetic dominance that witness conscious- posed to be measuring (validity). organs and systems in isolation, a refram- ness becomes stronger. ing that sets the stage for greater accept- ance of yoga therapy as a health interven- Supporting a client in finding this Interestingly, these five facets emerged tion in general. With regard to treating parasympathetic peace on the way to wit- out of a statistical back-and-forth analysis ness consciousness is readily done with process called factor analysis; in other depression specifically, yoga therapy is in 5 alignment with what many people express an / practice. For words, the data revealed these facets that they want: guided self-help without instance, eight or fewer weeks of asana through an objective quantitative process: 1 practice can be sufficient to induce no person went specifically looking for dependence on pharmaceuticals. 6 Spirit Rx: Witnessing the Suffering changes in heart rate variability, which is them based on any personal experience, an indicator of healthy autonomic nervous bias, or any particular contemplative back- system balance. A variable heart rate is a ground. For our purposes, this quantifica- One of the greatest benefits of practicing sign that the fight-or-flight sympathetic tion means that witness consciousness is yoga rests in the simple cultivation of wit- nervous system is not rigidly dictating the real, can be measured, and the compo- ness consciousness, the ability to view the contractions of the heart muscle like a nents identified by researchers match well world with nonjudgmental awareness and metronome. Pranayama can be a very the descriptions of traditional contempla- to be present with anything and everything skillful means of balancing the autonomic tive texts. that arises. Witness consciousness acti- nervous system activitynadi and shodhana managing vates the intuition that sees beyond the mood; in particular, bastrika (alter- nate nostril breathing) and (bel- depressed state. It is the discernment to 7 distinguish between what is changing and lows breath) are highly recommended. what is unchanging. Engaging in different The ayurvedic perspective is thattamasic depres- forms of contemplative practice, including sionrajasic may originate from either a or yoga, develops this witness conscious- imbalance. Tamasic depression is ness and is associated with lower rates of characterized by lethargy and may be 2 depression. improved with invigorating forms of pranayama that emphasize inhalation. In Witness consciousness allows us to contrast, rajasic depression is marked by unlock theYoga full potentialand the Quest of our for develop- the True symptoms of anxiety and agitation and ment. In may be alleviated by extending the exhala- Self 3 8 , Stephen Cope, MSW, described tion. The respiratory system is wired to the these six facets of witness consciousness: phylogenetically old parts of the brain and, therefore, intentionally modifying the breath • It does not choose good or bad, for or becomes a fast pathway to alter the state against. of arousal and alter the clarity of thinking. also shows promise in prevent- Witness consciousness has been • It allows and does not discriminate or 9 censor. ing or reducing depressive symptoms. shown to correlate with other measures of • It is an experience of the whole body wellness. For instance, Ruth Baer, PhD, with all of its intelligence, not just The qualities of witness conscious- MBC, and colleagues have shown meas- cerebral intellect. ness listed above have been discussed in urable differences in these facets of wit- contemplative texts for centuries and have ness consciousness among meditators • It is always there, waiting to be recog- 12 nized and cultivated. also garnered increasing attention for and non-meditators. More recently, • It can be objective and still, even in some rigorous scientific study in the past Baer's research group administered the the midst of the most intense chaos. decade. Of note here is the Five Facet Five Facet Mindfulness Questionnaire to a • It functions independently of time and Mindfulness Questionnaire, a set of thirty- clinically depressed sample. The nine questions that tap into different researchers hypothesized that specific space, always with the awareness of 10 now. aspects of mindfulness. Mapping well relationships (positive correlations or neg- onto Stephen Cope's list of witness con- ative correlations) would be found Through the tools of mindful move- sciousness traits, the questions are between different symptoms of depression ment, mindful breath, and self-inquiry, designed to tap into five components of and anxiety and the five facets. Baer et al. these qualities get nurtured and expanded mindfulness: observing, describing (articu- observed the strongest effects with

14 YogaTherapyToday | Summer 2015 www.iayt.org Science for the Yoga Therapist continued negative correlations between depression presently say is that depression and culating in the blood was analyzed. The and anxiety symptoms with the facets of inflammation are linked together. anti-inflammatory cytokine showed a 28% awareness, nonjudging, and nonreactivity. increase in yoga “experts” as compared to The more intensely people feel the symp- Inflammation is an immune response “novices”; however, although this change toms of depression and anxiety, the less that helps the body heal after injury, but is in the positive, wellness-producing they are able to act with awareness and when prolonged, it can lead to tissue dam- direction, it was not strong enough to come at the situation from a place of non- age. Moreover, inflammation has been reach statistical significance. Butwas the drop judgment; instead, they may react with a shown to increase the risk of a major in the pro-inflammatory cytokine sig- 13 heavy emotional gravity rather than depressive episode. There is a higher nificant. The bodies of yoga “experts” were thoughtfully respond with equanimity. To prevalence of depression among individu- producing 36% less of the pro-inflammato- use a common analogy, individuals with als who are physically ill; an immune sys- ry cytokine, in good agreement with the severe depression or anxiety tend to con- tem cascade that produces pro-inflamma- 2010 results on IL-6. To summarize, the fuse the storm clouds with the sky. Inter- tory cytokines (proteins that aid in healing) pro-inflammatory cells were decreasing estingly, there were only weak correlations may be implicated in this pattern. while the anti-inflammatory cells were between the ability to observe and increasing, although not quite as much. describe and the experience of depression A regular yoga practice tunes the and anxiety symptoms. immune system and reduces inflammation More research is needed to connect The Physiology of Depression throughout the body. Taken together, a the dots between how yoga dampens pair of studies did an elegant job of show inflammation and immune reactivity and ing how yoga reduces inflammation the degree to which this plays a causal In addition to these benefits in changing through two different routes. Psychoneu- role in episodes of depression and mood one's level of awareness and nonjudgmen- roimmunologist Janice Kiecolt-Glaser and dysregulation. tal acceptance of what is, it is becoming her colleagues study regular yoga practi- Conclusions increasingly important to think about the tioners and novices. In a 2010 study that physiology of depression—what is happen- focused on stress, inflammation, and 14 ing on the cellular level? yoga, the key finding was that women Current directions in depression research who were novices to yoga were less show that depression is much more than Depression has long been understood resilient to stress as measured by two dif- “in the head” of the person who is suffer- to be a complex outcome of many different ferent inflammatory markers that circulate ing. It is a pervasive physiological differ- influences, from genetic to environmental in the blood. When compared to women ence throughout the body. Yoga therapy to biopsychosocial influences. The impact who were regular yoga practitioners (more for depression provides a skillful way to of biology—how the physiology of a than one yoga class per week for at least embody the medicine, to use the body and the breath as healing instruments in man- aging mood. Moreover, it is the type of guided self-help, non-pharmaceutical solu- tion that many people are currently seek- ing. The complex mind-body-spirit interac- tions in riding the waves of depression show us that what is spiritual is cellular and vice versa—everything connected. Acknowledgement

The author thanks Amy Weintraub for helpful commentsYTT on an early draft of this article. For more information and resources: depressed individual may differ from a two years), novices' interleukin 6 (IL-6) http://yogafordepression.com/latest- non-depressed individual—is hard to levels were 41% higher. (IL-6 is an inter- research untangle. Does altered physiology cause cellular signaling molecule that stimulates the depressed mood, or does depressed a defensive immune response.) References mood alter the body's physiology? There 15 1. Hanson, K., Webb, T. L., Sheeran, P., & Turpin, G. are many facts to piece together here and, In a follow-up study, the Kiecolt- (2015). Attitudes and preferences towards self-help treat- recently, much more attention has been Glaser group continued digging deeper ments for depression in comparison to psychotherapy given to the role of inflammation in depres- into how the levels of pro-inflammatory and antidepressant medication. Behavioural and Cogni- tive Psychotherapy, 20, 1-11. doi: sion. Keep in mind that the results of stud- and anti-inflammatory protein molecules 10.1017/S1352465815000041 ies on depression and inflammation are, shift as one continues practicing yoga over 2. O'Connor, L. E., Rangan, R. K., Berry, J. W., Stiver, D. by definition, correlational studies, which time. As before, some female study partici- J., Hanson, R., Ark, W., & Li, T. (2015, June). Empathy, means that we cannot infer cause and pants were novices and others had prac- compassionate altruism and psychological well-being in effect. Is the depression causing the ticed yoga regularly for at least two years; contemplative practitioners across five traditions. Psy- inflammation? Is the inflammation causing these two groups were well matched on all chology, 6(8), 989-1000. doi: 10.4236/psych.2015.68096 the depression? We do not know the other variables. The concentration of two 3. Cope, S. (2000). Yoga and the quest for the true self. answer to that pair of questions. All we can adipocytokines (inflammatory modulators New York, NY: Bantam. that are secreted from body-fat tissue) cir- (continued on page 50) www.iayt.org YogaTherapyToday | Summer 2015 15 Members News Conference Corner Science for the continued frompage 6 continued from page 8 Yoga Therapist Bringing together and inspiring experts AUM hOMe Shala continued from page 15 from more than ten different countries, with 4. Shorter, S. M. (2014, Summer). The vagus nerves Receives National an estimate of at least 25% of attendees as a mind-body bridge. Yoga Therapy Today, 10, 14- Parkinson being healthcare professionals, the first 15. ICYTR can be deemed a great success! 5. Streeter, C. C., Gerbarg, P. L., Saper, R. B., Ciraulo, Foundation Grant How did this conference come about? D. A. & Brown, R. P. (2012, May). Effects of yoga on the autonomic nervous system, gamma-aminobutyric- acid, and allostasis in epilepsy, depression, and post- IAYT member Ever since I found yoga in 1998 when I traumatic stress disorder. Medical Hypotheses, 78(5), school AUM was working as a community psychiatric 571-579. hOMe Shala in nurse, I have strongly believed that this 6. Shapiro, D., Cook, I. A., Davydov, D. M., Ottaviani, Coconut Grove, practice could help the vulnerable group of C., Leuchter, A. F., & Abrams, M. (2007, December). people I work with. My dream became to Yoga as a complementary treatment of depression: Florida, has Effects of traits and moods on treatment outcomes. been awarded a connect my passions of yoga and psychia- try. Knowing the challenges in bringing this Evidence Based Complementary and Alternative Medi- $15,000 grant cine, 4(4), 493-502. mind-body approach into a medically ori- from the National ented space, I felt the need to study more, 7. Weintraub, A. (2003). Yoga for depression: A com- Parkinson Foun- passionate guide to relieve suffering through yoga. find my own voice, and build a community New York, NY: Broadway Books. dation to fund clinical yoga therapy train- of others interested in the same goals. ing and outreach in service to those with 8. McCall, T. (2007, August). Yoga for depression, part II. . Retrieved from Parkinson's and other neuromotor degen- In 2010, I created Network Yoga Ther- erative diseases. The initiative launches in http://www.yogajournal.com/article/teach/yoga-for- apy (NYT) and began to meet with small depression-part-ii/ August with the first training for yoga ther- groups of like-minded people to discuss apists interested in working with this popu- 9. Eastman-Mueller, H., Wilson, T., Jung, A. K., Kimu- yoga and mental health care. Since then, ra, A., & Tarrant, J. (2013). iRest yoga-nidra on the lation. we have met regularly to talk, inspire, and college campus: Changes in stress, depression, worry, connect. The community is growing fast, and mindfulness. International Journal of Yoga Thera- In addition to the training, AUM hOMe and the format is becoming more struc- py, 23(2), 15-24. Shala will offer a series of twenty group tured: we meet monthly for peer supervi- 10. Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, yoga therapy classes for those with sion, case study discussion, and ethical J., & Toney, L. (2006). Using self-report assessment Parkinson's, as well as free workshops for debate. Besides our monthly network methods to explore facets of mindfulness. Assess- the public on Parkinson's and the use of meetings in person, we meet online, and ment, 13(1), 27-45. yoga to reduce symptoms, restore bal- we offer training opportunities for yoga, 11. Bohlmeijer, E., ten Klooster, P. M., Fledderus, M., ance, and increase vitality. The mission of yoga therapy, and related topics. At the Veehof, M., & Baer, R. (2011). Psychometric proper- ties of the five facet mindfulness questionnaire in the project is to provide continuing educa- moment NYT is mostly a European initia- tive for professionals in yoga and the depressed adults and development of a short form. tion for yoga therapists, empower and Assessment, 18(3), 308-320. improve quality of life for those with health and welfare sectors, with a current focus on mental health and special needs. 12. Baer, R. A., Smith, G. T., Lykins, E., Button, D., Parkinson's, support caregivers, engage Krietemeyer, J., Sauer, S., Walsh, E., Duggan, D. & the community, and raise awareness of Williams, J. M. (2008). Construct validity of the five An important goal of NYT is to con- facet mindfulness questionnaire in meditating and the efficacy of yoga therapy for people tribute to the dialogue on professional stan- with Parkinson's. nonmeditating samples. Assessment, 15(3), 329-342. dards and criteria for yoga therapists. We 13. Dantzer, R., O'Connor, J. C., Freund, G. G., John- are inspired by IAYT's educational stan- Founded in 2005 by director Melinda son, R. W., & Kelley, K. W. (2008). From inflammation dards while at the same time developing to sickness and depression: When the immune sys- Atkins, AUM hOMe Shala offers the only standards that fit our own healthcare, insur- tem subjugates the brain. Nature Reviews Neuro- IAYT-accredited yoga therapy certificationYTT ance, and government systems. I see our science, 9(1), 46-56. program in the state of Florida. annual ICYTR conference as an important 14. Kiecolt-Glaser, J. K., Christian, L., Preston, H., cornerstone of NYT. Conversations with Houts, C. R., Malarkey, W. B., Emery, C. F., & Glaser, John Kepner of IAYT were highly inspira- R. (2010). Stress, inflammation, and yoga practice. tional in our planning of this year's confer- Psychosomatic Medicine, 72(2), 113. ence, and we are grateful for IAYT's spon- 15. Kiecolt-Glaser, J. K., Christian, L. M., Andridge, R., sorship in helping to get the word out. We Hwang, B. S., Malarkey, W. B., Belury, M. A., Emery, hope that more people in The Netherlands C. F., & Glaser, R. (2012). Adiponectin, leptin, and and Europe will become IAYT members to yoga practice. Physiology & Behavior, 107(5),809- 813. help build and support the global yoga therapy community. Stephanie M. Shorter, PhD, RYT, is an With great optimism we look forward to expert on mind-body the next ICYTR on May 10, 2016. If you research methods are a researcher/ lecturer interested in and the founder of a being part of this conference, please con- publishing company YTTtact us at http://networkyogatherapy.org. called Mind-Body Dilip Sarkar, MD, FACS, CAP, president of the IAYT Collective. She board of directors, speaking at the First Interna- Anneke Sips (IAYT, psychiatric RN, serves as the editor of a UN-affiliated tional Day of Yoga on June 21, 2015, at the E-RYT200) is founder of Network Yoga publication about social change called National Mall, Washington DC, sponsored by the Therapy and develops and teaches yoga She can be reached at Embassy of India, Washington DC, and Friends of programs for trauma and psychotic stress. [email protected]. Journal. Yoga. YTT

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