Teaching Experiential Practices in Medicine
What “knowing” means in experiential practices is to have had direct experience of a state of body and mind, rather than holding a collection of facts.
“Knowing” Through Direct Experience
What exactly is an “experiential” practice, and how is teaching such practices different from other forms of teaching in clinical medicine? A simple way to understand experiential practices is that they involve learning through direct experience, rather than by reading, listening or watching. In other words, you cannot learn these practices by reading a book; you can only learn them by doing them.
What “knowing” means is to have had direct experience of a state of body and mind, rather than holding a collection of facts. Some examples of experiential practices include meditation, yoga, and breathing techniques. Some examples of non-experiential knowledge include the names and uses of medications, the pathophysiology of diseases, and the ability to accurately recognize and categorize different diagnoses.
To be effective for your goals, and the goals of your patients, it is essential to experience these practices with guidance from a teacher, who has also been a student. That is, the teacher must have experienced these practices with guidance from their own teachers themselves. As you can see, this is quite different from typical clinical teaching, which usually involves educating patients by sharing data, rather than guiding them through an experience.
To Teach, you Must also Practice
I have been so pleased to see the progress the fields of psychiatry and psychology have made in recognizing the benefits of mindfulness-based practices in clinical work. When I was a medical and graduate student (2003-2011), I did not hear the word “meditation” at all during my education. Fast-forward to 2018, when I returned to clinical work after a hiatus, and there were dozens of psychiatry residencies proudly advertising mindfulness-based stress reduction (MBSR), and similar distillations of meditative practices, as a part of clinical training.
However…what I found was that trainees were typically given written scripts, which they would read to their patients in order to teach them meditation. Meditation was not necessarily experienced or practiced by the trainees, instead it was recited, similar to other types of medical education. I wonder…did those patients benefit from the teaching, and did they continue to practice? The teachers who have guided me in my own experiential practices have advised that if the teaching is mechanical, the practice is likely to become mechanical. Although you may benefit from such a mechanical practice in the beginning, you will likely reach a barrier, and without guidance from someone with experience, you may not continue to progress.
A few studies have looked into the factors that influence whether or not people benefit from meditation, and if they continue to practice. These studies have found that those who have had a retreat experience or have spoken with a meditation teacher are more likely to continue to practice, whereas those who had their first experience using a technology are less likely to continue to practice. This does not mean that learning from apps or scripts is “bad”; they reduce barriers to entry, and get many people started with meditation who cannot access a teacher. However, to move beyond the mechanics of experiential practices, and towards your goals, it is important to find a teacher, and importantly, find a teacher who also practices what they are teaching.
What is Yoga Therapy?
Yoga therapy involves making intentional changes to the way individuals relate to themselves, and to others, to achieve mental and physical well-being.
Yoga therapy is a systematic and individualized approach to achieving well-being, by way of yoga. The ultimate goal of yoga therapy is a healthy body and an integrated mind, which is achieved by correcting imbalances in the body and mind, through the practice of yoga.
Correcting imbalances in the body usually involves the physical movement practice of yoga, also referred to as “postures” or “asanas”, and is what most people in the U.S. understand to be “yoga”. Imbalances in the mind are usually corrected by regulation of the breath (pranayama) combined with meditation (focus). From the perspective of yoga, the body and mind are very much influenced by our behaviors, such as our thoughts and actions. Therefore, correcting imbalances in the body and mind also involves making changes to our behavior towards ourselves and others.
In other words, yoga therapy involves making intentional changes to the way individuals relate to themselves, and to others, to achieve mental and physical well-being.
How is Yoga Therapy Applied to Mental Health?
The word “therapy” can be a bit confusing, particularly when yoga therapy is used in the context of mental health treatment. Yoga therapy is not yoga plus psychotherapy; it is therapeutic through the transformative process of restoring balance to the body and mind, through the practice of yoga.
In this context of yoga therapy for mental health, the purpose of the physical movement practice is to increase the quality of the breath, and to prepare the body to be in a state of meditation. For most people, this requires correcting imbalances in the body that create discomfort, pain or restlessness in the body or mind when attempting to engage in breathing practices or meditation.
From the perspective of yoga therapy, the state of the body, breath and mind are interdependent and always affecting each other, and they are always capable of changing. Yoga therapy is a vehicle for change that works by addressing the imbalances in the body, breath, and mind that may result in illness, and offers a path towards long-lasting health and well-being.
Where Can You Learn More About Yoga Therapy?
Here are a few resources that I recommend to anyone who is interested in learning more about yoga therapy:
“Yoga Therapy: A Guide to the Therapeutic use of Yoga and Ayurveda for Health and Fitness.” A.G.Mohan and Indra Mohan
“Yoga for Body, Breath, and Mind: A Guide to Personal Reintegration.” A.G.Mohan
What is Integrative Psychiatry?
Integrative psychiatry offers patients something medication alone cannot, which is the opportunity to create long-lasting positive changes to their lives…
Integrative psychiatry is an approach to mental health treatment that combines psychotropic medications with non-medication alternatives. These non-medication treatment options are numerous, and can include psychotherapy, nutritional or herbal supplementation, mindfulness-based interventions, meditation, yoga, lifestyle changes, hypnotherapy, acupuncture, etc. The intention behind choosing an integrative approach may vary based on the psychiatrist, however, in my experience, most of us who identify as integrative are interested in prevention, understand both the usefulness and the limitations of medications, and want to offer our patients more choices on their path towards well-being. Usually this requires additional education, training, and experience beyond our medical school and residency or fellowship training, in one or more complementary modality. In my clinical practice, I rely heavily on experiential mind-body practices, based on the principles of classical hatha yoga, due to my training in yoga therapy, pranayama and meditation. This is not instead of, but in addition to medications, the evidence-based use of nutritional supplements and life-style optimization strategies.
Why Integrative Psychiatry?
Medications play an important role in most moderate to severe mental health challenges, however not all patients respond to medications, some patients respond only partially, and others cannot tolerate medications due to their side effects. Integrative modalities are used to augment medications, meaning that they can fill the gap in treatment that medications cannot achieve, helping patients to move closer towards their well-being goals. The integrative psychiatry approach also offers patients something medication alone cannot, which is the opportunity to create long-lasting positive changes to their lives through building new habits, new ways of interacting with themselves and others, and a new relationship to their bodies and minds. One way to think of this is that integrative approaches involve learning life skills that are free to use, do not have side effects, and do not depend on anyone except the individual, and their choices. The goal of integrative psychiatry is whole-person well-being, and this usually requires more than medication alone.