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  • Yoga for Mental Health

    Behind every sick man there is a spiritual man. Behind a diabetic there is a yogi. Behind a man suffering from depression there is an aspirant. When a patient comes for help, teach him yoga and make him better. Treat his sickness, but do not stop there. Take him further into the spiritual domain of life.
    -Hatha Yoga Pradipika


    Physicians talk about breakthroughs in personalized medicine and pharmacogenetics--of using information from a person’s genetic map to tailor medicine to his or her particular needs. But yoga can already do that. It can turn our bodies into customized pharmaceutical plants that churn out tailored hormones and nerve impulses that heal, cure, raise moods, lower cholesterol, induce sleep, and do a million other things. Moreover, yoga can do it at an extremely low cost with little or no risk of side effects. It has the potential to usher in a genuine new age, not one of wishful thinking.
    -William J. Broad, The Science of Yoga

     

    Yoga, Addiction, the Brain & Recovery

    The drug is an addict’s one coping skill; one doesn’t come to treatment for the sake of getting spiritually connected and healthy - treatment happens when someone has run out of options to keep using continually. So when a person arrives at a treatment facility or a 12-step meeting, the only tool they really have in their life toolbox is using or drinking. A full and accurate assessment for individuals arriving to detox and/or treatment can be complex and very difficult. Most clinical experts would likely agree that we don’t want people on medications that they don’t need to be on in recovery, and yet we don’t want anxiety and depression, which are so very often co-occurring with alcohol and drug dependence, to be sabotaging recovery. This is precisely where yoga can help in conjunction with cognitive behavioural therapy (CBT) and family therapy. A daily yoga practice can serve to precisely influence the parts of the brain affected by addiction and its related disorders.

    There is enough hard data on the effects of yoga on the brain that we can now confidently claim that a specific series of yoga poses in conjunction with breathing techniques can change brain function in such a way as to diminish anxiety and depression and stimulate workings in the right thalamus (which appears to govern creativity, intuition, aesthetics, and the sensing and expression of emotion); it also boosts activity in the frontal lobe of the brain, where lies the discriminative ability that can override impulsivity. Yoga can, very specifically, help put the brakes on an addict’s behaviour of reaching out for sensual gratification by increasing activity in the frontal lobe as well as boosting neurotransmitters that diminish the effects of anxiety and depression, extremely common co-occurring disorders with addiction.

    Yoga From Folklore to Fact

    Yoga is steeped in mythology and mysticism; traditionally information is passed from a trusted guru to an earnest practitioner, and while many yogis will stand by their claims, having the experiential knowledge to test their veracity, these claims fall short of the organized skepticism founding most infrastructure in the West. As a result, while yoga has long claimed powerful results, it has been too readily and too often relegated to the cultural scrap-heap of unfounded new-age mysticism. There is also the socially awkward issue of left-handed tantric yoga practices and how this exploration of sexuality as a path to the divine has at times, due to societal norms, tarnished yoga’s image in various cultures through various periods. The study and practice of yoga has been around long enough to have its fair share of hustlers and charlatans selling snake oil or making fraudulent claims, often of the miraculous. It also doesn’t help that some of yoga’s basic tenets are fallacious; for instance, it has long been claimed by yoga teachers that yogic breathing, or pranayama, floods the lungs and bloodstream with rejuvenating fresh oxygen, despite clear proof to the contrary.

    “What this means in plain English,” writes William J. Broad in his contentious and well-documented work The Science of Yoga, “as crazy as it sounds, as counter-intuitive as it seems, as contrary to the teachings of popular yoga as it appears - is that fast breathing lowers the flow of oxygen to the brain...the overall repercussions for mood and respiratory physiology are radically different if the yoga breathing is slow rather than fast [but the] consequences again center on carbon dioxide - only this time its rise in the bloodstream, not its fall.” It is precisely this documentation on how yogic breathing truly works, however, that explains how it has such deep mental consequences, amplifying raw awareness and a peaceful type of clarity and well-being. This is key for an understanding of how yoga can speed the healing of an addict’s brain.

    Something more than fitness has transformed the ancient practice from the Indian subcontinent into a multi-billion dollar industry in the West with no real oversight, organization or direction. Something keeps millions of practitioners coming back to their sticky mats to bend and stretch and breath while calling and recalling their awareness into the present moment, and it has to be something more than mere fashion or hype, or the ‘fad’ in the West would have faded decades ago. Fortunately for yoga, the scientific evidence of some of its claims has now been and is being explored in greater depth, with greater precision, and, with yogis like Amy Weintraub, to greater benefit. Just as the science of addiction and recovery has been exploding in recent years, so has the science of yoga. This proposal serves to assert that there is a nexus between the two.


    The Brain, Addiction, and Relapse

    Millions of Canadians are suffering from alcohol dependence, and most of them are undiagnosed. For those who do seek out treatment, the process can be long and painful and the path to recovery is often fraught with relapse. And it usually starts early in life. “This is a disease of young people,” claims Mark Willenbring, MD, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, “almost always starting between the ages of 18 and 25.”

    Paula Riggs, MD Associate Professor in Psychiatry, University of Colorado maintains that drugs of abuse are are at least five times more reinforcing and compelling as the things our brain reward system evolved in the first place, such as food or sex; drugs are so powerful and so much more rewarding, we will do anything to keep getting them - “they commandeer our brains reward system and drive our behaviour, and that takes powerful treatments to thwart.”

    It is a myth that addicts and alcoholics have to crash and burn before they can reach out for help. Similar to other chronic conditions, it appears, according to Michael Dennis, PhD, a senior research psychologist at Chestnut Health Systems, that the sooner addicts start treatment and the more they “stay on top of it,” the better the outcome. There has been a longstanding myth that for treatment of addiction to be effective, it has to be elected willingly by the patient; this turns out to be completely false. Mandated treatment by court or by workplace human resources departments often works for the patient - while being open-minded to treatment would certainly give an addict a leg up, a patient doesn’t have to willingly walk through the doors of a treatment facility in order to undergo the requisite psychic change that enables prolongued abstinence.

    Addiction is unpleasant for the person who has it and for that person’s family. The question is, what can be done to help an addict, as Dr. Willenbring puts it, “stay on top of it”? It’s important to first recognize that addicts (including adolescents) coming into treatment are often characterized by having multiple disorders; chemical dependency may not even be the main problem. The most common co-occuring disorders are anxiety and depression (and perhaps now PTSD), often accompanied by suicidal ideation, anger or rage, and self-harm.

    Nora Volkow, MD, director at the National Institute on Drug Abuse, is considered globally to be one of the leading experts in the field; clearly labeling addiction and alcoholism as a brain disease, she asks “How can we comprehend the concept of a person who wants to stop doing something and cannot, despite catastrophic consequences....despite these major consequences, they cannot control their behaviour; changes in the brain lead to loss of control. The signal in the brain is as strong as the signal to seek food when an individual is starving. It’s as if taking the drug is indispensable for survival. [This is how the] brain disease of addiction translates into abnormal [and unreasonable and irrational] behaviour. “

    All drugs [including behavioural addictions such as gambling, sex, and eating] activate the dopamine pathway. Dopamine is a neurotransmitter released with the occurrence of pleasurable events. Dr. Volkow was a pioneer with the process of using brain imaging techniques while intentionally stressing the dopamine system and taking pictures of addicts’ brains to measure how the rewards system is responding. She concluded that the behaviours of an addict are not performed out of free will, but as a reflex; this is not something that many people want to accept, it’s often very difficult for non-addicts to understand how behaviour cannot be consciously regulated. Quite simply, says Dr. Volkow, “ in addiction the area of the brain that allows us to do free choices is not working properly.” The drug goes to the dopamine reward system that kicks it repeatedly into overdrive; the brain changes.

    Even after months and often years, the tendency to relapse is still strong; many professionals are now vocally asserting that relapse is not a failure of treatment, as it was once widely considered, but part of the disorder. Anna Rose Childress. PhD, addiction specialist at Philadelphia VA Medical Center at the University of Pennsylvania School of Medicine explains this phenomenon with a red light / green light illustration: “At the level of the brain, there are a lot of cards stacked in the wrong direction [for sustained sobriety]. There are two main parts of the system at work here the ancient brain which responds to natural rewards, or the GO system, and then the more recent frontal lobe system that can evaluate data and decide when it is important not to act on cues, or the STOP system. In a healthy brain, the circuitry is intertwined and the two systems are working well together. With patients suffering from addiction, however, these two systems are “functionally disconnected” and the GO system, when cued by triggers related to the addict’s drug of choice, is running off on its own...the GO system becomes a rogue system and is not acting in a regular seamless integrated way with the STOP system. This GO system is so incredibly sensitive, it can set off craving state with images of 33 milliseconds, shorter than the conscious mind needs to grasp what is being viewed.”

    What is exciting in the field of addiction right now is that with brain imaging technology we can peek ‘under the hood’ and see what pistons are misfiring or not firing at all. With this diagnostic, specialists then have an idea about how to go about fixing it. What is doubly exciting for me, as an addict and a yoga teacher, is that as the science of yoga also expands, we are seeing results that almost seem to suggest the possibility that yoga is nearly custom designed to treat addiction, depression, anxiety and trauma - it has just taken some of us several thousand years to figure this out.


    Disease Discrimination

    It bears mentioning that, unfortunately, addiction as a disease is still often discriminated against; even with all the studies and the research behind its clear classification as a mental illness, it is too often seen, however obscurely, by influential decision-making elites (physicians, judges, politicians) as a moral issue, touching people with a pronounced lack of willpower. There still exists the notion that a person is voluntarily taking drugs or drinking alcoholically out of choice. There is no choice in active addiction. The pleasure of the high has usually long disappeared before the addict seeks help. David Rosenbloom, PhD, Director of Join together, Boston University school of Public Health avows that addicts and alcoholics are discriminated against in ways that people suffering from no other disease are subjected to and that this discrimination makes recovery much more difficult than it need be. People still have a stigma against drug addiction, and this is often because it is a disease that leads to behaviours that frequently harm others, such as accidents, stealing, lying, and so it is very difficult to recognize the baffling amount of shame and suffering that the addict lives with daily.

    Researchers at the U.S. National Institute of Health found a link between depression and traumas experienced in early childhood decades ago. “It all relates to something called the hypothalamic-pituitary-adrenal axis,” explains Candace Pert, research professor in the Department of Physiology and Biophysics at Georgetown University Medical Center. Candace Pert has been at this a long time, being the first one, in the 70’s, to isolate opiate receptors using, among other materials, rat brains and a blender. “Very simply, the hypothalamus is part of the emotional brain, the limbic system, and its neurons have axons that extend into the pituitary gland, which sits below it. There axons create a neuropeptide called CRF - cortical releasing factor - when this hits the pituitary gland it stimulates the secretion of ACTH, which travels to the adrenal glands and binds onto the adrenal cells.”

    What’s significant about this murky process that Pert describes as simply as she can in her book Molecules of Emotion is that this informational substance causes the adrenal glands to make steroids, specifically corticosterone, the stuff that helps with healing in the case of injury. Stress increases with increased steroid production, and depressed people have broken feedback loops to shut off steroid production in the blood, so their systems are in a constant state of ACTH activation.

    “Autopsies almost always show a tenfold higher level of CRF in the cerebrospinal fluid of those who killed themselves compared to those who dies from other causes,” reports Dr. Pert. “Depressed people are stuck in a disruptive feedback loop that resists any kind of drug therapy that aims at suppression of steroids. Eventually there is so much CHF in the system that fluctuations of other peptides throughout the organism are curtailed, leaving ever fewer possibilities in the range of behaviour [and response] which eventually drive people into an emotional black hole.”

    With yoga’s proven benefits of increasing self-awareness and contributing significantly to a change in mood, and as moods are central to meaning in life and our experience of well-being, in many ways defining us, yoga can play a significant role in shame reduction. And much of this it appears to do by increasing the level of gamma-aminobutyric acid (or GABA), a major neurotransmitter and staunch regulator of the human nervous system.


    Yo GABA GABA

    The most treacherous pitfalls that lead to relapse are stressful events and triggers. Kathleen Brady, MD, PhD, Profes- sor of Psychiatry at the University of South Carolina, asserts that somebody who has attained abstinence after a long period of use is likely to have an abnormal stress response, and if you stress that individual, you put them at great risk of relapse. By definition, simply considering the chaos (emotional, interpersonal, professional, financial) addicts have created while in active chemical (or behavioural) dependancy, they have a lot of stress waiting for them in recovery.

    Triggers represent almost all the things in an addicts neighborhood - anything that serves as a reminder of usage or the rituals around usage; these things are often coming in under the radar of conscious awareness and scratching at the brain’s response system. Something happens to the addict, and though he is not sure what, he gets triggered and suddenly, due to conditioned responses, he wants (or chemically speaking, needs) to use. When this happens, the STOP system, or the frontal part of the brain, isn’t coming into the picture. This is widely documented.

    In explaining triggers, Dr. Richard Rawson, Proffessor in Residence at The Jane and Terry Semel Neuropsychiatric Institute, David Geffen School of Medicine at UCLA offers “When you’re six months sober and you bump into an old using friend, you can feel your heart-rate go up, you can almost taste the drug in the back of your throat - it happens automatically. It’s not an intelligence issue, it’s a biological issue. That’s where the conditioning occurs, and that’s what the brain disease part of addiction is about.”

    According to Charles O’Brien, MD, PhD, Director of the Center for Studies of Addiction, at Philadelphia VA Medical Center, University of Pennsylvania School of Medicine, when a person who has this disease is exposed to cues or stimuli that have previously been associated with the use of a particular drug, there is an “uncontrollable reflex, it happens very quickly in the brain; we can see it in brain imaging. A person does not have the ability to stop it and may not even be conscious of it happening.”

    Another contributing figure to relapse is anhedonia, a state of mind in which one has lost the ability to experience any form of pleasure. “There’s a belief that the first weeks of getting sober are the hardest,” says Dr. Rawson. “That’s not really the case. What you often see is that for the first few weeks and months recovery is new and there is a lot of changes and there is often rapid progress. What happens after that is a period where not so much is changing and it’s a matter of sustaining sobriety - it’s a period we call the wall, where relapse is common, this period of anhedonia, and it’s where relapse vulnerability goes up. It’s an extremely difficult part of the recovery process because it lasts a long time. You may have months at a time where you are unable to enjoy simple pleasures in life without the pharmacological sledgehammer you have been using to get your dopamine rush.” So, just understanding brain disease and how it works is a powerful tool for addicts.

    In addiction the brain is rewired to be in a state of deprivation, where taking the drug becomes necessary, from the brain’s circuitry, for survival; what chance then does the addict have of stopping and staying stopped? Dr. Childress states that, for the addict, we need something in place to bring stimuli and their effects “within a normal range before the challenge of a GO moment.” Despite this seemingly insurmountable conditioning, the addicted brain has been shown to have a high capacity for recovery. Researchers and scientists and institutes backed by large pharmaceutical companies are still looking for the miracle medication. In the meantime, what if addicts actually have the ability to organically manufacture their own buffer to this GO system? What if people could exercise the frontal part of their brain to guard themselves against these triggers and recognize when craving occurs and how to change behaviour? What if people could develop the right hemisphere of the brain to help them be more creative in their outlook and decision-making, with an uplifted mood? What if patients in treatment could be shown, easily and for free, how they can stimulate their own ability to sense and express emotion? Yoga’s benefits, in a way, seem to almost be tailor made to support this type of recovery.

    In 2007 and again in 2010 psychiatrist and neurologist Chris C. Streeter and her team at the Boston University School of Medicine published a controlled, peer-reviewed study demonstrating that yoga caused major rises in the neuro- transmitter GABA, and test subjects all reported improved moods and lessened anxiety. In general, they felt better about themselves. Yoga, simply stated, enables practitioners to (among other things) exercise the frontal part of their brain to guard themselves against these triggers of a “GO” moment and recognize when craving occurs and how to change behaviour. “The autonomic system is bifurcated,” explains William Broad in recounting and compiling a se- ries of scientific investigations conducted between 1940 and 1970, “the sympathetic system is the body’s accelerator, and the parasympathetic the brake...the two also wield control over human moods and emotions rooted in primal energy states [and these] inner states resonate with some of the most fundamental of all human emotions--whether individuals feel safe and protected or threatened and endangered...the investigations showed that yogis have a special talent for applying the brake.”

    The areas of heightened blood flow after yoga include the frontal lobe, sometimes referred to as the seat of higher consciousness, and the prefontal cortex (the part that appears to set us apart from other mammals). These regions are both key to setting and achieving goals - an absolute necessity in recovery, even if the goal is as simple as to not take a drink or a drug for the next day, hour, or minute.

    The moral observances first codified by an ayurvedic healer (and possibly grammarian) by the name of Patanjali thousands of years ago, asana (referring most commonly to yogic postures), pranayama (life-force / breath control), concentration, meditation, and a profound spiritual experience form the basic limbs of the yogic path, which is, at root, nearly identical in nature to the path 12 step recovery program. Yoga complements 12-step based recovery in almost every facet. Given that yoga can increase self-esteem once it calms the mind and relaxes the aspirant, it can also be a powerful method of nurturing the spirit in a non-sectarian way. Not only can yoga help addiction and co-occurring conditions such as depression and anxiety, but yoga can regulate blood pressure, help detoxify internal organs, stimulate the endocrine and immune systems, among other benefits. And the key is that yoga does all these things at the same time.

    “Crying is one of the highest devotional songs. One who knows crying knows spiritual practice. If you can cry with a pure heart, nothing else compares to such a prayer. Crying includes all the principles of Yoga.” ―Kripalvanandji

    I believe that some of the misunderstanding of addiction at a social and even clinical level have to do with the relationships between stress, anxiety, the stressors these conditions cause in the body, and their common roots in trauma, which, for a child, Pia Mellody describes as “anything less than nurturing.” Feelings are retained in our memories down to a cellular level. We have enough convincing evidence on yoga to assume that yoga would prove to be a cost-effective and highly valuable part of daily treatment and recovery for addiction and its attendant complications or root causes. We don’t even need to know exactly how or why it seems to work so well before implementing it.

    The Buddha always told his disciples not to waste their time and energy in metaphysical speculation. Whenever he was asked a metaphysical question, he remained silent. Instead, he directed his disciples toward practical efforts. Questioned one day about the problem of the infinity of the world, the Buddha said, "Whether the world is finite or infinite, limited or unlimited, the prob- lem of your liberation remains the same." Another time he said, "Suppose a man is struck by a poisoned arrow and the doctor wishes to take out the arrow immediately. Suppose the man does not want the arrow removed until he knows who shot it, his age, his parents, and why he shot it. What would happen? If he were to wait until all these questions have been answered, the man might die first." Life is so short. It must not be spent in endless metaphysical speculation that does not bring us any closer to the truth.
    - Thich Nhat Hanh, in Zen Keys


    Yoga, like recovery from addiction, is a process, not an event, and we need to make room for mystery as well. It is explained most eloquently in the Hatha Yoga Pradipika: “What makes this method of treatment so powerful and effective is the fact that it works according to the principles of harmony and unification, rather than diversity. If you have fifteen grandfather clocks together on the same wall, all with pendulums of identical length and weight, you will notice that after some time all the pendulums become synchronized in their movements. This occurs quite naturally according to the law of mutual rhythms and vibrations.”

     

    Bibliography

    Broad, William. The Science of Yoga. New York: Simon & Schuster, 2012.

    Carnes, Patrick. Out of the Shadows. center City: Hazelden Books, 1983.

    Froemke, Susan & Hoffman, John (producers). Addiction. A series of HBO documentary films by leading documen- tary filmakers including interviews with the field’s lead- ing experts.

    Muktibodhananda, Swami. Hatha Yoga Pradipika. Bihar: Yoga Publications Trust, 1985.

    Pert, Candace. Molecules of Emotion. New York: Scribner, 1997.

    Weintraub, Amy. Yoga for Depression. New York: Broad- way Books (Random House), 2004.

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