Yoga for Seasonal Affective Disorder: Results of 10-week Course

A Report Submitted by Jill Dunkley, AVI Certified Yoga Therapist, to the SYTAR 2008 Conference sponsored by the International Association of Yoga Therapists

INTRODUCTION:

This report outlines and summarizes the results of a 10-class course I taught from January to March 2008 at the North Lanark Community Health Centre (NLCHC). The NLCHC is a community based non-profit health centre run by people who mainly live and work in the north part of Lanark County, Ontario, Canada. As a community health centre the staff are committed to:

•    providing accessible service;
•    encouraging individuals and communities to take charge of their own health;
•    wellness and illness prevention; and
•    providing comprehensive care.

The health team includes a doctor, nurse, nurse practitioner, chiropodist, nutritionist, physiotherapist, psychiatrist, social worker, health promoter and administrative staff.  Part of their mandate includes offering various health information sessions, such as on yoga and tai chi.

Our Yoga cooperative, The Yoga Connection, was approached by Sherry Baltzer, a social worker at the NLCHC, in the Spring of 2005 about the possibility of teaching a yoga class to individuals with chronic health conditions. Students would be referred to the class by members of the health centre team.  Because of my AVI (American Viniyoga Institute) training I was keen to teach the class.  I taught a 10 week session to 11 individuals in Fall 2005.  Sherry Baltzer participated in the classes and provided administrative and therapeutic support.  These classes were funded by the NLCHC and were offered free to individuals accepted into the program.  Students completed before and after questionnaires including program goals, physical health status, pain body maps, depression and anxiety scales, and final program evaluations.

The results of this first class were positive enough that the NLCHC provided persistent health concerns in the Spring/Fall of 2006/2007.  For more information on these classes see my Final Report for AVI’s Advanced Teacher Training Certification, June 2006.

In the Fall of 2007 I approached the NLCHC about teaching a 10 week session for individuals suffering from Seasonal Affective Disorder (SAD) as part of my course requirements for the AVI Yoga Therapist Certification.  The NLCHC was supportive of the initiative and funding was secured to teach such a course.

THE COURSE

Promotion

This program was less widely promoted in the print media than previous sessions.  Promotion consisted of:

•    NLCHC newsletter
•    Referral by members of the NLCHC health care team
•    Word of Mouth

Intake Process

Twenty-nine  individuals expressed an interest in the course.  Sixty-four percent were students who had taken previous yoga classes at the NLCHC.  The remaining new students were screened to determine eligibility.  Because of the number of interested individuals and the wide range of physical ability, two separate classes were offered:

–    Group One: a gentle chair yoga class; and
–    Group Two: a floor Yoga class for those who were able to stand, kneel, sit and lie down.

Sherry and I interviewed the new applicants prior to the start of the course.   We made it clear to the candidates that this program was not a regular yoga class but therapeutic in nature, specifically addressing the symptoms of SAD.

The prospective students were asked:

•    why they wanted to take the course;
•    their level of physical ability;
•    if they suffered from the symptoms of SAD;
•    if they had a level of commitment sufficient to complete the 10 week course; and
•    to fill out some detailed forms before and after the 10 week course
•   
Based on their answers, we determined their suitability for the program.  Eventually we ended up with thirteen people in Group One and fourteen people in Group Two.   In order to ensure class cohesiveness.no other individuals were admitted to the program after the 3rd week

Intention

My objective in this course was to introduce beginner and experienced students to a number of different yoga to help cope with the SAD. The intention was to assist the students in gaining a sense of empowerment by changing their relationship to their condition.  The tools included: Yoga postures, breath practices, guided visualizations, relaxation and meditation techniques.

Class Process

The format of each class included:

•    an educational component related to the week’s theme, e.g., tips for sleeping better, managing stress, coping with anxiety, increasing energy, and addressing negative thoughts and behaviour. 
•    a Yoga practice related to the theme
•    a simple technique related to the theme which was offered as “homework”
•    being available after class for any questions/comments

The Winter Session included 10 classes.  The two groups met every Thursday morning  at the NLCHC from January to March, 2008.

Class Set-up

The chairs for Group One classes were set up in a circle with mats placed in front of the chairs.  Some students placed a large pillow under their feet in order to sit in proper alignment.  I taught as part of the circle and demonstrated from the centre of the circle.

In Group Two, the class became too large to set up a circle.  In order to accommodate all eligible students we placed the students in rows with some students off to the side of the “L-shaped” room. Some chairs were still available for use if needed.  The returning students were notified ahead of time, so they could adjust to the change in room set-up.  I taught and demonstrated from the front of the class.

Sherry Baltzer participated in the majority of classes, sometimes assisting and demonstrating chair poses as needed.  She helped provide props for students when requested.  She was also available to address any administrative or process issues if they arose.

THE CLASSES

A summary of the classes is as follows:

Week One – “Yoga 101” – The Fundamentals of Linking Breath and Movement

The first week included a brief sharing (two or three sentences) about what each individual hoped to get from the program. 

The signs and symptoms of SAD were reviewed.  The students were informed that each week would include a theme to address the different signs and symptoms

I emphasized three scenarios regarding performing the asanas (physical postures):
1.    can do it;
2.    can’t do it but will get there over time; and
3.    can’t do it (contraindicated for their condition).

If students experience discomfort in a posture I requested that they come out slowly and carefully.

The introductory samana (balanced) practice explored the following themes:
•    become aware of the breath;
•    connect breath and simple movement;
•    explore exhale/inhale parts of the breath in simple postures;
•    proper standing alignment;
•    introduction to simple forward bends, back bends and twists; 
•    deepen breathing, inhale=exhale using the finger counting technique;
•    introduction to the observance of body sensations during final relaxation;
•    opportunity to share experience at the end of the class.

Week Two – “Slowing Down” – How to Relax and Calm the Nervous System Using the Exhale

One of the symptoms of SAD is feeling stressed and being unable to relax. The theme of the class was calming and relaxing the nervous system.  Yoga techniques included the following:
•    a breath technique called ujyaii breath;
•    developing the exhale part of the breath to help the mind/body to relax;
•     practicing postures which develop core strength in the body and emphasize the exhale;
•    a guided final relaxation designed to create deep states of relaxation.

Week Three – “Your Morning Cup of Yoga” – How to Energize the Body and Lift the Spirits Using the Inhale

This class was designed improve posture, energize the body and improve mood.  The techniques included:

•    diaphragmatic breathing;
•    emphasis on the inhale, and holding the inhale in postures;
•    increasing breath capacity using the simple finger counting technique;
•    emphasis on backbending postures;
•    an inspirational quote after final relaxation.

Week Four and Five  (repeated because of poor attendance due to bad weather) –“Mindfulness” – How to Recognize and deal with Negative Thoughts and Behaviour

In weeks four and five we worked on addressing negative thoughts and behaviour with positive affirmations to help change how the students’ thinking relates to their condition. To that end we:

•    reviewed patterns of negative thought and behaviour;
•    brought awareness  to the quality of the thoughts using the tool of the breath;
•    explored nyasa or hand gestures which  symbolize positive verbal affirmation to help replace negative thinking; 
•    explored verbal affirmation – “everyday in everyway, I’m getting stronger in my body, breath and mind”.
.

Week Six – “Let There be Light” – Understanding our Circadian Rhythms

The class received a fact sheet on circadian rhythms and their effect on the body as it relates to depression.  After some questions and discussion the yoga practice included:

•    opening the blinds to bring more light into the room;
•    visualizing drawing light into the body;
•    symbolic gesture (nyasa) to spread light throughout the body;
•    alternate nostril breathing emphasizing the inhale;
•    guided visualization on light;
•    an inspirational quote after final relaxation.

Week Seven – “Life of Balance” – Bringing Balance to the Body, Breath and Mind

The breath techniques introduced in this class were more complex, so they were taught at the beginning of the class and repeated again before final relaxation at the end of the class.  The practice included:

•    introduction of straw-breathing technique and alternate nostril breathing;
•    using postures to help lengthen both the inhale and the exhale; 
•    a balanced physical practice moving the spine in all directions of movement;
•    a guided relaxation to balance the flow of breath in the body;
•    an inspirational quote after final relaxation.

Week Eight – “Sleep Better” –Using Simple Posture Practices and Breath Techniques to Address Insomnia

The class was handed out a fact sheet on insomnia and some information on lifestyle tips for improving sleep. They were also provided a short yoga practice to do at home before bed.  The practice for this class included:

•    lengthening the exhale using an affirmation;
•    meditation on making the exhale breath twice as long as the inhale;
•    practicing different breath techniques calm the mind and go to sleep;
•    guided relaxation to move into deep states of relaxation.

Week Nine – “Crossing Over the Fear-Loving Streams of the Mind” – Understanding Mantra Using Breath and Postures

This class was designed to work with anxious states resulting from an agitated mind and body.  The practice was as follows:

•    unpacking the meaning of the word mantra;
•    working with holding the breath after inhale;
•    using the mantra  “This too shall pass” on the hold after the inhale in postures;
•    using the finger counter technique with the mantra  and the hold after inhale;
•    final relaxation;
•    an inspirational quote at the end of class.

Week Ten – “Yoga Off the Mat and Into Your Life” – A Simple Practice to Continue to Use at Home

The class was handed out a home practice to work with depression.  The home practice included:

•    a half-hour practice using simple postures used in class;
•    work with the hold after the inhale in postures;
•    lengthen the exhale in postures;
•    using the mantra  “This too shall pass” on the hold after the inhale in postures;
•    use the finger counter technique with the mantra  and the hold after inhale.

In final relaxation students were asked to reflect on why they came; what they learned, and what might tools they might take away from this class to manage some aspect of their condition.  They were also given an opportunity to ask questions during and after the class, to ensure they understood the techniques in the home practice;

Enough time was provided to have the students fill out evaluation forms at the end of the class and ask any questions of Sherry Baltzer or me regarding administration of the program.

OUTCOME

One hundred percent of individuals in Group 1 and 86 %in Group 2 who responded to the questionnaire found their signs and symptoms of SAD improved.  The only student from Group 2 who showed no improvement found that their signs and symptoms stayed the same.

Some noted increasing physical flexibility and strength, improved self-esteem and a more relaxed, positive attitude in dealing with their condition.

Therapeutic Factors

Participants noted the following factors contributed to an improvement of symptoms:

–    warm supportive environment(“not competitive at all – a warm, safe environment”)
–    normalization (“realizing others have similar problems sleeping and dealing with the winter blues”)
–    socialization (“helps me stay connected with outside world and people”)
–    breathing techniques
–    self-agency (“that I can find the answers within myself with the tools provided through yoga”)
–    relaxation and improved concentration
–    awareness and interruption of negative self-talk  (how to acknowledge the “nasty’s” and “let them go” )

Extra-Therapeutic Factors

Factors outside the class which were reported to improve symptoms included: increasing daylight in the early spring months, quitting drinking and smoking, participating in a stress reduction program, increasing vitamin D, and walking a dog.

Attendance

Individual attendance was higher than in previous sessions, despite extreme weather conditions – an average of over 70% over the 10 week. 

Physical Environment

For those with back conditions, there was a request for chairs that didn’t “slope down” at the back.  Simple folding chairs would provide better 90 degree support for the back.  Some participants found the temperature in the room “chilly” on some days.  One participant commented that “the mats were too short, slippery and noisy to move”.

DISCUSSION

The underlying premise of therapeutic yoga is to work with the whole person, not just the illness, in order to help the participant change the relationship to their condition.  This was the first time the yoga classes at NLCHC targeted the signs and symptoms of a specific condition – in this instance, SAD.  The classes were successful in helping the students learn to be not so identified with their illnesses and experience an improvement in their symptoms. 

While it is important to have a wide range of themes and specific techniques to address the signs and symptoms, there were two particular techniques that students reported as being particularly effective:

–    breathing techniques that emphasize the exhale and calm the nervous system;
–    awareness and interruption of negative self-talk.

One of the primary goals in therapeutic yoga is to foster a sense of self-agency.  In this respect, students in this program requested more classes throughout the year, and some are practicing three or four times a week at home.

Possible Future Programs

Following the success of Yoga for SAD, the NLCHC may want to consider yoga classes targeting the following chronic conditions.  Some suggestions are as follows:
–    Diabetes
–    Chronic Fatigue/Fibromyalgia
–    Multiple Sclerosis/Parkinson’s Disease
–    Arthritis
–    Back Pain
–    Eating Disorders
–    Stress and Anxiety

Source: Sytar 2008 Conference Report by Jill Dunkley

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