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."
When she has that image or the word peace in her heart's mind (60 percent of the cells in our heart are identical to the cells in our brain), here's how I lead it: "Inhale while you extend your arms out in front of your solar plexus (your abdomen) for the count of 4. Hold the breath for 4 counts and see that soothing image, or think the word peace in your heart's mind, your mind's heart. Exhale through the nostrils for a count of 6, drawing your hands to your solar plexus." We might repeat the gesture and breath 3 times, and then do another 3 rounds, but this time, drawing the hands to the heart. While holding the breath, I might verbalize a mantra like "I am that." This is the English translation of the Sanskrit Tat tvam asi. When I use it, I'm suggesting that there's no separation between that image of serenity and peace and the client herself.
Once your client is settled and relaxed, you can introduce a breath like stairstep breath (anuloma karma) to clear away the tensions of the day. This involves short sips of breath to fill the lungs, followed by a long slow exhale. You can add a brief 4-count retention, during which you guide your client to envision an image for calm strength, or silently to repeat a calming, soothing, or self-empowering phrase. I resist the impulse to provide the phrase, but I work with my client to allow the affirmation (sankalpa) to arise from the calm state of mind—his natural state of being when the accumulated tensions have been dissolved with his breathing practice. The coaching may come in helping him revise his phrase from future to present tense. So, for example, instead of "May I be calm and clear-minded," he might say, "I am calm and clear-minded." Or if his chaotic mind resists what sounds false in that moment, you might inquire if the phrase "clarity breathes through me now," feels more authentic.
Many clients and students come to therapy or to yoga class in bodies they've disowned. Life has taught them that it's safer to live from the neck up. Without saying "It's safe here" (because the mind might argue against such a notion), the therapist can create, with a few yogic strategies, a sanctuary of safety where clients can begin to sense their bodies again and reoccupy the disowned parts of themselves. Therapists who can teach their clients techniques to self-soothe and manage their moods aren't only empowering them to take control of their lives, but creating a firm alliance and a haven for recovery.
One of the greatest gifts yoga offers someone absorbed in depression, or mulling over a story yet again, is the opportunity to be present to pure sensation. In that moment, the story doesn't exist. Yogic practices absorb the mind in sensation, providing a window into moments of tranquility, when the identification with victimhood or the fusing with the mood is dropped. There's neither resistance nor striving. The fog of depression dissolves, even if fleetingly at first, in the light of the present moment. And you can give your client a glimpse of this feeling of well-being right in the consultation room.
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