Interviews with Dr. Loren Fishman & Terry Schaff Featured Article

The International Association of Yoga Therapists YogaTherapyTodayYogaTherapyToday Winter 2012 Volume 8, Issue 3, $5

Important Featured Article: Sharing Research Interviews with Conference Dates: Cleveland Clinic with the Medical Dr. Loren Fishman SYR and SYTAR Embraces Yoga Community & Terry Schaff 2013 YogaTherapyToday Winter 2012 www.iayt.org www.iayt.org Winter 2012 YogaTherapyToday 1 Yo g aT h e r a p yTo d a y Editor’s Note

n this issue, I wanted to focus on people PUBLISHER International Association of Yoga Therapists If u r thering the integration of yoga therapy EDITOR IN CHIEF Kelly Birch, ERYT-500, PYT-500 and medicine; specifically, those who off e r GRAPHIC DESIGNER Ken Wilson c o n c rete examples of the range of appro a c h- COPYEDITORS Denise Hodges, Morgan Hunt es by which inroads are being made. I find it very exciting that this work is occurring on Yoga Therapy To d a y is published in the spring, summer, and winter. so many fronts just as IAYT is offering edu- IAYT BOARD & MANAGEMENT cational standards and institutional sup- Eleanor Criswell, EdD, President p o r t — t o g e t h e r, we are moving closer to the Matra Raj, OTR, TYC, Treasurer tipping point. Molly Lannon Kenny, Vice President Bidyut K. Bose, PhD I found it particularly inspiring to include Judi Bar’s article Bob Butera, MDiv, PhD, E-RYT about her work at Cleveland Clinic—if you saw the first pre s i d e n t i a l Dilip Sarkar, MD debate you will have heard President Obama mention the clinic as a Ellen Fein, LCSW, RYT-500 h e a l t h c a re model of the future! Ms. Bar describes in detail how she Susan Gould-Fogerite, PhD Executive Director John Kepner, MA, MBA came to be at Cleveland Clinic and how the clinic embraced yoga as Membership Manager Jesse Gonzales part of its integrative model. Advertising Manager Abby M. Geyer It was a pleasure and a privilege to speak with Dr. Loren Fishman, MISSION a long-time pioneer in the integration of yoga and medicine, and to IAYT supports research and education in Yoga, and serves as a interview Terry Roth Schaff, a yoga therapist who works in his prac- professional organization for Yoga teachers and Yoga therapists tice at Manhattan Physical Medicine and Rehabilitation. Their com- worldwide. Our mission is to establish Yoga as a recognized and ments are highly edifying. The interviews prompted me to contact a respected therapy. physical therapist colleague and ask if I could shadow him during his MEMBERSHIP work and teach his patients some yogic breathing—to which he IAYT membership is open to Yoga practitioners, Yoga teachers, enthusiastically agreed! Yoga therapists, Yoga researchers, and healthcare professionals I asked several people in our field for advice on discussing who utilize Yoga in their practice. re s e a rch with the medical community, and the resulting Perspec- MEMBER BENEFITS tives article contains a wealth of material. I would like to extend my • Subscription to the International Journal of Yoga Therapy deep gratitude to all those who went out of their way to provide this • Subscription to Yoga Therapy Today i n f o r m a t i o n . • Access to IAYT’s research resources and digital library Amy Weintraub gives us a detailed insider’s view of her work • Professional recognition through IAYT’s online listings and an IAYT membership certificate with Jacquelyn Jackson, expertly guiding us through the process of • Discounted registration at IAYT events healing from tragedy and grief. Molly Lannon Kenny offers us a lovely piece on her equation for healing, and Cyndi Kershner eloquently CONTACT describes her experience in a hospital-based class. P. O. Box 12890, Prescott, AZ 86304 Phone: 928-541-0004 (M-F, 9AM – 3PM MST) We have a comprehensive training report on Ginger Garner’ s Fax: 928-541-0182 P rofessional Yoga Therapy Training from the perspectives of thre e www.iayt.org • [email protected] graduates, a must-read for those working within the medical c o m m u n i t y. HOW TO SUBMIT TO YOGA THERAPY TODAY It is my pleasure to introduce Jacob Griscom, who will be con- Writers Email a query or completed article to: [email protected]. Yoga tributing a three-part series for Yoga Therapy for Daily Living, pro- Therapy Today relies on submissions from the membership. Please viding us with expert advice on running a successful yoga therapy submit reports and articles on training, views and insights relat- b u s i n e s s . ing to the field and profession of Yoga therapy, as well as on inte- Please also savor our expanded Members News, including FA Q grative practices and business practices. Request writer guidelines from editor. Articles are reviewed and accepted on a rolling f rom John Kepner on the educational standards accre d i t a t i o n basis and may be submitted at any time. p rocess; dates for IAYT’s 2013 conferences registrations, abstracts Advertisers submissions, and more; Mentors’ Corner Q&Af rom Robin Rothenberg ; Call 928-541-0004 or email [email protected] for advertising an exemplary member profile of Linda Lang; Conference Corner; and rates and deadlines. Editorial decisions are made independently two media re v i e w s . of advertising arrangements. REPRINT POLICY In service, IAYT's reprint policy applies to all articles in the International K e l l y Journal of Yoga Therapy and Yoga Therapy Today. Fee: $1 per copy per article. The policy works on the honor system, e.g., if two Erratum articles are copied for 25 students, please send IAYT a check for In the summer 2012 issue of Yoga Therapy Today the article entitled $50 and note “for reprints” on the check. Questions? Email Jesse “Compassionate Presence” contained materials from the Trauma Gonzales, Member Services Manager, at [email protected] or 928- 541-0004. Center's Trauma-sensitive Yoga training manual as well as those from the book Overcoming Trauma Through Yoga: Reclaiming Your ENVIRONMENTAL STATEMENT Body, by Trauma Center Faculty, David Emerson, E-RYT, and Eliza- This publication is printed using soy-based inks. The paper contains beth Hopper, Ph.D., that were not properly cited. We apologize for 30% recycled fiber. It is bleached without using chlorine and the the oversight. wood pulp is harvested from sustainable fore s t s . Cover models: D r. Loren Fishman, Terry Roth Schaff, and Yenisei Bell. Photo credit: Lauryn Gerstle Photography, www.LaurynGerstle.com, [email protected]

2 Yo g aT h e r a p yTo d a y Winter 2012 w w w. i a y t . o rg Ta b l e O fC o n t e n t s Winter 2012

2 Editor’s Note 4 Members News 4 Important Dates for SYR and SYTAR 2013 4 4 FAQ on the Educational Standards for the Training of Yoga Therapists by John Kepner, IAYT Executive Director 5 Helping IAYT Thrive is Worth the Effort by John Kepner, IAYT Executive Director 5 Tribute by Eleanor Criswell, IAYT President 5 NCCAM Video: Scientific Results of Yoga for Health and Well-being 5 Mindful Yoga Therapy for Veterans: The Give Back Yoga Foundation 6 Conference Corner 6 The Third International Research Congress on Integrative Medicine and Health by Suzanne Bigelow, E-RYT 6 Moving From Inspired to Effective: The First Annual Yoga Service Conference by Rob Schware, PhD 10 6 Yoga Sangam: Philosophy, Health, and Research Conference by Grace Bullock, PhD 8 Yoga Therapy for Daily Living Inevitable Success by Jacob Griscom 10 Featured Article Cleveland Clinic Embraces Yoga: A History and Guide by Judi Bar, E-RYT 500 14 Mentor’s Corner: Q&A by Robin Rothenberg, CYT 16 Perspectives 16 In the Spirit of Collaboration: 16 Sharing Research with the Medical Community by Kelly Birch, E-RYT 500 20 Healer, Heal Thyself: An Equation for Change by Molly Lannon Kenny, MS-CCC 26 Insight Lessons Learned in Teaching a Hospital-based Yoga Class by Cyndi Kershner, RYT-500 28 Case Report Healing from Trauma, Moving through Grief by Amy Weintraub, ERYT, MFA 30 Interviews 30 With Loren Fishman, MD by Kelly Birch, E-RYT 500 34 With Terry Roth Schaff by Kelly Birch, E-RYT 500 38 36 Member Spotlight on Linda Lang, ERYT 38 Training Report Professional Yoga Therapy Studies by Amber Keating, LCSW, and Veronica Whetsel, PT, with Cassandra Kit, RYT, RSW 42 Reviews 42 The Big Book of Yoga Therapy: Yoga Practices for Health and Clarity by Remo Rittner, Reviewed by John Kepner, MA, MBA 43 Relax into Yoga: Finding Ease in Body and Mind by Carson, K. & Krucoff, C., Reviewed by Sue Tebb, PhD, RYT 44 Members News Welcome New and Renewing School Members w w w. i a y t . o rg Winter 2012 Yo g a T h e r a p yTo d a y 3 MembersNews Important dates for IAYT Conferences: 2013 Symposium on Yoga Research (SYR), Symposium on Yoga Therapy and Research (SYTAR), and Meeting of Schools

January 7 February 13 April 3 June 11-13 Call for SYR abstracts SYR notifica- Symposium on SYR research submissions tion of abstract Yoga Research abstracts opens deadline acceptance (SYR)

January February March April May June

January 7 January 7 February 6 March 28 April 12 June 12-13 June 13-16 SYR/SYTAR Call for SYTAR CIC* SYTAR CIC* SYR/SYTAR Meeting of Symposium Registration SYTAR presentations notification of Early bird Schools on Yoga opens CIC* pre- presentation Registration Therapy and sentations opens acceptance deadline Research (SYTAR)

* CIC: Common Interest Communities See the center spread ads for more information, and visit iayt.org/conferences

Q. Will there be grandparenting for those who graduated from FAQ on the Educational Standards for the Training IAYT member schools before the schools are accredited by IAYT, of Yoga Therapists as well as for long-time practitioners, including those pioneers By John Kepner, IAYT Executive Director who may not have had formal training in yoga therapy?

he standards have understandably raised many questions from A. Yes. Again, exactly how this will be done is also under careful Tschools and their students, as well as long-established yoga deliberation now. As described in the section on “Other Topics” in therapists. Here’s an attempt to begin to answer some of the most the published Educational Standards: “As a field develops stan- common questions. Please understand this is an evolving process, dards, grandparenting is typically addressed in a generous way, and many details are under careful deliberation and development. respecting original training, continuing education, and experience.” Currently we are refining this to be more specifically in alignment with the standards. Q. When can schools apply for IAYT accreditation for their yoga therapist training programs? Q. Does IAYT have any accredited/registered schools or certified/ registered Yoga therapists now? A. An application form should be available by mid-May, 2013. We will review the application process at the Meeting of Schools, A. No. IAYT only has member schools and individual memberships June 12-13, 2013, just before SYTAR. Actual applications can be sent at this time. We know, however, that there is some confusion out in only after SYTAR. All applications received by August 1 will be there. The correct terms are IAYT member or IAYT member school, or reviewed together by the whole accreditation committee in mid the equivalent. August. We expect results to be available in early fall. A second round of applications will be accepted in the fall, but we haven’t set Q. What about shorter general programs and specialty programs a date yet. that do not want to become accredited programs? This will be a rigorous application and likely take substantial time to fill out. It should, however, also be educational and helpful. A. These are important contributors to our field and don’t have to change. Some of these programs, however, may also become Q. What else will happen at the Meeting of Schools? modules for longer programs as part of an accredited program. Similarly, some programs will integrate on their own, combining A. There will be additional support for schools at the meeting, faculty and expertise, like a university department, in order to offer including many networking opportunities. A school-support com- an accredited program. This is a transition period for everyone and mittee is working on this now. I expect peer-led discussions of IAYT is trying to support constructive dialogue and networking student assessments. Remember, the standards are fundamentally on this. I expect this to be one of the topics too at the Meeting of based upon competencies, not hours, so student assessment with Schools. YTT respect to the competencies is an inherent part of the process. John Kepner, MA, MBA. Q. Will IAYT recognize individuals who graduate from IAYT- Executive Director accredited yoga therapist training programs? International Association of Yoga Therapists

A. Yes, recognizing individuals who meet the educational requirements of the new standards is an inherent part of this process. Exactly how this will be done is under careful deliberation now.

4 YogaTherapyToday WInter 2012 www.iayt.org MemberNews Continued Tribute Helping IAYT Thrive is Worth the Effort Dr. Patanjali Jayadeva Yogendra, the 37-year-old son of Dr. Jayade- John Kepner, Executive Director va and Smt. Hansa Yogendra, died on July 24, 2012, as the result of a tragic automobile accident. He is the grandson of Shri Yogendra, s a 501(c) (3) nonprofit organization, contributions to IAYT are tax founder of The Yoga Institute, the oldest organized yoga insti- Adeductible as allowed by law. tute in the world, founded in 1918. Dr. Yogendra received his MA IAYT is now 3,000 international members strong, with many in ancient Indian culture and his PhD from the University of accomplishments to be proud of, all primarily supported by dues and Mumbai. His doctoral thesis was titled “Yoga in Ancient India as the generous support of its members. Many long-running efforts con- revealed in the Yoga Upanishads.” Dr. Yogendra was the secretary tinue to propel our field forward. We are modestly self-supporting in and treasurer of The Yoga Institute, Santacruz, Mumbai. The assis- current activities, but quite limited in our ability to fund new respon- tant editor of the Institute’s journal Yoga and Total Health, his sibilities and opportunities to support our field. monthly features “The Story that Stirs” represented his deep inter- Your support makes a difference. For example, the two charter spon- est in the power of story to inspire. He is survived by his wife, Smt. sors (Healing Pathways Medical Clinic and the Medical Yoga Insti- Gauri Patanjali Yogendra, and his daughter Kum. Soha. When I tute of Sweden) of the Symposium on Yoga Research (SYR) in 2010 visited The Yoga Institute in 1997, I saw Patanjali, a radiant 22- enabled us to launch it as the first academic yoga research conference in the West. The striking success of that symposium turned out to be year-old, full of potential. He went on to develop much of his a landmark event for our field, and SYR has now become a key pillar potential, but there was so much more for him to develop. We of our mission and our international reputation. send our condolences to Dr. Jayadeva and Smt. Hansa Yogendra. May the memory of Dr. Patanjali Jayadeva Yogendra continue to Key Accomplishments in 2012 shine a light on the yogic path. YTT • Published Educational Standards for the training of yoga therapists. Standards are a key milestone for all emerging fields. This —Eleanor Criswell, President IAYT work was supported by over 100 IAYT member schools and 10 dedicated members of the Standards Committee. • Adopted a Policy Governance Manual for IAYT. This is an important pillar of nonprofit governance. Our sister association, the Nation- al Ayurvedic Medical Association (NAMA), adopted a similar policy. NCCAM video: Scientific Results of Yoga for • IAYT also completed our first financial audit due to the generous support of a board member. (We received a clean, unqualified Health and Well-Being opinion.) video highlighting the science and safety of yoga was released this Priorities for 2013 Asummer by the National Center for Complementary and Alterna- • Conference scholarships, as well as travel support for internation- tive Medicine (NCCAM), part of the National Institutes of Health. al presenters. Featured in this video is the work of two respected investigators in • Enhanced support for IAYT publications, including manuscript management software and supplemental online publication of the field. George Salem, PhD, is at the University of Southern Califor- Yoga Therapy Today. nia, and uses innovative technology to examine how older adults use • Enhanced support for IAYT’s website, including for a web-content their muscles and joints in certain yoga postures. Karen Sherman, editor. PhD, MPH, is at Group Health Research Institute in Seattle, and • Start-up support for implementing the standards, including soft- focuses on how yoga may be a beneficial complementary health prac- ware and administration. tice for people with chronic low-back pain, a common and difficult- to-treat problem. The video also provides valuable “do’s and don’ts” How you can help for consumers who are thinking about practicing yoga—National • Tell a friend about IAYT. Center for Complementary and Alternative Medicine (NCCAM) • Advertise in IAYT publications. • Attend SYTAR, IAYT’s membership conference or SYR, IAYT’s research conference. This video features two IAYT members: Karen Sherman has • Be a conference sponsor. been a presenter at both SYTAR and SYR and has been published in • Become a Patron Member ($1,008, which includes a 5-year mem- the International Journal of Yoga Therapy. Leslie Kazadi was the yoga bership). therapist on George Salem’s study, featured in the video, which Leslie • Make a donation. wrote about in the Winter 2011 YTT. Dr. Salem was a presenter at SYR • Directly sponsor one of the IAYT priorities listed above. 2011 and is an academic sponsor of SYR 2013. To watch the video Scientific Results of Yoga for Health and Well- Major Supporters to Date for 2012 Being, visit http://nccam.nih.gov/video/yoga. YTT • Healing Pathways Medical Clinic (new multi-year pledge) • Medical Yoga Institute of Sweden (new multi-year pledge) Mindful Yoga Therapy for Veterans Coping with To learn more about donation and sponsorship opportunities, Trauma is a collection of simple but effective contact John Kepner, IAYT’s executive director, [email protected]. yoga practices developed by Suzanne Man- since we spun off from the Yoga Research and Education Center afort and Dr. Daniel Libby through practical in 2004, renewing our organization, we have taken the International and clinical experience working with Veter- Journal of Yoga Therapy to peer review and PubMed indexing; estab- ans coping with PTSD and other psycho- lished Yoga Therapy Today as a tri-annual hard-copy magazine; emotional stress. While benefiting trauma launched the Symposium on Yoga Therapy and Research (SYTAR); patients safely and comfortably, the practices launched the Symposium on Yoga Research (SYR); developed a Dig- ital Resources Library to host professional conference presentations can be used by anyone dealing with stress. and support collaborative work by special interest groups; developed The Give Back Yoga Foundation is making a website with a search function for yoga therapists and a member’s this manual available for free to Veterans and section; electronically hosted IAYT publications with a professional VA hospitals. It is also available on our web- search function and a means to distribute subscriptions to academic site, http://givebackyoga.org/shop/mind- libraries; published professional standards for the training of yoga ful-yoga-therapy-for-veterans-coping-with-trauma, if you would therapists; and established strong working relationships with com- like to purchase the book and support free distribution to Veterans. plementary yoga, ayurveda, and professional health care organiza- This practice guide includes a supplement (poster-size) of the yoga tions around the world. YTT practices. YTT www.iayt.org Winter 2012 YogaTherapyToday 5 ConferenceCorner

The Third International Research Congress on This year’s conference was groundbreaking, from the opening talk by long-time Ashtanga Yoga teacher and Give Back Yoga Foun- Integrative Medicine and Health dation founder Beryl Bender Birch, to population-specific workshops, Portland, OR May 15–18, 2012 to visionary Seane Corn’s inspiring closing asana and meditation practice. rom beginning to end, the Congress was a continuous buzz as conversations on breaks and over meals buzzed with dramatic Fresearchers, integrative medicine professionals, and alternative care stories of how yoga helped attendees recover from depression, providers shared the latest in research from their respective fields. domestic violence, drug addiction, or prostitution. Others simply felt The meeting included 1,500 alternative health care providers, 42 par- called to serve. Regardless of the individual story, there was a shared ticipating organizations from around the world, and presentations by sense that meaningful transformation is never simply “all about me.” representatives from the National Heart, Lung, and Blood Institute; “Service means having a mindfulness practice that builds abundance, the Centers for Medicare and Medicaid Services; the Centre for Stud- abundance that you can share,” said Mark Lilly, Street Yoga Founder. ies on Human Stress; the Stanford Prevention Research Center; and “If I find something I love, like these tools I share in yoga service, it’s the Harvard School of Public Health. IRCIMH’s mission is “to foster because I value these tools immensely. I give them away, share them the development of new collaborations and to strengthen existing how best I can. “ partnerships,” and this certainly was the case here. IAYT member Jennifer Cohen Harper, also vice-president of the as a yoga therapist, I was most intrigued by the work on yoga Yoga Service Council, presented a workshop on how to make yoga therapy and mindfulness. The Oral Abstract session on Clinical Yoga safe, effective, and engaging for children, while building skills that Research, which contained clinical research on yoga for low-back will empower them throughout their lives. From Kelly McGonigal we pain, breast cancer, chronic stroke, and chronic migraine, was rich learned how to get involved in research from study design and data with information about the efficacy of particular protocols for specif- collection to peer review and publication, new skills that will help ic populations. The concurrent session on Yoga as Therapy: Rationale teachers share best practices for specific populations. B.K. Bose, IAYT and Research with Sat Bir Khalsa, PhD; Robert Saper, MD; Chris board member, brought the latest research in neuroscience, epigenet- Streeter, PhD; and Kim Innes, PhD, was a key highlight, as were the ics, and somatic psychology to in-class yoga, breathing techniques, sessions “Mechanisms of Stress Reduction and Resilience During and meditation for middle and high schools, called Transformative Mindfulness-Based Interventions,” “Touch Therapy,” and “CAM/IM Life Skills (TLS). in Educational Settings.” Yoga Service Council represents an important institutional vehi- one session that particularly piqued my interest was “The State cle capable of supporting yoga teachers and therapists as they move of the Art and Science in Creative Arts Therapies,” which included out of their studios and offices to bring yoga’s knowledge and gifts presentations on art therapy, drama therapy, and music therapy. I was into their communities. intrigued by the academic traditions behind each form of therapy and The next Yoga Service Council Conference will be held at the their journey toward accreditation, as it provided a perspective on Omega Institute June 7–9, 2013. yoga therapy’s current standardization milestone. —Rob Schware, PhD, President, Yoga Service Council. It was lovely to see each morning of the conference start with a yoga practice led by IAYT board member Susan Gould-Folgerite, and the steady stream of traffic surrounding the IAYT table. It was also encouraging that the early morning breakfast meeting, hosted by IAYT and the Northwest Yoga Therapy Collaborative, attracted a Yoga Sangam: Philosophy, Health, and Research number of yoga therapists and young researchers to hear Sat Bir Khalsa and colleagues address issues surrounding the increasing Conference body of yoga therapy research. Palo Alto, California, September 8–9, 2012 one overarching theme throughout the conference was the need for more rigorous clinical study to meet the prevailing scientific he International Yoga Sangam Conference celebrated Yoga Bharati’s research standards. It was also made clear that yoga therapy research is T10-year anniversary of spreading awareness of the holistic nature rapidly expanding—constrained, however, by inadequate funding. As of yoga to the West, as well as Swami Vivekananda’s 150th birth year. a low-cost and highly effective CAM, yoga therapy is sure to continue The 1st International Workshop on Space Health, Aging, and Yoga to grow as an important part of the integrative health community. Therapy: Metabolic Changes preconference, organized by Taksha —Suzanne Bigelow, Optimal Mindset founder and principal. University, kicked off this groundbreaking event. The preconference highlighted means through which yoga practices can be used to reduce bone loss and other related physical issues faced by individuals engaging in space travel and research. Moving From Inspired to Effective: The First Annual In collaboration with S-VYASA, Yoga Bharati delivered an inspired program that honored the traditions of yoga through discus- Yoga Service Conference sions of its rich philosophies and practices, as well as the dissemina- The Omega Institute, Rhinebeck, NY, May 18–20, 2012 tion of yoga-focused intervention research. IAYT presenters and hon- orees included Drs. Bidyut Bose, Christopher Chappel, Sat Bir Khal- ne of the goals of the Yoga Service Council (YSC) board of directors is sa, Dilip Sarkar, and Shirley Telles as well as executive director John Oto help those making yoga available to underserved populations Kepner. (or those who are interested in exploring this possibility) make a shift The international audience of several hundred participants was from being inspired to being effective. The first annual Yoga Service treated to a rich program of cultural events and afforded the oppor- Conference was a large step toward that goal. Over 150 representa- tunity to become steeped in Indian food, music, dance, and tives of service organizations, yoga teachers, social service providers, pageantry. Most importantly, this event united the global yoga com- and health care professionals from over 30 states, Canada, and Puer- munity and provided ample opportunity for discussion as well as the to Rico came together over three days at Omega’s beautiful campus. cultivation of collaborative partnerships around the world. In that time we built relationships; learned about the practical chal- —B. Grace Bullock, PhD, ERYT-200, RYT-500, editor in chief, lenges and benefits of introducing yoga and mindfulness practices to International Journal of Yoga Therapy, veterans, the incarcerated, trauma survivors, and at-risk youth; dis- International Association of Yoga Therapists. cussed research methods for our field; and identified ways to move forward.

6 YogaTherapyToday Winter 2012 www.iayt.org www.iayt.org Winter 2012 YogaTherapyToday 7 YogaTherapyforDailyLiving by Jacob Griscom Inevitable Success

Introduction to the Series

his article is the first of a three-part series I am contributing to Yoga TTherapy Today. If you’re a yoga therapist interested in starting or growing a financially sustainable professional yoga therapy practice, these articles will introduce you to important mindsets and strategies that will give you what you need to do this. It will also help you to avoid the common pitfalls that cause practitioners to lose clients and fail to build financially sustainable businesses. Without this education and implementation, based on experience with ayurvedic practitioners,1 I believe it is likely that the majority of graduates from yoga therapy programs will not go on to practice, and those who do will not build a sustainable practice without an additional source of income. In the next two articles I’ll teach you a five-step system for focusing your practice in a way that makes it easy to find and serve clients. You’ll learn how to become the “go to” expert for your market, and days, the next 90 days, and the full 6 months of this program. Enter how to build an automatic system for generating new client leads and a 30-minute period into your calendar at the same time each month enrolling them in committed long-term programs for sustainable to update your goals. results with their health. I’ll also show you how to implement the 3. Divide your new behaviors into specific daily and weekly success marketing strategies that give you the best return on your financial or rituals. What will you do? How will you do it? When will you do time investments. Finally, I’ll show you ways to leverage your busi- it? Enter it into your calendar on a recurring basis. ness model so that you can serve more people and generate more 4. At the end of each week, detail your objectives for the next week income, while freeing time in your own schedule. and the actions you need to complete to reach them. Enter the Before we go there, let’s use this first article to cover the founda- actions into your calendar. tional practices that are necessary to create the inner and outer time 5. Every day, detail your objectives for the day and the actions you and space you’ll need to actually implement these strategies. Practic- need to complete to reach them. Start with your highest-leverage ing what you learn here will set you up to quickly start or grow your actions first. practice through the strategies you’ll learn in the next two articles. In addition to plugging a new ritual into your schedule, you can Consciously Designing Results implement additional accountability strategies to make your success inevitable. Accountability strategies can include commitments to The results we reap in life are primarily a reflection of the actions other people (such as a coach or a colleague) as well as financial com- that we take on a consistent basis—our habits. Habits are formed mitments through fees paid for coaching or as a donation where a through behavior rituals that occur over and over until they are auto- commitment is not kept. matic. Generally, this happens somewhat unconsciously. However, if we want to change something with our health, wealth, or relation- Implementation ships, then we can prioritize creating new behavior rituals that will become automatic habits and generate new results, ones that we con- The biggest difference between practitioners who build sustain- sciously choose. able practices and those who don’t is, quite simply, implementation. If we can consistently do a new behavior for about 30 consecu- Sometimes, out of fear, we can get stuck in thinking about action as a tive days it starts to become anchored as a habit.2 To get through that substitute for it. Don’t wait until you feel like taking action—just do first 30 days, we need to employ some willpower and ritual. To gen- it. When we take action, we get results. We learn from our results and erate the willpower, it’s helpful to connect with the pain and prob- then take more action to keep learning and keep improving. If we can lems the old habit is creating and the positive outcomes the new habit adopt an attitude of taking action every time we learn something, we will generate. will make rapid progress. Take a moment right now to schedule an hour in your calendar A ritual for creating change has a few important ingredients:2 and do the “Success Rituals” exercise I just shared with you. You’ll be in an excellent position to implement the strategies I’ll share with you • It should be framed within the specific problems we want to over- in the next two articles to start and grow your successful yoga thera- come or avoid and the specific desired outcomes we want to py practice. YTT achieve. Notes • It should be mapped out in detail. 1. Presented by the NAMA board at the 2012 NAMA conference: 400 grads per year in • As much as possible, it should be done around the same time each the United States, 10% go on to practice. And, from my survey of our Everyday Ayurve- day. da list (of 2400, about 65 responded), I learned that the majority of practitioners are in • It should have a defined beginning and ending. part-time practice and have another source of income (partner or other job); average expected income from practice is $25-$30K/year. How to Create Success Rituals 2. Adapted principles from Eben Pagan’s “Wake Up Productive” program. Jacob Griscom is the president of Everyday Ayurveda, What are the steps you need to take to build success rituals and School of Business. The Grow Your Ayurvedic Business systems into your business and your life? certification program is designed to help you build a successful and transformative ayurveda or yoga therapy prac- 1. Clearly define the problems or challenges you’re facing and the tice for yourself, your clients, and your community. Learn new desired outcomes that you want. more at www.everydayayurveda.org. 2. Detail your desired outcomes into specific goals for the next 30

8 YogaTherapyToday Winter 2012 www.iayt.org www.iayt.org Winter 2012 YogaTherapyToday 9 FeaturedArticle by Judi Bar Cleveland Clinic Embraces Yoga A History and Guide

Background knew of me through my reputation in the program, and write a teaching curriculum to Cleveland area for my work in dealing with teach other yoga therapists and then manage or five years, I endured chronic and debilitat- chronic pain and disease using yoga. them. Fing back pain. Like many people who expe- Although the medical director already had a rience chronic pain and all that comes with it, general yoga class at the center, adding a The process of getting hired I felt powerless. I had hit bottom, and then a therapeutic class for chronic pain appealed to door opened; that door was yoga. Through her. Because I had a history of chronic pain In the winter of 2010 a new medical yoga I healed myself and I am now pain-free. myself and because I had worked with many director at the Center for Lifestyle Medicine That experience showed me my path. I knew patients/students with success, she allowed and the new administrator saw the advan- that I wanted to help others with their pain me to begin teaching yoga for chronic pain tage of having a full-time yoga program man- and disease, and I knew I had to help them classes and I was hired as a contractor. The ager and began the process of hiring me as a through yoga—so I began to teach. class was marketed as a gentle yoga class full-time employee. The challenge was that I I opened a studio and later I began co- designed specifically to help handle pain, didn’t fit into the existing medical model, teaching a yoga teacher and yoga therapist done in a chair, and tailored especially for the which means there wasn’t a precedent for hir- training program. My private yoga studio participants. The class was immediately well ing me and my job title didn’t exist. A job was thriving as I taught therapeutic yoga to received. description had to be found, and a pay scale groups and provided yoga therapy to indi- as the class evolved, I wanted to expand needed to be established. By February 2012, viduals in private sessions. But I still wanted the program into other institutes and depart- the job was offered to me and I was hired full- to reach more people, the people who would ments within the Cleveland Clinic. At that time as the yoga program manager for the not ordinarily take a yoga class because of point, in 2006, there was not as much scientif- Cleveland Clinic. pain or disease challenges, their size or age, or preconceived notions of what yoga is. A general shift in perception has happened in which the profound benefits of yoga have been embraced and are now, through the Expanding into the Medical Field work of many yoga therapists, being incorporated into the Western I felt that working in a medical setting medical model. would be the best way to reach such people, who may not otherwise try or even encounter ic evidence or acceptance of the benefits of My job today yoga. I was first introduced to that opportu- yoga in the Western medical community as nity at a health fair where I discovered the there is in 2012. In those earlier days, I all this brings me to where I am today. Cleveland Clinic’s Center for Integrative encountered many physicians who wanted My job is multifaceted. It entails overseeing Medicine. I knew as solidly as I know myself indisputable clinical proof that yoga works, the management of the Employee Wellness that I wanted to be part of it, and I set about or who believed in the benefits but didn’t Yoga Program, which involves everything learning how to make that happen. want to take a risk without research to back from assessing the capabilities of the teachers The challenge was how? From students, them up. and the quality of the classes being offered to I heard story after story of how yoga heals. as I continued trying to develop more setting the standards for the different types of How it changes people’s lives. As practition- yoga within the Cleveland Clinic, I was able yoga offered. I’m also always looking for ers of yoga we understand and have learned to pioneer yoga classes to employees. Things ways to expand the programs and seek out to integrate the yogic tenets into our lives and were beginning to shift. In the spring of 2008, new opportunities in developing classes in we understand how transformational yoga Cleveland Clinic began offering free yoga specialty areas; an example would be classes can be. How, through yoga, we heal the many classes to all employees, and I helped to for nurses working different shifts. We moni- layers and facets of our whole person. But develop that program. We went from only a tor and track all of our progress through sur- how could I get an academic medical center handful of classes to more than 60 offerings veys, which allows us to keep a pulse on the to embrace what I was seeing? per week, now at various Cleveland Clinic wide range of classes and participants to locations. ensure that everyone is adhering to the mis- First steps into the Cleveland Clinic That same year, during the summer, the sion and vision we have for the yoga offered medical director for the Center for Integrative at Cleveland Clinic. In 2006, I experienced my first break- Medicine recommended me to a new depart- another part of my job is to work with- through. My intention was to offer “yoga for ment, the Center for Lifestyle Medicine. They in the Center for Lifestyle Medicine to create chronic pain” classes under the safe umbrella were looking for a yoga therapist to write a yoga programs to promote lifestyle changes of the Cleveland Clinic, where the many peo- yoga program, and because of my back- that will prevent and reverse disease. Yoga is ple of all ages, shapes, sizes, and religions ground and the fact that I was already estab- always a part of these programs. I mainly who passed through its doors would be lished as a proven contractor, I was awarded work with twelve disease processes, includ- exposed to what yoga could offer. I arranged the position. My job was to co-write a stress- ing but not limited to metabolic syndrome, an appointment with the medical director of management program with a behavioral early-onset prostate cancer, multiple sclerosis, the Center for Integrative Medicine; she health specialist, implement it, instruct the breast cancer, and fatty liver disease.

10 YogaTherapyToday Winter 2012 www.iayt.org FeaturedArticle Continued

• Approach the doctor or medical director with your experience and the personal successes you have seen with your patients/students. • Offer to do a specialty class in their department to see how it is received. • Because yoga is not covered by most insurance plans, you will have to decide what the best payment option is for you and the institution you are working with. • Do your research. Is the current institution working toward offering complementary therapy modalities? Do you know someone that has a relationship with a current institution that can point you to the right person to ask for an interview? • Ask your own doctors and health care practitioners to recommend you. Getting the support of someone in the institution would be a big help. • Watch for want ads.

The opportunities are endless within the Photo credit: Cleveland Clinic current Western medical model: chronic pain, When I create yoga programs, I have to as we expand to other institutes within cardiology, rheumatology, respiratory are just understand the disease from a medical point Cleveland Clinic, I have noticed an increased a few of the departments that could be a start- of view, a yoga point of view, and the acceptance of and willingness to incorporate ing place. Remember that you have both patients’ point of view. Sometimes, I draw on yoga. A general shift in perception has hap- patients and employee populations to con- my previous yoga experiences for what pened in which the profound benefits of yoga sider teaching. Providers within the current works and doesn’t work in the actual classes. have been embraced and are now, through medical model are beginning to see how We have many different people with many the work of many yoga therapists, being yoga can help support and improve the well- levels of disease so I have to be very compas- incorporated into the Western medical being of their employees and their patients. sionate in how I build the programs. I make a model. In my experience, if there is a “top-down” point of training all of the yoga therapists acceptance of the importance of preventative I work with to know and understand con- We are in the right place at the right and complementary therapies, it is much eas- traindications for certain poses and diseases time ier to create opportunities to introduce and and to always modify poses for the partici- grow them. The chief wellness officer, the pants in the program. It requires a tremen- an issue that is tipping the scales in medical director at the Center for Lifestyle dous amount of skill, knowledge, and flexi- favor of yoga and preventative medicine as a Medicine, and other Wellness Institute Man- bility on the part of the yoga therapist teach- whole is the rising cost of health care. This is agers, peers, and administrators all embrace ing the classes in these programs to be able to also stimulating research to understand what yoga unconditionally. accommodate many different degrees and is causing the epidemic of chronic disease in as a now full-time yoga therapist at levels of participants in one therapeutic yoga all ages. Studies have shown that stress is Cleveland Clinic, I am fortunate enough to class, all while offering a class that is engag- implicated in 75% to 80% of all chronic dis- offer yoga in an environment that values and ing and impactful. This diligence in the thor- ease. Research has also shown that the effects provides profound support for complemen- ough training of our yoga therapists in the of stress can be ameliorated through lifestyle tary therapies. I find my personal balance by Cleveland Clinic style of Therapeutic yoga change and through practicing yoga. This endeavoring to live what I teach and by allows the yoga we teach to be accessible, looks promising as a cost-cutting measure. teaching several classes a week to help impactful, and safe to anyone; regardless of We have more NIH science and more studies myself stay compassionately connected to disease or physical mobility. reported in medical journals attesting to the the needs of the patients, employees, and many benefits of yoga. The importance of therapists I work with. Although I have all About our teachers these studies cannot be emphasized enough. certifications necessary, my best training was The more clinical studies that are done, the my life’s practical experiences of working currently, we have three categories of more doors and opportunities will open to us with the medical field for myself and eventu- yoga practitioners at the Cleveland Clinic: the as yoga therapists and practitioners. ally with others. Over the years I have accu- yoga program manager, who oversees and mulated thousands of teaching hours in develops programs in different areas of the Some tips to begin groups and one-on-one sessions, while work- clinic; yoga therapists, who are trained in the ing with participants’ physicians, physical style of Cleveland Clinic therapeutic yoga and how or where you are going to focus therapists, acupuncturists, and other health are certified at least at the 500-hour level of your efforts is entirely dependent on your care providers. I have a voracious appetite to yoga therapy training; and certified yoga experience and comfort level. If you are a learn and much of what I know has come instructors with a minimum of 200 hours of specialist, you can be more targeted with from working with physicians and from training. your approach to working within the medical reading and experience. I learned to under- community. Some tips include: (continued on page 12) www.iayt.org Winter 2012 YogaTherapyToday 11 FeaturedArticle Continued

every moment, and I remain connected to the rhythm and flow of love and kindness and joy on the path that is unfolding before me. YTT

If you would like to learn more about Cleve- land Clinic Therapeutic yoga or Cleveland Clinic Therapeutic yoga workshops that Judi Bar teaches, please email [email protected] or call 877-331- WELL (9355). Judi will also be one of the plenary speakers and afternoon speakers with her medical director at SYTAR in June 2013.

Judi Bar, ERYT-500, is a registered advanced yoga teacher, yoga therapist, and the yoga program manager at the Cleveland Clinic. Judi specializes in therapeutic yoga. While Photo credit: Cleveland Clinic working as the lead yoga therapist for the Cleve- stand the research while working in my pri- expertise is recognized, I am treated with land Clinic’s Center for Lifestyle vate practice, which specialized in chronic equal respect. I am clear that I am not a doc- Medicine, Judi developed a pro- pain and illness. Once at the clinic I learned tor and don’t pretend to know what they gram to treat patients with chron- not only to read the research but to interpret know, but I do know my art, and they respect ic pain, disease, and physical con- it, since I make presentations that need a sci- that. ditions through the healing bene- ence basis. Also I work with wonderful col- I love my work more than I could have fits of yoga. She also developed a leagues on studies and articles and I can ask ever imagined; I am nourished and chal- gentle, more approachable prac- them questions. I speak to doctors with the lenged by it. I have to be fluid and flexible in tice for people who feel intimidated by a tradi- respect they deserve, but with the confidence navigating and communicating effectively tional yoga class. of knowing my field. As yoga is becoming within a well-established medical environ- The style that she developed is practiced by more accepted medically, and our field of ment. I have to be mindful and present in both Cleveland Clinic patients and employees.

12 YogaTherapyToday Winter 2012 www.iayt.org Winter 2012 YogaTherapyToday 13 www.iayt.org Mentor’sCorner: Q&A by Robin Rothenberg Dear Robin, Would sessions specifically targeting vagal nerve stimulation be useful as an adjunct to cancer chemotherapy as well as the known benefits of yin yoga and yoga nidra? —Tony

Dear Tony, The vagus nerve is the primary nerve of the parasympathetic nervous system (PSNS), the aspect of our nervous system that is responsible for both calming us down and for putting the brakes on our fight-or- flight response (governed by the sympathetic nervous system [SNS]). According to the polyvagal theory proposed by Porges,1 the stress response can be viewed as the withdrawal of vagal tone to the heart in response to a challenge. Thus, our vulnerability to stress can be assessed by our vagal tone. In other words, the degree to which we can handle the curve balls life throws us without freaking out, acting out, or shutting down is a direct measure of our vagal tone and con- low this mode of practice: sequently the health of the vagus nerve. start on the back, non-weightbearing. Work asymmetrically, cancer and its treatment is certainly a huge life stressor and beginning with her un-injured side to assess her normal range of could challenge even the most calm and grounded of individuals. motion. This will help you both to be more aware of the imposed lim- The good news is that many of our practices in yoga, such as restora- itations from the injury when you switch to the other side. Once you tives, yin, and nidra, target activation of the PSNS. However, there are get a picture of where she’s particularly weak, use adaptations of other simple ways of accessing it as well. For instance, focus on asanas (still non-weightbearing) that focus her attention on recruiting extending the exhalation. Exhalation is governed by the PSNS and the necessary muscles to support the joint. Work slowly as in a automatically lowers heart rate. Adding a gentle contraction-release dynamic cobbler pose, fanning the knees apart and together to devel- of the abdominal muscles in coordination with the breath increases op strength and awareness. I have a rule for my chronic dis-locators the vagal tone and will amplify the PSNS effect. Mantra combined that they only stretch to three-quarters of their maximum range. with the exhalation can further boost the PSNS. Slowing asana way Working in a smaller range creates a more controllable movement down so that the slow-twitch rather than fast-twitch muscle fibers are and avoids any tendency to hang in the ligaments. activated is another direct route to PSNS stimulation. It will be very important to bring the core muscles on board as The vagus nerve also mediates the complex social and attach- you’re working with her, pelvic floor and transverse abdominis espe- ment behaviors that support bonding. It’s good to know that the rela- cially. Watch her breath, face, etc. In working with someone who has tionship skills we develop as yoga therapists in and of themselves had to cultivate a very high threshold for pain, you may need to reinforce social engagement, thus positively increasing vagal nerve coach her to notice her body’s discomfort before she’s even aware of tone. These include increased eye contact; empathetic facial expres- it. I’d suggest working from the back, side and belly, exploring the sion; strong listening skills; soft, encouraging voice tone; and smiling range of movements that are possible in the hip that emphasize the and laughter. strength of the adductors, abductors, hip flexors, glutes, and rotator great question—and one that highlights the incredible potential muscles. for yoga therapy to address a multitude of stress-induced conditions from there I’d suggest standing work, staying in that three-quar- that plague many of our clients. Thank you for asking. ters range or even less. Standing automatically ensures that the muscles around the hips will be recruited and poses like virabhadrasana I Reference and II (warrior I and II) can be adapted to bring even more focus on 1. Porges, S.W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, muscle strength with less emphasis on lateral rotation or hip exten- Attachment, Communication, and Self Regulation. New York: W.W. Norton Company, Inc. sion. I’d stay clear of poses like utthita trikonasana (triangle), especially in the style that emphasizes big hip glide in the socket. That kind of force could lead to dislocation. I would also avoid seated hip open- Dear Robin, ers, or poses like pigeon that offer no protection for the hip and are A veteran injured in Afghanistan was recently referred to me. She dislocat- all about stretch. ed her hip, and since returning to the United States has had surgery and coach her to move very slowly with great control, working intense physical therapy, including the use of machines that, she says, forced dynamically as opposed to statically. This will work on the deeper her body into painful positions. Before her injury, she used to practice Bikram stabilizers of the hip and help her develop strength and endurance Yoga. Now, she wants individual coaching to help get her back into shape, compassionately over time. YTT and she wants yoga because of its holistic nature and because she wants to use her own body to heal herself. What are some physical cautions that I should be aware of in terms of her hip’s tendency to continue “popping out?” —Kelly Robin Rothenberg is an internationally recognized yoga therapist, teaching in hospitals and clinics in the Seattle Dear Kelly, area. She offers an RYT-500 teacher training and compre- Destabilization of the hip is particularly disconcerting because of the hensive yoga therapist training for experienced teachers. potential impact on everything above and below, including the Robin is the author of The Essential Low Back Pro- sacrum, lumbar, and knees. Caution is well advised when doing any gram: Relieve Pain & Restore Health, and Soothing kind of deep hip rotation, flexion, or extension of the joint. If your the Spirit: Yoga Nidra to Reduce Anxiety (CD). client has not had specific recommendations from her doctor, I’d fol-

14 YogaTherapyToday Winter 2012 www.iayt.org www.iayt.org Winter 2012 YogaTherapyToday 15 Perspectives by Kelly Birch In the Spirit of Collaboration: Sharing Research with the Medical Community

e at IAYT are often asked for help in finding relevant research in Dilip Sarkar, MD, one of IAYT’s board members, who teaches a Wyoga, because, after all, we publish research in our journal, we lot of physicians about yoga, stresses that the best way is not neces- have a research conference (SYR) and we discuss research at our sarily to show the evidence, but to simply help the physicians to membership conference (SYTAR). I pondered what I would say to a start practicing. He and another IAYT member, Satkirin Khalsa, MD, busy clinician or other medical provider if I wanted to describe the have been pioneers in offering CME’s for workshops for physician current evidence base for yoga, in the spirit of collaboration. So, I sent on yoga. John Kepner, MA, MBA, IAYT Executive Director. the following question to a variety of people, including yoga therapists, trainers, and researchers, and received a variety of answers. Some answered the question as is, and, as might be expected from For hypertension, Herbert Benson; for heart disease, Dean Ornish; such a group, some turned the question around and provided cre- for back pain, Karen Sherman. ative answers to a different question that shed further light on the I’d summarize the evidence to cite the efficacy, the low cost, issue of communicating with medical providers, which was the intent and the positive side effects of better range of motion, greater of the question. I hope you enjoy the different responses and that this strength, improved balance and coordination, and lower anxiety, will be of some use to you. and maybe throw in some of Shirley Telles’ work there. Loren M. Fishman, MD, BPhil (Oxon), Manhattan Physical Medicine and Rehabili- tation. If a yoga therapist had 10 minutes to discuss with a doctor/clinician the evidence base for yoga therapy and how it could be of benefit to some of their patients as an adjunct The NIH has released a video and statement on their web site rec- treatment, how would you summarize the evidence base ommending yoga as a CAM therapy for a variety of conditions and/or what three research studies would you recommend? based on the growing evidence in the literature. Along with The International Journal of Yoga Therapy, a peer-reviewed journal on Summaries and Comments PubMed, many other medical journals such as the Annals of Internal Medicine, the Journal of the American Board of Family Practice, Cancer, “As you know, Doctor, many of your patients’ complaints are stress the Journal of Pain as well as health newsletters such as the John Hop- and lifestyle-related. Yoga therapy is far more than stretching and kins Medical Letter and the Harvard Women’s Health Watch publish here’s a desk copy of your colleague Timothy McCall MD’s Yoga As evidence-based articles on the efficacy and safety of yoga therapy. Medicine that offers some evidence. I can get you more specific evi- Nicole DeAvilla, E-RYT 500, Yoga director of Musculoskeletal Yoga Ther- dence for your patient population, but the best way to learn is for apy for Ananda Yoga Therapist Training, yoga teacher trainer and yoga you and your spouse to try a private complimentary session with therapist educator/trainer for the Stress Management Center of Marin, me to experience yoga therapy first hand.” Matthew J. Taylor, PT, PhD, IAYT Accreditation Committee, and author. ERYT, Matthew J. Taylor Institute of Scottsdale.

I would cite any study by Dean Ornish that deals with results of My understanding is that the conventional evidence base is current- lifestyle changes in the area that the MD is interested in. I would ly quite thin, but is growing rapidly. I would love to show them Sat summarize it by saying that today we know that the majority of the Bir Khalsa’s slide that demonstrates the rapid growth in peer- money being spent on health care is on chronic illness and only a reviewed studies. I would say that our field has its own peer- comprehensive lifestyle program can change that, and that yoga reviewed, PubMed-indexed journal and our own scientific research (which is more than asanas) deals with all aspects of lifestyle. Staffan conference. And I would love to show them the new NCCAM Elgelid PhD, GCFT, PT, CYT, associate professor of physical therapy at videos. Nazareth College, and owner of SomatologiK. The most famous series of studies in our field are the Dean Ornish Lifestyle Change studies showing that a yoga-based lifestyle consisting of a plant-based diet, regular exercise, stress reduction I have been using yoga in conventional healthcare settings for over (via yoga) and group support can reverse heart disease—and that ten years. In truth, I have never had to cite a research study, as every this program has been accepted for coverage by Medicare. This may get a doctor with whom I have ever worked has been interested and doctor’s attention most of all! In my layman’s view, some of the most excited by the idea of yoga and yoga therapy as an adjunct treat- influential studies over the past ten years are the clinical trials by ment. It is my passionate belief that it is who we are and how we Karen Sherman et al. showing that a well-designed and well-taught present ourselves professionally that doctors are most interested in, yoga program can be beneficial for chronic lower-back pain com- and that we must not perpetuate the divisive idea that “Western pared to straight exercise and especially better compared with the docs” see yoga as threatening. That being said, I have often created conventional treatment of handing the patient a book on self-care. simple handouts that list general benefits and relevant research for (IAYT Advisor, Robin Rothenberg, was the yoga teacher in that the population with whom I will be working. Molly Lannon Kenny, study.) MS-CCC, Founder and Executive Director, Samarya Center.

16 YogaTherapyToday Winter 2012 www.iayt.org Perspectives Continued Summaries and Comments Research Studies and Comments There is growing evidence that yoga has multiple positive effects on Streeter, C. C., Gerbarg, P.L., Saper, R. B., Ciraulo, D. A. & Brown, health and can aid in the management of a broad range of chronic R.P. (2012). Effects of yoga on the autonomic nervous system, conditions. For example, recent research suggests yogic practices gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and may be beneficial for improving physical and cardiopulmonary post-traumatic stress disorder. Medical Hypotheses, 78, 571–579. function; enhancing mood and sleep; reducing stress and anxiety; • Streeter (2012) represents a milestone in our field as yoga research improving memory function; decreasing pain, including chronic matures from describing the benefits of yoga to explaining the low back pain; and improving blood pressure, lipid profiles, and mechanisms that initiate and support those biopsychological other cardiovascular disease risk indices. Kim (Karen) E. Innes, MSPH, changes that move our clients to greater wellness. It put the vagus PhD; Associate Professor, Dept. of Epidemiology, West Virginia University nerve and the important related metric heart rate variability into School of Public Health; Clinical Associate Professor, Center for the Study the vocabulary of many yoga therapists; these will become foun- of Complementary and Alternative Therapies and Dept of Physical Medi- dational concepts in future yoga research. Stephanie M. Shorter, cine and Rehabilitation, University of Virginia Health System. PhD, yoga researcher, neuroscientist, program director, YogaFit Therapy Program. • This paper explains the neural and physiological correlates that When speaking with doctors about the relevance of yoga therapy, I give rise to global changes in the body. Heather Mason, MA, RYT-500, begin with my ANS (autonomic nervous system) elevator speech, Minded Institute. explaining yoga’s impact on increasing vagal tone and quieting the sympathetic nervous system fight-or-flight response. This focuses Streeter, C. C., Whitfield, T. H., Owen, L., Rein, T., Karri, S. K., on the science of stress and yoga’s huge role in shifting that para- Yakhkind, A., . . . Jensen, J. E. (2010). Effects of yoga versus walking digm to support healing. Then, I bring up the two lower back pain on mood, anxiety, and brain GABA levels: a randomized controlled studies I was personally involved in that were published in the MRS study. Journal of Alternative and Complementary Medicine, 16, Annals of Internal Medicine and Archives of Internal Medicine. I may 1145–1152. mention IJYT’s acceptance on PubMed, which lends evidence-based • In a randomized controlled MRS study, researchers at Boston Uni- credibility to our work; and Richard Davidson’s work on mindful- versity compared study participants who walked three times a ness, which includes brain scans, reports on immune function and week for exercise to a group assigned to three weekly yoga class- blood pressure, etc. The ANS speech is definitely my go-to. I recent- es over a period of twelve weeks. GABA levels were significantly ly used it to address the concern of a hospital doctor that I was elevated in the yoga practitioners and there were more mood attempting to “treat” cancer, rheumatoid arthritis, and MS via yoga. improvements in the yoga group on standard psychosocial meas- By the time I finished, he offered to refer a number of his patients to urements. Amy Weintraub, MFA, ERYT 500, Founding Director, LifeForce my therapeutic yoga class. Robin Rothenberg, Certified Yoga Therapist; Yoga Healing Institute. Founder, Essential Yoga Therapy. • A one-hour yoga intervention increases brain GABA levels above and beyond a walking control in a normative population. This indi- cates that yoga has the potential to curb various issues associated with reduced GABA including anxiety, depression, epilepsy, and chronic pain. Heather Mason, MA, 500-RYT, Minded Institute.

Streeter, C. C., Jensen, J. E., Perlmutter, R. M., Cabral, H. J., Tian, H., Terhune, D. B., . . . Renshaw, P.F. (2007). Yoga Asana sessions increase brain GABA levels: a pilot study. Journal of Alternative and Complementary Medicine, 13, 419–426. • I would cite Chris Streeter’s series of articles (2007, 2010, 2012) documenting (1) improvements in GABA levels, (2) the distinction between yoga and walking, and (3) suggested mechanisms of action, respectively. Amy Moran, MA, RYT, Veterans Affairs Health Care System, Veterans Meditation Project (4L100), Veterans Yoga Program (4KTBI).

• The field of yoga research has grown sufficiently to the point where we now have numerous recent publications reviewing yoga research in general and specific to special populations. I would therefore provide one or more of such review studies, for example:

Meditation practices for health: state of the research University of Alberta Evidence-based Practice Center Edmonton, Alberta, Canada (2007) www.mentalhealthwatch.org/reports/meditation.pdf

(continued on page 18) www.iayt.org Winter 2012 YogaTherapyToday 17 Perspectives Continued Research Studies and Comments

Effects of yoga on mental and physical health: a short summary From a biochemical standpoint, the evidence shows tha of reviews yoga decreases cortisol levels (stress hormone), increases GABA Büssing, A., Michalsen, A., Khalsa, S.B.S., Telles, S., & Sherman, levels (primary inhibitory neurotransmitter), increases HRV (heart K.J. (2012) rate variability), increases BDNF (neuroplasticity, genetic expres- http://downloads.hindawi.com/journals/ecam/2012/165410.pdf sion), and stimulates vagal nerve activity—all signifiers of improved mood. The effects of yoga on anxiety and stress. From a psychosocial perspective, there are a few rigorous Li A.W., Goldsmith C.A. (2012) (i.e., randomized controlled trials, or RCT) studies that use gold http://www.altmedrev.com/publications/17/1/21.pdf standard measurements like the Beck Depression Inventory (BDI) and the Profile of Mood States (POMS) to demonstrate that prac- Health impacts of yoga and pranayama: A state-of-the-art review ticing yoga improves mood, but in many large, well-funded RCTs Sengupta, P. (2012) that are designed to look at other outcomes like quality of life in www.ncbi.nlm.nih.gov/pmc/articles/PMC3415184/ cancer survivors or improvement in cardiovascular or diabetes symptoms, measurements also show that the yoga group shows a Yoga as an ancillary treatment for neurological and psychiatric marked improvement in mood as compared to controls. disorders: a review. There are many more large, well-funded studies underway. Meyer, H.B., Katsman, A., Sones A.C., Auerback, D.E., Ames D., & I also let clinicians know that when used in psychotherapy, yoga Rubin R.T. (2012) practices that do not require a mat can strengthen the therapeutic www.ncbi.nlm.nih.gov/pubmed/22772663 alliance, help clients focus and access feeling states, provide tools for mood regulation, and increase feelings of self-efficacy. Exercise, yoga, and meditation for depressive and anxiety dis- Amy Weintraub, MFA, ERYT 500, Founding Director, LifeForce Yoga Heal- orders. ing Institute. Saeed S.A., Antonacci D.J., Bloch R.M. (2011) http://www.aafp.org/afp/2010/0415/p981.pdf Streeter et al. (2012) Sat Bir S. Khalsa, PhD, director of research for the Kundalini Research Institute, research director of the Kripalu Center for Yoga & Health, and Ross, A., & Thomas, S. (2010). The health beneﬁts of yoga and exer- assistant professor of medicine at Brigham and Women’s Hospital, Harvard cise: a review of comparison studies. Journal of Alternative and Com- Medical School. plementary Medicine, 16(1), 3–12.

Field, T. (2011). Yoga clinical research review. Complementary Thera- Streeter et al. (2012) pies in Clinical Practice, 17, 1-8. • These three studies really speak to the benefits of yoga and why Shapiro, D., Cook, I. A., Davydov, D. M., Ottaviani, C., Leuchter, yoga works. I would summarize them by saying that one of the pri- A. F., & Abrams, M. (2007). Yoga as a complementary treatment of mary ways yoga is an effective treatment for a variety of conditions depression: effects of traits and moods on treatment outcome. Evi- is that yoga helps to reduce allostatic load by increasing parasym- dence-Based Complementary and Alternative Medicine, 4, 493–502. pathetic tone. How does this happen? Yoga postures and breath- • Of the 17 completers, all diagnosed with unipolar depression in ing techniques help to regulate the vagus nerve, which improves partial remission, who took 20 Iyengar yoga classes, 11 were in heart rate variability (a measure of resilience). Simple yogic tools complete remission after the intervention. Significant reductions such as the three-part breath help to activate the parasympathetic were shown for depression, anger, anxiety, and neurotic symp- system, which reduces stress and can lead to a reduction of physi- toms. The authors state that the overall remission rate of 65% cal and mental health symptoms. Angela Wilson, MA, Kripalu Center “compares favorably with other CAM interventions: 43% Sam-e; for Yoga & Health, Manager, Evidence-Based Yoga Curriculum. 20% Omega-3 fatty acids; 19% folic acid; 25% aerobic exercise.”

Bennett, S. M., Weintraub, A., & Khalsa, S. B. S. (2008). Initial eval- Curtis, K., Osadchuk, A., & Katz, J. (2011). An eight-week yoga uation of the LifeForce Yoga® program as a therapeutic intervention intervention is associated with improvements in pain, psychological for depression. International Journal of Yoga Therapy, 18, 49-57. functioning, and mindfulness, and changes in cortisol levels in • Between times one (before the LifeForce Yoga® program) and two women with fibromyalgia. Journal of Pain Research, 4, 189–201. (two weeks after learning it), participants reported a 64% decrease • Whereas most health-related studies emphasize stress reduction in total mood disturbance (POMS) and a 53% decrease in average and a decrease in cortisol, this pilot study showed that yoga depression scores (BDI). At two months, overall mood disturbance increased cortisol levels in women with fibromyalgia and lessened continued to drop. their pain, a powerful demonstration that yoga heals where it is needed. Yoga teachers often say that the practice provides exactly There is a growing body of scientific research that validates yoga what is needed-this study corroborates that beautiful sentiment. as a treatment for mood disorders, including anxiety, depression, and post-traumatic stress disorder, as well as other conditions like Bernardi, L., Sleight, P., Bandinelli, G., Cencetti, S., Fattorini, L., ADHD, OCD, and the management of bipolar disorder and schiz- Wdowczyc-Szulc, J., & Lagi, A. (2001). Effect of rosary prayer and ophrenia.

18 YogaTherapyToday Winter 2012 www.iayt.org Perspectives Continued Research Studies and Comments yoga mantras on autonomic cardiovascular rhythms: comparative Evans, S., Moieni, M., Taub, R., Subramanian, S. K., Tsao, J. C., study. British Medical Journal, 323, 1446–1449. Sternlieb, B., & Zeltzer, L. K. (2010). Iyengar yoga for young adults • A perfect example to refute the bias that yoga equals physical pos- with rheumatoid arthritis: results from a mixed-methods pilot study. tures and to open up a discussion of the importance of the breath Journal of Pain and Symptom Management, 39(5), 904–913. in the mind-body-spirit connection, this study by Luciano Bernar- di and colleagues reinforces that yoga is for absolutely anyone who John, P. J., Sharma, N., Sharma, C. M., & Kankane, A. (2007). Effec- iis breathing! Results showed that cardiovascular rhythms were tiveness of yoga therapy in the treatment of migraine without aura: a optimized when respiratory rate was six cycles per minute. randomized controlled trial. Headache, 47, 654–661. Stephanie M. Shorter, PhD, yoga researcher, neuroscientist, program director, YogaFit Therapy Program. Rollins, J. (2010). Reconnecting the head with the body: integrated care models. Counseling Today. An American Counseling Association Publication. Retrieved from http://ct.counseling.org/2010/01/recon- I would suggest the following reviews that are, in my opinion, the necting-the-head-with-the-body best on the effects of yoga as a therapy. Daubenmier, J. J. (2005). The relationship of yoga, body awareness, Khalsa, S. B. S. (2004). Yoga as a therapeutic intervention: a biblio- and body responsiveness to self-objectification and disordered eating. metric analysis of published research studies. Indian Journal of Physio- Psychology of Women Quarterly, 29(2), 207–219. logical Pharmacology 48: 269–285. • Because of yoga’s relaxing effects, yoga can be an excellent way to Innes, K. E., & Vincent, H. K. (2007). The influence of yoga-based help someone who is coping with the mental stress of physical ill- programs on risk profiles in adults with type 2 diabetes mellitus: a sys- ness, even if it doesn’t lower pain or alleviate symptoms of the dis- tematic review. Evidence-Based Complementary and Alternative Medicine, ease directly. These studies show how yoga can be used to both 4, 469-486. alleviate symptoms directly and help patients manage the stress Innes, K. E., Bourguignon, C., & Taylor, A. G. (2005). Risk indices and pain of illness. However, yoga is not a cure-all. Through the associated with the insulin resistance syndrome, cardiovascular dis- above studies, we are still exploring yoga’s effectiveness in alleviat- ease, and possible protection with yoga: a systematic review. Journal ing physical symptoms versus mental stress. Doctors should be sure of the American Board of Family Practitioners, 18, 491–519. to refer patients to yoga teachers and/or therapists with the appro- Yang, K. A. (2007). A review of yoga programs for four leading risk priate training and credentials for the symptoms and illnesses they factors of chronic diseases. Evidence-Based Complementary and Alter- treat. Michelle J. Fury, LPC, RCYT, yoga therapist, Ponzio Creative Arts native Medicine, 4, 487-491. Therapy Program-Children’s Hospital Colorado.

• Yoga has proven potential as a preventive, adjunct, and rehabilita- tive therapy and as it is cost effective and relatively safer, why not Ross, A., & Thomas, S. (2010). The health benefits of yoga and exer- try it? If you reduce medications for your patients by 10-20%, you cise: a review of comparison studies. Journal of Alternative and Comple- are reducing chances of adverse effects and side effects by 50%. mentary Medicine, 16, 3–12. Yogacharya Dr Ananda Balayogi Bhavanani, chairman: ICYER and Yogan- • A meta-analysis distinguishing yoga from exercise-yoga is not a jali Natyalayam. replacement for exercise or vice-versa. Shelov, D. V., Suchday, S., & Friedberg, J. P. (2009). A pilot study measuring the impact of yoga on the trait of mindfulness. Behavior Spicuzza, L., Gabutti, A., Porta, C., Montano, N., & Bernardi, L. Cognitive Psychotherapy,37, 595–598. (2000). Yoga and chemoreflex response to hypoxia and hypercapnia. • This pilot study suggests that yoga may serve as another vehicle for Lancet, 356(9241), 1495–1496. cultivating mindfulness. • Hypoxia is a contributing factor in many diseases resulting from both increased sympathetic tone and increased potential for From a mental health perspective, I would describe the evidence genetic mutation. This study demonstrated that slow breathing in base as small, growing, and promising. Amy Moran, MA, RYT, Veter- yoga reduced the chemoreflex and the impact was more powerful ans Affairs Health Care System, Veterans Meditation Project (4L100), when also using asana. The implications are substantial for chron- Veterans Yoga Program (4KTBI). ic disease management. Heather Mason, MA, RYT-500, Minded Insti- tute.

www.iayt.org Winter 2012 YogaTherapyToday 19 Perspectives by Molly Lannon Kenny Healer, Heal Thyself An Equation for Change

You + Your = Opportunities techniques for healing

omewhere around the winter of 2008, I moment at her patient with a look of deep Long before I initiated the Bedside Yoga pro- Sreceived a phone call that would lead to a care. She touched the woman on her head and gram for end of life, and long before I had any pivotal event in my life—as a human being, then turned to me with a quiet expression, as interest in or experience with yoga, I had as a therapist, as a yoga teacher, and as a yogi. if to say, “Here you go,” and shut the door. It been employed as a speech pathologist in a When I answered my phone, I heard the was just me, the dying woman, and the conventional setting. I had worked in both voice of the volunteer coordinator at the end- music. I felt instantly and simultaneously the acute care and follow-up units, and had of-life facility where I was a volunteer: both lost and empowered. I had been with spent several years working with people in “Molly, there’s a woman here who is begin- many people in the last days, and even hours, challenging health, and life, situations. With ning her imminent transition from life. She’s of their lives, but this was different: I had my clinical training and experience, I had scared and calling out and there is no one never been with anyone that I didn’t know at honed my techniques to the degree I could; I here to be with her. The nurses have asked for all, and who, as far as I could tell, was com- felt comfortable with, and knowledgeable support in her transition. They asked if any- pletely unaware of my presence. As the pan about, best practices and contraindications one from The Samarya Center was available flutes droned, and the waterfalls cascaded, I for a variety of conditions. I existed in a cul- to come down and be with her.” I’m not sure thought to myself, “This is it. This is every- ture that largely rejected the sense that the what made me respond the way I did-was it thing I have ever taught and everything I practitioner, as a unique human being, because as the person who started the Bed- think I believe. If I believe in my work, and I should be shared too generously with the side Yoga program, I thought it was my believe in the power of human connection, patient. This is, in fact, in direct contrast to the duty? Was it my ego reminding me of my then my presence here is meaningful and strong body of research suggesting that the own great importance in the matter? Was it a powerful. I just have to do what my intuition relationship between the patient and the ther- real calling from my heart? Was it because of tells me, and I may be able to offer some- apist is the single most important element in some divine sense that this would be a pow- thing.” With that I placed my hands on the the process of healing.1 erful, and deeply meaningful, moment in my woman’s head and began to offer prayers of life and growth? I really don’t know. Proba- peace and connection. Drawing from my I wanted to help people, I cared bly a little bit of all of that, but nonetheless, I Reiki training, I moved from her head to her deeply about their suffering, but heard myself saying, “I’ll be right there.” knees, to her feet to her hands. I sat for what When I arrived at the medical center, I seemed like hours with her hands in mine, I also wanted freedom from my was brought to the room of a woman I had praying that if I was offering her nothing par- own suffering, and from my own never met. Although I had already had the ticularly earth shattering, that I was offering ego, an ego that told me that profound, and profoundly humbling, oppor- this body, this being, this soul, some humble changing others was up to me— tunity to attend a scheduled death at the facil- gift of care and connection in her final ity, I had never been left totally alone with moments on this planet. that when people experienced someone who was in her final hours of life. I After some time, I wish I could say it was healing, it was because I had had absolutely no connection to the woman intuition, but more likely it was when it done a good job, and that when in Room 103. I was shown in by Margaret, became too uncomfortable to lean over her one of my favorite nurses at the program. body in bed, I quietly disconnected from her they did not, I had done a poor “She’s transitioning quickly, but she’s so and left her room. I was later told that she had one. afraid, and so alone. She’s been crying out passed shortly after I left, and the nurses and can’t seem to get comfortable. I thought reported that she seemed to pass in peace. I at the same time, I witnessed and clear- you might be able to help,” followed by, “I didn’t know what to do with that informa- ly understood that the equation could be wasn’t sure when you’d get here—I’ve just tion. I still don’t. Of course, I want to think it wrongly skewed in the other direction: the administered a sedative to help her relax.” I was because of me—my presence and my car- archetype of the all-knowing healer who, by will never forget entering her room. There lay ing had allowed her to transition quietly and sheer proximity to his or her greatness, could a woman alone, mouth agape, breathing seemingly without fear—but the truth is, it fix, cure, heal, or dismiss a patient. This, as I erratically, and for all intents and purposes, could have just as easily been the valium, or saw it, created disconnection not just between completely drugged out of any real sense of the time, or the body’s innate wisdom and the patient and clinician, but also within the what was happening. There was the unmis- ability to let go, or some combination of all clinician. For my part, the intense pressure takable smell of dying. And then there was those things. Whatever the reason, in my own and feeling that I should be the one making the music. The staff had put on what I now life this was a profound experience I return to the changes happen in my patients’ lives was refer to as “dying music”—insipid New Age again and again in my thinking, in my prac- manifesting both in my emotions and in my pan flutes and waterfalls, intended to create a tice, and in my teaching. physical body. I was routinely going home at calming environment. Margaret gazed for a But let me not get too ahead of myself. night both depressed and anxious, as well as 20 YogaTherapyToday Winter 2012 www.iayt.org Perspectives Continued

in physical pain, particularly centered both sides. To create the factor of “you,” you around my upper back, shoulders, and arms. must be committed to deep self-inquiry and Sometimes the pain would be so intense that constantly seek to see the other as atman, not less I couldn’t even lift my arms enough to pick than, but equal to “us.” This requires practice, up a dish or wash my face. dedication, and total commitment to the power I knew intuitively, even before I knew of this part of the equation. At the same time, we anything about yoga, that in the intention to must not confuse this understanding of the help and heal, there was some in-between power and potential of our loving presence with place, a new equation, in which a balance a hubris that suggests we don’t need specific between deep human connection and well- techniques. Our techniques give us something established interventions and techniques concrete to offer, and remind us of best practices would create the optimal conditions in which and contraindications. Indeed, it is our tech- healing would occur. I longed to understand niques, not us, per se, that we are promoting this place, to be shown this equation, to be and offering when we say we are therapists, able to do the correct math. I wanted to help start up programs like Bedside Yoga, or endeav- people, I cared deeply about their suffering, or to explain or share what it is that we are but I also wanted freedom from my own suf- doing to create conditions for change. fering, and from my own ego, an ego that I didn’t have this equation in mind when told me that changing others was up to me— I met the woman in Room 103; I hadn’t yet that when people experienced healing, it was arrived at this place in my own learning or because I had done a good job, and that when teaching. And yet that experience was one of the they did not, I had done a poor one. abundant with time and experience. What precise moments in time where I understood What a relief it was then, when through makes this part of the equation complicated is and trusted in this magical balance. I brought all my deepening spiritual pursuit through the fact that we often rely too heavily on tech- of myself to the experience, including all of my yoga, I discovered a simple truth: that we niques because we don’t see a need for or insecurities, curiosity, not-knowingness, and cannot change anyone or make anyone do don’t trust in our simple presence. We start to trust. I brought the sense that, as a human being anything. That we are in fact, not the “do- allow the techniques to dominate our work, with the intention to allay another’s fears, I ers,” and that to think we are creates confu- believing more in the techniques than we do would be able to offer something. But I also sion and suffering. The best we can do, and in ourselves or in the person with whom we offered my best techniques. If I hadn’t known the best we can do for others, is to help them are working. The techniques become the Reiki, or meditation, or basic Thai yoga tech- set up conditions for change, and to trust in engine driving our work and, in doing so, all niques, I wouldn’t have thought I had anything the innate wisdom, desire, and divine timing but subsume the subtle and powerful force of to offer. And finally, if I thought that I was the of the other person for that change to occur, real human connection and a sense of wonder “do-er,” that it was my job to make this in whatever form it takes. The understanding and divine wisdom. woman’s transition into death more peaceful, I of this truth led me to the equation I had been In my experience, this equation for heal- would have been unsatisfied with just about seeking, and one I have been passionately ing really is like a math equation-it must be any outcome. But since I understood that my job sharing for over a decade. balanced on both sides, and for us to make it was only to set the conditions for change, to The equation, thankfully, is quite simple, function, we must be willing to work on both offer an opportunity for healing, it was a job I because it requires only two elements. The sides simultaneously and to be able to see knew I could do, and whatever the outcome first is the understanding that our “gift is our how and why one side or the other is domi- was would be more than satisfactory. Of course presence.” In other words, the healing that nating. It also requires us to check often on the I’ll never know what that woman’s experience we hope to facilitate, or the yoga that we outcome-as we “show our work” we are mak- was as she passed. But I will know my experi- share, is within us, not dependent upon the ing sure that we are coming to the same con- ence: one free from ego and fear, that once again other. This abnegates completely our own clusion, that we are setting up conditions for deepened my faith in a human connection so agenda, our inflated sense of self and our change, opportunities for healing, and not powerful it could be felt and shared, through own importance. It invites an exquisite para- working toward a different outcome, one skillful means, intention, and loving presence, dox: on the one hand, that we have a pro- where we are trying to make a specific change in any situation anywhere-even in a room filled found ability to influence others and the tra- occur. with the oddly sweet smell of death and the jectory of their healing and, on the other, that I have seen, in both the conventional clin- warbling sounds of the pan flute. YTT we don’t actually have to “do” anything-we ical model and in the world of yoga-based Reference simply have to “be.” Of course, although I therapy, well-meaning interventionists miss- 1. Lambert, M. J., & Barley, D. E. (2001). Research Summary say that the equation is simple, requiring just ing out on the best part of healing work by on the therapeutic relationship and psychotherapy outcome. Psychotherapy, 38(4), 357-361. two elements, this first one, the true under- creating more difficulty than is necessary or standing of self, is actually incredibly chal- simply doing less than the best that is possi- Molly Lannon Kenny is the founder lenging. We have to first do the hard work of ble. I have seen and experienced the opposites of The Samarya Center based in healing ourselves, of understanding our own of ahimsa, satya, and asteya when the practi- Seattle, Washington, and vice presi- biases, prejudices, and limitations, as well as tioner robs the client or student of his or her dent of the IAYT board. She hosts a acknowledging and developing our greatest own self-efficacy by overreliance on one or biweekly podcast series called Trans- gifts, whatever they may be. the other parts of the equation. To really set parent: Yoga and Everyday Life in Fortunately, the second part of the equa- conditions for change, to provide opportuni- which she shares thoughts on all tion really is simple. Techniques are relative- ties for real, lasting, and empowered healing, things yoga and human. Look for her book, No ly easy to learn, and will get better and more we must work dutifully and courageously on Gurus Came Knocking, due out in April 2013. www.iayt.org Winter 2012 YogaTherapyToday 21 The International Association of Yoga Therapists is proud to an The Front Line of Yoga Research • • • • • • • • • • • • • • • • • • • • • • symposium on yoga research June 11–13, 2013 • Boston

SYR is the West’s foremost academic yoga research SYR Program Overview conference. SYR showcases some of the best new research and offers multiple poster sessions as well as Preconference Workshops June 11 “Fundamentals of Acquiring Yoga Research Funding” ample opportunities to interact with other scientists, Partap S. Khalsa DC, PhD, DABCO, Program Director at the National Center experts and professionals in the field. for Complementary and Alternative Medicine Keynote Speakers “Demystifying Scientific Writing: Simple Techniques for Successful Manuscripts” Grace Marie Bullock, PhD, ERYT, Editor in Chief, International Journal of Yoga Therapy

Main SYR Program June 11 – 13 SYR is a single-track academic research conference that includes both oral Herbert Benson, MD BN Gangadhar, MD Harvard Medical School NIMHANS, India and poster presentations by leading yoga research scientists. (See keynote and invited speakers, left.) Invited Speakers • Beth Bock, PhD, Professor of Psychiatry & Human Behavior, Yoga Research Poster Presentations Alpert School of Medicine, Brown University • Richard P. Brown, MD, Associate Clinical Professor of Psychiatry, The poster presentation sessions are a riveting and inspiring feature of SYR, Columbia University with representative research teams on hand to answer questions and discuss • Debbie L Cohen, MD, Associate Professor of Medicine, their research. Call for Poster Abstracts opens January 2013. University of Pennsylvania • Patricia L. Gerbarg, MD, Assistant Clinical Professor in Psychiatry, New York Medical College • Helen Lavretsky, MD, MS, Professor of Psychiatry and Biobehavioral Sciences. Director, Late-life Mood, Stress, and Wellness Research Program at UCLA SYR is offered back-to-back with SYTAR (Symposium on Yoga Therapy and • Crystal L. Park, PhD, Professor of Clinical Psychology, University Research) at the Boston Marriott Newton, June 11-13. of Connecticut, Storrs, and affiliate of the University of Connecticut Center for Health, Intervention and Prevention $100 registration discount for IAYT members. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • SYR 2009 photos by Andrea Killam

THE INTERNATIONAL ASSOCIATION OF YOGA THERAPISTS nounce the most in-depth Yoga Therapy conferences of 2013. The Front Line of Yoga Therapy • • • • • • • • • • • • • • • • • • symposium on yoga THERAPY June 13–16, 2013 • Boston AND research

SYTAR is dedicated entirely to professional education, SYTAR Program Overview research, practice, and policy issues for yoga therapy. This is the first time SYTAR will be taking place on the Plenary Sessions All attendees gather for these powerful keynote and plenary speaker East coast. presentations.

Keynote Speakers Practice Sessions: “Competencies in Action” Twenty practice sessions supporting the competencies in IAYT’s new Educational Standards for the Training of Yoga Therapists.

Common Interest Community Sessions Nischala Joy Devi Sonia Nelson Antaran- Vasant Lad Six intriguing fifteen-minute presentations modeled on “Ted Talks” Abundant Wellbeing ga Yoga/Vedic Chant BAMS, MaSC that will get people talking. Watch for Call for Proposals in January. Center The Ayurvedic Institute Plenary Speakers Topics • Rehab Professionals: Bridging the Past with the Future • Judi Bar, Center for Lifestyle Medicine, Cleveland Clinic • Göran Boll, Medical Yoga Institute of Sweden • Mental, Emotional and Spiritual Health • Loren Fishman, MD, Manhattan Physical Medicine & Rehabilitation • Mladen Golubic, MD, PhD, Center for Lifestyle Medicine, Cleveland Clinic Ayurveda 101 for Yoga Therapists • Sat Bir Khalsa, PhD, Harvard Medical School and Brigham and Womens’ An opportunity to learn how Ayurveda can inform yoga therapy. Present- Hospital ed by Hillary Garivaltis, Kripalu School of Ayurveda; Larissa Hall Carlson, • Gary Kraftsow, MA, American Viniyoga Institute RYT 500, Kripalu Center for Yoga and Health; and Arun Deva, DAS, AYT, • Rolf Sovik, Psy.D, Himalayan Institute • Subodh Tiwari, Kaivalyadhama Yoga Institute ERYT 500, Arunacharla Yoga and Ayurved SYTAR is offered back-to-back with SYR (Symposium on Yoga Research) at the Boston Marriott Newton, June 13-16.

$100 registration discount for IAYT members. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • SYTAR 2008 photos by Adam Latham

Registration opens January 2013 iayt.org/conferences IAYT Thanks our Sponsors for Joining Us on the Front Line for the Most In-Depth Yoga Therapy Conferences of 2013. SYR (Symposium on Yoga Research) and SYTAR (Symposium on Yoga Therapy and Research) are offered back-to-back June 11–16 • Boston Marriott Newton in Massachusetts Presented by the International Association of Yoga Therapists • • • • • • • • • • • • • • • • • • • Diamond Sponsor

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Association Sponsors Academic Sponsors www.iayt.org Winter 2012 YogaTherapyToday 25 Insight by Cyndi Kershner Lessons Learned in Teaching a Hospital-based Yoga Class

or the last several years I have been teaching a yoga class for patients students did not stay in the class very long, and at this time the class Fwith multiple sclerosis (MS) at Swedish Hospital in Seattle, Wash- had a high turnover rate. ington. This experience has taught me much about working with stu- I pondered the situation and realized how difficult it was for students in a setting very different from a typical yoga studio and has dents even to get to the class. Many of these folks have multiple phys- also helped me to understand what motivates students with chronic ical challenges and tire easily, so going to the class was a huge com- health conditions to practice yoga regularly. mitment for them. A typical yoga class in which students did not When I started teaching the class it was on a volunteer basis; the know each other well and were there mainly for a physical practice Neurosciences Department at the hospital wanted to see if a yoga most likely would not be motivating enough for these folks to spend program would “stick” with patients and if it was worthwhile to their precious energy on; they were not concerned with mastering invest resources in this way. One year into teaching the class as a vol- yoga poses or stretching themselves to attain anything, as is typical in unteer, the MS clinic went through an expansion and renovation, and mainstream yoga classes. They were just looking for a way to make donors who funded the new clinic specified in their planning that the their health conditions, and their lives in general, more manageable new clinic would offer yoga and several other programs that empha- and to find an enjoyable way to move their bodies. When I changed sized wellness. This program is one of several hospital-based pro- my approach to teaching and made it more student-centered and less grams in the United States taking the lead in integrative approaches pose-centered, I found that the students did enjoy themselves, they to health care; three years into the program the original class is now laughed and smiled, they did the asanas and pranayama with more funded through an ongoing grant. enthusiasm and engagement, and they came back. The Northwest MS Society, who originally approached me to see if I was interested in taking on the class, coordinated the logistics with the MS Clinic. The original intention of the class before it became part of the clinic’s regular offerings was to offer a wellness option for patients, several of whom were specifically asking for the Clinic to offer a yoga class. The class was completely optional, and was available to all patients who were interested in trying yoga to help alleviate and cope with their MS symptoms. It was originally designed as a drop-in class and advertised through the MS Clinic, who put flyers out all over the clinic to market it and promoted it to anyone who expressed interest. The MS Clinic allowed me complete freedom to run the class however I saw fit, were always thanking me for teaching it, and were very gracious. It was a very nice introduction to teaching in a clinical health care setting. I was excited to be able to offer yoga in a hospital setting, although unsure what would work well in this type of environment. Should we chant, should I talk about yoga philosophy, should I tone down the yoga trappings? I learned how to teach the class by teaching it. When I began Students enjoying a class with Cyndi. teaching the class I had worked with students with mobility issues one-on-one, but I had never taught a group class for people with MS, once I had this realization, I decided to focus on creating a yoga which is a very different set of dynamics. I tried out several approach- experience that would help the students feel empowered in their bod- es, and stuck with what produced the happiest and most engaged ies and connected to each other, and also help them to feel the burden students over time. I discovered that it was best to talk less about of their health conditions lighten a bit. They liked the asana and the yoga because the students’ eyes would glaze over whenever I said pranayama adapted to their needs, but what students really respond- anything in Sanskrit. We started out with chanting but I soon stopped ed to was the intimacy and connection that developed in the class. I this practice because students didn’t participate, and so it didn’t seem didn’t realize this by getting student feedback, but through observa- meaningful to them. When I started teaching the class, I thought it tion. I worked hard on memorizing their names and helping them to was the asanas (poses) and the pranayama (breathing) that the stu- learn each others’ names, which is the first step in building rapport in dents would appreciate most, but what I found was something very a group. I made sure to make contact with them as much as possible different. during class: eye contact, gentle hands-on assists during poses, and What I noticed when I taught the class from a perspective of “this being available after class to chat or answer questions. We played is a yoga class and so we’re going to act like we’re in a yoga class” movement games and we laughed. We learned about each other in was that the students would follow along, but they weren’t enjoying fun and interesting ways. Only when I felt the class was connected themselves, they weren’t smiling, and they did not seem at all inter- and engaged did I then introduce asana and pranayama. I noticed ested. I think they were showing up because they thought it was good over time that as I continued to facilitate and encourage positive for them, and they heard they should be doing yoga. Many of these interactions in the group, bonds formed between students and the

26 YogaTherapyToday Winter 2012 www.iayt.org Insight Continued

Only when I felt the class was connected and engaged did I then introduce asana and pranayama. I noticed over time that as I continued to facilitate and encourage positive interactions in the group, bonds formed between students and the class began to feel like a little community. class began to feel like a little community. Not surprisingly, atten- were very small children. This seemed patronizing to me, and I was- dance became stable as a core group of committed students formed. n’t even one of the students! Once I had a stable, core group, I did introduce the practice of I was trained in the Integrated Movement Therapy school of getting regular student feedback. Every six to eight weeks I pass out yoga therapy, and in this training my teacher Molly Lannon Kenny anonymous feedback forms, so that I can continue to improve my taught me something very valuable. She taught me that yoga teach- teaching and the class and meet specific student needs and requests. ing is a partnership between student and teacher, not a hierarchy of The feedback also gives them a chance to assess their own progress teacher to student. This philosophy is so valuable to me as a teacher and remember where they were before they started practicing yoga. who works extensively with students who have chronic health condi- In short, we stopped talking about and demonstrating yoga, and tions, because it is empowering both to my students and to myself. started being yoga. Yoga became less of the way they were moving Partnership lies at the heart of any truly healing endeavor, and is nice- their bodies and more of the experience they were having both indi- ly summed up by this quote: vidually and as a group. Some of the time the yoga was about asana and pranayama, some of the time it was about playing silly group “If you have come to help me, you are wasting your time. If you have come games and laughing together, and some of the time it was about talk- because your liberation is bound up with mine, then let us get started.” ing and processing ideas, life situations, and problems. —Lilla Watson I took care to cultivate a really positive environment for the students, because I had heard negative things from the students about Cyndi Terry Kershner, RYT500, IMT Therapist, is a yoga support groups that were focused on how difficult life was with a teacher and therapist in Seattle, WA. She directs the Yoga chronic condition. I also made sure to modulate my voice enough to for MS program at Swedish Hospital, Cherry Hill, and also help the students feel excited and engaged; I had seen too many yoga mentors teachers wanting to learn how to work effectively DVDs marketed toward special health conditions where the instruc- with MS. Contact her at [email protected]. tors spoke really slowly or overly empathetically, as if the students

www.iayt.org Winter 2012 YogaTherapyToday 27 CaseReport by Amy Weintraub Healing from Trauma, Moving Through Grief

ost of us have had some kind of trauma yoga empower students and help them to the beginning of our first session together, Min our lives. One in three women and self-regulate. And most vital, in my opinion, Jacquelyn’s breath was short and her hands one in five men have been sexually trauma- is that yoga teaches us all that no matter what shook. It was clear to me that the trauma was tized. That means that whether they have our trauma history has been or what mood still in her body and that talking about it now identified themselves to you or not, there state may currently be visiting, ultimately we was putting her through what author and are students with a history of trauma in are more than our mood and our story. neuropsychologist Richard Hanson calls your yoga class. Some of you may be offer- “one more lap through hell.” ing yoga therapy to clients who come to I gently suggested that, instead of you because they have back pain or some retelling the story, which she had written other physical symptom, but who, whether down for me in her pre-session assessment you know it or not, are also recovering form, we begin with the breath, inhaling from mood disorders or addictions. Let me deeply through the nostrils. I asked her to make it clear that I am not suggesting that place her hands on her lower belly and to you hang out a shingle and treat trauma notice them rising as the breath moved into survivors with yoga. I’m saying that trau- her lower lungs. Her hands didn’t move. ma survivors are already in your classes Jacquelyn was unable to take a deep breath. and in your treatment room. It’s important In this situation, I might invite a client to that as yoga professionals, we know how practice Yogic Three-Part Breath in the supine to help. position to relax the belly and deepen the When we’ve experienced a traumatic breath. Instead, I invited her to stand. It was event, the emotional center of the brain, clear to me that Jacquelyn was tamping known as the limbic region, goes on over- Jacquelyn Jackson down a lot of emotion. Had I pushed my own drive. The fight-or-flight hormone cortisol agenda of helping her to breathe more deeply floods the limbic brain, so that we are pre- as a case in point, let me introduce you in that first session, it would have risked an pared to act. Other systems of the body shut to Jacquelyn Jackson, who was at the Safeway emotional flooding in Jacquelyn. Most of us down, including digestion; the Broca area of in Tucson on January 8, 2011, when Jared have had a catharsis on the yoga mat, and it the brain which helps to control speech; and Loughner opened fire. Jacquelyn’s life was often facilitates a deep emotional and physi- the hippocampus, the part of the limbic spared in the shooting that took the lives of cal release, usually without a story attached. brain responsible for chronological memo- six people, many of them her friends, and But this was our first session together, Jacque- ry. As a result, our memory of the trauma critically wounded her former boss, Con- lyn was suffering from trauma, and I wanted may be fragmented and incoherent. We gresswoman Gabrielle Giffords. A year after to make sure that she felt safe with me so that have neither linear memory of the event nor the event, Jacquelyn sat on the couch in the her emotions might arise without shame or the words to speak it. New experiences that yoga therapy treatment room, because her blame in a manner that she could deal with. trigger a piece of the trauma memory can beloved brother had suddenly died of a brain To do that, I first needed to meet her in that set us into a tailspin of hormones that over- tumor at Christmas. Despite the good talk revved up, active (rajasic) place. stimulate the little amygdala at the center of therapy she did with a grief counselor after I did not want to move too quickly in a the limbic brain, and we may overreact to the Tucson tragedy, many of her symptoms way that might overwhelm and perhaps the new stimulus as though it were the orig- were back, including insomnia, anxiety, and frighten her. Therefore, I asked her to stand. inal event. When this happens again and binge-eating. In the year since the Tucson To get her moving and shaking out the ten- again, the hippocampus actually begins to tragedy, she had taken yoga classes with my sion I’d observed, we practiced a dance-like shrink. colleague Maria Kali Ma, RN, MS, ERYT-500, joint warm-up with lively kirtan music. From so how does yoga help? Let’s look at and had felt a sense of returning equanimity this standing position, I offered Jacquelyn a the science first. Numerous studies have and wellbeing after each class. So when her centering ritual of self-acceptance as we cre- shown that yoga has a direct impact on severe symptoms returned, she was drawn to ated safe and sacred space together. We used lowering cortisol (the stress hormone trig- try yoga therapy. eagle mudra (gesture) at the heart (hands gered in fight or flight). Yoga also raises lev- I’m going to jump ahead of the chronolo- crossed, thumbs interlocked) and a bija (seed) els of GABA (gamma-aminobutyric acid), a gy here to offer a precedent-setting fact: after mantra to vibrate the heart (the low tone of neurotransmitter low in those with depres- our first three sessions, Jacquelyn asked if I “yam,” with the emphasis on the long “y” sion, anxiety, and PTSD. Yoga has been would apply for reimbursement from the and the “m” sound.) I asked Jacquelyn to shown to increase heart rate variability Pima County Victims Fund. The County visualize her own soothing image of peace (HRV), which tends to be low in those suf- approved the request for eight yoga therapy and acceptance, or if an image didn’t readily fering from PTSD. In one study that com- sessions, and put no stipulations on treatment, come, to think the word “peace.” We toned pared eight group sessions of dialectical so we were free to continue in the “call and the mantra sound to vibrate the seeds of self- behavior therapy (DBT) to eight group response” manner in which we had started. acceptance and self-care in her heart. I didn’t yoga sessions, only the yoga group showed Through deeply attuning to Jacquelyn use the word “safe,” because some people a decrease in frequency of intrusive over time, I answered her call with a plan with a history of trauma feel that there is no thoughts and severity of hyperarousal informed by my study and experience of the safe place. For those people, the mind will symptoms.1 now evidence-based timeless teachings of immediately reject the word safe, and the Your students don’t have to under- yoga. That plan was never calculated in body-mind will move even further away stand the science to benefit. Yoga gives advance; it changed from session to session— from a feeling of connection. them skills they can use at home to manage sometimes from moment to moment—in from this place, I asked her to set an their hyperarousal symptoms. The tools of accordance with what she presented. At intention for our work together. She was vis-

28 YogaTherapyToday Winter 2012 www.iayt.org CaseReport Continued ibly calmer but anxiety was still present, so sensation during yoga practice (not the glob- In our work together, Jacquelyn and I we did a slow, brief round of Pulling Prana2 al direction to “feel the sensations in your started slowly, focusing on breath and sensa- at one breath per second. Then I asked her to body,” which is too vague and can actually tion. Over the course of our eight sessions, close her eyes and sense into her face, her increase anxiety in some trauma survivors) we incorporated a full range of grounding palms, and her feet after the practice. This was a good first step for someone like Jacque- yet empowering poses with mantras and cueing to sensation calmed her further and lyn. This window into the body-centered breath. Halfway through our series of ses- brought her fully into the present moment. moment can facilitate a “reoccupation” of the sions in Tucson, she flew east to attend a five- Her breath was now, finally, slow and even. body as a safe place. This can be yoga’s great- day program at Kripalu Center for Yoga & now I could safely lead her through self- est gift to a trauma survivor. Health in Stockbridge, Massachusetts. By day soothing practices, which included bee Throughout our work together, I gave four, she found she could hold heart-opening breath (brahmari); cooling, calming mantra Jacquelyn permission to stop, to modify, and poses that had previously been too difficult. tones; and mudras to calm and focus the to interrupt with a question or a response. “With all that breathing and yoga,” she told mind.3 I stayed attuned to Jacquelyn, check- After experiencing a traumatic event in me when she returned, “I slipped into bow ing in with her at every stage of each practice, which the victim or observer is helpless to pose with no problem.” By the time we com- observing and tweaking the practice to meet change the outcome, as Jacquelyn had during pleted our eight sessions, Jacquelyn was each shift in mood and attention. I led her the shooting, survivors often have terrible ready to move to the next step. Her practice through gentle forward-bending postures, feelings of powerlessness. So it was essential had brought her full circle, from traumatized focusing on breath and sensation and incor- that I let her know that she was in the driver’s victim to a newfound passion for sharing the porating cooling, calming mantras to help seat and could make choices about her own yoga that had healed her. Jacquelyn Jackson with sleep and general limbic deactivation. body—an empowering lesson for someone is currently enrolled in a yoga teacher-train- Yoga breathing and chanting are known who has had that choice taken away. This is ing program and will graduate as a Kripalu to activate the vagal nerve4 and engage the especially important in the case of survivors Yoga teacher in 2013. parasympathetic nervous system, slowing of sexual trauma. In summary, as yoga professionals, we heart rate, breath, and pulse; lowering body are being called upon to work with victims of temperature; and deactivating the limbic Current research shows that yoga trauma. The growing body of evidence that brain. When we are practicing yoga with 1 yoga can be an effective intervention for attention to breath and sensation, we are increases heart rate variability, mood disorders and trauma means that stu- whispering soothing messages to the poor which is an indication of the dents with mood issues and trauma histories overstimulated amygdala. Current research body-mind’s ability to flow with are being referred by their health profession- shows that yoga increases heart rate variabili- als and are showing up in larger numbers in ty,1 which is an indication of the body-mind’s ease between sympathetic nerv- regular yoga classes. In specialty training ability to flow with ease between sympathet- ous system activation (think programs, yoga and mental health profes- ic nervous system activation (think rajas) and rajas) and parasympathetic nerv- sionals can learn simple practices, appropri- parasympathetic nervous system activation ate in both yoga therapy and in clinical set- (think tamas). This physiological ability is ous system activation (think tings, that do not exacerbate already existing crucial to our wellbeing. When we suffer tamas). This physiological ability conditions but do empower their students from the effects of trauma, we are often stuck is crucial to our wellbeing. and clients to manage their moods. YTT in sympathetic activation, or hyperarousal, and we overreact to life’s challenges. after each practice with Jacquelyn, I on that first day with Jacquelyn, I con- References 1. Van der Kolk, B. A. (2006). Clinical implications of invited her to sense into her face, her palms, cluded our session with a yoga nidra and neuroscience research in PTSD. Annals of the New York her fingertips, and her feet. In the moments of then gave her the LifeForce Yoga Nidra for Academy of Sciences, 1071, 277–293. noticing specific sensation in her body on the Mood Management CD for home practice. 2. Weintraub, A. (2012). Yoga Skills for Therapists: Effective Practices for Mood Management. New York: W. W. Nor- safety of her yoga mat, she was totally pres- There is a slow progression through the ton, 83–86. ent, not gripped by story or mood. Many stu- koshas, (the five sheaths or bodies we all 3. Weintraub, A. LifeForce Chakra Calming Meditation. dents with a history of trauma will tell you inhabit—physical, breath, emotional, mental, 4. Bernardi, L., Sleight, P., Bandinelli, G., Cencetti, S., that they are living from the neck up-for them, and bliss) in this practice, making it appropri- Fattorini, L., Wdowczyc_Szulc, J., & Lagi, A. (2001). Effect of rosary prayer and yoga mantras on autonomic like Jacquelyn, it can be frightening when ate for trauma recovery. The exploration of cardiovascular rhythms: comparative study. British they feel too much body sensation. So to keep the opposites of emotion and belief culmi- Medical Journal, 323, 1446–1449. from feeling, trauma survivors find ways to nates in what psychologist and yogi Richard numb out through food, drugs, sex, alcohol, Miller, the founder of iRest®, calls “spacious gambling, work—whatever it takes—and awareness” beyond the polarities of story or they are at serious risk for addiction. Even mood. Between our first two sessions, she yoga can be practiced in a numbed out, dis- practiced the yoga nidra CD every evening connected and driven way so as not to feel. before bed and bee breath regularly, and she Amy Weintraub E-RYT, MFA, Gabor Maté, MD, the author of In the Realm of was able to give up the sleep medication is the founding director of the the Hungry Ghosts: Close Encounters with Addic- she had been using since the shooting. Dur- LifeForce Yoga Healing Institute tions, is a psychiatrist who has spent his career ing our second session the following week, which trains yoga and health treating people with addiction problems. He Jacquelyn paraphrased the language I use on professionals internationally. says he has never treated an addict who did- the CD, when she told me that she felt her She is the author of Yoga for n’t have a history of trauma. “spaciousness so much more than the story.” Depression and Yoga Skills for When you as a yoga professional move Aside from her calmer demeanor, Jacquelyn’s Therapists. The LifeForce Yoga protocol is used slowly and gently while cueing to sensation, abdomen was also now expanding during by health care providers worldwide. She is you are offering your numbed-out, hyper- inhalation and she was able to lengthen her involved in ongoing research on the effects of vigilant students a small window into feel- exhalation. She had come to this on her own, yoga on mood. www.yogafordepression.com ing, first the body, and then, as the window simply through a daily home practice. opens wider, the emotions. Cueing to direct www.iayt.org Winter 2012 YogaTherapyToday 29 Interview by Kelly Birch Interview with Loren Fishman, MD

Introduction

fter earning a graduate degree I get referrals from other physicians that say, “Evaluate and treat.” It’s Ain philosophy at Oxford, Dr. kind of paradoxical: you refer to an expert but you don’t know exact- Fishman spent a year in India ly what they are going to do or you wouldn’t refer to the expert. But, with B.K.S. Iyengar and has you have some notion that they are the right ones to treat that person been practicing yoga daily ever with that condition. since. Since graduating medical This does happen with yoga too. They don’t know what the yogi school in Chicago, he has been is going to do, just as they don’t know exactly what the surgeon will developing the connection he do. It’s a general phenomenon. With yoga, doctors are generally even perceived back then between less familiar with this different modality, which is based on a differ- yoga and medicine. Dr. Fish- ent physiological system that the doctors may not even know how to man completed a Tufts-Har- spell. Yoga therapy must be one-on-one. There are a few exceptions, vard residency program and such as Dean Ornish’s and Jon Kabat-Zinn’s work, and perhaps my was chief resident at the Albert own study in osteoporosis, where, after an interview with the patient, Einstein College of Medicine. therapy really can be in a dedicated class, but the leader is more ther- He is past president of the New apist than teacher. Photo credit: Lauryn Gerstle Photography York Society of Physical Medi- But for most musculoskeletal conditions and complex cases of cine and Rehabilitation, currently associate editor of Topics in Geriatric any kind, yoga therapy has to be one-on-one. As I say, I’m not sure Rehabilitation, on the staff at Columbia College of Physicians and Sur- how acutely physicians perceive this, but it’s up to us to tell them. geons, treasurer of the Manhattan Institute for Cancer Research, and Yoga is not yet widely taught in medical school. Psychiatrists may has a private practice on Park Avenue in Manhattan. He currently learn surgery even though it’s not their specialty; internists might serves on IYAT’s advisory board. learn public health although they’ll never do it. We all learn about Dr. Fishman’s work has been featured on World News with MRIs, but most don’t learn yoga. Diane Sawyer and by Jane Brody. His research has focused on yoga for rotator cuff syndrome and yoga for scoliosis, which he has pre- Is this to some degree because yoga therapists are not disseminat- sented at SYR as lecture and poster, respectively. Dr. Fishman has ing the information sufficiently? written and edited more than 80 academic articles and books, including Yoga for Osteoporosis and Yoga for Arthritis with Ellen Saltonstall, Well, of course, you can say partly it’s also the doctors’ own fault Yoga for Multiple Sclerosis with Eric Small, and Yoga for Back Pain with because if they want to refer people to yoga they should find out Carol Ardman. about it. But there are other issues here, and one of them, I think, is I knew of Dr. Fishman by reputation and from his lively and the confusion of marketing with research. The yoga therapist is best probing questions during presentations at SYR 2011. We met there perceived to be on the side of science; you don’t want your conversa- during his poster presentation, and he took great care to explain tion with a physician to be an “infomercial.” And yet, when you’re a how I could help a client with scoliosis. Given that he spans both the yogi and you want to tell people what you do and why it’s good, yoga and the medical worlds, I was very interested in hearing Dr. unless you really know the data, you don’t do it well and it may come Fishman’s thoughts about yoga therapist and medical community across as marketing rather than the product of research. collaboration. also, some yoga experts are better at teaching yoga than doing yoga therapy-they can’t adapt the poses easily and thoughtfully to the patient. To me, yoga therapy displays a humble elegance that is KB: Is mainstream medicine reluctant to embrace yoga as an the right thing at the right time. People that aren’t yet able to do it adjunct therapy? should work with people who already have the skills until they are ready. LF: Conventional provider referral rates to yoga are going up pretty high and pretty fast. In a 2007 survey from Harvard,1 38% of Ameri- What can we do about this situation? cans were using complementary and alternative medicine (CAM), and that is a big rise from 2002. Furthermore, mind-body therapy, I don’t favor professional marketing. That may be all right for the which includes yoga, accounts for 75% of the rise. The researchers pharmaceutical firms, but maybe not even there. I think the best thing collected information from 23,393 respondents, about two thirds of to do as an individual practitioner is to form relationships with doc- those questioned, and extrapolated out the information to conclude tors or chiropractors or physical therapists, the sorts of providers who that 6.3 million Americans were using CAM treatments due to refer- need yoga to treat their patients properly. rals from providers. However, 34.8 million were self-referred, which Don’t be shy about sending a patient to a doctor! That way the means that approximately one-sixth of the people that go to yoga are relationship can become reciprocal. referred by a conventional practitioner. It’s also good for the profession of yoga therapists. As an estab- lishment provider, if you know a good yoga therapist to whom you It seems that there are physicians who will tell their patients “do can refer your patients, then you have more respect for the entire pro- yoga” but without much understanding that general classes are typ- fession. ically not suitable for many people, especially those for whom doctors tend to recommend yoga.

30 YogaTherapyToday Winter 2012 www.iayt.org Interview Continued

So, it’s a question of getting doctors and yoga therapists together?

Yes, much more than you might think. It’s often a question of being shown that something is scientifically valid. But, that’s not the whole question. Here we are in 2012; psychiatry has not been shown to be valid. Nevertheless, people are referred to psychiatrists all the time because you know when someone has psychological problems, there is someone who deals with that. Maybe they can help them, maybe not. But they are going to be more comfortable taking care of them than the person referring them. In the same way, an internist is going to say, “Maybe this man is not flexible enough, or he’s not comfortable in his own skin or he’s too excitable, he doesn’t know how to calm himself down.” So, they send them for yoga.

How can we most effectively speak to those in the medical field about yoga therapy?

In the healing professions, actions speak louder than words. Cure those who are sent to you or explain why you cannot. But also, read the literature! Learn the language of medicine. In other words, don’t call them up and say, “Well, they couldn’t do halasana [plow pose], but they were pretty good at the crow.” You have to speak their language.

Learn to say things like “it’s a subluxation” or “she’s anemic.” Learn Photo credit: Lauryn Gerstle Photography some medical terminology. Dr. Loren Fishman, Terry Roth Schaff, and Caryna Wong.

How did you start with the yoga therapists in your practice? In William Broad’s book, The Science of Yoga,2 you say that “A lot of yoga therapists …. treat in a very generic fashion that can be dan- Actually they’ve been the assertive ones. One of them called me up and gerous.” Can you elaborate? said, “Can I watch you treat your patients? Can I come over to your office on Monday morning?” She made herself as useful as she could, Yoga therapists need to acquire diagnostic knowledge. It would mean she was nice to the secretaries, she dressed right, she was not afraid of distinguishing sciatica due to neuroforaminal narrowing from sciat- the patients. After doing this a couple of times a week for three months, ica due to spinal stenosis. It would mean that yoga therapists would I saw a patient with sacroiliac joint derangement, and I said to her, “Do recognize when to send their people back to a physician with the tact- you think you could do garudasana [eagle] and gomukhasana [cow] with ful recommendation: “Does this patient need an MRI?” or “Could this patient?” And she said “Sure!” And she did it very well. this be lupus?” or “This may be a job for an orthopedic surgeon at this and now that woman is really busy! A full year later she has a point.” Because responsible therapy does the best it can, the more room in the office and she sees patients there three times a week. She you know, the better you can do. has no medical background-she’s just been a serious practitioner and Yoga therapists aren’t the only ones that sometimes treat too teacher for 25 years or so. She knows what she’s doing, and she’s safe. generically: everyone who treats people does it sometimes. But, for She’s never hurt anybody. In fact, she has cured a number of people example, one may encounter a patient whose spinal stenosis that I couldn’t help no matter what I did, that the physical therapists responds positively to extension, exactly the opposite of what usual- couldn’t cure either. She had a different point of view and deep ly happens. insight. This yoga works! How can you learn diagnostic tools without going to medical What types of things has she helped to cure? school?

Mainly lower-back pain and cervical pain, those are the things she’s Well, how can you learn about computers without going to electron- really done well with, and the conditions we see most frequently. ic school? You can learn a lot! Yoga therapists can do more studying. She’s done very well with rotator cuff, too, but that’s not so surpris- We all should—I certainly should! ing because we have a special method for that. She’s also helped with But in particular you want to know when to send the patient arthritis of the knee, cervical disc disease, and general aches and back to physician—“does this patient have a systemic illness?” In pains, and spasms. Things like that. Those are the big ones. other words, if they communicate with the physician they will be able to use the physician’s diagnostic acumen. But they’ve got to know Does she use all of the tools of yoga? enough to do that, to think, “As a yoga therapist I expected that the patient would have been able to move his arm by now, and he can’t.” Some breathing, but usually not. She is mostly asana based and is real- So you know something is wrong. And you have to have enough ly quite resourceful. She adapts poses to start off where the patient is. knowledge to have an idea of what might be wrong. Maybe the patient has a fracture and needs an X-ray. Or, perhaps he has a rotator So, can I ask you how does she get paid? That’s a big question for cuff injury and maybe Lyme disease. Some knowledge. They don’t a lot of yoga therapists. have to know everything. But the more diagnostic acumen, the better. Read, and work with people who know what you want to learn! She charges about as much as a physical therapist. She is not reim- (continued on page 32) bursed by insurance. www.iayt.org Winter 2012 YogaTherapyToday 31 Interview Continued

Should yoga therapists be required to learn some diagnostic tools? makes them feel good—that’s very likely a person with spinal stenosis. Twisting poses to one side make back pain worse; the same pose Socrates said the unexamined life is not worth living. But also, unex- to the other side makes it better. Likely a herniated disc on the painful amined therapy is not worth giving. side! You can really diagnose a lot with yoga. Sometimes you don’t The simple answer is yes, the more they know, the better. If they even have to do yoga with them; sometimes a person will tell you the don’t know any diagnostics, they can’t be that sure that what they are poses they are having trouble with and will thereby tell you their own doing is making a difference. Unless they have a good idea of what diagnosis. They give you all the information you need before you the condition is, that is, the signs and symptoms, what it looks like even touch them. But verify! when it starts to get better-they don’t have any idea. It is largely a question of experience. So, working with other people they get that What is the model that you see best bridges the knowledge gap? experience, which is surely the safest road. IAYT’s efforts to establish satisfactory guidelines are a wonderful How about working in integrative medical teams, along with prac- effort that has gone out to so many people acquiring recognized legit- titioners who have the diagnostic tools at their disposal? imacy. It takes a long time in internship to be a physician, and it takes a long time in internship to be a good yoga therapist. In a way, it takes Yes. That’s a perfect way. It’s also good even for those who want to longer because there is less textbook stuff. A physician who special- work on their own—it’s a good start educationally and economically izes learns about that specialty. I think it would be a good plan for a to work in a team for a while. Working with one single practitioner, therapist to concentrate study on whatever he or she is going to spe- as I’ve already mentioned, is just the limiting case: a team of one. It’s cialize in. You make the bridge by getting to know the people who do like an internship or a residency, whatever you want to call it. It’s what you want to do. Whether they are yogis or acupuncturists or good for them to learn how the team thinks and what the team does. physicians, you get to know the territory. Letting go and having Also economically it’s good for the yoga therapists. If they sparkle, someone supervise you and evaluate you, taking you under their that team’s going to refer to them. wing, so you can tell them what you did and what seemed to happen, and they can say, “That’s right,” or “I never saw that before.” What is the minimum knowledge that a yoga therapist should have There is no peer-review at this point, no degree or accreditation. when working with a client with a medical issue? And that does hurt the credibility of the yoga therapist. You have to know that therapist individually, because it’s impossible to say that To know what he or she knows, and to know what he or she doesn’t he or she graduated from this school and so they are OK. That’s why know. That’s the big one. To break it down in less nifty form: the IAYT is so important. anatomy, kinesiology, and pathology of the problem, and then what they can do to help, and how to accomplish it, avoiding the pitfalls, If we have too low standards of educational requirements for yoga and recognizing when you’re succeeding or failing. therapists, do we run the risk of the medical profession coming up with their own standards and training so that the only yoga thera- What’s a good way to find out what you don’t know, as a yoga ther- pists that will be referred to will be the ones trained in medical apist? school (like physical therapists)?

Introduce yourself to a doctor, shadow him or her and see. It’s logically possible but I don’t think it’s going to happen. PTs as a say to the provider, “I don’t want to do what you do, I want to profession believe in western science, but yoga has its own sources do what I do, and that might be helpful to your patients as well. But, and higher aims. I appreciate the dilemma, though. Too much medi- I’m not here to market; I’m here to learn.” And they will see the kind cine and you’re more like a nurse than a yogi; too little and no one of things the doctor knows. I would recommend the two best will respect your abilities to heal. You’ve got to find a middle ground. providers to learn from are an orthopedic surgeon or a physiatrist, a You’re bringing something valid and new. It’s extremely valuable and physical rehab doctor (that’s what I do). Also good are pain special- strong. It meets the tests of western medicine and it adds to the ists, osteopaths, neurologists, and perhaps chiropractors. One yoga resources of western medicine, but it is not western medicine. And therapist who works with me spends a couple of hours a week with that’s, I think, the point. You’ve got to have the integrity to stand this a psychiatrist, who sends her patients. Many doctors do yoga; I’ll bet middle ground and the confidence that yoga’s going to bear you that many more of them will be willing to work with a yoga therapist. through. You’re using one set of principles in what you do, but will be another one is to read up on a condition. That’s what they do in evaluated by another. This takes confidence in your craft. You know, medical school: “Oh, I’ve heard of thrombocytosis, but what is it?” yoga’s going to show that it really does work. When you get a referral of a certain sort, that’s the time to read up on it and learn about it. And, you are not wasting your time, in the sense Is the western medical definition of “therapist” consistent with that first, you’ll help the person who was sent to you, and secondly, what we in IAYT describe as therapist? you will start to recognize when other patients have that condition, or don’t have it. I don’t think there’s a golden key to this-I think it’s hard “Therapy” comes from the Greek word, therapeuein “to cure, treat work, but it’s fun, it’s interesting, and you actually do some good. medically,” literally “attend, do service, take care of. Interestingly, it is Interestingly, some “yoga injuries” are injuries that you find in related to therapon “servant, attendant.” Yeah, that’s the right word, doing yoga but didn’t occur during yoga. There’s a study that comes that’s what we do. We serve. YTT to that conclusion from Australia.3 Sometimes an injury’s been there References for a while but unnoticed until they stretch in yoga or put weight on 1. Nerurkar, A., Yeh, G., Davis, R. B., Birdee, G., & Phillips, R. S. (2011). When conven- a part that usually is non-weightbearing. tional medical providers recommend unconventional medicine: results of a national Yoga is a good diagnostic tool for certain conditions. For example, study. Archives of Internal Medicine, 171(9), 862-864. PMID: 21555669. 2. Broad, W.J. (2012). The Science of Yoga. New York: Simon & Schuster. for back pain. If a person is in pain doing shalabasana [locust] and setu 3. Penman, S. J. (2008). Yoga in Australia: results of a national survey (master’s thesis). bhandhasana [bridge], but janu shirshasana [head-to-knee] actually Retrieved from http://researchbank.rmit.edu.au/eserv/rmit:6110/Penman.pdf.

32 YogaTherapyToday Winter 2012 www.iayt.org www.iayt.org Winter 2012 YogaTherapyToday 33 Interview by Kelly Birch Interview with Terry Roth Schaff, Yoga Therapist at Manhattan Physical Medicine

Introduction excellent physical therapists in our office. I have had the joy of being their yoga teacher and teaching them the yoga sequences that I have erry Schaff has taught yoga at put together for the medical conditions that we treat. TBard College since 2006. She developed yoga programs for What advice would you give to yoga therapists working in a med- the City of Hudson, NY, for sen- ical setting? ior citizens and at-risk children. In 2009, she designed a thera- First, have a diagnosis from a physician. Understand the implications peutic water yoga program for of that diagnosis. If you don’t understand what a specific diagnosis senior citizens at Brookmeade means, ask. Working in a medical office surrounded by medical pro- in Rhinebeck, NY. Since 2010 fessionals is a safe environment Take advantage of it. If you have any she has worked as a yoga thera- concern about what you are doing or a concern about the condition pist at Manhattan Physical of a patient don’t hesitate to ask for help. Bring in the other profes- Medicine and Rehabilitation in sionals in your office if you think that a patient might be better served New York City. by working with one of them. Take the opportunity to learn from and Photo credit: Lauryn Gerstle Photography Having interviewed Dr. Fish- with the medical professionals that you work with. Hold in-service man, I was eager to hear from Terry Schaff, one of the yoga therapists training sessions together on specific topics. If it is appropriate to the who works with him. work that you are doing learn how to read an X-ray, learn how to understand an MRI report. Become familiar with and knowledgeable KB: What training did you have that prepared you for your work about the medical terminology that relates to the work that you are with Dr. Fishman? doing. Become an ongoing learner, a keen observer, a careful listener.

TRS: I spent three years developing and teaching a chair yoga class In the light of your experience, what would you recommend as the for senior citizens for the City of Hudson, New York. While develop- most useful areas of training or study for yoga therapists? ing this program I also offered a series of yoga classes for people living with Parkinson’s disease (PD) in Rhinebeck, NY. What they might want to focus on is dependent on the kind of work I participated in the Dance for PD program at Mark Morris they are going to do. I would suggest taking college level anatomy Dance Company, which included information about neural process- and physiology courses. Learn the medical terminology that relates to ing delays, how exercise can impact Parkinson’s, and the anatomy the work that you are going to do. For instance if the yoga therapist and physiology involved with this condition. I also participated in a is planning to work with people with mental conditions then she or yoga teacher-training program sponsored by the Massachusetts he might want to take psychology courses and cognitive behavior Chapter of the American Parkinson Disease Association. I participat- courses in addition to understanding the neurological system. ed in numerous workshops with senior Iyengar and Anusara teach- What patients, medical professionals, yoga teachers, and yoga ers on the anatomy of yoga; many of which focused on specific parts therapists seem to find the most beneficial about working and learn- of the body. ing from Dr. Fishman and me is our expertise. And expertise comes My understanding and knowledge of human anatomy and from ongoing study but also a great deal of practical application. physiology has grown exponentially from people in the medical and academic community, especially from the incredibly generous and Do you have specific protocols for certain conditions or injuries? Did patient teaching and direction from Dr. Loren Fishman and the team you develop them on the job? How do you choose which ones to use? of physical therapists that he is nurturing at Manhattan Physical Medicine and Rehabilitation. I do have specific protocols for specific diagnoses. Dr. Fishman has Dr. Fishman, being a warm-hearted and open-minded physi- groups of yoga poses that he recommends for specific medical condi- cian, invited me in to observe him at work and that is where my med- tions. I have adapted many of these poses for patients that cannot do ical training truly began. After months of observing him at work, classic yoga poses and I have built sequences of poses for our patients learning the implications of specific diagnoses, and the do’s and to practice at home. don’ts of these diagnoses, I began to assist him as a yoga teacher first I co-taught a series of yoga for the spine classes with two physi- following his directives on which yoga poses to use for which diag- cal therapists in our office for close to a year. Classes were limited to nosis, and eventually beginning to adapt these yoga poses for four or five people with specific diagnoses. These classes helped me patients that couldn’t do classical yoga postures and to put together to create a careful, thoughtful curriculum for patients with spine sequences of poses for specific medical conditions. This has been a issues. gradual process. Subsequent to joining the team at Manhattan Physi- We are in the process of documenting the protocols that we uti- cal Medicine I have studied anatomy and physiology at Ulster Com- lize on a regular basis for specific conditions so that we will be able to munity College along with students prepping for nursing school and share them in a clear and useful manner. for entry into physical therapy programs. I have also read anatomy Developing specific protocols is just the start. From there we books and articles, and have studied with, and learned from, the observe closely what is happening. If a patient is not doing well with

34 YogaTherapyToday Winter 2012 www.iayt.org Interview Continued a specific protocol we change it. We are not rigid. We have a very big tool box of yoga postures and sequences that we have seen can help, but that being said there may be mitigating factors that we don’t know about, so the patient’s response to our work is paramount.

How can others learn more about how you practice in the doctor’s office?

Dr. Fishman and I began giving therapeutic yoga workshops at Kri- palu Center for Yoga & Health in Lenox, Massachusetts, in January 2012. We have held two so far, one on the back, and the other more broadly looking at the body from head to toe. In May 2013 we’ll return to Kripalu to offer a workshop on the joints and in July 2013 we will give a workshop on yoga injuries—when do they occur, how to avoid them, and how to treat them. These workshops have been an excellent opportunity for yoga therapists, members of the medical community, and yoga practitioners to study with us firsthand. Based on a series of spine care yoga classes that I had taught at Manhattan Physical Medicine and Rehabilitation for close to a year, I developed a workbook that explained in clear, concise terms, with photographs, all of the material that we had covered in the six-week courses. It is now available to our yoga patients/students at Manhat- tan Physical Medicine and on my website at www.terryschaff.com. YTT

Terry Schaff is registered as an experienced yoga teacher with Yoga Alliance and is a member of the International Association of Yoga Thera- Photo credit: Lauryn Gerstle Photography pists. For more information about Terry Schaff’s work visit her website at Terry Roth Schaff and Yenisei Bell www.terryschaff.com.

www.iayt.org Winter 2012 YogaTherapyToday 35 A Peek at a Week with Linda Lang

MemberSpotlight Monday: • Drive down the Potomac River to The George Washington Uni- versity Medical Center; teach two sections of “Introduction to Linda Lang Therapeutic Yoga” to medical school students, MPH (Master’s in Public Health), and physician’s assistant candidates at noon Primary Teaching Influences: and 5:30 PM. The writings of B.K.S. Iyengar; the language of • In between, visit the homes of three clients for an hour practice Anusara Yoga; the Yin Yoga of Judith Hanson with each. Teach a fourth class later in the evening. Lasater and Sarah Powers; Richard Miller’s Tuesday: heart and wisdom. • 10:00 am yoga group in Potomac followed by private classes and an after-school class with private school administrators and Professional Experience: staff. • Therapeutic Yoga Teacher, over 9,000 hours, since 1999 • Skype with a social worker in New Jersey about bringing thera- • Director, Therapeutic Yoga of Greater Washington, since 2004 peutic yoga to her Youth Advocacy Program (YAP). • Director of Therapeutic Yoga and Yoga Programming, Center for • Teach an evening “mother-and-daughter class” with a local Integrative Medicine at the George Washington University, since physician who refers patients to Linda for their “yoga emergen- 2008 cies.” This is one of three physicians who routinely “prescribe” • Medical Educator offering instruction in medical and health sci- therapeutic yoga to patients for creating safe and sacred space: ences schools, hospitals, and clinical settings; expertise and focus is coming to grips with difficult diagnoses, living with cancer, on yoga as a healing modality and avenue for prevention, wellness, addressing anxiety and nervous energy, physical rehabilitation, and rehabilitation, since 2009 social isolation, and to step into a realm of spirituality. • Clinical Instructor, Department of Psychiatry and Behavioral Sci- Wednesday: ence at the George Washington University School of Medicine and • Conference call with Consortium of Academic Health Centers Health Sciences, since 2012 for Integrative Medicine; Lang served on the 2012 Pre-Planning Committee and as the teacher for morning yoga programs at the Formal Education: 2012 CAH-CIM Annual Meeting. Lang’s affiliation continues as BA Psychology, American University, 1976 a member of the Education Working Committee. • Meet during midday with medical students for one-to-one Yoga Training: instruction and mentoring in yoga. 1000+ hours, including Cardiac Yoga certification; Yoga Alliance reg- • Teaches three private classes: two students are experiencing istry qualification with Doug Keller and Susan Van Nuys; Anusara health issues, retirement concerns, intense family trauma; the therapeutics with John Friend, Todd Norian, and Martin Kirk; Thai other is a middle-aged mom recovering from neck surgery. yoga massage with Kam Thye Chow; pranayama with Yoganand Thursday: A long day of teaching: Michael Carroll; meditation with Sally Kempton and Richard Miller. • 8 am: yoga at local fitness center, ninety minutes of concentrat- ed focus on an area of physical concern with therapeutic recom- Professional Summary: mendations followed by thirty minutes of group discussion about the class theme. Community building is critically impor- What distinguishes Linda’s work is passion for inclusion within tant to Lang. the medical community. She teaches yoga electives at the GWU Med- • 11 am: Therapeutic Yoga Intervention for HIP Research Grant, ical School and is director of Therapeutic Yoga and Yogic Program- at Family Services, Inc. , an affiliate of Sheppard & Enoch Pratt ming at the Center for Integrative Medicine. She is actively engaged Foundation, for adults with severe mental illness. with the Consortium of Academic Health Centers for Integrative Med- • Stop for a private student session before going to Fox Hill, a sen- icine. She worked with planning and presented experiential yoga ses- ior living community, to teach residents with Alzheimer’s dis- sions for the October 2012 Annual Meeting and was a poster presen- ease along with their aids and staff in a seated class. Focus is on ter for their International Congress on Medical Educators. As a mem- balance, major life transitions, and in-service training. ber of the education committee, she hopes to increase awareness of • At 5:30 pm: it’s Mother and Daughter yoga; for now, it’s just the and opportunities for yoga therapists in integrative medical settings. mothers. The girls were in fifth grade when they began to prac- linda built Therapeutic Yoga of Greater Washington, a virtual tice together; this fall, they are college freshmen. and regional home for professionals who share an interest in yoga as Friday: therapy. Within this framework, Lang organizes gatherings for teach- • Works with MPH student on practicum as preceptor. ers; encourages collaboration in integrative medicine; and engages in • Prepares notes for offering yoga therapy education for cardiac targeted dialogues on therapeutics, continuing education, and the rehabilitation nurses in Delaware, and designing individualized need for mentoring and supervision within the field of yoga therapy. certification programs. Dedicated to building a stronger sense of professional identity, Lang • Private sessions. initiated a series of thought-provoking discussions on the IAYT group Saturday: Shabbat. Although she is not devout, Linda recognizes forum on LinkedIn.1 the need for sanity in scheduling (as of about a year ago). Working linda advises and works with the Smithsonian Institution’s six days a week is enough. Freer Museum on developing programming for Yoga: The Art of Sunday: Transformation, a ground-breaking exhibition on yogic art from India • One group session and two private students. (http://www.asia.si.edu/exhibitions/future.asp). Her role includes • Registers for Mentoring Course at GWU where she will learn the designing museum workshops and training programs with a spot- formalities of becoming a mentor. light on medical yoga and therapeutics. • Meet late in the day with the medical students and with Beyond the D.C. area, Linda serves on the Contemplative Sci- the MPH candidate for one-on-one instruction and work as ences Center Council of Advisors at University of Virginia’s Center practicum preceptor. YTT for Contemplative Studies, a newly endowed yoga-centric program. Note 1. To follow or participate in the LinkedIn discussion, join the IAYT group and go Editor’s note: Be sure to add your own professional profile to your listing to “Discussions.” Scroll down until you find the discussion. on IAYT’s website! 36 YogaTherapyToday Winter 2012 www.iayt.org www.iayt.org Winter 2012 YogaTherapyToday 37 TrainingReport by Amber Keating and Veronica Whetsel with Cassi Kit Professional Yoga Therapy Studies

Introduction

Veronica Whetsel (VW): My first job was as a licensed physical therapist in an outpatient orthopedic clinic. I was expected to treat two to three patients per hour and had to justify my treatments to insurance companies through extensive docu- mentation. Spending less than 30 minutes with a patient was not my idea of delivering high-quality health care. Clearly, something was deeply wrong with our health care delivery system

In December 2011, I found Ginger Garner’s Med- ical Therapeutic Yoga video course on Home CEU Connection. I had been practicing yoga rigorously since 2009 to address my own musculoskeletal imbalances, but I didn’t fully understand the history or depth of yoga or actually use it in patient care. My patients suffered from pain far beyond the physical, and I was missing a comprehensive holistic paradigm that could address many of their needs at once. Because of the evidence-based research approach and clinical relevance of this study, I made the decision to pursue the complete program to earn a specialty certification in Profes- sional Yoga Therapy. To date, I have completed Modules 1-8 and I am preparing to take Modules Training site at Emerald Isle, North Carolina. 10 and 14 in fall 2012.

Amber Keating (AK): I discovered Professional Yoga Therapy in 2007, Course Organization while researching a variety of yoga therapy training programs. Devel- oped by Ginger Garner, MPT, ATC, Professional Yoga Therapy (PYT) is AK: When I took my PYT coursework, it was a combination of face-to- “a post-graduate medical level of yoga practice that enables the ther- face workshops and home-study tests and assignments. Now, those apist using it to apply in both prevention and pathophysiological set- courses are organized into a series of distance learning web-based tings.”1 I was drawn to its strong emphasis on research and the safe classes (so convenient for us busy professionals!) and onsite learning practice of yoga in order to heal the body, mind, and spirit. As a men- in Emerald Isle, North Carolina. I particularly appreciated the numer- tal health clinician, I valued this research focus because I understood ous case studies my classmates and I had the opportunity to com- that it would give me a solid foundation from which to improve the plete. We utilized vignettes in class and were able to draw from our lives of my clients. I knew that I did not want to just study yoga; I own client populations during these case studies. Between the wanted to use it as a clinical intervention with my clients who suffer coursework, non-contact work (required reading, practice, assistant from emotional and physical trauma. Another aspect of PYT that I teaching, and journaling), written exams, and the final thesis, I was greatly appreciated was the prerequisite that students pursuing certi- beyond well-prepared to utilize PYT’s yoga therapy principles in my fication as a Professional Yoga Therapist needed to already hold a mental health work. degree in a medical field. I had seen many other yoga therapy training programs that did not seem to incorporate formal Western edu- I especially appreciate how PYT gave me the cation into the therapeutic yoga classroom. This set the bar for our knowledge to be able to assess my clients from a classes, because each person was already well-educated in anatomy, more holistic, whole-person perspective and uti- physiology, and biomechanics. It meant that the classes could go more rapidly into the theory and practice of PYT. Of course, I was the lize yoga-based interventions that are grounded one student in all my classes for whom this was not true. As a mental in research. health clinician, my training and experience is the mind and emotions. Upon applying to the program, I was informed that I would There was also a rich sense of community that developed during need to study things like biomechanics and anatomy on my own, our onsite coursework. I remain in contact with many of my class- because students were expected to be medically trained at some mates and we continue to support each other as we pioneer our way level. As I read more about PYT, I realized that its developer valued through bringing integrative health and mental health care to greater education and research and expected a great deal from the students numbers of people. Looking back, the early morning meditation prac- accepted into the program. I found this impressive and it let me know tice was one of my favorite experiences. We would gather together that I was about to embark on a life- and career-altering path. just before dawn each morning and begin our meditation practice facing the sunrise over the water. These meditation practices were www.iayt.org 38 YogaTherapyToday Winter 2012 TrainingReport Continued often challenging for me, as my mind would race and my body would Integrating PYT into Professional Life become achy. But I learned there how to value sitting still and being alone with myself. This also set the stage for the development of my AK: PYT and Mental Health own personal yoga practice. As a requirement of our training, we cre- I now use my PYT training every day, whether for my own men- ated our own personal practice and then journaled about it through- tal health or for the healing of the issues my clients bring to me. I lead out the program. This has made yoga—including asana (poses), a pranayama and meditation class for staff each week at the mental pranayama (breathing), and meditation—an essential part of my life. health facility where I work. I also utilize PYT components with my So not only did I obtain a greater skill set as a mental health clinician clients: teens and adults recovering from traumatic stress. I show through the PYT program, but I also gained my own personal self- clients how to breathe and move in ways that support their recovery care strategies. and empower them to use these practical skills in their daily lives. This means my clients heal more quickly now than they did before I start- VW: Modules 1-7 “Medical Therapeutic Yoga for the 21st Century: A ed using the PYT skills. I especially appreciate how PYT gave me the Model For Improving Patient Outcomes & Health Care In Ameri- knowledge to be able to assess my clients from a more holistic, whole- ca” have prepared me in how to practice medically based yoga and person perspective and utilize yoga-based interventions that are engage in preventive medicine and public health for consumer grounded in research. It is deeply rewarding to know that I can send protection and responsibility. my clients home after an initial session with practical tools they can • Module 1 introduces the concept of exchanging a pathology-based use to balance their nervous system activation, improve their mood, medical model for a holistically driven model. We learn the Penta- and sleep better. I am also significantly more knowledgeable about gon of Wellness, a biopsychosocial model of assessment addressing anatomy, physiology, and biomechanics than any of my colleagues, not just the physical but also the intellectual, psycho-emotional, even those familiar with somatic practices in psychotherapy. I cannot and social, energetic, and spiritual elements of the patient. As clini- say enough good things about how PYT improved my own life and cians, we learn to focus on our intuitive side of healing in combina- the lives of my clients. tion with our scientific training. The pedagogy of the PYT curriculum and fifteen precepts are introduced. • Module 2 instructs students on how to become better healers and teaches medical therapeutic yoga experientially. It elaborates on the application of the Pentagon of Wellness and overcoming the five obstructions/kleshas: avidya (ignorance), asmita (egoism), raga (attachment), dvesh (hatred/diversion), and abhinivesah (clinging to bodily life, or clinging to death). • Module 3 addresses meditation, spiritual implications, and miscon- ceptions of spirituality. It demonstrates, from the evidence base, how the eight limbs of yoga empower the patient and prevent practitioner burnout. • Module 4 discusses pain theories and evidence-based neuroscience studies. It explains the seven physiological concepts: kinesthesia, respiration, motor control, mobilization, myofascial release, internal/external support, and relaxation and meditation. • Module 5 elaborates on evidence-based efficient breathing patterns and effects on the nervous system. • Module 6 reviews practical applications in biomechanical analysis Professional Yoga Therapy onsite training session. for yoga postures, with a significant focus on stabilization and safety validated by multiple research studies. • Module 7 analyzes the neurophysiology of yoga and the utilization VW: I am employed by a large health system and am able to treat my of myofascial release, scar adhesions, and neural mobilizations. patients with integrative therapy for 45 minutes and bill their treat- This method works to restore balance not only in the patient but ment as neuromuscular reeducation and therapeutic exercise. My also the clinician, who can grow weary focusing predominantly on patients, colleagues, physicians, and community are intrigued by this fixing our patients rather than guiding them. uncommon approach to medicine. Professional Yoga Therapy is a per- • Module 8 is the first onsite intensive seven-day training, held in fect tool for licensed clinicians to use in bridging the gap between med- beautiful Emerald Isle, North Carolina. Included are a daily 6 am icine and wellness. Becoming a PYT student has been a remarkable guided meditation and yoga practice, lecture and lab, rest time at journey for me personally as well. I have become more proficient in my the beach, delicious cuisine, and fellowship with other PYT stu- daily self-practice, scheduling my much-needed time for stillness in dents. We experienced firsthand how to use medical yoga for even meditation and applying the Pentagon of Wellness in my own life. the most clinically complex patient. Since completing Module 8 in The PYS Program offers an exciting graduate and post-profes- May 2012, I have been able to prescribe specific yoga postures, sional certification in yoga therapy that allows me the flexibility to breath, and meditation for individuals with herniated discs, continue working as a clinician and care for myself and my family. As spondylosis, scoliosis, osteoporosis, and morbid obesity, with a pri- an active student of the PYT program pursuing graduation within a mary focus on safety and stability. four-year period, I am expected to comply with specific requisites: the • Modules 9-15 can be found on the PYT website www.professiona- completion of PYT Modules 1-15 and an annual submission of a CEU lyogatherapy.org. hours log totaling 100 hours of self-study or 20 hours of recognized yoga coursework. This includes courses offered by PYT and any coursework (continued on page 40) www.iayt.org Winter 2012 YogaTherapyToday 39 TrainingReport Continued related to using yoga as medicine. I will also need to provide proof of A Yoga Therapist’s Perspective my current physical therapy license and CPR certification. by Cassi Kit, RSW, PYT-C If you are a medical professional seeking to make a lasting influence on your patients and communities in delivering innovative ver the last few years, I have been working as a yoga teacher and reha- health care based on wellness and disease prevention, I strongly Obilitation support worker (RSW) in Canada. In my capacity as an encourage you to explore the PYT website at www.professionalyo- RSW, I have worked under the supervision of occupational therapists gatherapy.org. YTT to assist with their rehabilitation of motor vehicle accident survivors with severe orthopedic conditions, and/or acquired brain injuries. Note over a year ago, my supervisor suggested that I might incorpo- 1. As of 2012, PYT is also being taught in doctoral-level graduate programs in physical rate my yoga expertise into my sessions with clients. I enthusiastical- therapy. ly accepted her suggestion, and began creating yoga programs struc- tured around the treatment plan prescribed by the other health care Veronica is a licensed physical therapist who currently professionals on the rehabilitation team. After just a few such ses- works at Anne Arundel Medical Center in Annapolis, MD sions, I observed how yoga can be a great complement for other ther- as an integrative PT specializing in orthopedics, complex apies and that it can strongly facilitate a patient’s progress, providing spine disorders, and bariatric optimization. She graduated them with the means to manage pain, increase body awareness, cope in 2002 with a Masters in Physical Therapy from the Uni- with stress, and improve mood and self-confidence. versity of Maryland School of Medicine. She teaches week- While continuing this work, and in conversation with my col- ly yoga and Pilates classes and wellness workshops in her leagues from other health care professions, there grew in me a desire community. She spends time outside of work with her husband of 16 years to familiarize myself with the current research, to understand more of and their two sons. the neurophysiological underpinnings of yoga, and to contribute, if I could, to this body of knowledge. Many yoga training sources seem Amber is a Licensed Clinical Social Worker with 10 years to lack scientific validation and biological underpinnings for their of experience as a psychotherapist. She has been practicing practices. Similarly, most other health care professions appear to lack the PYT method for five years and was certified as a Pro- the psycho-spiritual aspects of healing. The Professional Yoga Thera- fessional Yoga Therapist in July 2012. Her holistic mental py (PYT) program bridges this gap in education, providing the yoga health practice, Soulful Healing, is based in Los Angeles, teacher and health care professional with the essential link that will California. Her specialties include the treatment of anxiety, foster collaborative partnerships between the various fields. trauma, abuse, grief, loss, and chronic pain. Read more The usual prerequisite for the PYT program is to hold a degree in about Amber’s unique combination of healing techniques and find contact the medical field. Without this qualification, I still approached PYT, explaining my extensive experience in utilizing yoga as therapy in information at www.soulful-healing.com. conventional rehabilitation/medicine, and that I work under a licensed medical professional. Fortunately, these variables contributed to an acceptance in the PYT program. As yoga teachers, we have a responsibility to raise the bar of our own educational standards, in order that we may be well reputed among those in other health care professions. Both they and the public must be warranted in trusting that we have the necessary training to be able to handle the more complex cases that may be presented. PYT not only provides the yoga practitioner with the research and tools to assist these complex cases, but also strongly emphasizes the teaching of safe practices in order to heal the mind, body, and spirit. after having completed Module 8, “Yoga as Medicine”, I have already experienced the benefits of applying this higher education in my yoga therapy sessions. I’m able to understand my patients’ physi cal/psychological dysfunction more precisely, thanks to a more detailed understanding of the biomechanics and anatomy involved. And when I’m sharing this understanding with clients, I’m usually able to show them the applicable research underlying the proposed treatment. Furthermore, I now have a much stronger vocabulary to more accurately and succinctly discuss client concerns with other professionals; I now have more confidence in my ability to form and maintain partnerships with therapists in other fields. Most importantly, PYT has given me the opportunity to connect with like-minded health professionals who want to collaborate on bringing this traditional knowledge closer to its proper place of respect and integration with other more established health care treatments. YTT

Cassandra Kit is a registered yoga teacher and rehabilitation support worker (RSW). She has studied in Canada, USA, and India as a yoga therapist and instructor. She specializes in providing in-home yoga therapy working with individuals who are suffering from chronic pain, orthopedic injuries, anxiety disorders, and traumatic brain injuries. She lives in Ottawa, Ontario, Canada, and can be further contacted at [email protected].

40 YogaTherapyToday Winter 2012 www.iayt.org www.iayt.org Winter 2012 YogaTherapyToday 41 Review The Big Book of Yoga Therapy: Yoga Practices for Health and Clarity By Remo Rittiner Verlag Via Nova 2009 (German) Book Shaker, 2011 (English) Also available at www.ayuryoga- bookshop.com Review by John Kepner

This is an excellent and internationally popular book. The original Ger- man language edition was a best sell- er, and now it is published in Eng- lish, Spanish, Italian, Dutch and, very soon, Czech.

The way I see it, an unusual and valuable dimension is that this book can be useful and enjoyable for four audiences: 1. The experienced yoga therapist in one of the several offshoots of the Krishnamacharya lineage. You will likely learn many new things. I did, and I have been studying and teaching in this lineage for many years. 2. The experienced yoga therapist from other lineages, such as those using alignment-based methodologies. Even though you may not use the same principles of breath and movement shown in this book, you should be able to discern that many of the therapeutic approaches might apply to your methods. 3. The yoga teacher considering additional training in yoga therapy. You will be delighted to discover a wonderful expansion to the teaching of yoga and how the practice can be used therapeutically. This was my delight many years ago. You may also better appreciate the depth and breadth of study required for sound training as a yoga therapist. 4. The student in this lineage who likes to learn and practice in new ways. I’m already using some of the things I learned from this book in my regular group classes.

The book is divided into four chapters: 1. The foundations of yoga therapy, including a delightful section on “the art of joyful effort.” 2. An extensive section on structural yoga therapy guidelines and recommendations for practice, including anatomy and theory for each part. Two complementary examples are a “yoga program for a relaxed lower back” and “yoga practice for a stronger lower back.” Yoga for chronic low-back pain was a major part of my private practice for years, hence I immediately reviewed this part—and I learned some new methods I can use. 3. A shorter section on yoga therapy for chronic conditions, including straightforward and easy-to-follow ayurvedic recommendations. Rittiner, like his primary teacher, A.G. Mohan, is well grounded in ayurvedic principles as well. 4. A short practical session on healing and transformation. Don’t skip. Practice!

Overall, I find this book quite complementary to my main two reference books: Yoga for Wellness by Gary Kraftsow and Yoga Rx by Larry Payne and Richard Usatine, MD, without too much overlap. As a literally big book, I can lay it flat and read while practicing, so I don’t have to get this spiral bound, like I did with the other two. a personal note: I first met Remo in Chennai, India in 1996, while studying with A.G. Mohan. Remo was already quite the advanced student. It’s my pleasure to see how this book reflects many more years of sustained study, practice, and teaching, including western approaches to anatomy. YTT John Kepner, MA, MBA, is the executive director of IAYT and holds a teaching certification from A.G. Mohan and teaching and therapist certifications from the American Viniyoga Institute.

42 YogaTherapyToday Winter 2012 www.iayt.org Review Relax into Yoga: Finding Ease in Body and Mind- Carson, K. & Krucoff, C. (2012). Pranamaya, Inc. Review by Sue Tebb

Relax into Yoga: Finding Ease in Body and Mind is a DVD of safe and effective yoga practices for older adults and those wanting modifications to a more active asana (yoga poses) practice. The program is presented by Kimberly Carson and Carol Krucoff, who together offer yoga therapy teacher training at Duke Integrative Medicine entitled “Teaching Yoga to Seniors.” Having attended training with Carson and Krucoff, and working with older adults myself, I am always in search of resources to offer to those who want to establish a home practice but are need of audiovisual aids. Meeting people where they are, this DVD covers asana practices at four levels of mobility: in a bed or lying on the floor, seated in a chair, standing, and one that involves moving from standing to the floor with a chair. These practices vary in timing from 30 minutes to 55 minutes and use a steady chair, a yoga mat, and a blan- ket or cushion for props. Added to the offerings are three special practices that emphasize relaxation, balance, and core asanas for strength and stability. The additional programs vary in length from fifteen to twenty minutes. Consistent with my experience with the instructors, safety is foremost in their teachings. They use an easy-to-remember acronym, ABCs of Yoga: “A” for awareness of body, breath, and mood; “B” for breathing, encouraging appropriate breath when in postures; and “C” for comfort and stability. Again, safety is highlighted in finding a stable base as one moves with comfort. Each practice sequence consists of breath awareness, asanas, and savasana (supine relaxation pose). The DVD has five sections. Two were noted earlier, the Main Practices and Special Practices. The other three include an introduction to the DVD and the practices; a very through and important section on safety; and a section on extra practices. Extra Practices offers instructor credentials, information on the Pranamaya production of the DVD, large English subtitles, and a bonus downloadable MP3 version of the DVD so people can have the audio to use as a portable reminder after they have familiarized themselves visually with the asanas. participants on the DVD are everyday people, some of whom need modifications in their personal practice and some who have not practiced yoga before. The sharing of teaching by Kimberly and Carol is clear, concise, and slow, with many options for variations offered. The basic asana is described and modifications and challenges are provided for individual choice. The practices do not include forward bends or extreme twists, because the instructors’ research has shown that these asanas can compromise bone strength and safety when used by older adults. With the well-presented directions and the safety considerations on this DVD, I truly think that anyone could do these yoga practices. I believe that the instructors want yoga teachers and people of all shapes, sizes, ages and medical restrictions/challenges to know that everyone can do yoga, and that they can either recommend and/or use this DVD and reap the health benefits of increased strength, balance, and flexibility. YTT

Sue Tebb, PhD, RYT, professor of social work, LifeForce Yoga Practi- tioner-Level 2, and ever-learning yogini, is currently teaching yoga at the Center for Survivors of Torture and War Trauma and at Rosehill Senior Residence. Contact info: [email protected].

www.iayt.org Winter 2012 YogaTherapyToday 43 MembersNews Welcome New and Renewing School Members!* Note from John Kepner, executive director: IAYT has approximately 100 school members with both general and specialty certifications in yoga therapy. We had only five listed on IAYT’s website when I started with IAYT in 2003. This is a good indication of the tremen- dous growth of the field. Supporting School Members Integrative Yoga Therapy Training New England School of Integrative Mount Madonna Yoga Therapeutic Ratna Jenna Sturz & Brajesh NSEW Mindfulness Education Center Center Integrative Yoga Therapy Training Integrative Yoga Therapeutics Friedberg 1300-Hour Yoga College with Yoga Bo Forbes, PsyD, ERYT-500 Therapy Emphasis Michal Yarkoni & Gill Solberg Dynamic Therapeutic Resources Mariel Louise Bosin, MA, LMFT Sacred Rivers Yoga for Every Body Inc. YogSadhna 300 Hr. Yoga Therapy Certification 500 Hr. Teacher Training with Yoga 800+ Hr. AxiOm Yoga Therapy International School of Kundalini Therapy Emphasis Certification Yoga Training Indu Arora, MD Paula Scopino, ERYT-500, LMT Julie Whitbeck-Lewinski International Kundalini Yoga Therapy Training One Spirit Center for Sacred Study Body Therapies Yoga Training Tensegrity Yoga Therapy Center Guru Dharam Khalsa & 300/500 Hr. Yoga Therapist Training 300 Hr. Yoga Therapist Intern- Darryl O’Keeffe 500 Hr. Hatha Yoga Teacher Training with Therapy emphasis Heather Greaves, ERYT-500 & ship Pradeep Kumar MD, DAC Sherry Brourman, ERYT-500, PT, Yoga Bloom Gracia McKinley, Lisa Bergly, & Tricia Sletten & Leslie Kazadi, RYT-500, CT Yoga Bloom Yoga Therapy Training PranaYoga & Ayurveda Mandala Cora Wen Associacao Europeia de Terapias Yoga Club Yoga Cikitsa Orientais Hansa Knox Johnson ERYT-500, LMT Tai Sophia Institute 200/500 hr. Therapeutic Yoga Teacher Teacher Training with Yoga Ther- Training apy Emphasis Kimberly Duncan, PhD 7 Centers Yoga Arts Chrys Kub, ERYT-500, PT, and Paulo A. Hayes Melanie Snyder, RYT-200 Ruth Hartung TriYoga Boston 300-Hr. Yoga Therapy Training 500 Hr. Therapeutic Yoga Teacher Rama Lotus Yoga Centre The Minded Institute-Yoga Therapy Course 300 Hr. Yoga Therapy Teacher Training Brahmi (Beth) Gold-Bernstein for the Mind (NOTE: this is a name Training change from Yoga for the Mind) Ashtanga Yoga Tel Aviv Kristine Karpinski Ashtanga Yoga Therapy Training School Members Mindfulness for Mental Health Yoga Therapy Training Maya Gross & Anat Sheinman Pacific Rim College Center for Meditation Science Heather F. Mason Foundations of Yoga therapy 300-Hour Meditation Specialist SAVY International Certificate program Competency Training Subtle Yoga SAVY 500 Hr. Yoga Therapy Training & Diploma of Yoga therapy Susan Taylor, PhD, APMSIII-BC Elizabeth Flemming, LPC, & Kristine Jitender Krishan Sahdev Nikki Manzie Kaoverii Weber, MA, ERYT-500 Yogacampus Subtle Yoga Teacher Training for Yoga North *New and renewing since the Yoga Therapy Diploma Program Behavioral Health Professionals 500 Hr. Yoga Therapeutics Training IAYT Member Schools list pub- Lisa Kaley-Isley, PhD, Anna Black- Molly McManus & Ann Maxwell lished in the Summer 2012 Yoga more, & Uma Dinsmore-Tuli Therapy Today

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