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By Amy Weintraub
Take a Breath
Q: I've recently joined a yoga class and notice how much lighter and happier I feel afterward. I'm wondering if there are aspects of yoga that I can offer in my office to help my clients.
A: Many yoga strategies appropriate for a clinical setting can help your clients manage their moods more effectively at home and increase their sense of self-efficacy. Some yoga techniques can help you and your client right there in the session. Ancient yogis didn't have fMRI's or CAT scans, and yet, using the laboratory of their bodies and minds, they developed a system to help us sustain a more balanced state of being. A qualified yoga teacher or yoga therapist can teach your client many mood-managing practices that don't belong in the consultation room, but you yourself can use certain yogic tools without becoming a yoga teacher.
Let's start with the breath. Yoga teaches us that the breath is a pretty good indicator of mood. Often when people are depressed, they're breathing so shallowly that they may not be getting enough oxygen to the brain. Oxygen and glucose are two main building blocks for neurotransmitters, so if the shoulders are slumped and the breathing is coming from the upper chest, the brain may not be getting the components it needs to create the biochemistry of well-being.
Imagine that your client is slumped on the couch and saying little. You might invite her to sit up straighter, place her right hand on her belly, and breathe in through her nose so she can feel the breath lifting her abdomen against her hand. As she exhales, encourage her to feel the rhythm of the breath through her hand. Once she feels comfortable doing that, you can suggest that she place her left hand on her chest so she can feel the breath first moving into the bottom of her lungs and then expanding into her rib cage. Suggest that she release the breath slowly, drawing the navel back toward her spine. The next step would be to invite her to bring the breath first into the lower part of the lungs, expanding the belly, then into the midsection of the lungs so the chest lifts and the ribcage expands, and then all the way up to the collarbone. Again, she releases the breath slowly. You might suggest a 4 count in and a 4 count out.
What you and she are doing is a yogic breathing exercise known as Three-Part Breath (Dirga Pranayama), about which research is accumulating, especially research on its effects on the parasympathetic nervous system.
Let's say your client tells you she can't get a deep breath sitting on the couch. It may be easier for her to learn this breath from a supine position. If you and she are comfortable and your floor is clean, you can invite her to try the breath lying down.
Another way to facilitate this deep-breathing practice for someone who's struggling is to invite your client to make a simple sound, like "ah" or "e-i-e-i-o." To make the sound, she'll have to take a deep breath.
Asking a client to make such a sound can be an excellent way to interrupt a panic attack. When a client is experiencing an inability to breathe normally because his level of anxiety is high, he isn't going to be amenable to the suggestion to take a deep breath. He can't. But if you ask him to sing "e-i-e-i-o" with you, you're tricking his mind into taking a deep breath. As he sings with you, he's letting the breath out slowly, and research shows that a slow exhalation is calming to the autonomic nervous system.
Let's say your client is jumping out of her skin. Her speech is rapid and chaotic. You've pieced together that her 3-year-old has a temperature and a cough, her babysitter was late, she's gotten a speeding ticket on the way over, and she's just learned that her full-time position in the university library has been cut to part-time. She may lose her benefits, which might include her treatment with you. You both might need a little self-soothing at this point, and she certainly would benefit from a calming, cooling breath. (One added boon of teaching your client a yogic strategy is that you get the benefit, too!) You might teach her to use an alternate-nostril-breathing practice (nadhi sodhana) to calm and balance her mind. Studies have shown a correlation between unilateral nostril breathing and hemispheric activity in the brain, which effects mood.
You might teach her another self-soothing technique that involves breath, imagery, and sound. Yogis have been using guided imagery (bhavana) and sound (mantra) for thousands of years to help balance and manage mood. Invite her to close her eyes and imagine a place where she feels calm and serene—either a made-up place, or one she remembers where she felt totally relaxed and at ease. Some people have trouble visualizing, but I resist the impulse to suggest an image, because I want my clients to feel that they're in the driver's seat. "If an image isn't there," I'll say, "then simply think the word peace."