Previously it was believed that the ‘talking cure’ (Freud and Breuer, 1895) was the one and only treatment option for individuals suffering with mental illness. Yet yoga’s presence in the literature on psychotherapy has been noted as far back as 1918 and possibly further. Winter (1918) in ‘The Yoga Systems and Psychoanalysis’ compared, contrasted and related Freudian and Jungian psychoanalysis with Patanjali’s Yoga Sutras. Ever since there has been numerous writers and researchers proposing an integration between psychotherapy and Yoga and it seems that this is currently happening.
Over the last number of years various forms of psychotherapy such as Cognitive Behavioural Therapy (CBT), body-centred psychotherapy and self-help programmes such as the 12 Steps have been looking to the past and incorporating ancient traditions such as yoga and mindfulness meditation, as a means of improving treatment options and outcomes for individual with disorders such as depression and anxiety, addiction (substance misuse, eating disorders, self-harm) and trauma.
Cognitive behavioural psychotherapy makes a person aware of how their thoughts (psychological) affects their feelings (emotional) and behaviours (physical). Through education and awareness it aims to help people overcome problems and make progress towards personal goals by teaching new and more effective coping skills (Williams and Garland, 2002) such as mindfulness. By learning mindfulness techniques the person is more aware of all incoming thoughts and feelings, is able to observe them and accept them but is taught not to get attached to them or react to them (Linehan, 1993). Thus leading to improving such things as; health, self-care and self-regulation; anticipating, preparing for and managing stress; behaving more effectively in testing situations; and minimising or coping with unpleasant thoughts and feelings.
Similarly, yoga is recognised as a form of mind-body therapy that integrates the physical, mental and spiritual elements of an individual. It can be used as a process of self-investigation and self-regulation. Through asanas and meditation, the individual can direct attention inwards toward their health and wellbeing to improve these aspects of their lives (Iyengar, 1989).
Body-centered psychotherapies use movement-based and body-centered techniques to assess and treat psychological and physical distress thus supporting the processes of change and transformation (Aposhyan, 2004). A recent study ;Yoga Based Body Psychotherapy: A Yoga Based and Body-Centered Approach to Counseling, by Livia Shapiro (2012) looked at incorporating yoga into body-centered psychotherapy. Shapiro (2012) stated the aim of the approach was to overtly bring yoga postures into the context of body psychotherapy to support further development of body-centered ways of counseling, and to afford a new lens for the practice of yoga postures by making their inherently therapeutic nature overt in the context of a psychotherapy session so that eliciting emotional material becomes a potentially viable content for healing, growth and change…(p.42) The research of this study found that introducing yoga postures into the psychotherapeutic process provides body psychotherapy with another means of movement analysis and structural intervention to explore, thus broadening the scope of the field.
Much research has been conducted over the years citing the relevance of yoga practice in recovery from addiction. Studies have suggested that the skills, insights, and self-awareness learned through yoga and mindfulness practice can target multiple psychological, neurological, physiological, and behavioural processes implicated in the relapse (Khanna and Greeson, 2013). In various articles, comparisons have between the infamous 12 Steps programme and Patanjali’s Yoga Sutras. The 12- Step is a set of guidelines involving physical, mental, emotional and spiritual processes, which when abided by helps the individual to become sober and maintain their sobriety (Wilson et al.,2001). Similarly, Patanjali cited the eight limbs of yoga as ethical principles and practices for living a meaningful, purposeful, moral and self-disciplined life which leads to spiritual awakening.
In addiction treatment and rehabilitation facilities and addiction models, yoga is now often present as a part of the therapeutic structure (Lohman, 1999). Various rehabilitation centres are using integrative approaches to the treatment of addiction such as ‘Yoga of 12-Step Recovery’ and ‘Yoga of Recovery’ (Hawk, 2012). In his documentary film ‘Addiction, Recovery and Yoga’ Senior Iyengar Yoga Teacher and filmmaker Lindsey Clennell, interviews a several people who have combined the 12 step model with yoga as part of their recovery from various addictions (substance misuse, gambling, relationships). Their experiences highlight the positive outcomes of yoga in recovery (www.adyo.org).
More and more prisons are incorporating yoga and meditation curriculums. In America, the Prison Yoga Project was founded by yoga teacher James Fox. Since 2002, Fox has been teaching yoga and mindfulness meditation in various prisons across the States. Through his teaching, Fox recognised most prisoners are suffering from complex trauma and discovered that yoga can have a positive impact on alleviating symptoms. His experiences led him to found the Prison Yoga Project. The project advises prisons, private entities and/or individuals about establishing yoga programs as part of a rehabilitation program, and provides an already proven to be effective curriculum and protocol. Additionally the project offers trainings for yoga teachers who are interested in working with at-risk populations (Prison Yoga Project).
In 2008, the International Journal of Yoga Therapy published a study by Pashupati Steven Landau and Jagat Bandhu John Gross, titled Low Reincarceration Rate Associated with Ananda Marga Yoga and Meditation. In this five-year study, Ananda Marga (AM) Yoga was taught to 190 male inmates at Wake Correctional Center in Raleigh, NC. The results of the study concluded that Ananda Marga Yoga and meditation can safely and effectively be taught in prison to a varied population, irrespective of religion or race. Inmates voluntarily participating in four or more Ananda Marga Yoga/meditation classes were found to have a lower than expected re-incarceration rate.
A randomised controlled trial by Carter et al (2013) looked at a yoga based breath programme for Australia Vietnam Veterans with various disorders such as Post Traumatic Stress and substance misuse.The participants were encouraged to do daily yoga practice at home for 20-30 minutes in the morning and 10-20 minutes in the afternoon. They were offered group sessions once a week for one month and once a month thereafter. The 6 month follow up revealed improvements in measures of PTSD and in reducing substance abuse. These positive responses occurred despite the veterans having 30-year histories of treatment-resistant severe PTSD, alcohol abuse, and dependence on disability status.The study discussed the intervention of mind –body techniques as a valuable tool in the treatment of PTSD.
Another treatment approach which is rapidly developing is Trauma-Sensitive Yoga.Trauma sensitive yoga is founded in the belief that yoga helps people discover a different relationship to their body, one that is gentler and more forgiving, requiring practising kindness and patience. It allows for investigation of new positive habitual body patterns and explore new ways of being physical that have not been previously considered. Experimenting with these patterns and discover healthier and more expansive ways of being that in turn advances self-understanding thus awakening possibility (Emerson and Hopper, 2011).
The studies presented in this article have cited the need for further research into which styles of yoga are best suited to treating the different types mental illness. Outcomes also indicated that people’s beliefs about yoga may influence participation in yoga and outcomes of yoga interventions (Atkinson and Pemuth, 2009).
Cautions have been highlighted in the use of yoga and meditation as therapy. In trauma-sensitive yoga teachers must take into careful consideration the use of physical adjustment due to the many forms of trauma an individual may have experienced, for instance a physical touch by the teacher could be a trigger and lead to flashbacks of past abuse (an example of which is highlighted by Emerson and Hopper’s 2011 book, Overcoming trauma through yoga, p. 125). Similarly.
meditation may permit deepened access to the unconscious leading to the unlocking of latent memories of past trauma (Miller, 1993). However these concerns can be combatted through the use of comprehensive assessments for each client starting treatment, in order to insure they can tailor the therapies to the needs of the individual (e.g. using visual and verbal cues for yoga adjustments, altering the intensity of meditation).
Whether or not yoga is a panacea for mental illness remains to be seen, however increasing evidence indicates yogas and meditations profound usefulness with psychotherapy as an integrative approach, which in its true essence is what the Sanskrit term for Yoga means, union and integration.