Originally published in Yoga Therapy in Practice, a publication of the International Association of Yoga Therapists
“Yoga in action, on and off the mat, requires the three elements Patanjali suggests-will, self-study, and surrender to the flow of energy, prana, the divine.”
Amy Weintraub, MFA, E-RYT (500), is the author of Yoga for Depression, the founder and director of the LifeForce Yoga Healing Institute, and a senior Kripalu Yoga teacher and mentor. She leads workshops and trainings for Yoga teachers and mental healthcare professionals, including psychotherapists, social workers, marriage and family counselors, drug and alcohol counselors, and psychologists. YTIP talked to Amy about her approach to Yoga for psychological and spiritual healing. Interview by Kelly McGonigal
How has personal experience influenced your decision to focus on Yoga for depression?
I suffered from depression for many years and was on antidepressants for about nine of those years. When I began practicing Yoga, there was no popular literature on the efficacy of Yoga for balancing or elevating mood. Patanjali spoke of it in Yogic terms, of course, but I had no idea who he was when I attended my first Yoga class at the Kripalu Center. After that class, there was an immediate feel-good effect, no doubt the result, in part, of what studies are now showing about the physiological effects of Yoga. But I was also deeply affected by the language of acceptance. At Kripalu, I felt safe enough to be okay with whatever was showing up on my mat, including negative emotions. I was cultivating the witness as I observed my breath and the sensations in my body, so I was more present, but less reactive.
Over the course of eight or nine months of daily Yoga practice at home, I began to feel well enough that, with the supervision of a psychiatrist, I was able to slowly reduce my medication. That was in 1989, and I haven’t been on antidepressants since. When I became a Yoga teacher in 1992, I was passionate about sharing the help I had received on my mat with my students. I began to study more and more the effects of Yoga on mood, both in the laboratory of my own body, and by working with Yogi psychologists and researchers in the U.S. and India.
I think it’s important that a Yoga teacher who is not a psychotherapist find a Yoga teacher mentor who is, so that there is supervision in the work you are doing with students, especially if you’re working with individuals suffering from depression or other mood disorders. In the last two years, I’ve been fortunate to study and consult with psychologist/Yogi Richard Miller.
Do you think that Yoga therapists who have experienced depression or anxiety have more compassion or insight for working with these issues?
That’s hard for me to say. Certainly, I bring my own history of depression to the mat when I work with someone, but that doesn’t mean that someone who has never been depressed can’t learn about it and work compassionately with those who are. Most of us have experienced depressed mood, even if short-term, or we have lived with or loved someone who suffers. Very few of us are immune.
You mentioned going off antidepressants three years before yoga therapy training you began teaching Yoga. Is full recovery from your own depression necessary to teach individuals with depression?
Certainly not. But awareness of the places where the wounds still fester is essential. That’s why I think having a mentor or supervisor is essential. In my own case, although I feel content these days and, how to describe it… an underlying sense of well-being, I know that I still have work to do.
For example, I was working with a student whose father had died when she was two years old. Her grief-stricken mother became unable to offer her the consistency of love and support she needed. For years, her Yoga practice had been solely about asana, and a bit compulsive and driven. As soon as she allowed herself to deeply relax and trust, all those tamped down emotions rose to the surface. Shortly after she began breathing diaphragmatically in a supine position, she became teary and filled with a primal kind of rage.
I am accustomed to creating a safe enough container in my work with students that plenty of emotion can release. I can hold the space for grief and depression and fear and anxiety. But because of my own history of conflict avoidance — becoming depressed and disallowing anger — I could feel my own discomfort rising with my student’s rage.
The psychologists call this counter-transference. I was grateful to be able to call Richard and schedule a consultation with him to explore my response and the way I worked with this client. My telephone session with Richard was extremely helpful for me and, I believe, for my client in our continued work together. Likewise, I have students who consult with me.
It’s important, I think, that we stay open for a continuing inquiry into our own emotional triggers so that we are as clear as we possibly can be in the moment when we sit with another. In that moment, there is a deeply intuitive attachment with the other, and if we’re constricted and unaware of those constrictions, we might not be a helpful as we otherwise could be.
What would you say to someone who is suffering from intense depression, grief, or anxiety in this moment? How do you convey hope? Where would you begin a session?
That depends on how long they have been suffering, whether it’s related to a specific situation, like a loss, and other factors as well. In some cases, the depression has taken the form of numbness an inability to feel anything at all. Usually, the person feels as though a fog has descended, and it often affects their cognitive functioning in every day life.
In that case, I might help them create a safe container through ritual and personal interaction so that the grief can be welcomed in. I would help them to think of their mat as a safe and sacred space, where whatever shows up is an honored guest I truly believe the adage that “the only way out is through.” That doesn’t mean we have to know and talk about the story. In Yoga, we can allow grief to arise and be released through all the koshas, without getting stuck in the story. In fact, most often when someone releases through tears on the Yoga mat, it’s not connected to a remembered story. Just another samskma letting go.
On the other hand, if someone is already feeling too much grief the tears are flowing endlessly I would encourage that person to embrace the pain through Yoga, and to also begin to feel how much more room there is inside for other emotions, too. Through the energetic effects of asana and pranayama and kriya, I would encourage that student to notice how much bigger she is than her pain.
By encouraging students to observe sensation and breath in every moment as they practice, they are learning to observe the pain, without identifying with it. For someone whose mind is working overtime with negative self-talk, I would also actively work with samkalpa (positive affirmations) that are not layered on, because the mind will reject those, but that arise from the student’s own inquiry.
You teach a five-day intensive training for psychotherapists and Yoga teachers. What does this training cover?
LifeForce Yoga Training for Anxiety and Depression does not train psychotherapists to be Yoga teachers. Nor does it train Yoga teachers to practice therapy. A distinction is made between those techniques that may be appropriate for clinical use by a psychotherapist, and those that require the knowledge and instruction of a qualified Yoga teacher or Yoga therapist But more and more, those attending the training are both Yoga teachers and psychotherapists.
In the training, we look at the current research in neuroscience to see how it reflects the ancient wisdom of the Yogis. From a theoretical perspective, we look at Yogic strategies for balancing the emotional body, as outlined by Patanjali, that are not dissimilar from cognitive behavioral therapy (CBT) and current treatment for what psychologists call “complicated grief.” Our work together as Yoga teachers and mental health professionals takes a Yogic view in assessing the imbalances in the mind and body that might bring a client into psychotherapy or Yoga therapy.
Students in the training learn Yogic practices from classical Yoga and Tantric traditions that cross and embrace “lineage” lines. These practices help clients and students clear the mind’s clutter and the tensions in their bodies, so that they feel calmer, more alert, and have greater access to emotional material.
Included are breathing exercises, both simple pranayama like Yogic three-part breath and victory breath (ujjayi), and more energizing, clutter-clearing cleansing breaths like kriyas. We also study and practice mudra (hand gestures), mantra, the creation of bhavana (visualizations) that support an individual’s growth, the development of samkalpa (affirmations that arise from one’s own field of possibility), and meditation techniques that balance mood. The practices have their source in Yogic science — the Hatha Yoga Pradipika and other texts. Asana is only a small part of what takes place in the five days we spend together.
You mentioned using the Yoga Sutras of Patanjali as a foundation for your approach to emotions like grief. Can you say more about this?
The core of the LifeForce Yoga Training is the first sutra in Pada II: Tapas svadhyaya isvara-pranidhana kriya yogah.
This, I believe, is a Yogic formula for positive mental health. In LifeForce Yoga, we understand this sutra to mean that Yoga in action, or a balanced way of living in union, on and off the mat (kriya yogah), requires the three elements Patanjali suggests in this sutra: will, self-study, and surrender to the flow of energy, prana, the divine.
For some students suffering from depression, simply rolling out a Yoga mat and stepping onto it requires an act of will (tapas). On the mat, self-study (svadhyaya) is cultivated and “witness consciousness” is developed as we bring breath and awareness to strong body sensations, observing these sensations without reacting to them.
As we rely on the will to hold a pose (tapas), while observing the body, staying present to areas of comfort, discomfort or numbness (svadhyaya), we align with the flow of our own healing energy, literally surrendering to the flow of prana, or to stay with a more literal translation of the sutra, surrendering to the divine (Isvara-pranidhana).
How is the mental health field integrating Yoga therapy and psychotherapy?
The outer edges of mental health have been looking toward Yoga for years. The somatic psychotherapy movement dovetails and, in some cases, is founded on the principles and practices of ancient Yogic traditions. At mental health conferences these days, it’s not unusual to hear phrases common to most Yoga practitioners, like, “Where is it in your body?” and “The body remembers.”
More and more clinicians are integrating meditation, breath awareness, and even movement into the treatment room. For example, at a workshop I recently taught in Texas, an Iyengar teacher and psychotherapist named Maggie told me that she’s doing less talk therapy and more Yoga with the adolescents she treats one-on-one. “They show up for their sessions, but they don’t want to talk,” she said. “I find it’s much better for their self-esteem, if I get them standing on their heads! After that, they’re ready to talk.”
One significant shift in somatic therapy’s movement toward mainstream, and the inclusion of Yoga within that movement, has been the research and clinical work of the psychiatrist Bessel van der Kolk. In 1974, Dr. van der Kolk was completing his psychiatric residency at a VA hospital where he treated veterans returning from Vietnam. He noticed a disquieting pattern of responses in those vets the flashbacks, nightmares, and other symptoms we now associate with post-traumatic stress disorder (PTSD), a diagnostic category that didn’t exist before 1974. It was through van der Kolk’s efforts that the diagnosis was included in the DSM, the manual of diagnostic categories used in mental healthcare.
Last year, Bessel van der Kolk and his wife Betta, a body therapist, attended an evening talk I gave at Kripalu on Yoga and depression. Afterwards, he told me that he will not treat a trauma survivor illness he or she is also practicing Yoga. His emphasis on involving the body in treatment, and in particular, his ongoing advocacy of and research into the effects of Yoga, has caught the ear of psychotherapists around the world, especially those who deal with clients recovering from trauma.
My own book, Yoga for Depression, has been embraced by many in the mental health profession, and I have been invited to speak at international conferences on depression, and to offer trainings to psychotherapists in ways that they might integrate Yogic strategies into their work with clients.
What kind of collaboration are you seeing between Yoga professionals and mental healthcare professionals? It is exciting to see the growing cooperation between Yoga instructors and psychotherapists. Many Yoga teachers who have trained as LifeForce Yoga practitioners are working with psychotherapists in their communities to develop workshops and ongoing group sessions for people with depression and mood disorders. My students are being hired in psychiatric settings at places like McClean Hospital in Belmont, MA to offer Yoga as an adjunct treatment for hospitalized patients.
What role does research play in supporting collaboration?
Mainstream mental health professionals can no longer ignore the evidence that Yoga empowers people with mood disorders to manage their mental health. There is a growing body of research since the 1970′s demonstrating the efficacy of Yoga and meditation for depression. For example, the 2005 issue of the International Journal of Yoga Therapy published an article about Marla Apt and David Shapiro’s recent study at UCLA that demonstrated the positive effect of Iyengar Yoga postures on mood.
In collaboration with researchers at Harvard University, I am conducting a study on the effects of the LifeForce Yoga Program on mood. We are also conducting preliminary research on mood during LifeForce Yoga Institute retreats. So far, we’ve measured the mood change before and after a five-day retreat in Tucson and two two-day retreats, one at Kripalu and one at the Crossings. Participants in the five-day retreat showed a 62% increase in happiness, 61 % decrease in sadness, 76% decrease in anger, and 53% decrease in anxiety. Participants in the two-day retreat showed a 39% increase in happiness, 34% decrease in sadness, 54% decrease in anger, and 62% decrease in anxiety.
All three groups included Yoga teachers who had a long-term, regular Yoga practice, psychotherapists taking the course for continuing education credit, and beginning Yoga students suffering from depression. We have data differentiating these groups, but it has not yet been analyzed. I would suspect that when we separate the beginners who are suffering from depression from the professionals, we will find that the reported elevation in mood among the beginners is more dramatic, and that the professionals, especially those with long-term, regular Yoga practices, will show less change in mood from the beginning of the program to the end of the program.
If you weren’t teaching Yoga, how might you be spending your time and energy? Well, for years I was a depressed, ruminative, and mostly unsuccessful fiction writer. I won national literary awards for my short stories and for a novel-in-progress, but I have five unpublished novels stored on old floppy discs and zip drives. I loved my characters, and would like to think that the voices haven’t dried up inside me. Maybe I’ll write fiction again someday, but from a more contented place. On the other hand, it’s possible that my daily practice these past seventeen years has healed my characters, and I won’t meet them anymore. On a recent silent retreat with Richard Miller, poetry began to rise up in me again. Maybe it’s just about slowing down enough to listen.