Wednesday, August 29, 2012

Harvard, Brigham Study: Yoga Eases Veterans PTSD Symptoms

The words “Department of Defense” and “yoga” aren’t often uttered in the same breath, let alone in a long, conscious, exhale.

But preliminary results from a small study funded by the U.S. Defense Department, and led by a Harvard Medical School assistant professor, found that veterans diagnosed with post-traumatic stress disorder showed improvement in their symptoms after ten weeks of yoga classes, including meditation and breathing, done twice a week, and fifteen minutes of daily practice at home.
William Haviland never considered himself a yoga kind of guy. He served in Vietnam in 1968 during the TET offensive. Ask him about his combat experience and out comes a torrent of trauma: “I remember the things that happened, I’ve seen people killed right before my eyes,” he says. Among his vivid recollections, more than 40 years after the fact: a sergeant lured into a booby-trapped village, then castrated by shrapnel; the screams of a woman being raped and tortured all night. “I have a stream of memories,” he says, many which come out during sleep. Haviland, 63, says he frequently attacked his wife in the middle of the night, after nightmares that he was being chased by a fast-approaching enemy. Yoga, he says “took me out of myself” and had a more profound calming effect than drugs or drinking.

“PTSD is a disorder involving dysregulation of the stress response system, and one of the most powerful effects of yoga is to work on cognitive and physiological stress,” says Sat Bir S. Khalsa, Ph.D., an assistant professor of medicine at Brigham and Women’s Hospital and Harvard Medical School, and the principal investigator of the yoga study. “What we believe is happening, is that through the control of attention on a target — the breath, the postures, the body — that kind of awareness generates changes in the brain, in the limbic system, and these changes in thinking focus more in the moment, less in the past, and it quiets down the anxiety-provoking chatter going on in the head. People become less reactive and the hormone-related stress cycle starts to calm down.”
One common symptom of PTSD is the dissociation of mind and body, feeling disconnected from oneself and one’s surroundings, as well as an experience of time displacement. The brain portrays the traumatic event as though it is live and active in the present even though it may have happened decades ago. The practice of yoga combines physical exercises, postures and breath regulation together with meditation and awareness in the present moment and Khalsa says this integrative characteristic of yoga is likely important in resolving this dissociative aspect of PTSD.
Joseph Muxie served in the military from 1977-1984. While stationed in England, he said, he experienced an unbearable assault that is at the core of his PTSD. After years of alcoholism and a stint in rehab, he saw an ad about the Brigham yoga study and decided to try it. “I think what the yoga has really allowed me to do is give me the ability to ground myself,” said Muxie, 51. “As a result, I’m more peaceful with myself in whatever moment I happen to be in.”

According to the VA, as many as 20% of veterans of the Iraq and Afghanistan wars have PTSD; 10% of Gulf War vets and 30% of Vietnam vets are diagnosed with the disorder. In addition, approximately 23% of women reported they were sexually assaulted in the military and 55% of women and 38% of men experienced sexual harassment while serving. Military Sexual Assault (MSA) is a known factor in PTSD.
Because the incidence of trauma is so high, Khalsa says, the DOD’s, Telemedicine & Advanced Technology Research Center, which paid a total of $600,000 for this study, is exploring new approaches to treatment.

In the Brigham study, which has so far evaluated only the first 9 subjects to complete the protocol, each veteran’s PTSD severity was assessed using a tool called CAPS, the clinician-administered PTSD scale. The patient is scored by a trained psychologist using the CAPS scale both before and after the yoga intervention to determine any change in the scope and intensity of symptoms, which can include flashbacks, nightmares and a pervasive hyper-vigilance. According to Khalsa, the average baseline CAPS score before yoga in the subjects was 73.0, and the average score post-intervention was 43.6. (The average reduction in CAPS score pre-to-post was 29.4.) Here are the subject’s individual scores, before and after yoga:
– 113; 81
– 81; 40
– 111; 21
– 37;33
– 62;36
– 53;15
– 84;78
– 66;72
– 50;16

So, for 6 subjects, their scores improved quite a lot with yoga; for 3, there was little change. Khalsa said that typically even well-known, highly effective treatments don’t work for every patient and he is still evaluating other measures to determine if the yoga had any other non-CAPS benefits. “These subjects may possibly have benefited in things like depression or anxiety, even though their overall PTSD CAPS score did not change much (as was observed in a preliminary yoga-PTSD study in Australia)… Human subject research is pretty messy.”
Ultimately, he said he hopes to evaluate a total of 60 subjects, including a control group, but so far, recruitment has been slow, due to yoga’s “new age” reputation and its association with women. “There’s some sense that sissies do yoga,” he said.
Jennifer Johnston, a yoga teacher, licensed mental health counselor and the project leader, said that beyond recruitment, yoga’s “hot” reputation has in some sense eclipsed its greatest assets. “Because yoga is so sexy now, certain aspects get forgotten,” she said. “Yoga is a path to reconnect all of the parts of yourself. It’s a self-care strategy. The poses are important, but the philosophy is how we do our lives. The magic is in the meditation, integrating it and taking the yoga off the mat and into your life.”

Wednesday, August 22, 2012

Is Happiness Internal or External

“In our ordinary life, even thought we work very hard to find happiness it remains elusive for us, while sufferings and problems seem to come naturally, without any effort. Why is this? It is because the cause of happiness within our mind-inner peace-is very weak and can give rise to its effect only if we apply great effort, while the internal causes of suffering and problems-delusions-are very strong and can give rise to their effects with no effort on our part. This is the real reason why problems come naturally while happiness is so difficult to find.
From this we can see that the principal causes of both happiness and problems are in the mind, not in the external world. If we were able to maintain a calm and peaceful mind all day long we would never experience any problems or mental suffering. For example, if our mind remains peaceful all the time, then even if we are insulted, criticized, or blamed, or if we lose our job or our friends, we will not become unhappy. No matter how difficult our external circumstances may become, as long as we maintain a calm and peaceful mind they will not be a problem for us. Therefore, if we wish to be free from problems there is only one thing to do-learn to maintain a peaceful state of mind by following the spiritual path.
The essential point of understanding the mind is that liberation from suffering cannot be found outside the mind. Permanent liberation can be found only by purifying the mind. Therefore, if we want to become free from problems and attain lasting peace and happiness we need to increase our knowledge and understanding of the mind.”
Taken from Transform Your Life by Geshe Kelsang Gyatso

Sunday, August 19, 2012

Yoga Fixes From Head to Toes: Poses for 8 Common Conditions

From the Huffington Post:

Scientific research into what medical conditions yoga can heal and how it does its work is blossoming. Last year the National Institutes of Health funded 30 clinical trials covering everything from yoga for back pain to cognitive function, blood pressure, irritable bowel, and cardiovascular disease risk. Others in my community are also conducting or designing clinical trials like those I'm doing for scoliosis, bunion and osteoporosis.

Many patients come to see me with more than one complaint in more than one body part, and it's not difficult to find a way to use yoga to help almost everything. As a legitimate, mainstream modality for healing, yoga is a no-brainer. It's natural and nearly harmless. It has been proven to improve flexibility, balance, strength, coordination and mood. Expensive medications and surgeries -- even those I need to prescribe on occasion -- may sometimes have dreaded effects.

Yoga can be done at home, for free, with few if any negative side effects.

While there has been a lot of useful discussion about the possibility of hurting oneself while doing yoga, and shoulder stand and plow can be quite dangerous if done incorrectly, my own research has shown the greatest risk arises from trying too hard or being overly enthusiastic. I believe careful, conservative practice is quite safe, and I've been doing it myself every day for many years.
Obviously everyone is an individual with unique problems, but some common maladies hit us all from time to time. Here are eight for which yoga has been studied in clinical trials, or that I'm currently in the process of researching myself. Yoga from head to toes, starting at the top and working down:
Migraine: It's estimated that 28 million Americans suffer from migraine every year and yoga seems to be helpful. When a patient is willing to try yoga for migraine, I suggest forward bends or inverted poses such as headstand. (You don't have to stand on your head; the modified pose with your legs on a chair is fine.)
Neck Pain: A pain in the neck most commonly arises from stress, from poor posture or from arthritis. Almost miraculously one yoga pose -- The Rainbow (Urdhva Dhanurasana) -- is effective treatment for all three of these problems.
Shoulder Pain: A yoga-based maneuver has erased pain and disability for more than 800 of my patients who have rotator cuff difficulties, saving them from expensive, painful surgery and at least three months of physical therapy for recovery. The Triangular Forearm Support (TFS) is based on the headstand but you don't have to stand on your head to do it. It activates a muscle that takes over the function of the one that has been injured. Activating the muscle for a minute and then enthusiastically, fearlessing raising the arm on the bad side trains the subscapularis muscle to take over for the injured superspinadis. The injured muscle never has to work again. I have followed patients who have been cured by this maneuver -- painless full range of motion for 10 years.
Back Pain: A lot of work has already been done showing the efficacy of yoga.
Of course, different poses are healing for different causes of back pain. For spasm, one of the most common symptoms, I suggest forward bends.
Piriformis Syndrome: "Pain in the butt" accounts for as much or more pain than herniated disk. If you have it, relieve the pressure on your sciatic nerve by stretching the piriformis muscle with poses such as a modified Pigeon, (Kapetasana) or Twisted Triangle (Parvrtta Trikonasana).
Knee Osteoarthritis: As long ago as 2005 a pilot study suggested that yoga done in the BKS Iyengar style could help those who had osteoarthritis of the knee and who had never done any kind of yoga before, people who were obese or older than 50. My favorite poses for this widespread condition are Warrior I and II.
Plantar Fasciitis: A pad of fat in your heal covers the plantar fascia, a band of tissue that starts at your heel and goes along the bottom of your foot. Damage to the plantar fascia can be a cause of chronic, hard-to-cure heel pain. Stretching the calves, surprisingly, can add space that takes pressure off the tender heel. I recommend a forward bend, Janushirshasana -- Head to Knee pose.
Bunion: Surgery is the treatment of choice for the big, painful, deformed big toe joint, but surgery isn't always easy or successful. I have been working on my own right foot for a couple of years now, trying to prevent a bunion from forming, and although some believe bunions are genetically determined or develop through faulty walking patterns, I think there is some control. For a bunion trying to form I use yoga-based exercises to strengthen the abductor halluris, a foot muscle, and find that the growth of the bunion os sometimes reversed, usually stopped and almost always slowed.
For more by Loren Fishman, M.D., click here.

Sunday, August 5, 2012

The Power of Self-Reflection

We bring such a society into being by strengthening our conviction in humanity's goodness.  We do this by taking a few moments and feeling what's beneath all our daily concerns.  This trains us to become familiar with the simplicity of now, the only place and time that we can touch this deep inner reality, which brings a feeling of worthiness.  Even though we may not trust it or believe it, just allowing for that possibility has an impact on what we say and do.  In that moment, we are determining the outcome of the universe.

Sakyong Mipham