Wednesday, October 6, 2010

Closing Post, Can you measure open-heartedness?

Putting off writing this closing post of SYR has given me time to reflect on what I just experienced. We were asked in the evaluation handout about our preference of a smaller venue for future symposiums such as HI versus a larger venue to accommodate more attendees. [Undoubtedly there is bias in responding to that question. Questionaire data analysts take note!] Everything was fairly perfect for us at the Himalayan Institute.

We were cared for, no, doted on by what seemed like scores of residents. Attendees and residents shared rooms on the same floor, bathrooms, meals, yoga classes, and conversations. They were everywhere (not quite like the constant helpers Americans find themselves surrounded by in India, but getting close). It seemed like there was nothing they would not do for their guests. Monday morning as I left a resident of around 20 years wanted to hold an umbrella over me while I took my stuff to the car. The auditorium, one big screen in front and another half way down one side, was monitored by the AV specialist, and everything went off without a hitch in there. We could all see and hear. My only complaint, as noted previoiusly, was that the internet could be accessed only on the other side of the building and there are lots of steps and corners and long hallways full of spiritual art to get distracted by along the way. I actually have no doubt that this atmosphere is what Sat Bir Khalsa, the progenitor of this symposium, desires. HI is as sattvic a setting for a symposium as I can imagine.

The attendees were not your usual yoga conference crowd, by a long stretch. Judging from a show of hands Probably no more than 30% were yoga therapists. Most were academics or clinicians, doctors, nurses, physical therapists, PhDs in education or psychology, so many areas, most all practicing and believers in the power of yoga. Those present representing yoga/yoga therapy/yoga education, etc but probably not yoga research per se, consistently asked more questions about the yoga aspect of a study, i.e. yoga protocol, who offered the yoga to the subjects, precautions taken, modifications, etc. "Kind" of yoga used for a study and how important that may be was discussed more than once and whether it could be said that the subjects were "really doing yoga" was also acknowledged.

Discussion, in fact, is germane to the presentation of research results. The presenters of the preconference (Sapier, Innes, Cohen, and Khalsa) all (i think) spoke to its importance. That's where the authors really have an opportunity to bring up the challenges, missed opportunities, unforeseen outcomes that could be studies further etc. All good researchers it seems are looking for ideas to propel their work into the next stages of research that will offer proof of the power of yoga and other mindfulness based practices.

Among the many positive effects of yoga we have either personally experienced or learned about from studies, probably the one that I am most thrilled with—largely for personal reasons but also because so many people are affected by this— is yoga’s ability to change the course of Post Traumatic Stress Disorder. Dr. Bessel van der Kolk, a psychologist, shared with us his NCAAM funded study on PTSD.

Van der Kolk’s Saturday keynote came at that time during the symposium when people had fully emerged from their shells. It was after lunch where we’d been happily expressing themselves with one another, and had had a chance to walk outside or mingle in the poster session area. Part of this was actually due to Sat Bir’s planning brain, as he had envisioned this conference based on the Gordon model. This is where a very focused and appropriate group— sometimes even hand-picked delegates who apply for admittance—through the setting and intervals, pauses and pace come into a flow that generates a rhythm of convergence, divergence, crescendos and lulls and the energy and interactions are a bit more electric and unconstrained. There was a high energy in the auditorium even before van der Kolk’s talk began. I think we all felt it.

Van der Kolk is one of those magnetic speakers who command their surrounding space. I don’t know why this occurs and maybe there is a study somewhere on this type of personality. But we were all leaning forward, I noticed, and (I’m really not exaggerating) hanging on his every word.

He opened with a film of a traumatized woman in a chair seated near her psychologist. The psychologist asked the woman to recall the incident that was still traumatizing her. Van der Kolk asked us to notice her body posture, which was slumped and defensive. Apparently she would describe the horrible accident in vivid detail, over and over, and each time that she did her body would respond again to the trauma and she would begin crying. The body keeps reliving the trauma, he told us, and that trauma is an illness of the total organism.

He considered, he told us, how useful is it for a person to keep talking about their trauma again and again when the body just keeps reliving it when they do? First we have thoughts, then the emotions are expressed, and then the body reacts. How do you get people into a mode where it is over?

Showing a slide of a crowd of people running through the streets of NYC during 9/11 I think was brilliant audience manipulation probably unintended that way though. We were now psychologically part of the story he was telling because everyone in the room was sympathetic to the circumstance. But what he told us was new, at least to me: there was virtually no PTSD following 9/11 because people were able to run to a safe place, to home, and that support from around the world poured forth. He concluded that by and large, if you can run to a safe place following a potentially traumatizing event, you don’t get traumatized.

So trauma occurs when the body is unable to take actions it naturally would take. And this trauma remains embedded in the body possibly especially due to continued recounting of the event because the body believes it is back at the source of the trauma again.

As did all of the speakers who shared their research, some background or lead-up to theories was offered from other studies, and not only studies authored by the speaker. Throughout the weekend we witnessed the reliance and respect researchers have on results and insights to be found in the literature that may give them a new spark of insight which will help make their own work a unique contribution. There’s obviously competition for scarce funding dollars, but they are extremely respectful of contributions others are making.

Just as Dr. Shirley Telles is mining the yoga texts for explanations as to how yoga can work and then creatively applying those lessons in today’s world, Dr. van der Kolk had insight from Darwin’s work done back in 1872. Darwin offered that the pneumogastric nerve, as he called it, now called the vagus nerve, was the control center to the emotional body.

He commented that those who are using alcohol or drugs to make themselves feel better (often the case with traumatized people) , more than any other group, through peripheral activation of the vagus nerve is trying to change how they react to past trauma.

Overcoming trauma, then, is to regulate the physiology by learning to get out of flight or flight mode, and for this he used yoga with the woman previously noted (and other subjects who were traumatized). Van der Kolk noted heart rate variability (HRV) differences. Low HRV indicated anxious or depressed states; High HRV indicated resistance to stress. Please go to the Digital Resources Library and look at his slides and graphs, etc.

Recognizing the reality of what yoga does to people, he asked subjects how they Felt about their bodies (mood scale questions). He went to MIT and somebody figured out a way to measure HRV on 8 people at the same and learned that some people remain hyperactice during savasana – they are actually in the fight or flight mode during savasana! The question then arose of how to get them totally, safely relaxed during savasana and he emphasized the importance of qualitative assessment to capture that. There can be no doubt in anyone’s mind after attending this symposium on yoga research, how critical is the information generated from qualitative assessments.

We come then to brain hemispherity and the medial part of the brain. Via the left hemisphere there is no pathway to the emotional brain. Because we know that the left hemisphere is the center for language and logic, we must strongly consider that we can’t talk ourselves out of an emotion that we are feeling. But via the right hemisphere, where symbols help us be the social animals that we are, we can access emotions. And, self-awareness, which is what we have been searching for in our struggle out of this pain, can be touched through the medial part of the brain, the medial prefrontal cortex.
Interestingly, the medial prefrontal cortex is also involved with empathy.

I leave you to study his slides when they are posted on the DRL.

But the upshot of all of this is that when traumatized subjects do yoga, they become consciously in touch with their bodies. A traumatized person is basically out of touch with both body and feelings. With PTSD there’s a breakdown in cortical timing, a messed up default system. When a person is traumatized, different parts of the brain are not working together, there is lack of brain coherence (something that has been studied quite a lot at Maharishi University, but I saw nothing of their work at this symposium). Yoga does something to the brain.

Finally, again we see the woman we were introduced at the beginning of the presentation. She has been practicing yoga. The psychologist asks her about the event. She is sitting up straight, head tilted to one side, and says with perfect assurance and clarity something like: Oh, I don’t know. I’m really not that interested in talking about it right now. I’m tired of talking about it.

Certainly not all yoga teachers or yoga therapists are interested in yoga research, either reading it or participating in it. But for those who are, SYR was a real gift. And for those who aren't, take heart in this question posed by Dr. Cohen: "Can we measure open-heartedness?" The answer, of course, is no. There are some things about yoga that are beyond the reach of science.

In service, Julie Deife

Sunday, October 3, 2010

Sunday, part II

Admission: I couldn't figure out how to continue with the first Sunday post, so here's part II. It was necessary to get outdoors and enjoy the sunshine and this overall glorious fall weather here this afternoon.

to continue...
Cohen was considering why yoga wasn't showing a reduction in intrusive thoughts. His research was showing improvements in physical functioning but increases in intrusive thoughts. He began thinking about trauma research, which shows that having intrusive thoughts is a positive not a negative finding because if one is allowing oneself to think about what is happening to the body, to one's life, relationships, etc. while in treatment, then the ability to work it through while doing the yoga would actually be beneficial.

A lower level of depression among cancer patients is a significant predictor of survival. Cohen discussed that through the research we know that living with cancer causes stress which causes physiological changes that leads to widespread damage in many organs and systems of the body.Through yoga practice this is reduced such that a better quality of life is maintained.

One of the areas that turned out to be especially important in many of the studies shared is that of the qualitative feedback generated. Cohen employs journal writing with subjects (along with blood samples, videotaping of the yoga sessions, etc) that proves to reveal much that cannot be measured. quantitative vs qualitative. The qualitative feeback is extremely important. Key point: there is a lot of insight that can be gained that is missed through data collection. We learn that people can find meaning, spiritual or otherwise, in the illness experience.

Another point Cohen made is that many beneficial effects of yoga may have nothing to do with the yoga. So it is important to have active control groups in one form or another. In other words, it might prove better to have a control group that is doing some other kind of physical activity since any kind of physical activity can also alter mood in a positive direction.

Throughout the weekend, 'what kind of yoga' is being tested, used for an intervention, etc was occasionally brought up for discussion. Cohen said that this was brought up to him by the Vivekananda group who is a partner on the current breast cancer research. Cohen typically calls the yoga in his research studies hatha yoga. But the Vivekananda group preferred that it be called Patanjali Yoga and he agreed to it.

The breast cancer patients in the studies at MD Anderson have yoga onsite. This is also considered a positive event because it is something a woman can form a positive association with something when she comes in for treatment.

Of note is that at M.D. Anderson they have begun training nurses to teach mindfulness techniques to patients who will be undergoing treatment. This should break down the Pavlovian relationship that occurs between the patient, their treatment and their drugs.

Dr. Cohen spoke so fluidly and clearly about the benefits of yoga for people receiving radiotherapy for cancers that it begs the question, why isn't it a standard of care at M.D.Anderson Cancer Center where he is the director of Integrative Medicine.

He explained to us that for Yoga or mindbody practices to become standard of care, it is going to take more than evidence, even though it is evidence that puts it in the pipeline. It will also take showing that there is a cost saving for this low-tech, next to free therapy. He has included a cost benefit aspect in the most recently funded study for a phase 3 clinical trial on yoga with breast cancer patients. It is the hope that the subjects will not need to check in as often as those in the control group, not phone in as frequently, need fewer medications, etc. But even more than that he emphasized that it is going to take the general public, people at the grass roots level, applying political pressure.

Another study that Dr. Cohen will be working on is the effects of meditation on what is commonly referred to as 'chemo-brain'. Women on chemotherapy show forgetfulness, lack of attention, general fogginess and he hypothesizes that meditation activates the same areas of the brain that the chemo is hindering. Watch for this.

Cohen ended by telling us that he has asked many yoga masters over the years what would the yoga practice be that would ensure a person would turn to a path of wellness. All have answered that it would take a daily practice of 6 months. This is the real challenge, he says, because how many people will do this? If we would, then it would really change the physiology, the dna, and then it would be something the body would be telling us to do, not the mind.

Again, I will post some of the highlights from Dr. van der Kolk within the next 2 - 3 days and will also not 'last post' when this is completed.

Thank you for reading. In service, Julie


Happy Campers are we. I'm quite sure the evaluations for this symposium will be superb. (And I'm quite sure John will let us all know!)

I'm going to cover what Lorenzo Cohen presented this morning in the final keynote. I realize that I skipped much of Saturday, my apologies, but this is a bigger challenge than I'd imagined it would be. Thanks for your patience. My plan is to offer thoughts in a future post about Bessel Van der Kolk's keynote talk yesterday , which was fantastic and really got everyone juiced. The air in the auditorium was palpably energized. When I'm finished in a few days I'll label the title as "final". Thanks for reading and thank you Jean Stojkov, IAYT's webmaster, for setting this up.

Lorenzo Cohen was refreshingly open and off the cuff with his closing presentation this morning. While he didn't find it important to reveal his yoga background until well into the talk, I think it adds to the picture to tell you up front that his grandmother is Vanda Scaravelli. In my mind, that brings a whole other dimension to his view of yoga research. He studied with her growing up, shared images of her in asana, told us about a revised upcoming edition of her book (her revisions, but never published),along with a little background that Krishnamurti was her main teacher, she studied with Mr. Iyengar and Desikachar. Mr. Iyengar on these Italy visits would teach yoga to Krishnamurti. So Dr. Cohen's understanding of yoga is deeper than that of most doctor's who are researching yoga, and certainly of most who are authorizing the use of yoga with patients.

Again, slides will be posted on the DRL for all of the talks.

Dr. Cohen began his presentation by sharing his earliest research on mindbody practices with us. He came to the mindbody research after a colleague successfully determined that chronic stress promotes tumor growth in mice. An entry point!

Dr. Cohen developed studies using Tibetan Yoga for women with breast cancer finding that lower levels of sleep disturbances resulted. But interestingly, another finding was that there was not a reduction in intrusive thoughts. Why?

Saturday, October 2, 2010

Saturday evening

Throughout the day I talked with people who are absolutely thrilled about this symposium. Researchers are definitely a unique group and they have been amazed that there are so many yoga therapists and yoga teachers interested in research.

John Kepner, IAYT Director, opened by giving awards and thanks.

Among them: Visionary Award for envisioning and manifesting this symposium to Sat Bir Khalsa. Recognition to Richard Miller as founder of the International Journal of Yoga Therapy 20 years ago! Now that's visionary!

Shirley Telles presented the evening keynote: Effects of Yoga Practice: Evidence from the Ancient Texts and Present-Day Research

Dr. Telles opened with a quote from the Katha Upanisad. The sages were the greatest Yoga researchers, she maintains, but that both modern and ancient research is needed because we need to recognize both experience and experiements.
Her premise is that times have changed, so probably have our bodies, the air we breathe, the food we eat. Research on yoga may be necessary even though we have the ancient text upon which to draw.

Entertaining speaker, showed slides of laboratories at Patanjali Yoga Peeth outside Haridwar where she is the chief researcher. Her lab contains state of the art resonance imaging equipment, as would be expected of the world's most prolific yoga researchers.

Alternate ostril breathing was observed by the ancients who said left nostril would be appropriate for peaceful activities and activities that required more energy would be best achieved through right nostril breathig. From the Swara Yoga text: Use left nostril for Collecting grain; Use right nostril for Controlling an Elephant!! Telles' research has validated the r and left nostril part of these claims.

Right nostril: greater oxygen consumption; higher blood pressure; blood flow to the skin greater; grip strength greater; spatial memmemory greater.

Left nostril, quiet activities: Lower blood pressure, imperceptible sweating, spatial & verbal meory, grip strength decreased.

Telles has gone on to study dharana and dhyana from P.Y.S. She has charts and slides and images that will be posted to show changes during ddharana and dhyana. (there are probably only about 10 people in the room who understand completely this research). In summary, however, meditation appears to be a unique state characterized by: EFFORTLESS ATTENTION!!

Telles has also developed yoga modules for airline pilots, school children, software professionals, and other and maintains if she know which aspects need to be addressed, she and her team will develop appropriate yoga practices. She has published studies showing all of these modules.

Telles then covered methodological issue in Yoga and rehabilitation research. This is a special interest to her because of studies she did after the Indian Ocean 2004 tsunami and the Bihar floods. She discussed ethical issues with a captive population, difficulty soe special groups ave in comprehending subtle aspects of yoga, and the problem getting special populations to and from research sites. The most interesting part of this section was around the tsunami and the Bihar floods where she provided a visual description of the people affected and how they were helped by yoga.

Telles is also iterested in prevention of two pre-morbid conditions: obesity and neuroticism. Obesity in India, she says, is more likely to occur in those who are middle class with adequate educational levels (unlike in the U.S. where obesity is more likely to occur among the poor and less educated). Here research looked for changes in BMI< chamical which act on the hypothalamus giving signals to feed/stop feeding, and unusual complications using yoga as an intervention. Interesting results. Leptin levels changed, but obese persons and diabetics have high leptin levels. After One week in yoga camp they also had lower levels. This will be explored further because one week is only an indicator that something is happening.

What about neuroticism? After six days of a yoga program, voila1 Not so neurotic! But...says Telles, it was not so much the activity of the yoga (although that worked too) but the theory and philosophy of yoga that made a bigger difference.

The importance of theory...from the Gita 5/23: "He who is able to stand the rush (speed) of lust & anger in this very life, is accomplished and alone is a happy perso."

Researchers are yogis too!On one of the islandShe discussedethical issues in Yoga a

Saturday morning

A sort of settling in has occurred. The first day of any conference, especially one with a preconference where half of the attendees are present and the other half still arriving, is hectic, overly busy figuring out schedules, how to get from one place to another. Today we have it down.

The sun rose as we were yoga classes: two were offered, an all levels in the auditorium and a level II on an upper floor yoga room of the dorm area. My class was with Mary Cardinal who is the Yoga therapist at the wellness center here. So good.

I was also struck as I was making my way from the room down to this hall in the breaking dawn, at how much attention is paid to the d├ęcor in the building. At each turn a painting I hadn’t noticed yesterday greeted me, or a vase of flowers carefully set on a Indian cloth smiled.

The 9 AM session has just opened and John Kepner announced that the slides from all the talks will be up on the DRL within the next couple of days.

Kim Innes announced the first speaker, Chris Streeter, MD, on brain imaging. It’s about Gamma-aminobutyric acid (GABA) which is a inhibitory neurotransmitter in the mammalian brain. And it is very important for treating alcohol, depression, epilepsy, other. Subjects were put in mRIs and GaBA was measured. Using MRS, GABA levels are low in people who are depressed, anxious, alcohol dependenc, cocaine dependence or with epilspy. She’s talking why there is overlap and that it’s probably related to GABA

She is trained as a neurologist and psychologist. Increasing GABA levels increases symptoms. Yoga has been shown to improve symptoms associated with the same disorder. So they hypothesize that Yoga improves the symptoms related to depression, anxiety, and epilepsy y increasing brain GABA levels.

The pilot stydy is called Yoga Asana session increases Brain GABA Levels: A Pilot study. Practitioners 3z/wk, no other mind body practice.

Design: they had the scan. 60 minut yoga session, rest, get back in scan and have second scan. The were well matched, not smokers, not drinkers. Could do a wide variety of types of yoga, 4-6 times per week. Lots of yoga instructors in the group.

Showing slide of brain scan: Measured changes in each boxed area. Most of the changes occurred in the deep brain area showing a great increase in GABA. Now she’s showing a slide that shows the GABA pattern before and after Yoga. It is a measureable effect.

There was really nothing going on in the control group.

She’s saying that menstrual stage does matter. Hadn’t controlled for it.Menstrual stage did not effect the association.

The conclusion is that in experienced yoga practitioners increases in brain GABA levels are associated with the asana session.

Study 2, Also Dr. Streeter, Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA evels: A Randomized Controlled MRS Study

Streeter notes, to laughs from audience , that she was told if you’re going to do research, do it with something you like because you’re going to do it for much longer than you’d thought.

Streeter goes through the design which you’ll be able to see on her slides soon on the DRL. The scans on these two groups were done in the thalamus. Important: in this study they also did mood scales using the EIFI, Panas and STAI. Showed the yoga group had significant improvements and decreases in anxiety, greater changes than the walking group.

This is a really interesting study because there is already a lot of literature showing that exercise improves mood levels. This study shows that yoga improves the mood more than walking, increases the GABA levels more.

Dr. Streeter qualifies these results by telling us that the walking was done in the basement of a gym, most of the walkers were used to a lot more activity. But does support what we know, that we feel better if we do a regular yoga practice.

Discussion is around parasympathetic nervous system and the vagus nerve. Heart rate variability is mediated by the vagus nerve. Data indicates that decreased HRV has been documented in depression and anxiety; increases in HRV have been shown with yoga breathing and that Iyengar Yoga increases HRV.

It is probably parasympathetic stimulation that is the common thread to treating depression and epilepsy.

Now I have to run to the tearoom to post this. Back to back presentations today, 30 minutes each. Will post on some of these.

Friday, October 1, 2010

Dean Ornish inspired us!

Back to the tearoom where we have the internet connection. Unfortunately, there is no connection in the lecture hall. I will come back to the research preconference later

The symposium is now officially open! Rolf Sovik from HI reminded us about the research that Swami Rama underwent at the Menninger Institute in the '60s in order to help the western scientists understand yoga and meditation. Pandit Rajmani Tigunait offered a prayer and spoke briefly about Yoga and meditation no longer being "Eastern subjects" - largely because of the number of studies offered. John Kepner offered thanks to Sat Bir Khalsa who visioned this conference and was instrumental in making it happen. Sat Bir announced the 2nd Symposium will be sept 23-25, 2011 at Kripalu.

I've heard Dean Ornish speak a number of times, but for some reason he really came across in a direct, present excited manner today. As I said previously, he was not here rather broadcast live into our lecture hall. He was at the AARP convention in Florida which was attended by 25000 people. Of course he has every right to be excited at this time, having just had in August the Dean Ornish Program for Reversing Heart Disease accepted for Medicare Coverage - the first lifestyle program ever!

His work exemplifies the power of comprehensive changes in lifestyle. He emphasized how that work addresses the underlying causes of problems. That the body has the capacity to heal itself. That, finally, this method is accepted not only as treatment, but as prevention even though Congress sees it as being even more costly since people will now live longer!

Ornish told us that good science got him (and us) pretty far but it isn't good enough. We have to address the cost structure and that's why he went after the reimbursement. If reimbursement is changed, then the system can be changed he believes. So, we'll see.

Thewhole system is having a heart attack right now, says Ornish. We are paying for things that are dangersou, expensive and ineffective. It's a fear-based model, but it we connect, love one another, experience happiness, and rediscover that the source of joy is within us, we will thrive.

He called us touchy, feely creatures. We need connections. A tiny example of that is that I'm blogging...and you're reading...

One thing that I've learned already about HI, is that you don't want to miss dinner. On that note, let me hear from you and I'll share more later.

Om shanti, Julie

Friday afternoon part 1

Phew! Just came out of the Preconference Yoga Research 101: The Basics of Yoga Research for Therapists, Instructors, and New Investigators. It was a very fast, intensive session with four speakers individual and sitting on a panel, plus questions. This could only have happened with Sat Bir running this program, it's safe to say. I'll have to write this in parts because in 20 minutes we are to be back in class for a live-video feed with Dr. Ornish - don't want to miss that!!

Lorenzo Cohen spent a quick 25 minutes on his topic of Documentation, Evaluation, and Measurement. (of course this is all aimed at Yoga research). He told us that the most important thing with developing your research is to use standardized measures. If you want to measure back pain you need to find an instrument that already exists for assessing that type of outcome and not just developing something for yourself. You will need to do literature searches to identify these measures. If it’s not in the literature, then it isn’t valid, isn’t standardized, and don’t go out an invent something because you're probably going to be wasting lots of time (and money).

He talked about how some treatment effects will be obvious in terms of improvement. Flexibility, for example, is expected and easy to measure. It's easy to assess; clients can easily assess it themselves.

But, getting at more subtle aspects of effects of yoga, he says, is the real challenge and opportunity and that we haven't been able to quantify these more subtle things.

Other quick points he made, having so little time to present, were:

Longer follow-up intervals are better because we'd like to study longterm effects. We need to know if people who are in a study are continuing to do the yoga and if the effects are the same as previously noticed.

Timing is also important , and other presenters hit on this too. Exactly when do you ask people the followup question? Recommends up to a week after and then certain intervals after the formal instruction is over.

Sample size: larger samples can detect smaller treatment effects. There is a bias in the literature in favor of larger sample size, more on this when I get to Cohen's presentation.

Be aware that there is a difference between what might be clinically significant versus statistically significant. P.05 (statistical significance) is usually considered necessary to get a study published. But people often forget what is clinically significant. What is a clinically meaningful difference between groups? This all needs to be written into the discussion section of the study.
Cohen emphasized that the more demographic characteristics that can be known about the subjects the better off you will be. In addition to the demographics, also find out the medical characteristics - and not by relying on the patients. Cohen related how most patients in a particular study were unable to report at what stage their cancer was in. Get access to medical records if possible. Other covariates that influence the outcomes are such things as knowledge of medications, or how could a job be influencing the outcomes for a person in a low back pain study, for example.

Yes, this is a crash course on Yoga research. Back soon.