Yoga Therapy

Theory and Practice

Ellen G. Horovitz, Staffan Elgelid, Ellen G. Horovitz, Staffan Elgelid

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317597896
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Yoga Therapy: Theory and Practice is a vital guidebook for any clinician or scholar looking to integrate yoga into the medical and mental health fields. Chapters are written by expert yoga therapy practitioners and offer theoretical, historical, and practice-based instruction on cutting-edge topics such as application of yoga therapy to anger management and the intersection of yoga therapy and epigenetics; many chapters also include Q&A "self-inquiries." Readers will find that Yoga Therapy is the perfect guide for practitioners looking for new techniques as well as those hoping to begin from scratch with yoga therapy.

Section II

Models of Practice

5 Yoga and Neuronal Pathways to Enhance Stress Response, Emotion Regulation, Bonding, and Spirituality

Patricia L. Gerbarg and Richard P. Brown

Practicing is not only playing your instrument, either by yourself or rehearsing with others – it also includes imagining yourself practicing. Your brain forms the same neural connections and muscle memory whether you are imagining the task or actually doing it.

Yo-Yo Ma

Figure 5.1

© Can Stock Photo Inc.

Introduction

Although the methods, concepts, and terminology used in psychotherapy, yoga, and neuroscience differ, each discipline sheds light on aspects of the mind, body, and spirit. Studying their points of convergence enriches our understanding and generates fresh approaches to maintaining and restoring physical, psychological, emotional, and spiritual wellness.

Traditional psychotherapies consider the bodily presence of both the patient and the therapist, but have relied predominantly on verbal communication between the mind of the therapist and the mind of the patient. Body-centered treatments such as Emotional Freedom Techniques (EFT), Eye Movement Desensitization and Reprocessing (EMDR) (Shapiro, 2001), Somatic Experiencing (Levine, 2005), and “energy work” are being used more in Western health practices, although their roots are in Eastern traditions. In contrast, the eight limbs of yoga engage and seek to unite the mind, body, and spirit. Based on the assumption that the mind is an expression of brain function, neuroscience probes the activity of anatomic structures, neural pathways, neurohormones, and brain chemistry.

As with all human knowledge, the science of the mind begins with observing inexplicable events that compel us to find explanations. Here we will examine what neuroscience has to say about the effects of mind–body practices on wellness and how to incorporate specific practices into psychotherapy. The main focus will be on breathing practices because they are essential in yoga, Qigong, meditation, Judaism, Christianity, Islam, and tribal religious practices worldwide (Brown & Gerbarg, 2009, 2012). Our interest in how specific breath practices help restore physical, emotional, and spiritual health grew out of listening to people describe transformative experiences during and after yoga breathing workshops and from working with survivors of mass disasters such as the September 11, 2001 terrorist attacks on the World Trade Center. In addition, teaching selected breath practices to patients in treatment for anxiety, depression, or PTSD appeared to enhance their capacity to tolerate and benefit from treatment. Initial responses included reduced anxiety and worry, as well as improved sleep, mood, concentration, and wellbeing. Over time, the daily use of breath practices enabled patients to experience more positive emotions such as love and compassion. Some became more aware of other people’s feelings, more insightful about their own emotions, and better partners in close relationships. This discussion will include our clinical observations, the results of research studies, and our evolving hypotheses about how breath practices affect stress response and emotion regulatory systems. The central theme will be bonding, a human capacity that is essential for physical, emotional, psychological, cognitive, and spiritual wellbeing.

Human Bonding and Love

Human bonding usually refers to the process of developing a close, interpersonal relationship or attachment, most commonly between family members, partners or friends, but it also exists among groups such as military units, first responders, sports teams, co-workers, theater ensembles, community volunteers, and others engaged in intense collaborative efforts. Bonding usually involves trust, loyalty, commitment, love, empathy, and caretaking (Bowlby, 1969). People can also bond with animals, sometimes more deeply than with humans.

Plato proposed that love directs the bonds of human society. In The Symposium (c. 385–380 BC), he said that the highest form of love “is directed, in temperance and justice, towards the good, whether in heaven or on earth: happiness and good fortune, the bonds of human society, concord with the gods above.” Socrates asserted that the highest purpose of love is to become a philosopher or, a lover of wisdom. In other words, to Socrates, there is no higher bond than the bond of love between a philosopher and wisdom.

We suggest that the neural substrates for human interpersonal bonding may also support other kinds of deeply meaningful attachments, for example, to a cherished belief, an idea, a deity, a higher power, a community, a nation, all of humanity, or the universe. Consider how many people have been willing to die in defense of an idea that they love more than life itself. In this sense, meaningful bonding is essential for human love relationships with others, self-love, and spiritual love, all of which can be impaired by stress, trauma, neglect, or betrayal. Such adverse experiences are known to cause temporary and long-term dysfunctions in stress responses, emotion regulatory systems, and the capacity for healthy relationships. The authors propose that interventions that enhance or correct the functioning of these impaired systems should be therapeutic or restorative in any or all domains of bonding.

Stress Responses and Homeostasis

Stress and trauma challenge the capacity of regulatory systems to maintain homeostasis and optimal levels of functioning. Wellbeing can be viewed as a healthy, predominantly positive subjective sense of one’s physical, psychological, and relational state that depends upon the ability to effectively respond to stress or perceived danger, endure the burden of allostasis/adaptation to stress, and return to a normal homeostatic condition upon resolution of the stress or threat. Acute or cumulative stressors may overwhelm the capacity to restore homeostasis, resulting in dysfunction in autonomic and neuroendocrine systems (McEwen, 2007). When this occurs, the systems become less efficient and less flexible, burn more energy, generate more free radicals, and lead to damage to the organism. Acute over activity of the sympathetic nervous system (SNS) may be necessary to survive immediate danger through fight-or-flight responses. However, chronic over activity of the SNS and hypothalamic-pituitary-adrenal (HPA) axis can result in illnesses such as cardiovascular or gastrointestinal disease, inflammation, and neuronal damage due to excess levels of excitatory neurotransmitters, free radicals, and cortisol (Streeter, Gerbarg, Saper, Ciraulo, & Brown, 2012).

The Autonomic Nervous System

The autonomic nervous system is well known for maintaining automatic functions including respiratory, cardiovascular, digestive, and glandular. More recent research on evolution and neurobiology is revealing that it also plays a major role in positive social behaviors such as bonding, care-giving, social communication, and emotional expression (Carter, 1998; Porges, 2009). The autonomic system has two main branches, the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The SNS contains both a behavioral activation system (BAS) that motivates us to seek rewards and a behavioral inhibition system (BIS) that protects us from acting too impulsively and helps us to avoid harm (Beauchaine, 2001). Activation of the SNS leads to increases in adrenaline and glucocorticoids in preparation for fighting or fleeing. Once the threat has passed, the SNS should quiet down and its counterpart, the PNS, should become active to slow the respirations and heart rate, restore resting patterns of blood flow, rebuild energy reserves, and reduce inflammation.

The main pathway of the PNS is through the two vagal nerves (10th cranial nerves), which innervate all the internal organs and other internal tissues. Each vagal nerve contains multiple pathways. About 30% of vagal fibers (efferents) carry messages descending from the brain to the body. These messages regulate the autonomic functions such as heart rate, respiratory rate, vasodilation, vasoconstriction, digestion, inflammation, and energy utilization. Approximately 70% of vagal fibers (afferents) carry sensory information from inside the body (interoception) up to the brain. These ascending messages strongly influence stress response, emotion, and neurohormonal regulatory networks that include the thalamus, limbic system, hypothalamus, prefrontal cortex, and other critical regions of the cerebral cortex (including the prefrontal cortex). The PNS affects facial expression, communication, emotional expression, and love (Berntson, Sarter, & Cacioppo, 2003; Carter, 1998; Porges, 2009).

Interoception is the perception of sensations from inside the body such as air hunger, visceral pain, cramps, heat, cold, vibration, intense sensual touch, food hunger, nausea, satiety, and others. Based on neuroanatomic mapping, Craig postulates that the Sylvian fissure inside the insular cortex, which he calls the interoceptive cortex, receives the information about the internal state of the body and forms a kind of interoceptive map or homunculus. Perception of this information becomes the basis for the subjective experience of the body (Craig, 2003; Critchley, 2005).

The Respiratory System

The respiratory system is rich in sensory receptors, which send millisecond-to-millisecond information through interoceptive pathways where they affect the centers of autonomic, and emotion regulation (Brown & Gerbarg 2005b; Yu, 2005). Neural pathways between the brain and the respiratory apparatus are phylogenetically old, rapid, and strong. The authors hypothesize that changes in respiratory patterns may induce powerful, rapid changes in mood and cognition because signals about breathing receive top priority. Breathing is vital to survival. If anything goes wrong with respiration, the brain must immediately focus all of its attention and resources on resolving the problem or the organism will be dead within minutes. Among the millions of signals processed in the brain, respiratory messages must gain immediate attention and cause widespread effects in order to coordinate survival behaviors.

Most anxiolytic (anti-anxiety), anti-depressant, and anti-psychotic medications reduce the activity of the SNS. To date, there are no psychotropic medications that have been shown to elevate the activity of the PNS. However, certain mind–body practices, positive emotional experiences, and supportive social activities have been shown to activate the PNS.

Heart rate variability (HRV) is the rate at which the heart rate changes. Normally, the heart rate increases during inspiration and decreases during expiration. Higher HRV correlates with health and wellbeing, but it diminishes with age, illness, stress, and lack of exercise. Respiratory sinus arrhythmia (RSA) has been used to estimate SNS and PNS activity, but currently researchers mainly use HRV. PNS activity, as measured by HRV, tends to be low in anxiety disorders, panic disorder, depression, and stress-related medical conditions such as irritable bowel syndrome, cardiovascular disease, and obesity (Friedman & Thayer, 1998; Thayer & Brosschot, 2005). Studies showing that mind–body practices can reduce SNS and increase PNS activity, as indicated by increases in high frequency HRV have been reviewed elsewhere (Brown & Gerbarg, 2009; Brown, Gerbarg, & Muskin, 2009; Streeter et al., 2012).

Certain mind–body practices have been shown to reduce SNS and increase PNS activity, thereby increasing HRV (Satyanarayana, Rajeswari, Rani, Krishna, & Rao, 1992; Telles & Desiraju, 1992). This action is thought to be a significant mechanism by which these practices may improve emotional regulation and alleviate stress, anxiety, and depression. Furthermore, emerging evidence suggests that improving the balance between the SNS and PNS may strengthen the capacities for bonding, love, compassion, and empathy.

Polyvagal Theory, Stress, and Paced Breathing

In humans, there are three phylogenetic vagal systems. The newest and highest level evolved with the neocortex and the myelinated vagal pathways within the PNS. These pathways regulate facial expression, head movements, vocalization (verbal communication), and oxygenation of cortical areas involved in communication, empathy, and caregiving. Under conditions of threat, this high level stress response system keeps the mind and body calm while attempting to deal with the situation by evaluating the perceived threat, mentalization (see below), and using verbal communication to resolve conflict. However, if the stress is too intense or prolonged, the PNS component may become less active such that the system reverts to the phylogenetically older SNS response. This state, called parasympathetic withdrawal, leaves the SNS unopposed as it tries to counteract the perceived threat by activating arousal networks in the mind, speeding up the heart and respirations, and generating angry fight or fearful flight reactions. In situations where there is no possibility of fighting or running away, the SNS may default to the lowest level of defense, the vagal brake, expressed as freezing, becoming paralyzed, playing dead, fainting, or passive behavior. The following study is consistent with the authors’ proposals that slow paced breathing could help maintain sympatho-vagal balance and prevent anxiety, emotional and cognitive regression, and other stress-related symptoms.

A randomized study of 30 healthy college students exposed to a threat of electric shock showed that paced breathing at 8 bpm increased cardiac parasympathetic tone as indicated by increasing HRV significantly more than nonpaced spontaneous breathing or breathing paced at 15 bpm (Sakakibara & Hayano, 1996). The authors suggest that by stimulating the PNS activity, the slower breathing prevented parasympathetic withdrawal. This helps explain how certain yoga practices could ameliorate anxiety states and enable people to feel calmer and more clear-headed during periods of stress or threat (Clark & Hirschman, 1990).

Steve Porges hypothesizes that physiological states, characterized by increased vagal influence on HRV, support social engagement and bonding. Stimuli that increase feelings of safety can recruit neural circuits that support social engagement and inhibit defensive limbic activity (Porges, 2009). Evidence indicates that mind–body practices, especially slow (3 to 6 bpm) breathing techniques, can activate PNS pathways that induce feelings of safety and bonding while reducing defensive (angry and fearful) emotions and behaviors (Brown & Gerbarg, 2012). Furthermore, resistance b...