Yoga related intervention studies have been following the scientific methodology which emphasizes on randomized controlled trials and an objective empirical demonstration of significant effect of treatment on the target group or conditions. However, the practical difficulties of having an adequate sample, individual variability within group and also accurate measurement of intra psychic dynamics have made it a stupendous task for the the researchers to present effectiveness of yoga practices in a systematic manner. As a process oriented therapy yoga is amenable to qualitative studies and also single case analysis. The narrative descriptions of experiences and events of the interaction between therapist and the care seeker provide insights about the process of transformation.
Yoga therapy is applied in handling many psycho physiological issues. The practices are mainly technique oriented and little emphasis is given to the yoga based counselling. The individualized approach to yoga in the Krishnamacharya tradition focus on the personalizing the asana, pranayama or meditation and also providing support for transformation at physical and mental level leveraging the philosophical and practical steps provided by sage Patanjali in yoga sutras.
This article based exclusively on individual case analysis provides the application of the conceptual understanding of mind through sutras and providing supportive practices for achieving well being. The author also highlights the issues and limitations that may crop up while using this strategy.
The practice of yoga as health promotive strategy and alternative support to disease management is widely accepted. Yoga teachers and therapists are emerging as professional helpers in public health domain.
Research evidence presents the psycho physiological benefits of practicing regularly Asanas, pranayama, meditation, and also following principles of right eating and right attitudes. The researchers irrespective of the tradition that they come from accept that yoga philosophy is a strong theoretical support to the application of the tools of yoga be it asana or meditation in promoting wellness. Literature on yoga philosophy and specifically on mental health emphasize that yoga is the science of mind and process of its transformation. As one of the six systems of Indian philosophy, it is systematically presented in the yoga sutra by sage patanjali. Everything in yoga sutra is a discussion of interplay between mind, consciousness and senses. In ancient time it was the role of an acharya or a seer to educate and counsel those who were afflicted and our traditional scriptures provide ample evidence to such philosophers who could transform the agitated mind to a state of clarity.
Currently, though majority use yoga as a physical fitness culture, the spiritual or psychological health aspects is never neglected. Psychological correlates of yoga practices have documented its therapeutic impact in emotional regulation. mood stabilization, anxiety reduction (Woolery et al 2004; Kirkwood et al 2005; Smith et al 2007; Agarwal, 2013) cognitive performance enhancement (Manjunath, Telles 2001, 2004; Madanmohan,Udupa and Bhavnani 2003; Kauts and Sharma 2009 Latha and Jayapriya 2011) positive self concept ,other specific changes in personality dispositions, managing symptoms of depression and a sense of subjective wellbeing. In all these studies the focus of intervention is on the various techniques of practices like asanas, pranayama, meditation, to an extent certain life style adherence. The recent issue of Indian journal of psychiatry (August 2013, Vol 55, Issue 7) provides scientific evidence on yoga as a potential intervention for addressing the psychiatric population in clinical setting. Throughout the focus is on techniques or practices are emphasized but the Practical applications of principles of therapy as profounded in yoga sutra are not incorporated as model for counseling the patients.
Guiding Principles in Yoga sutra
Yoga sutra provides clear ideas about the nature of mind and its functions (Desikachar,1987). Studying the four chapters of sutra using the various commentaries available and a systematic learning under a teacher helps one to understand
- What constitute Mind and Consciousness
- Characteristic activities of mind
- The source of Mental agitation
- Consequences of such agitations
- Means of reducing conflicts and gaining clarity
- Potentials of a stable and one pointed mind.
- The transformative power of mind and the consequent clarity and freedom
Many yoga practitioners are completely knowledgeable about these processes and do apply these principles in their own life and practice. Very few therapists use this strategy as one to one personal transformation process.
Generally, people approach psychologists to deal with the anxiety, depression or adjustment problems. However now many psychiatrists and psychologists are referring the clients with such problems to yoga therapy knowing the potentials of such practices on the mind. At this juncture where the psychological benefits achieved through a technique based practice is well known, integrating yoga sutra based counseling as a form of therapeutic sessions can provide additional benefits which is long lasting.
A strong need to present systematically a process of counseling incorporating yoga sutras as guidelines is an appropriate supportive step to therapists and teachers of yoga. And application of these principles in addressing issues like anxiety, depression will be a beginning in this direction.
Citta Vikshepa to Chitta prasadanam – a qualitative experience analysis
It is common to see adults some times experience sudden episodes of panic attacks associated with some form of stress either linked to personal life or work life. The source of such experiences can be traced to work deadlines, changes in roles and responsibilities, relationship problems or it may be some life threatening events. This attack may not be linked to any particular situations. The varied psycho physiological symptoms interfere with the daily living and thus affect productivity and well being. Even though anxiety is the underlying symptom the physiological manifestations include aches, pains, muscle stiffness, restlessness, and watchfulness. The person also exhibit unrealistic worries, negative self evaluations, and behavioral symptoms of withdrawal or avoidance from situations that cause worry or anxiety.
The yoga sutra of Patanjali presents the afore mentioned state of mind as a distracted one. He calls it Citta Vikshepa.. When the mind is distracted; there arises a feeling of uneasiness, suffering, despair, negative thoughts, and instability in body and discomfort in breath. (Yoga sutra, Chapter I:30 and I:31)
Usually Psychologists deal with such problems by teaching relaxation techniques and specific supportive counselling to handle anxiety. Psychiatrists prescribe medicines to calm the mind so that the person can carry on daily activities. They also refer clients to practice some safe yoga under supervision as a form of self regulatory or stress management mechanism.
Yoga sutra provides a body –mind integrated practice which builds skills and also gives an approach to yoga therapists to address the source of conflicts or stress which disturbs the mental equilibrium and take steps to restore that functional quality. The following narratives provide a context where such guidelines from sutras are applied to help the transformation from a state of citta vikshepa to citta prasadanam.
Journey process of person with panic attack.
Mr C is 42 year old executive in a private company. He experiences a sudden panic attacks, which is affecting his work and also family relationship and sense of wellbeing. Headaches, palpitations, sleeplessness, restless walking, lack of joy in usual activity and feeling of being overwhelmed were noticeable symptoms and he had stopped going to work.
His family and close friends are concerned, yet supportive, felt that he needed professional help and referred him to Yoga.
During the initial consultation the consultant could establish an adequate rapport and Mr C was very forthcoming about the troubles that he is going through. His wife was also interviewed and confirmed the experiences the care seeker was going through.
The first phase of training was to teach him the mind-body relaxation; using the breath regulation in simple postures and recitation of om. This is the method proposed by patanjali in the sutras I:34 and I:39 as a means to achieve citta prasadanam. The client was doing this practice twice daily diligently and clearly experiencing a sense of wellbeing and could control panic type reaction at somatic level.
The second phase of this interactive session was to explore the source of his distractions or conflicts. A thorough enquiry (Non judgmental supportive questioning) with the client revealed a pattern in his thoughts which would provoke anxiety in him. He felt anxiety with a) thoughts about possible failures in executing his work. b) uneasy feelings that he is being evaluated, judged or ridiculed by his colleagues. c)fear that his failure or mistakes in job will affect many d) he also felt that he needed more support from his colleagues.
In a psychological counseling set up, it is normal that the personality and current emotional status of the person are assessed to guide the therapy. However in yoga, there are no such measurement tools, it is the skill and self practice discipline of the trainer which guides them. The process of “Prasnam” (Questions) should help the therapist or trainer to identify the quality and functional status of the Manas, the mind. Thus, in this case based on the enquiry the care provider could establish the source of vikshepa in the mind which would affect his sense of wellbeing, functional efficiency and the manifestation of symptoms at body level.
During third week his practice was little more intensified with an opportunity for self reflection, while he is completing a specific set of pranayama. He would be asked to be more concentrating on the breath and the chant to the extent where his mind becomes passive. Taking advantage of his faith in a supreme force he was guided on the principle of surrendering to that (Higher force) whenever he encounters a personal difficulty (thoughts or worries which trigger an uneasiness). These two principles are clearly presented as action based approach to gain clarity in the mind and remove the unwanted sources of conflicts. (Yoga sutra II; 1 and2)
Subsequent to diligent practice the client found an expansive awareness about self. He felt “I am capable’ “I can do”; my capacity is Much More” This Feelings were though momentary; he reported that he would feel more confident.
In his words “I underwent a journey …. I’m having clear sleep 7-8 hours without any disturbance (and) I won’t getup once I have sleep. I will get up in the morning fresh. My other (problems) like in terms of headache are totally gone I was not getting any of those (these) issues in the morning and once I started practice….. I’m fresh, cool and calm and also gain lot of like confidence. In nature (my nature now is) confident moving forward and it has made me really now calm fresh and energetic person. I feel the transformation.
One basic thought pattern was like there are so many things which I have to handle will I able to handle? Will I able to take-up more and more than? (What I can?) for example what I can choose…. and thought it was so difficult to choose…… this was one of the thought pattern there earlier …but one key suggestion you gave (Refers to trainer) was when you do a meditation and when you do the pranayama…. “I have to see my body is different and what I am”… is different from the thought….. and I can handle more I can do more… this is only the tool which I ‘m doing (Taken the suggestion of mind is broader or expansive than the body) so (i) focus on that and then do the pranayama and meditation and it will give you the capability and capacity to take-up more, I’m using it and I feel very wide (gestures widely with hand)
And what I do when think certain times… when I have to think and then say .Earlier incident…..whatever is there I would say something immediately. Now I take 30 seconds as you said and delay the response..
Around this time he started to go back to his work and felt very comfortable and adjusted.
During subsequent sessions Mr C reported that he had become more alert to his mental states and knew the moments of “Flow’ where there were no obstructions to his work efficiency. And those moments which would put a constraint in this flow and take him away from his focus. It could be random negative thought or a feeling of anxiety which would steal away the small joys of life. He wanted to be much more peaceful and wanted to be free from such constraints. Sometimes his work related issues would interfere with his enjoyment at home. At times the thoughts will overtake him and he would get so preoccupied that he could not even enjoy the quality time with family.
An enquiry to track the source of such anxiety revealed that he had a craving that everything must be alright and an attachment to the children, family and a fear of unknown affecting the sense of wellbeing.
The above state of being is one rooted in Klesha, ie fear of loosing or attachment to objects of joy.In yoga sutra it is termed as Abhinivesha and Raga.
When actions, thinking are rooted with such an intensions or state of mind the long term consequences are more pain. (Yoga sutra II: 13)
Mr C was given a practice (Short duration) to be done in the evening so that he can achieve a transition from work to family situation. A moment of relaxation and focus would help the mind to empty the preoccupations of work place. This is also a “ process of being here and now”
The yoga teacher asked him to reflect on the moments where he is happy and peaceful and see what sustains it. Whether it is because he is happy by himself or because it was dependent on something outside or external?
The analysis of content of the mind in a gradual manner as long as it is possible to focus gives a sense of coherence and meaning to individual.
Analysis helped him to identify those patterns of thought which were making him distracted, emotional and also feel a sense of helplessness and a sense of constriction in the chest.
He wanted to regulate these aspects of his mind. In his practice, where he is in a state of physical passivity and breath regulation is smooth, he was asked to introduce positive affirmation that “I cannot control everything outside” “ I can accept things as they come” He practiced this in front of his teacher and could understand how his own mind is contributing to many negative thoughts. These affirmations facilitated him to relate to some of the events at office that happened in the day and about his own role in aggravating the anxiety feelings.
Slowly gaining clarity that it is not possible to control every happenings or people reactions, participation of others, but anything that happens can be acceptable without becoming upset about it. Only when he understood these aspects it was possible for him to completely surrender and let go of the incessant thoughts.
By Fifth week of these interactive sessions the practice had become very well established and he understood the way mind influencing his moods and motivations. He was completely free from panic reactions, more confident and reported that wanted to go ahead more positively with life started enjoying the blessings in his life.
In his own words “I am able to completely put my faith in the supreme and have stopped about what is going to happen and do not allow the feelings to well up…I feel now less burdened..and just want to go ahead with …..like I used to be….”
The Yoga intervention here constituted an ambience of support from a trainer, with whom he could share his thoughts and accepted her as a teacher. A teacher is like a “Mirror” reflects the Mind of student and also provides appropriate skills to correct or regulate the thoughts and feelings. Secondly the trainee or care seeker must practice all the body,breath,mind coordinated skills to get a view of his own psychological states and gain clarity on the way to come out of situations which would overwhelm him.
Application in a person with performance anxiety
There are some who are very much achievement oriented and always would like to prove them and would not like to fail. This would be a typical rajasic mind which is ragatmaka and is always focus on some work or the other and they cannot keep quiet. Performance anxiety is a situation where a person puts self in a high standard of expectations and will be very anxious to fulfill it. A high level of targets, need to be number one or a star performer can be a source of problem.
28 year old Mr M was a victim of such a self imposed expectations and had to be hospitalized to get him to sleep and also needed medications to reduce his restlessness and hypervigilence. Being an enthusiastic gym worker, he completely lacked ability to achieve mental relaxation.
Yoga Postures and rhythmic breath practice in a stepwise manner could help him to achieve a state of relaxation where he could sleep normally and the need for medication also reduced.
According to him the yoga practice of 45 minutes gave him the needed “ space” where there was no racing thoughts and yet there was an “alertness” to function. He felt that now he has learnt to prioritize and organize the tasks very clearly.
The yoga life style includes a conscious decision of avoiding stimulants like coffee and tea which he had given up. He could feel more energy and relaxation. He could guide some of his colleague in business strategy and this has given him confidence in self. During the interview Mr M disclosed that from his school days he was a top performer and achiever and had never failed and this habituation to success made him to be always striving. Yoga sessions where slow breathing and time to watch body, breath and thoughts provided him an opportunity to be a non striving person.
Mind is always changing and dynamic. How long the person sustains this mental equilibrium is always a question? It depends on their personality, motivation, self efficacy beliefs and other situations. The yoga therapist must be alert to all these manifestations and provide support appropriately using both the practices and philosophy.Counseling based on yoga sutra principles is a process of supportive enquiry and practices provide a tool to these people to regulate the mental afflictions and focus on their activities. The insights learnt must be consolidated and harnessed in different situations. This is key in the path of transformation. To quote world renowned yoga teacher Desikachar “The point of Yoga is to keep the mind clear of its built up impressions…and yoga is to give mind its best possible form” Thus like any other short term counseling yoga approach also provides a support to individuals to overcome the psycho behavioral issues when practice like asana, pranayama, meditation must be coupled with Sutra based counselling.
Dr. Latha Satish, Trustee, KYM, Senior Consultant and Mentor