Yoga Now Standard Treatment for Vets with PTSD

Yoga's not usually the first thing that springs to mind when thinking about treatment for post traumatic stress disorder in veterans. But from the Veterans Administration to the Pentagon, yoga classes are becoming not just commonplace, but in some rehabilitation programs mandatory.

One of the places in the forefront of change is the Newington Yoga Center, in Newington, Connecticut.

About 20 veterans train to become yoga teachers. Suzanne Manafort of the Veterans Yoga Project, said what began as a small project has burgeoned into programs across the country. Manafort taught yoga for years before using it as a treatment for PTSD. She said she had no idea she might need to make adjustments to her teaching, until she made mistakes.

"Touching is a mistake. In yoga classes we touch all the time. But to somebody whose been sexually assaulted that's a huge violation. Walking behind them is a huge mistake because it feels like they have to pay attention to what's going on in the room instead of just practicing their yoga practice," Manafort said.

She said ultimately it was veterans themselves that guided her, in some cases just by the courage it took simply to stay in class.

"Some of the men and women that I work with are Vietnam Veterans so they've been at home suffering for 40 years," said Manafort. "And when they come into this treatment program and they're told they have to do yoga, 'they're like are you kidding me?'"

"I thought it was a joke," said Vietnam veteran Paul Gryzwinski. "And I remembered actually laughing out loud and they said no we're really not kidding you're going to be going to yoga."

Gryzwinski is training to teach yoga to veterans. Many years after returning from the war, PTSD hit him hard. He ended up turning to the VA. Where he first encountered yoga.

"And I just thought of myself in like, tights with you know a bunch of women. And I know that sounds sexist — and I'm not, so forgive me — but it was such an alien concept to me," Gryzwinski said with a chuckle.

And Gryswinski's early misperceptions are one reason that Dan libby, a co-founder of the Veterans Yoga Project, said the 12 week yoga training for treating vets with PTSD tries to strip all the new-agey stuff out.

"We really emphasize, 'leave all the Sanskrit names at home, right. Leave the candles at home, don't talk about you know moonbeams and chakras and all these things,'" he said. "It's really just about learning about your body and your experience; learning to breathe."

Lt. Col Melinda Morgan deployed right after 9-11 and started teaching yoga to those who had served and those who were preparing to go to Afghanistan.

"So I started teaching veterans 10 years ago and one of those veterans that I taught became an instructor himself. And so in 2007 when he was in Iraq and I was in another location, he writes me a note that said, 'I have to teach yoga and I don't think I can.' So I'm like, 'yes you can.' I wrote it down all of the poses, emailed it to him and helped him on his way to become a certified teacher," Morgan said.

Today, Morgan teaches at the Pentagon, and she said classes once sparsely attended are now full every day. But despite an increased demand for yoga paired with a growing number of alternative treatment programs in the military and the VA, there's scant hard science about why yoga or most of the other alternative programs work.

Yoga instructor Dan Libby hopes the government does some studies soon, because without more data, returning troops won't take the programs seriously.

This article originally appeared on pri.org
Host Marco Werman
Reporter Susan Kaplan

Links

• VetsYoga
• Veterans Yoga Project
• Give Back Yoga

The Science of Yoga - What Research Reveals

In a world that demands substantive clinical research evidence to support different approaches to health care, yoga is gaining attention. Despite rapid advances in medical technology and continuing pharmaceutical research into using medication to relieve symptoms, in the past few years we have seen a significant growth in research addressing the impact of yoga on health and wellbeing.

To mark World Yoga Day on Sunday, we have collected some of the latest research into yoga in a virtual special issue.

Yoga is an ancient practice; it has been associated with cultural, religious and physical activity for more than 2,000 years. Its practitioners have asserted its effect on balancing emotional, physical and spiritual health for decades, but only recently has there been a move to substantiate these claims through research. So far, the result has been definitive, significant evidence of the broad-ranging benefits of yoga, both as a treatment and as a preventative form of medicine and health care.

The health benefits of yoga

In this technological age, health care paradoxes abound. Computerization, designed to facilitate daily life, carries with it a demand to be externally connected to events at all times. In doing so, paradoxically, we become alienated from reflecting personally upon body, mind and spirit. Use of pharmacological medication can assuage some of our symptoms, but this approach can also mean that we can carry on as normal with our busy lives, reducing our ability to monitor and focus on our personal health and wellbeing.

At a time when technology and drugs dominate the way we live our lives, it is refreshing that yoga not only persists but that researchers are taking the time to explore exactly how this practice can help us. In a climate focusing upon evidence-based medicine, it is important to be able to substantiate clinical claims made for any therapy, and yoga is no exception. We need to know who would benefit from a therapy, contraindications of use and the extent to which specific medical issues that can be ameliorated by a particular therapy.

Journals like Complementary Therapies in Clinical Practice frequently publish research on yoga. Recent papers have focused on practicing yoga to reduce essential hypertension and anxiety during pregnancy, its effect on regulating heart rhythm, the connection between yoga and changes in brain wave activity, the improvement of core stability and balance, and relief of post-partum depression.

Highlights of the special issue

To assess the potential of yoga poses for training and rehabilitation, the authors of this study examined the muscle activation patterns in selected trunk and hip muscles. Before this figure, they explain: "In the Downward facing dog pose ( Fig. 2a), the EOA showed significantly higher activity than RAU and RAL (p < .018). In the Upward facing dog pose ( Fig. 2b), the LT and EOA produced significantly higher muscle activities than RAU and RAL (p < .019). In the High plank pose ( Fig. 2c), the EOA produced significantly greater electrical activity than all other muscles (p < .001). In the Low plank pose ( Fig. 2d), the EOA produced significantly higher activity level than RAU, RAL and GM (p < .001)." (Source: Meng Ni et al, "Core muscle function during specific yoga poses," Complementary Therapies in Medicine, February 2014)

We have selected papers that give us an insight into the health benefits of yoga, reflecting the growing evidence-based research into this practice. It seems apparent that yoga may provide broad ranging healthcare benefits for mind and body. It may be practiced to maintain health, reduce particular symptoms, commonly associated with skeletal pain, and assisting in pain relief and enhancing emotional wellbeing.

In her review, Dr. Tiffany Field, Director of the Touch Research Institute at the University of Miami, provides a fascinating overview of the effect of yoga on anxiety and depression, pain, cardiovascular, autoimmune and immune conditions and on pregnancy.

In research looking more closely at the effect of yoga on anxiety, Dr. M. Javnbakht and colleagues from the Psychiatry Department of Islamic Azad University in Iran showed that participating in a two-month yoga class can significantly reduce anxiety in women with anxiety disorders. In their paper published in Complementary Therapies in Clinical Practice, the researchers say this “suggests that yoga can be considered as a complementary therapy or an alternative method for medical therapy in the treatment of anxiety disorders.”

Another study, published in Complementary Therapies in Medicine, examined the effect of yoga on lower back pain. Dr. Padmini Tekur and colleagues from the Division of Yoga & Life Sciences at the Swami Vivekananda Yoga Research Foundation (SVYASA) in India carried out a seven-day randomized control trial at a holistic health center in Bangalore, India, with 80 patients who have chronic lower back pain. They assigned patients to one of two groups – yoga therapy and physical therapy. Their results showed that practicing yoga is more effective than physical therapy at reducing pain, anxiety and depression, and improving spinal mobility.

Yoga also reduces stress in pregnancy, according to research published in Complementary Therapies in Clinical Practice. Svetlana Bershadsky and colleagues from the Department of Psychology and Social Behavior, University of California, Irvine tested the effect of yoga on 51 pregnant women, looking at their levels of the stress hormone cortisol and their mood before and after a yoga session.Their results showed that practicing yoga while pregnant can reduce stress, improve mood and even reduce postpartum depression symptoms.

What’s next for yoga?

Yoga challenges the “mores” of modern day life, providing us with a return to simply being, watching the world around us and an awareness of the impact of this world upon ourselves. In the prevailing Western economic system, should yoga ever become a therapy alleviating many of our illnesses, anxieties or distressing emotions, it will have a fight on its hands to become a dominant therapy. Unlike pharmaceutical medications, yoga cannot be packaged in a box or simply taken mindlessly, nor can it be marketed in huge batches to make enormous profit.

Instead, yoga offers something else: reconnecting with ourselves and learning to see ourselves, and our reactions to the world around us, from a different perspective. It takes emotional and spiritual strength to reflect inwardly and directly address personal conflicts, anxieties, hopes and fears, and understand how we respond to them. It also takes time to learn how these states of mind impact directly on physical wellbeing, and how we can change this.

Research into yoga continues to reveal the health benefits it can have, supporting the case for its use in health care. Through randomized trials, reviews and other studies, we are learning more about the effect yoga can have on different aspects of our physical and mental health. Regular yoga practice can increase our awareness about how our body actually feels, with all its aches and pains, and help us restore balance.

Yoga isn’t as simple as taking a pill, but mounting evidence suggests it’s worth the investment of time and effort. Ultimately, in order to benefit from the positive health effects of yoga, we need to be mindful of the present: this moment, now. In such a non-stop world, that, surely, has to be a good thing.

This article originally appeared on Elsevier.com and was written by Denise Rankin-Box.

Yoga Therapy: Why Doctors Are Prescribing The Ancient Practice

In 2011, Jacquelyn Jackson had the most traumatizing year of her life. On a beautiful morning in Tucson, she was just 25 feet away when her former boss, Congresswoman Gabrielle Giffords, and 18 others were shot in a grocery store parking lot. In the weeks that followed, as Jackson began suffering symptoms of post-traumatic stress disorder (including chronic anxiety and difficulty sleeping), she turned to a psychotherapist. The sessions helped “tremendously,” she says but 11 months later, when her seemingly healthy younger brother died suddenly from a brain tumor. “the trauma was so great I felt like I needed something more.”

Desperate, Jackson looked online for support and stumbled upon yoga therapy, an emerging treatment for people struggling with anxiety, grief, and trauma. Long practiced in India, yoga therapy was introduced in the United States some three decades ago but has begun gaining popularity only in the past five years or so. (Membership in the International Association of Yoga Therapists [IAYT] has quadrupled since 2004, to about 3,200, and next year the IAYT plans to begin accrediting yoga schools to offer a standardized certification program.)

“It’s not just postures,” says yoga therapist Janice Gates. “We use all the tools of yoga — breath work, sound, visualization, and meditation — and tailor them to a client’s specific health condition.” One of Gates’s clients was a woman in her 40s who was experiencing serious depression and anxiety but couldn’t tolerate psychiatric medication. While a doctor oversaw the medical issues, Gates worked with the client weekly to manage her moods. On days when she was anxious, Gates led her through exercises like standing poses and forward bends (to help her feel more grounded) and exhalation breath work (to calm her down). When the woman was depressed, she did back bends and inhalation exercises, designed to give her energy. Six months later, the woman’s crippling dark moods, once a thrice-weekly occurrence, now overtake her only a few times each month. With her newfound energy — and time — she’s teaching art classes to children.

Though research on the efficacy of yoga therapy is ongoing, traditional doctors are taking notice — and finding it, in some cases, to be a valuable complement to the work they’re already doing. “Yoga therapy can be extremely helpful for people who need a way to work through what they’re experiencing, not just in their minds but in their bodies,” says psychotherapist Jack Obedzinski, MD, of Corte Madera, California. “Often, it allows my patients to experience a feeling of calm in a way they couldn’t in talk therapy.” And, he says, this calmness can bring more clarity and awareness to their traditional sessions.

For Jackson, one-on-one yoga appointments with Amy Weintraub, a pioneer in the field and author of Yoga for Depression, proved transformative. In their first session, Jackson “was practically hyperventilating with anxiety,” says Weintraub, who created a program that included “stair-step” breathing, building up to deeper and deeper breaths. “What the yoga did was provide a slow, gradual path to help her manage her moods and not immediately react when grief arose.” After just a few sessions, Jackson no longer used medication to help her sleep at night. “Working with Amy was like doing emotional Roto-Rooter-ing,” she says. “I had so much stress in my body, and she was able to help dislodge it — and clear it out.”

This article originally appeared on huffingtonpost.com and was written By Laura Hilgers.

Check out our UPCOMING MENTAL WELLNESS WORKSHOPS with Shari Arial: Yoga for Anxiety, Stress & Trauma.

Yoga for anxiety and depression.

Studies suggest that this practice modulates the stress response.

Since the 1970s, meditation and other stress-reduction techniques have been studied as possible treatments for depression and anxiety. One such practice, yoga, has received less attention in the medical literature, though it has become increasingly popular in recent decades. One national survey estimated, for example, that about 7.5% of U.S. adults had tried yoga at least once, and that nearly 4% practiced yoga in the previous year.

Yoga classes can vary from gentle and accommodating to strenuous and challenging; the choice of style tends to be based on physical ability and personal preference. Hatha yoga, the most common type of yoga practiced in the United States, combines three elements: physical poses, called asanas; controlled breathing practiced in conjunction with asanas; and a short period of deep relaxation or meditation.

Many of the studies evaluating yoga's therapeutic benefits have been small and poorly designed. However, a 2004 analysis found that, in recent decades, an increasing number have been randomized controlled trials — the most rigorous standard for proving efficacy.

Available reviews of a wide range of yoga practices suggest they can reduce the impact of exaggerated stress responses and may be helpful for both anxiety and depression. In this respect, yoga functions like other self-soothing techniques, such as meditation, relaxation, exercise, or even socializing with friends.

Taming the stress response

By reducing perceived stress and anxiety, yoga appears to modulate stress response systems. This, in turn, decreases physiological arousal — for example, reducing the heart rate, lowering blood pressure, and easing respiration. There is also evidence that yoga practices help increase heart rate variability, an indicator of the body's ability to respond to stress more flexibly.

A small but intriguing study further characterizes the effect of yoga on the stress response. In 2008, researchers at the University of Utah presented preliminary results from a study of varied participants' responses to pain. They note that people who have a poorly regulated response to stress are also more sensitive to pain. Their subjects were 12 experienced yoga practitioners, 14 people with fibromyalgia (a condition many researchers consider a stress-related illness that is characterized by hypersensitivity to pain), and 16 healthy volunteers.

When the three groups were subjected to more or less painful thumbnail pressure, the participants with fibromyalgia — as expected — perceived pain at lower pressure levels compared with the other subjects. Functional MRIs showed they also had the greatest activity in areas of the brain associated with the pain response. In contrast, the yoga practitioners had the highest pain tolerance and lowest pain-related brain activity during the MRI. The study underscores the value of techniques, such as yoga, that can help a person regulate their stress and, therefore, pain responses.

Improved mood and functioning

Questions remain about exactly how yoga works to improve mood, but preliminary evidence suggests its benefit is similar to that of exercise and relaxation techniques.

In a German study published in 2005, 24 women who described themselves as "emotionally distressed" took two 90-minute yoga classes a week for three months. Women in a control group maintained their normal activities and were asked not to begin an exercise or stress-reduction program during the study period.

Though not formally diagnosed with depression, all participants had experienced emotional distress for at least half of the previous 90 days. They were also one standard deviation above the population norm in scores for perceived stress (measured by the Cohen Perceived Stress Scale), anxiety (measured using the Spielberger State-Trait Anxiety Inventory), and depression (scored with the Profile of Mood States and the Center for Epidemiological Studies Depression Scale, or CES-D).

At the end of three months, women in the yoga group reported improvements in perceived stress, depression, anxiety, energy, fatigue, and well-being. Depression scores improved by 50%, anxiety scores by 30%, and overall well-being scores by 65%. Initial complaints of headaches, back pain, and poor sleep quality also resolved much more often in the yoga group than in the control group.

One uncontrolled, descriptive 2005 study examined the effects of a single yoga class for inpatients at a New Hampshire psychiatric hospital. The 113 participants included patients with bipolar disorder, major depression, and schizophrenia. After the class, average levels of tension, anxiety, depression, anger, hostility, and fatigue dropped significantly, as measured by the Profile of Mood States, a standard 65-item questionnaire that participants answered on their own before and after the class. Patients who chose to participate in additional classes experienced similar short-term positive effects.

Further controlled trials of yoga practice have demonstrated improvements in mood and quality of life for the elderly, people caring for patients with dementia, breast cancer survivors, and patients with epilepsy.

Benefits of controlled breathing

A type of controlled breathing with roots in traditional yoga shows promise in providing relief for depression. The program, called Sudarshan Kriya yoga (SKY), involves several types of cyclical breathing patterns, ranging from slow and calming to rapid and stimulating.

One study compared 30 minutes of SKY breathing, done six days a week, to bilateral electroconvulsive therapy and the tricyclic antidepressant imipramine in 45 people hospitalized for depression. After four weeks of treatment, 93% of those receiving electroconvulsive therapy, 73% of those taking imipramine, and 67% of those using the breathing technique had achieved remission.

Another study examined the effects of SKY on depressive symptoms in 60 alcohol-dependent men. After a week of a standard detoxification program at a mental health center in Bangalore, India, participants were randomly assigned to two weeks of SKY or a standard alcoholism treatment control. After the full three weeks, scores on a standard depression inventory dropped 75% in the SKY group, as compared with 60% in the standard treatment group. Levels of two stress hormones, cortisol and corticotropin, also dropped in the SKY group, but not in the control group. The authors suggest that SKY might be a beneficial treatment for depression in the early stages of recovery from alcoholism.

Potential help for PTSD

Since evidence suggests that yoga can tone down maladaptive nervous system arousal, researchers are exploring whether or not yoga can be a helpful practice for patients with post-traumatic stress disorder (PTSD).

One randomized controlled study examined the effects of yoga and a breathing program in disabled Australian Vietnam veterans diagnosed with severe PTSD. The veterans were heavy daily drinkers, and all were taking at least one antidepressant. The five-day course included breathing techniques (see above), yoga asanas, education about stress reduction, and guided meditation. Participants were evaluated at the beginning of the study using the Clinician Administered PTSD Scale (CAPS), which ranks symptom severity on an 80-point scale.

Six weeks after the study began, the yoga and breathing group had dropped their CAPS scores from averages of 57 (moderate to severe symptoms) to 42 (mild to moderate). These improvements persisted at a six-month follow-up. The control group, consisting of veterans on a waiting list, showed no improvement.

About 20% of war veterans who served in Afghanistan or Iraq suffer from PTSD, according to one estimate. Experts treating this population suggest that yoga can be a useful addition to the treatment program.

Researchers at the Walter Reed Army Medical Center in Washington, D.C., are offering a yogic method of deep relaxation to veterans returning from combat in Iraq and Afghanistan. Dr. Kristie Gore, a psychologist at Walter Reed, says the military hopes that yoga-based treatments will be more acceptable to the soldiers and less stigmatizing than traditional psychotherapy. The center now uses yoga and yogic relaxation in post-deployment PTSD awareness courses, and plans to conduct a controlled trial of their effectiveness in the future.

Cautions and encouragement

Although many forms of yoga practice are safe, some are strenuous and may not be appropriate for everyone. In particular, elderly patients or those with mobility problems may want to check first with a clinician before choosing yoga as a treatment option.

But for many patients dealing with depression, anxiety, or stress, yoga may be a very appealing way to better manage symptoms. Indeed, the scientific study of yoga demonstrates that mental and physical health are not just closely allied, but are essentially equivalent. The evidence is growing that yoga practice is a relatively low-risk, high-yield approach to improving overall health.

This article originally appeared on www.health.harvard.edu

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