For more than 15 years, I’ve been teaching the Healthy Heart Program, a 10-week yoga and wellness program for individuals with hypertension and Type 2 diabetes. Still, each time a new program begins, I feel a sense of anticipation, even a slight nervousness, as I meet the group of new participants for the first time. The Healthy Heart Program, like other yoga therapy groups we offer, has a very different feeling from a yoga class for the general public. Many of the participants have learned about yoga very recently. Many have been sedentary for much of their lives. Many have never sat like this in a circle where they are going to share something about themselves and their lives with strangers. Most have never had the time—we could even say the luxury—to stop and think about their role in their own healing process.
Most of the participants have come to this group because of a recommendation from their healthcare providers, and this, in itself, is relatively new. Fifteen years ago, these yoga therapy groups were met with curiosity, even some skepticism. Today, those attitudes have almost reversed to the point where there is an understanding in many healthcare settings that, when all else fails, yoga works. This acceptance of yoga therapy in healthcare is positive overall, but often lacks a deeper understanding of how yoga heals.
So, how does yoga heal?
What I’ve discovered in more than 20 years of working in yoga therapy is that while yoga techniques, such as asana and pranayama, are a key part of the healing process, the deepest and truest healing comes from the cultivation of positive qualities, called bhavanas. Each of the 10 weeks of the Healthy Heart Program takes one of these qualities as its theme, and by the end, the participants have developed a new way of seeing themselves, life, and other beings—which I feel is the essence of yoga healing.
This 10-week journey of healing is based on three essential principles of yoga therapy. First among these is that the yoga therapy journey is a homecoming to a place of inner balance, awareness, and wholeness that, however distant, is always present as a potential. Yoga therapy sees each person as an expression and reflection of the infinite possibilities and intelligence of the source energy. The skill and practice of the yoga therapist comes through an in-depth understanding of all the facets of yoga, in order to open the appropriate doorway to the student’s own potential for health, healing, and awakening, all of which is already present.
The second principle is that the healing journey of each individual is multifaceted and in line with the five koshas, the different dimensions of our being. These include the physical, energetic, psycho-emotional, higher wisdom, and spiritual dimensions. Yoga therapy group programs and individual sessions include methods and techniques for integrating and healing at each of these levels.
The third principle defines the role of the yoga therapist: our scope of practice. We create appropriate yoga programs for healing based on the student’s needs for optimal wellness at the level of each of the koshas. We then serve as a guide or mentor for the journey of healing and self-discovery. Rather than offering a diagnosis and treatment for a specific condition, the yoga therapist uses their skills and intuition to bring together the optimal methods, techniques, and approaches among all the tools of yoga to support the student in remembering their own innate healing resources. This process respects the student’s pace and needs for self-exploration and discovery.
How is this optimal yoga therapy program created? There are five steps in the process of creating a yoga therapy program for a specific group or individual:
Understand the participant’s health profile from both the Eastern and Western perspectives.
The yoga therapist always begins work with a group or individual by gaining a global vision of their primary health conditions from both the Eastern and Western perspectives. This involves understanding what the condition is and the treatments an individual is receiving from the Western allopathic perspective. This allows the yoga therapist to work together with medical professionals and to be aware of possible contraindications. The yoga therapist also looks at the condition from the perspective of yoga’s subtle anatomy as well as Ayurveda—what kind of imbalances might accompany this condition at the level of the chakras, the prana vayus, and the Ayurvedic doshas.
Explore areas of imbalance and separation.
In Step 1, we create a conceptual framework for a yoga therapy program. In Step 2, we explore actual imbalances at the level of each of the koshas. One way of conceptualizing imbalance in yoga therapy is as separation. From this perspective, the inherent nature of the individual is wholeness at all dimensions of being, and imbalance reflects all the ways in which they have become separated from that wholeness. Separation can be seen at the level of each of the five koshas:
• Imbalance in the physical body: Separation in the physical body is seen as a lack of body awareness. As the individual becomes more aware of the messages from the body, including areas of comfort and discomfort, we create the essential conditions for return to a state of balance.
• Imbalance in the energy body: Separation in the energy body manifests as a lack of awareness of the breath and of the flow of energy in the body. This can also manifest as a sense of separation from the natural world, which is becoming more common as we become increasingly computer oriented.
• Imbalance in the mind and emotions: Separation in the mind and emotions can manifest as a “me against them” mindset, which results in fear and anxiety. Imbalance at the level of the mind also manifests as separation from parts of oneself.
• Imbalance in the wisdom body. Separation from the wisdom body—the part of ourselves that has the ability to see and release our own limiting beliefs—results in an inability to access whatever liberating insights might arise from within our own being.
• Imbalance in the bliss body. Separation from the bliss body amounts to a denial of our true nature and all of our inherent positive qualities. At the deepest level, all imbalance is separation from Spirit, the most powerful and essential source of healing.
How do we assess these imbalances? This assessment of imbalance, or separation, encompasses specific methods for groups and individual sessions. In a group session assessment, each participant meets individually for approximately 20 minutes with the group facilitator or psychologist, and completes a health and wellness questionnaire that is structured along the five koshas. For example, the physical body section includes questions about body awareness and diet; the energy body section deals with breath and energy levels, while the psycho-emotional section focuses on stress. This assessment process is also ongoing. Each of the classes in a 10-week series includes an awareness exercise and sharing related to the week’s theme. An example of this is an exercise where participants explore where stress and tension are present in the body.
In individual sessions, the therapist uses a set of evaluation techniques that encompass all five koshas. For example, the breath is assessed by looking at all basic breathing parameters, such as breaths per minute, relation of inhale to exhale, and holding patterns in the breath. Some of these evaluation tools are used in the first session and others are incorporated throughout a series of individual sessions, so the evaluation process is also ongoing in individual sessions.
Understanding the stress response in relation to the group or individual.
In Step 3, we explore the role of stress in relation to a group or individual. This in-depth assessment of stress is key, because stress is a major factor in many of today’s most common chronic health conditions, such as hypertension. Additionally, stress-management techniques specific to a particular health condition are one of the main channels that yoga therapy uses to support the healing process. This role of stress is assessed at the level of each of the koshas. The examples used below are from the Healthy Heart Program.
• Stress and the physical body: In relation to the Healthy Heart Program, we find that one aspect of the stress response is constriction of the arteries, increasing heart rate and blood pressure. In an emergency situation, this ensures a rapid supply of energy. When the stress response becomes chronic, however, the body adapts by maintaining blood pressure at elevated levels. Yoga therapy employs guided imagery exercises focused on the circulatory system to bring awareness to and relax the heart and arteries.
• Stress and the energy body: When the physical body becomes tense, the breath and energy body also become constricted. Yoga therapy offers techniques to modulate the stress response with the breath. There are also techniques for opening the energy centers with a specific focus on opening the heart.
• Stress and the psycho-emotional body: The contraction in the physical body and energy body reflect tension and conflict that arise in the mind through the daily struggle to meet perceived needs and avoid that which we dislike or fear. In relation to hypertension, yoga therapy offers exercises for understanding the relationship between emotional responses and blood pressure, together with relaxation techniques that focus on the circulatory system specifically.
• Stress and the wisdom body: The wisdom body is our higher mind, or buddhi, which allows us to see and transform limiting and negative ways of thinking and acting. The chronic stress response is exactly the opposite; to ensure survival, it keeps us in “red alert” mode, focused on perceived threats as reality. Yoga therapy offers meditation and yoga nidra exercises that allow the individual to create space around negative patterns that are the source of stress. These negative core beliefs are the main source of imbalance, because they create contraction in the mind, the energy body, and the physical body. Their release is the primary source of healing in yoga therapy.
• Stress and the bliss body: The bliss body represents all of our inherent positive qualities that awaken naturally, as negative and limiting beliefs at the level of the wisdom body are released. The positive qualities are the bhavanas, the core themes of group and individual sessions, supported by affirmation and mudras.
Define wellness objectives.
This step describes our plan of action based on all the information gained from Steps 1 to 3. Again, using the koshas as a framework, we put together a list of wellness objectives for an individual or group. This step includes looking at the limbs of yoga as resources that support the wellness objectives we define. The examples given are again applicable to the participants in the Healthy Heart Program.
• Wellness objectives for the physical body: The focus is on cultivating body awareness, improving posture, and enhancing circulation. Postures open the chest and side ribs while encouraging circulation to the extremities.
• Wellness objectives for the energy body: Focus is on sighing breath to release tension, cooling pranayamas to decrease blood pressure, and awareness of the energy centers, especially the heart chakra.
• Wellness objectives for the psycho-emotional body: Focus is on pratyahara (withdrawal of the senses) exercises, such as bringing awareness to each of the senses and then relaxing them. Yoga nidra exercises locate the most relaxed area of the body and then distribute that feeling of release to the rest of the body. A specific relaxation for hypertension uses the image of a soothing, cooling stream flowing through each area of the body.
• Wellness objectives for the wisdom body: At this level, we focus on the development of concentration, dharana, through exercises such as tratak, gazing at the flame of a candle. Another key technique is the Shelf Meditation, where participants place all aspects of their life on a shelf and then witness them from a distance—as a way to stand back and take a wider view of their lives.
• Wellness objectives for the bliss body: At this level, we remember the joy and peace of our authentic being. These qualities are awakened through appropriate bhavanas, supported by mudras and affirmations. These bhavanas are woven throughout the program and are used as the basis for the final meditation. For example, the affirmation “I am whole and healed” is repeated three times out loud, three times quietly, and three times in silence. Participants are then encouraged to rest in this wholeness and healing beyond words for several minutes.
Designing a program for the individual.
The final step of the yoga therapy process is to create a specific program for individual or group sessions that encompass all of the understandings and wellness objectives at all levels of being. This program includes all eight limbs of yoga, but with a special focus on integrating the bhavanas, the inherent positive qualities of our true being.
The practice that we develop is, of course, not static and will change along with the changing needs of the individual. Yoga therapy offers a vision of optimal health at each level of the person—physical, energetic, psychological, and spiritual. The process of yoga therapy is a journey of healing and integrating all these aspects of ourselves within a growing awareness of who we are and the spiritual source of our being.
Joseph Le Page is the founder of Integrative Yoga Therapy (IYT) and a pioneer in the development of yoga therapy training programs. Find out more about the Kripalu School of Integrative Yoga Therapy.