Yoga Therapy

1. Yoga Therapy For Holistic Palliative and Hospice Care 2019 WSHPCO By (Rev.) Dr. Sandra Bochonok CHI Franciscan Hospice Bereavement Counselor

2. Yoga Therapy Workshop Description • Yoga therapy is a relatively new emerging field of holistic care provided by professionally trained and credentialed yoga therapists. • This workshop is based partially on a 2018 – 2019 grief yoga pilot program offered by CHI Franciscan Hospice for bereaved clients. • This session will describe pragmatic uses of yoga to benefit palliative and hospice clients, their families and caregivers, and professional staff.

3. Learning Objectives • On completion of this session, participants will experience a condensed sequence of breath work (3 – 5 techniques) found useful in past grief yoga mini –retreats that could be adapted for palliative and hospice clients, staff and caregivers. • By participating in this workshop, participants will be able to experience 3 – 5 restorative/gentle poses appropriate for personal and professional use. • At the conclusion of this workshop, participants will be able to identify 3 yoga therapy palliative and hospice care resources online and offline for patients, bereaved family members, caregivers and staff. • Trigger question: How can yoga therapy provide accessible, achievable, practical, low cost holistic care for patients, staff, family members and bereaved clients?

4. Yoga for Palliative Care • 2015 World Health Organization Palliative Care Fact sheet • Each year estimated 40 million people need palliative care. • 78% live in low and middle-income countries • Global need to develop effective economically feasible care strategies

5. Yoga • A mind body spirit practice which aims to create harmony and balance of physical, mental and spiritual aspects of life • A scientific system of self-investigation, self-transformation and self-realization • Views humans as a multidimensional system that includes all aspects of body; breath; and mind, intellect, and emotions and their mutual interaction • Basic principle is that intelligent practice can positively influence the direction of change within these dimensions

6. Yoga for “everybody in every body” (Yogafit) • Breathing • Feeling • Listening to the body • Letting go of competition • Letting go of judgment • Letting go of expectations • Staying in the present moment

7. Some yoga terms • Asana – gentle yoga poses • Pranayama – regulated breathing techniques • Meditation – internalized awareness • Mantra – repetitive word, phrase, sound • Chanting - singing • Mudras – hand gestures • Ritual, disciplined lifestyle

8. Yoga Therapy in Palliative and Hospice Care • Relatively new, emerging field • Based on gentleness and compassion • Can help some patients accept and face illness and death • Can be practiced almost anywhere, even in hospital bed or chair • If you can breathe, you can do yoga • Can be practiced at any age

9. Yoga Therapy Definition by the International Association of Yoga Therapists (IAYT.org) • Yoga therapy is the process of empowering individuals to progress toward improved health and wellbeing through the application of the teachings and practices of yoga • Requires specialized training and skill development • Applied in a therapeutic context • Goal includes eliminating, reducing, or managing symptoms that cause suffering; improving function; helping to prevent occurrence or reoccurrence of underlying causes of illness; moving toward improved health and wellbeing

10. Difference between Yoga Therapist vs Teacher A Yoga Teacher A Yoga Therapist Is tasked with applying yoga techniques to specific health conditions. Must have training in yoga techniques and therapeutic applications of these techniques Must have knowledge of the conditions they are working with. Trained to look at health conditions through a yoga therapy lens, and assess from a western medicine perspective. • Often taught within a certain system such as Ashtanga, Bikram, Sivandada, etc. • In Western world teachers trained to teach classes that are primarily a physical practice with labels like “vinyassa” “hatha” “restorative” “yin”, etc

11. Yoga therapists International Association of Yoga Therapists (IAYT) Yoga teachers Help students learn whatever style or system they are sharing. Educates students in all aspects of yoga including progression to a spiritual level. Students often go to a yoga class as a system of exercise or general therapeutic benefits • Standards require a minimum training time of 800 hours • This is in addition to the prerequisite of a 200 hour yoga teacher training. • Graduates must have proven ability to work with medical conditions in a safe effective way.

12. The Yoga Therapy Client Why? The Yoga therapist Focuses on their clients’ needs. Their job is to understand why clients have come to see them and determine what they can do to support them. Therapists are trained to assess clients through listening, questioning, observing, appropriately touching. Therapists look for ways to help clients reduce or manage their symptoms, improve their function, help them with attitude in relation to health conditions. Therapists establish appropriate goals, interventions, specialized techniques • Usually not going to learn yoga, but to get help with or relief from some symptom or health condition that is troubling them. • The instruction focuses on their condition and how the yoga techniques can help them feel better or improve their function.

13. Health Care Providers • Biopsychosocial-spiritual approach to wellness • Yoga therapy programs are increasingly included in university and continuing education curricula for healthcare providers • Yoga therapy can complement physical, occupational, massage therapy; psychotherapy and more • Therapists are trained in anatomy, physiology, and mental health

14. Medical examples • Mayo Clinic Health System – individual yoga therapy and ongoing small group classes • Memorial Sloan Kettering Cancer Center – small group classes and workshops • University of Maryland – offers services such as integrative yoga psychotherapy • Cleveland Clinic: gentle yoga sessions so everyone can participate regardless of age, physical ability, or experience level • MD Anderson Cancer Center: group yoga, mindfulness, meditation support all areas of health. Classes are free and open to patients, family and caregivers

15. University curricula for healthcare providers • Emory University physical therapy program • Southern California U of Health Sciences chiropractic, acupuncture, physician assistant programs • University of Maryland trainings for medical students and other healthcare providers • Maryland University of Integrative Health master of science in yoga therapy • Duke University integrative yoga for seniors professional training

16. Self -care • Yoga practices ideally suited to support healthcare providers and prevent burnout • Greatest benefit comes from a consistent integrative practice • “Yoga is strong medicine but slow medicine. Don’t expect overnight cures with yoga.”

17. 7 dimensions of holistic wellness • Social • Emotional • Spiritual • Environmental • Occupational • Intellectual • Physical

18. Grief Yoga Mini Retreat Client A • Client A is a recent widow in her 70’s with COPD, anxiety, depression and several other mental health issues. • She was often in emergency rooms with panic attacks and shortness of breath • She participated in two grief yoga mini – retreats and it’s now been 5 months since she has been to the ER. • “When I’m stressed, I go back to my breathing.”

19. Grief Yoga Mini Retreat Client B • Client B is a 50 year old with some mental health issues. She cared for her terminally ill father for years, was with him when he died, and then a neighbor had a heart attack in front of her and she had to perform cpr until paramedics arrived. Her neighbor died and she has flashbacks, guilt, and struggles to cope with her father’s loss and her mother’s aging. Her life diminished while she cared for her parent. • Since the death of her father, she has participated in 3 grief yoga quarterly retreats and had “aha moments.” She now practices yoga daily in her backyard outdoor labyrinth to reduce anxiety, promote calm, and regather herself with journal writing.

20. In Grief Groups • Open and close grief groups with 30 seconds to 2 minutes of yoga breathing exercises. • Sometimes when participants get anxious in group or counseling, it’s time to take “a yoga breath.” • A stress reducer

21. “How Yoga is Transforming Health Care” Yoga Journal Healing Issue 2019 • Cancer, children and their caretakers “find calm” • Yoga medicine can help manage and prevent pain • Yoga for Diabetes • Yoga for “every body” • Yoga for focus, balance, stress • Yoga for back pain

22. Specialized yoga sequences • Osteoporosis • Glaucoma • Digestive health • Cardio stress reduction • Calmness

23. Workshop Yoga Sequence Chair or Standing • Warm up • Build heat • Stretch and relax

24. Grief Yoga One Hour Yoga Class by Melissa Phelps, C - IAYT. Integrative Health Practitioner (melissa.phelps@harrisonmedicalcenter.org) • Easy seated mountain (body scan and mindfulness) • Belly breathing • Cat/cow • Seated forward fold/child’s pose • Easy seated mountain • Bee’s breath • Meditation (tree feeling rooted) 3 – 5 min

25. Grief yoga class • Equal ratio breath • Neck rolls • Chest expansion/hugs • Lateral flexion • Spinal twists • Forward fold/heart opener flow

26. Grief Yoga class continued • Breaking the chains (good for relieving anger and frustrations) 4 – 6 breaths • Sit comfortably • Bring arms up level with chest/shoulders;arms stacked with elbows bent to 90 degrees • Inhale through nose • Exhale nose or mouth, forcefully push elbows back and open through chest/heart • Inhale through nose and repeat as needed

27. Grief Yoga class mantra to self • I am free from suffering • I am at peace and at ease • I am well in my mind, body, spirit • Meditation (Untangling heartstrings) 3 – 5 minutes

28. Grief Yoga: Flowing and holding poses • Joy (wide arms), love (hugs), gratitude (tall), peace (prayer) • Holding poses (chose 2) • Warrior 1 • Pyramid • Warrior 2 with open and wrapped arms • Tree pose

29. Grief Yoga: Throwing away the struggle (4 – 6 breaths) • Start in mountain, slowly sit back into chair pose • Bring arms tight into the chest with hands in fists as you inhale • Start to hinge forward and exhale forcibly say “Ha” and throw the arms/hands out behind you • Imagine throwing away anger, stress, grief or whatever no longer serves you

30. Grief Yoga positive affirmations • I love myself just as I am • I am enough • I accept myself completely

31. Grief Yoga restorative poses (choose 1 or 2) • Supported child’s pose • Supported twist • Supported bridge • Reclining bound angle/butterfly • Legs up the wall • Final relaxation (Savasana) • Meditation (river/stream/clouds • journaling

32. Online and offline resources • IAYT.org • Yoga magazines such as Yoga Journal (yogajournal.com) • Local yoga studios, YMCA, community centers, local hospital and wellness programs • Public library • Hospice websites offering yoga therapy, grief support, classes for patients, caregivers and bereaved • Selected bibliography

33. Summary • Yoga therapy is a relatively newly emerging field of holistic care provided by professionally trained yoga therapists • Yoga can provide accessible, practical, low cost care for patients, staff, caregivers and bereaved clients. • YT is based on gentleness, compassion and competency • Can be practiced almost anywhere even in hospital bed or chair • Can be experienced at any age • If you can breathe, you can do yoga