Catherine McDowell: Good morning and welcome. I am so glad you joined us today for the topic of yoga for depression. I really hope that you are immediately able to take some of the techniques and incorporate them right away into the work you are already doing.
Depression
Depression is classified as a mood disorder. It affects people very differently. We have all seen, even possibly experienced ourselves, mild depression. There is a range of symptoms from just not able to get moving or things just seem to be a slight struggle, to the very debilitating level of depression where getting out of bed just seems like an absolute impossibility. The type of depression a person has will largely determine the kind of medical treatment the person should receive.
According to the Diagnostics and Statistical Manual of Mental Disorders, there are two main categories of depression: major depressive disorder, dysthymia, and a grouping of less common disorders. There are also a number of other mood disorders that can cause depressive symptoms, and we are going to look at a few different levels of this. I am not going to go through all of these in Figure 1.
Figure 1. Types of depression.
You certainly can go through these. Anyone working with this population already knows many of these different levels and the characteristics. For example, what a major depressive disorder looks like as compared to post traumatic stress disorder or bipolar disorder.
Why Yoga?
Since the 1970s, meditation and other stress reduction techniques have been studied as possible treatments for depression and anxiety. Often when a new client comes in and is in this place of fog and inability to move, introducing something like yoga can just be way beyond their comprehension. Often I hear, "I'm not 20 years old, I don't weigh 80 pounds, and I can't touch my toes. I can't do yoga." A lot of what I do is correct that misnomer, or that visual that most people have of what yoga is.
Yoga has always received a lot less attention in medical literature, though it has become more increasingly popular in recent decades. The 2016 Yoga in America study shows that the number of U.S. yoga practitioners has increased significantly to over 36 million from 20 million in 2012. This is a significant increase. As I had said, the misnomer in many people's minds is, "I can't do yoga. I'm not young and bendy." On occasion I have Googled the term "yoga for normal people" to give clients a different visual of what yoga is. This group in Figure 2 is an adult group.
Figure 2. Adult yoga group.
Yoga is for all body types, men, women, and all ages. They can all participate together and be successful. That is usually the first thing to work through with a new client. Thirty-four percent of Americans, or 80 million people now, say they are likely to try yoga for the first time in the next 12 months (Yoga in America study, 2016). The results show that 72% of the practitioners are women. Men and older Americans are trying yoga at a slower rate. I believe a lot of this is media presentation, or the visual we have in our minds of 20 year olds who can twist themselves up into incredible postures. In fact, the Western visual of yoga is so different from that of the Eastern view or what it was originally intended to be. It is wide open for everyone.
There are also so many views and ranges of yoga practices. Yoga can reduce the impact of exaggerated stress responses, help with anxiety and depression, and yoga functions like other self soothing techniques. Yoga also incorporates meditation, breathing, socialization with friends, relaxation and the necessary exercise.
Hatha Yoga
Hatha yoga, which is the most practiced type of yoga in the United States, is typically what you see in all the pictures. It combines three elements: physical poses or asanas, controlled breathing, deep relaxation/meditation. The classes can vary from very gentle to very stressful. You can practice a very quiet restorative yoga where you are on the floor being supported by bolsters, or practice a bikram yoga where you are moving through postures in a hot room with heavy breathing and lots of heat and sweat. It really comes down to what a person's personal preference is, what their body needs are, and to what level they have taken their yoga practice.
Yoga is holistic. It is a combination of the mind, body, and spirit. It is primarily seen for building physical and mental strength, but it is also seen as a path towards enlightenment. What enlightenment means is based on an individual's belief. For many practitioners, enlightenment is the point where you achieve a stillness in your mind and body or understand the true nature of the world and your place in it; that ah-ha moment. A breath practice, or a pranayam, is the regulation of breathing through certain techniques or exercises.
When we are looking to introduce this to a client, I am a true believer that you cannot preach something that you yourself are not doing. Starting a yoga practice or taking a couple yoga classes at a local studio is an excellent way to start bringing this into your OT practice. Again, there are many different levels. There is a vinyasa class which works on the flow of different postures, and is often what you see in marketing pictures. There are both heating and cooling classes. They rev up or calm down the body. There are restorative classes that use the environment for support with bolsters, blocks, blankets, and gravity to facilitate gentle stretch. It also uses music and meditation. Deeper than that is a class called yoga nidra or a yoga sleep that helps to put the individual into a sleep like state. It is a facilitated meditation to induce a conscious sleep. The meditation is comprised of a large variety of techniques to facilitate clearing the mind and slowing of the thoughts.
I love to get groups together and ask them what they do for meditation. Most of the time I hear, "Well, I don't. I don't meditate," or, "I've tried to meditate but I can't sit still that long," and one of the first thing I like to teach is that meditation is just being one minded, or one focused. For example, if you are washing the dishes, that can be an incredible meditation. Focus on washing the dishes, and not on the grocery list or all of the things you need to do. I have found many people meditate when they are doing activities such as riding horses, surfing, or physical activities where you have to stay focused on what is going on around you.
Occupational Therapy and Yoga
Yoga is designated as a CAM (complimentary and alternative medicine) according to the American Occupational Therapy Association position paper.
Occupational Therapy practitioners may utilize CAM in the delivery of Occupational Therapy services when they are used as preparatory activities to facilitate the ability of clients to engage in their daily life occupations.
American Occupational Therapy Association Position Paper 2011
Here are a couple of courses that I recommend. They are right on the website here, and they will give you a little more background into what complimentary medicine and a basic introductory course to yoga.
Why is yoga called a practice? We have to practice it consistently and over time in order to find the small nuances to change our body's response. A daily yoga practice will help bring the body, the emotional body, into balance, and it also restores a sense of well being and energy.
