Schizophrenia, Trauma-Sensitive Yoga and Embodied Healing

We appear to  have gone wrong somewhere in Western society in our treatment of people diagnosed with schizophrenia, which is characterised in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by hallucinations, delusions, disorganised thinking (speech), significantly disorganised or abnormal motor behaviour (including catatonia), and negative symptoms. Despite conventional treatment in the modern age, many people diagnosed with schizophrenia have poor outcomes. U.S. data on outcomes from severe mental illness such as schizophrenia show that there is greater psychiatric disability today than in the 1940s. People diagnosed with schizophrenia also have higher suicide rates today and the utilisation of hospital beds for this population has not improved. Data also indicates that outcomes for people diagnosed with schizophrenia are at least as good, and in many cases better, in the developing world than in the West. Where have we gone wrong?

In the late nineteenth century, Emil Kraepelin concluded, on the basis of symptom and outcome data, that there are three main types of psychosis: schizophrenia (then more commonly referred to as dementia praecox); manic depression; and paranoia. The philosopher-psychiatrist Karl Jaspers then argued that psychotic symptoms can only be explained in terms of aberrant biology and never in terms of the person’s experiences. This was, and is, a very dangerous and reductionist viewpoint which, shockingly, continues to underpin much of the thinking and treatment of schizophrenia today.

The assumption that schizophrenia can be explained only in terms of haywire biology has seemingly encouraged the use of drastic biomedical interventions, discouraged attempts to address people’s emotional and psychological needs, and also denied other systemic factors such as trauma and abuse. In short, it has placed all of the blame on the person’s biology and any potential sense of responsibility and shame, therefore, within the person themselves.

As we have written about elsewhere, diagnoses need to have both reliability and validity in order to stand on any kind of legs at all. To be reliable, any system of categorisation needs to have stable and consistent outcomes. In order to diagnose someone with schizophrenia, however, the medical profession must exercise a great deal of personal judgement and opinion-based reasoning; what might be deemed as a ‘negative symptom’ in one culture may be seen as positive in another. The experience of voice-hearing, for example, is often seen as a sign of spiritual awakening in the African continent but typically seen as a symptom of psychosis in the West.  In order to be valid, any scientific system needs to measure what it says it measures. Since the process of diagnosis relies heavily on opinions and subjective judgements, it is impossible to ascertain if diagnostic labels actually reflect the presence of any actual pathology.

Given the limited reliability and validity, and indeed success, of aetiological research based on biology, some researchers have begun to seek alternatives and to consider other factors such as trauma within the conglomeration of symptoms typically diagnosed as schizophrenia. Indeed the the Hearing Voices approach, and its application of Voice Dialogue, sees the experience of hearing voices not as pathological but, rather, as pointing to deeper experiences and struggles in the person’s psyche that need addressing and assimilating. Other approaches appreciate the aspect of embodiment in schizophrenia, focusing on the presentation of symptoms through the body i.e. auditory hallucinations and other somatic experiences.

A research study conducted this month (Nyboe et al, 2016) looked at physical activity and anomalous bodily experiences in people with first-episode schizophrenia (FES). The purpose of the study was to compare physical activity in patients with FES with controls; to investigate changes in physical activity over one year of follow-up; and to explore the correlations of physical activity and anomalous bodily experiences reported by patients with FES. Physical activity and aerobic fitness were found to be significantly lower in people with FES compared with healthy controls. Over one year of follow-up, people with FES had lower physical activity and aerobic fitness. Those with more severe anomalous bodily experiences had significantly lower physical activity compared with others with fewer such experiences. An obvious conclusion to draw from these findings is that people with FES may benefit from physical activity given that both anomalous bodily experiences and negative symptoms are significantly correlated with low physical activity.

One such form of physical movement, with the additional benefits of the mindfulness, embodiment and interoceptive elements, could be trauma sensitive yoga. Here at the Minded Institute we have found that yoga can have incredible potential benefits to people diagnosed with schizophrenia in a plethora of ways, which is an understanding underpinned by a growing body of compelling research in this area. To explore our trainings in yoga for schizophrenia and psychosis, please visit our CPD page at, http://www.yogaforthemind.info/events-in-the-uk-and-europe/ or contact us as email@themindedinstitute.com. Namaste.

 

Nyboe, L., Moeller, M., Vestergaard, C, Lund, H. &, Videbech, P. (May 2016). Physical activity and anomalous bodily experiences in patients with first-episode schizophrenia. Nord Journal Psychiatry, 5, 1-7.

 

 

 

Clarity Within the Haze: The Benefits of Yoga and Meditation for Alzheimer’s and Other Dementias.

Alzheimer’s UK, the UK’s leading dementia research charity, launched Yoga for Alzheimer’s early this year, an initiative encouraging people to get into their favourite yoga positions while raising money to help find treatments for dementia, which affects 850,000 people nationwide. The initiative will take place at sixteen venues across the UK from Sunday 12th June 2016 until International Yoga Day on Tuesday 21st June 2016.

The benefits of yoga and meditation for Alzheimer’s and dementia are multiple and far-reaching. Whilst there is no cure for Alzheimer’s, research suggests that yoga and meditation may play a role in prevention and improve symptoms and quality of life for patients and their caregivers. In 2014, the first study to suggest that memory loss may be reversed was conducted by Dr. Dale Bredesen of the UCLA Centre for Alzheimer’s Research In this small, novel study, nine out of the ten participants displayed subjective and objective improvement in their memories within three to six months of participating in a 36-point therapeutic program, which included diet changes and exercise.

In another small British study conducted in the same year, a holistic program including yoga and meditation was shown to ease the burden for people with Alzheimer’s and other kinds of dementias and their caregivers. “This is an activity that caregivers and patients can do together,” said study lead author Yvonne J-Lyn Khoo, a researcher with the Health and Social Care Institute at Teesside University in Middlesbrough, U.K. “Because everyone is doing the program together, caregivers have peace of mind to at least allow themselves to ‘let go’.” The study, which received assistance from the U.K. Alzheimer’s Society, was published recently in the Journal of Bodywork and Movement Therapies.

Yoga and meditation may be so efficacious for Alzheimer’s and other forms of dementia as they engage different parts of the brain based on the various components of the practice, which commonly includes pranayama, asana, chanting, and different forms of concentration. Each of these facets can help the brain to form new connections through the stimulation of neuroplasticity. Yoga has also been found repeatedly by multiple studies to soothe and diminish stress, which has been shown to be a strong correlate of Alzheimer’s both for sufferers and their caregivers. Such stress is associated with inflammation in the body and central nervous system, hormone dis-regulation, sympathetic nervous system over-arousal and compromised quality of life. Yoga can reduce stress and inflammatory factors in people with Alzheimer’s and their caregivers and help a person to cope more effectively with the body’s stress response. Meditation has also been shown to improve memory and reduce cognitive decline; adults with mild cognitive impairment who practiced mindfulness, for example, have demonstrated less atrophy in the hippocampus than those who did not meditate. Furthermore, caregivers who practice yoga and are, therefore, less stressed themselves are in a better position to provide optimum care to those they love.

In a study released just this month, the effects of meditation versus listening to music on perceived stress, mood, sleep, and quality of life in adults with early memory loss was studied in the form of a pilot randomised-controlled trial. The effects of two 12-week relaxation programs were assessed within this trial, namely Kirtan Kriya Meditation (KK) and listening to relaxing music. Sixty people were randomised to either group and asked to practice for 12 minutes daily for 12 weeks over the course of three months. Pleasingly, 53 participants (88%) completed the study with participants in both groups showing significant improvements at 12 weeks in psychological wellbeing and in multiple domains of mood and sleep quality. Those assigned to the meditation intervention showed greater gains in perceived stress, mood, psychological wellbeing and quality of life-mental health measures relative to the music intervention.

Yoga and meditation, therefore, may have much to offer people experiencing Alzheimer’s and other dementias and also provide many benefits for their caregivers. In a society which places such value on speed and productivity, the aging population are often marginalised with their self-worth being woefully forgotten. People with Alzheimer’s and other dementias are often undervalued and marginalised to an even greater degree. Bringing yoga and meditation to this population is a much-needed and valuable gift which can provide not only stress relief, improved memory, reduced cognitive decline, diminished depression and soothed hyper-arousal but also covey a powerful message of compassion and valued worth.

Bibliography

Bredesen, D., Easton, M (2014). Reversal of cognitive decline: A novel therapeutic program. Aging, 6(9).

Khoo, Y, van Schaik, P. &, McKenna, J. (2014). The Happy Antics programme: Holistic exercise for people with dementia. Journal of Bodywork and Movement Therapies, 4, 553- 558.

Innes, S., Selfe, T., Khalsa, D. &, Kandati, S. (2016, ahead of print). Effects of Meditation versus Music Listening on Perceived Stress, Mood, Sleep, and Quality of Life in Adults with Early Memory Loss: A Pilot Randomized Controlled Trial. Journal of Alzheimer’s Disease, due for release on 8th April 2016.

 

Quelling the Waking Nightmare: Yoga’s Benefits for Obsessive-Compulsive Disorder (OCD).

Obsessive Compulsive Disorder, more commonly referred to as OCD, is a grossly misunderstood and all-too-frequently trivialised condition. Indeed, it has been referred to by sufferers as a ‘waking nightmare’. OCD is defined as a mental health condition and typically presents as obsessive thoughts and compulsive activity. Obsessions are unwanted and unpleasant thoughts, images, or urges that repeatedly enter a person’s mind, causing feelings ranging from mild unease to clinical-level anxiety. A compulsion is a repetitive behaviour or mental act that a person feels they must carry out in order to temporarily relieve the often overwhelming feelings ignited by the obsessive thought. For example, a person with a fear of becoming ill may repeatedly and compulsively check the use-by-date on food items to ensure they are not eating anything that could potentially be contaminated.

The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists, for the first time, OCD under the category ‘OCD and Related Disorders’ to reflect the increasing evidence of these disorders’ relatedness to one another and their distinction from other anxiety disorders. The disorders under this new umbrella include obsessive-compulsive disorder, body dysmorphic disorder and trichotillomania (hair-pulling disorder), as well as two new disorders: hoarding disorder and excoriation (skin-picking) disorder.

As is the case with the other anxiety disorders, OCD symptoms can range from mild to severe, with some people engaged in obsessive-compulsive behaviours for a minimal proportion of their day whilst others experience their lives as being completely taken over by these thoughts and behaviours. We are still unsure of what causes OCD although it is clear that it is often preceded by acute anxiety. It is experienced by men, women and children alike, although it most commonly emerges in adolescence. It is estimated that around 12 in every 1,000 people in the UK are currently affected.

Given OCD’s strong links with anxiety, with a correlation between yoga and anxiety reduction having been noted in many studies, it would make a tremendous amount of sense to assume that yoga could have some therapeutic benefits for this population. There is a shameful dearth of research into this area however. Thankfully, a recent study by Bhat and colleagues has attempted to formulate a generic yoga-based intervention module for OCD. And it is about time too. A yoga module was designed based on traditional and contemporary yoga literature and sent to ten yoga experts for content validation. The final version of the module was then piloted on seventeen patients with a diagnosis of OCD for both study feasibility and effect on symptomatology. Excitingly, the module, having been engaged with by the participants for just two weeks, was found not only to be feasible but also to promote improvement in symptoms of OCD on the Obsessive-Compulsive scale, which includes time spent on obsessions or compulsions, resistance, interference, distress, and control. Whilst further clinical study is needed to confirm efficacy, this is a very promising start indeed.

The few other earlier studies on yoga for OCD have also been hopeful. Two year-long clinical trials have been conducted, for example, to test the efficacy of kundalini yoga meditation techniques for the treatment of OCD, one of which was a randomised controlled trial. In the first trial by Shannahoff-Khalsa & Beckett in 1996, the intervention group showed a mean improvement of 55.6% on their OCD-Scale score. In the later RCT, conducted by Shannahoff-Khalsa and colleagues in 1999, groups of patients were randomly assigned to either twelve months of the kundalini meditation protocol or twelve months of employing the relaxation response alongside mindfulness meditation. The kundalini yoga group demonstrated greater and statistically significant decreases in a range of OCD-related symptoms.

The personal testimony of a 20-year-old female participant, enrolled in the kundalini meditation intervention in the 1999 study, is particularly poignant. Her OCD symptoms began at the age of ten, with Body Dysmorphic Disorder (BDD) and social anxiety tendencies beginning at the age of seventeen. Her obsessions revolved around a paralysing fear of inadvertently hurting others, to the point that she feared phoning her relatives in case they were driving at the time and she caused them to have a car accident. She explains;

“The very first session I had altered my experience of anxiety so much that the rushing of thoughts that seemed so constantly harrowing before had dissipated to a state of calm and relaxation. In addition to this, the body dysmorphic disorder I was experiencing totally disappeared for the rest of the day. And, finally, the OCD disappeared completely and the results again lasted for the remainder of the day…The yoga gave me balance and put me in a relaxed state of mind immediately….The most beneficial aspect of the experience, however, was the immediate release from anxiety…The continuation of the practice has led to a greater state of peace and general strength that has continued up to this day.”

We are very blessed to have Veena Ugargol, who has direct experience with the anxiety clinic at the Maudsley, working with us at the Minded Institute. Veena teaches on OCD for our Professional Yoga Therapy Training. To find out more, please contact us on email@themindedinstitute.org

 

Bibliography

Bhat, S., Varambally, S., Karmani, S., Govindaraj, R. &, Gangadhar, B. (April 2016). Designing and validation of a yoga-based intervention for obsessive-compulsive disorder. International Review of Psychiatry, 27, 1-7.

Shannahoff-Khalsa, D. &, Beckett, L. (1996). Clinical case report: Efficacy of yoga techniques in the treatment of obsessive-compulsive disorder. International Journal of Neuroscience, 85, 1-17.

Shannahoff-Khalsa, D. et al (1999). Randomised controlled trial of yoga meditation techniques for patients with obsessive-compulsive disorder. International Journal of Neuropsychiatric Medicine, 4, 34-46.

Beyond a Deficit View of Autism

‘All humans are sacred, whatever their culture, race or religion, whatever their capacities or incapacities, and whatever their strengths or weaknesses might be’.  (Jean Vanier, founder of L’Arche).

The single deficit model of autism is, in our opinion at the Minded Institute, doing people diagnosed with autism and their families a gross dis-service. Autism is complex and multi-faceted and, as yet, is not attributable to any specific physiological pathology. We have been searching for biomarkers for autism for some time now. We are still searching. We shall look in this blog post at arguments for and against the notion that autism can be characterised by a specific deficit.

Arguments For a Specific Deficit

One approach used to study autism has been the neuropsychological approach, in which the brain is characterised it terms of a normal brain with some modules impaired. One model, which comes from the neuropsychology tradition, is the single cognitive deficit model which traces autism to a single underlying cognitive deficit. Within this approach, autism has been viewed as caused by impairments to specific modules; some researchers have argued that autism, for example, is due to a deficit in a module that handles ‘Theory of Mind’ (TOM) computations. The central understanding is that only one module is damaged, resulting in a specific cognitive deficit, known as a ‘pure case’. However, ‘pure’ cases are in fact extremely untypical and the notion of a ‘pure’ case assumes that modules pre-exist. A non-modular architecture can produce an apparently ‘pure’ case, however, and the argument, therefore, rapidly falls apart. Furthermore, even the few ‘pure’ cases that have been documented would reveal subtle secondary deficits once more dynamic hypotheses have been considered.

From the recent evidence, therefore, the neuropsychological approach falls short of explaining the so-termed deficits underlying autism and does not fit in with recent developments in developmental neurobiology. Recent findings suggest that brain development turns out to be highly plastic across the life span as opposed to being comprised of static modules as the neuropsychological approach suggests. In addition, another recognised complication for single cognitive deficit models is the possibility of cognitive subtypes, which has been discussed for some time in the case of autism.

From Single Deficit to Multiple Deficit Explanations.

The Diagnostic and Statistical Manual for Mental Disorders , which includes criteria for autism, has taken a phenomenological, categorical approach. This suggests that all defined ‘disorders’ are heterogeneous and cannot therefore be defined by a single deficit. The diagnostic criteria for autism, for example, accepts that children are affected in multiple domains of function due to both biological and environmental factors, which modify the risk for aberrant pathways during brain development.

Another approach for understanding autism is the causal model. This attributes the ‘deficits’ found to three main arenas, namely biological, cognitive and behavioural.

It is increasingly accepted that autism is a complex disorder that is unlikely to have a single cause. It is, however, in many ways more complex than many mental health and development disorder presentations on account of the triad of impairments first defined by Wing (1980) – impairments of reciprocal social interaction, communication and imagination – each potentially requiring a causal theory of their own. The most convincing evidence for a genetic disposition comes from studying close relatives of those with autism, with twin-studies being particularly informative. Concordance has been found with over 60% of monozygotic twins, whilst there was no concordance found with dizygotic twins. Whilst the particular genes involved are not yet known, a strong candidate is a locus on chromosome 15q.

It has also been reported that close relatives of those with autism have an elevated frequency of Aspergers and schizo-affective anxiety disorders. It would, therefore, follow that the genetic risk factors for autism may extend to other, distinct brain conditions. Furthermore and interestingly, far more boys are affected than girls; one study puts the estimate at 3.8:1. This could be argued, however, not to be a genetic phenomenon, but rather that the male brain is more susceptible than the female brain. Indeed, recent research by Janet Treasure at the Maudsley has suggested that this is indeed the case, with anorexia argued to manifest in girls as a form of autism. The diversity of the gene mutations identified in autism point to the conclusion that there is no single ‘autism gene’, with the rising prevalence suggesting an environmental factor. Current thinking hypothesizes that there needs to be genetic susceptibility, which could extend across multiple genes, and exposure to environmental factors in order for autism to develop. Potential environmental factors have been suggested including nutrition, living in towns as opposed to rural areas, drugs used in pregnancy, and heavy metal toxicity amongst others.

In addition to biological and environmental factors, cognitive factors also come into play in the conundrum of autism. Structural abnormalities in the limbic system are seen in people with autism for example. Studies have found there to be disturbances of memory function, alongside deficits in attention and cognitive flexibility, both attributable to the hippocampus. In addition, mood disorders such as anxiety often accompany autism, with 84% of children with autism meeting the criteria for an anxiety disorder in one study. Such anxiety is also attributed with hippocampal and amygdale function, as is the desire for routine found in many people with this diagnosis. Another well-documented trait of autism, namely the perception of facial emotion, has been suspected to involve the hippocampus, amygdale and overlying cortex, with social interaction known to be adversely affected by hippocampal lesions. The ‘chicken or the egg’ question, however, remains. Are the anomalies in brain structure a pre-curser to autism or do the behaviours exhibited by the child with autism alter the brain structure? Whilst the jury is still very much out on this, it is interesting to note that in more than 90% of cases, there is no medical explanation for the autism present.

It would appear, therefore, that multiple biological and environmental factors modify the risk for autistic behaviour, but, and most importantly, this risk is further moderated by measurable environmental factors (leading to self-accommodation). We therefore seem to have a circle of inter-related factors wherein it is impossible to determine what exactly causes which deficit and what exactly is a marker for which behaviour. Thus, biological markers, coupled with environmental factors can feed into cognitive abnormalities and behavioural presentations, which are then moderated by environmental factors and so on. Deficits themselves arise from each of these levels, not only in autism but also in other developmental disorders and mental health presentations.

Associations between deficits in autism are extremely difficult to interpret because they could reflect bottom-up influences (stemming from the ‘innate’ deficit) on high-level processes, top-down influences (reversing or altering the ‘innate’ deficit) on low-level processes or the deficits could be causally connected. When we consider the difficulty in isolating the ‘innate’ deficits, the ability to interpret associations becomes close to impossible.

The notion of a person with autism having a normal brain with certain modules impaired simply fails to take into account the plethora of inter-related factors which cause the varying phenotype of each person with this diagnosis. Thankfully, researchers such as Karmiloff-Smith are taking away the very legs such reductionist beliefs are standing on. Whilst further research is certainly needed into each of the factors present, implications for treatment can already be drawn. A multi-modal, multi-disciplinary approach, as suggested by Reiss, would appear to be the way forward, with seemingly separate disciplines such as neuroscience, psychiatry, psychology etc. accepting and embracing the wisdom and potential contributions that could be made by the other. Further research would, therefore, draw on methods from multiple disciplines and include extensive inter-disciplinary dialogue. The multiple benefits of yoga for people with autism would also, one would hope, form part of this discussion.

 

Working Psychotherapeutically with Grief-Fuelled Depression

Whilst we all have days when we would rather stay in bed, depression is an insidious and hope-draining affliction in which the sufferer truly sees life itself as the enemy. Whilst the word ‘depressed’ is now commonly used colloquially to express the sense of  feeling a bit down, depression is a recognised illness in the Diagnostic and Statistical Manual (DSM) with a clear set of symptoms and a range of treatment options. Any ethical therapist, whether a yoga therapist or otherwise should, therefore, be aware of the symptoms and strive to become adept at recognising clients suffering from depression. Therapists need to be aware that there are two types of depression; endogenous (resulting from an internal, biological source) and exogenous (which can be traced back to an external trigger). Alarm bells for endogenous depression might ring for the therapist who hears their client complain of physical ailments whilst also bemoaning a low mood, inability to sleep, changes in motivational levels and appetite etc. It is to be remembered, however, that endogenous depression may not have any related physical complaints and that these two types of depression can be, and often are, inextricably linked.

Exogenous depression may be more easily identifiable in the context of yoga therapy, since pointers will mostly come from what the client directly says. At such recognition, it may be useful to ascertain how often such episodes of low mood occur, enquiring as to their severity and finding out their common duration. If the episodes of low mood and associated difficulties are frequent, severe and of extended duration then the likelihood that the client is suffering from depression is quite high. There are also particular symptoms related to specific types of depression. A person with unipolar depression, for example, may complain of a feeling of constantly low mood, a person with bipolar may describe (or, indeed, present with) extreme highs and extreme lows, a person with major depression may complain about feeling apathetic and seem completely disinterested in life and so on. It is useful to use what the client says, the way in which they present (are they staring at the floor? Are they of unkempt appearance? Have they lost/gained weight for no apparent reason?), and knowledge of the life events of the client. A client who has recently given birth and struggling with chronically low mood, for example, may be suffering from postnatal depression.

When planning a yoga therapy program for a depressed client, all of these elements will need to be taken into account; the type and severity of the depression, the life events and family situation surrounding the depression, previous incidences and treatments of such depression and so on. An ethical therapist would also carefully consider whether or not, indeed, they would be able to treat the client; clients with psychotic depression, for example, may also need to be referred to a specialist. Harm to self or others could also be indicators that a higher level of care is needed.

Recent bereavements should also be taken into account when dealing with a client with depression. Currently, the Diagnostic and Statistical Manual of Mental Disorders assigns special status to bereavement-related depression, claiming that it is distinct from all other depressive episodes. However, some recent findings refute this special status as Sidney Zisook, MD, from the University of California, San Diego, explains to Medscape Psychiatry; “depression that occurs in the context of the loss of a loved one is essentially identical to depression that occurs in the context of any other negative event or loss,” Dr. Zisook from the Journal of Psychiatry agrees; “if a bereaved person’s depression otherwise meets criteria for major depression, it should be taken seriously, diagnosed as major depression, and treated accordingly, rather than continuing to use the bereavement-exclusion rule and treating this as ‘normal grief’”. Below are some guidelines for grief, which may be useful when working with clients with depression who have suffered a recent loss in their lives

Guidelines for Grief

  • Face your feelings. You can try to suppress your grief, but you can’t avoid it forever. In order to heal, you have to acknowledge the pain. Trying to avoid feelings of sadness and loss only prolongs the grieving process. Unresolved grief can also lead to complications such as depression, anxiety, substance abuse, and health problems.
  • Express your feelings in a tangible or creative way. Write about your loss in a journal. If you’ve lost a loved one, write a letter saying the things you never got to say; make a scrapbook or photo album celebrating the person’s life; or get involved in a cause or organisation that was important to him or her.
  • Look after your physical health. The mind and body are deeply connected. When you feel good physically, you’ll also feel better emotionally. Combat stress and fatigue by getting enough sleep, eating right, and exercising. Don’t use alcohol or drugs to numb the pain of grief or lift your mood artificially.
  • Don’t let anyone tell you how to feel, and don’t tell yourself how to feel either. Your grief is your own, and no one else can tell you when it’s time to “move on” or “get over it.” Let yourself feel whatever you feel without embarrassment or judgment. It’s okay to be angry, to yell at the heavens, to cry or not to cry. It’s also okay to laugh, to find moments of joy, and to let go when you’re ready.
  • Plan ahead for grief “triggers.” Anniversaries, holidays, and milestones can reawaken memories and feelings. Be prepared for an emotional change, and know that it’s completely normal. If you’re sharing a holiday or lifecycle event with other relatives, talk to them ahead of time about their expectations and agree on strategies to honour the person you loved.

(Guidelines dapted from the Help Guide for Mental Grief and Loss, Smith &, Seagal, 2012).

 

 

 

 

 

 

 

Halasana in the Hospital: Yoga to be Offered to NHS Staff

Back in September of last year, Simon Stevens, NHS England’s chief executive, pledged to launch an initiative to improve staff health and cut the growing amount of sick leave. As part of this initiative, NHS staff are to be offered health checks, Zumba, and yoga classes whilst at work as part of a major drive to improve the wellbeing of the country’s biggest workforce. At his organisation’s annual conference in Manchester, Stevens explained, “NHS staff have some of the most critical but demanding jobs in the country. When it comes to supporting the health of our own workforce, frankly the NHS needs to put its own house in order”.

A growing body of research suggests rising levels of stress in nurses, doctors and other medical professionals. In one study, the number of sick days taken by a group of 125 nurses correlated significantly with scores on the stress and burnout scale (Kennedy, 2005) whilst in another study of 301 nurses, more than half scored so highly on the burnout inventory scale so as to indicate considerable emotional exhaustion (Hannigan, Edwards, Coyle, Fothergill &, Burnard, 2000). One study of more than 10,000 nurses from five different countries found an incidence of burnout that ranged from 32% in Scotland to 54% in the USA (Aiken, Clarke &, Sloane, 2002). Medical professionals’ response to stress naturally varies though has been found to include depression, emotional depletion, tension, fatigue, decreased overall health, headaches and stomach problems to name just a few (Edward &, Hercelinskyj; Vishwanath, Galperin &, Lituchy, 1999).

The proposal to make yoga classes available to all NHS staff was greeted with eager anticipation by the yoga community, who have long understood the numerous and far-reaching health and psycho-social benefits of yoga, which can be particularly beneficial for those under considerable amounts of stress. Yoga interventions, in fact, are already offered to hospital staff as a matter of course in many healthcare institutions in other countries with the USA, Canada, Sweden and Australia appearing to lead the way in such initiatives.

The practice of yoga has been found to reduce serum cortisol levels (Gopal, Mondal, Gandhi, Arora &, Bhattacharjee, 2011), reduce stress and anxiety (Michalsen, Jeitler, Brunnhuber et al. 2012) and improve confidence in dealing with stressful situations (Harfiel, Havenhand, Khalsa, Clarke &, Krayer, 2011). A regular yoga practice has been associated with increased positive mood (Berger &, Owen, 1992) and has been shown to increase dopamine levels with a subsequent impact on the brain’s pleasure and reward systems (Kaier, Bertelsen, Piccini, Brooks, Alving &, Lou, 2002). Research on yoga has also revealed that it increases GABA levels in the brain (Streeter, 2007 & 2010), increases brain-derived-neurotropic factor (Naveen, Thirthalli, Rao, Varambally, Christopher &, Gangadhar, 2013) and enhances emotional regulation (Arch &, Craske, 2006). Of particular note to medical professionals whose jobs require intensive physical work, yoga has been found to be efficacious in the alleviation of chronic lower back pain (Sherman, Cherkin, Erro et al., 2005).

In a study which offered tai chi and yoga to nurses, heightened sensations of calm, enhanced problem-solving abilities and an increased ability to focus on patients’ needs were just some of the benefits highlighted by participants (Raingruber &, Robinson, 2007). One nurse explained;

“My colleagues tell me I’m calmer. I know I’m more motivated at work and at home. I’m watching TV less and being more active. My yoga time brings me back to my centre. It’s a place where I find clarity about my feelings and decisions. I really enjoy the class”.

The Minded Institute is closely affiliated with the Yoga4theNHS steering group, which aims to lobby, raise awareness and provide support for yoga’s infusion into the NHS. To find out more visit #yoga4theNHS on Twitter or our Facebook page at; https://www.facebook.com/Yoga4NHS-1683386525269475/

 

References

Aiken, L., Clarke, S. &, Sloane, D. (2002). Hospital staffing, organization, and quality of care: Cross-national findings. Nursing Outlook, 50, 187−194.

Arch, J. &, Craske, M. (2006). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44, 1849-1858.

Berger, B. &, Owen, D. (1992). Mood alteration with yoga and swimming: Aerobic exercise may not be necessary. Perception and Motor Skills, 75, 1331–1343.

Edward, K. &, Hercelinskyj, G. (2007). Burnout in the caring nurse: Learning resilient behaviours. British Journal of Nursing, 16(4), 240-242.

Gopal, A., Mondal, S., Gandhi, A., Arora, S. &, Bhattacharjee, J. (2011). Effect of integrated yoga practices on immune responses in examination stress—a preliminary study. International Journal of Yoga, 4, 26-32.

Hannigan, B., Edwards, D., Coyle, D., Fothergill, A. &,  Burnard, P. (2000). Burnout in community mental health nurses: findings from the all-Wales stress study. Journal of  Psychiatric Mental Health Nursing, 7, 127–134.

Hartfiel, N., Havenhand, J., Khalsa, S., Clarke, G. &, Krayer, A. (2011) The effectiveness of yoga for the improvement of well-being and resilience to stress in the workplace. Scandinavian Journal of Work and Environmental Health, 37(1), 70-76.

Kennedy, B. (2005). Stress and burnout of nursing staff working with geriatric clients in long-term care. Journal of Nursing Scholarships, 37, 381–382.

Kjaer, T., Bertelsen, C., Piccini, P., Brooks, D., Alving, J. &, Lou, H. (2002). Increased dopamine tone during meditation-induced change of consciousness. Cognitive Brain Research 13, 255–259.

Michalsen, A., Jeitler, M., Brunnhuber, S., et al. (2012) Iyengar yoga for distressed women: a 3-armed randomized controlled trial. Evidence Based Complementary Alternative Medicine.

Naveen, G., Thirthalli, J., Rao, M., Varambally, S., Christopher, R. &, Gangadhar, B. (2013). Positive therapeutic and neurotropic effects of yoga in depression: A comparative study. Indian Journal of Psychiatry, 55(3), 400-404.

Raingruber, B. &, Robinson, C. (2007). The effectiveness of tai chi, yoga, meditation, and reiki healing sessions in promoting health and enhancing problem-solving abilities of registered nurses. Issues in Mental Health Nursing, 28, 1141-1155.

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Exploring the Benefits of Yoga for Skin Disease

The skin is our largest organ. It acts as a waterproof, insulating shield to protect our bodies from extremes of temperature, sunlight, and harmful substances. It is also wonderfully packed with nerves for keeping the brain in touch with the outside world and is the main visceral medium through which we connect physically with others. Healthy skin condition, thus, is integral to both our physical and emotional health.

Psychodermatology is the discipline of exploring the links between psychological health and skin conditions. This approach has its roots as far back as 1865 when Hillier implicated anxiety as a root cause of skin disease in his research. Indeed, more recent research has found that emotional stress deeply influences the immune system, which can then result in cutaneous illness. Associations have also been made between stressful life events and the onset of various skin conditions. The skin disease best known to be stress-associated, and by far the most extensively studied for this association, is psoriasis, with 40-60% of cases found to be triggered by stress.

In additional to having the potential of being rooted in psychological distress, skin conditions can also ignite stress and anxiety given possible physical manifestations including pain, itching, and tightness. Moreover, skin conditions, depending on their nature and location, can be highly visible and therefore prompt body image difficulties and appearance-related distress. Thus, shame and the desire to hide are known correlates of various skin diseases.

There is now a growing appreciation of how skin diseases affects children and adults alike. Note worthily, people with real or perceived skin imperfections in key body areas such as the face, scalp, hands and genital area are particularly prone to stress. Blemishes on other parts of the body can also cause significant distress. People with Body Dysmorphic Disorder, acne, psoriasis, and particularly men and women with facial conditions are more likely to be experience reactive depression and to be at risk of suicide.

In a recent study published in AYU Journal (https://www.ncbi.nlm.nih.gov/pubmed/27011717) the clinical efficacy of Apamarga Kshara Yoga, which is steeped in Ayurvedic tradition, was explored in the management of vitiligo. Vitiligo is a long-term skin pigmentation condition which causes pale, white patches to develop on the skin due to the lack of the chemical melanin. Some people only get a few small, white patches whilst others get larger patches that join up across vast areas. These white patches are usually permanent. Whilst it is unclear as to what exactly causes such a lack of melanin, it has been linked to problems with the immune system (autoimmune conditions) and nerve endings in the skin. Perhaps the most well-known sufferer of vitiligo was Michael Jackson, who indeed experienced acute psychological distress, including low self-esteem, on account of his skin condition.

Apamarga Kshara Yoga is a classical formulation in Ayurveda containing ‘Apamarga Kshara’, an alkaline ointment. In the current study, a total of 50 patients were randomised into two groups. Group A (n=25) were treated with Apamarga Kshara ointment and group B (n=25) were given another formulation, namely Rasayana Churna. Significant improvements were found in the symptoms of vitiligo in both groups, although the Apamarga Kshara Yoga group had statistically greater benefits.

The current study was based in Ayurveda and did not contain any yogic asana, meditation or pranayama. More research into the area of yoga’s benefits for various skin conditions is desperately needed. Thankfully, experts in the field including Hasmukh Jadav and Galib Prajapati, recommend that people with skin conditions should be reminded of the interplay between skin disease and stress, and that the importance of stress reduction through practices such as deep breathing, meditation and yoga should be emphasised.

Yoga’s benefits to people with skin conditions perhaps become clear when we consider that yoga stimulates the parasympathetic (‘rest and digest’) nervous system, which reduces the body’s stress respond. This, subsequently, can have a huge influence on the immune system. Studies have also shown that yoga can quell inflammation in the body, which is a common correlate of autoimmune disease of course. We are convinced of these benefits here at the Minded Institute and, therefore, explore yoga therapy for skin conditions extensively in our flagship 500-Hour professional training, the next of which begins in March 2017. To attend our Taster Day on 30th April in London, please email email@themindedinstitute.com. We would love to see you there!