Saturday, December 15, 2012

Yoga and Addiction Recovery


Yoga's Potential in Treatment for Substance Abuse
Tara Shugrue
Yoga: Theory, Culture and Practice
Laura Douglass
Fall 2012

Introduction

Addiction is “the out-of-control and aimless searching for wholeness, happiness, and peace through a relationship with an object of event”(Williams 2002). Addiction is a disease that is unprejudiced in the type of person it infects. An addict or alcoholic does not fit any specifications when it comes to physical traits or cultural background. Our collective culture as Americans, however, “a society that glorifies addiction and subtly and incessantly pushes us toward it”(Williams 2002). Addiction has become an element to popular culture within the past generation. Celebrities cite “exhaustion” and check into glorified rehabs that share more similarites to a five-star hotel than a clinic. It is no longer taboo in our society to check into rehab for any form of addiction. It has evolved to the point of reality television, chronicling lower-rate celebrities as they work through the recovery process. The definition of addiction in our society as Americans has become twisted and warped into something that makes it appear as more of a joke than anything. Addiction, in any form, is a serious disease that can become fatal if left untreated.
The challenge with this population is that each addiction, each recovery is a completely unique experience to that person; thus treating addiction and maintaining sobriety is no easy feat. The desired end result of the drug and alcohol recovery process is to indeed stay clean and sober. There are numerous approaches to treatment, because of the uniqueness of the disease. There is always a need for an improvement to treatment, that may work for the person that nothing else seems to leave an impact on. Yogic practices have been added to addictions treatment as a result of that searching.
From the research I have conducted thus far, three major practices have continue to stand out: Mindfulness Meditation, Transcendental Meditation and Kundalini yoga. The first two practices are significant elements to yoga, which goes beyond the western persepective of simply a form of exercise. Meditation brings focus to being fully present in the moment, completley aware of the mind-body connection that develops through yoga. Meditation quiets the mind, and brings peace to the body, a helpful practice for those going through the recovery process.

Clinical Issues Facing Addicts and Alcoholics

The recovery process is challenging, because the individual has to face their emotions and environment without their main coping device. Addicts and Alcoholics are professionals at avoiding the negative things in their lives, they use to block out the bad emotions, situations, or mental state they were experiencing. Breslin et al. address Experimental Avoidance, “defined as the attempt to alter the form or frequency of unpleasant states by ignoring or distorting bodily sensations, emotions, thoughts, or memories”(2002). The 12-step program, created by Alcoholics Anonymous, is also used in recovery for Addicts. The first step is to admit that the addiction has taken control over one's life, and that their life has become unmanagable. That initial step is a challenge for a population that functions on never being fully present or aware. Denial is an obstacle each addict faces when they begin treatment, but the underlying issue is dealing with the amount of shame that they feel towards themselves. Holding on to their denial of the situation, their addiction, themselves, that is what helps them to function with their overwhelming sense of shame.

Mindfulness Meditation

Incorporating mindfulness practices into treatment does greatly impact patients in recovery, and working through their experimental avoidance. “Mindfulness practices help prevent relapse through increased awareness of overlearned patterns of thoughts and emotions that potentially lead to relapse”(Dakwar & Levin 2009). Although practicing mindfulness is a simple action, it does not make it in any way an easy feat. Treatment is a fragile time, and bringing awareness to thoughts and emotions that have been previously avoided can be overwhelming. Especially when the learned response of coping has been removed. Becoming aware is the first step, how reality is percieved through that newly aquired vision is the next. Integrating the power of positive thought into mindfulness practices is essential to suceeding. “Present-moment awareness also facilitates a cognitive focus on positive aspects of everyday life, rather than past or future concerns”(Kissman & Maurer 2002). Being fully present in the moment takes the focus off of the past and regrets it may bring, and takes the focus off of the future, and the anxieties it can hold. As Omar Khayyam famously said: “be happy for this moment. This moment is your life.” To find contentment is the slightest detail of the present is to enjoy your life for how wonderful it is, this comes from practicing mindfulness.

Breslin et al. (2002) said this about the role negativity has concerning relapse:
Negative affect appears to be an especially important trigger for several reasons. First, the majority of clients attribute their relapse to interpersonal stress or negative emotions. Second, when alcohol clients relapse, the more intense negative affect appears to elicit a conditioned response (e.g., desire to drink) that increaseses the risk for relapse

The above quote is supportive in my belief that positive thinking is essential in addiction recovery. Addicts are surrounded by negativity, from themselves and their projections of how the world views them. O'connell and Alexander (2009) explain it well, “the recovery process necessitates a fundamental change in the patient's identity and conception of reality.” The addict needs to change everything about their life in order to recover, they need to step out of the darkness and negativity, into the light.
Being able to percieve the self and the surrounding environment in a non-negative way is a significant change for most people going through treatment. “One brings an attitude of acceptance to the inevitable distractions that occur when one sits still. Even when experiencing an unpleasant emotion or distracting thought, one observes or investigates the experience rather than avoiding or supressing it”(Breslin 2002). even for someone who is not battling an addiction, simply observing thoughts and emotions is hard. Unpleasant thoughts and emotions are triggers for addicts to use, simply observing those urges and not acting upon them is a true test of willpower, which can strengthen over time.
Mindfulness practice work harmoniously with the 12-Step program, sharing essential points of acceptance of reality, and reacting in a healthy way. Mindful Meditation is applicaple to each of the twelve steps,“the eleventh step involves engaging in prayer or meditation regularly”(Dakwar & Levin 2009). Alcoholics Anonymous is often associated with the idea presented in the literature of a “higher power” which deters those that are not religious. It is worded vaguely enough to give enough room for options, meditation being one of them. Giving that option to those in recovery is likely to bring higher results of success with sobriety, by taking away a religious association to those not comfortable with it.
To commit to becoming mindful and accepting of reality, the person has to learn a completley new way of thinking. Addictions form for different reasons, it really depends on the person. Some are a result from some form of trauma earlier in life, some are predisposed to addiction, and some just don't think they are good enough. Addicts and alcoholics possess a unique sense of shame, a heavy weight that they carry with them. This shame is not from a single action, it is from simply existing. To dull that overwhelming pain, they learn to cope with a substance, and to make themselves feel better by self-medicating. As the addiction progresses, however, they begin to feel shame for using, adding fuel to the fire.
Practicing mindful meditation, although a great challenge, can reap many benefits to those in treatment. They are able to develop skills to help maintain their sobriety, “from the meditation componenet, practioners also develop an increasing self-awareness of both their psychological and physical state, which can lead to an increase in self-control”(Khalsa et al. 2008). Self-control is ultimately the deciding factor when a patient is teetering between sobriety and relapse, which can be defined as a single drink to an overdose. The threat of relapsing is constantly present in recovery, meditation can be a great aid against the cravings.
Dakwar & Levin (2002) mentioned some benficial effects meditation has on cravings:
meditation has been correlated with a reduced stress response and lower cortisol levels. This finding suggests a role for meditation in addressing craving states: it may potentially reduce stress-induced craving, dampen the salience of drug craving, and increase craving tolerance.
Meditation is known for reducing stress, a positive result for anyone, but for this population, stress “may contribute to addiction by throwing out of balance neuro and biochemical pathways”(William 2002). Keeping stress at a minimum is important, especially for those early in their recovery.

Transcendental Meditation

From the very beginning of recovery, starting at detoxification, Transcendental Meditation is an effective approach to healing. Transcendental Meditation or TM plays “a valuable role in the management of withdrawel symptoms...patients who learn TM during detoxification often report reduced feelings of irritation and agitation and less physical pain”(O'Connell & Alexander 1995). TM is an intense practice, that produces results if the person is completley commited to the practice. For those who are truly serious about obtaining and maintaining sobriety, commiting to TM will help them reach their goals. An author of one of the articles I read believed that Transcendental Meditation claimed to work too much and too well, and that TM calimed to be the only treatment needed to get clean and sober.
The truth is, as with any holistic approach to healing, there needs to be a combination of different treatments to create a succesful recovery process; especially for this population. As I said earlier, each recovery process is different, it depends on the individual. Finding that perfect compromise of treatment is key, Kissman & Maurer (2002) cite Dr. Seigel: “patients have higher recovery rates when they take part in medical treatment and are involved in spiritual practices and belief, such as the mental visualization of wellness (Seigel 1998)”.

Kundalini Yoga

Kundalini yoga is a common form of yoga used in treatment centers around the world; not only for addictions, but psychological diseaseses as well, including Obsessive-Compulsive Disorder, depression, and anxiety. Yogi Bhajan, “a living master of Kundalini yoga, Hatha yoga, and White Tantric yoga”(Shannahoff-khalsa 2004) claimed a specific posture would promote sobriety to those in recovery. It involves activating the Pineal gland, where addiction stems from in the brain, and regulating the balance to rid the mental addiction from the mind. This is done by applying pressure to the sides of the head while chanting a mantra that “puts your consciousness through the cycle of-infinity, life, death, and rebirth. This mantra cleanses and restructures the subconcious mind to help live in a conscious state that is merged with the infinite”(Shannahoff-khalsa 2004).

Conclusion

A reoccuring statement made in each article was the lack of research done on the subject of using meditation or yoga therapy to treat addiction. The small-scale studies done yielded different results, and although the benefits can be estimated, there does not seem to be a strong foundation of evidence-based information. Further research on a larger scale would make a hugr improvement on the amount of scattered results that exist currently. Another reoccuring statement was about the difficulty of gauging the results, as meditation is a significantly unique and personal experience, as well as the process of recovery.
It is frustrating that the results found in any study cannot resolve to any concrete conclusions. There can only be speculation or assumptions made on the benefits of yoga with patients in recovery. That seems to be a running theme in Holistic practices, each individualized to work the best for each person; there is no way to then apply those results to a larger scale. The individuality of Holistic approaches to healing is both its greatest strength and its greatest weakness. From what has been found, the results are profound, to those that were receptive to these different approaches to treatment. I believe that taking a holistic approach to treating addiction is the most effective way, combined with standard rehabilitation treatment as well. Because this disease is so unique in each person infected by it, and this way of treatment is so personalized, they seem to be able to fit together like corresponding puzzle pieces.
I am frustrated and even slightly saddened by the weight that our culture has in deciding what is legitimate. Holistic practices, though gaining popularity within the past decade or so, are still treated with a sene of humor, and not taken as seriously or treated with as much respect as traditional medicine. I have a holistic psychology specialization with my counseling major, and it is something that I plan on incorporating in my career in addiction counseling. Because they are not scientific with solid results, and because a good amount of faith is needed for them to work, holisitic treatments and practices are looked at as not effective. Although they can improve the overall quality of life, and can work better than most medications, these treatments are not covered by health insurance. I hope that one day our culture will evolve enough to have an open mind about treatment options, so that they can be made available to those lucky enough to have health insurance. I plan to continue to research the role that yogic practices have in recovery for addiction, and hopefully one day I will be able to use them in my professional career.


References

Brady, Maggie(1995) Culture in treatment, culture as treatment. A critical appraisal of developments in addictions programs for indigenous North Americans and Australians. Social Science & Medicine 41(11) pp 1487-1498 doi: 10.1016/0277-9536(95)00055-C

Brown, R. P., Gerbard, P. L. (2005) Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part II-Clinical Applications and Guidelines. Journal of Alternative & Complementary Medicine 11(4) p711-7 doi: 10.1089/acm.2005.11.711

Breslin, F. C., Zack, M., & McMain, S. (2002) An Information-Processing Analysis of Mindfulness: Implication for Relapse Prevention in the Treatment of Substance Abuse. Clinical Psychology: Science and Practice 9(3) p275-299

Dakwar, E., Levin, F. R. (2009) The Emerging Role of Meditation in Addressing Psychiatric Illness, with a Focus on Substance Use Disorders. Harvard Review of Psychiatry 17(4) p253-267 doi: 10.1080/10673220903149135

Khalsa, S. B. S., Khalsa, G. S., Khalsa, H. K., & Khalsa, M. K. (2008) Evaluation of a Residential Kundalini Yoga Lifestyle Pilot Program for Addiction in India. Journal of Ethnicity in Substance Abuse 7(1) p67-79 doi: 10.1080/15332640802081968

Kissman, K., & Maurer, L. (2002). East meets West Therapeutic aspects of spirituality in health, mental health and addiction recovery. International Social Work, 45(1), 35-43.

Murphy, K.M. (2008). Managing Your Recovery From Addiction.

O'Connell, D.F., & Alexander, C.N. (1995). Self-recovery: Treating addictions using transcendental meditation and Maharishi Ayur-Veda (vol 1). Routledge.

Shannahoff-khalsa, D. S. (2004) An Introduction to Kundalini Yoga Meditation Techniques That Are Specific for the Treatment of Psychiatric Disorders. Journal of Alternative & Complementary Medicine 10(1) p91-101

Williams, P.G. (2002). The Spiritual Recovery Manual: Verdic Knowledge and Yogic Techniques for Addicts, Codependants and Adult Children of Dysfunctional Families. Incandescent Pr.

Thursday, December 13, 2012

Yoga as a Treatment for Eating Disorders


Yoga as a Treatment for Eating Disorders
Nick Tuccinardi
Lesley University 


Author Note
This paper was prepared for Yoga: Theory, Culture, and Practice CSOCS 3452, taught by Ph.D. Laura Douglass.

Abstract
                        In this paper, “Yoga as a Treatment for Eating Disorders” I intend to provide an in-depth understanding of the use of yoga as a treatment for eating disorders. The paper will discuss where, why, and how these treatments take place with a focus on the Cambridge Center for Eating Disorders. The paper will also view how the mindfulness of yoga relates to the psychology of eating disorders. I will obtain research from scholarly journals, treatment centers, especially the Cambridge Eating Disorder Center, and online sources. This paper uses original research from interviews with friends who have attended the Cambridge Eating Disorder Clinic; I will speak with them to get some real personal reflection on whether or not treatment seems to be effective. Overall this paper serves two purposes, first to provide it’s readers with knowledge of how and why yoga can be and is used for the treatment of eating disorders. Secondly, in synthesizing information from friends, research, Ph. D. Douglass, as well as my own opinions I will examine whether or not yoga as treatment for eating disorders is effective. 









Introduction
It took a lot of research to find a suitable yet concise definition of what yoga truly is and truth be told, while The American Yoga Association has provided a solid definition it is not the “end-all” definition of yoga (Appendix A). Yoga varies tremendously depending on culture, style, location, tempo, and purpose. Although The American Yoga Association offers a very broad definition of yoga it serves as a simple background to those not familiar with the practice. One of the many uses for yoga that has become increasingly popular in the past couple of decades, in the Western world, is yoga for treatment of diseases or injuries. Specifically, this paper will examine the use of yoga as a treatment for people with eating disorders.
What is an eating disorder?
Just as it is important for the readers of this paper to understand what yoga is, it is equally important for the reader to understand eating disorders. There are some common misconceptions about eating disorders such as; it is limited to making oneself throw up or not eat. Some also believe that eating disorders are strictly a problem faced by females, not males. Others tend to neglect that there is sometimes a psychological or biological underlying condition that causes eating disorders. This leads to a misinterpretation of how eating disorders arise and how they should be handled.                                                                                                                          The National Eating Disorders Association has a copious amount of reliable information on eating disorders. It gives a simple definition of an eating disorder, “anorexia, bulimia, and binge eating disorder include extreme emotions, attitudes, and behaviors surrounding weight and food issues” (neda.org). It is crucial to understand these terms before moving forward, I have consulted the NEDA website in condensing the following definitions of specific eating disorders (these definitions have been paraphrased from definitions on the National Eating Disorder Associations website) :
Anorexia Nervosa- potentially life threatening, characterized by self-starvation and excessive weight loss                                                                                                                                Binge Eating Disorder- “Recurrent binge eating without the regular use of compensatory measures to counter the binge eating”. Essentially eating an excessively unhealthy amount on a regular basis and not properly exercising, dieting, or throwing up (bulimia nervosa)           Bulimia Nervosa- “A cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.” This disorder occurs when an individual eats an excessively unhealthy amount or any amount for that matter and then makes themselves throw up to make up for the excessive eating.                                         Eating Disorders Not Otherwise Specified (EDNOS)- “A person does not have to be diagnosed with Anorexia, Bulimia or BED to have an eating disorder. An eating disorder can include a combination of signs and symptoms but not meet the full criteria.”
Yoga as a Treatment for Eating Disorders
            Yoga as a treatment for eating disorders is a fairly new train of thought, as Laura Douglass points out in her 2010 publication, “Only a few studies support the efficacy of yoga for eating disorders and at least one study has shown that yoga has no effect all” (Douglass 84). This sentiment is echoed in a number of publications such as, “When eating disorder patients become more attuned to their bodies, experts say, they are more likely to treat them with the respect they deserve…Few scientific studies have explored these claims” (Columbia News Service). In my opinion, it is ok that science is not yet behind these claims. Perhaps not ok, but understandable. Science needs time for research and case studies. Yoga may be 5,000 years old but it has only been in the public eye of the West since about the 1960’s. Furthermore the use of yoga as treatment has only been around for a few decades. A lack of scientific proof does not mean that yoga is ineffective as a treatment; at the same time it does not prove the opposite. In our culture and society today, we want scientific proof. This raises the question what is being done to get that proof out to the public?
            Recent studies have been conducted by a number of institutions to try and prove yoga’s efficacy. Tartakovsky recently reported that a pilot study (Appendix C) published in the Journal of Adolescent Health found that yoga was effective in treating adolescents with anorexia, bulimia and eating disorder not otherwise specified. This was in 2009 but as early as 2005 there were such studies being conducted. The 2005 study was published in an issue of Psychology of Women Quarterly. The tests and results can be seen in Appendix D. Laura Douglass explores some cases studies such as these in her 2009 article “Yoga as a intervention for eating disorders: does it help?”. It is promising to see that leading researches in the field are now studying others research to solidify whether or not the treatment is effective. Research is ongoing, in 2010 Eating Disorders Review conducted a study that concluded, “The authors concluded that individualized yoga therapy holds promise as adjunctive therapy to standard care.” All of this research seems promising, but what is truly being researched? All of the experiments list that yoga is being used but what kind and how? For these answers, let us explore the lead source. A local eating disorder clinic, The Cambridge Eating Disorder Clinic, uses yoga as a treatment.
Cambridge Eating Disorder Clinic
            The Cambridge Eating Disorder Clinic, or CEDC was founded in 2000. It’s website is very helpful and providing general information about the clinic and detailed information about eating disorders as well as many resources. Unfortunately the website does not discuss how it implements yoga as a treatment. I have some friends who have attended CEDC and one was willing to let me ask them some questions about their history and experiences at CEDC (Appendix B). Her answers provide great insight not only into yoga as a treatment for eating disorders but also the journey of how an individual develops an eating disorder and how it affects them. Her reflection on yoga in the clinic is quite thoughtful and supports that while yoga is helpful, it is not an end all cure.
Conclusion
            Yoga as a treatment for eating disorders can be viewed as a Westernly ideal or the exact opposite. On the one hand, in the West we want hard empirical proof of everything. It is hard to bend our beliefs, if we cannot see then we choose not to believe. On the other hand, as a society we like to think that we are on the cutting edge and jump at the opportunity hop on the latest bandwagon, changing fads like we change clothes. Thus I believe there is a divide between whether or not people believe yoga is an effective treatment for eating disorders.
            Personally, if I were to write this paper prior to this semester I would probably laugh at the title. I have a pretty firm grasp of what a terrible thing an eating disorder is due to the number of my female friends who suffer from them. I had little to no knowledge of what yoga really was. A semester later I feel ashamed of my prior ignorance, a small sense of enlightenment, and a realization that I have so much to learn. My journey started at the end of the summer, I was having a discussion with a friend about how in psychology we watched a video about a lady who became a millionaire selling a book/movie on how to literally “think away cancer”. She claimed that it was all about attitude. I was sick to my stomach that someone was selling such ludicrous garbage. The friend I was telling had been to India and practiced some mediation and tried to explain how although energy cannot completely cure cancer, the lady was on to something. We talked for hours about energy and what the human body and mind was truly capable of. I was not convinced of anything, but definitely intrigued. This class, Yoga, Theory, Culture and Practice further opened my mind to different possibilities. As my friend says in Appendix B, sure yoga does not cure bulimia but it provides strong tools that help to fight it.
            It is hard to accurately describe my thoughts on holistic healing. Part of me wants to scream this is pure ignorance and insanity. Then there is another part of me that wants to see how it is possible. At the very least it is important to be willing to study and understand other views. It will be a long time before the world knows such acceptance. Just the other day I was discussing my finals with my dad and brought up yoga. He had so many questions, what is yoga? How is it an academic class? What can you learn from it? He was not asking these questions maliciously he truly just did not know, I tried my best to explain, it is hard because yoga is so complex and diverse. It is my belief that yoga is a catalyst. Whether it is eating disorders, anxiety, opening the mind, sports etc. Yoga can be so helpful, so vital, in so many ways; it is time for the world to wake up and take notice of this ancient art. Yoga is not the answer to any disease or any problem but it provides a spark in a step in the right direction. Namaste.



References
“Appendix B.” (Personal Communication, December 7, 2012)
"Cambridge Eating Disorder Center CEDC specializes in treatment of eating disorders." Cambridge Eating Disorder Center CEDC specializes in treatment of eating disorders. CEDC, n.d. Web. 19 Nov. 2012. <http://www.cedc-inc.com/>.
Daubenmier, J. J. (2005), THE RELATIONSHIP OF YOGA, BODY AWARENESS, AND BODY RESPONSIVENESS TO SELF-OBJECTIFICATION AND DISORDERED EATING. Psychology of Women Quarterly, 29: 207–219. doi: 10.1111/j.1471-6402.2005.00183.x
DOUGLASS, L. (2011). Thinking Through the Body: The Conceptualization of Yoga as Therapy for Individuals With Eating Disorders. Eating Disorders, 19(1), 83-96. doi:10.1080/10640
Douglass, L. (2009). Yoga as an intervention for eating disorders: Does it help? Eating Disorders: The Journal of Treatment and Prevention. 17 (2): 126-139. Link to Abstract & Order Article:  www.ncbi.nlm.nih.gov/pubmed/19242842. 266.2011.533607
"General Yoga Information." Welcome to The American Yoga Association. N.p., n.d. Web. 19 Nov. 2012. <http://www.americanyogaassociation.org
Haynie, Devon . "Yoga: a new way to fight anorexia." Columbia News Service 1 (2007): n. pag.                      Student Work. Web. 19 Nov. 2012.
"National Eating Disorders Association." National Eating Disorders Association. N.p., n.d. Web. 25 Nov. 2012. <http://www.nationaleatingdisorders.org/>.
" Sprouting Yoga." Sprouting Yoga. Sprout Yoga, 23 Jan. 2010. Web. 19 Nov. 2012. <http://padmaease.wordpress.com/page/2/
Tartakovsky, M. (2009). Yoga, Eating Disorders & Body Image. Psych Central. Retrieved on November 19, 2012, from http://blogs.psychcentral.com/weightless/2009/11/yoga-eating-disorders-body-image/
Walters, J. (2006). Child Psychology Selection. Child & Adolescent Mental Health, 11(1), 57-59. doi:10.1111/j.1475-3588.2005.00389_3.x
Whittington, Heather. "National Eating Disorders Awareness Week: Q & A With Yoga Practitioner Heather Whittington ." The Center for Eating Disorders at Sheppard Pratt. Sheppard Pratt, 25 Feb. 2008. Web. 19 Nov. 2012. <eatingdisorder.org/blog/2008/02/national-eating-disorders-awareness-week-qa-with-yoga-practitioner-heather-whittington/>.
Yoga Sessions Show Promise as Adjunct Therapy. (2010). Eating Disorders Review, 21(1), 11.
"Yoga Takes A Bite Out Of Eating Disorders." Science Daily: News & Articles in Science, Health, Environment & Technology. Blackwell Publishing Ltd., 18 May 2005. Web. 19 Nov. 2012. <http://www.sciencedaily.com/releases/20


Appendix A


What is yoga?
“The classical techniques of Yoga date back more than 5,000 years. In ancient times, the desire for greater personal freedom, health and long life, and heightened self-understanding gave birth to this system of physical and mental exercise, which has since spread throughout the world. The word Yoga means “to join or yoke together,” and it brings the body and mind together into one harmonious experience. The whole system of Yoga is built on three main structures: exercise, breathing, and meditation. The exercises of Yoga are designed to put pressure on the glandular systems of the body, thereby increasing its efficiency and total health. The body is looked upon as the primary instrument that enables us to work and evolve in the world, and so a Yoga student treats it with great care and respect. Breathing techniques are based on the concept that breath is the source of life in the body. The Yoga student gently increases breath control to improve the health and function of both body and mind. These two systems of exercise and breathing then prepare the body and mind for meditation, and the student finds an easy approach to a quiet mind that allows silence and healing from everyday stress. Regular daily practice of all three parts of this structure of Yoga produce a clear, bright mind and a strong, capable body.”       -The American Yoga Association








Appendix B

An Interview with a Cambridge Eating Disorder Clinic Patient 12/7/12

Do you feel comfortable answering some questions about your condition and your treatment in regards to yoga practices? If at any time you don’t feel comfortable answering a question or continuing please let me know.
Yes sure, I’m ready as I’ll ever be.
What is it that your condition?
You mean what am I suffering from? I was diagnosed with bulimia with anorexic tendencies. The unofficial term is bullimarexia. I’ve shown tendencies since the age of 14 but was only diagnosed when I was 18. I’m now 20. I was also diagnosed with generalized anxiety disorder and depression in October of 2012.
When were you first committed to the Cambridge Eating Disorder Clinic?
At the beginning of my senior year in high school (2010) I went to a Primary Care Physician weekly for weight and vital checks. I was also seeing an outside therapist but it was not a good experience so I stopped going. My PCP referred me to CEDC where I went for the first time in the summer of 2011. I was in the Intensive Out Patient program, I went three nights a week for three hours and, but I didn’t participate in any yoga.
Do you have any experience with yoga?
When I was 15 I went to a “stretching yoga” class with my mom at a Methodist Church in my hometown.  The demographics were mainly women in their 40’s, the teacher was very hippy-like, there were many mirrors in the room and I felt very self conscious. I hated it. I then did not practice yoga in any capacity until the fall of 2011. I was attending Syracuse University. I was not doing well with my eating when I left for school; my therapist said I was “functioning in a downward spiral.” At school my anorexic tendencies increased and I felt a lot of stress to achieve a 4.0 GPA. My friend encouraged me to attend a Saturday evening yoga class from 10 to 11pm. Although I vowed to never do yoga again after the uncomfortable experience in my mom’s class, my friend really pushed how relaxing it was, so I gave it a try. It was a Hatha yoga class and I fell in love. It was a nice way for me to escape the stress and pressures of the week. I did it from October until May, but did not continue over the summer when I got home. In the fall, 2012, I transferred to the University of Virginia. My PCP was hesitant to send me to school; I had a breakdown towards the end of the summer and fainted. My weight was low and I was depressed. Despite these warnings I went to school as planned.
Do you think your breakdown would have been avoided if you continued your yoga practices?
I think that it would have helped to lower my anxiety but by no means would it have been a cure. Yoga helped lower my anxiety levels and anxiety tends to lead to greater eating disorder tendencies.
Did you pick up yoga again at UVA?
No. Unfortunately a month and a half into the semester I had another breakdown. I was sent home. It was a new low pint for me, I had it rock bottom. The first day I got home I went to the hospital got my vitals checked and got an EKG. The next day I went for an intake at the CEDC. My parents encouraged me to go immediately. The intake was a series of questions about my history, behavior, background, mental stability, physical evaluation, and vitals. I was then placed into Partial Hospital Therapy. I would be attending the clinic 5 days a week for 6 and half hours a day. The options for treatment at CEDC are Residential, where you live at the clinic 24/7, IOP, which I previously mentioned/was enrolled in, or Outpatient, where you meet with a CEDC therapist.
What did a normal day look like for you?
We would check in and talk about or struggles from the previous night. We then had snack followed by two group sessions. We then had lunch and two more group sessions. A short group and then a session where we would plan out our evenings followed a pm snack.
What are the groups?
Recovery narratives, bibliotherapy, target behavior, psychotherapy, coping, nutrition, healthy anger, relationships, roadblocks to recovery, CBT-cognitive behavioral therapy, emotional regulation, and yoga.
Can you talk about the yoga you practiced?
We practiced for 40 to 50 minutes on Tuesday afternoons. We had the option of yoga or meditation. It was a very gentle stretching type of yoga. The clinic restricts exercise so we mostly held the poses.
Do you know which poses you did?
Childs pose, downward dog, tree pose, sitting back stretch, warrior two, cat/dog, and some others that I cannot remember.
Did you do any meditations or chanting?
We didn’t mediate but we occasionally ended with an om. There was a great emphasis on breathing techniques, which I found to be the most helpful.
Why did you choose yoga over meditation?
 Mediation seems helpful if you have the right mindset going in, the breathing tactics of yoga force me to get into the right mindset.
What sort of mindset does yoga get you in?
Well, it’s interesting. Yoga focuses on the body, which is something that an individual with an eating disorder may not want to do. But it’s a different kind of self-awareness of the body. It’s hard to explain. Focusing on breathing helps me to detach. It’s the kind of thing that like, if I thought of binging, I could focus on my breathing and try to push the bad thoughts out of my mind. Yoga is all about breathing and being mindful. As someone with an eating disorder, I will always be in some state of recovery; having the mindfulness that yoga preaches helps with different coping mechanisms to not engage in harmful behaviors.
Could you please evaluate the following statement: Yoga is helpful in curing eating disorders.
First off cure isn’t really the right term, as I said if you have had an eating disorder you are always in recovery. That being said, I think that on its own, in most cases, yoga will never be the cure. I do think that it’s helpful to focus on mindfulness of the body and breathing. It’s a safe way to indulge in thinking about the body in a positive way. I focus on my body in a negative way, but yoga focuses on the positives.
Is it hard to practice yoga when our Western culture pushes crazy ideals? Like women in sports bras and booty shorts?
I cant say for sure because I haven’t engaged in that sort of class, but at CEDC all the girls where sweats and sweatshirts, or whatever they wore that day. CEDC is a welcoming environment for body image, there are no mirrors, no competitive or sexual Western ideals, and it’s helpful that all the girls are in a similar place. There is a sense of community. I know yoga is all about the internal focus, but on a subconscious level, it’s helpful to know the girls around me are going through the same struggles.
So yoga at the clinic is helpful?
Yes but I wish it were done more. We only do it once a week and it is on Tuesdays. I wish we could do it on a Friday afternoon to release the stress of the week.
Thank you very much, any final comments?
Thank you and yes. Eating disorders are often overlooked. I was in the clinic for about 3 or 4 weeks and am now being forced to leave because I am no longer physically at risk. My insurance no longer covers the treatment. I don’t blame CEDC in the slightest but it is terrible that just as I am starting to progress I have to leave. I fear that I will fall into old habits, which could be avoided if I were to just continue at the clinic. I guess in short I just want to see awareness raised; it is a serious issue and does not get the attention it deserves.
Appendix C
“Specifically, the study looked at two groups: one group received standard care, which involved an appointment with a physician or dietician every other week; the second received standard care plus yoga.
Immediately after the yoga sessions, teens reported being less preoccupied with food. At 12 weeks, these teens also had lower scores on the self-report questionnaire, Eating Disorder Examination. While the teens who didn’t practice yoga experienced an initial decline in scores, they returned to their baseline at week 12. Also, importantly, the teens didn’t lose any weight. The researchers concluded that, “Results suggest that individualized yoga therapy holds promise as adjunctive therapy to standard care.”- Margarita Tartakovsky, Yoga, Eating Disorders, and Body Image
Appendix D
“Study 1 consisted of three types of women: those currently taking yoga classes, those partaking in aerobic classes, and those who had not participated in either for the past two years. Participants were asked to complete a survey on "women and exercise" that they completed at home and mailed back. Study one consisted of women who, on average, were thirty-seven years old. Study two consisted of undergraduates, a population known to be at greater risk for self-objectification and eating disorders. The results were consistent in both studies. "Through yoga, this study suggests that women may have intuitively discovered a way to buffer themselves against messages that tell them that only a thin and 'beautiful' body will lead to happiness and success," the author explains.” –Science Daily

Iyengar Yoga for Depression


Iyengar Yoga for Depression
Manli Nouri
Lesley University

Abstract
This paper will focus on the development and uses of Iyengar Yoga. It will cover B.K.S. Iyengar’s life and how Iyengar yoga was first started. It will also cover how it used in the west to cure ailments. The ailment that this paper will focus on will be depression, including research done on it and the results that have been found on how it is known as being a treatment for depression. It will end with what research has not done yet, but will also look at what it can do in the future.


Introduction
            I chose to do this topic because it interested me on many different levels.  Since my dad has depression, I first wanted to write my paper on how yoga is used to treat depression.  However, after doing some research, I came to find that most of the research done on yoga being used as an alternate form of treatment for depression had to specifically do with Iyengar yoga.  This finding made me interested in Iyengar yoga and what was special about it.  Therefore, I changed my topic to learn more about Iyengar yoga: its roots and how it is used to treat depression.  Prior to taking this class and specially before doing this research, I had never heard of yoga being used to treat different types ailments, specifically depression.  I had heard of people doing yoga to relieve stress, but treating depression seemed much more serious than daily stress.  To my surprise, there is much research and data on this ailment and why Iyengar yoga was used to treat depression instead of other types of yogas.
B.K.S. Iyengar
Bellur Krishnamachar Sundararaja Iyengar was the founder of Iyengar yoga.  He was born on December 14, 1918 as a very ill and sickly baby.  Iyengar suffered many diseases as a child.  He had gotten malaria, tuberculosis, and typhoid by thirteen.  Because his father passed away when he was nine years old, the family was left with a large financial burden and Iyengar was sent to live with his brother in Bangalore.  During this time, his health kept getting worse, making his attendance at school very poor (Iyengar, 2007).
In 1934, Iyengar was invited by his sister to stay with her and her new husband, Professor Tirumalai Krishnamarcharya.  It was here that yoga would become part of B.K.S. Iyengar’s life.  Krishnamarcharya, a gifted man who was very advanced at yoga, ran a yoga school where Iyengar was invited to attend and learn yoga asanas (Iyengar, 2007).  At first, Iyengar struggled and found the asanas to be very painful and difficult to complete, not only due to the limitations of his body but also mind, as well.  His mind was not yet ready to let go of certain thoughts during meditation and he struggled when he had to clear his mind to concentrate.  However, with his determination and his guru’s strict ways, he gradually mastered some of the asanas.  While he was mastering these poses, he realized that his health was improving (Iyengar, 2007).
The Start of Teaching
Seeing how well he was advancing, Krishnamarcharya asked Iyengar, who was at this time eighteen years old, to start teaching.  Iyengar did not know how to speak Marathi, which was problematic, because Marathi was the only language his students knew how to speak.  He had never been explained the techniques for the asanas by his teachers, which caused him to struggle as a teacher.  To overcome this, he practiced persistently in hopes of gaining an in-depth knowledge of each posture and the movement of each body part (Iyengar, 2007).  The accuracy he established was later reflected in his teaching.  By working as a teacher, he had also become fluent in Marathi, as well as English, Sanskrit, Hindi, Tamil, and Kannada, which enabled him to communicate with all of his students.
With a growing reputation as a successful teacher, more and more people of all ages and abilities started coming to him, including many people with ailments.  Since yoga had improved his health, they thought it could do something for theirs (Iyengar, 2007).  Iyengar “developed the use of props, such as ropes, belts, wooden blocks, and bolsters to help the elderly, weak, and inflexible experience the therapeutic effects of yoga” (Iyengar, 2007, p. 12).  He would come up with different asana patterns for people with different ailments (Pilkington, Kirkwood, Rampes, & Richardson, 2005).
Iyengar Goes International
As his reputation spread, members of the Indian royalty and important business, sports, and entertainment individuals came to Iyengar.  In 1952, a violin expert, Yehudi Menuhin came to Iyengar for help from his constant fatigue and lack of sleep.  Iyengar prescribed him with a list of asanas and after doing so, Menuhin saw that his pains completely disappeared and his regular sleeping pattern was restored.  After this, Menuhin arranged Iyengar to teach abroad in London, Switzerland, Paris, and other places around the world (Iyengar, 2007).
B.K.S. Iyengar traveled to the United States for the first time in 1956, returning often in the 1970s.  His different and new way of yoga helped popularize and promote yoga within the United States.  His first book, Light on Yoga, was published in 1966 and became an international success and was soon translated into seventeen languages.  His second book, Light on Pranayama, was published in 1981 and was also a success, being translated into twelve languages (Iyengar, 2007).  He has toured twenty-five countries and has published fourteen books.  He has also won hundreds of awards and is widely known for popularizing yoga. Some even consider him as the Michelangelo of Yoga (Eirk, 2011).  These all show his importance and significance to what people think of all he has brought in the world of yoga.
Iyengar Memorial Yoga Institute
In 1975, in memory of his wife, Iyengar opened the Ramamani Iyengar Memorial Yoga Institute in Pune, India (Iyengar, 2007).  Iyengar started out teaching all of the yoga classes and kept teaching until 2003 when he officially retired from teaching, because he believed it was time to “let the next generation come through” (Iyengar, 2007, p. 13).  After he retired, his daughter, Geeta, and son, Prashant, as well as other senior teachers who were trained under Iyengar’s strict teachings, took over and still teach his classes today (Iyengar, 2007).  Today, he lives with his family in a house next to the institution and still vigorously practices yoga.  Although he is retired, he still teaches the special needs’ classes.  These classes consist of people with problems such as “heart conditions, arthritis, diabetes, migraines, multiple sclerosis, and cancer” (Iyengar, 2007, p. 22).
His success has to do with many aspects of yoga that Iyengar did differently.  Iyengar looked beyond the body’s muscular and skeletal systems, using his own body to see how each asana affected internal organs and the nervous systems.  As a result of this knowledge, he came up with a system of yoga that was different.  He organized over two hundred classical yoga asanas and fourteen different types of pranayamas, which allowed beginners to easily move from basic levels to more advance ones.  His success may also have to do with the fact that he was not fully concerned with the perfection of the postures (Iyengar, 2007).  He was more concerned with the “harmony and spiritual awakening as the mind, body, and soul are united” (Iyengar, 2007, p. 24).  He also recognized that each person is different and may need different accommodations.  His use of props allowed the people needing them not have to concentrate on their limitation, while getting the same practice as people without their limitations.  These props were also for beginners who were not yet flexible enough to still be able to enjoy yoga without harming or straining himself or herself (Garfinkel & Schumacher, 2000).
Remedy for Ailments
Yoga, in general, has therapeutic effects that aid in relaxation.  It teaches one how to develop a greater awareness of his or her physical and psychological state.  This gives one coping mechanism, which then increases one’s ability to deal with everyday stress, which may be the cause of their depression (Iyengar, 2007).  Iyengar yoga had become very popular to people with ailments.  Since Iyengar himself overcame his sickness with yoga, others believe, and have proven, that yoga can help them, too.  People have overcome not only illnesses, but addictions and traumas (Iyengar, 2001).  They “are taught yoga, meditation, introspection, group therapy alongside a 12-step Alcoholics Anonymous Program” (Iyengar, 2007, p. 22).  After finding out about their ailments, Iyengar would come up with a group of asanas for that person, which was different for every ailment (Iyengar, 2007).
Depression
Yoga is sometimes referred to as a self-soothing technique and compared to meditation, relaxation, exercise, and even socializing with friends, because all of these activities are known to distress and relax oneself.  After going to a yoga class, people usually say that they feel less stressed and their moods are uplifted.  That is why yoga is the perfect treatment for depression.  In a survey conducted by the Iyengar Yoga National Association of the US (IYNAUS), depression was ranked as one of the top five reasons for participation in yoga (Shapiro, Cook, Davydov, Ottaviani, Leuchter, Abrams, 2007).  Ever since the 1970s, there have been a lot of studies done on finding possible treatments for depression (“Yoga for anxiety and depression,” 2009).  In the West, most people that have depression take pills, which does not get rid of the depression, but just supposedly makes you feel better for a short amount of time.  Recently, there are been studies done on exercise, and more specifically, yoga as a form of treatment.  Many of the studies done on Iyengar yoga being used as a treatment for depression have been proven to be successful.  Most research has showed that it does make people less depressed, if not cures their depression altogether.  It has been found to increase positive and decrease negative moods (Woolery, Myers, Stemliebm, & Zeltzer, 2004).  These studies show that its benefits are similar to that of exercise and relaxation techniques (“Yoga for anxiety and depression,” 2009).
What Research Has Been Done
In 2004, there was a pilot study done to examine the effects of a five-week Iyengar yoga course on symptoms of depression on young adults.  Since B.K.S. Iyengar chose specific sequences of asanas for different ailments, there was a sequence specific to depression.  These “include asanas that open and lift the chest, especially back bends, inversions, and vigorous standing poses” (Woolery et al., 2004, p. 60).  The study was predicted to have reduced levels of depression and since depression has been associated with abnormal levels of cortisol, it was predicted that there would be a change in cortisol levels (Woolery et al., 2004).
It was found that depression levels did, in fact, reduce in the experimental group who was practicing yoga.  In the wait-list, or the control group, there was not much of a change found.  It was found that the yoga participants showed a higher morning cortisol level than that of the control group (Woolery et al., 2004).
In 2005, a similar study was done on twenty-four women who were described as being “emotionally distressed.”  Like the last study, this research also had a control group that consisted of people who maintained their normal activities.  At the end of three months, women in the yoga group reported improvements with their depression scores improving by fifty percent (“Yoga for anxiety and depression,” 2009).
One research, done in 2007, took a different approach by choosing patients who were on anti-depressants, but who still had lasting symptoms of depression.  The study was initially done with a sample of twenty-five adults who had major depression.  However, the result contains twelve more participants who underwent the same treatment after the initial testing.  It was found that there were significant improvements in their moods after the testing, compared to before.  For those who were on anti-depressants, their depression severity scores were significantly dropped (Shapiro et al., 2007). 
Issues in Studies
There were a number of problems in each research.  For example, none of the researches looked at how the practice of physical postures (asanas), as opposed to breathing and meditation impacts mood in persons who are depressed” (Woolery et al., 2004).  Although yoga consists of asanas and meditation exercises, this is problematic, because reduced levels of depression may only have to do with one aspect of yoga and not all of it.  If there was research done comparing the two parts, it might find an easier or another treatment for depression.  Another problem has to do with the number of participants in each study.  The first study mentioned above only had twenty-eight participants.  The second study had only twenty-four participants and the third only thirty-seven.  Furthermore, the last study had six participants not attending any class, six attending only one of whom did not participate in the final assessment (Shapiro et al., 2007). The results in all studies did show a drastic reduction in depression, but the studies did not consist of a large number of people, making the researches not generalizable.  Another limitation lies in the participants describing themselves as depressed or emotionally distressed, instead of a counselor giving them that label.  This is problematic, because any person can be going through a tough time in their life and describe themselves as being depressed.  However, if a psychologist or counselor could talk to and analyze a patient and give them that label, it would make the research more reliable and accurate, because the patient would not be using their own judgment to diagnose themselves.  Another problem rests on the fact that people usually feel better about themselves after mastering something.  In this case, they are mastering yoga poses, which could make them feel happier.  However, if mastering were the case, then anything worth mastering to the patient could be used instead of the treatment of depression being reduced to only yoga.  The spiritual component to yoga is also in affect and could be seen as a shortcoming in the studies, because there is no way to test and measure how yoga has affected someone spiritually, thus never knowing whether or not it was the spiritual aspect of yoga that reduced their depression.
Depression is usually associated with a slumped back and yoga consists of many back bends and other chest opening asanas, which would get rid of the slumped back.  This is important, because many psychological studies have shown a “connection between open body posture and mood” (Woolery et al., 2004).  These classes may have done more joint and muscle movements in the beginning of class, focusing on getting rid of the bad posture.  Exercise in general is also known for relieving stress and making someone’s mood better.  That is why it would make sense that some classes focused on intense exercise in the beginning of the class and left relaxation for the end of the class, so that by the time the participants had gotten to the relaxation part, they would be able to relax.  However, this would in return cause errors for the result, because not all classes would be having the same routine of exercise followed by relaxation.  Opposing this idea, meditation “has been associated with diminish[ing] stress and worry [and] descreas[ing] anxiety and depressive symptomology” (Smith, Greer, Sheets, & Watson, 2011).  Therefore, the data could have been swayed because of this, as well.
Similar to all other researches done on human beings, the placebo affect might have had an affect on some of the participants in these studies.  Knowing that this study was supposed to make them feel better, the participants may have felt better just by knowing that they were suppose to (Chaoul & Cohen, 2010).
Conclusion
            Bellur Krishnamachar Sundararaja Iyengar had a very inspirational life that has made an impact in many people’s lives.  His defeat of his illnesses made people all around the world, especially in the West, believe that they could have similar results.  In the west, Iyengar is more commonly known for being used for treating ailments, one of which include depression.  It is interesting to look at the Western view on Iyengar yoga and how they are taking a more biomedical approach towards yoga.  Westerners always have to have a label for everything and only do something that will benefit themselves.  They want to get something out of everything they do (Lea, 2009).  Therefore, by thinking of yoga as an alternative treatment for depression, it puts a label on it and gives a reason why they should be preforming yoga.  Whereas in the East, they do not need this label to perform yoga.  They just perform it merely to perform it, not because they are getting something out of it.  Iyengar also makes it more suited to biomedical application by his use of props (Shapiro et al., 2007).
            In the past decade, there have been many studies, three of which are mentioned in this paper, done on how Iyengar yoga is used to treat depression.  Most research has proven this to be correct.  However, there is much more that the research has not looked at.  For example, the research has not looked at if there is specifically a part during the yoga class, such as the meditation or the physical exercise, that causes the mood change or the affects of different types of yogas on depression. Some questions researches may want to consider, for their research in the future, may include whether or not the pace of the yoga matters and whether or the not the time of day when yoga is practiced matters. They may also want to look at different types of depression, such as major and postpartum depressions, and test how well Iyengar yoga works with each type. Research on this topic right now is still in its beginnings, however I am sure in the next decade there will be much more research done and many more conclusions made on yoga being used as an alternate treatment for depression.



References
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