Joann Lutz, L.I.C.S.W.

Transcription

1 Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards Joann Lutz, L.I.C.S.W.

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4 Overview of the Day: Trauma and the autonomic nervous system. Basics of brain functioning. Somatic Psychotherapy. The Royal Path of Yoga. Major research on yoga for psychological healing. Break Bringing Yoga postures into the season. Chair yoga practicum. Lunch. Bringing yogic breathing practices into the session. Breathing practicum. Case Example. Break. Yogic deep relaxation lecture and experience. Closing Meditation.

5 Revolution in psychotherapy: New developments in psychotherapy are based on findings from trauma studies: neuroimaging of the brain. physiology of autonomic nervous system. study of animal behavior. Focus is on the effects of a dysregulated autonomic nervous system. Yoga seems to have been designed to re-regulate this system.

6 Autonomic Nervous System 101 Composed of two branches: 1) Sympathetic Nervous System (SNS; Fight or Flight) 2) Parasympathetic Nervous system (PNS; Rest and Digest) EXPERIENTIAL: 1)Press palms together; release arms to sides. 2)Inhale: sympathetic activated. Exhale: parasympathetic activated.

7 Fight and Flight: Called defensive responses. Necessary to protect oneself and live a successful life. Can be too strong or too weak.

8 Physiological Markers of SNS Arousal In sympathetic arousal: TAKE ACTION. the pupils of the eyes are dilated. the flow of saliva is inhibited. the heartbeat and breathing rate quickens. digestion is inhibited.

9 Physiological Markers, cont. glycogen is converted to glucose for quick energy. secretion of stress hormones adrenaline and noradrenaline is increased. the bladder is contracted. These functions assure survival of the species. They are the opposite for parasympathetic arousal: REST & DIGEST

10 Natural Rhythm of Regulated Autonomic Nervous System (Window of Tolerance)

11 Window of Tolerance/Comfort Zone Called tolerance because individual feels comfortable with experience within the window. Notice oscillating wave between sympathetic and parasypathetic arousal. Notice width of the window.

12 The Dysregulated Autonomic Nervous System (Window of Tolerance)

13 ANS Disregulation & Mental Disorders Without sufficient resources to handle present- moment experience, the nervous system gets overwhelmed & stuck in the past. Unprocessed material is stored in the brain; is recycled when triggered. Creates patterns of nervous system activation. Correlates with PTSD, anxiety/depression & other conditions. Mental disorders are being reconceptualized as the effect of unhealed trauma.

14 Some Symptoms of PTSD All involve increased physiological reactivity. 1) Sleep disturbance. 2) Irritability/outbursts of anger. 3) Difficulty concentrating. 4) Hypervigilance. 5) Exaggerated startle response. All related to ANS dysregulation. Same with some symptoms of depression and anxiety.

15 ANS Dysregulation Sympathetic nervous system (SNS): Arousal produces fight/flight. Healthy defensive response. More severe arousal can be dysregulating: anxiety/panic attack. Overwhelm contributes to freeze response. Theorized to be an overarousal of both systems.

16 PNS Dysregulation Dysregulation of parasympathetic nervous system (PNS) produces dysthymia/depression/ freeze.

17 Goals of Somatic Approach. Decrease symptoms of dysregulation through: Restoring natural pattern of oscillation. Widening window of tolerance. We can accomplish this through yoga practices, which naturally regulate the ANS.

18 Healing Nervous System Dysregulation Create safety through your relationship. Teach the client to recognize when their system is dysregulated. Teach self-regulation tools from somatic psychotherapies and yoga.

19 The Triune Brain Model

20 Yoga & the Nervous System The Triune Brain Diagram: Neocortex: Strategizing. (governs cognition) Limbic system: Bonding. (governs emotion) Reptilian brain: Instinctual Survival. (governs sympathetic nervous system activation).

21 The Reptilian Brain Key area of brain to work with initially, especially for trauma survivors because it activates fight, flight, freeze responses. Governs breathing. Accessible through body sensations. Instantly triggered; takes 7 times longer than cognitive processes to come back to balance.

22 Hand Model of the Brain Daniel Siegel, M.D.

23 Systems Work Together When you decrease nervous system activation, the endocrine system & cognitions are also positively influenced. It is most effective to begin with the reptilian brain, where autonomic nervous system originates. Example: we can't voluntarily stop adrenals from producing cortisol but we can influence the brain stem using various yogic interventions.

24 Accessing the Reptilian Brain Yoga accesses the reptilian brain through focus on: body sensations. breathing patterns.

25 Experiencing the Yoga Zone. Notice your breathing rate, muscle tension, general state of mind. Notice the contact between the chair and the back of your legs and torso; the bottom of your feet and the floor. Bring your awareness back to the body. Has anything changed?

26 Components of the Personality. SIBAM, from Somatic Experiencing: S Somatic (Body Sensations) I Image B Behavior (Actions) A Affect (Emotions) M Meaning making (Mind, thoughts, cognition) These categories similar to Psychological Functions in Psychosynthesis. Trauma research introduces new emphasis on sensation and on physiology in general.

27 Power of Physiology: Stephen Porges

28 Physiological Effects of Trauma Stress/trauma shuts down frontal lobe of brain, higher cognitive functions: activates sympathetic nervous system,fight/flight/ freeze (freeze from PNS) response. Physical immobilization accompanies trauma; body is frozen in the past. In brain scan of frightened people: the area controlling visual imagery lights up; the verbal part of the brain shuts down. from van der kolk.

29 Bessel van der Kolk on Yoga & Trauma

30 Implications for trauma therapy. 1. Research shows that initially, verbal interventions are not effective for PTSD 2. Therapist can help the client to identify and tolerate simple feelings and sensations, to work with the body to learn to modulate arousal and to take effective action. 3. Therapist can help client reinterpret uncomfortable body sensations with non-judgemental curiosity, patience, kindness.

31 Yoga and Polarities The word yoga itself means union. The chart which follows illustrates the healing of somatic, emotional, mental and energetic/spiritual polarities, from a dysregulated state to a unified, centered state, called the yoga zone.

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35 Exploring the Cognitive Polarity. Cognitive Distortions Negativity Bias: Evolutionary tendency to skew experience to the negative. Produces hypervigilance, worst case thinking.. Particularly strong in PTSD, anxiety, depression.

36 Top Down/ Bottom Up Polarity Top-down: an approach with a strong cognitive focus which attempts to direct the limbic and primitive responses. (Trad. psychotherapy & education) Bottom up: an approach where the individual focuses on the experience of body sensations and emotions to inform the thinking mind. (somatic approach to psychotherapy,contemplative & authentic movement, dance therapy) STRATEGY: ANALYZE WHICH AREA IS WEAKER, STRENGTHEN IT. GOAL: THREE PARTS OF THE BRAIN WORK TOGETHER.

37 Perspectives from Neuroscience. 1) Interpersonal Neurobiology Key Theorist: Daniel Siegel, Psychiatrist. Based on discovery of mirror neurons: variety of visuospatial neurons which respond to actions we observe in others. Example: arm-raising research.

38 2. Neuroplasticity New brain science: The brain is not static; its neural network changes with every thought and action which we perform. Mirrors ancient concept from yoga: What we think, so we become. Swami Sivananda Empowering thought for clients.

39 When we learn... the individual neurons get more efficient in two stages. First, the map in the brain grows. This requires attention. Neuroplasticity, cont. Then, when individual neurons within the map become more efficient, fewer neurons are required to perform the task. EXAMPLE: playing the piano. The Brain That Changes Itself. Doidge,

40 Neuroplasticity, cont 2. As neurons are trained, they can process faster; their signals are clearer; they are better able to fire in sync; and they have more impact on the brain. Brains that fire together, wire together. (Hebb s Law) Paying close attention is essential to longterm plastic change. Yoga helps to develop this ability.

41 Impact of discoveries on Therapy. Subconscious nervous system interaction between client and therapist may be the most crucial element in therapeutic encounter. The stories that clients repeat in session may increase influence in their neural networks.

42 Why Yoga? POWERFUL RESEARCH RESULTS First wave: Relaxation Response, Dr. Herbert Benson, Harvard Medical School. Mindfulness-based Stress Reduction. Jon Kabat-Zinn Second wave: Bessel van der Kolk, The Trauma Center, Brookline, Ma., Yoga for trauma; Richard Miller, Yoga Nidra for veterans w/ptsd.

43 Why Yoga, cont. Research is showing yoga to be an excellent way to regulate the nervous system. Van der Kolk, Yoga helps regulate emotional & physiological states. It allows the body to regain its natural movement & teaches the use of breath for self-regulation. From interview, Integral Yoga Magazine

44 Most Relevant Research Results The Trauma Center Study: Yoga as a Complementary Treatment for Chronic PTSD. Three-year study of yoga as a treatment for women with chronic PTSD. Results: Experimental group, after 10 weeks: 33% decrease in PTSD symptoms; 17% for cognitively-based group. After 2 months, 52% didn t qualify for PTSD diagnosis; 21% for control group.

45 Additional Research 1 Carney, Cuddy & Yap, Power Posing: Brief Nonverbal Displays Affect Neuroendocrine Levels and Risk Tolerance, Psychological Science, 9/27/2010. Posing in high power poses produce elevations in testosterone and a decrease of cortisol, increased feelings of power and tolerance for risk. Also, bodily movement and facial displays can effect emotional states.

46 Power Poses, Amy Cuddy

47 Additional Research 2 Streeter, Gerbarg, Saper, Ciraulo and Brown, Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. (2012). Excerpts: Controlled studies have demonstrated that yoga practices decreased symptoms in Post Traumatic Stress Disorder, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, Panic Disorder and anxiety after natural disasters... Studies... suggest that yoga practices reduce stress- induced allostatic load in... the Autonomic Nervous System...

48 Additional Research 3 Boston University Study: Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA Levels. GABA elevates the production of alpha waves in the brain causing relaxation without drowsiness and boosting mental alertness; lowers beta waves that contribute to nervousness, racing thoughts and hyperactivity. Yoga subjects: greater improvement in mood and greater decreases in anxiety than the walking group. Positive correlations between improved mood, decreased anxiety and thalamic GABA levels.

49 Kinser, P., Goehler, L., Taylor, A. How Might Yoga Heal Depression? Yoga can: Additional Research 3 mitigate stress responses via both top-down (psychological reappraisal) and bottom-up (working directly with primitive brain and emotions) methods. support pharmacological and psychological therapies by improving autonomic responses to stress and self- regulating coping behaviors.

50 Additional Research 4 From Scientific American, 3/1/14: Yoga and the Brain by Chantal Villemure and Catherine Bushnell, National Center for Complementary and Alternative Medicine, Bethesda, Md.: Findings: In yoga practitioners, the brain volume was larger in areas that: -contain a mental map of the body -direct attention -control vision -reduce stress -define our concept of self

51 Other Benefits of a Regulated Nervous System. Biochemical changes: Increase in DHEA, anti-aging hormone. Release of Oxytocin, the bonding hormone. Increase in Positive feelings Boost to immune system. Inhibition of defensive strategies of fight, flight, freeze.

52 B. What is yoga? Patajanli s yoga sutra #2: Yogas chitta Vritti Nirodhah. Yoga is the cessation of the mental modifications of the mind. (Vrittis.) Traditionally, yoga & ayurveda were used in individual consultations to heal psychological conditions,

53 The Royal Path (Raja Yoga) Also called: Eight-limbed Path or Ashtanga: 1. Yama (non-killing, truthfulness, nonstealing, continence, not accepting gifts) 2. Niyama (internal and external purification, contentment, austerity, scriptural studies, worship of God) 3. asana (word means steady and comfortable ) 4. pranayama (breath control)

54 Raja Yoga (cont.) 5. pratyahara (sense withdrawal) 6. dharana (concentration) 7. dhyana (meditation) 8. samadhi (transcending the discursive thoughts) (TOP-DOWN AND BOTTOM UP.)

55 Yoga as Energy Psychology: Subtle Anatomy Seven chakras (subtle nerve plexus centers): Correspond to 7 major glands in the body: pineal, pituitary, thyroid, parathyroid, thymus, adrenals, gonads. 1) Muladhara: (Root support)stability vs. mistrust 2)Svadhistana: (Self-sustaining) vitality vs. inhibition 3) Manipura: (full of gems) personal power vs. disempowerment

56 Chakras, cont. 4) Anahata: (that which cannot be destroyed) compassion vs. criticism 5) Vishuddha: (extraordinarily pure) self-expression vs. fear 6) Ajna: (command) intelligence 7) Sahasrara: (1,000 spokes) inspiration

57 Subtle Anatomy 72,000 subtle nerves (nadis) radiating out from the body (create aura ). Primary nadis: Ida (ends at left nostril, connected to right brain; related to PNS) Pingala (ends at right nostril, connected to left brain, related to SNS) Sushumna (central column) Gives yoga its power.

58 The Major Nadis

59 Subtle Anatomy, cont. Kundalini (serpent power, spiritual energy) stored at base of spine. The yogic system works with these subtle energies, building and storing them for healing and transformation. Energetic purpose of yoga practice to keep subtle energies flowing, preventing them from accumulating at their most vulnerable sites and causing disease.

60 The Gunas The three Gunas (qualities of body/mind): Rajas. Body: agitated, anxious, irritable. Mind: angry, fearful, demanding, impatient. Tamas. Body: heavy, toxic, sluggish. Mind: negative, dull, in denial. Sattva. Body: light, pure, calm, flexible. Mind: Peaceful. (from Halpern, Ayurvedic Yoga Therapy) Corresponds to imbalanced SNS (rajas); imbalanced PNS (tamas); Goal: sattva.

61 The Major Nadis

62 Yoga Therapy as a Three-step Process Stages of Practice: 1) Break up Tamas (inertia, low energy, frozen PNS) with active, stimulating poses. 2) Calm rajas (agitation, hyperactivity, SNS overarousal) with relaxing postures, pranayama, mantra, affirmations & visualizations. 3) Increase sattva (peacefulness,balanced, oscilla- ting nervous system) with focused meditation.

63 Additional Ways to Enhance Sattva Eat pure, fresh, organic vegetarian food. Avoid hard cheeses, stale and spicy food. Keep surroundings neat & clean. Spend time in nature. Choose uplifting influences. Do not engage in emotional dramas. Practice yoga. (from Halpern, Ayurvedic Yoga Therapy)

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65 Trauma-Informed Chair Yoga Joann Lutz, L.I.C.S.W.

66 Healing Trauma through Yoga

67 Areas of Inquiry, Therapeutic Yoga Postures 1. Gross Anatomy (pain; repair.) 2. Effect of posture on mental & emotional life 3. Subtle Anatomy (movement of prana). 4. Effect on gunas.

68 The Yoga Pose as Resource. Example: The Half-Spinal Twist BENEFITS Client experiences: Positive body sensations which encourage curiosity and exploration. Clarity of mind. Steady rhythm of breath and heartbeat which is comforting.

69 Pose as Resource, cont. Increase and then release of muscular tension which promotes relaxation & reduces anxiety. Contact with supportive surfaces & release to gravity which provides emotional security. Compression of spine & squeezing out of toxins. Enhanced connection between practitioner & client.

70 Key Aspects of Practice 1) Focus on the breath. 2) Coordinate breath and movement. 3) Increase awareness of physical sensations and the flow of subtle energy. 4) Train attention to be present, which then regulates the nervous system. 5) Promote a deeper examination of inner processes. Healing from the outside in.

71 Choosing the Most Appropriate Posture Assess state of the ANS to determine the most appropriate poses: Forward bending poses stimulate PNS. (Release of muscular energy, relaxation of spine, inward focus.) Backward bending poses stimulate SNS. (Use of muscular energy; extension of the spine, outward focus.)

72 Most Appropriate Posture, cont. Slow movements stimulates PNS; fast ones stimulate SNS. Standing poses can be neutral; prone or supine poses increase PSN.

73 Aspects of Yoga which indicate Resetting of Nervous System Tingling, warmth, vibrations or trembling, expanded breathing, coughing/throat clearing, release of phlegm, crying, laughing, burping/stomach gurgling, itching, yawning, cooling, clearing of sinuses. From TRM Skills, Miller-Karas, Leitch.

74 Chair Yoga Practicum Experience of script. Work in partners from script.

75 Benefits of Yoga Poses 1. Balance the ANS, bringing attention to the present moment. 2. Increase self-mastery through control of voluntary muscles. 3. Reduce muscle tension which can reduce anxiety.

76 Benefits of Yoga Poses, cont. 4. Improve functioning of major body systems circulatory, lymph, glandular; organs of digestion & elimination to increase vitality. 5. Give client an opportunity to gradually reexperience uncomfortable body sensations. release stored traumatic material. 6. Release stored life energy and assist it to flow where it is needed.

77 Elements of Trauma-Sensitive Yoga (From David Emerson & Trauma Center) Environment Structure of Group/Class Teacher Qualities Assists Language: Invitatory and Interoceptive. Choices Community

78 Toward a Nervous- System Informed, Trauma-Sensitive Yoga 1. Assess state of client s nervous system. 2. Choose appropriate poses, strategies. 3. Introduce poses at the client s pace. 4. Help the client to the maintain a focus on the breath. 5. Offer a second point of somatic focus. 6. Build stillness into the practice. 7. Practice poses to the right, then to the left.

79 Nervous-System Informed, Cont. 8. Rest in relaxation pose between active poses. 9. Train your voice to be soothing and encouraging. 10. Teach the same pose, or sequence of poses, each time. 11. Encourage choice through invitatory language ( If you like, may I suggest, if it works for you, etc.)

80 Benefits of Yoga for Psychotherapy 1. Increases capacity to tolerate intense affects. 2. Reduces the need to avoid emotions through repression, suppression, denial, numbing, dissociation. 3. Reduces anxiety, over-reactivity and sleep difficulties. 4. Brings unconscious content from trauma-related neural & muscular patterns into consciousness. From How to Use Herbs, Nutrients and Yoga in Mental Health Care. Brown, Gerbarg, Muskin.

81 Benefits, cont. 5. Improves cognitive-emotional integration. 6. Reduces trauma-related somatic experiences including visceral, sensory and painful sensations. 7. Enables the patient to acquire a sense of mastery and competence rather than feeling helpless or passive. 8. May help overcome a therapeutic impasse. 9. Strengthens the therapeutic alliance through patient empowerment and collaboration.

82 ASSESSMENT TOOL 1. Is the client open to a somatic intervention? 2. What is your treatment goal for bringing yoga into the session? 3. Which yoga practice(s) would be most beneficial for that client (stretching, postures held in stillness, breath awareness, relaxation, meditation, or a combination)? 4. Does the client have any medical condition which would limit or benefit by the practice? 5. What is your analysis of the autonomic nervous system balance in the client (SNS/PNS over-activation; under activation; both; no imbalance)?

83 6. What is the dominant energy state (guna) of the client: lethargic, hyper-energized, or stable and balanced? 7. Which symptoms of imbalance, if any, are you seeking to reduce? 8. Which interventions do you think would be most beneficial? (Be as specific as possible.) Moral/ethical Physical postures Breathing practices Deep Relaxation Meditation

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87 Summary: Yoga as Undoism Ancient yogis' system in alignment with current findings in neurobiology & trauma theory. Through regulation of the nervous system, provided by the comprehensive nature of the yogic healing process, awareness, attention and general health are improved. This allows the nervous system to become more resourceful & better able to maintain a connection with the present moment.

88 Trauma-Informed Yogic Breathing Practices (Pranayama) Joann Lutz, L.I.C.S.W.

89 Foundations of Pranayama Step 4 in Raja Yoga. From Patanjali's Yoga Sutras: Pranayama (is) the controlled intake and outflow of breath in a firmly established posture. From the Hatha Yoga Pradipika: Being firmly established in the practice of asanas, with his senses under control, the yogi should practice pranayama as taught by his Guru, observing a moderate and nutritious diet.

90 Bringing Trauma-Informed Yoga into Mental Health Clinical Practice What is Prana? Prana translates as life energy. It can be inter- preted as the spiritual element in spiritual- ity, which comes from the Latin word spiritus, meaning of breath, of wind. Prana is both subtle (life energy) and gross (breath). From M. Halpern, Ayurvedic Yoga Therapy.

91 The Gross & Subtle Physiology of Prana A. Prana is inhaled with air. It is absorbed in the sinuses and carried to the brain. B. Prana courses through the nerves of our physical body and the nadis of our subtle body. C. It's movement can be controlled through the application of various breathing techniques, and by the focusing of our attention on particular part of the body. Energy flows where attention goes.

92 Breath Awareness Exercises 1) Focus on the place in the body where you can hear the breath. 2) Follow the movement of the breath in the body. 3) Feel the breath where it enters and leaves the nostrils. From The Yoga Sutras of Patanjali.

93 Breath Awareness & the Brain Dr. Daniel Siegel on breath awareness: 1) It stabilizes the mind & trains it to be embodied and relational, allowing more insight into one's own and others internal states. 2) It helps the brain to regulate and reorganize, promoting neural integration and increasing the thickness of the myelin sheath. Essential because he sees all DSM diagnoses as evidence of unintegrated brain function, able to access only chaos or rigidity.

94 Why Control Prana? 1) Flow of breath affects the health of the body and the mind. All disease involves the aberrant flow of prana. Healthy prana flow creates a peaceful mind. 2) On the gross level, breath is the major function of the autonomic nervous system which can be consciously controlled. It is the doorway into autonomic nervous system regulation.

95 Emotions & Breathing Patterns Excitement causes an increased rate. Depression causes a decreased rate. Fear increases rate and decreases depth. Anger/urgency increases rate and moderates depth. From M. Halpern, Ayuredic Practitioner.

96 Prana & the Nose A. In yoga it is recommended to breathe through nose rather than mouth. The nose is specially created to clean and warm air and regulate its volume. B. Emotional health facilitated by keeping sinuses open. Blocked sinuses are associated with depression. C. The nose is site of Swara Yoga.

97 Interior of Nose

98 Swara Yoga Swara Yoga is the Science of Nostril dominance: one nostril is dominant (wider) for about 2 hours, then dominance switches. Right nostril: warm, aggressive, alert, external world; Left nostril: quiet, passive, internal, cool. (Related to SNS and PNS.) Shape of inner passageways, turbinates, shapes air flow and prana uptake by brain. Can be used to control moods; facilitate digestion, sleeping, concentration.

99 Additional Ways to Influence ANS Nasal laterality can be promoted by pressing into the armpit on opposite side you want to be dominant; by breathing only through the nostril you want to be dominant; by lying on the side of the body opposite from the one you want to be dominant.

100 Additional Ways to Influence ANS PNS dominance can be activated by: making the exhale twice as long as the inhale. (For SNS dominance do the opposite.) pressing with the fingers around the orbits of the eyes. closing the eyes. The autonomic nervous system can be balanced by lying on one side for 10 min. and then lying on the other for another 10.

101 Vagus Nerve Stimulation The Vagus nerve is a major actor in the sympathetic nervous system. It connects to hindbrain, face, back of the throat, inner ear, heart, lungs, diaphragm muscle, gut. 80% of fibers of vagus nerve run TO the brain. When diaphragm is stimulated by breathng, the vagus sends a message of relaxation to the brain & entire nervous system.

102 Practicum in teaching breathing practices (pranayama): 2 parts. 1) Observe the client's breathing pattern as you observe your own. 2) Practice leading 3-part deep breath from script, with partner. Script for breathing practices used with permission, Integral Yoga Institute.

103 Coherent Breathing Coherent Breathing is a breathing pattern which facilitates autonomic nervous system balance. It involves breathing at the nominal rate of 5 breaths per minute with equal inhalation and exhalation. That pattern is found in practices in religions around the world in chanting, singing and praying.

104 Benefits of Pranayama to Psychotherapy Respiration exercises have been recognized as useful in the treatment of trauma since the1800 s. (Pierre Janet, 1925) 1) Brings in more prana, energizing the body. 2) Puts client in touch with deeper emotions held in the diaphragm and stomach. 3) Keep sinuses open, which stabilizes mood. 4) Allows client to regulate the balance between the PNS and SNS. 5) Activates the vagus nerve.

105 Research on Pranayama Dr. Shirley Telles has proven the effectiveness of specific yogic breaths on schizophrenics, anxious children and survivors of repetitive trauma. Drs. Gerbarg and Brown have also studied the benefits of yogic breathing for disaster victims with PTSD and individuals with anxiety and depression. They report that "stubborn areas of trauma opened and resolved." (from The Healing Power of the Breath)

106 Bringing breathing into session. Clients generally overbreathe or underbreathe." (Ogden et al, Trauma & the Body) Ask client often to notice flow of the breath. Introduce it: a. when there is nervous system dysregulation b. when you observe a shallow breathing pattern. c. when there is rapid/excessive talking. d. when there are signs or self-report of anxiety e. when there is physical pain.

107 To whom to Offer Breathing Practices a. Three-part deep breathing is safe to do with all clients. b. Other breathing techniques should only be taught by Certified yoga teachers. c. Breathing techniques can disturb flow of prana & destabilize trauma clients; use with caution.

108 The Flow of the Session Experiment with different approaches. One standard approach: Open with a short, grounding, centering moment anchored with the breath, the gaze. Use body and breath awareness like a thread that runs through the session, as is done in a yoga class. Introduce each time client is leaving the zone of tolerance. End with another reflective moment, anchored with the breath.

109 Case Example: Clips from a session.

110 Summing Up Asana and Pranayama With the proper choice and sequence of yogasana (and pranayama), one can play the body like a violin, exploring all of the notes possible in the course of several hours. Mel Robin, A Handbook for Yogasana Teachers

111 Yoga Nidra: The Yogic Sleep

112 Yoga Nidra (yogic sleep). On branch #5 of 8-limbed path, sense with- drawal" (pratyahara).the mind is awake while the body is asleep. Yoga nidra based on general descriptions in texts: Yoga Sutras I.10; Hatha yoga Yoga Pradipica V.43-50; Mandukya Upanishad.

113 Styles of Yoga Nidra. Traditional Style: Developed by Swami Satchidananda, Swami Vishnudevananda, Swami Rama and others. Therapeutic Adaptations: Popularized by Richard Miller, Ph.D., who introduced yoga nidra to U.S. military (active duty soldiers & veterans).

114 Traditional Yoga Nidra Yoga Nidra Represents a state of the symptoms of deep, non-rem sleep, including delta waves, while simultaneously remaining fully conscious....eeg readings may register no discernible electrical activity. ( cessation of mental modifications of the mind, from Patanjali.) Defining Yoga Nidra. International Journal of Yoga Therapy, no. 23 (1), 2013:

115 Classic Version: Research Swami Rama demonstration: full awareness in a delta wave state. In EEG study of yoga nidra, he entered conscious deep sleep for 10 minutes. Delta waves were recorded. He was able to recount verbatim all conversations that occurred in the lab during that time. (Greene & Greene, 1977).

116 Benefits Enhances positive brain wave states. Brings awareness through the 5 sheaths (koshas), to the most subtle level, where deep personality change can occur. Strengthens observer part of self. Frees prana to heal the body.

117 The 5 Koshas (sheaths with different vibratory frequencies):

118 The Five Sheaths 1) annamaya kosha (physical body, earth element; food is necessary for wellbeing). 2) pranamaya kosha (energy body; water element; relaxed breathing is necessary fror wellbeing; breath is bridge between mind & body.)

119 Sheaths (cont.) 3) manomaya kosha (mental body; healthy intake of sensory impressions for wellbeing.) 4) vijanamaya kosha (wisdom body; bridge between ordinary consciousnes & higher cons. 5) anandamaya kosha (bliss body; is causal body ; past impressions stored there.)

120 Integral Yoga Version (Swami Satchidananda) Consists of: 1) progressive deep relaxation (tense & relax muscles while naming body parts). 2) mental scan of the body. 3) visual imagery of healing energy spreading down body. 4) focus on breathing (1 min.), thoughts (1 minute), the peaceful place beneath the thoughts. (5 min.)

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124 Experience of Classic Yoga Nidra Script used with permission, Integral Yoga Institute.

125 IREST yoga nidra Developed by Psychologist Richard Miller. Adapts practice for trauma survivors and other groups. Trains practitioners to focus on 10 steps. Has large body of research behind it.

126 Richard Miller: 10 Steps of irest 1. Intention 2. Heartfelt Desire 3. Inner Resource 4. Physical Sensation 5. Breath and Energy 6. Feelings and Emotions 7. Cognitions, Beliefs, Imagery 8. Joy 9. Witnessing & Well-Being 10. Integration into life

127 irest Research Research studies completed on partner violence; sexual trauma; college students; chemical dependency; group therapy; combat-related PTSD; active-duty military service members; healthcare workers; the homeless; MS, cancer. Detailed on the website:

128 Benefits of Yoga Nidra, cont. From research done by Richard Miller, Ph.D. (irest protocol:) Yoga Nidra decreases insomnia. Reduces depression, anxiety and fear. Decreases perception of chronic & acute pain. Improves interpersonal relations. Increases comfort with situations which are out of participant's control.

129 Bringing Yoga Nidra into the Session a. Assess reason for doing this practice in session. b. Eyes can be open or closed. c. Can be done sitting up or lying down. d. Can be adapted to accommodate client or time frame. e. Use only the progressive deep relaxation part (tensing and relaxing muscles) initially for trauma survivors, dissociative or psychotic clients.

130 Bringing Trauma-Informed Meditation into Mental Health Clinical Practice. Joann Lutz, L.I.C.S.W.

131 Meditation Van der Kolk, Those with PTSD should first learn to regulate their physiology with breath, postures and relaxation and work toward meditation. From Interview, Integral Yoga Magazine.

132 History Limb #6 & 7 on the Raja Yoga tree. Two major forms: focused and open. Example of focused meditation: mantra. Example of open meditation: mindfulness.

133 Mantra Meditation Sacred sanskrit sound creates internal, cleansing vibration. Involves building up internal prana so that the mind is fully charged & peaceful. Is repeated, silently or out loud.

134 Mindfulness Meditation Jon Kabat-Zinn, Ph.D. Mindfulness means paying attention in a particular way; on purpose, in the present moment, and nonjudgmentally.

135 Complimentary Nature of Mantra Meditation and Mindfulness Use of the will: Yoga: practices direct the flow of energy in the body. Mindfulness: Witness consciousness observes the flow and accepts it as it is. Use of the mind: Yoga: practices focus & concentrate the mind to go beyond it. Mindfulness: uses the observer function of the mind to witness whatever is happening. Both are important in psychotherapy. Joann Lutz, L.I.C.S.W.

136 The Medicalization of Meditation 1975: The Relaxation Response published by Herbert Benson, M.D., Faculty, Harvard Medical School 1. All conclusions based on Medical-model research. 2. Opposite of Fight or Flight Response; activates parasympathetic nervous system. 3. Prescription: Twice a day for 20 mi.

137 Nine Ways to Elicit the Relaxation Response. 1. Meditation a. Slow, deep breathing. b. Repeat uplifting word or phrase in rhythm with the breath. 2. Diaphragmatic breathing 3.Guided imagery/visualization 4.Yoga postures 5. Progressive Muscle Relaxation Training. Developed b German psychiatrist, Teaches the body to respond to verbal command.

138 Relaxation Response, cont. 6. Mindfulness 7. Autogenic training. Developed by German psychiatrist, Teaches the body to respond to verbal command. 8. Repetitive prayer 9. Repetitive exercise.

139 Experiential: Relaxation Response

140 Bringing Meditation into the Session. Assess for trauma history. which could cause dissociation. Ask client if they already have a meditation practice and if so, build from there. If not, assess which type of meditation practice would be more suitable. (focused/diffuse; more inner/outer focused; silent/chanting; sitting/walking). General recommendation: combine focused meditation (inhale/exhale on nostrils, sound, etc.) with a more open style (scan the body, watch the breath, watch the thoughts). Make any formal meditation period brief. Joann Lutz, L.I.C.S.W.

141 Summing It Up. Yoga can be integrated into any style of therapy as a somatic component. It fits into a continuum of self-care, from sessionreliant instruction to an internalized, independent tool of ongoing self-care and selftransformation.