Mindfulness practice, yoga one clinical tool, not universal remedy
Mental illness is a hard thing to talk about. It’s difficult because a person’s mental health is so incredibly personal and often a source of shame. What we’ve seen recently is that people are trying to be more open about having mental health conversations and discussing mental health care options. While this is really important, it’s also quite obvious that we’re far from where we need to be, and cultural perceptions and popular psychology assumptions around self care can add obstacles to improving the social support for people with mental illnesses.
In my experience, one of the most prominent points of frustration for people with mental illnesses is the umbrella prescription of meditation and yoga for every disorder. This tends to be a well-intentioned recommendation, but it also tends to be invalidating. It is worth unpacking the application of yoga and mindfulness in a clinical setting to explain why this can come across as insensitive.
Yoga and meditation interventions are increasingly becoming topics of interests in clinical and health psychology. Several studies have suggested that mindfulness based therapies for depression and anxiety are as effective as medication in both the short and long term. Mindfulness interventions have also been shown to lower cortisol levels and decrease blood pressure. It is connected with improved self-regulation, and researchers are currently investigating its potential for reducing high risk behavior in children and adolescents. Research has also found that mindfulness tends to be most effective in high stress populations, which makes it promising for clinical social work.
This is just a broad overview of the body of mindfulness research, and scientists are working on identifying the specific mechanisms at play in mindfulness meditation, as well as its limitations. Mindfulness is defined by an observation and an acceptance of experiences, so it can really be taught and practiced in a wide variety of situations. The wide range of practices is significant because in a clinical setting, meditation and yoga interventions are going to be very different from the classes at a generic yoga studio. Consider the difficulty a person suffering with a mental illness faces entering a space of slim, upper-middle class, Lululemon-wearing women to deal with their most personal problems. While all practices of yoga should include the cognitive portion of mindfulness, this component looks very different in a clinical setting, both in content and culture.
Part of this difference is a modification of language that could be triggering to people with mental illnesses. There are also certain parts of mediation are going to actually be more harmful than helpful. For example, a traditional mindful practice might include sitting with an emotion with your eyes closed in silence for long periods of time. This means that you take time to be present and allow yourself to experience your emotions fully, without judgement or trying to change it. This would not work for everyone, and certainly not for someone dealing with severe mental illnesses where certain emotions can be damaging or scary. This means that included in the diverse practices of mindfulness are therapies designed for specific disorders. Furthermore, these therapies often use mindfulness as a component of the treatment plan rather than the sole focus.
Because mental illnesses are so complicated, with a multitude of influences from environmental, to genetic, to hormonal, treatment plans usually require a diverse approach. Medication can be a part of someone’s treatment — sometimes it is a necessary step — but generally doctors also work with lifestyle and cognitive changes. A therapist and psychiatrist works with their clients to figure out what strategies work best, and this may not include yoga or meditation in the traditional sense. In therapies such as dialectical behavioral therapy, the idea behind mindfulness is incorporated in more subtle ways than breathing exercises and downward dog. What that boils down to is the idea that mindful meditation is just a tool in a toolbox of strategies to deal with psychological distress, and it may not be useful for everyone.
The “Well, have you tried yoga?” question comes across as thoughtless when it doesn’t take into consideration how recovery is complicated and sometimes not the current goal. Mindfulness, yoga, exercise, diet, and sleep are all important for stress management and mood, but they are not cure-all remedies for every disease. Suggesting lifestyle changes like taking up yoga or getting a full night’s sleep to someone with severe mental disorders is insensitive not only because problematic sleep patterns or discomfort in your body that can make yoga triggering are part of the disorder, but it also implies that disorders can be cured by trying harder.
People often see those with mental illness as weak, lazy, or attention-seeking, and that has a serious impact on how they seek out treatment. Because of this, it’s important to be careful about providing support in a way that doesn’t blame people for their mental illness. There is not a one size fits all approach to being supportive and discussing mental health care. What is relatable and relevant will change from person to person. It it is important to have conversations about ways you can take care of your mental health, especially considering that 20 percent of Americans have never even tried stress reducing activities. But a good place to start is listening first to what someone is actually going through and working with them, based on their resources and needs, to find the best next step whether that is treatment, a consultation, a lifestyle change, or a mindfulness based intervention.