Hello Dear Friends, I have been a bit absent writing on the blog due to having many projects this year. I was working on contributing to a book but had to resign today due to one to many time constraints on my time and energy. I have decided to share my article with you here. I have two and this is the one I originally posted. I will post the other shorter one soon. I hope someone finds this helpful.
With Love,
Courtney
Courtney Robinson, C-IAYT
Stress Management Specialist Ornish Reversal Program, E-RYT 500 , RCYT, RPYT, Y12SR, POLY-500, U.C.I. Solution Focused Coach
I see clients in my private practice and at Saline Heart Group (private medical practice)
in Benton, AR, under the guidance of Dr. Allan Hatch, Cardiologist.
Title: “Empowering Through Treatment and Remission”
Stage:
Cure and Remission
Intervention: Though I see small groups of patients in many stages of cancer recovery
rehab, I have the same main focus with an individual: to bring the nervous system back
into homeostasis or balance through the parasympathetic nervous system or PNS. The
treatment looks at a variety of other underlying factors such as anxiety, depression,
fatigue and reduction of lymphatic congestion. There are many facets to treatment and
remission. Many tools are needed in the mental and physical toolbox. The main focus is
to bring the body into the PNS to assist in the body’s ability to begin healing through rest
and digest by engaging the bodies own self regulation process.
I teach a gentle practice to engage the PNS which include:
● Relaxation techniques
● Visualization
● Meditation
● Affirmation or positive internal dialogue
● Safe asana or postures
● Breathing techniques (pranayama) two part or diaphragmatic, three part, and
when appropriate alternate nostril breathing
We (myself as a facilitator with the client) utilize these techniques to induce a positive
hormonal (reduction of cortisol, increase in serotonin, dopamine, and oxytocin)
response to reduce pain, decrease depression and anxiety, reduce lymphatic
congestion, decrease heaviness in the limbs, increase cognitive ability, and reduce
fatigue.
The Practice:
1. Centering: We begin with centering to bring the mind and the body into the
same place. The mind is often filled with worry about the future or concerns
about what one could have done differently.
2. Pranayama: Work with the breath to slow the breathing response and begin to
bring the body into the parasympathetic response. Two part and three part
breathing allows for more oxygen in the blood which is needed to heal organs
and prevent a recurrence of illness. If appropriate, at the end of class I will add alternate nostril breathing if the client is comfortable. Due to some issues with the
nostrils and tenderness from treatments, this is not always possible.
Breathing is continued with the entire practice with an emphasis on inhaling and
exhaling on the movement or action.
3. Body Scan or Progressive Relaxation: I go through a body scan or relaxation
process utilizing the peripheral nervous system, relaxing from the feet to the hip
joint, then the fingers to the shoulder joint, one limb at a time. We move on to the
base of the spinal column, working up the neurological tree utilizing the planes of
the torso, front, middle, and back. Each breath brings awareness to the point of focus and the exhalation
relaxes the body part we are focusing on, ending with the neck, face, and head
relating to the brain. This is a journey inward from the outer areas of the body
into the brain. This format that we follow also follows the pancha maya kosha
model. I tie these together with breathing, body scanning and work on cognitive
function as we begin to add meditation, positive thinking, and affirmation to fit the
clients needs that day. We end up with the mental and emotional focus, wisdom
and intuition towards the end and deep meditation focused on brain, mind or
consciousness in final mediation. Then, work back out through breath and
physical body.
4. Transition meditation, cognitive work with affirmation or mantra: After
centering and focusing on pranayama and relaxation, we come to meditation and
affirmation. There is a period of quiet focus and then a focused affirmation or
positive thought in the positive present tense, such as an “I am” or “I have”
statement. The focus is on the clients needs that particular day. For example, “I
am strong”, “I am brave”, “I am capable”. It can be what the client chooses. This
is the major cognitive portion before moving onto the somatic or movement
portion.
5. Postures or Movement: Postures and movement begin to carry information from the brain down the spinal column through the body or through the neural pathways, which helps to address
moving the cognitive work through the body by means of postures, and carrying
the work of the mind through the body which also is another way of working though the nervous system, in the yoga world we relate this to samskaras or patterns. We follow a posture process of working from the head and
neck, shoulders, elbows, hands, spine, hips, knees, and feet using small
movements of each joint to address all the lymph chains and lymph glands in the
body. These movements have been shown to reduce lymph congestion, increase
artery flexibility and circulation, which supports a healthy immune system and
increases oxygen carried throughout the circulatory system. These movements
have been shown to reduce pain and increase awareness in the body and further
the relaxation response. Typical movements include moving the joints in the way
in which they are meant to be moved such as a hinge joint moves like a door.
Shoulders are a ball and socket so they have a large range or motion such as
shrugging the shoulders back, up, and forward. Common postures you will see
are simple seated spinal twist, seated forward fold (head kept above the heart for
safety) , and gentle cat cow. There always has to be an awareness of devices
the client may have. Commonly, there will be a port. Inversions can aggravate
the port so I tend to stick to modified versions.
6. Final Meditation: Once postures have been completed, the client is then placed
in an appropriate supported position for final meditation. I will go through the
pancha maya model. We will focus on relaxing the body again from the feet to
the head (Annamaya), breath awareness (Pranamaya), and belly region
(Manomaya) for checking in with self. The client will look at themselves like
looking at beloved friend and check in. A question may be “How am I doing
today?” Self compassion and non judgement are encouraged. We then move
onto the solar plexus area and heart (Vijnanamaya). Ask “What do I need for self
care today?” or “What is it that I need to pay attention to?” with a focus on inner
intuitive listening or the inner guide. We will stay here in the heart area and focus
on gratitude and finding the good in each day. We will use visualization through
this process: seeing what we are grateful for and naming it. Moving on to the
head and brain, we will focus behind the eyes, between the ears, or the middle of
the mind as we center on breath and meditate quietly (Annadamaya). We will
come back out as we focus on bringing this all to a cellular level: breathing in,
bringing light, or positive thoughts down through the body filling every cell. I may
use a visualization like sunshine pouring through the body, removing anything
that doesn't need to be there and leaving only health or wellness. It could be
emotional or physical. We wrap this up with breathing, focusing on the middle
body or trunk, arms, legs, wrists, ankles, and feet (moving from the inside back
out).
Case Study: My client is Mandy, a 42 year old who is a wife and mother. She
previously worked in social work and had been recently diagnosed with breast cancer.
Mandy was feeling scared, and she was trying to navigate treatment for herself with the
uncertainty that comes with a cancer diagnosis.
Her concerns were for her family and not only their worries and fears, but also finding
help for all their needs and her own while she was in treatment. Mandy and I met when
she called me about attending my yoga teacher training. She reached out to me a few
months later to let me know of her diagnosis. We switched gears to focus on her health
together rather than schooling. She would see me in my office at least one to two times
a month depending on her treatment schedule. I often try to make sure that sessions
work with the treatment schedule. For instance, scheduling a few days prior to treatment
rather than after a treatment when the client may experience more negative symptoms
such as digestive issues and severe fatigue.
Our focus was to give her the tools in her mental toolbox to regulate her nervous system
so she could manage her health and assist her body in doing the hard work ahead of
her. I shared with her the dietary guidelines from Dr. Ornish’s Program for Reversing
Heart Disease because of the analysis that has been shown on the improvements of
breast cancer patients who participated in the research.
Each session included a time for her to talk and for me to listen. I would allow her to
express her feelings openly. She was feeling a lot of frustration and some anger at the
situation. Others would say things to her such as “It’s all going to be okay” when truly no
one knew if it would or not.
Our sessions included centering, pranayama, two and three part, and alternate nostril
breathing. For Mandy, she was familiar with alternate nostril breathing. I added it to her
practice because of its calming and balancing impact on the body and mind.
We would then do a deep relaxation to activate the PNS to a deeper state or relaxation
to bring balance (homeostasis) to the body and mind.
Postures were used to assist with reducing fatigue, keeping the muscles supple to keep
up her range of motion, and reduce lymph congestion to allow her circulation to remain
healthy. Working in cardiac rehab I also knew that if I could help her learn to regulate
her PNS, the impact to her heart from treatment may be reduced.
We would also do some chanting of Lokha Samastha Sukhino Bhavantu to mentally
bring a sense of peace, but also to activate the PNS through cranial nerve No. 10 or the
vagus nerve since studies show that chanting or humming is very relaxing to the
nervous system. She enjoyed chanting, and it helped soothe her mind and body. It
became a default mechanism for her when under stress.
We would often use the guided meditation in the above protocol working through the
pancha maya model. Sometimes we would use other visualizations like envisioning the
future with perfect health. One particular day, she told me that all she could see was
sitting on her deck with her boys doing normal life things. Recently, she told me that she
was getting some pressure from people to go back to work or figure out her passion.
She told me, “I want to be a wife, mother, friend, and do what I am doing.” I felt strongly
that her image from her previous visualization had come to be true, as she was doing
exactly what she envisioned.
Mandy had many rounds of chemo, a double mastectomy, and subsequent
reconstruction. She is doing very well now. Her hair is growing out, her appetite is back,
and she is fully enjoying life. She expresses deep gratitude for the practice and shares
her experience of what she learned in yoga therapy with others.
Ancient Text that inform the practice.
1. Taittiriya Upanishad (2:1-5). The five sheaths (pancha-koshas).
1. Annamaya kosha, "food" sheath (Anna)
2. Pranamaya kosha, "energy" sheath (Prana)
3. Manomaya kosha "mind" sheath (Manas)
4. Vijnanamaya kosha, "discernment" sheath (Vijnana)
5. Anandamaya kosha"bliss" sheath (Ananda)
2. The Yoga Sutras 3:9 Nirodha parinama, the transformation of the bounded state,
occurs when the attention moves from the rise and fall of the minds impressions to the
silence that pervades when it’s activity is settled. Through practice the mind is settled
and the PNS is engaged. One experiences a sense of peace and well being. A state that
does not associate with illness or disease but with a sense of oneness and joy.
Research Sources
Breastcancer.org. (n.d.). Yoga. [online] Available at:
https://www.breastcancer.org/treatment/comp_med/types/yoga
Katuri, K., Dasari, A., Kurapati, S., Vinnakota, N., Bollepalli, A. and Dhulipalla, R. (2016).
Association of yoga practice and serum cortisol levels in chronic periodontitis patients with
stress-related anxiety and depression. National Center for Biotechnology Information.
Krishnakumar, D., Hamblin, M. and Lakshmanan, S. (2015). Meditation and Yoga can Modulate
Brain Mechanisms that affect Behavior and Anxiety-A Modern Scientific Perspective. [online]
National Center for Biotechnology Information. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769029/ [Accessed 29 Aug. 2019].
LI, S., SUN, Y. and GAO, D. (2013). Role of the nervous system in cancer metastasis. [online]
National Center for Biotechnology Information. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3629128/
Narahari, S., Guruprasad, M., Thernoe, L., Bose, K. and Ryan, T. (2016). Yoga protocol for
treatment of breast cancer-related lymphedema. [online] National Center for Biotechnology
Information. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959325/
NJTV News. (2018). Could practicing gratitude have health benefits? | Video | NJTV News.
[online] Available at:
https://www.njtvonline.org/news/video/could-practicing-gratitude-have-health-benefits/
Ornish Lifestyle Medicine. (n.d.). Ornish Lifestyle Medicine | TIME: For Breast Cancer, It’s Not
Nature vs. Nurture—It’s Both. [online] Available at:
https://www.ornish.com/zine/time-breast-cancer-nature-vs-nurture
Patanjali, & Shearer, A. (2002). The Yoga Sutras of Patanjali. New York, Bell Tower.
Publishing, H. (n.d.). Yoga for anxiety and depression - Harvard Health. [online] Harvard Health.
Available at: https://www.health.harvard.edu/mind-and-mood/yoga-for-anxiety-and-depression
San
karācārya, Sureśvarācārya, Mādhava, and Mahadeva Sastri, A. (1980). The Taittiriya
Upanishad. Madras, Samata Books
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