Yoga Therapy for Holistic Palliative and Hospice Care Notes Description: Yoga offers selective breathing techniques, restorative poses and physical movements to reduce stress, improve breathing in body, mind and spirit. Poses are easily adapted for chair, bed, and floor positions. This one hour workshop is based on a 2018 – 2019 Grief Yoga Mini-Retreat pilot program offered by CHI Franciscan Hospice for Bereaved clients that is easily adapted for palliative and hospice clients, family members, caregivers, staff and volunteers. Learning objectives: 1. On completion of this session, participants will experience 3 – 5 breath techniques to enhance mindful breathing. (belly breathing, bee’s breath, inhaling/exhaling through nose, 3 part breath, equal ratio breath, ujjayi breath, alternate nostril breathing) 2. By participating in this workshop, participants will be able to list 5 restorative poses appropriate for their patients and bereaved clients(supported child’s chair/mat, supported twist, supported bridge, supported savasana, meditation in chair or on a mat). 3. At the conclusion of this workshop, participants will be able to identify 3 palliative and hospice care resources online and offline for patients, bereaved family members, caregivers and staff. Trigger questions: How can yoga therapy provide accessible, achievable, practical, low cost holistic care for patients, staff, family members and bereaved clients? What is Yoga? “Originated in India more than 5000 years ago, yoga is a mind body practice which aims to create harmony and balance of physical, mental and spiritual aspects of life.” Anjali Deshpande “Yoga is a scientific system of self-investigation, self-transformation, and self-realization that originated in India.” “The yoga tradition views humans as a multidimensional system that includes all aspects of body; breath; and mind, intellect, and emotions and their mutual interaction.” IAYT 1 What is Yoga Therapy? “Yoga as therapy is still a relatively new and emerging trend in the health care field.” Anjali Deshpande Dr. Tim McCall. “The field of yoga therapy is relatively new, and so far, there are no universally accepted standards of training and certification. In general, it’s best to find as experienced a teacher as possible, ideally one who has worked with cancer patients.” “With an aging population …yoga has practical utility for those facing life- limiting illness.” Kate Binnie, HCPC registered music psychotherapist, yoga and mindfulness teacher (CPCAB) with an Msc in Palliative Care. Blogs found on Life of Breath website. UK “Where there is illness and death there is grief and loss. Mindful yoga can be used for patients dealing with their own losses and facing death, plus support those who are or will be bereaved.” Kate Binnie writes, mindful yoga helps provide room for non-pharmacological interventions as part of integrated care. Mindful yoga can help with diagnostic groups experiencing pain, breathlessness, and issues with movement, fatigue, anxiety and depression. Breath awareness is core to this way of working. For health care professionals self-care is important when working with loss death and dying. Mindful yoga “is the perfect “resilience toolkit.” Kate Binnie “Yoga therapy aligns with a biopsychosocial-spiritual approach to wellness and is increasingly included in university and continuing education curricula for healthcare providers.” YogaTherapy.Health “Yoga therapy is the appropriate application of these teachings and practices in a therapeutic context …” “Yoga therapy is the process of empowering individuals to progress toward improved health and wellbeing through the application of the teachings and practices of yoga.” International Association of yoga Therapists IAYT “IAYT certified yoga therapists are trained in anatomy, physiology, and mental health.” 2 “The goals of yoga therapy include eliminating, reducing, or managing symptoms that cause suffering; improving function; helping to prevent the occurrence or reoccurrence of underlying causes of illness; and moving toward improved health and wellbeing. Yoga therapy also helps clients/students change their relationship to and identification with their condition.” IAYT “Growing body of research on yoga for palliative care has shown improvements in the sleep quality, mood, stress, management of physical symptoms and overall quality of life.” Anjali Deshpande “Yoga is not a matter of take this pose and call me in the morning. The greatest benefits of yoga therapy … come from a consistent, integrated practice that includes elements that address all levels of one’s physical, mental, emotional, and spiritual environment.” Experienced yoga therapist Carol Krucofff “Yoga is strong medicine but it is slow medicine.” Timothy McCall, MD, Yoga as Medicine. Identifying the need: World Health Organization Yoga for Palliative care by Anjali Deshpande According to World Health Organization’s Palliative Care Fact sheet 2015, each year an estimated 40 million people need palliative care. 78% live in low and middle income countries. From a global perspective, there is a need to develop effective economically feasible palliative care strategies to address the needs of these populations suffering from serious illness and improve their quality of life. “Integrating ancient wisdom of yoga and spirituality in the conventional palliative care setting appears to be a promising, cost-effective, and time – honored holistic approach offering a comprehensive wellness plan for patients.” Dr. Timothy McCall, medical editor of Yoga Journal, author of Yoga as Medicine: The Yogic Prescription for Health and Healing, www.DrMcCall.com: “Increasing evidence suggests that yoga, the ancient Indian mind-body 3 discipline can be a useful adjunct to standard care for cancer patients. Yoga – which includes a variety of techniques, including physical postures, breathing, meditation, and relaxation exercise – appear to have utility for patients undergoing radiation therapy, chemotherapy, patients in remission who have completed treatments and patients in hospice or palliative care.” “One feature of yoga that makes it appropriate for most cancer patients is its adaptability.” “Gentle classes tailored to individuals with cancer are available in a growing number of hospitals and community settings. Major institutions that offer yoga include Memorial Sloan – Kettering Cancer Center in York, Duke Comprehensive Cancer Center in Durham, NC, and Houston’s MD Anderson Cancer Center. Yoga practices can be modified to allow even those who are bedridden or chair bound to participate. For those unable to do any physical postures, simple breathing or meditation techniques can be substituted. Restorative yoga, therapeutic settings, involves positioning the body in a variety of yoga poses. Props, blankets, bolsters, chairs, support body weight, allowing almost anyone to participate. “ “Even when the likelihood of a cure is remote or not possible, yoga can help.” “What yoga can offer in palliative care is a holistic approach in which the individual as a whole is focused on, not just the disease. It includes a patient centered wider perspective of wellness with the aim to offer relief from symptoms, pain, physical difficulties and mental stress of illness and improved quality of life. Yoga can be practiced at any age and performed almost anywhere, even on the hospital bed. It is said that, “If you can breathe, you can do yoga.” “Practices are modified for unique circumstances, of even bedridden or chair bound individuals and participants facing realities of sickness, pain and death. Palliative potential of home based yoga sessions in women with advanced cancer were evaluated in a study and showed enhanced mind-body, and body- 4 spirit connections, plus benefits at physical, mental, and emotional level as well. Meditation and pranayama (breathing), along with relaxing yoga poses (asanas) s can help with emotional aspects of chronic pain, reduce anxiety and depression, and improve quality of life. Asana reduces fatigue and pain in patients with cancer. Restorative yoga using props facilitates stretching, provides support and induces relaxation. Substantial evidence suggests yoga reduces impact of exaggerated stress response and coping with anxiety and depression. Downregulates the hypothalamic pituitary adrenal axis and sympathetic nervous system. Mindfulness – a relaxed wakefulness practice based on meditation reduces pain. Suggests acceptable approach for pain, fatigue, sleep disturbance, psychological distress. Relaxation postures and yoga nidra have been found to reduce analgesic requirements and improve sleep and reduce fatigue in malignant pan states. Emotional regulation through present moment awareness, acceptance and non-reactivity in mindfulness practices has potential to enhance quality of life and overcome fear of death. Fear of death present in all aspects of human consciousness. Yoga therapy can help overcome some of this. “Yoga therapy for palliative care is based on gentleness and compassion. It aims to empower the patient to accept and face the illness and death by holistic experience which has physical, mental, emotional and spiritual dimensions.” Anjali Deshpande 5 WSHPCO Yoga Therapy for Holistic Palliative and Hospice Care Workshop Selected Bibliography By (Rev.) Dr. Sandra Bochonok CHI Franciscan Hospice Bereavement Counselor About Grief Yoga – Grief Yoga. Retrieved 5/2/2019 from https://griefyoga.com/grief-yoga/about-grief- yoga/ Alive Hospice. Healing Grief with Yoga. 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