Integrating Mindfulness Yoga as part of a Mind-Body Health approach to reduce Stress - Ann Bracken - recently qualified 500 hour Certified Bodhiyoga teacher

The medical definition of stress describing it in terms of cause and effect is; “a physical, mental, or emotional factor that causes bodily or mental tension. Stresses can be external from the environment, psychological, or social situations or internal e.g. from illness or a medical procedure for example.” (William Shiel MD, 2018). When the stress reaction is triggered, it initiates a complex neurological and endocrinological response to prepare the body to react to a perceived threat. However,  repetitive stress can have an adverse affect on physical, emotional and psychological health and wellness. 
We have between 12-52,000 thoughts in a 24-hour period according to the National Science Foundation (2003). When stress impacts on the mind, there is an increase in thinking that can be ‘catastrophic’ in emotional tone, also creating feelings of being unable to cope. It impacts on the body by; creating muscle tension, tightness in the chest and over stimulating the vagus nerve – which prompts the body to go into ‘fight, flight, freeze-collapse’ reactions. 
The combined Mind-Body reaction to ongoing stress or trauma causes a heightened internal ‘alarm’ system – distress in Mind and Body where they feed into each other e.g. an anxious mind causing tension in the body and a tense body causing cognitive distress.

Physical impact of stress

When the body perceives a threat it triggers a release of catecholamine hormones; adrenaline or noradrenaline which in turn prompts the muscles and heart to spring into action to prepare for this perceived threat. Digestion slows down or may even stop and the blood vessels constrict. There is a release of nutrients; fat and glucose to fuel the body and also a relaxation of the bladder. The reproductive system is also impacted and may even stop ovulation. Our vision becomes highly focused, ‘tunnel vision’ and our hearing becomes finely tuned to notice frequencies of sound that may be threatening. This short term physical reaction to stress is beneficial when one is under immediate threat and has contributed to our survival as a species. Unfortunately, even when we are not listening or on the look-out for dangerous predators, we are still going through the same physiological sequence even if that perceived threat is actually just an internal stress because we “can’t cope” with the train being five minutes late!
Repeated chronic stress accumulates in the body. It can suppress the immune system, increasing the risk of viral infection. It also causes cardiovascular problems and digestive related issues including stress ulcers due to increased acid concentration, irritable bowel syndrome and altered insulin needs within the body which can lead to diabetes. It can also lead to muscle tension and panic attacks. Stress is also believed to influence inflammatory diseases such as cancer. “There is no scientific evidence of a direct cause-and-effect relationship between the immune system changes and the development of cancer. However, recent studies found a link between stress, tumour development and suppression of natural killer (NK) cells, which is actively involved in preventing metastasis and destroying small metastases”(Salleh M. 2008).

In brief, Stress in the Body can lead to:

The ‘fight, flight, freeze or collapse’ reaction which suppresses the digestive and reproductive system in preparation for a perceived threat. In addition, it increases the heart rate and blood pressure.
Repeated high levels of stress can lead to elevated cortisol and adrenaline in the system potentially causing high blood pressure, digestive issues e.g. Irritable bowel syndrome, heart related problems or hormone imbalances. 

Psychological impact of stress

Some individuals are more susceptible to stress than others. This explains why some people experience Post Traumatic Stress following a traumatic experience and others don’t. It can be influenced by genetics (e.g. where there is a family history of anxiety), one’s personality type (e.g. emotional sensitivity) and also whether there is a social support available. For example, if a person experiences a traumatic event and this is then minimised or not ‘heard’ by a parent or carer, e.g. potentially with childhood abuse, this can leave the person more vulnerable to stress as they feel unsupported in times of threat and so can become hypervigilant in their engagement with life. This heightened stress response can potentially progress into generalised anxiety and/or post traumatic stress disorder (PTSD). Stress is also commonly associated with depression, anger and hostility, hypertension and mood disorders.

Stress in the Mind can lead to:

Racing thoughts that add to feelings of stress.
Over-estimating the problem and underestimating one’s ability to cope.
Seeking constant reassurance from others.
Difficulty accessing reasonable solutions to the issues one is facing.
Playing ‘worse case scenarios’ over and over in one’s mind.
Creates heightened adrenaline in the system that leads to agitation and nervousness. It can also lead to feelings of emotional ‘numbness’ where a person feels disconnected from oneself and others. This is often combined with an internal dialogue that is full of self or other criticism. 
Behaviours can change with ongoing stress e.g. relationships may suffer or in an attempt to numb out difficult feelings, individuals may turn to alcohol, emotional eating or over-working to distract from challenging emotions. However, over time this causes additional problems.

A Mind-Body approach to Health & Healing

As highlighted by Harvard University’s, Mind-Body Health pioneer, Dr Herbert Benson as early as 1975 in his book, ‘The Relaxation Response’, modern medicine has been taught that the mind and the body are separate and should be treated as such, ever since the seventeenth-century teachings of the French Philosopher, mathematician and scientist, René Descartes. Slowly, science is now beginning to understand the interconnectedness between body and mind and mind and body. 
Just as the Harvard physiologist, Walter Cannon  had discovered the ‘fight or flight’ reaction and the impact our survival instincts had on our bodily functions, so too Harvard University, cardiologist and research fellow, Dr Benson discovered that to regularly elicit what he termed, “the Relaxation Response” leads to an internal quietude that calms the nervous system and restores the heart rate. According to Benson it is positively beneficial in the treatment of hypertension, cardiac rhythm irregularies, anxiety, pre-menstrual syndrome and mild to moderate depression. He cites yoga, meditation and Qigong as ways in which to elicit the opposite to ‘fight flight freeze’ reactions in the body with the ‘Relaxation Response’.  

Efficacy of Mind-Body Health 

As research has advanced in regard to the benefits of Mind-Body approaches to health and wellness, it has become more acceptable in the mainstream to express an interest in treatment from a more holistic psychological, emotional, physical, spiritual and social perspective.  Previously, this interaction had been downplayed and mistrusted by mainstream medicine. Research has now provided the scientific evidence base for combining approaches that have been perceived as a yogic way of life for many thousands of years! A yoga lifestyle often includes consideration of the nutritional and healing potential of whole foods and diet, exercise/yoga asanas, mindfulness meditation and a reflective practice to develop emotional awareness and mind-body equanimity.
Having trained with Dr Alice Domar in Mind-Body Medicine in Harvard University, I became more aware of how Mind-Body Health & Wellness was being integrated into mainstream medical care. Research supporting Mind-Body health in fertility included research undertaken with over 200 women engaging with fertility treatment and combining it with Mind-Body health approaches – Mindfulness stress reduction programme, acupuncture, nutritional therapy and yoga. Successful IVF outcomes for this group was 52% compared with 20% usually (A. Domar et. Al. Fertility & Sterility, 2011).
An accumulation of negative lifestyle choices also adversely affects health. According to the World Health Organisation, eliminating tobacco and poor diets and inactivity from peoples lifestyles would mean that 80% of heart disease, stroke and type 2 Diabetes would be prevented (WHO 2005). Also, a Metabolic Syndrome has been linked to memory loss in older people. Metabolic Syndrome includes such factors as excess abdominal weight, high blood sugar and low high-density lipoprotein (HDL) also known as ‘good’ cholesterol. (C. Raffaitin, Neurology, 2011).   
In addition, there is now an emerging link between gut health and brain chemistry for example Irritable Bowel Syndrome is frequently linked with high levels of stress and associated with anxiety or depression. (P.Bercik et. al, Gastoenterology, 2011)
Increasingly, research is highlighting the direct correlation between Mind and Body health and the harmful physical and psychological effects of repeated elevated levels of stress. As outlined, there is a strong evidence base to support the benefits of taking a Mind-Body health and wellness approach.

Returning to Homeostasis with Mindfulness & Yoga

Homeostasis is the term used to describe the biological internal, physical and chemical conditions for optimum functioning of a human being. Interestingly, this word was coined by the Harvard physician who brought us the concept of ‘Fight, flight, freeze’, Walter Cannon (1932). 
Since Benson published his research findings on the Relaxation Response (1975) in which he cites yoga and meditation as being ways in which a balanced physical and psychological state can be restored, there has been an expansive amount of research expounding the physiological and psychological benefits of yoga and also Mindfulness meditation. According to Researchgate, between 1980-2018, there have been more than 2,900 publications with Mindfulness in the title. A review of Mindfulness empirical studies in 2011 expressed, “We conclude that mindfulness brings about various positive psychological effects, including increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioural regulation. (Shian-Ling Keng, Smoski M. et al, 2011).
Although much of this research relates to Mindfulness in the context of Western medicine and psychological health, Mindfulness has been a core part of the Theravada, Tiantai and Chan schools of a Buddhist tradition for over 2,500 years. The discourses expounding the Buddha’s teachings on Mindfulness Practice are known as The ‘Anapanasati Sutta’ (Awareness of Breathing Sutra) and ‘Satipatthana’ (establishment of awareness sutra) – (Boccio F. 2004). 
Mindfulness as a form of meditation integrates well with yoga and sits naturally at home with a conscious mind-body unifying practice such as Hatha yoga. Mindfulness very often uses breath as an anchor to bring one’s awareness to the present moment and Hatha yoga integrates breath as the ‘prana’ life-force to support a yoga asana practice. 
In the Bodhiyoga teacher training of Mindfulness yoga, the manual describes a presentation of two practices, yoga and mindfulness, that have their own lineage of teaching, (Sudaka and Sadhita, 2015) -
“in this interconnected path of Buddhist teachings and yoga, we are not unifying the two schools of thought. The Buddha teaches that we can take for our Dharma practice (our practice that helps us to evolve) whatever helps us to gain the following: 
- helps us release grasping and self-clinging - gives rise to energy (for higher good) or 
- Virya helps purify the mind stream.”. 
Thus, through an integration of Mindfulness from a Buddhist tradition and increasingly taught in secular settings, and yoga as expounded by Patanjali’s yoga sutras (500 BC), we can be supported in a letting go of all that does not serve, and enjoy an elevated life condition with a clearer mind-set. 
A purified mind also leads to the ability to discern helpful thoughts versus unhelpful or stress induced thinking. It also supports the life-force breath necessary to engage in the asana (yoga posture) practice known to unify both body and mind. In so doing, we can awaken our more evolved sense of self and with practice and let go of habitual ways of clouding our mind or engaging with behaviours that are harmful towards our body. 
Mark Stephens explains in his book, ‘Yoga Sequencing’ (2012) that Patanjali’s yoga sutras expound “four levels of yogic evolution in practices that are designed to control the mind – chitta vritti nirodaha, “to calm fluctuations of the mind” and open one to bliss.” The body-breath-mind experience of Hatha yoga was first expressed in Swami Swatmarama’s fourteenth Century literature on Hatha yoga practice. Combining both optimises a sense of homeostasis in mind and body. 
Just as there are over 2,000 papers relating to Mindfulness and its role in psychological and emotional health, so too the effects of yoga on physical and mental health are well documented. One research review of 30 review papers and 300 separate studies on yoga and mental health published between 2002 and  2014, proposed that yoga should be recommended by physician’s due to its transformational effect on anxiety and depression, “yoga typically improves overall symptom scores for anxiety and depression by about 40%, both by itself and as an adjunctive treatment.” They cite the benefits of yoga asana and breathwork; “It appears that deep slow breathing in combination with movement and other aspects of yoga are at the heart of yoga’s ability to bring people a greater sense of tranquillity” (Shroff, F. and Asgarpour, M. 2017).
As stated in the Bodhiyoga manual, Hatha Yoga is a “tool that one can use to develop the mind also”. Yoga integrates conscious breath and mindful movement to bring a sense of embodiment and balance in mind and body. This connection of body and mind is heightened through the direct experience of breath, body movement and mindfulness meditation.
Hatha yoga combines asana (posture) with pranayama (unhindered breathing) for yoga sequences that are grounding, strengthening and elevating for the mind and the body. Mindfulness cultivates an awareness of our present experience and an ability to observe rather than become enmeshed with the narratives of the mind. This combination facilitates us to let go (or release grasping and clinging) of habitual ways of thinking or behaving when we experience ‘stress’ triggers. As outlined in the Bodhiyoga training approach we combine; Metta (loving kindness), Mindfulness practice, with yoga asanas and breathwork to explore (Dhamma-vichaya) our mind-body experience and cultivate more skilful (Viriya) states in our awareness and practice. In so doing, we can lessen the stress experienced and cultivate a healthier relationship with our external and internal stimuli. 


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