Tim Gordon, MSW, RSW, is a clinical social worker and the developer of Mindful Yoga-Based ACT (MYACT), an approach to group psychotherapy that combines the benefits of yoga and cognitive-behavioral group therapy. His research and academic writing has focused on using yoga and contemplative practices as a mental health intervention.
Praxis: Talk to us a bit about how you’re incorporating yoga into your acceptance and commitment therapy (ACT) work.
TG: My master’s thesis explored the ways yoga practices can be used to train psychological flexibility with people who suffer with anxiety and depression. The data I collected in the process inspired me to create a therapy group that blended ACT and yoga practices. It’s a fun group that starts with a meditation in a passive yoga posture. We then move into seated group exercises, and participants are invited to do experiential exercises. Within the group, we create a really powerful culture of vulnerability and working in the here-and-now.
That group is called Mindful Yoga-based ACT.
I’ve adapted it a number of times. Like, we broke it down into a four-hour group intervention for inpatients diagnosed with schizophrenia—people considered high-risk to be re-hospitalized—and used it as the basis for a short-term study. The data showed that the intervention made a really profound difference in the lives of these folks, leading to a reduction in their number of hospital visits over time.
The bottom line with this group is about training the six processes in ACT without getting into too much heady talk. We try to stay present in the moment and within the group. We explore the six core processes in how they relate to our bodies.
Praxis: That sounds very unique. Are there others in the ACBS community doing similar work?
TG: Kate Morrissey, an active member in the ACBS community, created a really interesting ACT and yoga protocol, I believe she’s a yoga teacher; we’ve talked a lot and she has really cool ideas about teaching yoga in an ACT-consistent way.
Kelly Wilson is another yoga teacher—who also happens to be an ACT founder. He speaks really beautifully about concepts that are used in yogic philosophy like ahimsa (non-violence) and how one can live with ahimsa through acceptance, mindfulness, and a connection to our values.
Praxis: Why is yoga such a good fit with the work we do with ACT?
TG: Many of the yoga lineages promote similar concepts and values as we see in ACT, but that’s not where I think we see the most important link. Many philosophies of yoga (whether Vedic, Tantric, or Shramanan) dictate ways of living, codes of conduct, golden rules, and so forth. ACT is not so much about telling you what to do as it is about inviting you to move in the direction of your values, to listen to your pain, and to discover what wisdom may be there. ACT doesn’t preach Patanjali’s Yoga Sutras. Instead, ACT invites you to realize your own sutras.
That being said, here’s what yoga lends to ACT: Imagine a physical practice that embodies mindfulness, a practice that can challenge you physically but also offer opportunities to modify postures, to be gentle with your body, and to learn how to listen to your experience. This is yoga. Essentially, yoga is the embodiment of mindfulness; the living and doing of mindfulness, systematized in a way that can be engaging.
When I was a student, I worked in a really difficult place—an inpatient forensic setting. This was a place where people with criminal backgrounds were held, assessed, and then treated. I worked with people who had zero interest in mindfulness. I would work through the dialectical behavior therapy (DBT) protocol with them, but found it was falling flat on its face. It was so hard to get these inpatients engaged in the mindfulness exercises.
At some point I asked one of the inmates, “Have you ever tried yoga?” His response was pretty much, “Uh, isn’t that for pot-smoking, tree-hugging hippies?” And I said, “I don’t know. But I do it. Could we try some yoga?” We did it, and he was hooked! And after that, I found that a lot of these guys were very receptive to the practice. It worked for them. I had a hunch this could work, that it could be an easy way to get people socialized to mindfulness—and it paid off.
Praxis: In your opinion, what is the role of spiritually-based practices like prayer and meditation when it comes to things like values, purpose, and meaning?
TG: I’m not very interested in prescribing prayer, in the sense of a system of spiritual thought, purpose, or meaning to people. I first learned to meditate when I was thirteen, and have been practicing Buddhism since I was fourteen. However, that’s my own journey. I mean, I’ve found things that matter to me, but the paths I wandered down were often pretty cluttered.
I think what’s at the heart of ACT—the stuff we call values—is in essence who and what we want to be. Realizing this is the heart of this journey. I recommend everyone take it! But everyone needs to find their own way. I think people can use yoga or any other way of practicing and doing acceptance and mindfulness to connect with this stuff, to help them find their way to wherever it is they need to go.
Praxis: People in the yoga community often refer to this thing called “the edge,” which generally refers to a place we get to in asana practice that scares us or activates our threat-detection system. Does that place have a function in clinical work? And how would an ACT therapist approach helping a client be in that place?
TG: This is a really cool question. Surprisingly, you’ll get unexpectedly powerful (and statistically significant) results from having people only practice savasana (resting or corpse pose) for thirty minutes a day. In fact, the effect size is rather close to psychopharmacological drug interventions for depression. So, really, you’ll find that most therapists working with this stuff use rather passive practices when doing yoga for mental health. Our group’s asana practice includes restorative poses and a few balancing poses to help people come in contact with judgments and the busy work of our minds.
In longer groups, with people who suffer with depression, we’ll give them a more active asana practice. In my qualitative research, I’ve interviewed a bunch of really cool mental health practitioners who use yoga in various clinics around the world. Looking over that data, you’d find that people suffering with anxiety issues typically get restorative and relaxing postures and those struggling with depression tend to get more active or challenging postures and sequences.
Yoga and ayurvedic philosophies have a lot to say about this kind of “prescribe the antidote” kind of approach. Even DBT would call this kind of thing “opposite action.” But I prefer to take a more functional-contextual view: Restorative postures function to demonstrate how to sit with sensations, learn to breathe, and be present. Active postures function to get people moving. This broadens their behavioral repertoire by getting them to sweat and to feel their bodies moving. This is the kind of direction you want to go with people struggling with depression.
Praxis: Do you know of any compelling literature that supports using yoga in clinical settings? Can it be effective for people with more severe mental health issues or is asana practice best for mild stress-reduction?
TG: We know that asana works great with inpatients who suffer with psychotic symptoms. It also works with outpatients dealing with chronic pain. It actually seems like it works well with quite a few different populations. Yoga has been greatly overlooked in the mindfulness literature, but take a look at the article where I talk about using yoga as a mindfulness skill, and then look at all the many evidence-based applications of mindfulness. Loads more data needs to be collected, but I would argue that the two could be used interchangeably. I also think that yoga is more accessible and engaging to a range of client populations than some more sedentary mindfulness practices.
Praxis: In your own experience, what does practicing yoga have to teach us about experiential avoidance?
TG: I love this question! I like to talk about noticing when you’re gripping. You know, like when your toes are turning into little talons? Or at least we try to use them that way! You find yourself gripping the mat, gritting your teeth, holding your breath, comparing yourself to the other bodies in the room. You have thoughts like, “That guy can do chair pose super deep! I should be able to as well” or, “Everyone will think I’m lazy if I drop to my knees into child’s pose, so I’m going to stay in downward dog.”
Like other kinds of formal practice, yoga creates this kind of “behavior sandbox.” We get a much more limited context in the yoga studio than we do in “the whole world.” And in this more limited context, we have a chance to notice things we might otherwise miss with more distracting stimulus. Seeing when you’re avoiding a challenging experience is a lot easier on the yoga matt than it is standing in the middle of a bus terminal with your phone buzzing and some guy asking you for spare change and someone bumping into you and…you see? You create the context where you have a chance to really catch this stuff in flight, and it slowly works its way into the rest of your life.
Our minds are fascinating and our bodies have a lot to teach us. Yoga is a great opportunity to slow down and listen really closely to those messages.
Don’t miss out on the opportunity to learn more from Tim about effectively integrating mindfulness, acceptance and commitment into your clinic practice. Join him for an upcoming ACT I: Introduction to ACT workshop in Madison or Minneapolis. Also, November 3 – 6, 2016, Tim will be in Tampa, Florida, facilitating our four-day ACT BootCamp®, a distillation of everything that’s so exciting about acceptance and commitment therapy. Register now for your seat at this transformative training experience!
Register now for an ACT I: Introduction to ACT training event near you!