Summer 2014

a publication of The International Association of Therapists YogaTherapyToday Volume 10, Issue 2, $5 Features Interview Yoga and the Path of with Richard Miller, Self-Discovery IAYT’s Co-founder Yoga for Grief Relief Yoga Therapy in Practice The Truth About Back Pain Creating an Adaptive Class

SYR Sept. 24–26 Kripalu see page 11

Celebrating IAYT’s 25th Anniversary! YogaTherapyToday | Summer 2014 www.iayt.org Thank You for Attending SYTAR 2014 See You Next Year in SYTAR 2015 Newport Beach, CA! June 4–7,2015 At the beautiful Newport Beach Marriott Hotel & Spa—the ideal location for a true taste of the Southern California coastal lifestyle. Fashion Island’s world-class shopping, enter- tainment and dining destinations will provide you with never-ending excitement at your fingertips. Back at the hotel, experience curated service and unparalleled style that will allow you to relax and unwind. IAYT and the hosts at Newport Beach Marriott Hotel & Spa are expecting you at SYTAR 2015!

symposium on yoga therapy and research Editor’s Note YogaTherapyToday his issue marks the 25th anniversary of IAYT! I invite PUBLISHER International Association of you to reflect on what this Yoga Therapists T organization means to you— EDITOR IN CHIEF Kelly Birch, ERYT-500, PYT-500 GRAPHIC DESIGNER Ken Wilson whether it be participating in defin- COPYEDITORS Lokiko Hall and Stephanie Shorter, PhD ing the field, being a part of a pro- fessional community of peers, offer- Yoga Therapy Today is published in the spring, summer, and winter. ing and receiving best practices, mentoring beginning yoga therapists IAYT BOARD & MANAGEMENT or being mentored, conducting or Dilip Sarkar, MD, FACS, CAP, President supporting research, sharing stories Matra Raj, OTR, ERYT-500, Treasurer and advice on launching a yoga therapy practice and working Eleanor Criswell with clients, or enjoying—and contributing to—our publications Carrie E. Demers, MD and conferences. Amy E. Wheeler, PhD Executive Director John Kepner, MA, MBA We have come far! Advertising Manager Abby M. Geyer Conference Manager Debra Krajewski Accreditation Administrator Aggie Stewart As we continue on our mission, it is my deepest hope that we keep alive the truths of yoga in our practice and in our lives. MISSION In these pages we often focus on how to use yoga to address IAYT supports research and education in yoga, and serves as a challenges and problems, which is, of course, a large part of professional organization for yoga teachers and yoga therapists what we do professionally. But it is also valuable to remember worldwide. Our mission is to establish yoga as a recognized and what this practice is predicated on—our own connection with and respected therapy. ability to point our clients to that which is always whole and doesn’t need fixing. MEMBERSHIP IAYT membership is open to yoga practitioners, yoga teachers, This connection and the importance of adapting the practice yoga therapists, yoga researchers, and healthcare professionals to the client, and not the other way around, are dual themes who utilize yoga in their practice. running through this issue—each author touches on these MEMBER BENEFITS foundations of yoga therapy. • Subscription to the International Journal of Yoga Therapy • Subscription to Yoga Therapy Today Kate Holcombe in her Feature article focuses on Patanjali’s • Access to IAYT’s research resources and digital library Yoga Sutras as a practical guidebook to self-awareness and con- • Professional recognition through IAYT’s online listings nection with our authentic Self and as the means to living a life • Discounted registration at IAYT events of greater freedom and clarity. Our other Feature, by Antonio Sausys, explains the natural grieving process and how a yoga CONTACT therapist might work with a client’s grief, especially through IAYT compassionate listening. In our Reflections section, Baxter Bell, P.O. Box 251563 a physician and teacher trainer in therapeutic programs, offers Little Rock, AR 72225 us his valuable reflections on yoga therapy and medicine. Phone: 928-541-0004 (M-F, 10AM – 4PM CST) www.iayt.org • [email protected] Our interview this month features Richard Miller, co-founder HOW TO SUBMIT TO YOGA THERAPY TODAY of IAYT with Larry Payne. Richard reflects on the past, present, and future of yoga therapy and emphasizes the importance of Writers Email a query or completed article to: [email protected]. working with each client to co-discover what his or her individual Yoga Therapy Today relies on submissions from the membership. needs are, even in a group setting. Richard also discusses Please submit reports and articles on training, views and insights yoga’s philosophical underpinnings and yoga therapy’s unique relating to the field and profession of yoga therapy, as well as on contribution to society. integrative practices and business practices. Request writer guide- lines from editor. Articles are reviewed and accepted on a rolling In this issue’s Yoga Therapy in Practice, we include, from basis and may be submitted at any time. Shelly Prosko, a well-informed, in-depth article on low-back pain Advertisers as a biopsychosocial phenomenon, including a different perspec- For advertising rates and specifications, contact Abby Geyer at 702- tive on core stability and back pain. Cyndi Kershner offers a fas- 341-7334 (M–F, 9 AM–3 PM, PST) or [email protected]. cinating step-by-step description on how she and a colleague Editorial decisions are made independently of advertising developed an adaptive yoga class in a healthcare facility. arrangements. Our final Mentor’s Corner contribution from Nicole DeAvilla REPRINT POLICY explains how storytelling can be a valuable, and often over- IAYT’s reprint policy applies to all articles in the International Journal looked, instructional tool for yoga therapy clients. We are grateful of Yoga Therapy and Yoga Therapy Today. Fee: $1 per copy per to Nicole for her sage advice for the last three issues! Please article. The policy works on the honor system, e.g., if two articles send me your nominations for the next columnist. are copied for 25 students, please send IAYT a check for $50 and note “for reprints” on the check. Questions? Email Debra Krajewski I look forward to seeing many of you at the upcoming at [email protected]. SYTAR in Austin, , and at SYR at the Kripalu Center for Yoga & Health in September. I am always eager to meet our ENVIRONMENTAL STATEMENT members and to hear your thoughts on this, your membership This publication is printed using soy-based inks. The paper contains magazine. YTT 30% recycled fiber. It is bleached without using chlorine and the wood pulp is harvested from sustainable forests. In service, Kelly

2 YogaTherapyToday | Summer 2014 www.iayt.org TableOfContents Summer 2014

2 Editor’s Note 4 Members News 6 The Next 25 Years By John Kepner, MA, MBA, Executive Director IAYT 6 IAYT Accreditation Committee By John Kepner, MA, MBA, Executive Director IAYT 6 Tribute to Mukunda Stiles By AmarJyothi 8 IAYT Welcomes New Staff and Board Members By John Kepner, MA, MBA, Executive Director IAYT 8 The Wisconsin EAB Endorses IAYT Accreditation of Yoga Therapy Training Programs By John Kepner, MA, MBA, Executive Director IAYT 12 10 Conference Corner Yoga and Health: Research and Practice By Heather Mason, MA 10 IAYT-Sponsored Conferences

12 Mentor’s Corner By Nicole deAvilla, ERYT-500, RPYT, RCYT

14 Science for the Yoga Therapist The Vagus Nerves as a Mind-Body Bridge By Stephanie M. Shorter, PhD, RYT 24 16 Feature Articles Yoga and the Path of Self-Discovery By Kate Holcombe 20 Yoga for Grief Relief: Relevant Knowledge for Yoga Therapists By Antonio Sausys, MA, IGT, CMT, RYT 24 Perspective A Physician’s Reflections on the Field of Yoga Therapy: The Future is Now By Baxter Bell, MD, E-RYT

28 Yoga Therapy in Practice The Truth About Back Pain: A Biopsychosocial Approach to Treatment 28 By Shelly Prosko, BScPT, PYT, CPI 36 The Process of Creating an Adaptive Class: Partnering with Allied Health Professionals and Forging Community Alliances By Cyndi Kershner, CYT, E-RYT

40 Interview Richard Miller: A Conversation with IAYT’s Cofounder By Kelly Birch, E-RYT 500, PYT-500

52 IAYT Member Schools www.iayt.org YogaTherapyToday | Summer 2014 3 MembersNews The Next 25 Years

By John Kepner IAYT Executive Director

n the occasion of IAYT’s Silver Anniversary, I encourage you to Ojoin me in stepping back from our day-to-day focus on work and think about the future we are all creating. Here are a few of my thoughts about key forces shap- ing our future as a professional field. I would love to hear yours.

• Students in the new accredited yoga therapist training programs. I think of L to R, Veronica Zador, Amy Gage, Richard Miller, John Kepner, Larry Payne, and Trisha Lamb. these as the next wave of pioneers.1 They will shape much of our future over The reason is simple and compelling. sessions and small classes taught in the next twenty-five years. They are As Dean M. Ornish, MD, testified before homes and personal studios, and paid committing to growing our field by the U.S. Senate, for privately. These sessions, based investing deeply in the first professional- upon the yoga therapist’s skill, personal level training programs in the West. Heart disease, diabetes, prostate can- relationships, and transmission are still cer, breast cancer, and obesity account the heart of yoga therapy. I expect to • IAYT-certified yoga therapists, either as for 75% of these healthcare costs, and see demand for these to grow as stu- graduates of IAYT-accredited programs yet these are largely preventable and dents increasingly recognize and cher- or grandparented through one of two even reversible by changing diet and ish the breadth and depth of the bene- avenues: recent graduates of 300-hour lifestyle. Our research, and the work of fits and relationships inherent in this yoga therapy training programs (plus others, has shown that our bodies have practice, and as the supply of skilled the additional mentored practicum or a remarkable capacity to begin healing, therapists grows once the new higher experience) or seasoned yoga thera- and much more quickly than we had standards begin to take effect, all unfet- pists. Let me be very clear, we still once realized, if we address the lifestyle tered by insurance and other third-party have a lot of work to do before we are factors that often cause these chronic payers. One factor spurring demand will able to specify all the details, much less diseases.3 be the increasing dissatisfaction with the provide an actual application. It’s an quality, impersonality, and narrow focus inherently challenging, lengthy, and Getting our healthcare financing system to of healthcare provided by third-party uneven process. A well-recognized and recognize and support such efforts, how- and public financing. YTT respected credential, however, is a nec- ever, is the challenge. Only in 2010 was essary part of the professional develop- the Ornish program finally accepted for ment of a field. We are already beset reimbursement by , after 1. Current practitioners, what we might call “seasoned with demands for credentialed practi- decades of developing the evidence base. yoga therapists” and those recently graduated from tioners and we can’t meet them yet— (mostly) 300-hour programs, are part of what I call the but we will. current wave or generation of practitioners. We are • Branded yoga therapy programs provid- indeed the ones shaping the future now, but maybe ed privately or as part of corporate, • Yoga therapy as part of what is some- not so much over the next twenty-five years. governmental, or other organizational times described as “integrated medi- 2. University of Texas MD Anderson Cancer Center treatment and wellness programs. Integrative Medicine Program. http://www.mdanderson. cine” or “lifestyle medicine,” such as the These will be based upon clinically test- org/education-and-research/departments-programs- Ornish Program for Reversing Heart ed protocols with a strong evidence and-labs/programs-centers-institutes/integrative- Disease and a variety of similar pro- medicine-program/index.html May 1, 2014. base, such as the iRest program, the grams now practiced in the Cleveland 3. Ornish, Dean. U.S. Senate Health Reform Testimo- Mindfulness-Based Stress Reduction Clinic’s Center for Lifestyle Medicine, ny on Integrative Care: A Pathway to a Healthier program, the Viniyoga Therapy for Anxi- the MD Anderson Cancer Center’s Inte- Nation, reprinted in the International Journal of Yoga ety and Depression program, and oth- Therapy; 2009, Vol. 19 pp. 43-46. grative Medicine Program, and else- ers as the research develops. Financing where. This, of course, includes other the research, of course, will be one of integrative models that are being used the major limitations. It is encouraging John Kepner, MA, MBA, within both the physical and mental that some of the research is financed by Executive Director health realms. Representative goals are International health insurance companies. Branding to encourage “patients and their families Association of and marketing programs like these, to be active participants in improving Yoga Therapists however, is not something most of the their physical, psycho-spiritual and field is used to, much less skilled at—yet. social health.”2 The programs typically • Last, but not least, classical individual encompass diet, exercise, group sup- port, and yoga. (Members News continued on page 6) 4 YogaTherapyToday | Summer 2014 www.iayt.org Thank You to Our 2014 Initial Sponsors for SYTAR and SYR SYTAR (Symposium on Yoga Therapy and Research) June 5–8 • Austin, TX SYR (Symposium on Yoga Research) Sept. 24–26 • Lenox, MA Presented by the International Association of Yoga Therapists Diamond Sponsor

Gold Sponsors

Silver Sponsors

Exhibitors

Bridgebuilders to Awareness in Healthcare Living Bhakti School Piel Canela Peru Fair Trade Organization

Media Sponsors

Association & Affiliate Sponsors Academic Sponsors

For 2014 Sponsorship Opportunities, Contact Debra Krajewski, [email protected] Members News continued

IAYT Accreditation Tribute Committee An Appreciation of By John Kepner, Mukunda Stiles IAYT Executive Director By AmarJyothi

he IAYT Accreditation Committee ukunda Stiles, founder of Structural T(AC) met in person, March 20–23, M Yoga Therapy, passed away on Feb- 2014, at the Ancient Yoga Center in ruary 18, 2014. Austin, Texas, to refine the accreditation- review process. Thirty-six applications for I was extremely fortunate to have IAYT accreditation of yoga therapist train- studied with Mukunda. From the outset, in ing programs were received by January 2003, I was amazed by how perceptive, 15, the round two deadline—about twice gentle, and compassionate he was with as many as were expected. Accreditation people who sought his counsel, whether is a strong term of art in the self-regula- for sciatica, for advice on jobs or spirituali- tion of healthcare disciplines. The com- ty, or for the frequent “boyfriend-itis,” as margin of a worn copy of Vashista. Later, mittee intends to live up to this for the he called it. during class, he’d share his morning long-term credibility of the field; hence insight, seamlessly linking it to working this is a very rigorous application. This is Someone said of Mukunda at his with clients. Mukunda’s 2002 interpretation a groundbreaking, and thus initially inher- viewing: “He was an extraordinary man liv- of Patanjali reads like poetry. It is my go-to ently laborious, process for our field. We ing an ordinary life.” manual for assisting clients—perhaps expect to announce the first set of even more so than his seminal book, accredited programs at SYTAR 2014, He taught us to treat the person, not Structural Yoga Therapy. with more approvals of round one and the ailment. He altered his persona to best round two applications expected the rest reach the person he faced. With some he Mukunda taught humility and he of the year. Although this is not yet defini- sat close, with others, far. To some he embodied love. With tears rolling down his tive, the next deadline for applications is spoke in a soft voice. Others were scold- cheeks he would speak about his , expected to be in September, 2014. ed. His chief desire was to help people Swami Muktananda, and of the love he recognize their truth, whether it be about received from his baba. The same rush of The AC is a peer-review committee, their uneven pelvis or failing marriage. tears would fall years later as he looked at moving to formal three-year terms start- Prana is strong, he taught, when truth is his wife, Chinnamasta. His humility was as ing in September, 2014, with approxi- recognized. startling as it is rare. No student was more mately one third of the committee rotat- important because he or she was handy ing off each year. Mary Northey will be He taught the basics, of course, such with the goniometer; no client less impor- the first new member of the AC. Mem- as using a goniometer to measure range tant because his or her suffering stemmed bers potentially interested in serving on of motion. But his favored and most effec- from a bunion. the Accreditation Committee have been tive tools were the Yoga Sutras and invited to attend a meeting just before the Vashista’s Yoga. I’d often find him at a cof- He always started sessions with the annual Meeting of Schools at SYTAR fee shop near Integral Yoga in New York, invocation “With great respect and love, I 2014.YTT sipping chai and penciling notes in the honor my heart, my inner teacher,” to remind us where healing, truth, and love ultimately comes from.

Mukunda’s reach continues to expand in every direction. His books, articles, and teachings heal and inspire. Testament to this is the support and love that flowed toward him from my students. Though most of them knew him only from his teachings, they knew him deeply. YTT

Loka samastha sukinoh bhavantu. May all beings everywhere be happy and free.

AmarJyothi (Bonnie Pariser) is the founder and director of Yoga Loka in Frenchtown, New Jersey. For more information, visit www.yoga-loka.com Back Row, L-R. John Kepner, Dan Seitz, Sue Tebbs, Leigh Blashki, Hansa Knox and Eleanor Criswell. Front Row, L-R Nicole DeAvilla, Mary Northey, Robin Rothenberg, and Aggie Stewart. (Members News continued on page 8) 6 YogaTherapyToday | Summer 2014 www.iayt.org www.iayt.org YogaTherapyToday | Summer 2014 7 Members News continued

Amy E. Wheeler, IAYT Welcomes PhD, IAYT Board of New Staff and Board Directors The Wisconsin Amy Wheeler, PhD, EAB Endorses IAYT Members has been a professor of kinesiology at Cali- Accreditation of Yoga William M. Boggs, fornia State University, MD, Editor in Chief, San Bernardino, for sixteen years. Dr. Therapy Training International Journal Wheeler’s degrees include a BA and an Programs of Yoga Therapy MA in health promotion and a PhD in edu- During his thirty-year cation and psychology. She has extensive By John Kepner yoga training in the Krishnamacharya tra- career, Dr. William IAYT Executive Director Boggs has been dition and is certified as a yoga teacher, a board-certified in internal medicine, holis- yoga teacher trainer, and a yoga therapist. The Wisconsin Educational Approval Board tic/integrative medicine, and medical She teaches yoga therapy in the Loyola (the state vocational-training licensing acupuncture. He has also studied and Marymount Yoga Therapy Rx program. agency) has recently endorsed IAYT accredi- incorporated into his clinical practice She is currently involved in several yoga tation as the standard to approve yoga ther- Ayurvedic medicine, Thai yoga massage, therapy research projects pertaining to apy training programs in the state. One rea- yoga therapy, functional medicine, herbal metabolic syndrome, kidney dialysis, son for this is their general support for medicine, age management, and medical colon and rectal cancer, and ovarian and training programs that follow national nutrition. Boggs has written regularly for uterine cancer with researchers at Vander- standards with rigor and that have a well- Reuters Health for the past seventeen bilt University. Dr. Wheeler is helping to years and has served for many years on set standards for yoga therapists in organ- defined structure for titles, such as ours for the editorial review boards of the journals izations such as the National Ayurvedic yoga therapy training. Another is the sound Medical Acupuncture and International Medical Association. She is a co-founder business and educational practices embod- Journal of Yoga Therapy. As an associate and co-director of North ied in our requirements, which meet their editor of Medical Acupuncture for the past America and she founded the Healing regulatory goals for both consumer and two years, he has spearheaded an effort Yoga Institute in 2007. Dr. Wheeler contin- management protection. For example, to award continuing medical education ues to train yoga teachers at the 200-, schools need to detail how their program credits for selected articles, and he is the 300-, and 500-hour levels. will operate; to define expectations and author of the book Journey to Fertility. requirements; and to have policies and pro- As an avocation, Boggs works as a coach cedures in place for admission, attendance, and as a faculty member of a personal academic progress, code of conduct, and trainer certification program at his graduation. local gym. This is significant because Wisconsin, in Carrie E. Demers, general, and this agency in particular, have a MD, IAYT Board of national reputation for sound and reason- Directors Bob Butera, PhD, and Staffan Elgelid, able regulation. Board-certified in PT, PhD, have left the board. We sincere- internal medicine, ly thank them for their service and contri- Executive Director’s Note: While in graduate Dr. Demers is a holistic butions. You will see Staffan at SYTAR school in economics in Wisconsin, I worked physician who blends 2014 in Austin, and we hope to have Bob for the Department of Revenue, the Depart- modern medicine with traditional back soon. They have become a good ment of Economic Development, and the approaches to health. After receiving her team and Staffan is on the faculty of Bob’s Public Service Commission. medical degree from the University of Cin- YogaLife Center in Devon, PA. YTT cinnati, Demers went on to study mas- sage, homeopathy, nutrition, herbal medi- cine, yoga, and ayurveda. She has been the director of the Himalayan Institute Total Health Center for the last sixteen years. Widely recognized for her expert- ise, Demers has been interviewed by numerous magazines and newspapers and lectures nationally on holistic health and ayurveda. She is a frequent contribu- tor to Yoga International.

IAYT Board of Directors at the Annual Board Retreat, February 2014, at the Ancient Yoga Center in Austin, Texas L-R, Eleanor Criswell, John Kepner, Carrie Demers, Dilip Sarkar, Amy Wheeler, Matra Raj.

8 YogaTherapyToday | Summer 2014 www.iayt.org

ConferenceCorner Conference Corner features IAYT-Sponsored Conferences, events sponsored by IAYT Summer & Fall 2014

Yoga and Health: During the four-day event, which began with a meeting of European yoga Research and Practice therapy schools, followed by a three-hour 10th Annual Integra- London, England training by Sat Bir Khalsa, PhD, on how to April 3–6, 2014 access, read, and conduct yoga research, tive Oncology Train- participants were treated to various ing Conference for delights, including new evidence as to By Heather Mason, Acupuncturists, Mas- yoga’s efficacy by some of the world’s Founder of Yoga for the Mind leading researchers and tantalizing work- sage Therapists, and shops that offered practical skills training. Yoga Teachers/Mind- he yoga therapy conference in London, Dr. Khalsa kicked off the official confer- Body Practitioners TYoga and Health: Research and ence, conveying yoga’s role in preventive Practice, was a resounding success, high- University of Texas patient care. Through an array of research MD Anderson Cancer Center lighting the desire for communication and studies, he revealed that yoga practition- cooperation between yoga therapists and ers have better habits, better biometric Houston, Texas healthcare professionals in a movement markers of health, improved quality of life, July 18–20, 2014 toward improved patient care. The enthu- less stress, and use less medication. Next, siasm of both groups was palpable. Yoga Lorenzo Cohen, PhD, director of MD Lorenzo Cohen, MD, yoga researcher and Anderson’s Integrative Medicine Pro- teachers and therapists were exhilarated director of the Integrative Medicine Pro- gram, will be a keynote speaker at by cutting-edge research findings that lent gram at the University of Texas MD Ander- SYTAR 2014. Kelly Birch, editor of scientific credibility to yoga practice and son Cancer Center, one of the world’s top Yoga Therapy Today, will be there. articulated important considerations nec- cancer hospitals, shared new research essary for working with different patient that suggested yoga’s role in enhancing Yoga Therapy populations, while health professionals positive long-term prognosis. On the fol- were eager to learn therapeutic skills that lowing day, Kim Innes, PhD, reviewed Conference could be added to their own clinical prac- substantial evidence for yoga’s role in type Garopaba, Santa Catarina, Brazil tice. The experience left me uplifted as I 2 diabetes treatment, and Luciano Bernar- October 16–19, 2014 realized so many others share my vision. di, MD, presented compelling evidence This conference with Joseph and It was like meeting a sangha of my heart’s for the benefits of slow breathing in heart desire! Lilian Le Page and guests brings disease and COPD patients. Finally, on together Brazil’s leading physicians the last day Holger Cramer, PhD, gave a My own practice of yoga transformed and researchers in the field of mind- witty and insightful presentation on how body health and healing, exploring years of deep depression and anxiety, yoga can be used in pain management. hence, I know its therapeutic value and I how they are integrating yoga and Also that day, Göran Boll and I discussed into mainstream medicine. want to raise awareness of this in general. our experiences of bringing yoga into Further, in working as a yoga therapist This year’s keynote speaker is Dilip healthcare. Göran focused on his suc- Sarkar, MD, IAYT’s board president. and running a training school, I deeply cess in infiltrating the Swedish healthcare Presentations will be in Portuguese. appreciate how yoga can change the lives system, while I recounted the importance For more information, visit of people suffering from a host of mental of educating future doctors about yoga as www.yogaencantada.org/. and physical illnesses. Following the suc- an adjuvant treatment and covered my cess of last year’s U.K. yoga therapy con- experience of practicing this at the Boston The 14th Annual ference and inspired by statistics that University School of Medicine. At the end of reveal more and more doctors are pre- the conference, our wonderful chair, Dr. Texas Yoga Retreat scribing yoga to various patient popula- Tamara Russell, echoed the sentiment of Austin, Texas tions, I suggested to Jane Ryan, the the whole room by expressing that “surely October 24–26, 2014 founder of Confer, that this year we focus this event speaks of the sheer value of our conference on how to effectively align mind-body techniques in healthcare, and This yoga retreat is the worlds of yoga therapy and health- the desire of the yoga and medical worlds aimed at building a care, thus providing a forum for this to converse and begin, in some instances, caring, diverse, and emerging movement. I knew that many to unite.” I could not have said it better empowered yoga com- yoga aficionados would be interested in myself! YTT munity. New this year is this interface, but I was unprepared for the an expanded yoga level of positive response. therapy track. For more information, visit www.texasyoga.com.

10 YogaTherapyToday | Summer 2014 www.iayt.org Sept. 24–26, 2014 Stockbridge, MA

symposium on yoga research The Front Line of Yoga Research SYR is the West’s foremost academic yoga research conference. SYR showcases some of the best new research and offers multiple poster sessions as well as ample opportunities to interact with other scientists, experts and professionals in the field. SYR2014 will be held at the Kripalu Center for Yoga & Health in the beautiful Berkshires in western Massachusetts. Keynote Speakers: Tiffany Field, PhD, Frederick (Rick) Hecht, MD, Helene Langevin, MD

REGISTER NOW! International Kripalu Center for Association of Yoga & Health Yoga Therapists iayt.org

www.iayt.org YogaTherapyToday | Summer 2014 11 Mentor’sCorner

By Nicole DeAvilla

n the last two issues, I have discussed overlooked yoga therapy interventions. If you want your point to stick, tell a the importance of knowing when and Going back to our roots can be good for good story. People tend to remember sto- Ihow to bring spirituality into yoga thera- our clients and good for us as yoga thera- ries more readily than they remember py sessions. In this issue, I will explain pists. other information. Stories can inspire and why storytelling is good practice for yoga show other perspectives on how to deal therapists and how to effectively imple- We are also hard-wired to desire to with and conquer problems. You can also ment the use of yoga stories. I have found hear the ending, the conclusion of a story, tell a story about a particular subject that storytelling to be one of the best means to so it keeps our attention, unlike during a you want to test out to see if your client is successfully address the spiritual dimen- lecture or instructions where we are more interested in hearing more. For example, sion of yoga therapy with my clients. likely to tune out or even to interrupt the students from Christian backgrounds often speaker. Stories speak to a part of our love hearing stories that show that the Spiritual questions are often over- brain that is less judgmental, opening us symbolism of yoga and in the Bible are looked in traditional medicine for both psy- up to possibilities and ideas that we might often the same. I have also found using chological and physical ailments. Yoga not otherwise have been able to access or the stories from the Bhagavad Gita, therapy is where the interface between consider. , Autobiography of a Yogi, the physical, mental, and spiritual can most naturally take place. When I teach and mentor yoga therapy trainees and yoga therapists, I am often asked how to introduce the subject of spirituality in the first place and how to discuss it in a way that does not sound like proselytizing, preaching, or just plain weird talking about concepts that may be foreign to the client. Questions and concerns on how to approach the subject without offending are important. In many complex cases where clients have been failed by traditional medicine, they have pointed to the fact that yoga therapy treated their whole being, including their spiritual life, and that was what made the difference in their healing journey. The use of stories, I have found, is an excellent way to convey spiri- tual and healing concepts that go straight to the heart of the matter without having to explicitly explain yoga doctrine.

A good story captures our mind, our imagination, and our hearts. Telling stories can sell us products, help us learn in school, is a useful management tool and a persuasive political tool, and helps us teach the values of a culture, home, or corporation. We evolved to tell and listen When the yoga therapist relays a and other yoga literature has been very to stories; we create narratives to make story in the third person then it depersonal- effective in working with my yoga therapy sense of our lives. izes the message, so that it’s not about the students. yoga therapist’s beliefs vs. the client’s. It’s We listen more carefully to stories an impersonal idea, concept, or teaching I especially like to tell stories from the than to lectures, instructions, and admoni- that can be discussed without concern of Bhagavad Gita. Arjuna exemplifies the stu- tions. It is perhaps why the age-old cus- hurting feelings or being disrespectful of dent of life with his questions and doubts, tom of telling stories to their disci- each other’s religious or non-religious lean- and Krishna represents the master ples has been so effective over the millen- ings. Listeners can draw their own conclu- teacher and healer. With students who feel nia and their stories have been handed sions that are appropriate for them at any that they are not good enough, or don’t down over the generations. I think story- given point in time. Therefore, yoga thera- have the energy to do what they know telling in yoga—from the stories of the pists need to be careful to not overly inter- would serve them, or who are struggling in pret or moralize the stories they offer their yoga texts to those tales between master some way with their practice, I like to and disciples—is one of the most often- clients. share how Krishna teaches in the Bha-

12 YogaTherapyToday | Summer 2014 www.iayt.org Mentor’s Corner continued

gavad Gita that there is a path for every- his bow slump from his grip. The bow rep- My guru and master teachers have one to reach their highest potential. Krish- resents the spine, Arjuna’s feelings of told many stories that have enriched not na explains to Arjuna that the “highest hopelessness in the moment. The warriors only my life but also those of my students, path” is that of being a yogi. Arjuna, feel- preparing for battle are all of his subcon- trainees, and those I mentor. I have ing weak and demoralized, implores Krish- scious mental qualities warring against included a few of these stories here in na: but what if you can’t sit still and medi- each other. The rest of the Bhagavad hopes to enrich and clarify my points, tate and do all of the other demanding Gita that follows is the conversation between as well as to inspire and help you to yoga practices—what then? Krishna’s Arjuna—who, like us, has a plentitude of remember to use them in your own answer is that a person can instead do excuses and questions—and Krishna’s practice. YTT good deeds, read good works, and so on, patient answers that allow Arjuna to once and if all else fails, just to cling to him in again lift his bow and carry on with his thought. In other words, cling to the inten- life’s mission and challenges. tion of where you are trying to go. I have Nicole DeAvilla, found that this really helps give people the I also use stories from my personal E-RYT500, RPYT, perspective and confidence to find their life. For example, when I talk about the RCYT, bestselling own way for their own personal path to chakras, I often relate the story of being a author, researcher, wellness and their highest potential. new mother with my first child, having to Two-Minute Yoga host, be up night after night with very little sleep pioneer in prenatal When working with clients who are and seeing my yoga practice slip away yoga and yoga thera- struggling with both physical and emotion- until one night I decided, while nursing, to py, has appeared on radio and TV. al issues, to help them make the connec- try chanting, visualizing and feeling the An Ananda-trained (1984) disciple of tion between their posture and their mood, chakras, or energy centers, near the Paramhansa Yogananda, she serves I like to relate the first chapter of the Bha- spine, which led to my very own deep per- through ministry, yoga therapist training, gavad Gita, which ends with Arjuna letting sonal exploration of the chakras and the yoga online, and the IAYT Accreditation . Committee.

www.iayt.org YogaTherapyToday | Summer 2014 13 SciencefortheYogaTherapist The Vagus Nerves as a Mind-Body Bridge

By Stephanie M. Shorter Because these nerves circuit of the sympathetic system have the ability to receive interacting with the adrenal he mind-body healing connection information about the glands came online, forming requires anatomical interfaces where nature of social interac- the basis of the fight-or-flight Tmovement, sensation, thoughts, and tions, as will be described response. Finally, the myelinated emotions are able to interact with and below, their dual sensory- branches of the vagus nerves influence the physical body. The vagus motor capabilities make developed with sensory capabili- nerves function as one of these inter- them uniquely equipped ties related to social communica- faces—a mind-body bridge. In this article among the family of cranial tion and perceived safety. we will explore how these nerves connect nerves to function as a different aspects of our inner anatomy and mind-body bridge. These three evolutions of the physiology with the ever-changing world autonomic nervous system still outside the body and how we can improve The vagus nerves are leave their mark today. Physiolog- the functioning of these nerves with the the main peripheral path- ically, the myelinated vagus cir- various tools of yoga therapy. way (i.e., outside of the cuit, the sympathetic-adrenal cir- brain) of the parasympa- cuit, and the unmyelinated vagus What are the Vagus Nerves? thetic nervous system, the circuit respond in a sort of hierar- “rest and digest” branch of chy depending on the magnitude The vagus nerves are one pair of the the autonomic nervous and duration of our life’s stres- twelve pairs of cranial nerves. In contrast system. Within the chest, sors. That is, we physiologically to spinal nerves, which originate and the vagus nerves connect respond to stress in the most extend from the spine, the twenty-four cra- first with the pacemaker evolved way possible, but when nial nerves originate from inside the brain cells in the right atrium of the more sophisticated circuit (usually the evolutionarily older brain- the heart and do the critical becomes unavailable, we revert stem). Most cranial nerves extend just a job of regulating the heart to using the more primitive circuit. short distance from their origin in the brain rate. In the yoga research When stress keeps the body to register sensations or control move- literature, more attention amped up in fight-or-flight mode, ments in the face and neck. However, the has recently been given to the ability to self-soothe vagus nerves are very well travelled and heart rate variability (parasympathetic calming) is descend down the neck alongside the (HRV).1 HRV is an impor- compromised. Behaviorally, this carotid arteries and then branch exten- tant measure because of what it repre- means that when we cannot respond with sively throughout the torso. The term sents: a form of biological resilience. In equanimity, we react by fighting or fleeing, “vagus” itself comes from the Latin root other words, a person with robust HRV is and when the stressor is even more trau- meaning “wandering,” like “vagabond,” more adaptable and better able to respond matic and fear-evoking, we cannot even and these meandering nerves do wander to the ups and downs of life. A resilient fight or flee, and we completely freeze. around! The vagus nerves bifurcate and heart pumps at a slightly irregular rate, branch as they come into contact with the speeding up during inhalation and slowing It is important to realize that the heart, lungs, esophagus, stomach, intes- during exhalation; HRV is more desirable parasympathetic (“rest and digest”) and tines, and sexual organs. Therefore, vagal than a steady metronome-like heartbeat. sympathetic (“fight or flight”) branches of activity is important in controlling heart As a sign of good balance between the the autonomic nervous system evolved rate and blood pressure, metabolism, parasympathetic and sympathetic nervous together, and even in the cases of the detoxification, cell repair, inflammation, systems, HRV is more variable in resilient simplest behaviors are co-active at all digestive peristalsis, immune function, and individuals in good health with higher vagal times—ideally, their activity keeps each other functions. In short, wherever these tone and is less variable in individuals who other in dynamic balance. A common mis- 2 nerves touch tissues, glands, and organs self-report higher levels of stress. conception is that a person is either in there is the possibility to influence healing parasympathetic mode or sympathetic and increase somatic sensitivity. By these mode, as if it is possible to flip a toggle diffuse connections throughout the body, How Do the Vagus Nerves Help Balance the Nervous System? switch and be in one mode or the other. In the vagus nerves can improve a vast fact, there is always a push-pull relation- array of health conditions, from epilepsy to ship occurring at a very fast time scale depression to PTSD and more,1 when The autonomic nervous system evolved its two branches in three different evolutionary and continuously across the levels of their activity is increased—also known as cells, fibers, tissues, organs, and systems. improving vagal tone. stages.3 First, the branches of the vagus nerves that are unmyelinated emerged. Most cranial nerves have either a (Myelin is a coating of protein and fatty Putting It into Practice sensory function (e.g., optic nerves con- lipids that insulate nerves, increasing the duct light signals from eye to brain) or a speed of their communication and reducing Yoga is all about finding balance, including motor function (e.g., hypoglossal nerves inappropriate electrical crosstalk between bringing parasympathetic and sympathetic control the movement of the tongue). neighboring cells, just like rubber coating neural activity into greater harmony, However, a few cranial nerves, including on electrical wires.) As the most rudimen- moment by moment. Practicing yoga can the vagus nerves, have both a sensory tary development of the parasympathetic lift the detrimental metabolic load of stress and a motor component (i.e., input and or calming branch of the nervous system, by stimulating GABA release (the major output), which means that they are infor- the function of the unmyelinated vagus inhibitory neurotransmitter in the brain; mation highways routing bidirectional was limited and crude: when the organism important for regulating anxiety, memory, communication between brain and body, was stressed, the unmyelinated vagus trig- concentration, and other functions) and allowing for thoughts and emotions to gered freezing behavior and simply shut increasing activity in the parasympathetic influence the body and vice versa. down metabolic processes. Second, the nervous system while decreasing flight-or-

14 YogaTherapyToday | Summer 2014 www.iayt.org Science for the Yoga Therapist continued flight activity in the sympathetic nervous Breathing at a rate of five to six cycles Summary system.1 The sympathetic nervous system per minute, with each inhalation plus is chronically revved up (and the sophisti- exhalation lasting about ten seconds, is The wandering vagus nerves are an cated myelinated vagus nerves less optimal. This slow rate of breathing coordi- anatomical mind-body highway that is of active) in many people in our modern, mul- nates the activity of the heart and lungs growing interest to yoga therapists and titasking, high-octane, caffeinated culture. and increases arterial baroreflex sensitivity yoga researchers. Mechanical stimulation Most people would do well to develop a (important for blood pressure homeosta- of the vagus nerves through chest-open- practice or make lifestyle changes that sis). A wide range of studies—even some ing asanas or through slow, controlled decrease sympathetic activation and that compared yoga practitioners and breathing increases activity in the increase parasympathetic activation. Himalayan mountain climbers5 or chanting parasympathetic branch of the autonomic monks and people singing the Ave Maria nervous system, which moves the body As a yoga therapist, how can you help in Latin6—have shown that a breath rate into a state of rest and repair. As a gauge increase parasympathetic activity in your of six cycles per minute has benefits down of social safety, the vagus nerves also clients by teaching them methods of stimu- to the cellular level, including antioxidant play a role in mediating the therapeutic lating the vagus nerves? protection and decreased acidity. bond between client and yoga therapist. In multi-faceted ways not yet fully explained, Asana Physiology of Social Safety vagus nerves are a connector between psychology, behavior, social attitudes, The vagus nerves can be stimulated Yoga therapists and teachers often talk of physiology, and anatomy—in other words, mechanically through stretching the torso. creating “sacred space” or a “safe contain- a true mind-body bridge. YTT One of the best ways to stretch and stimu- er” for their clients, and it turns out that the late these nerves is through chest-opening vagus nerves play a role here as well. The References postures (backbends). For instance, camel autonomic nervous system shapes our 1. Streeter, C.C., Gerbarg, P.L., Saper, R.B., et al. pose stretches the vagus nerves while social world and our perception of safety, (2012). Effects of yoga on the autonomic nervous sys- also increasing lung capacity and blood starting with infant attachment to caregiv- tem, gamma-aminobutyric-acid, and allostasis in epi- flow and stretching the tissues that sur- er. The felt sense of safety is a physiologi- lepsy, depression, and post-traumatic stress disorder. round the vagus nerves in the torso and cal reality. Stephen W. Porges, PhD, Medical Hypotheses, 78, 571-579. perhaps neck. Not coincidentally, these paints a comprehensive picture in his poly- 2. Chandola, T., Heraclides, A., & Kumari, M. (2010). chest-opening postures are also potent vagal theory about vagal activity and Psychophysiological biomarkers of workplace stress- mood elevators and are highly recom- social safety.7 In conditions where the ors. Neuroscience and Biobehavioral Reviews, 35, mended in a practice sequence for individ- vagus nerves are impaired (e.g., autism), 51-57. uals with depression.4 Restorative bridge individuals find interpersonal relations 3. Porges, S.W. (2001). The polyvagal theory: Phylo- can be used in a gentle sequence, per- challenging and may not be able to recog- genetic substrates of a social nervous system. Interna- haps accompanied with slow, controlled nize social safety or empathy. His findings tional Journal of Psychophysiology, 42, 123-146. breathing. underscore that the ability to perceive 4. Weintraub, A. (2004). Yoga for depression: A com- being in a psychologically and physically passionate guide to relieve suffering through yoga. How is it possible to access the vagus safe place does not solely arise from New York, NY: Broadway Books. nerves with asana? It turns out that prac- thoughts in the brain; the body also con- 5. Bernardi, L., Passino, C., Spadacini, G., et al. ticing yoga increases vagal tone. How is tributes to the perception of safety. (2007). Reduced hypoxic ventilator response with this possible? Different sensory fibers are preserved blood oxygenation in yoga trainees and specialized for receiving certain types of The vagus nerves are a socially Himalayan Buddhist monks at altitude: Evidence of information—light, smell, sound, heat, sophisticated mind-body interface that a different adaptive strategy? European Journal of pressure, and so on. Nerves can be stimu- translates psychological safety into signals Applied Physiology, 99, 511-518. lated with different forms of physical ener- to the parasympathetic nervous system. 6. Bernardi, L., Sleight, P., Bandinelli, G., et al. (2001). gy, but their output remains the same. That When the vagus nerves detect safety, Effect of rosary prayer and yoga mantra on autonomic is, you can stimulate the eye by touching metabolic demands adjust, enabling the cardiovascular rhythms: Comparative study. British it, for example, but the signal that goes to transformation of both mind and body. Medical Journal, 323, 1446-1449. the brain is still one about the presence This process of detecting safety or danger 7. Porges, S.W. (2011). The polyvagal theory: Neuro- of light-perhaps the illusion of some shim- is called neuroception, and it is not fully physiological foundations of emotions, attachment, mering stars when you get poked in the understood yet how this detection ability communication, and self-regulation. New York, NY: eye. Likewise, you can mechanically stim- emerges out of the activity of a neural W.W. Norton & Company. ulate the vagus nerves by pressure and circuit. Neuroception is subconscious (i.e., movement, and because they are wander- the wisdom of the body) and familiarity ing between the organs of the viscera, helps reinforce the sense of safety. The anything that moves those organs in rela- polyvagal theory7 was, in part, constructed tion to one another also stimulates the from observing conditions where individu- Stephanie M. Shorter, vagus nerves. als are impaired in sensing social safety PhD, RYT, is an expert (e.g., autism, depression, anxiety, schizo- on mind-body Pranayama phrenia) and correlating it with impair- ments in the vagus nerves. research methods and Breathing is the only autonomic function the founder of a pub- that can be willfully controlled. Pranayama Finally, the vagus nerves work in con- lishing company called and mantra chanting stabilize the respira- junction with other cranial nerves that con- Mind-Body Collective tory rate and have an immediate effect on trol the larynx and tissues in the face to www.mind-bodycollective.com. Trained as blood pressure and heart rate. Taking slow facilitate speech and self-expression. a behavioral neuroscience and cortical Thus, the safe container created in the and deep breaths so that the belly and electrophysiology researcher, she pub- thoracic chest expand will stimulate the yoga therapy session also facilitates client vagus nerves, signaling the body to slow self-expression, and in this way a thera- lished studies in visual perception, atten- down, relax, rest, digest, and heal. peutic bond between yoga therapist and tion, and movement control before shifting client is created and reinforced. her focus to yoga research. www.iayt.org YogaTherapyToday | Summer 2014 15 FeatureArticle Yoga and the Path of Self-Discovery By Kate Holcombe level of healing through yoga: even when the non-profit center Desikachar had one is unable to change their circum- founded in honor of his father in 1976. I first met my teacher, Sri T.K.V. stance, and in fact, can even be quite also began to study the Yoga Sutras of Desikachar, in 1991 quite by accident. I unhappy about it, there can still be pro- Patanjali in earnest, even learning the I had come to India as part of a university found healing, and most importantly, one Sanskrit so I could understand them more study abroad program to study social work need not suffer. deeply. I began studying the sutras one- and was working with the state social wel- on-one with Mr. Desikachar and his wife, fare board and Indian child welfare society Mary’s Lou’s example impacted me so Menaka, going through the sutras word- on their female infanticide prevention pro- greatly that when the university hired me by-word from the Sanskrit. While I learned gram. The co-director of the program, to help run their study abroad program in much about how personalized, therapeutic Mary Louise Skelton, had been a long- Madras (now Chennai) after she died and practices can help people feel better, it time student of Sri T. Krishanamacharya I was back in India again, I asked Mr. was through the intensive study of Patan- and had encouraged me to also study the Desikachar if he would please teach me jali’s Yoga Sutras that I really understood Yoga Sutras with Sri Desikachar, which the therapeutic application of yoga to help how yoga is most powerful in supporting was offered as part of that program. I others in this way. He took me on as his healing. found them interesting, but it wasn’t until I personal student and I had the great was hit by a motorcycle while crossing the street on my bike one afternoon that I was presented with an opportunity to discover the healing potential of yoga first hand. It was this accident and the time I spent with Mary Lou through her battle with breast cancer and eventual death that inspired me to shift my career focus to yoga therapy.

About a week after the accident, I was still in incredible pain, and not only had difficulty moving but also found simply sitting and standing both painful. Mary Lou brought me to see Sri Desikachar, who designed and wrote out a personalized, therapeutic practice for me to help support my healing process and recovery.

The practice was very mild, gentle movements with simple breathing that did- n’t seem unusual or special at the time, yet when I returned to the three months later, the specialists I saw couldn’t believe how well I was recovering. “Whatever you’re doing, keep doing it,” they said. It made sense to me: yoga seemed a lot like physical therapy. The physical benefits I experienced and the healing of my body were clearly the result of that practice Sri Desikachar had designed to help me heal. I soon discov- ered there were many other benefits to fortune of not only studying with him pri- Over those years of study in India, I yoga I had yet to learn. About a year later, vately each day but also to observe him was able to witness first-hand yoga’s pro- Mary Lou, who had become a dear friend and other senior teachers at the Krishna- found healing potential as I watched stu- and mentor, had a recurrence of breast macharya Yoga Mandiram (KYM) when dent after student come through the doors cancer. In the year before she died, and they worked therapeutically with students. of the KYM with such a wide variety of cir- particularly while spending time with her cumstances—from pregnancy, eating dis- during the final weeks of her dying I studied every day with Desikachar orders, severe depression, cancer, chronic process, I was able to witness another and observed and interned at the KYM, pain, and injury, to the young boy whose

16 YogaTherapyToday | Summer 2014 www.iayt.org Feature Article continued

parents were killed in an accident and the we act solely from the mind and the pull of and the Self). (3) Patanjali tells us we young girl who wanted to improve her the senses and emotions, we often end up must then choose a goal, or hanam— table tennis for international competition. in situations that exacerbate our experi- where we want to go. And the goal, The common thread in each of these ence of suffering or make our situation according to Patanjali, is kaivalyam, or cases was that, while each of these stu- worse. We end up reacting hastily, falling independence from suffering, meaning dents were given a practice that included into the same destructive patterns and that my happiness is not dependent on my asana, the asana was only a small part of relationships, and feeling out of control. In circumstances (i.e., my status, health, job, their practice and why it worked so well. fact, with my children, we talk about partner, the car I drive, and so on). As Surely relationship is important and, no behavior that is harmful or inappropriate a result, when challenges, difficulties, or doubt, the many skilled and caring teach- as “losing one’s Self.” losses arise in life, I am less thrown off my ers at the KYM developed important and center or connection to my authentic Self. meaningful relationships with their stu- I may still express anger, joy, heartache, dents. But there was another key element I wonder how many or grief—appropriately so—but I can rec- common among them as well: each prac- people realize that ognize that those responses are simply tice prescribed was ultimately about help- that. They are my authentic response to ing the student connect with his or her out of 195 sutras, all my current reality but I need not be own true, authentic Self; to help find, culti- designed to help us defined by them or become overtaken by vate, and strengthen his or her own inner them. Instead, I can move through my guide. This is Patanjali’s goal for us in the quiet and focus the feelings or allow the feelings to run their Yoga Sutras: to focus and refine the mind mind so we can course moving through me. This so that we can differentiate between our kaivalyam, or independence, is achieved mind, body, and senses (what is imperma- better connect with through viveka (discernment), the ability to nent and constantly changing) and our our true Self, only differentiate between two things that are deepest Self, which, according to similar or very closely linked (viveka is the Patanjali, is pure, perfect, unchanging, three have anything opposite of samyoga). (4) Finally, Patanjali and permanent. to do with asana! outlines the means (upayam) that help us to focus and refine the mind, to distinguish We all know yoga can help us feel between mind and Self, to connect with better at multiple levels—physically, men- and act from Self, and, as a result, to feel tally, emotionally, and spiritually—and, in Of course, Patanjali doesn’t say that better (to experience kaivalyam, freedom fact, is designed to achieve this. Yet many we won’t suffer. The Yoga Sutras is, in from the experience of suffering). of us forget or even don’t quite realize (or fact, quite clear that none of us is immune remember) yoga’s goals according to to hardship, challenges, loss, and suffer- The Yoga Sutras is a guidebook of Patanjali’s Yoga Sutras: to help us focus ing. However, Patanjali teaches us that by wonderful tools to gain freedom from suf- the mind so that we can differentiate connecting with and acting from the place fering, and the means that Patanjali speci- between the mind and our own, true Self; of the Self, we can reduce our experience fies in the second chapter are the eight to connect with the Self; and to act from of suffering, even if we can’t change the limbs of astanga yoga (yama, niyama, that quiet place of the Self and, as a circumstances that initiated the suffering. asana, pranayama, pratyhara, dharana, result, reduce our experience of suffering In short, while we often can’t change our dhyanana, and samadhi). Most importantly, so that we feel better. Patanjali uses sev- circumstances, the practices of yoga as Patanjali mentions in the very first sutra eral words to describe this “Self”—cit, teach us that we can influence our with the word anusasanam—yoga is an purusa, drastr (seer/witness), pratyakc- experience of that circumstance, and thus, ongoing, experiential practice. It is not the- etana (internal consciousness)—and we suffer less. oretical but practical. As a result, you have can understand it in English as witness, to show up and actually do the work. In the observer, Self, or even soul. More impor- In the second chapter of the Yoga first sutra of the second chapter, Patanjali tant than what we call it is our actual Sutras, Patanjali describes a model for underscores the importance of this with experience of it. When we are acting from healing in four parts: (1) We recognize the the concept of kriya yoga: this is yoga in the Self, we are clear, calm, centered, and symptom, or heyam, the thing we want to action, through action, of action. The three don’t take things personally. We can see a avoid or eliminate. According to the Yoga components of kriya yoga are tapas (elimi- broader perspective and we respond con- Sutras, the heyam (symptom) is duhkham, nation/purification), svadhyaya (self-reflec- sciously, rather than simply reacting to or suffering. (2) We try to ascertain the tion), and isvara pranidhana (acting in the events, whether internal or external. This cause, or hetu, of that suffering or symp- best way we possibly can while letting go doesn’t mean we are “steamrolled,” that tom. Again, according to Patanjali, the of the outcome). We must be present—to is, having no passion or feelings or not cause of our suffering is the inability to dif- whatever degree we are capable—in every holding appropriate boundaries. It is quite ferentiate between the mind and the true action we do, from walking the dog, paying the contrary. We may experience more Self. Patanjali calls this samyoga: the the bills, communicating with our friends or passion and stronger feelings, as well as inability to differentiate or discern between our partner, to performing a concert or an increased ability to create appropriate two things that are intimately linked or making a big work presentation. boundaries with others. However, when very close together (in this case, the mind www.iayt.org YogaTherapyToday | Summer 2014 17 Feature Article continued

While Patanjali’s four-part model can ter in San Francisco with La Casa de Las tices that I hope will be useful. The real certainly be applied to physical issues and Madres, or the many people I work with work of self-discovery, transformation, and mental, emotional, or psychological individually for therapeutic, healing sup- healing that evolves from the practice is stresses and conditions (it even works as port, I tell my students I have three goals the result of the students’ own efforts. The a fabulous business model!), ultimately, for them: beauty of Patanjali’s Yoga Sutras is that yoga is a spiritual quest, one of personal 1) to feel better physically, mentally, and it is indeed experiential and practical: we transformation. Patanjali tells us that we emotionally through access to simple yet have to show up and do the work. While are looking to reduce or eliminate our powerful tools they can use on their own an experienced guide or teacher is an duhkham or experience of suffering, not to help reduce pain and ease symp- important part of this journey, the process the suffering itself (which Patanjali teach- toms; for each of us is highly individualized and es us we cannot avoid), by connecting 2) that whatever practice we do (asana, the efficacy depends on our own efforts. with our own true Self—that quiet inner meditation, visualization, chanting), my resource of strength and resilience, of goal is to teach them how to help sup- As teachers and therapists, we must wisdom and inner knowing, and also of port their parasympathetic nervous sys- do our own work, of course, constantly our own deep joy and peace. The authen- tem (or relaxation response), supporting striving to quiet and refine our own minds tic Self lives in the place within each of us the healing process at multiple levels; so that we can better connect with and act that transcends the body and mind and, and from our own true authentic Self. We not according to Patanjali, is pure and 3) Finally, but perhaps most importantly, I only feel better in our own lives, we can permanent. tell them my goal is also to help them act with more clarity, and navigate our quiet the mind and connect with that challenges and ups and downs with Because Patanjali recognizes that we quiet, inner resource within that I call greater grace and equanimity, hopefully are each individuals and that the process their own true authentic Self. inspiring our students and those around us of personal transformation cannot be a to do their own work. It is a practice that, cookie-cutter approach, the Yoga Sutras is while not easy, is there to meet us where full of many different choices, possibilities, Most importantly, as we are and serve us throughout our and solutions for calming and focusing the Patanjali mentions in llifetime. mind and helping to differentiate between mind and Self and to better connect with the very first sutra Patanjali’s model of healing, particu- (and act from) Self. I wonder how many with the word larly the importance of self-awareness, people realize that out of 195 sutras, all —yoga self-discovery, and the process of acting designed to help us quiet and focus the anusasanam from our authentic Self is the cornerstone mind so we can better connect with our is an ongoing, of healing. It is a highly personalized jour- true Self, only three have anything to do experiential practice. ney and a crucial piece that we can never with asana! forget in yoga therapy, no matter how It is not theoretical impactful or effective the asana, pranaya- To continue with my own story: When but practical. ma, or other tools in reducing or managing I came back to San Francisco after sever- symptoms. Ultimately, it is this journey of al years of living in India and studying with self-discovery that helps support us in Sri Desikachar, I focused my energies on every area of our lives, no matter what starting a non-profit healing center in San When I openly communicate these challenges life may bring. YTT Francisco modeled after the KYM. In goals to my students, it not only illustrates 2006, I founded the Healing Yoga Founda- yoga’s comprehensive and integrated Kate Holcombe began tion (HYF), with a dedicated team of approach to healing, it empowers students her yoga education in teachers and supporters, to fulfill the goal as conscious and active participants in 1991 as a student of of providing access to the tools of yoga their own healing. Understanding the T.K.V. Desikachar in for support to underserved populations in importance of self-awareness and self-dis- Chennai, India, and need. covery in the healing process underscores continues to study with that it is not me as teacher who is healing him regularly for extended periods of intensive, one-on-one When I teach now, whether as part of them, but the students themselves who study. Kate has over 20 years of experi- the Commonweal Cancer Help Program, are responsible for their own healing and ence working with individuals facing a transformation—they are not dependent HYF’s weekly classes for the homeless broad range of health concerns and ill- on me or anyone else to feel better. It through Compass Homeless Family Ser- nesses. She is the founder and director of vices, or our newest program, a weekly shows that ultimately, as Sri Desikachar the non-profit Healing Yoga Foundation in class for women facing domestic violence always says, as a teacher I am “just the San Francisco, California, and a contribut- and their children at the confidential shel- postman,” passing along tools and prac- ing editor for Yoga Journal magazine.

18 YogaTherapyToday | Summer 2014 www.iayt.org www.iayt.org YogaTherapyToday | Summer 2014 19 FeatureArticle Yoga for Grief Relief Relevant Knowledge for Yoga Therapists By Antonio Sausys Three Myths of Grieving Myth #1 Grief only appears as a result of someone having died. The truth was first struck by major grief at the To help yoga therapists understand what is that grief is the normal reaction to the age of 19 when my mother, my best they might need to know about grief, loss of people or things that we are Ifriend, died of a stroke at age 52. The there are three important myths about attached to. We can grieve the loss of a journey into the grief that followed my grieving that I would like to address here relationship, an ideal we once held dear, or mother’s departure transformed my life, so that yoga therapists may be more pre- even the discontinuation of a TV series that and it continues to do so today. pared to deal with the grief they will we watched for the past three years. encounter with their clients, even if grief Believing this myth to be true can result in At that time I was on my way to is not the presenting symptom. people being unaware of their own losses becoming a psychotherapist, studying and subsequent grief, believing that losses at a university that offered humanistic such as divorce or moving to a new city are psychology. Simultaneously, and not valid causes of grief. Not somewhat surprisingly, I also found only does this hinder the griev- myself starting a journey into a new ing process, it can intensify it. world of interconnectedness, For example, I often hear peo- through meditation and integration ple sharing in a circle who feel into my life of the practices of yoga. shame or guilt for grieving a rel- After witnessing in my psychothera- atively minor loss such as los- py practice that talking about one’s ing the family photos to a fire or problems does not necessarily even for grieving a divorce. In resolve them, I immersed myself in not acknowledging that such somatic psychology, learning to use grieving is normal and to some the body as both a diagnostic tool extent inevitable, and in unfa- and a field of operation for healing. vorably comparing their losses Yoga and somatic psychotherapy to the loss of a loved one, they became an inseparable dyad. Little are unable to appropriately did I know then, back in 1996, that I process and move through was practicing what we today call the grief they are actually yoga therapy! experiencing.

A few years later, I met Lyn Myth #2 Grief is purely Prashant, PhD, the creator of Inte- emotional. Grief affects the grative Grief Therapies. She was whole being and presents emo- conducting interviews for instructors, tional, spiritual, and neurologi- and during my interview she asked cally based mental and physical me if I could design a routine to symptoms. The latter was for address the physical symptoms of years grossly disregarded in the grief. I was astonished and pleasant- field of grief work, but is now ly surprised. Someone other than being recognized. Physical me was aware that grief is not just symptoms of grief include alter- emotional! In the years to come, she ations of breathing, eating, sex- helped me understand grief and the ual, and sleeping patterns, as need for a somatic approach to grief well as changes in heart counseling and therapy. The more I rhythms and endocrine and immune functions.1 It is also learned about grief, the more I normal to experience pain, real understood that it is a lot more com- physical pain, usually in the mon than we might think. Although chest area. Even emotionally, grieving is a normal process, not a most people associate grief pathology, it can be a fierce and with just sadness, not recogniz- intense experience during which ing that anger, guilt, and anxiety people often need support to fully can also be emotional symp- allow it to run its natural course. toms of grief.

20 YogaTherapyToday | Summer 2014 www.iayt.org Feature Article continued

Myth #3 Grief is the price we pay in mitigating the symptoms but also can for love. This well-known phrase was I have come to under- help the griever through a profound oppor- uttered by Dr. Colin Murray Parkes, made tunity for a kind of rebirth, a renewal after famous later by Queen Elizabeth II, and stand that grief is the the loss of what formerly was part of his or many people believe it. However, in my second most preva- her self-definition. opinion, grief is the price we pay for lent feeling in the attachment, not love. While secure attach- So, going on the assumption that ment is crucial for early development, at human heart after every yoga therapist will encounter griev- some point we need to let go of our love and that all of us ing individuals, whether grief is the primary dependence on childhood securities and presenting symptom or not, here are some develop a mature relationship with attach- will feel it throughout appropriate initial treatment guidelines to ment. Attachments are, after all, inherent our lives in one way best serve those grieving. to the human condition, and we all devel- op them. However, if we continue to or another. Yet love is “Grieving individuals need to be depend on the presence of another for our often spoken about, heard,” 2 not to be told what to do—hear happiness or even for the presence of while grief is hidden them out. love, we are bound to suffer. Ultimately, love is not dependent on anything for its away and rarely Because of the common discomfort existence, and in that sense it is the oppo- brought out in the surrounding grief, we may be inclined to site of attachment. From this viewpoint, try to relieve the pain clients are experi- grief as a response to the loss of some- open. encing by asking them to do something to one or something that we are attached to change it, whether it’s an asana or a trip to is a different stream in the flow of life. see a shaman in the mountains of Peru. an absolutely healthy life. As a result, most However, for a grieving individual, such The Grieving Process yoga therapists will face grieving individu- suggestions may feel like they are not als in their practice and should expect the being given the space to grieve, or even Once we lose something or someone we symptoms of grief to appear in addition to that they ought not to give themselves are attached to (primary loss), other loss- the symptoms of the condition being treat- that space. Instead, I recommend es occur as a result (secondary loss). For ed. The symptoms of each condition need compassionate listening. By that I mean example, after a divorce (primary loss) it is to be properly differentiated and under- just listen, holding a quiet and calm spiritu- usual to lose the social network the part- stood in order to generate an effective al space—refraining from nodding con- ners enjoyed together (secondary loss). treatment plan. If the yoga therapist is not stantly, touching your client’s hand, or Secondary losses are as valid sources of aware of the root cause of symptoms, he even giving clients tissues when they have grief as the primary ones, and sometimes or she may then pay attention to some not asked for them. Stay present, with they are felt even more intensely than the partial symptoms of grief, such as persist- steady eye contact, and just listen to what primary one. This is partially related to the ent sadness, and perhaps think that the clients are saying. In that way, you’ll avoid fact that while the primary loss is a single client is depressed. Normal grief is some- unhelpful interventions and, more impor- event—you divorce only once—secondary times misdiagnosed even by mental-health tantly, you will be giving your clients oppor- losses occur frequently, for example, each practitioners as clinical depression, anxiety tunities they probably are not getting from time you are not invited to a social event disorder, or even post-traumatic stress dis- their regular social interactions. As because you lost your social circle. In order. Having adequate knowledge regard- expressed by Dr. J. William Worden in his addition, new grief triggers old grief, and ing grief can inform the choices of yoga book Grief Counseling and Grief Therapy: othes’ grief triggers our own. Considering therapists and help them determine the A Handbook for the Mental Health Practi- the total sum of these losses and the best course of action for their clients. tioner: “The first task of grieving is to come resulting grieving processes, I have come full face with the reality that the person is to understand that grief is the second In general, it would be sufficient to dead, that the person is gone and will not most prevalent feeling in the human heart receive general information about the return.”5 (p. 39) Emotional acceptance of after love and that all of us will feel it grieving process as part of a yoga therapy the reality of a loss (not just loss from throughout our lives in one way or anoth- training, where a deep knowledge of yoga death) is a crucial part of the normal griev- er. Yet love is often spoken about, while is also provided, but if the yoga therapist ing process. For a certain period of time, grief is hidden away and rarely brought intends to actually support and assist a repeating the details surrounding out in the open. Repressing this powerful grieving individual using yogic tools, then the loss, including the feelings and - force in the heart can cause multiple psy- special training is needed. While knowl- tions, helps grievers accomplish this task. chological and physical imbalances. edge of yoga is foundational, a deep understanding of the grieving process, Most grievers want to regain a sense of Every health condition, whether men- including the neurophysiological bases for self—help them normalize, control, and tal or physical, implies a certain degree of the symptoms, and a clear understanding balance their reactions. grief because it involves some form of of the spiritual implications of this human loss: either loss of functionality due to the experience are essential. Then the thera- It is common for grievers to think they condition itself or the loss of the illusion of pist can do more than just assist a griever are going crazy, to feel that nobody can www.iayt.org YogaTherapyToday | Summer 2014 21 Feature Article continued

understand what they are going through classical insomnia that worries most griev- we lose the things and persons we are and that they will not be able to overcome ers.4,6 In addition, this technique can help attached to we lose part of who we are, the painful situation they are in. Based on balance the endocrine system, which is but because we continue living, a new some general knowledge of grief, yoga quite taxed while grieving; greatly reduc- identity must be recognized. Your com- therapists can let clients know that “the ing the characteristic mood swings those passionate assistance in this difficult profound changes he or she is experienc- grieving experience. process can help individuals re-identify ing are normal and involuntary reactions themselves. Because we are yoga thera- to loss”3 (p.18), that most grievers feel sick We can be present for another’s grief pists, our help in this re-identification at some point, even though grief is not an only to the extent that we know our process can lead an individual back to his illness. They can let their clients know that own—go there yourself. or her own soul, the ultimate destination it is common to experience difficulties in of yoga. If that is the case, you are honor- making decisions, even simple ones, due It is probably true that you don’t need ing the yoga in yoga therapy, helping indi- to the fact that grief “shatters and scatters to have arthritis to understand and help viduals to connect with their deepest linear thinking,” as I have often heard my people who suffer from it, but in the case selves in a wise and compassionate way. mentor Lyn Prashant say. Normalization of grief, your knowledge of your own grief YTT gives appropriate context to the grievers is essential if you want to be therapeuti- and can help to calm anxiety. cally effective. This is true regardless of References: whether you are professionally dedicated 1. Gardner, J. (2002). Handout for U.C. Berkeley to grief counseling and therapy through Extension Continuing Education Workshop “Somatic Normal grief is some- yoga or whether you have detected grief Aspects of Loss and Grief,” Berkeley, CA, October times misdiagnosed symptoms in your chosen practice. Unless 26-27. Retrieved from: recognized and resolved, your own grief http://journeyofhearts.org/about/somatics.html even by mental will cause you to project your own reality 2. Prashant, L. (June/July, 2002). Grief and degrief part 3—The art of holding space: Degriefing from the health practitioners onto your clients, most likely in the form of therapist’s perspective. Massage Bodywork. Retrieved trying to fix them and “save” them, rather from http://www.massagetherapy.com/articles/index. as clinical depression, than accompanying them through their php/article_id/53/Grief-and-Degrief-Part-3 anxiety disorder, or journey of grieving. Instead of remaining 3. Prashant, L. (2002). The art of transforming grief: A practical guide for combining conventional and even post-traumatic in the seat of the therapist and supporting complementary mind-body therapies. San Anselmo, your clients, beginning with the way you CA: Self-published. stress disorder. react to your clients’ disclosures, you are 4. Schoenfeld, F. B., DeViva, J. C., & Manber, R. more likely to interact with them in a (2012). Treatment of sleep disturbances in posttrau- social way and repeat some of the chal- matic stress disorder: A review. J Rehabil Res Dev, 49(5), 729-52. Retrieved from The next tier is often helping clients lenges they are already experiencing in doi:10.1682/JRRD.2011.09.0164 with some kind of calming and balancing their regular lives. Therefore, yoga thera- 5. Worden, J. W. (2009). Grief counseling and grief technique, depending on the symptom. pists must be rigorous in their self-inquiry therapy: A handbook for the mental health practitioner Grief is inherently an out-of-control situa- into their own grieving before attempting (4th ed.). New York, NY: Springer. tion—if we could control loss, we would to assist others in theirs. 6. Khalsa, S. B. S. (2004). Treatment of chronic insomnia with yoga: A preliminary study with sleep- probably not lose anything in life! The wake diaries. Applied Psychophysiology and Biofeed- resulting reaction includes a certain lack of Yoga therapists should not be expect- back, 29(4):269-278. control of the regular rhythms (heart ed to know everything about every condi- beat) and functions of the organism such tion, but because of grief’s incidence in all as the eating and sleeping cycles. In the aspects of life, having some initial knowl- same grieving process, a person can feel edge about grief and how to support anxious and hyperactive the first two those grieving is at the base of any effec- months after a loss, then depressed and tive therapeutic yogic interaction. Most Antonio Sausys, MA, fatigued the following month. The simple yoga therapists can listen compassionate- IGT, CMT, RYT, is a somatic psycho- practice of single-nostril breathing can ly and offer some words of normalization therapist and yoga offer the griever the possibility of calming and techniques for control and balance to instructor specializing when agitated (chandra bhedana pranaya- a grieving individual. Then, if necessary, in yoga for grief relief. ma), and energizing when depleted (surya clients can be appropriately referred to a He is the founder and bhedana pranayama), helping them devel- competent psychotherapist who can take executive director of the International op a much-needed sense of control. Once adequate care of them. Yoga Therapy Conference and a TV host the symptoms are relatively under control, for YogiViews. balance should be maintained. Suggesting In the meantime, by simply being www.yogatherapyconference.com the practice of trataka (concentrated gaz- present for your clients’ losses, you are www.yogaforgriefrelief.com ing), for example, half an hour before bed- helping them with one of the most vulner- www.yogiviews.com time and half an hour after waking up, can able aspects of life. Because we identify www.iamhealthyradio.com reset the sleeping cycle and combat the ourselves through our attachments, when www.satyoga.com

22 YogaTherapyToday | Summer 2014 www.iayt.org www.iayt.org YogaTherapyToday | Summer 2014 23 Perspective A Physician’s Reflections on the Field of Yoga Therapy The Future is Now

By Baxter Bell due to their personal yoga practices. Fast unusual skin condition affecting the ankles forward to the present, we see the acceler- and feet with swelling as a side effect. It ack in 1989, I was not really aware ated exposure of yoga therapy in the news was quite natural to recommend viparita of the world of yoga, let alone the and the development of complementary karani (legs up the wall) as part of her Bexistence of a group of dedicated clinics in large medical centers around the home care. practitioners who were then coming country. I recently gave a grand rounds together to create IAYT. I was knee-deep presentation to the hospital staff at a As my private practice has become in my first year as a full-time family doctor teaching hospital in Omaha, Nebraska, part-time, my teaching of yoga and yoga and too busy to be aware of much of any- entitled “How Yoga Can Help Our Patients: therapy has grown more full-time. Even thing else. But what became more evident The Studies, the Theory and the Practice,” early on in my teaching career, I was invit- to me over the ensuing years was that like so things are definitely moving forward at ed to teach modules for teacher training all forms of healthcare treatment, mine as a good pace! programs on experiential anatomy, where a family doctor had many limitations. And, I admit, this was frustrating to me. I was also noticing the effects of intense work and lifestyle choices that contributed to my perception of “stress.”

Yoga first showed up in my life in 1994 as a way of reconnecting to a qui- eter, more genuine strand of myself that was often lost in the relentless intensity of work and family life. What I recognized from the start was that I was delighted with the way my yoga practice left me feeling and I wanted more of that. As my personal practice grew, one of my yoga teachers encouraged me to consider teaching yoga, which had never been a conscious thought on my part until that moment. But once the seed was planted, it quickly germinated. And I suppose some part of me was already thinking about how yoga could be a hands-on therapeutic option for my patients.

It was not until I began my training to become a yoga instructor in 2000 that I read my first issue of the International Photo credit: Rebecca Pixely Journal of Yoga Therapy. I became very Baxter highlights the quality of flexibility as it relates to healthy aging at a recent weekend workshop at the Omaha Yoga & Body Work Center. excited at the prospect of using yoga ther- apeutically for my students and patients and even took this enthusiasm back to my Yoga as a Healing Tool students apply what they are learning hometown of Covington, Kentucky, where about anatomy to the actual yoga poses. I offered my first presentation and experi- Referring to the work I do with yoga as a Invariably, the discussions would turn to ential workshop on Yoga for Medical Con- healing tool, I wear several hats—as a injury and illness and my presentations ditions to the medical staff at the hospital I medical physician, medical acupuncturist, began to morph into a more combined used to admit to. The turnout was small— yoga instructor, and yoga educator. I fully focus on anatomy and therapeutics. mostly my closest colleagues—but there recognize the therapeutic applications of About three years ago, I was asked to was a curiosity, although not necessarily yoga, but I don’t presently refer to myself teach at a new yoga therapy training in an acceptance of yoga therapy at the as a yoga therapist, mostly because this Berkeley, California, for which I developed time. title is still evolving and could mean differ- modules on skeletal issues, digestive con- ent things to different people. In my medi- ditions, endocrine disorders, men’s health I talked about the concept of yoga cal practice, I see a mixture of students issues, and, most recently, occupational therapy in my public classes, where nurs- and patients for medical acupuncture and health issues. Programs around the coun- es, physical therapists, medical students, private yoga sessions about 12 hours a try have invited me to participate as a vis- and even the occasional physician were in week. Even with my patients that come in iting faculty member in their therapeutics attendance. These healthcare practition- strictly for acupuncture treatment, I often programs as well, often hearing about my ers were very interested in yoga’s thera- add in appropriate yoga tools to the treat- work from my Yoga for Healthy Aging blog peutic potential, likely spurred by their per- ment mix if the patients are game. For and some Yoga Journal blogging I did for sonal experiences and transformations instance, a person came in recently for an two years.

24 YogaTherapyToday | Summer 2014 www.iayt.org Perspective continued

I’ve been asked whether I think that in whether on the physical level of injury, or ty of yoga research still has a long way to the future more physicians will study yoga the physiological level of something like go. So let’s be honest about that too. I to use as an adjunct to their medical prac- the endocrine system, or the mental-emo- tend to be very careful about the kinds of tice. My answer is, the future is now! I get tional level, can provide insight into where explanations that I often hear for the several emails or phone calls every year to take the therapeutic treatment. Such effects of certain poses and how they from physicians-in-training that are simul- foundational knowledge also enhances work. A classic myth is that twisting taneously studying yoga. They often want communication with healthcare providers asanas “detox” the organs. It turns out guidance on how they might integrate we may interact with on our student’s that the body’s detox system is mostly the their yoga knowledge with their medical behalf. In some ways, I see the advantage liver, and, to my knowledge, no studies on training. I try to encourage them to make and need for lots of well-trained yoga ther- improved liver function through yoga or sure to complete their medical training apists who are “generalists,” just as family specifically twists have yet been done. and get some solid clinical practice experi- doctors, internists, and pediatricians serve So we may want to stick to the obvious ence in their field of medical study, even if that role in the allopathic system, which effects on the musculoskeletal system and they also want to start teaching yoga or dominates the Western healthcare system, stress reduction, for example, until we sharing the practice with their patients. simply because generalists can serve a actually have solid research that tells greater population of people who need us more. What Do Yoga Therapists Need to what we know. As an educator in several Know? yoga therapy teacher training programs, I Yoga Therapy as Medical Yoga struggle with trying to find the right bal- I feel fortunate that most of my interac- ance between my trainees having enough As someone who has certain titles and let- tions and decisions when I work with yoga relevant knowledge of Western diagnostic ters that follow my name, I am aware of therapy clients are informed in a helpful criteria for things like Parkinson’s and what is implied from terms such as “medi- way by my many years as both a family hypertension and their specific role in cal yoga.” In comparison, I refer to the kind of acupuncture I practice as “medical doctor and, more recently, as a medical addressing such conditions. Finding this acupuncture,” because that is the title acupuncturist (a designation given to balance gets complicated by the fact that given to it by an organization called the physicians who have completed a post- we are in the midst of a period of acceler- American Academy of Medical Acupunc- graduate program in acupuncture ating research on what illnesses and dis- ture. Now, it is not a household phrase, designed for MDs). eases yoga can effectively influence and and I often explain what it means to my how yoga might best fit into a helpful mul- patients before we begin working together. tidisciplinary treatment approach. What Because we have an organization— In yoga therapy training programs, I may be adequate for someone to know IAYT—that is in the process of credential- teach topics ranging from yoga for skeletal now is likely to be different five or ten ing something called “yoga therapy,” it issues to endocrine disorders to digestive years from now. would seem reasonable if we are in the issues, and I have had the clinical experi- field and working toward an official desig- ence of caring for patients over the years nation to call what we do “yoga therapy.” with these kinds of health issues, so I can I tend to be very Language like “medical yoga” might imply share real-life stories of how a certain formal training in both medicine and yoga, condition impacted a patient’s health, careful about the which I am guessing is probably only work, relationships, and so on—all things rarely the case. I feel that “yoga therapy” that therapeutic yoga tools could influence kinds of explanations now carries enough weight by virtue of the as well. that I often hear for research and collaborations that are hap- pening that inaccurate and possibly mis- From what I’ve observed, more clini- the effects of certain leading phrases like “medical yoga” are cal training settings need to be estab- poses and how they really unnecessary. They don’t make our lished in many yoga therapy programs to work more credible and might do more take the knowledge from theory to real work. harm than good. And the first rule in heal- experience. For some yoga therapist ing, of course, is to do no harm. YTT trainees, there is an obvious gap between conceptual understanding and practical 1. McCall, M.C. (2013). How might yoga work? how-to knowledge and skills. Trainees I think it is essential that new thera- An overview of potential underlying mechanisms. pists clearly convey their level of training Journal of Yoga & Physical Therapy, 3: 130, doi: need to absorb the information about cer- 10.4172/2157-7595.1000130. tain health conditions and possible yoga and experience. I remember being a new tools to address them and then have the doctor just out of medical school and invaluable hands-on experience of work- telling my patients how green I was. How- Baxter Bell, MD, ever vulnerable I felt about admitting that, ing with actual clients with those issues. E-RYT, directs the they always appreciated my honesty, and We try to give trainees supervised hands- Piedmont Yoga we would work together if I needed to get on time with clients in one program I teach Studio’s teacher some guidance from senior docs in my in by inviting the public to a three-hour practice. With yoga therapy, that kind of training program in workshop on the topic at hand, so as to upright honesty is also essential. And I Oakland, CA, is on have some real people with certain med- think we also need to be clear about the faculty at many yoga ical conditions—for example, type 2 dia- quality of the yoga research literature therapy training programs nationally, and betes. when talking about “proof” of how yoga leads workshops, trainings, and retreats in works. A recent review article1 that came the United States and abroad. To learn Having a reasonable understanding out a month or so ago was pretty clear of the most common health issues that more, visit www.baxterbell.com and that we are just at the beginning of truly www.yogaforhealthyaging.blogspot.com. your clients are likely to present with, understanding how yoga works—the quali- www.iayt.org YogaTherapyToday | Summer 2014 25 26 YogaTherapyToday | Summer 2014 www.iayt.org www.iayt.org YogaTherapyToday | Summer 2014 27 YogaTherapyinPractice The Truth About Back Pain A Biopsychosocial Approach to Treatment

By Shelly Prosko cause of LBP oversimplifies a complex issue. Perhaps ver the past sixteen years as a this is one of the reasons physical therapist (PT) and yoga why LBP tends to be so Otherapist working in an outpatient poorly managed or treated orthopedic clinic, the most common com- in the context of our current plaint I hear from my clients is related to healthcare system. low-back pain (LBP). In fact, over 80% of North Americans suffer from back pain at I feel that the majority of some point in their lives.1 The Global Bur- cases can certainly be better den of Disease Study 2010 revealed that managed if people suffering LBP is the number one cause of disability from LBP, along with their globally2 and has been found to be the healthcare providers (includ- most common reason for time loss from ing yoga therapists), had a work in much of the world.3,4 There are better understanding of the many different opinions about what caus- complexity of the causes of es LBP. Perform an online search with the back pain and also had Photo credit: Punctum Photography keywords “causes of low back pain,” and Shelly is gently nurturing and guiding a client into a exposure to some of the 44 million entries will result. This is quite modified version of utthita parsvakonasana research about the efficacy of some of the ironic, since approximately 90% of LBP (side-angle stretch) using a physio-exercise ball for treatment approaches to back pain. cases are nonspecific, meaning the exact added support. causes remain unclear.5 I must clarify that In this article, I share my perspective, I will be discussing nonspecific LBP treatment approach works—when it does, experience, and knowledge about what I throughout this article and not the remain- for example, core stability training or have learned so far in my career of treat- ing 10% of cases that do have specific acupuncture—are often poorly under- ing clients with persistent LBP using a known causes. stood. combination of physical therapy and yoga therapy. My insights come from a combi- Causes of Nonspecific Low-Back The more we learn about how com- nation of clinical experience with clients; Pain plex the science surrounding pain and the my studies of the evidence-based litera- pain experience is, the more we realize ture; reflections on perspective pieces of What do we know about the causes of the that pain, including LBP, is an experience other leaders in the field; and my personal majority of LBP cases? Are they due to that involves numerous systems in our yoga practice, intuition, and self-reflection. dysfunctional or damaged structures? Are physical bodies; in our minds, emotions, Following are some trends that I have they due to muscle strength and flexibility and spirits; and in our social relationships. seen in working with the persistent LBP imbalances or to joint dysfunctions sur- Lorimer Moseley, PhD, a leading pain sci- population: rounding the spine? Are they related to ence researcher, confirms that the pain postural alignment, postural habits, or experience “does not provide an accurate 1) Create an individualized body mechanics? Abnormal neuromotor measure of the state of the tissue.”12,13 treatment plan unique to each client’s sequencing and timing? Dysfunctional In other words, pain is a biopsychosocial needs. synergistic action of muscle groups? Or process rather than a purely anatomical or are they related to psychosocial factors physiological one,14 so it would make I have learned that people with persistent such as unmanaged stress, depression, sense that in order to successfully and LBP respond differently to different meth- anxiety, fear-avoidance behaviors, dys- optimally treat such a complex biopsy- ods of treatment regardless of diagnosis. functional relationships, or ineffective chosocial problem such as LBP, one For example, two people could have the emotional awareness, expression, and would need to take a biopsychosocial exact same diagnosis of spinal stenosis at management? Does a sedentary lifestyle approach.14,15,16 L4-5 with irritation to the left exiting L4 or being overweight play a role? Or is it nerve root, and even have the exact same a combination of the above? Different Yet it amazes me that even with this structural presentation such as tight hip groups of people offer different answers, knowledge and the science to support it, flexors and adductors, weak gluteals, and quite often these answers appear to our current healthcare system continues quadratus lumborum compensation, and depend on what type of service the to primarily use a biomedical model that increased lumbar lordosis, but they each groups provide. Many risk factors have focuses on just the physical aspects of the may respond differently to a proposed been reported to be associated with non- patient when assessing and treating LBP. treatment protocol (which may include specific LBP, but there is little evidence The biomedical model does not address yoga asana, PT exercises, manual physi- that demonstrates actual causation of the psychological factors such as the client’s cal therapy methods and education) majority of LBP cases. In fact, for a long mental and emotional health, or sociologi- based solely on the structural biomechani- time now we have known that the specific cal factors, such as the client’s relation- cal presentation. Sometimes directly damage to the spine or tissues has a very ships with others, self, and the environ- addressing the structural deficits helps, poor correlation to LBP.6–11 To make it even ment; cultural factors; and socioeconomic sometimes it does not. more confusing, the underlying mecha- factors. This reductionist approach of try- nisms that explain how and why each ing to find and treat the one underlying

28 YogaTherapyToday | Summer 2014 www.iayt.org Yoga Therapy in Practice continued

In physical therapy school, for safety throughout the spinal column. Dr. M. Pan- and to help guide our treatment plan, we We know that certain jabi, leading international researcher of learn numerous treatment guidelines, pre- spine biomechanics and past director of cautions, and contraindications that are muscles of the core Yale Biomechanics Laboratory, which spec- essential to understand and follow with activate just prior to ializes in lumbar spine biomechanic each diagnosis. However, also incorporat- research, defined the term “neutral spine” ing a well-rounded therapeutic yoga limb movement and as “[t]he posture of the spine in which the approach and addressing all five koshas that training the overall internal stresses in the spinal col- by using a biopsychosocial assessment timing of the core is umn and the muscular effort to hold the can result in a more individualized posture are minimal.”17 Neutral spine may approach to developing and implementing more effective than be important when the spine is being each client’s treatment plan. It is important strengthening; how- loaded through heavy lifting, performing to point out that assessment of all the lay- repetitive movements, or when we are in ers is an ongoing process that continues ever, there are no prolonged static positions. But overall, the each time I see a client for follow-up treat- conclusive studies that spine is designed and meant to move in ment sessions. The “bio” aspect of the I could find that show healthy and biomechanically efficient assessment consists of analyzing the ways, including in and out of its static physical and subtle bodies, which includes core training is signifi- neutral position. Panjabi defines this as alignment, movement mechanics, stability, cantly any more the “neutral zone” of spinal movement: nutritional habits, breathing patterns, and “That part of the range of physiological energetic expenditure and levels (anna- effective for nonspecif- intervertebral motion, measured from the mayakosha and pranamayakosha). The ic persistent low-back neutral position, within which the spinal “psyche” aspect involves discovering a pain treatment com- motion is produced with a minimal internal sense of the client’s mental and emotional resistance.”17 In other words, whether the state of health (vijnanamayakosha and pared to other forms spine is in its static neutral position or manomayakosha). The “social” aspect of of exercise. moving out of neutral position, the load the assessment involves discovering a throughout the spine still needs to be sense of the client’s relationships to oth- evenly distributed in the most optimal way, ers, to self, and to the environment (anan- to each treatment modality is what dic- that is, the spine needs to be stable. Pan- damayakosha and manomayakosha). tates the next step during the session and jabi outlined three components of joint Gaining knowledge about any cultural or beyond. A practice that calms the nervous stability: 1) passive components (bones, socioeconomic factors that may influence system one day may create anxiety or irri- ligaments, discs), 2) active components treatment is also considered. As a physi- tation and worsen the pain experience (muscular tissues), 3) neuromotor control. cal therapist, I am not trained to perform another day. Practicing ongoing reassess- These three systems have to work togeth- formal mental health or behavioral assess- ment of the efficacy of the treatment and er in order to transfer load efficiently and ments. I am also not a trained spiritual modifying as appropriate is part of the safely along the spinal column.17 Addition- guide. I perform a thorough subjective work of a therapist. I am hesitant to say ally, Diane Lee, a physical therapist interview, which is a combination of asking that I sense some trends in our yoga ther- known for co-developing the Integrated questions, sometimes guided intuitively, apy profession developing toward a less Systems Model of Function that is widely and listening and observing. By actively individualized approach. Workshops, arti- used by therapists internationally, listening to the client, I can often get a cles, books, and classes geared towards describes a fourth component to pelvic sense of the client’s social connections to asana, pranayama, or meditation proto- stability: awareness and response to emo- others, to self, and to the surrounding cols for specific dysfunctions or illnesses tional stress factors.18 People with persist- environment, as well as their emotional are becoming more prevalent. These are ent LBP move and breathe differently, per- awareness and intellectual state—that is, I essential educational tools for us to learn haps partly due to fear or anxiety, and this get a sense of the client’s ability to dis- from and the information we glean from can lead to even more reduced or abnor- criminate, think critically, and problem them serve as guidelines. However, we mal movement patterns that further feed solve. Knowing this helps to determine must remember that the “therapy” in yoga into the pain cycle. As a result, the ner- what type of client education is best for therapy is about addressing the individual vous system starts to change and the neu- treatment and for achieving patient com- needs of each person and not the general ral pathways that contribute to the pain pliance, which in turn results in more suc- trends of the dysfunction itself. If we are experience can persist, even when no real cessful outcomes. Throughout the entire not cautious, we can fall into the same damage or threat to the tissues exist.12,13 physical examination, I am also watching, paradigm we are trying to improve upon listening, and observing cognitive-behav- with our current healthcare system! I Clinically, I find that the majority of my ioral responses and getting a sense of the believe this individual approach to treating LBP clients respond much better to gen- depth of the mind-body connection that persistent LBP is especially important, and tle, dynamic, and biomechanically safe the client evinces. Additionally, each indi- consequently more effective, because of movements within pain-free ranges vidual may have different imbalances of the complexity associated with LBP. instead of attempting to find and hold a doshas or gunas, breathing-pattern dys- neutral spine. Generally, I find when they functions, or learning styles that will also 2) Teach biomechanically safe are instructed to keep a neutral spine, it influence what treatment approach to use. movement. seems to perpetuate the guarding, rigidity, The intention is always to treat the person, bracing, reduced movement, altered instead of the diagnosis. Most of us will agree that postural align- breath pattern, and muscular inefficiency ment plays a role in maintaining a healthy by activating more muscle groups than Furthermore, I find the individualized spine. The three natural curves help required. This leads me to share my per- treatment plan is a good base to start absorb shock, allow for ease of move- spective on core strengthening in the con- from, but ultimately the client’s response ment, and distribute forces evenly text of LBP treatment. We know that cer- www.iayt.org YogaTherapyToday | Summer 2014 29 Yga Therapy in Practice continued

each client. The asanas or movements I Applying muscle- choose depend on the assessment find- ings and are continually being reassessed energy techniques to and modified as the session unfolds. All five koshas are taken into consideration, Rob’s hamstrings is as well as the gunas and doshas as only a small part of appropriate. how Shelly addresses 3) Address the breath.

his back pain. Persis- In my clinical experience, I have noticed tent back pain is a that dysfunctional breath patterns are a common denominator in the majority of biopyschosocial issue the LBP clientele. An inefficient apical breath pattern results when the accessory and should be muscles of respiration are habitually used. treated as such. The respiratory diaphragm excursion is reduced with such dysfunctional breath patterns. The respiratory diaphragm is an important contributor to spinal stability,25 and it has also been shown that breathing exercises can be used as a component of spinal stability exercises.26 One study compared breath therapy (defined as “a Western mind-body therapy integrating

Photo credit: Punctum Photography body awareness, breathing, meditation, and movement”)27 and high quality, tain muscles of the core activate just prior considered for each individual in order extended physical therapy in a group of to limb movement19 and that training the to determine what movements would be thirty-six chronic LBP patients for twelve timing of the core is more effective than safe. I sometimes forget that my training, sessions over six to eight weeks. The strengthening; however, there are no con- knowledge, and skills as a physical thera- results showed that the chronic LBP clusive studies that I could find that show pist are not necessarily shared by other patients improved just as much with core training is significantly any more yoga therapists. Yoga therapists can learn breath therapy as with extensive physical 27 effective for nonspecific persistent LBP more about biomechanically safe patterns therapy. Also, I have noticed that treatment compared to other forms of in their training programs and ongoing reduced rib expansion and poor thoracic exercise.20 continuing education courses. I also rec- mobility are also common in my LBP ommend that yoga therapists communi- clientele. Clinically, I have witnessed an In my experience with LBP clients, I cate with the client’s physical therapist for improvement in thoracic and rib mobility find that when they attempt core-stability guidance regarding the physical compo- and a subsequent successful reduction in exercises, the result is more of a “bracing” nent of treatment, just as I would commu- LBP in many clients who have been of the spine. Chronic LBP patients have nicate with the client’s psychologist for instructed to use ujjayi breathing as part of been found to evince an abnormally guidance on precautions, contraindica- their LBP management program. However increased co-contraction muscular force tions, or areas of mental health to focus I do not know if the success in reducing with regular movement,21 one that can on during the yoga therapy treatment. back pain is due to improved biomechan- potentially contribute to an even more ics of the breathing pattern (including abnormal movement pattern, reduced I commonly initiate the introduction of mechanical efficiency and spinal stability), movement, muscle inefficiency, and even movement by asking clients to explore and changes in overall movement patterns as increased spinal compression.21–24 I find allow their normal and natural breath pat- a result of improved breathing pattern, that traditional core exercises tend to feed tern to emerge. I may follow with a mind- reduced fear and anxiety resulting in into the abnormal and reduced movement fulness meditation that consists of observ- increased confidence to move, changes at pattern that persistent LBP clients are ing the abdomino-diaphragmatic breath, or the level of the nervous system that are already experiencing. I find that introduc- belly breath, followed by gentle hip, shoul- responsible for pain modulation, or a com- ing biomechanically safe, gentle, slow der, or spinal range-of-motion assessment bination of the above. What I do know is movements in a pain-free range and in while promoting concepts of “less is more” that breathing somehow plays a significant conjunction with efficient breathing pat- or “letting go and getting out of your own role in the treatment of LBP. Research terns seems to yield more favorable out- way.” I find that giving a client several supports some of what I found clinically: comes in pain reduction and functional instructions such as “engage this muscle, that breathing pattern disorders such as abilities than core strengthening. Biome- then lift this, then hold that while keeping hyperventilation syndrome or use of chanically safe spinal movement patterns this in” typically results in abnormal and accessory breathing muscles can reduce are those in which the forces acting along inefficient movement patterns, breath hold- chest wall movement and reduce 28 and within the spine are at a minimum. In ing, and frustration, all of which exacer- diaphragmatic function. Science also other words, the spine still must remain bate the pain cycle. When the client is shows us that an inefficient breath pattern relatively stable as it is moving. However, practicing asanas, I tend to keep the causing an over-stimulation of the sympa- what may be biomechanically safe for one asana very “alive” and moving, either with thetic nervous system response can fur- person may not be for the next. The com- small oscillations in timing with the breath ther increase anxiety, muscle pain, and 29 ponents of spinal stability as discussed pattern or moving into and out of the fatigue. above by Panjabi and Lee must all be asana in a safe and enjoyable way for (continued on page 32)

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4) Encourage pleasure. may wish to). This seems to serve us both Treatment methods well. I also meditate briefly with the client It is likely not a huge surprise to yoga prior to setting the intention. therapists that there is a strong correlation that restore confi- between psychological factors and chronic I hope this perspective has shed LBP.30 When LBP clients focus on the sto- dence have been some light on the management of non- ries surrounding their unpleasant and shown to reduce LBP specific LBP using a therapeutic yoga stressful personal or professional situa- approach. I have consistently seen an tions, there is a reduction in movement, by addressing clients’ overall improved outcome in movement, change in breath pattern, and an increase emotional factors such function, and pain reduction in my LBP in pain complaints, but when they arrive clients by using this approach. Yoga thera- for treatment just after experiencing some- as fear or anxiety. py can be very effective in managing a thing that brought them profound joy, they biopsychosocial issue such as nonspecific seem to focus on that rather than the As yoga therapists, LBP because the assessment and treat- pain. They move and breathe with more we have many tools ment modalities are also biopsychosocial ease, as if joy has permeated every cell, in nature. YTT and their symptoms and complaints signif- at hand to help build icantly reduce. Manomayakosha, vijnana- rapport and restore mayakosha, and anandamayakosha are References important to address in any plan of care, confidence in our 1. Balagué, F., Mannion, A. F., Pellisé, F., & Cedraschi, C. (2012). Non-specific low back pain. but they are particularly essential for clients. Lancet 379(1914), 482-91. Retrieved from clients suffering from persistent LBP. I http://www.ncbi.nlm.nih.gov/pubmed/21982256. refer clients to mental health care profes- 2. Hoy, D., March, L., Brooks, et al. (2014). The sionals or to their spiritual counselors as and feel confident about what they were global burden of low back pain: estimates from the appropriate. Sometimes I encourage, or Global Burden of Disease 2010 study. Annals of the doing. Consequently, they seemed to have Rheumatic Diseases, 73(6). doi: even help, clients make a list of things a better chance of improving. I continue to 10.1136/annrheumdis-2013-204428. that bring them joy in their life that they believe this today. There is also now some 3. Andersson, G. B. J. (1997). The epidemiology of can feasibly access, such as listening to research to support this hypothesis as it spinal disorders. J. W. Foymoyer, T. B. Ducker, et al. music, spending time in nature, visiting a (Eds.) The Adult Spine: Principles and Practice. relates to LBP. Treatment methods that Philadelphia, PA: Lippincott-Raven. grandchild or friend, having a phone con- restore confidence have been shown to versation with a loved one, and so on. I try 4. Center on an Aging Society Georgetown Univer- reduce LBP by addressing clients’ emo- sity. (2003). Chronic back pain: A leading cause of to carefully observe clients’ emotional tional factors such as fear or anxiety.31 As work limitations. Challenges for the 21st Century: responses to different treatment modali- yoga therapists, we have many tools at Chronic and Disabling Conditions, (8). Retrieved from ties. I may notice a certain asana or http://hpi.georgetown.edu/agingsociety/pdfs/backpain. hand to help build rapport and restore con- pdf. pranayama practice resonates on a pleas- fidence in our clients. Here are a few of urable level for some clients. Or I may 5. Krismer, M. & van Tulder, M. (2007). Low back mine I would like to share: pain (non-specific). Best Practice & Research Clinical even ask clients to observe how a practice Rheumatology, 21(1), 77-91. makes them feel and to share their feel- Listen. Many people with chronic pain 6. Haig, A. J., Tong, H. C., Yamakawa, K. S., et al. ings with me if they choose. I think it is feel they just need someone to listen to (2006). Spinal stenosis, back pain, or no symptoms at important not to force joy or try to make them and understand. Developing a strong all? A masked study comparing radiologic and electro- someone feel something they are not feel- diagnostic diagnoses to the clinical impression. rapport can start with taking the time to lis- Archives of Physical Medicine and Rehabilitation, ing. We have a tendency to want to fix the ten. Once good rapport is developed, it is 87(7), 897-903. Retrieved from client, instead of listening and discovering more likely the clients can start to relax, let http://www.ncbi.nlm.nih.gov/pubmed/16813774. what the client needs. However, introduc- go, and begin to trust in you and them- 7. Deyo, R. A., & Weinstein, J. N. (2001). Low back ing joy and pleasure can be very healing, selves. Observe. Paying close attention to pain. The New England Journal of Medicine, 344, 363- 370. doi: 10.1056/NEJM200102013440508. particularly for persistent LBP clients who body language and other subtleties can may be stuck in patterns of negativity. This 8. Borenstein, D. G., O’Mara, J. W. Jr., Boden, S. improve communication. Maintaining your D., et al. (2001). The value of magnetic resonance fosters a mindful presence and sense of own meditation practice will help with clar- imaging of the lumbar spine to predict low-back pain in observation throughout their home prac- ity so that your observation and critical- asymptomatic subjects: a seven-year follow-up study. tices as well. thinking skills are optimal. Educate. Keep- Journal of Bone & Joint Surgery-American Volume, 83, 1306-1311. Retrieved from ing up on the recent literature of evidence- 5) Develop trust and confidence. http://www.ncbi.nlm.nih.gov/pubmed/11568190. based practices and being able to share 9. Bogduk, N. (2000). What’s in a name? The the information in a clear way will help labelling of back pain. The Medical Journal of I recall a presentation I gave to PT stu- your clients to trust you and the treatment Australia, 173(8), 400-401. dents about fourteen years ago. I was approach and process, and from there, 10. Jensen, M. J., Brant-Zawadzki, M. N., Obu- asked to speak about the factors that I ultimately, to trust themselves when it is chowski, N., et al. (1994). Magnetic resonance imag- thought were most important in contribut- ing of the lumbar spine in people without back pain. time to perform movement. Provide. To New England Journal of Medicine, 331(2), 69-73. ing to successful patient treatment out- the best of your ability, ensure that the comes. I had only been practising for 11. Boden, S. D., Davis, D. O., Dina, T. S., Patronas, physical, energetic, emotional, spiritual, N. J., & Wiesel, S. W. (1990). Abnormal magnetic- about two years. I spoke from my heart and mental space you are providing resonance scans of the lumbar spine in asymptomatic and my two years of experience—I did not makes clients feel safe. If they do not feel subjects: A prospective investigation. Journal of Bone do any research for the presentation. My safe, they will not be able to let go or trust. & Joint Surgery, 72(3), 403-408. last slide had one big word across the Guide. Use your knowledge, skills, talents, 12. Moseley, G. L. (2012). Teaching people about screen: T R U S T. I spoke about how pain: Why do we keep beating around the bush? specialized training, and experience as Pain Management, 2(1), 1-3. doi:10.2217/pmt.11.73. important it was to develop a strong rap- authentically as you can. I always set an 13. Butler, D., & Moseley, G. L. (2003). Explain pain. port with clients and how I thought that if intention prior to seeing each client, and I Adelaide, Australia: NOI Group Publishing. clients gained trust in their therapists, then ask the client to set one as well (we don’t they could more easily trust in themselves share these with each other, although you (continued on page 34)

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14. Gatchel, R. J., Peng, Y. B., Peters, et al. (2007). the externally preloaded trunk: Variations in motor 29. Clifton-Smith, T. (1999). Breathe to succeed in The biopsychosocial approach to chronic pain: Scien- control and its effect on spine stability. Spine, 31(13), all aspects of your life. Ringwood, Australia: Penguin tific advances and future directions. Psychological 387-393. Retrieved from Books. Bulletin, 133(4), 581-624. http://www.ncbi.nlm.nih.gov/pubmed/16741438 30. Pincus, T., Burton, A. K., Vogel, S., & Field, A. P. 15. Gatchel, R. J. (2013). The biopsychosocial 23. Marras, W. S., Ferguson, S. A., Burr, D., et al. (2002). A systematic review of psychological factors as model of chronic pain. Clinical Insights: Chronic Pain, (2005). Functional impairment as a predictor of spinal predictors of chronicity/disability in prospective cohorts 5-17. doi:10.2217/ebo.13.469. loading. Spine, 30(7), 729-737. Retrieved from of low back pain. Spine, 27(5), 109-120. Retrieved 16. Waddell, G. (1999). The back pain revolution. http://www.ncbi.nlm.nih.gov/pubmed/15803073 from http://www.ncbi.nlm.nih.gov/pubmed/11880847. Edinburgh, Scotland: Churchill Livingstone. 24. van Dieen, J. H., Cholewicki, J., & Radebold, A. 31. Vibe Fersum, K., O’Sullivan, P., Skouen, J. S., et 17. Panjabi, M. M. (1992). The stabilizing system of (2003). Trunk muscle recruitment patterns in patients al. (2013). Efficacy of classification-based cognitive the spine. Part II. Neutral zone and instability hypothe- with low back pain enhance the stability of the lumbar functional therapy in patients with non-specific chronic sis. Journal of Spinal Disorders & Techniques, 5(4), spine. Spine, 28(8), 834-841. Retrieved from low back pain: A randomized controlled trial. European 390-397. http://www.ncbi.nlm.nih.gov/pubmed/12698129 Journal of Pain, 17(6), 916-928. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23208945. 18. Lee, D. (2006). An integrated model of joint func- 25. Hodges, P., Kaigle, H. A., Holm, S., et al. tion and its clinical application. Retrieved from (2003). Intervertebral stiffness of the spine is http://www.physioblasts.org/p/content/content. increased by evoked contraction of transversus php?content.80. abdominis and the diaphragm: In vivo porcine studies. Spine, 28(23), 2594-2601. Retrieved from 19. Hodges, P., Cresswell, A., & Thorstensson, A. http://www.ncbi.nlm.nih.gov/pubmed/14652476. (1999). Preparatory trunk motion accompanies rapid Shelly Prosko, BScPT, 26. Kweon, M., Hong, S., Jang, G. U., et al. (2013). upper limb movement. Experimental Brain Research, PYT, CPI, is a gradu- 124(1), 69-79. The neural control of spinal stability muscles during different respiratory patterns. Journal of Physical 20. van Tulder, M., Malmivaara, A., Esmail, R., & ate of the University of Therapy Science, 25(11), 1421-1424. doi: Koes, B. (2000). Exercise therapy for low back pain: Saskatchewan, Canada, 10.1589/jpts.25.1421. A systematic review within the framework of the and the Professional 27. Mehling, W. E., Hamel, K. A., Acree, M., et al. cochrane collaboration back review group. Spine, Yoga Therapy 25(21), 2784-2796. Retrieved from http://www.ncbi. (2005). Randomized, controlled trial of breath therapy nlm.nih.gov/pubmed/11064524. for patients with chronic low-back pain. Alternative Studies program, Therapies in Health and Medicine, 11(4), 44-52. 21. Cholewicki, J., Panjabi, M. M., & Khachatryan, A. North Carolina. She lectures and presents Retrieved from (1997). Stabilizing function of trunk flexor-extensor http://www.ncbi.nlm.nih.gov/pubmed/16053121. at conferences, medical colleges, and muscles around a neutral spine posture. Spine, yoga teacher trainings. Shelly is actively 22(19), 2207-2212. Retrieved from 28. Chaitow, L. (2002). Biomechanical influences on http://www.ncbi.nlm.nih.gov/pubmed/9346140. breathing. In Chaitow, L., Bradley, D., & Gilbert, C. involved in promoting the integration of Multidisciplinary approaches to breathing pattern dis- 22. Brown, S. H., Vera-Garcia, F. J., & McGill, S. M. medical therapeutic yoga into our current orders (83-110). Edinburgh, Scotland: Churchill Living- (2006). Effects of abdominal muscle coactivation on healthcare system. www.physioyoga.ca stone.

34 YogaTherapyToday | Summer 2014 www.iayt.org www.iayt.org YogaTherapyToday | Summer 2014 35 YogaTherapyinPractice The Process of Creating an Adaptive Class Partnering with Allied Health Professionals and Forging Community Alliances

By Cyndi Kershner

s the students wheeled in one at a time, my co-teacher and I looked Anervously at each other and checked our notes for the last time to make sure we were in agreement about what each of us would be teaching. The group of volunteers hovered, anxious to begin assisting. Caregivers came in as well, curious to see how exactly we were going to do yoga with this group of stu- dents, all of whom had profound move- ment differences and some of whom had little conscious movement or sensation in their entire physical bodies. We had five students with wheelchairs, four volunteers, two teachers, one caregiver, and a bunch of props in Beth’s conference room, which was about 120 square feet. We started Photo credit: Chris Wade with a body scan and breath awareness Teachers and assistants press on the knees to provide an experience of grounding through the sitting bones practices. As the students began to settle and a sense of reference to where the body is in space. This is a helpful practice for students who have limited into the yoga practice, we felt the energy or no sensation in their legs. in the room begin to shift the way it always does in a yoga class when the stu- tices. Traditional rehabilitation for spinal me during my own teacher training at the dents settle into the experience of their cord injuries teaches the injured person Samarya Center. Matthew’s training bodies in the present moment. We were practical compensatory skills but does not turned all of my notions of adapting yoga thrilled that we had finally reached our include mind-body integration as part of on their head; before this training I had goal and created this healing community. the rehabilitation process. Beth had thought teaching an adaptive class was observed and been inspired by Matthew simply a process of modifying poses to be This class had been two years in the Sanford’s yoga classes for people with accessible to student’s bodies. Matthew making. My co-teacher Beth Reite, OTR/L, spinal cord injuries, and she wanted to taught me to go much deeper by helping and I had met because she saw a previ- create something similar in the Seattle me to experience in my body—both in ous Yoga Therapy Today article I had writ- area. From studying and practicing yoga movement and in stasis—the subtle flow ten about developing a hospital-based herself, Beth believed that yoga could pro- of prana and how prana is not limited by class for students with MS, and then con- vide her patients with the mind-body inte- the physical form. This experience of sub- tacted me to see if we could co-develop a gration that was currently lacking in the tle energy and inner awareness is how it class for students with spinal cord injuries. dominant rehabilitation paradigm and offer is possible for a paralyzed person with Both of us were interested in adapting them a level of healing that would be very little sensation in their physical body yoga practice to make it safe and accessi- unavailable to them in traditional rehab, to experience yoga asana. ble for people with movement differences, which only emphasizes the physical levels including paralysis. This process of modi- of healing. Seeking Allies fying activities for people who can’t per- form them in the usual manner has come Meeting regularly to get to know each To begin the process of developing the to be known in the disabilities community other, we began dreaming about creating class, we scouted locations and spread as “adapting,” and it is common to hear an adaptive yoga class together. We the word in the rehab and yoga communi- people in these communities speak of observed each other’s classes to see if ties that we were starting a class and “adaptive skiing” or “adaptive rugby.” After our styles were compatible and gave each were trying to find students and volunteers meeting, Beth and I decided to explore other feedback. We agreed we wanted to to help. In modeling our class after developing an adaptive yoga class together. work together and create a class, yet had Matthew Sanford’s, we wanted to be able no idea where to start. Beth initially want- to transfer people from wheelchairs onto At that time, Beth was an occupation- ed to start the class at Harborview, but the floor, which can require several people al therapist working with people with new soon after decided she wanted to leave per student to complete the transfer, so spinal cord injuries at the local trauma the stressful pace of hospital work and we knew we were going to need lots of hospital, Harborview Medical Center, and start a private practice. In the meantime, I volunteers. We talked to everyone we was also training to be a yoga teacher went to Minnesota to train with Matthew knew and even reached out to many peo- because she felt there was something Sanford, a pioneer in adaptive yoga, ple and organizations where we had no missing in traditional rehabilitation prac- whose book Waking had deeply inspired connections. I did the majority of outreach

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in the yoga community while Beth focused takes to host a class that is accessible so her energy on the local rehab community. In adaptive classes, a that people with wheelchairs can safely I emailed and called yoga studios; if I attend. We had to find a space that was didn’t have any connections there, I just certain level of chaos either on the ground level with no stairs or used the general email or phone contact that had an elevator; with doorways and for the studio. I talked to students, teach- is a given: bodies with bathrooms designed to accommodate ers, and the local yoga therapy training disabilities are unpre- wheelchairs; and with parking that had programs; I also posted frequently on designated spaces for wheelchair users. social media outlets, particularly Face- dictable, unexpected We also needed a space that was appro- book, to groups run by yoga teachers. things often happen, priate for yoga and with storage for lots of props because adaptive yoga is very Nothing much came back at first and and chair-to-floor prop-intensive. We eventually found an we were discouraged. Both of us were accessible space at a yoga studio and very busy with our regular schedules, and transfers don’t always negotiated a reduced rate because the putting a class together from scratch with follow a script. studio owner was impressed that we no real support or encouragement from would be meeting the needs of an under- existing yoga or rehab communities was served population and wanted to support difficult! Beth had originally hoped that her that work. After securing the location, we old employer, Harborview, might be inter- us as volunteers were people that we had got the class started by Beth inviting a few ested in hosting the class, but after reach- some personal connection to; the cold call- of her current patients to come. At our ing out to staff she knew, she did not hear ing and emailing did not end up being an very first class, we had only two students. anything back. In our naiveté we had effective mode of outreach. Our most We continued putting out the word to expected that because of the nature of effective marketing for the class was shar- everyone we knew, hopeful that once the what we were doing and the current popu- ing, in person, what we wanted to do with program got off the ground, we would get larity of yoga outreach to underserved all the people we knew, and asking them a big break, as I had gotten when communities, yoga studios would be excit- to help, either as a volunteer or by spread- Swedish Hospital approached me to lead ed about the work and eager to participate ing the word to help us find a space. a class for students with MS. We were by hosting the class or spreading the word hopeful that a larger organization such as for volunteers. This was not the case, In scouting potential locations, I got a University of Washington healthcare however, and all of the people who joined quite an education about what it actually training program, the local spinal cord

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injury patient network, or a yoga therapy A Community of Healing training program would take an interest in us and provide support with student or The first class came together seamlessly. volunteer referrals. At this point in the pro- Although we had prepared, planned, and gram, we were actively recruiting students, strategized ad infinitum, we were still volunteers, and teaching the classes. unsure how the students would receive our work and how the class itself would Soon after starting the class, we held unfold. In adaptive classes, a certain level a training for our volunteers. The type of of chaos is a given: bodies with disabilities yoga we were teaching required holding are unpredictable, unexpected things and supporting students’ limbs in different often happen, and chair-to-floor transfers positions. The first training yielded a few don’t always follow a script. It’s absolutely volunteers, but it was difficult to keep vital to bring your complete presence to them engaged with such a small group of the human being right in front of you students. We continued on in this manner because their safety—and yours— for three months with no more than two depends on it. In this particular class, the students per class, at which point we student group was harmonious, the volun- decided to take a break to regroup teers were spot-on, Beth and I hit our because we weren’t attracting anyone marks with teaching, and, most import- new. Even though the students were pay- antly, the students all left with smiles on their ing for class, we still didn’t make enough faces and an intention to continue with Photo credit: Chris Wade to cover our expenses and were financial- A teacher and an assistant help a student to come yoga classes. ly subsidizing the class. into a forward fold with the use of a prop and then give the student an experience of reference into his After two years of hard work, Beth Moving Ahead back body. This provides the student with a sense and I had created a valuable working part- of stability in the pose and guidance as to where his nership and an alliance with Harborview Two months after our hiatus from teach- body is in space. that was beneficial for their patients and ing, we got our big break. One of the peo- their rehabilitation program. We currently ple Beth had previously reached out to in Each class series would have five stu- have an agreement with the medical cen- our marketing efforts, a former colleague dents, and we wanted to have enough vol- ter to continue classes through 2014. Now and recreation therapist at Harborview, unteers so that each student could get lots that we have successfully completed our contacted her and expressed interest in of support and assistance while we first session, we are in the midst of start- sponsoring a class as part of Harborview’s focused our attention on teaching the ing an additional community-based class Transitions program. The purpose of the class. We began recruiting volunteers in that will be open both to graduates of the Transitions program is to encourage newly earnest, reaching out to the local yoga and Transitions class and to other people from injured patients to re-integrate back into rehab communities, as well as the Univer- the larger community who have movement community classes and activities after sity of Washington. We got more interest differences. extensive inpatient rehab. This was exact- this time around, most of it coming from ly the kind of opportunity we had been yoga students who were looking for serv- One additional thing that has come hoping for! The Transitions program was ice opportunities in the local yoga commu- out of this work that was unexpected for seeking new community-based activities nity; some interest also came from stu- me was the start of a small community of for patients to become involved with and dents of a local yoga therapy training pro- dedicated volunteers who love and are yoga was a program that they wanted to gram that wanted to get some hands-on inspired by this work. In my connection try. This program is coordinated through experience. We led a free orientation to with the adaptive students, I have experi- Harborview Hospital and is funded adaptive yoga, which included training on enced deep and profound healing, and I through a combination of private dona- how to transfer students from wheelchair see the same thing happening with the tions and foundation grants. Beth met with to floor, a technique that we had both volunteers. I am so grateful to be able to the recreation therapist and presented a learned from Matthew Sanford’s work and provide opportunities for service within the proposal for regular yoga classes, includ- was an important part of our class plan. local yoga community and to keep ing reimbursement of $75 per class, which Being on the floor is an especially healing expanding the circle of healing. YTT was accepted. Harborview would refer activity for those who spend the majority of patients to us and would pay for the pro- their time in wheelchairs, and we were gram, which included three six-week both excited to give the students this Cyndi Kershner, CYT, series of classes. Students would be able opportunity. E-RYT, is an Adaptive to attend the classes for free. Yoga teacher in Seat- In training the volunteers in transfer tle, WA, who has part- We gave ourselves three months to skills, Beth patiently guided the group for nered with local hos- find a larger space and recruit volunteers. over two hours and gave everyone a pitals to create yoga After much discussion and weighing of chance to experience the roles of both stu- programs for their options, we decided to temporarily hold dent and volunteer so they could under- patients. Her work focuses on bringing the class in the conference room at Beth’s stand the mechanics of the transfer from yoga into healthcare environments and new office. The space was ADA accessi- all angles. The volunteers were enthusias- ble, which is very hard to find in Seattle, tic and excited to practice their new skills she trains and mentors yoga teachers and and free. We decided we would continue on actual students under our supervision. healthcare professionals in Adaptive Yoga. to look for more optimal situations without At the end of this training session, we felt She can be reached at any time pressure. we were ready to start the class. [email protected] and www.fullcircleyogaarts.com.

38 YogaTherapyToday | Summer 2014 www.iayt.org www.iayt.org YogaTherapyToday | Summer 2014 39 Interview with Richard Miller A Conversation with IAYT’s Co-founder By Kelly Birch

Richard Miller, PhD, is a clinical psycholo- reviewed journal, which it has now thanks gist, researcher, yogic scholar, and spiritu- to Kelly McGonigal, who also got it al teacher who has devoted his life to inte- indexed in PubMed, and the hard work of grating Eastern and Western traditions of many people. We now have a professional awakening and psychology. He is the journal that’s gaining respect in all founding president of the Integrative quarters. Restoration Institute, co-founder of the International Association of Yoga Thera- I feel the vision that Larry and I had pists, a senior advisor for the Baumann for IAYT as building community has also Foundation, and co-founder and past been achieved, through the hard work of president of the Institute for Spirituality John Kepner and the IAYT board. While and Psychology. Richard has authored IAYT has changed presidents over the Yoga Nidra: The Meditative Heart of Yoga years, Larry’s and my vision has been (Sounds True) and The iRest Program for advanced to where it stands today. One of Healing PTSD: Yoga Nidra Meditation for our original desires was to develop a work- Deep Relaxation and Overcoming Trauma ing definition of yoga therapy, as well as (New Harbinger, Winter 2014). Richard standards for becoming a yoga therapist. conducts trainings and retreats interna- I’m delighted to see that now coming to tionally and engages in research on the fruition after many years of meetings that iRest Yoga Nidra meditation protocol he Around 1982 we settled on the name the started in the kitchen of Amy Gage, where has developed for health, healing, and International Association of Yoga Thera- she and I, Judith Lasater, Jnani Chapman, awakening. pists. We had the vision of creating an and others met and began the process organization where the yoga community that has now grown into an organized I met Richard at the first-ever SYTAR could come together for dialogue and dis- body of teachers who have been coming in 2007 and over the years that I have semination of information. Larry and I together to work out these standards. known and trained with him, I have always agreed that I’d be the founding editor of been deeply inspired by his wisdom, the professional journal and Larry would KB: I hear a lot of people saying that integrity, and approachability. It was a move the administrative aspects of the “we know yoga works” and that great pleasure and honor for me to have organization forward—membership, fund- research is only necessary to convince this conversation with Richard, which ing, board of directors, advertising, etc. the medical field and others. What are touches on some profound aspects of your thoughts on that? yoga therapy as well as Richard’s The journal was an idea that I’d con- innovative iRest yoga nidra protocol. ceived of years before with the idea of RM: The view that “we know yoga works” publishing Eastern and Western research is a naïve view. Through research we’ve that was pertinent to the field of yoga come to understand that certain assump- Kelly Birch: This year is the twenty-fifth where it could be available to yoga thera- tions that we thought were true, for anniversary of the founding of IAYT. pists and yoga teachers who might other- instance how a particular pose works, are Would you talk a little about your wise not have access to such articles from false. Research is honing our ability to vision for yoga therapy when you the fields of medicine, nutrition, physical truly say, “This is how yoga works.” At the cofounded the organization with Larry therapy, and other fields related to the same time, I agree that in the Western Payne? How did the term “yoga practice of yoga. world, which is quantitatively oriented, we therapy” come to be used? need research that shows that yoga does KB: So right from the outset it was work and how. Like it or not, we need Richard Miller: Larry and I came together important to you to be integrated with research that enables the world to view in 1980 in what was then Madras, now other disciplines? yoga as a credible intervention. Without Chennai, India, when we were studying research credibility, the field of yoga, and with T.K.V. Desikachar. We both recog- RM: Absolutely. yoga therapy specifically, isn’t going to nized that there was an emerging field move forward in the Western world. At the within the United States that we saw as, KB. Can you share your thoughts on same time research may never be able to for lack of a better term, “yoga therapy.” I where the organization stands now in study some aspects of yoga, such as liked the term “yoga education” better, but relationship to your initial vision? awareness, because it’s impossible to realized that as I moved around different study awareness directly, as awareness yoga circles in the Western world, “thera- RM: Let me start with the journal. My isn’t an object. All this is to say that we py” was replacing the word “education.” vision was that it would become a peer- have a responsibility to keep finding ways

40 YogaTherapyToday | Summer 2014 www.iayt.org Interview continued

to inform the other fields of the full expose our teachers to the entire breadth our felt-sense and belief of separation that breadth, depth, and effectiveness of yoga. of yoga. Where they gravitate to is then we experience within ourselves and/or with going to depend on their developmental all of life. Yoga recognizes that we are KB: You incorporate both the dualistic phase. always and already whole, but that we’ve view of -Patañjali and the non- lost touch with our wholeness. We’re inter- dualistic perspectives of Advaita and ested in addressing the entire person: body, Kashmir Shaivism in your teachings. I’ve tried to make mind, soul, and spirit and understanding How important is it for yoga therapists yoga nidra a very where separation is occurring. When we to understand the various philosophi- work with an individual who is coming to us, cal underpinnings of yoga? personal and secular we, as yoga therapists, have a set of tools enquiry that anybody that helps us address and enable our stu- RM: I think there are two issues here. dents to heal their suffering. We have a First, how much does the student need to can do, whatever complementary knowledge that works in understand, and second, how much does their cultural or reli- concert with the other fields, but we under- the teacher need to understand. For me, stand that for true healing to take place, to really be a teacher in the field of yoga gious background. some aspect of separation within the person we need to hold a comprehensive under- That’s been very must ultimately be resolved. We may be standing, both experientially and philo- important to me in all working at what looks like a physical level, sophically. What we pass on to our stu- i.e., helping a person heal through back dents depends on the student, who they the elements of yoga pain, high blood pressure, or other seeming are and their specific needs in the that I teach. physical symptoms. But we are always keep- moment. They may or may not need phi- ing in mind that they are already whole and losophy. But as yoga therapists and teach- healthy. As we give them what they want, we ers, I think it important that we possess a KB: And so in that context, should also keep in mind the “something else” that broad and in-depth understanding that yoga therapists specialize in a particu- is at a deeper level, helping them realize includes both dualistic and nondual per- lar area of interest? their essential essence that is already free of spectives. As we bring forward schools suffering. and standards I think our standards need RM: All teachers need to be exposed to a to include sufficient breadth and depth so general knowledge, but then most teach- KB: We spoke earlier about the tendency the teachers we’re turning out can hold ers are going to find a specialty. Just as of “medical yoga” to focus on what’s the base knowledge. My experience and we see in other fields such as psychology, wrong and needs fixing. I also hear peo- training as a yoga therapist has always medicine, , nutrition, etc., prac- ple say that, “it’s the trauma that con- been concerned with what the individual titioners tend to specialize in their area of nects us.” Can you comment on this? needs. We never want to impose teach- interest. Then developmentally, over the ings on our students. We’re always work- years, they may expand and embrace RM: Yes, I think you’re making an important ing to discover what they need and deliver more and more specialties. I think that’s distinction. Yoga at its heart sees and under- interventions accordingly. Every student how we mature as students of yoga. Com- stands that there’s nothing about us that’s wants to know how to end his or her suf- ing out of a yoga therapy school or training broken that needs fixing. Yoga, instead, rec- fering. For some, a philosophy interven- our teachers should have the basic tools ognizes that there’s a basic misperception of tion may be most useful. For others, they so that they can begin the practice of understanding that needs to be clarified. just want to know how to pull the arrow yoga and yoga therapy. We know it takes Yoga, at its heart, is an educational process. out. They don’t need to know who made it decades for a student to mature fully into We’re helping people understand that their and how it got there. their field. I don’t think we can expect that basic essence is okay. Their basic essence coming out of any particular school a stu- is a sense of well-being, and connectedness KB: What if a yoga therapist has an dent should posses the maturity of some- with themselves and the universe where understanding of yoga history and phi- one who has been teaching for thirty, forty, they don’t feel separate. People under losophy, but doesn’t yet have a level of or fifty years. The adage of our schools duress, stress, or some kind of wounding self-realization or even the desire for it? should be something like, “We graduate can feel disconnected from themselves and you with the understanding that you have the world around them. As yoga therapists RM: There will always be a continuum of achieved a level of competency so that we’re trying to help people re-establish that understanding amongst teachers. I don’t you understand the scope of your training, sense of connectedness with themselves think we can hold teachers to the highest who you can help, when you need to refer, and the world around them. When they real- realization that yoga speaks to. That said, I and when you need to get supervision or ize that their basic essence isn’t broken, think that a teacher needs to be exposed additional mentoring.” their perspective changes. Then we can also to the breadth of what’s possible, what look at what is broken and does need fixing, yoga truly can enable us to realize. We’re KB: I want to ask a “big picture” ques- like a bad back or neck, or some mispercep- all interested in particular domains of tion. What are we offering society as a tion they’re having about themselves or the understanding at different developmental whole that’s unique to yoga therapy? world. Yoga is different this way from West- phases of our life. But I strongly believe ern medicine, which is based on separation that as educational schools we want to RM: Yoga is that which enables us to heal and subject-object relationship. Yoga is www.iayt.org YogaTherapyToday | Summer 2014 41 Interview continued

based on non-separation and understand- ultimately, relieve their disconnection ing our interconnected wholeness. We’re with themselves. We give them yoga always working to help our students rec- When troops started poses, breathing, and/or meditation exer- ognize their underlying wholeness. coming back to cises. Each intervention we give is an educational process that’s ultimately KB: Would you say that healing is pos- Walter Reed, doctors designed to help ease their suffering. sible without that sense of connected- were overwhelmed They think we’re helping them heal their ness? because they didn’t back. Ultimately, we’re helping them learn how to enquire into themselves, RM: At one level, yes. At another level, have adequate inter- just as Buddha did. Buddha was the ulti- no. Because the basic core of suffering ventions to meet the mate yoga therapist. that yoga emphasizes is our fundamental disconnection from self and world. Until challenge they were KB: I’d like to talk about your work our basic sense of separation is truly facing with so many with iRest. You have people engage in understood, there’ll always be a core body sensing but you don’t necessar- aspect of suffering that remains. warriors returning ily incorporate asana. Can you talk a with these signature little bit about that? KB: Would it be accurate to say there’s a continuum of healing? wounds. RM: Early on I saw that many of the groups that I approached resisted the RM: Yes. There is a developmental contin- hatha yoga component of yoga nidra— uum to understanding and healing. At first So, creatively, they they didn’t want to engage in movement it may be at the purely physical or psycho- had wise thinkers who for one reason or another. As a result, logical level. But when the experience of said, “Let’s open the they were throwing the entire practice non-separation and unitive consciousness out. So I intentionally split off the hatha comes in, it turns our life in a new door and study inter- yoga portion and focused on the medita- direction. As we live our understanding of ventions we would tive aspect of sensing the body while unitive consciousness, it expands through lying still. When I work with an individual our entire life, relationships, and all our not normally have they may need movement to develop a interactions in the world. Through our recommended.” greater capacity to welcome their body, practices of meditation, body sensing, and so then I teach them a moving body breathing we orient to subtler and subtler sensing that’s akin to hatha yoga, which, elements of dissatisfaction, misunder- and with the world around us, is the by the way, I always do when teaching standing, and disconnection. The process degree to which we can have empathy retreats. As yoga therapists, we’re of healing is ongoing across many levels. and compassion towards those we work always interested in what works best for And there comes a critical moment where with. As yoga therapists we are holding the individual, what they’ll actually take all sense of doubt drops away, enlighten- space for those we work with to experi- home and practice. ment comes and eliminates our search for ence and meet themselves. As we’re able happiness. Then, as a human being with a to meet ourselves, so we are able to help They may come in with a particular human body, we’ll always have physical those we work with meet themselves. want, and our job is to figure out what issues or pains to be worked with. But at a they actually need to reduce their suffer- phenomenological level, suffering is totally KB: We see this in the life of Buddha. ing. But we have to understand that if we eliminated. Yoga therapy, at its heart, is He was someone who saw the suffer- don’t give them enough of what they concerned with the ultimate cure, the end- ing of those around him and became want, they’ll go find it somewhere else. ing of suffering. devoted to ending suffering, first within Sri Desikachar helped me recognize this himself, then in those around him. understanding. He taught me to “teach to KB: Some people hold the belief that if what a person wants as you’re helping you haven’t experienced what your stu- RM: Buddha was a yogi. He is someone them to get what they need.” dent is experiencing, you can’t truly who looked around, saw suffering every- feel compassion or be able to fully help where he turned, and then went inside KB: Can that be modified for groups them. and met the suffering and disconnection of people with similar issues? within himself. Yoga therapists are people RM: As human beings we’ve all experi- who have seen the suffering within them- RM: Absolutely. I always interview my enced disconnection, separation, and suf- selves and through their own inquisitive- groups to find out what their wants and fering to one degree or another. To the ness to self-enquire within themselves their needs are and then design the degree that we’ve faced suffering within have developed a capacity to help others. classes so each individual get what he or ourselves, to the degree we’ve healed our As yoga therapists with specialized tools, she both wants and needs in the midst own inner sense of lack and disconnec- we can help a person enquire into what of a group session. This entails a certain tion, to the degree we feel our own sense they come to us for, whether it’s to heal skillfulness, which we grow into under- of wholeness and connectedness within their back, solve a psychological issue, or standing how to do as we mature as

42 YogaTherapyToday | Summer 2014 www.iayt.org Interview continued

teachers. Where initially I taught every- tural archetypes of India that were embed- oping an iRest research protocol that is body in a group the same thing, now I can ded in the practice. Instead of imposing an both reliable and valid. Each group we teach a group many different things all at image, for instance, I began asking my teach in every research study receives once, where everybody’s going away with students to enquire as to what they were essentially the same protocol, which is what they need, not what the person to experiencing within themselves. The yoga crucial for research. That said, my aim is their left or right needs. nidra I began to teach became client-driv- always to have the individual, even in a en rather than teacher-directed. My early research study, enquiring as to what they KB: What’s particularly appealing to me mentors, Laura Cummings, T.K.V. need so that they’re learning how to adapt about iRest is that you don’t direct peo- Desikachar, Krishnamurti, and Jean Klein the practice to suit their needs in the ple in the way that occurs in more class- all asked me to not impose what I felt my moment. When the protocol is used out- ical forms of yoga nidra. How did your students needed, but rather to help them side of research, it is quite flexible—practi- formulation of the iRest protocol enquire and tell me what they were experi- tioners can focus on different parts of the evolve? encing and needed. For me, the integrity protocol that seem to be the most helpful of yoga nidra lies in its ability to help a stu- for individuals in the moment. RM: I first learned yoga nidra as a cook- dent enquire. I’ve removed the cultural book approach. Everything was scripted, impositions and tried to make yoga nidra a KB: Your focus on the process of self- and everyone received the same practice. very personal and secular enquiry that enquiry seems to relate to the concept As a beginning teacher, that was helpful. I anybody can do, whatever their cultural that you as a yoga therapist are not did what I was told. But I didn’t really or religious background. That’s been very “fixing” anybody. understand the why behind what I was important to me in all the elements of yoga teaching. My teacher said, “Trust me, this that I teach. RM: Right. I like to feel that as a teacher works. Do it this way.” At first this was And, more recently, as I became I’m working together with my students to useful. But I have a skeptical mind, and involved in research on my iRest yoga discover what they need and what particu- when somebody says “trust me,” I always nidra protocol, I was asked to have a pro- lar interventions work. I do have interven- want to understand how and why some- tocol that could be duplicated, was manu- tions that I use as starting points, based thing works. Over the years, beginning in alized, and that had a certification process on prior experience. But I think of every the 1970s, I began separating out the cul- for teachers. This was necessary in devel- intervention I give as an experiment. I’m

www.iayt.org YogaTherapyToday | Summer 2014 43 Interview continued

White House Roundtable Discussion on Complementary Therapies in Rehabilitation

Miller, Richard, PhD, President, Integrative Restoration Institute; Manoj, Jain, MD, MPH, Rollins School of Public Health, Emory University, Contributing Writer: Wash- ington Post; Jon Kabat-Zinn, PhD, Center for Mindfulness Medicine, Healthcare, and Society, University of Massachusetts Medical School; Dean Ornish, MD, Preventa- tive Medical Research Institute; Tina Tchen, Chief of Staff to First Lady Michelle Obama; Christina Lagdameo, Deputy Director, White House Initiative on Asian Americans and Pacific Islanders

trying to see what works, what doesn’t ings of Krishnamacharya and traveled to hatha yoga, in the pranayama, in chanting, work, and how the person responds. I India in 1980 to study with his son, and in meditation. The first practice he want to feel that we’re working together to Sri Desikachar. From my very first lesson gave me actually made me feel worse. I come to the right intervention. with Desikachar he let me know, “I don’t came back to him the next day and said, “I know what you need. Let’s find out togeth- feel worse from what you gave me.” And KB: You’re not saying that teaching is er.” We were doing enquiry together in the he actually said, “Great! Now we know amorphous and anything goes. what doesn’t work. Now try this.” And so we began a period of experimentation that RM: Right. In iRest, as in all my teachings enabled us to come to the right methodol- of yoga, I have specific interventions that I As yoga therapists ogy that ultimately healed the various start with. I always ask, “What brings you with specialized tools, physical issues that I had when I came to here?” I’m fishing for their intention. I ask, him. We also sat together and examined “When you turn your attention into your we can help a person various case studies of the people I was body, what draws you? Is there a sensa- enquire into what working with back in the U.S. We went tion, an emotion, a thought, an image that through them one by one, looking at the draws your attention?” When I do this I’m they come to us for, interventions I was using, where were they asking them to hold their attention within whether it’s to heal working or not working—and what might their body. That’s a specific intervention be better interventions? I have tremen- with an open invitation. It’s directive, but their back, solve a dous gratitude for the skillfulness and flexible. open mindedness that he brought to me, psychological issue, my students, and every person I saw him Our three main tools as yoga thera- or ultimately, relieve work with. pists are our ability to listen, welcome, and get out of the way so we can truly see their disconnection KB: I’m always looking for what didn’t what is the action that the student needs with themselves. work in case reports for YTT. It’s of to take. Not what I think they should do. equal importance to understand what We give them yoga doesn’t work, as to what does. KB: Great, and that’s applicable poses, breathing, across all of yoga therapy, not just RM: Yes. All my teachers taught me to “Be iRest. and/or meditation a light unto yourself, and help others be a exercises. Each inter- light unto themselves.” Learn what works, RM: Right. While I started out as a hatha and discard what doesn’t. But be careful. If yoga teacher, from the beginning I was vention we give is an you throw something away with one interested in enquiry. I was always inter- educational process person, the next person who shows up ested in how do I help my students who may need what you just threw away. So were coming with very different issues. So that’s designed to teaching and yoga therapy are always a the practice of yoga therapy was interest- help ease their process of listening, openness, discern- ing to me from the very beginning. In the ment, and flexibility. mid 70s I became interested in the teach- suffering. (continued on page 46)

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a doubt through research.” The military knows that there’s a tremendous need. If something looks like it’s working, based on feasibility studies or by testimonials coming back to them from service mem- bers or veterans, they’re putting it into the field in ways they wouldn’t have before. But they do know that ultimately they want the research to prove that each interven- tion does work.

The other arena that yoga therapy is moving toward is the general population, as people are leading more and more stressful lives. While living a stressful life may bring a better lifestyle, more money, a nicer house, etc., people are discovering that they’re unhappy. Traditional interven- tions haven’t helped. So people are turn- ing to alternative resources such as yoga, Richard works with a student in a demonstration of iRest in a dyad format at a Level I training. yoga nidra, and meditation. Yoga is becoming mainstream and more and more KB: Switching gears now, where do wars, the signature wound has been trau- medical practitioners are also taking up you see the field of yoga therapy matic brain injury and post-traumatic these practices, and then they’re turning moving toward? stress. When troops started coming back around and giving them to their patients. to Walter Reed, doctors were over- Interestingly, back in 2004 when I was RM: It’s an amazing moment for yoga whelmed because they didn’t have ade- holding conferences with higher-ups in the therapy. I see it coming into all sorts of quate interventions to meet the challenge military, they were all telling me they’d new places where it’s being received with they were facing with so many warriors secretly been doing meditation and yoga open arms where I wouldn’t have imag- returning with these signature wounds. for fifteen and twenty years! Now the clos- ined that ten years ago. For instance, my So, creatively, they had wise thinkers who et doors have swung open and they can work with the military has taken off. We said, “Let’s open the door and study inter- come forward and say, “This has worked went from a feasibility study at Walter ventions we would not normally have rec- for me for years. Now we can talk openly Reed Army Medical Center—which is ommended.” Hatha yoga, pranayama, about it.” amazing in itself that we actually did a meditation, and yoga nidra have gained feasibility study with active duty wounded significant approval, along with guided KB: This has been wonderful spending service members using yoga nidra—and imagery, eye movement desensitization time together. Is there anything else now we’re in over thirty VA centers, six- processing (EMDR), and cognitive behav- you would like to say? plus department of defense active-duty ioral psychology. The whole field of alter- sites, and are expanding into new ones on native treatments opened up. The military RM: I have a profound gratitude for the a regular basis. As a result of the research saw that yoga and yoga nidra interven- board, the advisors, the executive direc- we’ve been doing, yoga nidra is now rec- tions were working, so they said, “OK, let’s tors who have come and gone and who ognized as a Tier I intervention for chronic open the doors to these types of interven- are now present and for all who’ve moved pain in military settings, and has been rec- tions. They seem to work.” IAYT forward as an organization. It takes ommended for continued studies with many people to move a vision forward PTSD, TBI, and sleep issues. KB: Work in what way? through its cycles of ups and downs. It feels like IAYT is in a lovely up-cycle at KB: Why do you think yoga has taken RM: They help reduce suffering. They the moment. But the vision that Larry and off in the military? help people heal through their post-trau- I had was that it is the community of yoga matic stress and other war-related injuries. therapists and teachers who ultimately RM: If we look back historically, great Yoga helps them develop a sense of inner drive the organization forward. So I feel strides in treatment are always made in resilience to overcome their disabilities. tremendous gratitude! Gratitude for you, times of war. In World War II we saw What’s also been interesting to me is that for all the key players, and for our yoga incredible advancements in plastic sur- while the military and VA are research- community. gery, hand repair, and psychological treat- driven, I’ve been told that ”research takes ment because of all the wounds that sol- five to ten years to complete and come KB: Thank you. I’m so grateful to you! diers returned home with. During the Viet- out in the literature, and we don’t have the YTT nam War, we encountered a whole new time to wait. If your protocol looks like it’s set of injuries and saw tremendous working, we’re going to put it into the field, advancements in medicine. In recent even before we’re able to prove it beyond Richard Miller’s website is www.irest.us

46 YogaTherapyToday | Summer 2014 www.iayt.org www.iayt.org YogaTherapyToday | Summer 2014 47 48 YogaTherapyToday | Summer 2014 www.iayt.org www.iayt.org YogaTherapyToday | Summer 2014 49 50 YogaTherapyToday | Summer 2014 www.iayt.org www.iayt.org YogaTherapyToday | Summer 2014 51 IAYT Member Schools (as of April 21, 2014)

IAYT School Membership is for schools with, or considering, yoga therapist certification programs. The objectives of this program are to recognize schools that provide professional yoga therapy training and to help students find the right program for them. All of these schools have also made a significant contribution to the field by supporting the development of standards for the training of yoga therapists and, more recently, a process for accrediting programs that meet these standards.

Supporting Member Agama Yoga Essential Yoga Therapy Life in Yoga Institute Pranayoga School of Yoga Svaroopa Vidya Ashram Yoga Institute Schools 800 Hr Therapeutic Yoga Essential Yoga Therapy: Life in Yoga 5-fold Therapy and Health Svaroopa Yoga Therapist Yoga Teacher Training Teacher Training Therapist Training Dilip Sarkar, MD 1000 hr Yoga Therapy and Certification Course with Yoga Therapy American Viniyoga Dr. Mihaiela Pentiuc Robin Rothenberg Dr. Rajan Narayanan Ayurveda Teacher Training Nirmalananda Saraswati Dr. Jayadeva Yogendra Institute Lynn Hughes, M.D., Psychi Dani Vani McGuire Hansaji Yogendra AVI Viniyoga Therapist Therapies liv-ing-yoga Svastha Yoga and Ayurveda Training 300 Hr Ahimsa Yoga Thera- Etowah Valley Yoga liv-ing-yoga with jasmine Prema Yoga Therapeutics Svastha Yoga of Krishnam- Yoga Mountain Inc Gary Kraftsow pist Training and Ahimsas 600 hour Yoga Therapy lieb, hatha yoga teacher Prema Yoga Therapeutics acharya Therapy Program Professional Yoga Therapy Tawni Maughan BA, E-RYT, C Training Jasmine Lieb 500 hour Teacher Training Ganesh Mohan Certification Gurukul Yoga Holistic Susan Hopkins ERYT-500, PY Dana Slamp Gail Walsh Center Ajna Yoga Marianne Wells Yoga Laina Jacobs Tensegrity Center Yoga GYHC Yoga Therapist 300 Hr, 500 Hr  800 Hr Foundational Knowledge School Therapy Yoga North Training  Yoga Therapy Training Yoga Psychotherapy 300 Hr. Yoga Therapy Purusha Yoga School 300 Hr. Yoga Therapist 500 hr.  1000 hr. Yoga Manju Joshi Jules Payne Foundational Knowledge: Training Purusha Yoga Therapy Internship Therapeutics Training Prashant Joshi Michelle Schroeder Yoga Psychology, Modern Marianne Wells ERYT-500 Certification Sherry Brourman Molly McManus Ps Marguerite Heie MPT, OCS, Joy Ravelli Ann Maxwell Heartland Yoga Therapy Align Yoga Studio Karen Armand RYT-2 The Wisdom Method School Heartland Yoga Therapist 300 Hour Align Yoga Reconnect with Food® of Yoga Yoga Teachers School of Training Teacher & Therapist Functional Synergy Yoga MindBody Centering Yoga Inner Door Center® 700 Hr. Wisdom Method Excellence Nancy Schalk Training Course Therapy MindBody Centering Yoga Yoga Therapy for Eating Yoga Therapy Level I Certified Yoga Therapist Willy Vijayaputra Functional Synergy Therapy Training Disorder Recovery Kellie Adkins M.Sc, Training Institute for Medical Yoga Therapeutic Yoga Training Nina Be Beverly Price ERYT-500, CYTher. Deborah Perry Yoga Therapist Training Ananda School of Yoga & Susi Hately Goran Boll Meditation Mindfulness-based Yoga ReFlex Arts The Yoga and Wellness Yoga Therapy International Ananda Yoga Therapy Gentle Therapeutics Yoga Therapy ReFlex Arts Studio Yoga Therapy Diploma Integrative Yoga Therapy Training 200, 300 and 500 Hr Thera- Mindfulness-based Yoga Ginny East 300 Hr. Yoga Therapy Program–1080 Hours Professional Yoga Therapy Mangala Loper-Powers peutic Yoga Certification Therapy Programme David Shaddock Program Maggie Reagh Mary Northey Allaine Stricklen E-RYT-500 Cathy-Mae Karelse Darlene Maclachlan E-RYT- Ananda Seva Guru Kula Dorit Mordehay Rocky Mountain Institute of 500 Yoga Tune Up® i-SKY Kundalini Medicine Institute Mount Madonna Center Yoga and Ayurveda Yoga Tune Up Therapist International Kundalini Yoga Yoga Therapy Certificate Glenmore Yoga and Well- Ratna Jenna Sturz Yoga Therapy Certification Transformation Yoga Training Therapy Training Training ness Center Brajesh Friedberg Program Trainings Jill Miller Guru Dharam Maetreyii Nolan, PhD Glenmore Yoga Therapy Dona Smith 500 Hr. Yoga Therapy Train- NicoleQuibodeaux Singh Khalsa Ananda Deviika Ma’ M.Sc. Training 800 hr Mount Royal University Sarasvati Buhrman, PhD. ing with Healing Our Back Darryl O’Keeffe Nancy Glenmore Tatum Yoga Therapy Certificate Director Lillah Schwartz MS, Yoga University of Florida Kripalu Schools of Yoga & Asheville Yoga Center Brad Robinson Sacred Rivers Yoga for CYT, ER 270 hr Yoga Therapy Train- Ayurveda 500 Hr. YA Therapeutics Guru Ram Das Center for Donna Palmer Every Body ing 850 hr Yoga Therapy Andrew Tanner Teacher Training Medicine and Humanology 500 Hr. Teacher Training Trinity Yoga Center MyLinda Morales-Hutchings Stephanie Keach e-RYT-500 International Kundalini Yoga New England School of with Yoga Therapy Emphasis 500 Hr. Yoga Teacher Train- LifeForce Yoga Healing Therapeutics Teacher Integrative Yoga Paula Scopino ing with Yoga Therapy Em Yoga Yoga School of Yoga Institute Ashtanga Yoga Tel Aviv Shanti Shanti Kaur Khalsa Therapeutics Harshad Jeff Thomlinson Therapy LifeForce Yoga Practitioner Integrative Yoga Therapy Navneet Kaur Khalsa Integrative Yoga Samadhi Yoga Institute Uchita Sonya Thomlinson 800 hr. Yoga Yoga - Yoga Training Training Therapeutics Yoga Clinica–Samadhi Therapy Program Amy Weintraub Maya Gross Healing Yoga Foundation Bo Forbes Method 200/300 Hr. Yoga TriYoga Boston Lori Johnson Anat Sheinman Yoga Therapy Training Teacher 500 Hr. Therapeutic Yoga Mehtab Benton Maryland University of Program Niroga Institute Lizelle Arzuaga Teacher Training Integrative Health Associacao Europeia de Kate Holcombe Niroga Institute Yoga Brahmi (Beth) Gold- Yogacampus Mary Lauttamus Terapias Orientais Therapy Specialist Training San Diego College of Bernstein Yoga Therapy Diploma Doug Keller Teacher Training with Yoga Heaven on Earth Yoga Bidyut K. Bose Ayurveda Lorrie Jacobsohn Program Therapy Emphasis Institute & Integrated NAMA reviewed Ayurveda Dr. Lisa Kaley-Isley Sangha Yoga/Red Lotus Paulo Alexandre Hayes Health Yoga Therapy Nosara Yoga Institute Yoga Therapy Health Union Yoga Ayuurveda, Anna Blackmore Yoga School Yoga Therapist Training Self-Awakening Yoga Thera- Educator Singapore Uma Dinsmore-Tuli 200 and 500 Hour, emphasis AUM hOMe Shala Karen Claffey peutics Training Susan O Connor 500 Hr Certificate in Yoga on Yoga Therapy Clinical Yoga Therapy Don and Amba Monica Groover Therapy and 850 hr Cert YogaJoy Becky Morrissey Certification Program Level Holistic Yoga Therapy Brahmanand Stapleton Dr. Satyam YogaJoy Yoga Therapist Melinda Atkins, M.ED, Institute Scottsdale Community Col- Dr Satyam Tripathi MD Certification Wellpark College of Natural E-RYT5 200/500/800/1000 HR Novato Institute of Somatic lege Ong Pei Jia Monalisa DYT Sarahjoy Marsh Therapies Therapeutic Yoga Teacher Research and Training SCC Yoga Therapy Certificate Diploma of Yoga Therapy Australian Institute of Yoga Training Somatic Yoga Professional Program yama studio–Yoga, Ayurve- YogaLife Institute NZQA Level 6 Therapy Chrys Kub Training Program Carlyn Sikes da & Meditation Arts Comprehensive Yoga Dr. Sridhar Maddela Graduate Certificate in Yoga Melanie Snyder Eleanor Criswell yama therapeutics Therapy 300 hrs Therapy Sivananda Ashram Yoga Diane Divyamani Robert Butera, PhD, WholeBeing Institute Leigh Blashki Hot Yoga Wellness Nydia’s Yoga Therapy Retreat Finlayson ERYT500 YogaSpire Janet Lowndes 350/500 Hr.Yoga-Qigong Studio 500 hr. Advanced Yoga Kristen Butera, ERYT500, Megan McDonough Therapy/Teacher Training Nydias Yoga Therapy Yoga Teacher Training YATNA—Yoga as Therapy CYT Elissa Cobb Beloved Yoga 300 Hr. Sujun Chen Research Team Training Rukmini Rukmini North America YATNA Yoga Therapeutic Yoga Program Nydia Tijerina Darby MS, P Therapist Training Yogaspirit Studios Yoga Bloom Maryam Ovissi Inner Peace Yoga Therapy Sivananda Yoga Vedanta Dolphi Wertenbaker Yogaspirit Therapist Yoga Bloom LAB Yoga Julia Kalish Inner Peace Yoga Therapy One Aum Yoga Center Center–Yoga Farm Bossart & Wheeler Certification Program Therapy Training Certification Program 1000 Hour Therapist Train- 200 and 500 hr. Teacher Kim Valeri Cora Wen Black Mountain Yoga Michele Lawrence ing Program Training Programs YCat Yoga Therapy in Can- Yoga Therapy Training Shannon Sharma Sean FM Swami Sitaramananda cer and Chronic Illness YogaVahini Yoga School Martia Rachman Institute for Yoga Teaching, YCat Yoga Therapy in Cancer YogaVahini Yoga Therapist Yoga School Yoga Therapist Brad Rachman Therapy & Research Paramanand Institute Soul of Yoga Institute and Chronic Illness Certification Training Yoga Developments of Yoga Sciences and 800 Hr Yoga Therapist Train- Jnani Chapman RN Saraswathi Vasudevan Becky Gelatt Body Balance Yoga Veronica Zador Research ing and 300 Hr. Advance Devi Pat Fitzsimmons Body Balance Yoga Therapy 300 Hr. Yoga Therapy Certi- Monique Lonner Yogaville/Integral Yoga Yoga Therapy Rx at Loyola Training Integrative Restoration fication Training Dawn Castillo Yoga 4 Cancer—y4c Teachers Association Marymount University Jenny Otto Institute Dr. Guruji Omanand Yoga 4 Cancer Specialty IY Therapeutic Yoga Training Yoga Therapy Rx Lisa Long Integrative Restoration Dr. V.P. Bansal Stress Management Center Training Program James Gopal Watkins Certification (iRest) Yoga Nidra of Marin Tari Prinster Lakshmi Sutter Larry Payne Body Therapies Yoga Richard C. Miller Phoenix Rising Yoga 200/300/500 hr. Teacher Jennifer Price Rick Morris, DC, L1, Training Rick Echler Therapy Training in Yoga Therapy YogSadhna David Allen, MD, L3 300/500 Hr. Yoga Therapist PRYT Practitioner & Teacher Robin Gueth Yoga Energy Studio 300 Hr. Yoga Therapy Training Island Yoga Vista PAYTA Trainings Ayurveda Yoga Therapy Certification YogaFit Training Systems Heather Greaves Professional Ayurvedic Yoga Beth Triano Subtle Yoga Certification Dr. Indu Arora Inc. Therapist Apprenticeship Jen Munyer Subtle Yoga Teacher Train- Timothy Ganley YogaFit Yoga Therapy Center for Contemplative Sandra Shotton ing for Behavioral Health Sylvie Vasiliki Binga One Spirit Center for Sacred Program Therapy Pose by Pose Yoga Professionals Study Heidi Dix Contemplative Yoga Therapy KC Fitness Link Pose by Pose Yoga Elizabeth Flemming LPC Yoga For Arthritis 500 and 1000 Hour Yoga Beth Shaw Training Yoga Therapist Training Jennifer Leavy Kristine Kaoverii Weber MA, Yoga for Arthritis Therapy Training K. Orr Program eRYT-500 Steffany Haaz Moonaz, PhD Gracia McKinley Member Schools Darryl Olive Pranakriya School of Yoga Lisa Bergly East Coast Yoga Therapy Healing Arts Subtle Yoga Yoga for Seniors 7 Centers Yoga Arts East Coast Yoga Therapy Kingwood Yoga and Well- Pranakriya Yoga Therapy Subtle Yoga Therapeutic Therapeutic Yoga for Seniors Aloha Yoga 300 Hour Yoga Therapy Terry Brown ness Center Yoganand/ Teacher Training Program Teacher Training 1000 Hr. Yoga Therapy Training Course Valerie Kiser 300 Hr. Therapeutic Yoga Michael Carroll Kristine Kaoverii Kimberly Carson Certifcate Program Ruth Hartung Training Marlysa Sullivan Weber MA, E-RYT-500 Carol Krucoff Martine Bergeron EquiLibrium Thai Massage Marita Gardner-Anopol Abhyasa Yoga Center & Yoga Therapy Venkata Ponnaganti PhD PranaYoga & Ayurveda Surya Chandra Healing Yoga Impact Training 800hr. ‘Into Yogatherapie’ AYC Yoga Teacher Training Yoga for MySelf: Yoga Mandala Yoga School Yoga Impact Therapist Professional Therapist J. Brown Therapy for MS & Disability kula-kamala-yoga Yoga Cikitsa 1000 hr.  Yoga Therapy Training Manon Simonis-Bruens Training 800 Hours PYT (Professional Hansa Knox Training Nancy Candea AeroYoga© Institute Nathalie de Meyenburg Yoga Therapist)  and H JJ Gormley-Etchells Diploma in AeroYoga® Sudha Allitt (Anti-Gravity Yoga) Rafael Martinez 52 YogaTherapyToday | Summer 2014 www.iayt.org

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