Katy, who is now 19, struggled with anxiety and depression for years. After several unsatisfying attempts at therapy, her psychiatrist prescribed an anxiety medication and suggested that she try a new kind of group therapy called Yoga and Talk. "I had already done traditional psychotherapy groups and wanted to do something other than talk," recalls Katy, who asked that her full name not be used. The program, developed by clinical social workers Kelly Inselmann and Anita Stoll of Austin, Texas, combines Kundalini and hatha yoga with talk therapy.
Through the group work with Inselmann and Stoll, Katy became aware of her tendency to hold in anger at others and redirect it at herself, and she recognized that this was causing her debilitating depression and anxiety. She says that confronting her emotions through this unique approach, which addressed her symptoms on the physical, intellectual, and emotional levels, helped her depression and anxiety subside. "Yoga gave me the courage to be my true self," she says. Now, instead of biting back her anger as she had done for so many years, Katy feels equipped to identify its true cause and, when appropriate, confront it head-on.
For centuries, the yoga tradition has understood that the body and mind are inextricably intertwined—and now psychology is catching on. As more psychotherapists undergo some form of yoga teacher training, many are discovering that integrating yoga and therapy can increase healing synergistically. As a result, therapists across the country are finding innovative ways to incorporate yoga into their sessions. Working on both the physical and emotional levels helps clients loosen their defenses and connect more deeply with their core thoughts and feelings, therapists say. And then the healing can begin.
The Issues in the Tissues
Both yoga and psychotherapy aim to foster a sense of self-awareness. While traditional psychotherapy often involves talking about a problem to achieve a change in the emotional state, therapists who incorporate yoga often look to change the physical state first so that the client has more resources from which to draw.
During Yoga and Talk sessions, groups begin with 30 to 45 minutes of asanas, relaxation, and meditation. According to Inselmann, who is a licensed clinical social worker and a Kundalini Yoga instructor, the process enhances participation in the group therapy session that follows, by fostering the members' compassion for themselves and others. Furthermore, the mindfulness aspects of the yoga practice help anchor group members in the present, allowing participants to take the stories of their past and begin working through them in the present.
Inselmann says that practicing yoga just prior to therapy calms the nervous system and focuses the mind, enabling individuals to better tolerate painful feelings without shutting down.
"Kundalini Yoga does a lot of balancing of the left and right hemispheres of the brain," she says. This type of bilateral stimulation is similar to Eye Movement Desensitization and Reprocessing, which has become a widely accepted psychotherapeutic treatment for addressing trauma.
The Science of Stress
Sat Bir Singh Khalsa, a yoga researcher and an assistant professor of medicine for Harvard Medical School at Brigham and Women's Hospital, has studied yoga's impact on conditions such as insomnia and anxiety. He believes that yoga is a great complement to talk therapy because it helps people to better cope with stress. "One of the things common to many mental and physical disorders is that they have a strong stress component," Khalsa explains.
Chronic stress can put the sympathetic nervous system into overdrive—better known as the "fight-or-flight response"—and may over time potentially activate symptoms of depression or anxiety. Yoga's ability to help calm the nervous system, Khalsa says, enables us to better handle this stress psychologically and physically.
Khalsa also notes that those who become more mindful of their physical and emotional states can more easily recognize when something is out of sync. For example, they may become more skilled at witnessing and catching a self-critical thought before it spirals out of control or feel that telltale knot in their stomach alerting them to anger. Khalsa explains that yoga may function like cognitive-behavioral therapy (CBT), a form of therapy that helps people identify and replace dysfunctional thoughts that can trigger anxiety or depression. "But yoga may well go deeper than CBT," theorizes Khalsa, "because it may also influence the genesis of the thought in the first place."
Many Approaches, One Goal
The way a practitioner weaves yoga and psychotherapy together exists on a continuum informed by the counselor's unique combination of mental health and yogic training. The experience you're likely to have with a psychoanalyst who integrates vinyasa yoga may be different from the experience you might have with a cognitive-behavioral therapist schooled in, say, Integral Yoga.
More than 20 years ago, Phoenix Rising Yoga Therapy was born out of the experience its founder, Michael Lee, had with Kripalu Yoga and the work of psychologist Carl Rogers. A pioneering movement in the integration of yoga and psychotherapy, Phoenix Rising promotes itself as a combination of classical yoga techniques and contemporary psychology designed to encourage a deeper connection with self.
Karen Hasskarl, co-director of programs at the Phoenix Rising Center, in Vermont, describes a typical individual session as beginning with a centering meditation that invites the client to connect with the body and breath, to acknowledge any issues that might be present, and to set an intention for the session. The practitioner then guides and supports the client through a series of asanas while simultaneously asking the person to describe the experience.
Utilizing another approach, Los Angeles therapist and yoga instructor Hala Khouri runs workshops that aim to help participants access their emotions on a physical level. With a master's degree in counseling psychology and three years of specialized training in Somatic Experiencing (which focuses on releasing trauma from the body), Khouri incorporates Ashtanga, Iyengar, and Anusara yoga approaches with the goal of teaching people how to work with emotions as sensations in their bodies.
Isabelle (who asked that her full name not be used) says that her individual and group sessions with Khouri provided her with a greater level of healing than she'd been able to achieve through psychotherapy alone or through her individual yoga practice. After her mother was diagnosed with cancer, Isabelle turned to Khouri to help her process her anger over the childhood abuse that was making it difficult for her to come to a place of forgiveness and, subsequently, closure. Becoming aware that she was angry and being able to work through it was hugely transformative, Isabelle says.
"Talking to Hala, coming into a posture, and feeling where I experienced [the anger] in my body allowed me to feel vulnerable and strong at the same time...and, ultimately, allowed me to say goodbye to my mother." Isabelle recalls Utkatasana (Chair Pose) as particularly healing, since it enabled her to access difficult emotions while remaining grounded.
The yoga used in therapy doesn't have to be solely physical. New Jersey psychologist Susan Herman forgoes yoga postures entirely; she instead relies on the underlying philosophy. While she has undergone Phoenix Rising training, Herman refers to herself as a conventional therapist informed by the teaching and practice of yoga. She incorporates yoga by guiding clients through a meditation or simple breathing exercise, and then asks her clients to practice the techniques after their sessions. Herman credits her combination of psychoanalytic and yoga training with helping clients to pick out strengths that they may tend to discount in themselves. "Yoga has a different point of view about human nature than traditional psychotherapy has," she states. "It is a very empowering philosophy."
And the Research Says
While data specific to the integration of yoga and talk therapy is hard to come by, Phoenix Rising Center reports that, over the past four years, participants of an eight-week group program have typically experienced a 54 percent reduction in stress and anxiety symptoms.
We can take some clues from research that points to yoga's success in treating mental health issues. In a 2005 study published in the Journal of Alternative and Complementary Medicine, yoga was found to be a beneficial adjunct treatment for conditions such as anxiety, depression, and posttraumatic stress disorder. Other studies have shown an improvement of mood among psychiatric patients after yoga is introduced.
While some clients report making a breakthrough after the very first session, others can take months or even years to do the same. Three and a half years after beginning Yoga and Talk, Katy's psychiatrist deemed her "in remission" and took her off her medications.
It's been a powerful transformation for Katy. Reluctant to leave home after high school, she has since moved across the country to attend a small liberal arts college this fall. While she may have stopped attending the group therapy sessions, Katy is still committed to maintaining her yoga practice. And she is also eager to share it with others.
Now in the midst of an intensive KundaliniYoga teacher training program, Katy says that Yoga and Talk continues to enhance her practice. "I know how to access what I'm feeling a lot better," she says. "And because of my therapy experience, I am able to go deeper."
Finding a Practitioner
The integration of yoga and therapy is a relatively new trend, so it can be difficult to find a practitioner. Therapists come to this approach from diverse backgrounds, with no nationally accepted standards or certification. While Phoenix Rising Yoga Therapy has a provider directory on its website (,a href="http://www.pryt.org">pryt.org), no central organization lists licensed psychotherapists who integrate yoga into the practice, which means you'll need to do research on your own.
A good place to start is by asking the staff or owner of your local yoga studio for recommendations. As you review their referrals, be aware that the words "therapist" and "psychotherapist" are generic: A practitioner doesn't need mental health training in order to use them. This might not matter if you are just looking to deepen your self-awareness. However, if your condition is interfering with your daily functioning, you'll want to make sure that your therapist is a licensed mental health practitioner (such as a psychologist, clinical social worker, or professional counselor). This will help ensure that he or she has the proper training and oversight. It also means that the practitioner will be able to draw from complementary interventions such as cognitive-behavioral or psycho-dynamic therapy to facilitate your progress. As you interview prospective therapists, here are some potential questions:
- What type of professional training do you have in both yoga and mental health?
- Will we be doing physical poses during sessions? If so, will you be supporting me during those poses?
- Have you worked with people who have had issues similar to mine?
- How do you think you might be able to help me?How a therapist answers these questions should give you a sense of their background and relational style. But, in the end, your instincts can be your best guide to finding someone who is a good fit.
What is your style of therapy, and how do you incorporate yoga?
Elana Verbin Bizer is a therapist and freelance writer in Austin, Texas.