Every Season of Life Matters

I’ve lived in four season climate my entire life. Sometimes the seasons seem a bit confused. But the reality is they come and go in varying degrees. Some people feel because of this variation that seasons don’t matter. This sentiment should not carry over into our lives, and yet it seems to.

We go through seasons in our lives. Great seasons and terrible seasons, chaotic seasons and calm seasons. No matter the season the expected and unexpected matter, and it matters that we understand that. Embracing the season may not be easy, but it is important all the time. Our circumstances are not a life sentence, and we need to embrace the idea that our circumstances are opportunities. How do we overcome the tension of difficult seasons and welcome opportunities for influence? First is the awareness that all seasons are important, these things can happen.

Nature’s seasons teach us about ourselves. In winter we go inward and do our internal work, reflection, hibernation, and planning brings self-reflection. Then spring comes and offers a chance for renew, learning, opportunity and progressive thinking, an opportunity for learning. The summer arrives while we steep and marinate in our new growth, rewards, celebration and fulfillment, happiness. Finally, fall comes, and we shed what no longer serves us, for survival, mistakes and problems, pain.

In summer you’ll find yourself undertaking these activities: Networking, traveling, leisure, accomplishing goals, taking risks, proactive action, expanding your comfort zone, thinking optimistically. In summer you may be experiencing these emotions: excitement, passion, euphoria, courage, confidence. The evolution of summer requires real plans, preparation, solid choices and decisions, prolonged self-reflection, capitalizing on the right opportunities.

What impact has the summers had on your life?
What have summers taught you about yourself and others?
How have summers transformed your personality?

In autumn you’ll find yourself undertaking these activities: avoiding responsibility, contracting your comfort zone, hesitating, thinking unrealistically, ineffectively and pessimistically. In summer you may be experiencing these emotions: anger, anxiety, frustration, stress, disappointment and overwhelm. The evolution of autumn requires certain factors that come into play that naturally enable us to transition through this phase like ineffective decision-making, failure to capitalize on opportunities, ignorance, mistakes stemming from ineffective thinking and mistakes originating from limiting habits of behavior.

What impact have autumns had on my life?
What have autumns taught me about myself and others?
How has autumn so transformed my personality?

In winter you’ll find yourself undertaking these activities: time for finding inner peace and solitude, time for bonding with family, friends and loved ones, time for journaling thoughts and feelings, time for thinking critically, realistically, problematically and thoughtfully about life. In winter you may be experiencing these emotions: guilt, fear, relief, grief, hope. The evolution of winter includes these factors of lack of emotional intelligence, reactive behavior to losses and uncontrolled circumstances, ineffective choices, habits, and thoughts.

What impact has the winters had on my life?
What have winters taught me about myself, life and others?
How have winters transformed my personality?

In spring you’ll find yourself undertaking these activities: developing new skills, habits, and social contacts; altering personal mindset; expanding knowledge, options, and opportunities; setting goals; thinking strategically, tactically and insightfully. In spring you may be experiencing these emotions: love, trust, joy, gratitude, appreciation. The evolution of spring of enhanced self-belief, increased self-confidence, solid reflection time that enables you to clarify what you want most in life are factors that come into play that naturally allow us to transition to this phase of life.

What impact have the springs had on my life?
What have springs taught me about myself, life and others?
How have springs transformed my personality?

The seasons of life are always changing as a result of the choices and decisions that we make on a daily basis. The life seasons transition naturally from one phase to another because of they are simply a reflection of our human nature. Our seasons of life are temporary just as nature’s seasons are. The joy you feel during summer will not last forever, the length of time it takes us to process through each season is simply a reflection of our state-of-mind a reflection of our ability to adapt to the conditions and circumstances we find ourselves in. The seasons of life are there to teach us lessons about ourselves and our lives. They are there to help us grow emotionally, physically and socially. When we succeed we celebrate. When we fail, we complain and blame, and eventually find our way into contemplation of who we are, what we want and how we would like to show up in the world. All of this shapes our character, paints the canvas of our life as we evolve. We naturally create and transition between the four seasons of life as a result of our responses and reactions to people, events, and circumstances. How we respond to our environment will directly influence what we get back from our environment whether they are problems or opportunities.

Yoga Therapy helps you build tools that allow you to flow through these seasons. It teaches you how to support, love and forgive as you go through these seasons of life. So you can ride the waves of life seasons with grace.

Which season are you currently transitioning though at this very moment?
How have the seasons shaped your character?
Have the seasons strengthened your character?
How have seasons of life enriched your experience of life?

The seasons of life don’t necessarily cycle from summer to autumn to winter to spring and then start over again. They transition any-which-way depending on the emotional choices and decisions we make on a daily basis.

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Case Study Fibromyalgia

Case study for a forty-four-year-old male named Kevin diagnosed with Fibromyalgia (FM). The case study is to inform Kevin how yoga therapy can support him with his health concerns as well as persuade him to challenge some of his belief systems and lifestyle patterns. The purpose of this paper is to communicate how the Pancamaya Model can assist healing at multiple layers of his being and to outline clinical decision making and the rationale of the proposed treatment plan. The plan will also make suggestions of attitudes of behaviors the client may want to consider changing by growing their knowledge on specific topics. An attempt will be made to evaluate client outcome for subsequent sessions as well as a method of evaluation to measure these results. A sample summary of the proposed plan of care for the client’s primary care physician (PCP) is provided. The goal of the paper is to inform the reader concerning FM, to evaluate the written intake form and to persuade toward Yoga Therapy (YT) as a treatment plan. Given the written intake provided about Kevin, I conclude as a complement to his current care plan that Ayurveda and Pancamaya Model tools will change Kevin’s life and lead him on a healing journey.

Introduction

Can you imagine having a disease that causes widespread pain throughout your body, all conventional tests come back normal, and yet your entire life is being affected by this pain? Fibromyalgia (FM) is a disease that knows no gender, culture or age and affects over 10 million Americans a year, with a higher occurrence in women, according to the National Fibromyalgia Association (NFA). This paper will take you through a snapshot of Kevin’s life. Kevin was a security officer at a high-security government facility with “negative air flow” and high mental stress, frustration and anger which he found difficult to manage. He was a volunteer firefighter. He enjoyed socializing and participating in his community. It is estimated by NFA that FM affects 6% of the world population.  The individual patient on average spends $1,000 out of pocket per month above their health care program, while it costs the United States health care system upwards of $14 billion a year and an overall national productivity loss of two percent. What do you do when you are so ill it is affecting every area of your life? You appear healthy on the outside and you may be told you are making it all up. “Controlling the breath is the precursor to controlling everything about your life- the physical body, the emotions and the spirit.” – Sam Dworkis

While we are just beginning to untangle FM and its truths, one thing seems to be clear, it affects the central nervous system, and its symptoms can come on slow or quickly. FM on PubMed shows over nine thousand research studies have been done to date. Some of them are showing there is a difference in physiological abnormalities such as increased levels of Substance P in the spinal cord, decreased levels of blood flow to the thalamus, HPA axis hypofunction, low levels of serotonin and tryptophan and abnormalities in cytokine function. Given the written intake provided about Kevin, I conclude as a complement to his current care plan that Ayurveda and Pancamaya Model tools will change Kevin’s life and lead him on a healing journey

As a practicing mind-body practitioner for a decade and in school studying to receive my Masters of Science in Yoga Therapy, I have experienced first-hand the struggles of patients with FM and how mind-body modalities of movement including yoga therapy can enhance FM patients’ quality of life. This paper will first discuss a literature review concerning FM. Second, we will examine the Pancamaya model. Third, we will describe clinical decision making, treatment plan, client education and outcome evaluations. Finally, we will provide a summary of professional communication for Primary Care Physician (PCP).

Literature Review

YT can be applied to neurological and immune disorders such as pain and FM. In this literature review I will show that YT may have a role in the treatment of pain and FM by improving physical and psychological aspects as well as a quality of life. The Fibromyalgia Impact Questionnaire (FIQ) appears to be the gold standard for measuring outcomes during FM research. FIQ measures seven factors related to FM: pain, fatigue, anxiety, depression, morning stiffness, awakening unrefreshed and disability.

 Physiopathology may include the central nervous system (CNS) dysfunction related to pain modulation as well as neuroendocrine dysfunction and dysautonomia meaning a disorder of autonomic nervous system (ANS). (Bir, 2016) Researchers seem to agree thus far that FM is a disorder of central processing with neuroendocrine/neurotransmitter dysregulation.

FM is characterized as having a heightened sensitivity to sensory input. It has a complexity of symptoms such as widespread musculoskeletal pain, stiffness, fatigue, disturbed sleep, dyscognition, affective distress and reduced quality of life. (Bir, 2016) At this time there is no diagnostic lab test for FM, but there have been elevated levels of a pain mediator called Substance P found in spinal fluid in FM patients, indicating there is a problem in the processing of pain sensations in the spinal cord and brain which greatly amplifies pain. Their pain is real and can be debilitating even though the sensation is out of proportion to the actual damage or trauma. (McCall, 2007)

The majority of FM patients have four or more co-morbid pain or central sensitivity syndromes (CSS). Irritable bowel/bladder, headaches, pelvic pain, regional musculoskeletal pain syndrome, restless leg syndrome, and chronic fatigue suggest a shared pain processing. (Mist, 2013) FM and its common co-morbid diseases seem to have a central sensitization link. In a randomized, double-blind control study, pramipexole (dopamine agonist), a D3 agonist, has been shown to be effective in FM. Several studies have shown that the biology of depression is different in FM. Dexamethasone test shows no suppression in major depression compared with mostly normal suppression found in FM. The HPA axis is hyperactive with hypercortisolemia in major depression as opposed to relative hypocortisolemia in FM. The depression observed in CSS patients, including alpha-delta sleep has different characteristics. (Yunus, 2007)

Interventions with little side effects such as physical and behavior approaches may be valuable contributors for FM treatment. (Bir, 2016) An eight-week yoga program which included gentle poses, meditation, breathing exercises, coping methods and group discussions with a three-month follow-up showed significant reduction of symptoms of FM. Symptoms of FM that decreased were: pain, fatigue, stiffness, sleep problems, depression, memory, anxiety, tenderness, balance, vigor, and strength. Psychological improvements in coping with FM pain also improved by utilization of problem solving, acceptance, relaxation and activity engagement instead of using maladaptive strategies. (Bir, 2016). Female FM patients underwent an eight-week course in mindfulness-based-stress-reduction (MBSR) and found a modest reduction in anxiety symptoms but no decreased rates for pain or health-related quality of life indicators. However, when they took individuals and did an eight-week trial that included yoga, meditation and education there was a sizeable reduction in pain. These two eight-week programs suggest that a strategy of combining MBSR, yoga, and meditation may be more efficient than any of these techniques done singularly. (Bradshaw, 2012) A twenty-eight percent reduction in FIQ scores was noted after a two times per week eight week Hatha yoga research session. They included a blend of yoga styles including Hatha vinyasa, kundalini, and Iyengar. (Rudrud, 2012) The data seems to be consistent with earlier reports on ‘mindful’ meditation therapies reducing sleep disturbances, fatigue, and depression and improving the quality of life. Sub-analyses have found that only yoga also relieves pain. (Mist, 2013)

FM poses a financial burden on our society both in the use of health care costs and the result of an inability to work and lost income that FM patients face. (Rudrud, 2012)  Titrating practice to the patients’ energy level is critical and requires an understanding of relevant pathophysiology since FM is likely due in part to altered pain processing in the CNS and peripheral nervous system. Additional factors include genetic predispositions, autonomic dysfunction, and emotional, physical or environmental stressors. (Mist, 2013) FM, to our knowledge at this time, does not progress, cause death or do damage to joints, bones, internal organs and so on. (McCall, 2007)

Pancamaya Model

The following will be a snapshot of Kevin’s intake form using the Pancamaya model which will describe the full depth of how yoga therapy can impact his healing process.

Annamaya Kosha/ Physical Body:  Kevin explains his general health as “in pain and surviving.” He is forty-four years old. His physical body feels widespread pain. He has strong areas of pain in his feet, hands, elbows, and shoulders. He indicates symptoms such as heart palpitations, lower abdomen cramping, rashes, fatigue and so on. His current medical conditions include FM (2013) with co-morbid conditions of obesity, sleep apnea, insomnia, depressive symptoms, high blood pressure, glaucoma, gastrointestinal dysfunctions, borderline personality disorder and transforaminal lumbar interbody fusion and posterior instrumentation of L5-S1. He has debilitation for multiple days after engaging in physical activities such as mowing the lawn. He gets to bed at eight p.m. and wakes at five a.m. He does not rise rested, and it takes several hours to get moving. He relies on his furniture during this time. His dietary intake has been irregular, high caffeine, dairy, carbohydrates and nicotine (new to a cessation program) until recently. For work, he walks ten miles a day with heavy boots and carrying heavy cages on his shoulders. He currently takes Colace, Mirilax, Lumigan, Lisinopril, Bystolic, Nortriptyline and Piroxicam. (May want to ask your Dr. about SAM-e S-adenosyl-l-methionine and 5-HTP 5-hydroxytrypotophan as it may help improve tender points) He sees the following doctors: Rheumatologist, Ophthalmologist, PCP, Neurologist, Dentist and at times Psychotherapist. (Possible additional referrals may be: acupuncturist, massage therapist- not deep tissue, marma therapist and an osteopath) As a yoga therapist, I would be interested in observing the following in Kevin:

  • Muscle tension locations,
  • Guarding behaviors,
  • Posture,
  • Ease of casual movements, and
  • Testing limitations in ROM.
  • Also, what planes of motions cause him more or less discomfort?

I am curious to explore the following questions with Kevin to develop more clarity:

  • How long can you sit/stand before you want to sit/stand?
  • How is this affecting your life?
  • Is it getting better/worse/same?
  • Describe a twenty-four hour day in your life.
  • What do you do during your free time?
  • What health care practitioners/therapies have helped you the most? What worked? What did not?
  • Was it pedicle screws or cages?

Right now Kevin has a separation from his physical body and lacks awareness of his Ayurvedic constitution. The goal will be to build body awareness through asana, a standing practice on high energy days and a restorative practice on low energy days. Each practice should be done at 50%-60% of that day’s energy level-less is more, also look at developing an appropriate diet and lifestyle routine for him. Warm sesame oil self-massage before bathing and at bedtime, soothes vata and nourishes skin, joints and nervous system. A fifteen-minute oil massage then taking an Epson salts bath is preferred.

Pranamaya Kosha/ Energy Body: Kevin is having sleep apnea with breath cessation of over one hundred seventy-five times per night and wears a CPAP machine at night. Kevin is sleeping on average nine hours a day. He has significant fluctuations in appetite/diet with associated weight gain/loss. Kevin has gastrointestinal dysfunction with bleed fissures from the colon. His energy levels have been extremely low. Kevin left a high-stress job and his current job has significant physical demands and he must wear a ventilator the entire day. Kevin experiences energetic challenges. He has heart palpitations, anger and anxiety. As a yoga therapist, I would be interested in observing the following in Kevin:

  • Breathing pattern during discussions,
  • Breathing pattern while we did some movement,
  • Where does he breathe the best?
  • What is his self-report of his breath awareness and description?
  • Does he have the ability to calm body tension by calming breath?
  • Does he report that he feels his ability to calm the body with breath?

I would be interested in asking him the following questions:

  • How is your overall digestion?
  • What do you do to manage your stress?
  • How often do you suffer from insomnia and how long does it last? How is your immune system?

Kevin is showing signs of energy blocks especially in the lower chakras and lack of breath awareness. The goal will be to build breath awareness and to reconnect him with nature and other sources of prana. Apana vayu will help to ground the lower chakras and to help with nourishing the eliminatory systems, prana vayu to nourish the immune system and udana vayu to nourish the nervous and endocrine systems.

Manomaya Kosha/ Emotional Body: Kevin experiences headaches and has an informal diagnosis of depression and possible borderline personality disorder. He has very few memories before age seventeen. He feels let down by his health care team and describes his experiences as “shuffle him through too quickly.” His previous job had high mental stress, frustration and anger that he found difficult to manage. He is open to returning to psychotherapy in the future. He experiences mental and emotional challenges and has mental/verbal disturbances. He has experienced significant life events such as the death of sister (2006), recovery of a dismembered child’s body as a firefighter, loss of a job as a firefighter and social community due to his health. He lives near his parents but prefers solitude and therefore does not socialize much. I would be interested in observing the following:

  • Speed of speech
  • His ability to understand what is being taught and is he able to pick it up quickly or slowly
  • Do I see tamasic, rajasic or sattva qualities

Additional questions that I have are:

  • How is your short and long term memory?
  • How do you continue educating /feeding/exercising your mind as you age?
  • How is your mood? Positive/negative/ moody?
  • What does your pain mean to you? Why do you think your pain persists? How much of your life is impaired by pain?
  • How much better do you believe you can feel?
  • How would your life be different if you did not have widespread pain?
  • Is there anything you have discovered about yourself from having widespread pain?
  • Point to where it hurts most? What have you done for it? Does it radiate down the extremity? Numbness, tingling, weakness, dizziness, nausea, altered vision/hearing?
  • Can you tell me about the non-pain sensations you can feel in your body? In areas of pain, tension, or discomfort?

Kevin shows signs of awareness with his thought patterns and emotional reactions. Using Yoga nidra with eyes open, introspective asana, R.A.I.N. meditation and five-minute sprint or gratitude journaling, and introduction to Rosenberg style of nonviolent communication process may help him explore healthy emotional expression.

Vijnyanamaya Kosha/Wisdom Body: He has practiced paganism mostly on his own rather than in a community setting. He prefers solitude. I would like to observe his personality, values, ability to be self-reflective and how he interacts with the world around him. I would like to engage in conversations regarding these questions:

  • What motivates you to live a full life? What do you do every day to feed that interest or passion?
  • How do you view your life experiences? Glass half full or empty? Can you shift that perspective?
  • What old habits are you carrying around that are affecting your ability to be happy with your life?
  • How do you view your communication skills?
  • How open-minded are you?
  • Are you easy going or a perfectionist? Are you demanding of self and others?
  • Do you struggle with boundaries of speaking the truth in a way that can be received?

Kevin is struggling to see the big picture and to flow through the roller coaster of life with its painful ups and downs. The goal will be to teach Kevin to be the witness, to learn how to focus and stabilize the mind and access discriminating intuition which informs us, as he is whole and complete. Meditation, as part of sadhana (practice), quiets the mind (manomaya kosha) and frees us from misperceptions (vijnyanamaya kosha). Journaling this process is a tool for healing on the manomaya kosha and vijnyanamaya kosha by pacifying the mind and revealing wisdom.

Anandamaya Kosha/Bliss Body: Kevin can be prone to frustration, anger, anxiety and depression. His spiritual connection is strong and practices paganism.  His relationships are lacking due to his poor physical health. I would want to observe his level of joy, depressed, ability to be present, scattered, disassociated or connected. Questions that I would have for Kevin would be:

  • What brings you joy? What takes you away from joy?
  • Do you have personal relationships in your life? Do they connect you to your inner joy?
  • How does paganism connect to your inner joy?
  • Do you have a teacher/mentor/guide? What form does that take for you – a teacher, counselor, friend or parent?

Kevin appears to have a strong spiritual connection. I believe getting him to integrate the natural self into everyday living is the challenge. The goal may be to get him to read some spiritual books that align with his belief system and how what he reads aligns with the nature of the true self which is all aspects of life. Yoga Nidra can be used to relax the mind and the body, accessing stillness, peace and bliss as a reflection of our true self. Yoga nidra is a healing technique for all four lower koshas and a way to experience the bliss of the anandamaya kosha. Using meditation, as a method, allows the joy and bliss of anandamaya kosha to arise.

The primary dosha which is present in FM is Vata disease. Ayurveda views FM as having two leading causes. First, there is a disturbance in the nervous system function called vata and the second is an accumulation of toxins and blockages called ama through the physiology. Once these imbalances reach critical levels, the nervous system becomes less stable and aggravating impurities accumulating in the body is the breeding ground for fibromyalgia to be created. Indicating that there is a lack of trust in the universe and at a young age he was imprinted with thoughts of “I am not enough,” safety and security issues.  The kidney stones that he removed in 2014 indicate he is struggling with fear. (Lad, 2008) Vata imbalance expressed emotions that Kevin presents with are fear, anxiety, loneliness, emotional instability, and mood swings. He also shows signs of a Pitta imbalance with feelings of frustration and anger. Often Vata imbalances have ignored body signals or pushed through them. The metabolic fire is burnt out and as a YT we will want to get it moving again.

A difficult and insidious cycle that afflicts FM patients is the sedentary life because exercise is painful. The body feels like cement, the lack of exercise results in weight gain and fuels depression, which then makes it hard to overcome the lethargy of FM. The patient feels heavy, darkness around the eyes and has dullness to the skin. It is important to share with the client that at some point during their movement practice they will turn a corner. As you move your body, the “fuzz” (Fascia) will break up. The importance of movement and stretching is to maintain the sliding properties of the tissues in the body. Fascia seems to be tactilely tighter in pain points, learning to use your breath and stretch can help loosen fascia to make movement easier and more pain-free. Suggesting that the patient develops a movement routine that meets 50%-60% of their energy capacity that day, oil massage before or after their bath/shower, eating warm vegetables and working to learn to manage their stress response can help FM patients deal with a disease that is poorly understood medically and publicly.

Clinical Decision Making, Treatment Plan, Education and Evaluation

Titrating a practice that will match the patient’s energy level that day is important, a one size fits all program does not work because it must be able to flex and flow depending on energy levels. The more the patient practices with consistency, the more they will develop discernment of monitoring their body’s response and make better choices.   There are several contraindications to be aware of with Kevin with FM and the co-morbid diseases he is experiencing.

Contradiction Related Disease
Hot humid rooms Gastrointestinal Dysfunction, Insomnia
Transitioning to quickly FM, HBP, Depression
Full Inversions/ Strong Backbends Obesity, HBP, Glaucoma / Anxiety, Insomnia, HBP,
Strong breathing techniques/ left nostril breathing/ right nostril breathing Anxiety, HBP/ Depression/Anxiety
Strong Twists Gastrointestinal dysfunction (if struggling with diarrhea)
Vigorous repeated flow FM, Insomnia, HBP, Gastrointestinal dysfunction
Undo weight on particular joints (one-limb balances) Obesity
Careful with praise & corrections, avoid practicing near mirrors, eyes open and use grounding meditations Personality Disorder, Depression

Yoga therapy can help by teaching FM patients how to manage their stress response and learning breath techniques which will calm an agitated, nervous system and generate an inner sense of peace. Yoga Nidra and deep relaxation can help them to improve their sleep. Starting a meditation practice can help FM patients selectively focus their awareness and modulate the pain sensations down to a more manageable level. Consistent asana can improve posture and create better alignment of bones, and muscles. Introspective asana can help FM patients express what they are feeling as a huge emotional backlog may be lodged in the tissue causing pain. Sangha “community” therefore encourages patients to join an FM support group. Patients feel alone and misunderstood. A group can help them to share health care professionals, tips and facilitate connection with others.  “Let’s go into where in your body you feel that despair and that sadness, and let’s breathe into that, and release as much of it as we can.” Ana Forest

Kevin’s goal concerning YT is to establish a regular self-care routine to support a healthy life balance, ultimately decrease pain and improve physical functionality and overall quality of life.  Kevin’s home care plan will focus on establishing self-care mindfulness routines such as: creating good sleep hygiene routines, Yoga nidra before bedtime, walking meditation that he can use on his ten-mile walk, eating meditation, nature meditation, learning how to make driving, showering, tooth brushing and shaving a meditative routine as well as starting a journal practice. Eventually, we will build into developing a high energy day movement practice and a low energy day movement practice. We will start on the low energy practice first with a goal to use this as home practice. It is important to understand that FM patients only wake up with a certain quantity of spoonful’s of energy each day and they need to be able to have choices to modify for their needs that day. Other meditations that we may grow into are loving-kindness, separating two arrows and mudra meditations. An example of a good energy day practice may be: (vata reducing practice) mountain, wall push, chair, warrior 1, seated chair twist, low lunge, child’s pose, legs up wall, lotus, staff, one leg seated forward fold, seva pose, Savasana with a natural relaxed breath as they relax into stillness (3 blankets under knees, 1 blanket rolled for ankle, eye open, wrap a blanket around top of head, ears, neck and neck roll). An example of a low energy day practice may be: supported half dog an a table (1 or more folded blankets), supported relaxation pose (5 blankets, block, 2 pillows) towards the end adding some gentle arm movements, Seated Forward Fold leaning on a chair, Supine twist (1+ blankets), heal slides, cobra, and standing flowing twist, spinal movements at a table or counter. The goal for the first session is to go over the intake and create some additional clarity through conversation, set boundaries for our working relationship, to agree upon mutual goals between YT and client, to do a body scan and breath awareness techniques (an audio recording for client will be made and emailed to them).

It is important to teach Kevin that pain can be reduced, managed or eliminated if we move in a range-of-motion (ROM) that does not cause increased pain. If he does move into increased pain, the nervous system sees exercise as a stimulus and responds. If Kevin moves within his respected ROM his body will shift. Small steps make for significant change.  He may surprise himself. Kevin should try to move in as pure of a movement as he can and reduce compensation of which he may be aware. Those that move in their ROM improve faster than those who do not. Often the way the body unwinds and unravels tension and holding patterns is not the way we think it will go. A journaling suggestion for Kevin maybe to answer the following questions:

  • What did I do yesterday that left me feeling overdone today?
  • Do I have less pain than usual the day after YT session/ practice?
  • Am I relaxed and energetic?
  • If I practice YT sessions regularly does my mood improve? How about my sleep?

Realizing it may take longer to notice benefits than for the average person but in time he will continue to see the benefit of practicing. Journaling if he has less pain than usual the day after practice, recognizing if he is relaxed and energetic, as well as mood and sleep improvement will help track the progress that is being made for the mind. Also, using the FIQ and having the patient rate on a scale of 1 to 10 (1 = passive nothing going on and 10 = vigorous and painful) for a workout intensity level and asking that they workout at nothing above a 3-5 will help them learn to do subtle work, effort with ease, allowing for a steady practice of growth with less setbacks or injury.

See Appendix A for Home Plan of Care until the next YT

See Appendix B for PCP letter summarizing YT assessment with proposed plan of care (I would also enclose a YT FM brochure that had the latest research)

Conclusions and Future Study

Teaching FM patients to fully participate in CAM programs such as YT may produce long-term benefits and help erode self-defeating beliefs by taking control of their self-care. (Bir, 2016) A greater number of randomized control trials (RCT) are needed and current research supports YT as CAM for FM. Participants who completed weekly journals suggested increasing it to more than once a week because it did not capture the richness and variability of their experience. (Rudrud, 2012) Future research determining the role that a charismatic or caring YT plays rather than the intervention itself along with standardization of protocols, scripting mindfulness interventions, posture sequences and a range of modifications is needed. (Mist, 2013) CSS paradigm seems an important new concept with considerable significance that deserves further exploration. (Yunus, 2007) This growing body of research is proving that FM is not a made up disease and one that needs to be taken seriously.  Allopathic, Ayurveda, and Pancamaya model tools can lead to an incredible healing journey.

References

 

Bir, S. K., Cohen, L., McCall, T. B., & Telles, S. (2016). The principles and practice of yoga in

health care. Pencaitland, UK: Handspring Publishing Limited.

Bradshaw, D. H., PhD., Donaldson, G. W., PhD., & Okifuji, A., PhD. (n.d.). Pain Uncertainty in

Patients with Fibromyalgia, Yoga Practitioners, and Healthy Volunteers. International Journal of Yoga Therapy, 22, 2012th ser., 37-45.

Frawley, D., & Kozak, S. S. (2001). Yoga for your type: An Ayurvedic approach to your Asana

practice. Twin Lakes, WI: Lotus.

Lad, V., & Durve, A. (2008). Marma points of Ayurveda: The energy pathways for healing body,

mind, and consciousness with a comparison to traditional Chinese medicine. Albuquerque, NM: Ayurvedic Press.

Lasater, J. (1995). Relax and renew: Restful yoga for stressful times. Berkeley, CA: Rodmell

Press.

McCall, T. B. (2007). Yoga as medicine: The yogic prescription for health & healing: A yoga

journal book. New York, NY: Bantam Dell.

Mist, S., Firestone, K., & Jones, K. D. (2013). Complementary and alternative exercise for

fibromyalgia: A meta-analysis. JPR Journal of Pain Research, 247-260. doi:10.2147/jpr.s32297

National Fibromyalgia Association’s Home Page: Join us here. (n.d.). Retrieved August 06,

2016, from http://www.fmaware.org/

Page, J. L., & Page, L. L. (2014). Mudras for Healing and Transformation (Second ed.).

Sebastopol, CA: Integrative Yoga Therapy.

Page, J. L., & Page, L. L. (2005). Yoga toolbox for teachers and students: Yoga posture cards for

integrating mind, body & spirit: A powerful tool for healing. Shelby, NC: Integrative Yoga Therapy.

Rudrud, L., EdD. (n.d.). Gentle Hatha Yoga and Reduction of Fibromyalgia-Related Symptoms:

A Preliminary Report. International Journal of Yoga Therapy, 22, 2012th ser., 53-57.

Siegel, R. D. (2010). The mindfulness solution: Everyday practices for everyday problems. New

York: Guilford Press.

Yunus, M. B. (2007). Fibromyalgia and Overlapping Disorders: The Unifying Concept of

Central Sensitivity Syndromes. Seminars in Arthritis and Rheumatism, 36(6), 339-356. doi:10.1016/j.semarthrit.2006.12.009

 

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Yogic Principles

What does it mean to incorporate more saucha, santosha, and svadhyaya in a client’s life? How can niyamas (specifically these three mentioned above) affect chronic pain?  Chronic pain is driven less by tissue damage and more by sleep, mood, thoughts, and emotions. Chronic pain diseases interact with their nervous system, immune system, and endocrine system.  Learn how the principals of the niyamas (also known as observances/ moral commitments) help clients relate to their inner self, the private ritual regarding self-care and how they can apply to those living with chronic pain. Learn how saucha, santosha and svadhyaya interact with the disease mechanisms/ pathways and the connections between physical, mental, emotional and social health. Find out how yoga therapists apply the niyamas with their clients. It is a journey, not a process; they check off their list. Taking it one-step at a time and proceeding with compassion (versus worrying about perfection) is needed while the client learns to dance on their edge of pain and comfort.

Saucha/ Sauca (Yoga Sutra 2:40-41) is purity and at the root concerned with keeping different energies distinct and maintaining the sanctity of the energy around us (Satchidananda, 2005). Using the perspective that there are shattered pieces of themselves, what seems like broken pieces are, what make them whole – they are a soupy mess of transformation called growth.  When faced with a chronic disease and rushing to doctor’s appointment… and subsequently rushed diagnoses in allopathic medicine the client leaves feeling fragmented as their body is talked about objectively in pieces. Practicing saucha they can un-fragment and start to see themselves as a whole. As a yoga therapist, using practices like pranayama and chanting Om (Aum) can help unify their head and heart, bringing them into the present moment. Breathing into intense discomfort at times dissipates the pain. Having a pranayama and chanting practice can bring the body into deep relaxation, relieving tension, tightness, reducing mental noise, agitation, and self-doubt.

Clients loved ones mean well; and while the customer is the ones sitting in the room facing the disease head-on, health care providers and loved ones do not see “them” anymore. They, like others, are approaching the experience with a cluttered mind scattered with thoughts. Clients leave their healthcare appointments with even more scattered thoughts than when they came. Taking a moment to practice pranayama at the end of a meeting can bring closure.   Before the appointment, it can bring clarity to the mind resulting in improved communication during the doctor’s appointment. Taking time to slow down is hard especially in our society where hurrying, multitasking and busyness are often viewed as success symbols.   They are killers of saucha (purity). When they can use pranayama to cleanse themselves, there may be a visceral reaction a feeling of being lighter, having more space and mental expansiveness. The side effects of practicing saucha are feelings of being more alive; their mind is clearer, and the heart is more compassionate (Adele, 2009).

Through pranayama, an inner cleanliness can help with being healthy (Deiskachar, 1995). The external cleanliness of the body and internal cleanliness of pure food digested removes impurities of mind such as arrogance, conceit, and malice (Keller, 2015). Sattvic food is light, fresh and nourishing.  Items such as grains, seeds, fruit, vegetables and dairy food promote health (Fields, 2001).

Santosa/ Santosha (Yoga Sutra 2:42) is being content with what they have already attained and wanting what they already have, accepting what is and making the best out of everything (Satchidananda, 2005).  Approach it from the perspective of; they are responsible for their disturbances.  Waves of emotional disturbance such as being upset, hurt, left out, not appreciated, put upon and mourning the past could be considered giving their emotional state away to someone or something outside themselves.  This is their loss of control and contentment.  The verbal explosion and ruminating are a waste of useful energy, silence, withdrawal, confiding in someone can be helpful.  At the time of diagnoses of a disease, using their energy to heal is very important. The toll is high when they are facing disease and at times have tunnel vision their health and well-being are affected, they have emotional and physical pain, misunderstanding and sloppy work. When they are upset and replaying negative events, they are the ones disturbing the flow of life, not the noise and storms in their lives. They keep themselves out of contentment because emotional disturbance can be traced back to them (Adele, 2009).

As a yoga therapist, using journaling and tracking times that clients are not in pain is a useful tool. Journaling what activity they are doing at that time as well as keeping a gratitude journal can help build more santosha (contentment) in their lives. Accept what has happened with the new diagnoses versus dwelling on the past.  Learn during the process and do not attach results with their actions.  Save them disappointment and despair as they navigate the new waters of living with chronic pain (Desikachar, 1995). Journaling can help uncover pain patterns and triggers that increase episodes of pain as well as patterns that bring them great joy and decrease pain. In learning these patterns, it allows for a better understanding of self and improved communication with health care providers. As a yoga therapist clients respond well when focusing on the patterns that bring joy and decrease pain. Journaling does not always have to be about a health record or pain; it can be about happiness, creativity, feelings, and needs. Journaling helps in the healing from stresses and traumas.  It has been linked to boosting the immune function in chronically ill patients (Murry, 2002).  Twenty minutes a day of pen and paper can be cathartic for the writer (Baikie, 2005). Santosha is the absence of desire beyond what is immediately necessary to maintain one’s life.  They feel that what they have been enough (Keller, 2015). The lack of greed results in calmness and serenity regardless of external and internal circumstances and working toward preventing mental disturbances (Fields, 2001).

Svadhyaya (Sutra 2:44) is the study of one’s self through careful observation (Satchidananda, 2005). If they think of self-study from the perspective of “being the witness.”  There is power in becoming the observer of themselves and learning how their belief system works. Can the need for fixing themselves, while controlling to keep things the same, be changed? Can they witness their reactions and respond with choice?  A yoga therapist might suggest to the client to observe their thoughts, feelings and emotional disturbances looking for clues about their matrix of belief systems. What are the stories they are telling themselves? Can they watch the ego rather than identify with it? Listening brings healing.  Beginning to know their self as something different than who they thought they gave them the opportunity to know their true self.  Understanding how they create their reality marks progress in their growth. Be curious to a beginner’s mind stepping outside their boxes and becoming free (Adele, 2009).

As a yoga therapist, using transcendental meditation ( technique, based on ancient Hindu writings and founded by Indian guru Maharishi Mahesh Yogi, by which one seeks to achieve a relaxed state through regular periods of meditation during which a mantra repeated) to help the client build svadhaya or self-study. Transcendental meditation can help support the autonomic nervous system, neuroendocrine axis, cardiovascular and immune systems and well as supporting the physiology state and function through changing life conditions reducing stress (David Lynch Foundation, 2016). 

Yoga eventually influences all aspects of a person: mentally, emotionally, spiritually and physically. Many layers in the yoga philosophy can support a client in approaches to relax, energize, remodel and strengthen body and psyche. As Swami Sri Kripalvanadji stated, “When you pick one petal from the garland of yamas and niyamas, the entire garland will follow.” These niyamas mentioned here can provide direction to participants for clients that are finding it difficult to focus their thoughts and calm their mind. As starting any new endeavor, it ‘s hard in the beginning, but if the client continues to grow and learn about the niyamas, they will bring new behavioral patterns and a deeper understanding of how to build these practices into their life, until one day you realize they have become part of their heart and mind.

 

 

 

 

References

Adele, D. (2009). The Yamas & Niyamas Exploring Yoga’s Ethical Practice (pp. 105-161). Duluth, Minnesota: On-Word Bound Books.

 

Baiklie, K., & Wihelm, K. (2005, August). Home | BJPsych Advances. Retrieved March 08, 2016, from http://apt.rcpsych.org/

 

David Lynch Foundation. (n.d.). Retrieved March 08, 2016, from http://www.davidlynchfoundation.org/

 

Desikachar, T. (1995). Living in the World. In The Heart of Yoga: Developing a personal practice (Rev. ed., pp. 101-102). Rochester, Vermont: Inner Traditions International.

 

Fields, G. (2001). Value Theory and Ethics: Health and the Good in Yoga. In Religious Therapeutics: Body and Health in Yoga, Ayurveda and Tantra (pp. 109-111). Albany, New York: State University of New York Press.

 

Keller, D. (2015). Patanjali’s Yoga Sutras- The Niyamas: Inner Observances. In Heart of the Yogi: The Philosophical World of Hatha Yoga (pp. 145-146). Doyoga.com.

 

Murry, B. (2002, June). Writing to heal. Retrieved March 08, 2016, from http://www.apa.org/

 

Satachidananda, S. (2005). Sadhana Pada Portion on Practice. In The Yoga Sutras of Patanjali (11th ed., pp. 131-151). Buckingham, Virginia: Integral Yoga Publications.

 

 

 

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Applied Yoga Philosophy

In this paper you will learn how the classical text of Ramayana has influenced my life and my yoga practice. I will discuss the core principles and/or teachings of this text with regard to historical context and to the contemporary application of it today. I will also describe how the teachings in this text have influenced my role as a Yoga Therapist and how it is applicable to my clients.  Ramayana gives insights into how to live our various dharma’s and ethical standards at times of mental turmoil. It teaches us lessons of mortality and is a guide for righteous living. Ramayana inspires old and young and cuts across all barriers such as income levels, cultures and religions from around the world. The Ramayana story retold by William Buck is one that speaks to me. (Buck, 1976)

Ramayana was originally written in Sanskrit in the tradition of Vedas. The story is about the romance of Rama and the Court and the struggle of good over evil. It contains twenty-four thousand couplets (verses). These verses were written in thirty-two syllable meters called sloka (two line verses with sixteen syllables each). The meter is called anustup, chapters are called sargas and books are called kandas (of which there are seven). Each phrase of the story is connected to the next phase. This text dates back to 880,000 BCE (before Common Era or Christian Era). (Anonymous, “Ancient World History”)

The most important lesson that Ramayana teaches us is the relationship between Dharma, Artha, Kama and Moksha. Ultimately we are striving for Moksha and if we follow our Dharma we will obtain Moksha however at times Artha and Kama muddy our ways as we lean toward excess or scarcity in these categories rather than defining what is enough for us to fulfill our Dharma. I love how Rod Stryker describes the four desires. He says: Dharma in simple terms is the drive to fulfill your potential, you might also think of it as your duty (daughter, sister, etc.); Artha refers to material resources that will help you fulfill your dharma; Kama is the desire for pleasures of all kinds and Moksha is the longing for liberation and true freedom. (Stryker, 2011, pp. 20-23)

Ramayana is relevant more than ever in our modern society. Ramayana can be used as a set of values or a code of conduct in how to love our individual life, our family life, our career and how to connect with others in society. The young can learn from their mentors/ elders about wisdom in practicing the lessons taught in Ramayana. Currently in our society I see an undertone of solitary accomplishments being a metric of success. Success equated to worthiness, yet we are born worthy and unity is success. Relationships are being based on economy and greed instead of love, honesty and loyalty. Think of your hand for a moment. What if each finger did its own thing? How much can you accomplish with one finger? When all five units work together what can you accomplish then? We have teens who don’t heed parental advice and parents that aren’t concerned with their teen’s future. We have students that don’t respect teachers and teachers who don’t impart wisdom to students. We are one.  We breathe the same air, drink the same water and put our pants on the same way. Unity is diversity. We must all do our own work to understand ourselves better to be at peace for the world to be at peace.  One of my character strengths is the love of learning. I remind myself every day to take my acquired book knowledge and put it into practical knowledge to live by. “Ramayana is more than just a story. It assimilates principles of science and psychology, within its broader fold of spirituality and wisdom and this affords an all-inclusive solution.” –Dr. Ramesh Kumar Gupta

 How do we preserve our values? We are busy working hard to achieve individual success through greed and disregard for family, spouses, friendships, and fortunes. We have lost sight of what is truly important; unity, connection, loyalty, family, higher power, purpose and love. “Spirituality destroys narrow mindedness and confers unity, cooperation and universal peace.” ~Sai Darshan Pressures to perform deteriorate our life.  Without connection and spirituality we end up losing ourselves and our happiness. (Gupta)

Rama said in the second battle episode of the siege of Lanka: Vibhishanal! Self-confidence is my chariot and my courage and patience are its wheels. Truth and character is my flag while my strength, knowledge and self-control and goodwill are the four horses of my chariot. Forgiveness and uniform behavior are the ropes used to tie these horses. Faith in God is my charioteer while contentment and charity is my sword and axe respectively. My principles are my arrows. Devotion to the Brahmana’s and to my preceptor is my impenetrable amour. What other means of victory can one crave for? (Bhanot, 1992, p. 12)

My life and work is filled with love and through the life lessons of Ramayana. I can inspire myself and others to heal through movement. The fourteen lessons that Ramayana teaches us and I apply in my profession as a Yoga Therapist are:

If I come back to my soul’s dharma code I can relinquish my excess of wants in materialism and sense pleasures. I have dharmas or duties to carry out through other roles such as being a wife, daughter, friend, aunt, Yoga Therapist etc. Working through my four desires and developing clarity on my soul’s dharma code has helped me stay grounded as a Yoga Therapist while guiding my clients in finding clarity for themselves.

 Ramayana’s lesson of being married to one partner in our lifetime is built on long term meaningful relationships that are loyal and respectful of both parties. I like this quote by Kabbalah “We all come to this world as half a soul, we stumble about in this existence, trying other halves, preparing for the day when we will meet our kindred spirit. That’s when life really begins, that’s when it picks up speed and starts to flow and we can cast off. But we can’t meet that kindred spirit unless we discover our mission in life first.” It reminds me to do my work so others can do their work as well. Relationships are not perfect. They require growth, forgiveness and compassion especially after the affinity fades and the relationship changes into something that isn’t as new.  Relationships are a living moving piece of art that is always seeking balance and harmony. By having boundaries for myself and as a Yoga Therapist it allows me to have compassion and empathy. Happiness is obtained from the inside not from the outside.

If we take our time and speak our truth we are keeping our promises and honoring ourselves and others. As a Yoga Therapist I use my tools from Marshal Rosenberg (Psychologist and creator of nonviolent communication) and speak in a style that is non-violent and honor the profession and me. This maybe at times saying “I don’t know, I’m struggling with that myself, I feel this professional would be more helpful, I can’t fix but I can guide you to finding a more comfortable space if you are willing to do the work.”

It is my duty as a pioneer in this field to be respectful of the client in front of me, to my peers and those coming behind me. Reminding myself of my own detachment challenges without disappointment. Reminding myself to stay in a professional role rather than a friendship role with my clients so that they we can detach as a celebration of how far they have come without disappointment.

Not to listen to pointless and useless stories of my life especially stories that are vicious. It reminds me that my personality or way of healing my not be right for everyone and it is okay to excuse myself from a relationship with a client if I feel it isn’t providing healing for the client and a strain on my energy level. There are many needing guidance.

Not to accept valuable goods or presents from anyone, as this does the service of Yoga Therapy an injustice. A fair wage for the session provided is enough. I always tell my clients the greatest gift you can give me is to first heal yourself and then share your story, tell others about this service and then invite them to start their work.

Sometimes things come to you in disguise and to try and not get swayed by suspect attractions. Follow my gut and trust my personal intuition. As a Yoga Therapist I can always ask curious questions to understand things better and to see if what I’m feeling is client’s truth.

To always speak mindfully and to think before I speak sometimes my findings as a Yoga Therapist should be just that; my findings. My words could cause the client harm. They don’t need to know all of my assessment findings right from the start as they are usually coming to me wounded from a trauma of some sort. I want to create a trust, a safe place emotionally and physically- then I guide them through layers of self-discovering and healing as they are ready and ask for the knowledge and specifics.

All people have value and deserve to be treated fairly. No one deserves to be part of a violent act whether that is verbal or physical or be the subject of cruelty or bullying behavior. As a Yoga therapist I always lay out the expectations of what I agree to bring to each session and what I ask my client to bring to each session. It sets a boundary and a tone of what to expect during our times together.

My life and work is filled with love that moves people to heal; I am light in a dark world. I believe love exceeds all barriers. As a Yoga Therapist (I ask first) I always give my clients a hug on the way out. Hugs are healing and so many times I am the only loving touch they received all day. Vitamin L (love) is what will heal the world.

As a Yoga Therapist I am only their guide on this great adventure of theirs. They have to do all the work. I’m humbled and honored that they chose me to guide them.

We are wired for connection, belonging and friendships. As a Yoga Therapist I create times where there is a sense of community at the studio. A place where like-minded individuals can go, belong and friendships can be made. The connections here have a major impact on our local community.

Those that have the biggest bark, the toughest exterior, the souls that hurt others are the ones that need help the most. I pray daily for strength to be given to me, for the wisdom to ask the right question that will help them heal. On the inside they want love, connection and belonging more than anyone.

At times I have to jump into the middle of a fire to set a higher standard. As a Yoga Therapist I hold myself to high standards, others say they are impossible standards. As a teacher I guide my clients to lean into their fears to find calm waters and to set a standard for themselves and role model it to others.

 

References

Ancient World History. (2012, July 22). Retrieved October 19, 2015.

 

Bhanot, T. (Ed.). (1992). Ramayana: Part 9: Battle episode 2. (p. 12). Nai Sarak, Delhi: Dreamland Publications.

 

Buck, W. (1976). Ramayana: King Rama’s way (35th ed.). Berkeley, California: University of California Press.

 

Gupta, R. (2011, April 4). Ramayan for our daily lives – The Times of India. Retrieved October 19, 2015.

 

Stryker, R. (2011). For the purpose of the soul. In The four desires: Creating a life of purpose, happiness, prosperity, and freedom (pp. 20-23). New York: Delacorte Press.

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