Might the practice of yoga Nidra be the new prescription for mental health?

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I’ll never forgot my first exposure to a relaxation technique. It was long before my discovery of yoga and my journey of becoming a licensed mental health provider. I was at a work conference and it was an optional gathering at the end of a long day of attending educational sessions. I don’t know what led me there, yet I am forever grateful. The technique was progressive muscle relaxation, where you tense a specific muscle group for about 5 seconds and then release it for 30 seconds and move through the entire body from toes to face. It was so powerful for me as it made me aware of how much tension I held in my body and allowed me to experience deep relaxation, perhaps for the first time in my life! Fast forward 40 years, I now am a big proponent and teacher of yoga Nidra, which offers a more gentle route to physical sensation awareness and deep relaxation. Could such a practice be the new prescription for mental health?

If you live a stressful life (and who doesn’t in this day and age), chronic stress impacts our mental health, inviting in symptoms of anxiety and depression. All of us having the opportunity to read this blog survived a global pandemic, which was traumatizing and contributed to the global mental health crisis. Stress, anxiety and depression pose major public health concerns, yet conventional interventions, such a prescription medications and talk therapy, have shown limited success in addressing these multifaceted issues. The limitations have encouraged researchers to think outside of the box and explore complimentary and alternative solutions. The amount of research around contemplative yogic practices has grown significantly over the past several decades. Yoga as a practice typically can include movement, controlled breathing, and some opportunity for stillness or meditation, so research struggles to identify what specific parts of the practice have the most impact on our brains and mental health. Overall, the research does suggest that yoga practices have many mental health benefits.

However, not all yoga practices are accessible to everyone. Yoga Nidra is a meditative practice and has gained momentum over the past decade as a potential holistic approach to mental health care. The practice can be offered online and several sites, including UCLA Mindful, have free guided meditations translated into multiple languages. But does it help to reduce symptoms of stress, anxiety, and depression? Well, a recent meta-analysis of 73 studies involving 5,201 participants showed significant benefits of yoga Nidra for exactly these symptoms, reinforcing this practice’s therapeutic potential!

Benefits of Yoga Nidra on Mental Health

Prescribing yoga before medication for sleep disorders?

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As we age, sleep changes and may become more elusive. And sleep is mission critical for our mind/body health and longevity. Personally, as I have gotten older, I’ve kind of become obsessed with sleep, wanting to make sure that I get enough that includes adequate REM and deep sleep. I recently started to wear the Oura Ring to track my sleep and learn what I might be able to change in order to improve my sleep scores. I also read any new research that comes along related to sleep, including the benefits of it, the impact of the lack of it, and what life style changes support better sleep. So, I always get excited to see how such research continues to validate my own personal experience as it relates to the connection between yoga and sleep.

When working with clients and I learn about their struggles with their mental health, I explore their experiences with sleep, including perceptions and barriers to quality sleep. It is important to know that our sleep patterns do change as we age and the days of sleeping “soundly” for 8 hours as a child are behind us. Our circadian rhythms shift, leading to feeling sleepy earlier and going to bed earlier. It can also result in more difficulty staying asleep through the night. Hormonal changes, such as a reduction in melatonin that regulates sleep, can impact our sleep. Data shows that there is a change in our sleep architecture as we age, including spending less time in deep, restorative sleep stages and sleep becomes lighter and more fragmented, with more awakenings throughout the night. Knowing this information is important so we don’t develop thoughts like “I had a lousy night sleep.” just because we woke up several times throughout the night. These thoughts, when repeated, tend to become beliefs that incorrectly inform your mind/body health status. The best indicator of a good night’s sleep is not based upon how many hours of “solid sleep” you get, but instead waking up feeling refreshed and ready to start your day and not relying on caffeine to stay awake during the day.

Dealing with medical conditions, such as pain and urinary problems, can impact our ability to fall asleep and stay asleep as well. If you are taking prescription medications for chronic medical conditions, these medications can impact the quality of your sleep too. Changes in our activity level, diet and social habits as we move into the later stages of life can also impact our sleep. So, when we take a look at the broader view of sleep, we might feel like there is not a lot we can do to improve our sleep. But wait! Knowing that lifestyle factors, such as diet, exercise, and social interactions, have up to an 80% impact on our health and longevity, we do have the opportunity to make such changes.

The benefits of a yoga practice at any age has been shown to have many positive impacts on our mind/body health. And, as the number of people aged 65 and older increases, there are more yoga teachers and classes focused on this population, making gentle yoga and chair yoga options more available than ever. So no need to twist yourself into a pretzel or flip upside down to integrate the practice into your life and reap the benefits from it.

Research continues to show the many benefits of yoga. Specifically, how it improves sleep quality in the elderly, including improvements in sleep disturbance, sleep duration, sleep efficiency, and overall sleep quality. If you would like to read more on the recent research into the beneficial effects of yoga on sleep quality in the elderly, click the link below:

Benefits of Yoga on Sleep Quality in the Elderly

As an intervention, what impact might yoga have in the lives of female survivors of intimate partner violence?

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I know intimate partner violence (IPV) is not a pleasant or easy topic to think and talk about, yet it is the only way forward. When you think about IPV, I suspect most people first think about physical violence. Yet, did you know that psychological violence is the most common form? IPV, in all of its forms, is a serious public health issue, with an estimated more than 30% of women in the US experiencing it. So, as a yoga teacher, I think it is vital to learn how the practice of yoga might support (or harm) female survivors, as a simple yoga class of 10 might have up to 3 or 4 survivors attending.

It is important to acknowledge that not all yoga styles and/or teachers might be appropriate for such survivors. More and more, in the healing arts, a concept of ‘trauma-informed’ is emerging. However, simply taking one course on trauma-informed medicine does not make a trauma-informed provider. In fact, I have learned of many stories (both as a yoga teacher and a psychotherapist) where a teacher or provider claimed to be trauma-informed and actually activated the survival response in the encounter! Therefore, it is critcal to ensure IPV survivors experience the practice of yoga in a way that ensures physical, emotional, mental and psychological safety.

The consequences of psychological IPV include, but are not limited to, depression/suicidal ideation, anxiety, PTSD, low self-esteem, somatic complaints and substance abuse. So, as a holistic healer, I have come to view these conditions as symptoms of trauma and not diagnoses. As such, I am able to offer a different perspective that validates a person’s lived experience and honor their needs on their healing journey. There is much research on how yoga can reduce particular symptoms of trauma, yet more research is needed to clarify the distinct aspects of the yoga being offered and how, specifically the practice is trauma-informed.

 I was very excited to come across a very recent research study from Exhale to Inhale in NYC that did just that! This study included 526 female survivors and data was collected over 3 years and across 66 domestic violence agencies. It clearly describes what makes the yoga trauma-informed and the target symptoms of stress, somatic complaints and self-efficacy. This study showed that trauma-informed yoga is a capacity-building intervention with female IPV survivors.

To read more, click the link below:

Trauma-informed Yoga in IPV healing

Yoga and Your Heart

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When I turned 40, I was overweight and showing signs of being diagnosed with hypertension and high cholesterol, all considered precursors for the development of cardiovascular disease (CVD). I feel blessed as it was the same year that I discovered yoga! By showing up on my mat for myself on a regular basis, I was able to change behaviors that were not supportive of my mind-body health and longevity. I am now 60 and my blood pressure is actually on the low side and my LDL/HDL ratio is 1.3 (which for women is 1/2 the average risk for developing CVD) all without any medications. Is it possible that yoga can play a significant role in the primary prevention of CVD? Let’s check in with the latest research.

Randomized controlled trials (RCTs) are the gold standard research design and meta-analysis is a study design that typically is based on RCTs to systematically assess the outcomes of previous research to extract overall results about a particular body of research. In this month’s Current Problems in Cardiology, a meta-analysis that included 64 RCTs (16,797 participants) studying the effects of yoga on modifiable CVD risk factors was published, so this is hot off the press information! In the introduction to this research, it mentions that 80% of CVD is caused by modifiable risk factors, leaving only 20% due to perhaps family history or genetics (nuture versus nature). The most significant modifiable risk factors include hypertension, diabetes, hyperlipidemia and body weight. Yoga, as an ancient Indian practice, traditionally involves breath practices along with physical shapes and meditation, supporting the balance of the sympathetic and parasympathic parts of the autonomic nervous system. Such combination of exercise and relaxation has been studied and reported to reduce CVD risk factors.

It was my personal experience that yoga and all of its contemplative practices assisted me in reducing my overall stress levels and softened my ‘Type A’ personality that developed from a chaotic (AKA traumatic) childhood. As my stress levels came down, my opportunities to choose healthier experiences for myself expanded. I became a more conscious consumer, in what I ate, what TV and movies I watched, what news I read, and which people I engaged with. I started to notice what charged my batteries and what depleted my batteries and moved towards the uplifting experiences and away from the ones that felt dark and heavy in my body and mind. As a result, I lost weight (and friends), lowered my blood pressure and cholesterol levels, and discovered the freedom of setting healthy boundaries for myself, which is a lifelong gift I gave myself. But, if you don’t want to just take my word for it, take a look at this latest research that concluded yoga is effective in controlling those modifiable risk factors and can play a role in the primary prevention of CVD!

Yoga Effective in Preventing CVD

Benefits of Integrating Yoga Into Postgraduate Mental Health Curriculums

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As we find ourselves in a bit of a lull in the Covid-19 outbreak here in southern California, I have found my way back to teaching yoga in-person in a local yoga studio. My heart is full as I have greatly missed the opportunity to bring this healing modality back in-person to a larger audience. Yoga, including all of its contemplative practices, has been the largest tool in my self-care tool kit, even becoming my way of life over the years, and it is truly what kept me grounded in gratitude through the pain and chaos of the past two years. Although I may not have found myself on my yoga mat regularly, especially for those yummy 90-minute classes that include an extra long savasana shape at the end, I know how important these practices are for supporting our mind-body-spirit health. And, as a mental health provider, I know it is mission critical to prioritize our self-care practices in order to be fully present and prevent burnout. With increasing rates of burnout in mental health providers during the pandemic, the question becomes is it possible to integrate yoga into postgraduate curriculums for mental health providers to ensure the long-term wellbeing of such providers?

A recent research study took a look at including yoga into the curriculum for first-year mental health students to test the feasibility of such a proposal. Introducing such tools to all students in this setting ensures all mental health providers would have the first-hand knowledge and experience of the impact on their well-being before actually moving into the space of providing services to clients, where the stress level of the role only increases. Although the results of this research advocates for such a change to the curriculum, it only provided a brief, 15-day offering. It is my belief that offering longer curriculum based yogic interventions would not only provide more sustained self-care tools to the mental health provider but it would also equip the mental health provider with the skills to bring such self-care tools to their clients.

Yoga Benefits in Postgraduate Mental Health Curriculums

Yoga for helping health professionals during a pandemic

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As a helping health professional (HHP), I rely on my yoga practices to maintain mind-body health, work-life balance, and healthy boundaries with my clients.  When colleagues share that they are challenged to maintain these things and ask me what I might do, my first response is all things YOGA.  The responses I get range from a smile to a rolling of the eyes.  Which got me thinking . . . since HHPs are among the highest risk occupational groups for mental and physical health challenges, is my self-care go-to  (yoga) experience unique to me or might these tools really have a more across-the-board impact on such a group of professionals?

When I first started to practice yoga movement, I noticed how it relieved my low back pain that came from a herniated disc.  It was due to practicing yoga movement on a regular basis that I did not require any physical therapy or back surgery then or now (although I did integrate regular chiropractor adjustments into my self-care practices since).  As my back pain went away and I continued to add additional yoga practices to my activities of daily living, I discovered how much calmer and centered I felt mentally and emotionally.  It was these cumulative positive experiences that motivated me to pursue becoming a yoga teacher and then a yoga teacher trainer!

One of the most powerful yoga practices that has served me well is Svadhyaya.  It is one of the five Niyamas, or sacred habits for healthy living, of yoga.  It is often translated simply as self-study within a larger connotation of introspection.  Most of my yoga practices now occur off the mat, but finding the mat for the movement practice certainly reduced the symptoms of anxiety enough to open the door to the practices that actually become a way of life.  That is why I am so passionate about recommending all things yoga to everyone!

So what does the research say about yoga as a tool to support those in the helping health profession overall, beyond me?  Well, recent research took a look at that exact question.  A systematic review that included 25 research articles around the effectiveness of yoga interventions among HHPs and students found that implementing yoga interventions in this population brings mental and physical benefits across a variety of settings and backgrounds, including a reduction in stress, anxiety, depression and musculoskeletal pain.

If you are interested in reading more, click the link below.  If you are a helping health professional or student, consider sharing this link with those that might be in a position to support the implementation of such practices in the workplace or school.

Yoga Benefits in the Helping Health Profession

Might Yoga Help Prevent Teacher Burnout?

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The pandemic caught most of us off guard and added significant stress to our lives, asking us at times to think out of the box to come up with creative ways to do what we did in the past differently.  In a flash, life went virtual!  Teachers, in particular, who, as a profession rank high amongst those helping professions that are predisposed to mental health challenges due to stress on the job, were asked to convert in-person curriculums to remote learning overnight.  Teachers were already at risk of burnout before the pandemic, with a significant percentage of teachers leaving the profession within the first 5 years.  The pandemic has simply added salt to an already open wound.

Past research has looked at the benefits of bringing yoga into the schools for the students.  This research has shown the positive effects on the developing minds of children, including but not limited to reducing stress and anxiety, improving memory and attention span, enhancing coping skills, and increasing self-confidence and self-esteem.  By building yoga into the students’ curriculum, it was accessible to everyone and was not designated as an optional, after-school activity.  By supporting students in this way, it certainly indirectly helps the teachers.  However, with such a high burnout rate in this profession, it is just as important to look at what might prevent such teacher burnout more directly.

More recent research is now looking at bringing yoga to the teachers at school.  One such recent quasi-experimental study looked at the connection between improving the mental and emotional well-being of teachers through a twice-a-week yoga class, including gentle meditation exercises, and a reduction in burnout.  Yoga, and is contemplative practices, was considered for this research because it is a discipline that has been shown to enhance body awareness and encourages equanimity in the mind.  The design of this research included concern for the need to adapt to the working environment, so that no particular setting would be required, making it easy to replicate.

The research was able to identify a significant, positive effect of yoga on the psycho-physical well-being and resilience response on the job of the teachers.  The program was short, only 8 weeks, and did not identify any risks.  The conclusion suggests that schools would benefit by offering yoga to the teachers to reduce burnout.

If you are interested in reading the full article, click the link below.  If you are a teacher or know a teacher, consider sharing this article with those that might benefit, including the principal of your school.

Yoga Reduces Teacher Burnout

Can yoga influence the gene expression of your DNA?

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I believe so as I personally dove into all of the mind-body interventions yoga had to offer to prevent one of the most important risk factors for cardiovascular disease, which is the leading cause of mortality. Both of my parents were diagnosed with hypertension, with my mother getting the diagnosis in her 30s, and both went on to develop cardiovascular disease that is managed by multiple prescription medications.  When I turned 40, my physician informed me that I was pre-hypertensive, which sent me on a journey that not only reversed this diagnosis, but changed my life in so many other ways!  Different life experiences can influence your genes and cause subconscious behavioral patterns that are passed on over generations, including trauma.  And now we might be discovering how yoga and all of its contemplative practices can change and perhaps undo the damage of such life experiences.

There is a newer focus of research that is digging deeper into how the contemplative, mind-body practices of yoga impact our genes, especially in relation to the stress response and inflammation.  This body of research is looking at the autonomic nervous system’s response to stressful events, specifically the pro-inflammatory gene expression pattern.  The human body’s autonomic nervous system is made up of two main branches, the sympathetic and the parasympathetic.  When presented with signals and sensations, the autonomic nervous system responds and takes one of three pathways through these two main branches to keep us safe.  The oldest route from an evolutionary development perspective leads to immobilization (think freeze/faint) through the parasympathetic dorsal vagal nerve branch.  The next pathway to develop led to the mobilization response (think fight/flight) through the sympathetic nervous system branch.  The final one to evolve led to social engagement (think safe and social) through the parasympathetic ventral vagal nerve branch, which is unique to mammals.

When danger is sensed, the human body’s autonomic nervous system travels backwards through the sympathetic nervous system’s fight/flight response and then perhaps, if we feel trapped, to the parasympathetic dorsal vagal nervous system’s freeze/faint response.  When the body arrives in the space of immobilization for survival, it can be a long and painful journey back to the space of feeling safe and social.  So anything that might make this journey shorter and less painful is welcome!  That is where understanding how yoga can support such intentions is vital.

Without going too deep into the science (click on the button below to read more if interested in a deeper dive), when the human body encounters stress and triggers the sympathetic nervous system, it increases production of chemicals that regulate how genes are expressed, activating genes to produce proteins called cytokines that cause inflammation.  When these higher levels of cytokines persist over time, the human body is put at a higher risk of a whole range of diseases, including cancer and psychiatric disorders.  This newer research is finding that people who practice mind-body interventions such as mindfulness meditations, yoga or Tai Chi, actually reflect the opposite effect, namely a decrease in the production of cytokines, leading to a reversal of the pro-inflammatory gene expression pattern.  One of the more recent studies considered one of these mind-body interventions, specifically meditation, an emotional and attentional regulatory activity that supports a state of inner quiet.  From this inner quiet grows increased self-awareness which has the power to reduce stress-related symptoms.

To read more about the growing evidence that stress can cause changes in gene expression and how intentionally engaging in mind-body practices can transform the genetic effects of stress, click below:

Effects of Meditation on Gene Expression and Epigenetics

Can yoga change your brain?

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What if we could see inside of our brains when we are practicing our deep breathing, sun salutations, and savasana?  Would you want to see/know what parts of your brain are being turned on and off or growing and shrinking?  Well, this might not quite be reality yet, however, with neuroimaging technology what it is today, it is pretty close!  When I started my yoga practice almost 20 years ago, I didn’t know what the practice did to my brain if anything, I just felt relief each time I left class.  Now, all these years later, it excites me to know that it supported my brain’s own natural ability to heal.

Before discovering yoga, I was a workaholic that was in a constant state of flight or fight with the world around me.  I figured I had inherited my mother’s anxiety and there was nothing I could really do about it.  Boy was I wrong!  My first yoga class spoke to me in a way that I had never experienced before, calling me back to the mat that first year 5 to 6 times a week.  I thought it had become my new addiction, yet it changed me so profoundly that I was finally able to find the long sought after balance I craved in my life.

I believed yoga was a huge contributor to my healing journey, although at the time I might not have fully understood how it worked.  Today, with the integration of neuroimaging and neurophysiological techniques into the study of yoga, research has begun to reveal consistent structural and functional changes in the brain.  With the benefit of magnetic resonance imaging (MRI), positron emission tomography (PET) and/or single-photon emission computed tomography (SPECT) scanning, the benefits of yoga are lighting up our brains!

Although the various research studies have looked at different aspects of yoga, such as movement versus meditation as well as styles of yoga, these studies reflect relatively consistent cerebral structural and functional changes.  What this tells me is that you can’t do it wrong!  It doesn’t matter if you practice Iyengar, Yin, Hatha and/or Kundalini yoga, it will help your brain.  It doesn’t matter if you practice movement, breathing techniques, meditation or chant, it will help your brain.  And with all of the different approaches, including Kids and Chair yoga, yoga is available to help our brains throughout the entire life cycle.

Fast forward with the increasing popularity of yoga worldwide, research is still scarce in yogis yet it is expanding with the assistance of neuroimaging.  And this research is showing that yoga effects the brain both structurally and functionally, specifically in areas involving interoception, posture, motivation, and higher executive functions.  Moving forward, more research is needed to reflect the changes in the brain through neuroimaging when the brain is suffering from the effects of anxiety, depression, PTSD and other stress-induced mental health challenges.  I would have loved to see what my brain looked like before discovering yoga and after integrating my practice into my everyday life.  I think the results would have been very validating!

What Does Neuroimaging Demonstrate on the Neurobiology of Yoga

Can yoga – and all of its contemplative practices – contribute to a healthier cognitive aging process?

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My husband and I try to remember to laugh when we walk into a room and then have to stand there for a few minutes because we realize we forgot why we were heading there in the first place.  And I think a sense of humor is critical in many circumstances, so applying it to myself as I age is putting a value into action!  However, instead of accepting the gradual decline in the neural circuitry of the brain as we age, what if you were to learn that there was a simple way to preserve the connectivity in our brains that contributes to overall health?  Would you be willing to try it?

Well, with the assistance of brain imaging, research studies can see the impact of contemplative – or attentional – practices on very specific areas of the brain, which opens the door to more rigorous studies that shed light on how such practices can support a healthier cognitive aging process.  These brain imaging techniques have shown that there are changes in the functional connectivity of our neural networks as we age.  Now the idea of ‘before and after’ imaging can be applied more broadly in research, beyond the studies that focus on prescription medications.

My experience when I am able to give something my full attention is one in which the memory of the moment is so much richer and stronger, whether it is a conversation with someone or simply sitting outside in nature.  I find that I can more easily recall the details of the experience when reflecting on it, almost as though I am experiencing it again in all of its colors and textures.  So if there is something I can do to help support the health of my ability to maintain my attention, I say ‘sign me up!’

Recent data from studies looking specifically at yoga and other contemplative practices such as meditation suggest that such practices may revert, at least in some part, the effects of aging on the functional connectivity in the brain.  The intention of the research is to look at how using the body and breath as the focus of contemplation helps to preserve cognition and the neural connectivity of those brain areas that typically decline with age.  When we hold the body in one of the shapes of a yoga practice, and bring the mind’s awareness to focus on the experience of the breath in that shape, it supports the parts of the brain that support cognition and brain connectivity.  Sounds pretty good to me for simply moving the body and breathing with intention and attention!

If you are so inclined to read more about the details of a recent research study looking how yoga and other contemplative practices impact specific parts of the brain involved in maintaining a healthier cognitive aging process, click the link below:

Functional Connectivity in Elderly Yoga Practitioners