I met Becky in round one. She showed up at Hotel Prentice with bright eyes, a smile that extends for miles- and a purple lipstick in hand.
She had started reading my blog a few weeks before and she was taken with my latest entry that revealed my love affair with lipstick and my intention of wearing it during every round.
I didn’t know Becky, but she felt that she knew me. It took very little time for that feeling to become mutual.
Becky took me on a journey through mindfulness, a journey through mediation, a journey through the mind-body connection.
She showed me how to slow down my breath, to clear my head, and to connect with a body that I no longer understood.
She taught me to honor and embrace what I was feeling-as well as to enter each round, each day, each moment with a renewed intention.
Becky became my guru, my confidant, my guide throughout last year’s twists and turns, triumphs and falls.
Becky is and continues to be a tremendous source of strength- and she serves as a constant reminder that I have the tool kit necessary to handle the most dire of circumstances.
Inhale one, two, three, four, five.
Exhale one, two, three, four, five, six.
Here is Becky’s academic review of our work together.
I think you will soon see that she is nothing short of remarkable.
Mindful Social Warriors:
One MSW Student’s Approach to Using
Gentle Yogasana, Pranayama, and Meditation
to Help a Young Woman Battle Cancer-related Stress
Rebecca J. Strauss, Registered Yoga Teacher (RYT)
Masters in Social Work (MSW) Candidate, Matriculation – May 2012
Loyola University Chicago
ABSTRACT: It is widely published that physical, psychological, and social stressors adversely affect many individuals who are diagnosed with cancer, influencing their experience of treatment and perhaps, their medical outcome. No one is prepared for this battle, yet most patients are forced to make split-second decisions that are critical to their care. This case study highlights the mindfulness approach taken by one Masters of Social Work (MSW) student/yoga teacher to help a young woman during her journey with Grey Zone Lymphoma. By guiding her through gentle yoga postures, pranayama (yoga breathing), and meditation this patient learned how to regain some degree of control in managing her illness-related stress, and perhaps improve the quality of her life during treatment. As more hospitals combine conventional treatments with complementary healing therapies, they provide tools any patient can use to instill hope and promote wellness during this most challenging time and beyond.
KEY WORDS: cancer; onco-fertility; yoga; pranayama; meditation; complementary and alternative medicine.
Receiving a diagnosis of cancer can seem like stepping into active battle without any basic training. The disease sneaks up on most individuals by way of a suspicious lump, night sweats, unexpected weight loss, headaches, or extreme fatigue that one assumes is due to working too hard or other life stressors. No one is prepared for this battle, yet most patients are forced to make split-second decisions that are critical to their care. Once the decisions are made, the treatment begins and the patient is faced with the need to accept, surrender to their circumstances, and fight for their life. The world becomes their basic training, navigating responsibilities related to their health, their own perception of self as well as the perceptions of their family, friends, and work colleagues.
Despite medical advancements, 12.2% of women born today will be diagnosed with breast cancer alone at some point in their life (National Institute of Health, 2010). At least 20% of patients continue to suffer severe distress for two years or more post-surgery, experiencing recurrent anxiety, depression, and somatic preoccupation (Spiegel, 1997). Although traditional medicine has made tremendous progress in alleviating cancer-related stressors by minimizing treatment side effects and extending one’s life, prolonged stress can weaken the immune system, effectively reducing the body’s defenses against future tumors, bacteria, and other viral infections (Palmer, 2000). Consequently, anything that can enhance a patient’s ability to minimize stress may have a positive effect on treatment outcome.
Cancer is a complicated diagnosis for any person, but for younger women, cancer treatment means surrendering to uncertainty in many significant areas of their life. Cancer-related stress results from a genuine loss of control over treatment procedures and scheduling, fear of death, physical side effects, issues related to dating and intimacy, and interruptions in career or family life. Young women feel victimized and vulnerable as hair loss chips away at their femininity. They continue to experience body betrayal in extreme fatigue, mental fog, and permanent scarring. Chemotherapy compromises one’s immune system and often forces isolation, adding another layer to one’s grief over the loss of their former healthy and independent self. As more young women fully recover from their respective cancer treatments, future fertility has become a very relevant issue in their long-term quality of life. Cancer therapies can have a profound impact on ovarian functioning, often reducing the window of reproductive opportunity (Stroud, Mutch, Rader, Powell, Thaker, & Grigsby, 2009). Almost immediately after diagnosis, critical decisions have to be made regarding fertility preservation yet logistical barriers and inadequate financial resources prevent timely patient referrals and coordination of such care, adding yet another layer of stress and anxiety to the illness (Woodruff, 2010).
The good news is that all is not lost. Perhaps the antidote to one’s healing is finding that internal space where one can regain some degree of control in their recovery. With an acceptance of their diagnosis and an awareness of their body and mind, all patients can be partners in their healing, and reconnect with survival and a promising future. Young women with cancer have every reason to take such a proactive stance, as they are not only fighting for their life, but for the lives of their unborn children. They are fighting for a future with their young families, their careers, their need to physically and mentally heal, and their need to redefine their perception of self in many areas of their life. As a social worker in the field of mental health, it is important to help our clients access this internal space that allows for healing, either on the emotional level through a more refined state of awareness, or on the physical level through the reduction of stress, or both.
YOGA AS A COMPLEMENTARY INTERVENTION
Yoga is an ancient practice that encompasses various domains of physical and mindful experiences. The practice of yoga includes ethical and moral disciplines, asanas (physical postures), breathing techniques, meditation, and the emphasis of uniting the mind and body for health and a more profound awareness of self (Smith & Pukall, 2009). In the asana portion, each yoga posture is linked to the next one by a succession of transitional movements, synchronized with the inhalations and exhalations of one’s breath. The union of mind and body then takes place with the breath acting as the harness (Ramaswami, 2005). When one integrates yoga movement with the breath, the mind stops its obsessive thinking and begins to slow down. It is an ideal way to preserve health and longevity in the body, regulate the nervous system, and allow the mind to withdraw inward towards relaxation (Raman, 1998). A regular yoga practice does not free a person from stress but it may train the body to respond to stress differently.
Pranayama, or yoga breathing, has been repeatedly shown to be a valuable resource for people suffering from stress by directly addressing one’s physical and emotional body (Somerstein, 2010). As breathing is intricately related to one’s nervous system, deep breathing and the lengthening of one’s breath not only improves lung capacity, but it slows down the heart rate and stimulates the relaxation response (Brown & Gerbard, 2005). Breathing is the only function of the autonomic nervous system that can be automatically and consciously controlled, effectively becoming a bridge between mind and body, and therefore a powerful mechanism in reducing stress (Somerstein, 2010). For many individuals, breathing practices are often the most rapidly effective method to engage the relaxation response and balance the nervous system (Brown, Gerbard, Muskin, 2009).
The quieting of the mind also occurs in meditation, the practice of focusing the mind’s attention on either the sensation of one’s breathing, or a mantra, a sacred word or prayer that has special meaning (Iyengar, 1979). The goal of meditation is to become aware of one’s thoughts or worries as they enter the mind, and learn to move through them without getting stuck. This awareness allows one to harness distractions, without judgment, and bring attention back to the here and now. The inward concentration of meditation trains the mind to focus on the present moment. In doing so, meditation may help one develop greater capacity to accept, rather than be consumed by their illness.
In recent years, gentle yoga postures, pranayama, and meditation have received growing recognition as powerful tools in promoting one’s quality of life during and after cancer treatment. Yoga-based approaches have very practical implications for individuals with cancer as they view the body as the gateway to the mind. These approaches prioritize making the connection at the somatic level first through a gentle asana practice, and subsequently move to the emotional and cognitive levels through deep breathing and meditation (Emerson & Hopper, 2011). They help to cultivate one’s ability to remain present and build a new connection with the self, especially when one’s perception of self is changed through illness. They teach individuals to listen to their body and make accommodations when it needs a little extra help.
CLIENT HISTORY AND METHODOLOGY
In this case study, the client was 29 years old, female, professionally engaged in the field of community activism, and enjoying a robust social life. With one phone call from her doctor, confirming a diagnosis of Grey Zone Lymphoma, this client was frozen in fear and uncertainty. Within days she had endured many tests to establish a preferred treatment regime. Before treatment began however, and with great surrender, she met with onco-fertility specialists in order to preserve her future fertility. The unknown was almost too much to bear.
Warriors fight by nature and this young woman chose to be a warrior by being proactive and fighting the Grey Zone Lymphoma that invaded her body. As a precautionary measure to ensure her safety, I requested that she get her doctor’s permission before we began our work together. More specifically, she needed permission from her oncologist to breathe deeply, lift her arms up over her head, and perform gentle extensions and twists of the spine while in a standing or seated position. I have been a registered yoga teacher (RYT) for four years, a practitioner of yoga and meditation for eight years. Within this framework, I began my therapeutic work combining my current Masters in Social Work training at Loyola University-Chicago, with my experience in teaching yoga and meditation, to help someone overcome their unique personal challenge in living.
Each session was structured with 10 minutes of pranayama, 20 minutes of gentle asana practice, 10 minutes of meditation, and 10 minutes of processing thoughts and feeling states. Although the structure of each class was the same, the content varied depending on how the client was feeling at that particular moment. The pranayama technique of slow yoga breathing was chosen because of its ease of use and its ability to calm the nervous system (Bernardi, Porta, Spicuzza, & Sleight, 2005; Somerstein, 2010). The normal breathing rate for most individuals is about fifteen breaths per minute (Ramaswami, 2005). For the purpose of this study, the rate of breathing was reduced considerably to six breaths per minute, or to a five second inhale, five second exhale, pace (Bernardi et al, 2005). The asana portion consisted of a sequence of gentle postures taken from the Vinyasa Krama system, a style of yoga passed on by legendary teacher, Sri Krisnamacharya. This system encourages one to focus on the slow inward and outward movement of breath, while simultaneously performing simple movements of the arms and torso (Ramaswami, 2005). At other times, we integrated simpler hand gestures or mudras with slow breathing, bringing awareness to the connection of the fingertips and the warmth that followed by pressing hands to the heart.
The meditation portion further encouraged the client’s awareness of her thoughts, fears, or concerns. There were many conversations about feeling judged, either by herself or perceived judgment by others. About half way through treatment, tests revealed that the client was cancer free. This was such extraordinary news, met with joy from all her friends, family, and work colleagues. But with that joy came an odd sense that she was supposed to be healed and ready to reenter normal life. Nothing was farther from the truth. Meditation provided a means to access that internal space in which she could observe her thoughts, rather than being consumed by them, accept her challenges rather than be a victim to them, and find a sense of control that she could harness in her battle to survive.
Working with individuals with cancer requires flexibility in the clinician’s approach as sessions have to be altered in length or location to accommodate fatigue or other symptoms related to their illness (Spira & Kenemore, 2002). In one situation, our plan was to conduct our session at her home, however blood tests showed that her immune counts were too low to have visitors. I suggested that we connect via Skype, a real-time online interactive tool that allows individuals to meet virtually. She agreed and we did our session seamlessly. She was in her home, I was in my home, and neither of us felt as though anything was missing from the session, except for our final hug. Another adaptation occurred during one of our hospital sessions when the client’s energy was extremely depleted. I asked if she would like to try doing, “yoga in the mind.” She agreed and we proceeded to conduct our session while she was lying on her bed, eyes closed, covered up and as comfortable as possible. As I verbally instructed the pranayama and asana portions of our session, she imagined doing everything in her mind at the same pace, same time. The client engaged in the meditation and the final processing of thoughts and feelings and reported feeling stronger after the session, even though it was done without any observable movement on her part.
As a graduate student in the field of clinical social work and an RYT, helping this client find her internal space where she could collect some measure of control during illness was very powerful to witness. In the reflections portion of each session, emotions often surfaced as she would describe the release of tightness or stress that had been lodged in the area around her heart. At times she would reflect on her surprise at how light she felt afterwards, as the numbing in her fingertips or heaviness in her arms seemed to be less obvious. Other times she focused on how freeing it was to work through her personal challenges without judgment. She reported that when waiting for test results, she would engage her secret weapon of slow, yoga breathing to reduce her anxious feelings and find a sense of calm. When she found herself feeling out of control, she responded with silent meditation, as a means to harness her fears and strengthen her will to fight.
Traditional medicine treats the specific physical symptoms of one’s illness through various drug interventions, surgical procedures, and other therapeutic means. Yoga is a more holistic system that optimizes every function of the body including the muscles, digestion, circulation, the immune system, and the nervous system in order to enhance physical and emotional well-being (McCall, 2007). Although the gifts of yoga are tangible, they are often more subtle and accessible only by experiencing the practice on some level. Elements of yoga, such as gentle postures, pranayama, and meditation are not just interventions, they are part of a philosophy that permeates one’s thinking over time. This philosophical component requires one to develop a deeper sense of their body, breath, and mind. Through awareness, one may be able to cultivate his/her ability to act, instead of react under stressful circumstances, and may be in a better position to regain a sense of control during illness and other life challenges. The practice of yoga won’t change one’s diagnosis but it may reduce one’s reactivity to diagnosis, treatment, and resulting side effects. When offered in a slow and deliberate way, yoga interventions may calm the nervous system, quiet the mind, and allow the physical body to let go of stress and heal.
There are numerous limitations to this case study that prevent the findings from being generalized to larger populations. All outcomes were based on self-reporting measures taken from a single case study. Although the positive psychological and physical effects of yoga interventions are noted, it is not clear which aspect of the intervention(s) may have been responsible for such improvements. Although the structure of each session was kept constant, the content of each session varied due to the patient’s health or other psychosocial stressors at that time, reducing yet another layer of reliability. And unlike many other patients, the subject was physically fit prior to her diagnosis and very open to the idea of integrating mind and body for the purposes of her own health and recovery. The subject also used many other tools to fight her disease, in addition to practicing mind/body interventions. She actively engaged in her treatment options, published regularly in an online blog, gathered strength from her family, faith, and friends, and found meaning in reaching out to other cancer patients in need of support. Although any medical or mental health practitioner can engage a client in slow breathing techniques, an additional limitation is that not every clinician is trained in the instruction of yoga and mindfulness meditation, a qualification that would be essential to offering this type of intervention.
The mind/body interventions presented in this case were chosen specifically to help a young woman manage her cancer-related stress during chemotherapy. Additional research is needed to specify which cancer patients benefit from yoga interventions, given the various types of cancer and the different treatment protocols that patients face as a result of their diagnosis. Further research may be necessary to identify which aspects of these mind/body interventions lead to positive outcomes such as relaxation, stress reduction, increased coping skills, and acceptance. The positive feedback reported by the patient in this case may indicate that aspects of a yoga practice, such as gentle asana, pranayama, and meditation may have future value as part of other clinical interventions. As a clinical social worker in the field of mental health, future research may be pursued to support the possible link between yoga postures, pranayama, and/or meditative practices as a means to reduce stress (Brown & Gerbarg, 2005), manage anxiety (Somerstein, 2010), and mitigate effects of trauma (Emerson & Hopper, 2011). By integrating holistic approaches that are intrinsic to the practice of yoga and mindfulness, perhaps we can provide our clients with tools to regain emotional and psychological control in their life, regardless of unexpected challenges.
After six months, the young woman in this case study is healthy and cancer free. As originally feared, however, chemotherapy profoundly impacted her ovarian functioning, leading to premature menopause and loss of fertility. But due to her diligence in seeking onco-fertility treatment prior to chemotherapy, this client will find her way to motherhood, perhaps through in vitro fertilization, surrogacy, or adoption. With her gentle yogasana practice, yoga breathing, and meditation tools in place, it is certain that she will fight this pending battle with the power of a warrior and a young woman’s grace. It was truly an honor to combine the healing powers of yoga with my clinical social work training to help this individual regain a sense of control and promote her own wellness under such a challenging circumstance.
For more information on this young warrior’s efforts to help others fight cancer, please visit her website at http://twistoutcancer.org/ .
To contact Becky Strauss please email firstname.lastname@example.org
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