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.

Sherman, K., Cherkin, C., Erro, J., Miglioretti, D. &, Devo, R. (2005). Comparing yoga, exercise, and a self-care book for chronic low back pain: A randomised, controlled trial. Annual International Medicine, 143, 849-856.

Streeter, C., Jensen, J., Perlmutter, R. et al. (2007) Yoga Asana sessions increase brain GABA levels: A pilot study. Journal of Alternative and Complementary Medicine, 13, 419–426.

Streeter, C. (2010). Effects of yoga versus walking on mood, anxiety, and brain GABA levels: A randomized controlled MRS study. Journal of Alternative & Complementary Medicine, 16(11), 1145-115.

Vishwanath, B., Galperin, B. &, Lituchy, T. (1999). Occupational mental health: A study of work-related depression among nurses in the Caribbean. International Journal of Nursing Studies, 36, 163-169.

 

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!

The Benefits of Yoga for Depression and Anxiety

The most common neurotic disorders in the United Kingdom are anxiety and depression, with one in six adults having been found to experience such presentations in any given week in the UK (Office for National Statistics, 1995). Anxiety is a normal response to stress or danger and manifests as the arousal of the sympathetic (‘fight or flight’) nervous system, which involves adrenalin being pumped quickly through the body to enable it to cope with any impending catastrophe. Problems arise, however, when this response is out of proportion to the level of actual danger present in the situation or, indeed, if no true danger is present. The physical symptoms of anxiety can include a rapid heartbeat, shortness of breath, a tight chest, nausea, the urge to pass urine or empty bowels, tremors, and sweating to name just a few. Psychologically, a person with anxiety may experience tension, agitation, a sense of a loss of control, impending feelings of dread, and a sense of detachment.

Clinical depression is characterised by a persistent anxious, sad, or empty mood. Anxiety and depression, therefore, whilst separate diagnoses which can manifest independently, can commonly occur simultaneously. Other symptoms of depression include feelings of hopelessness, a sense of guilt or worthlessness, a loss of interest or pleasure in hobbies and activities, fatigue and decreased energy, sleeping and eating changes and thoughts of death and/or suicide. In order to be diagnosed with clinical depression, a person must have had such symptoms for most of the day, nearly every day, for at least a two-week duration.

There is a growing body of research and increasing interest in the use of yoga as a way to soothe and manage both depression and anxiety. There are several ongoing large-scale randomised controlled trials exploring yoga’s potential benefits to these populations with preliminary evidence indeed suggesting that yoga can be helpful for both depression and anxiety in a myriad of ways. Studies to date citing yoga’s effectiveness in managing depression include those by Woolery, Myers, Sternlieb &, Zeltzer (2004), Krishnamurthy &, Telles (2007), and Shapiro, Cook &, Davydov (2007); and studies looking at the therapeutic benefits of yoga for anxiety include those by Smith, Hancock, Blake-Mortimer &, Eckert (2007), and Bhushan &, Sinha (2001). Prevalent findings include reductions in depression and anxiety scores, a modulation of the stress-response through an increase in parasympathetic (‘rest and digest’) nervous system arousal, reductions in obsessive compulsive tendencies, an easing of respiration, and improved mood following a yoga intervention. Further controlled trials of yoga practice have demonstrated improvements in mood and quality of life for the elderly, people caring for patients with dementia, breast cancer survivors, and patients with epilepsy.

To take the example of one study, conducted in Germany in 2005 (Brown et al, 2005), 24 women who described themselves as ‘emotionally distressed’ took two 90-minute yoga classes a week for three months. The women in the control group maintained their usual activities without engaging in an exercise or stress-reduction program during the study period. At the end of the three months, the women in the yoga group reported improvements in perceived stress, depression, anxiety, energy, fatigue and well-being. Depression scores improved by 50% and anxiety scores by 30%. Complaints of headaches, back pain, and poor sleep quality also resolved much more often in the yoga group than the control group. These findings are echoed by Cyndi Roberts, now a yoga teacher, who explains;

I was diagnosed with severe depression and anxiety disorder at the age of eighteen and put on prescription medication, from which I quickly began to experience side effects. Shortly after, I was misdiagnosed with bipolar disorder. There was a time when I was hopelessly lost in the dark. I was trapped in the despair of depression and the crippling grip of anxiety, with a prescription in my hand as the only thing that was supposed to make me feel better. For twelve long years I believed it was the only option.

Moment by moment, I now choose life on my terms instead of waiting for the quick fix or the magic pill. I choose life without clouded judgment or the fog of medication like I once did. For me, yoga is not a gimmick. Exercise and meditation aren’t fads—these practices helped saved my life and have become an inextricable part of my daily routine.

It would seem from the research and anecdotal evidence, therefore, that yoga has huge potential benefits to offer people experiencing depression and anxiety in their lives. Our Yoga Therapy for the Mind Eight-Week Course for Stress, Anxiety and Depression encompasses these findings and is an evidence-based program designed as a therapeutic treatment for depression, anxiety, and stress. The course is a thorough investigation and journey into the body and the mind drawing on ancient yoga principles and mindfulness meditation techniques that are the foundation of Mindfulness-Based Cognitive Therapy (MBCT) one of the fastest growing new therapies for depression. To find out more, please visit our training website at http://www.yogaforthemind.info/about-us/yoga-for-the-mind-8-week-course.html.

References

Brown, R., et al. (2005) “Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part I — Neurophysiologic Model,” Journal of Alternative and Complementary Medicine, 11(1), 189–201.

Bhushan S. &, Sinha P. (2001). Yoganidra and management of anxiety and hostility. Journal of Indian Psychology, 19:44–49.

Krishnamurthy, M. &, Telles, S. (2007). Assessing depression following two ancient Indian interventions: Effects of yoga and Ayurveda on older adults in a residential home. Journal of Gerontology Nursing 33, 17-23.

Office for National Statistics (1995) ‘Surveys of Psychiatric Morbidity in Great Britain. Report 1 – The prevalence of psychiatric morbidity among adults living in private households.’ The Stationery Office.

Shapiro, D., Cook, I. &, Davydov, D. (2007). Yoga as a complementary treatment of depression: Effects of traits and moods on treatment outcomes. Evidence Based Complementary and Alternative Medicine 4, 493-502

Smith, C., Hancock, H., Blake-Mortimer, J. &, Eckert, K. (2007). A randomised comparative trial of yoga and relaxation to reduce stress and anxiety. Complementary Therapies in Medicine, 15, 77-83.

Woolery, A., Myers, H., Sternlieb, B. &, Zeltzer, L. (2004). A yoga intervention for young adults with elevated symptoms of depression. Alternative Therapies in Health and Medicine 10, 60-63.

 

 

 

 

How a Trauma Survivor Overcame Post-Traumatic Stress Disorder using Yoga

Yoga Therapy for PTSD Training offered by the Minded Institute; London (near Euston) from 13th-17th April 2016. Secure your place now; email@themindedinstitute.com. http://www.yogaforthemind.info/events-in-the-uk-and-europe/yoga-therapy-for-ptsd.html

Trauma can be defined as an experience within which we encounter intense feelings of terror and helplessness and are unable to escape or fight back in any way. Given this definition, it is probable that many of us have experienced some degree of trauma within the course of our lives. For some people, such trauma can lead to Post-Traumatic Stress Disorder (PTSD) within which re-experiencing (i.e., flashbacks, nightmares, frightening thoughts) and avoiding (i.e., staying away from reminders of the experience, emotional numbness, guilt, depression, suppressed memory) symptoms are typically present. People experiencing PTSD are also commonly easily startled, have difficulty sleeping and can have trouble regulating their emotions.

The estimated lifetime prevalence rate of PTSD among adults is around 7.8%, with women (10.4%) being twice as likely as men (5%) to be affected. The most frequently experienced traumas by this section of the population are witnessing someone being killed or badly injured, being involved in a fire, flood or natural disaster, being involved in a life-threatening accident and combat exposure.

In this article (http://edition.cnn.com/2016/01/15/health/john-thurman-yoga-pentagon-ptsd/), a survivor of 9/11 explains how yoga helped him to move beyond his distressing PTSD symptoms. John Thurman found himself in Washington in an office-based position after spending time in Germany during the Cold War, and then Saudi Arabia during the first Gulf War; one might assume that he thought the traumas of his life were safely behind him. When American Airlines Flight 77 slammed into the west side of the Pentagon, however, Thurman was tragically inside. After many years in the army, Thurman’s survival instincts kicked in and he found himself trying to lead his colleagues to safety. After managing to reach a back door and acquire some help, he was taken to hospital and treated for severe smoke inhalation. Shortly afterwards, Thurman began to experience intense survivor’s guilt. In addition, he had trouble sleeping and experienced nightmares and flashbacks; 26 of his co-workers had been killed in the attack. He was diagnosed with PTSD and tried a plethora of treatments to little avail.

Around six months after the fateful day the PTSD symptoms were showing no sign of abating. It was at this point that a friend of Thurman’s suggest that he try yoga. Despite doubts, he was willing to try and, within a few short weeks, was seeing amazing benefits.

The biggest benefit for Thurman was a reduction in what he calls the ‘mind chatter’ he experienced as part of his PTSD, enabling him to feel relaxed for the first time since the attack. Yoga became such a blessing for him in fact that he eventually took a teaching training course, subsequently deciding to pursue yoga full time. He left the army in 2013 and has not looked back. Beautifully, the very place of the trauma and the starting point of Thurman’s yoga journey, the Pentagon itself, later hired him to teach a weekly yoga class for active duty military, civilians and retired military. He explains, “I have been able to become resilient and recover, and live my life. I have a responsibility to do that. For the people who lost their lives on that day, you have a responsibility to live and be well.”

A review paper on emerging interventions for the treatment of Posttraumatic Stress Disorder (PTSD) was published in the Journal of Trauma and Stress in January of this year. Yoga is cited as one of these emerging interventions. Novel interventions seem to be appearing for PTSD almost daily yet the notion of yoga as a potential treatment has been around a bit longer, with a great of debt being owed to researchers such as Bessel van der Kolk amongst others. In this scientific review, there were four interventions stemming from a mind-body philosophy, including yoga, which had moderate evidence from randomised controlled trials. More research is desperately needed in this area. In an interview for Integral Magazine, van der Kolk explained that “people with PTSD lose their way in the world. Their bodies continue to live in an internal environment of the trauma. We all are biologically and neurologically programmed to deal with emergencies, but time stops in people who suffer from PTSD. That makes it hard to take pleasure in the present because the body keeps replaying the past. If you practice yoga and can develop a body that is strong and feels comfortable, this can contribute substantially to help you to come into the here and now rather than staying stuck in the past”. Here at the Minded Institute we couldn’t possibly agree more.

 

 

Yoga Spreading Like Wildfire; the Growth of Yoga in the US, the UK and Beyond.

A new survey carried out by Yoga Alliance and Yoga Journal, in conjunction with Ipsos Public Affairs, questioned 2,000 people in the general United States population and 1,700 additional yoga practitioners. The study aimed to quantify the spread of yoga across the US and to look at who is practicing yoga and their motivations for doing so. Findings gleaned from this national study included the following figures; there are an estimated 36.7 million yoga practitioners in 2016 in the US, 72% of practitioners are women and 28% men, 74% of yoga practitioners have been practicing for five years or less, 80 million US citizens are likely to try yoga in 2016, and an estimated $16.8 billion dollars are to be spent on yoga classes, clothing, equipment and accessories in 2016. These are very proud figures indeed!

One-in-ten people in the US, therefore, are practicing yoga, which is double the amount of just a few years ago. Sex differences are also decreasing; in 2012, women outnumbered men by a ratio of four-to-one whilst almost a third of practitioners are now men. The large percentage of people who have been practicing for five years or less points to a huge increase in the number of new practitioners, thus highlighting yoga’s increasing popularity over the past few years in particular.

This picture of yoga’s increasing popularity would also appear to be mirrored in the UK, though we are yet to gather and publish national data in such detail. Karen Pilkington and colleagues at Westminster University, with the support of the Minded Institute, are in the process of planning such a nationwide study in the United Kingdom, following on from recent research by Kantar Media, who surveyed over 20,000 people. Findings from Kantar include the following figures; 5.4% of the UK population were estimated to have practiced yoga in 2015 (circa 1,263,000 people) and there was an increase of 388,500 yoga practitioners between 2014 and 2015. Excitingly, these upward trends are showing no signs of abating with such growth also being present across many other areas of the globe.

People have a whole host of motivations for wanting to engage in a yoga practice, most typically centred around health, flexibility, physical and emotional wellbeing and spirituality. In the US study, 61% of people said flexibility was what drew them in; for 56% it was stress relief; for 49% it was general fitness; for another 49%, overall health was the goal; and for 44% the desired outcomes were around physical fitness. Research in each of these areas would certainly seem to suggest that people seeking such benefits are unlikely to leave feeling disappointed. Studies show that yoga can be supportive in increasing flexibility (e.g. Castro Goncalves et al., 2011), enabling a person to go beyond their normal range of movement. This, in turn, may make performing daily activities easier. In terms of stress relief, a growing body of research points to yoga’s benefits for stress reduction, including the alleviation of depression (e.g. Woolery et al., 2004) and anxiety (e.g. Smith et al., 2007). Yoga also has multiple benefits for general health and fitness, a wonderful review of which by Ross and Thomas (2010) can be found here; http://ensoyoga.com.au/wpcontent/uploads/2014/02/47734998.pdf

A particularly interesting finding of the US-based study was that the most common place for people to practice yoga is at home. Whilst classes have increased in popularity, therefore, most people opt to roll out their mats in their own abodes, though the research fails to delve into reasons for this which may include finances, privacy, ease-of-access and the growing number of online videos and Apps for personal yoga practice. Platforms such as YogaGlo and Gaia offer us the option of following a personalised yoga practice from the comfort of our own living room and there is perhaps a lot to be said about the benefits of such an option. Attending a face-to-face yoga class, of course, has the additional advantages of connecting us with other like-minded members within our community and can also provide opportunities for adjustment of asanas under the watchful eye of a qualified teacher, thus increasing safety and promoting the advancement of our practice. Wherever we chose to practice, however, the statistics are clear; more and more of us are engaging in the transformative practice of yoga and are reaping profound benefits on many levels and in a multitude of ways.

References

Castro Goncalves, L., Gomes de Souza Vale, R., Barata, N., Vareja, R. &, Dantas, E. (2011).  Flexibility, functional autonomy and quality of life (QoL) in elderly yoga practitioners. Archives of Gerontology and Geriatrics, 53, 158-162.

Ross, A. &, Thomas, S. (2010). The Health Benefits of Yoga and Exercise: A Review of Comparison Studies. Journal of Alternative and Complementary Medicine, 16 (1), 3-12.

Smith, C., Hancock, H., Blake-Mortimer, J. &, Eckert, K. (2007). A randomised comparative trial of yoga and relaxation to reduce stress and anxiety. Complementary Therapies in Medicine, 15, 77-83.

Woolery, A., Myers, H., Sternlieb, B. &, Zeltzer, L. (2004). A yoga intervention for young adults with elevated symptoms of depression. Alternative Therapies in Health and Medicine 10, 60-63.