Stanford health psychologist Kelly McGonigal, PhD, author of Yoga for Pain Relief, gave this lecture as part of the Stanford Healthy Library’s “Doctors Speak” series. Learn more about how yoga and meditation can help reduce headaches, back pain, anxiety, and other forms of chronic pain and stress (70 min)

It’s caring, it’s cost-effective, and it works. Is integrative medicine the future of health care? Kelly McGonigal explores this emerging field of medicine.

This article originally appeared in the Jan 2011 issue of Shambhala Sun.

In 1998, Jeffrey Brantley, MD, was knocking on colleagues’ doors, trying to raise the visibility of a new project. He had just launched a Mindfulness-Based Stress Reduction program at Duke University Health System, the beginnings of what would become Duke Integrative Medicine. He laughs when he tells the story of the reception he got from some physicians. One prominent gastroenterologist eagerly agreed with Brantley about the importance of the mind–body connection, and described the role of stress in many of the cases he saw every day. “Let me show you something,” he told Brantley, pulling a book on holistic healing out of a filing cabinet. “I have to hide this book, because if my colleagues saw it, they’d think I was crazy.”

More than a decade later, fewer physicians feel the need to hide in the mind–body closet, and more medical centers around the country are embracing a holistic approach. Last year, more than six hundred health care professionals packed a standing-room only Summit on Integrative Medicine, held at the Institute of Medicine in Washington, D.C. The first of its kind, the summit brought together a range of experts to explore the practice of integrative medicine, its scientific basis, and its economic and policy implications.

To many, integrative medicine has become the one bright spot in a struggling health care system. It promises to control costs, prevent or reverse many chronic conditions, improve quality of life, and even return the idea of “health” to what is better described as a disease care system. But integrative medicine faces many challenges. Some conventional Western health care providers criticize integrative medicine for bringing what they view as unsupported and unscientific therapies into an evidence-based field. Others worry that its comprehensive approach to health and healing, while ideal, is too expensive to implement on a large scale. But the leaders in this emerging field are ready to tackle those challenges and prove that the U.S. is ready for a new kind of medicine.

What is Integrative Medicine Integrating?

The words “integrative medicine” may bring to mind holistic approaches such as acupuncture, massage therapy, and stress reduction. Although these can be important parts of an integrative approach, the field does more than merely integrate alternative and conventional medicine.

The Consortium of Academic Health Centers for Integrative Medicine defines integrative medicine as “the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing.” Key to this definition is integrative medicine’s embrace of any therapy that supports health and healing, regardless of its origins. Treatment for cancer, for instance, might include everything from surgery and chemotherapy to diet, spiritual counseling, and yoga.

Integrative medicine also strives to integrate every aspect of the health care system, from self-care and primary care to urgent care and hospital care. This requires a level of communication and cooperation rare in modern health care. Integrative medicine also acknowledges the many resources a patient has outside of the medical system, including the body’s innate capacity for healing, the support of family and friends, cultural or religious beliefs, and the ability to find meaning within illness and suffering.

Finally, integrative medicine reflects a return to a core value of medicine—the power of the therapeutic relationship. This is easily overlooked in the modern, technology-driven culture of health care, but in integrative medicine, the time spent and the trust built between caregiver and patient is considered the foundation of effective health care.

Health Is More Than the Absence of Disease

Health, says Christiane Northrup, MD, is a vibrant thriving that includes pleasure, joy, and meaning. It is not simply the absence of disease.

Northrup is a leading advocate for women’s health and the winner of the 2010 Integrative Health Care Visionary Award. Part of Northrup’s vision is a world in which every individual recognizes his or her own capacity to create health. “True health care,” she says, “is often not found in hospitals—that is disease care,” she says. “They have a role, but your role in your own health is far more potent than hospitals, doctors, and insurance companies.”

Northrup says that even what medicine calls “health promotion” is usually just disease screening. “At a health fair, you can have your blood pressure taken, your cholesterol measured, and get a mammogram.” These tests can detect a problem, but they do little to create health, and by spending so much time and energy searching for what is wrong with the body, we miss opportunities to care for the body, mind, and spirit. Northrup recommends broadening our view of health care to include the things that create health and joy on a daily basis, whether it’s dancing the tango, reading a good book, or spending fifteen minutes a day in natural sunlight. “Begin to think about your health care as a program that you are in control of,” she says. “It includes your thoughts and beliefs and the people you spend time with. It includes turning off the news and getting massages regularly. Just being present with another human, being present in the moment, ramps up your circuitry of health.”

Moreover, Northrup says, true health care is possible even in the presence of pain, grief, or illness. Illness can provide the catalyst for learning how to be with yourself in a compassionate way, and focus your attention and energy on what matters most. “When you move toward that which is most fulfilling, pleasurable, and life-enhancing, healing follows, regardless of what your physical health is like in that moment.”

A New Kind of Medical Practice

“What if a visit to the doctor left you feeling replenished, rejuvenated, and motivated to make changes in your life? What if you belonged to a health care practice that understood every aspect of your well-being—physical, emotional, and spiritual?”

That’s the invitation on the website of Duke Integrative Medicine, part of Duke University’s world-class medical system. This promise of integrated care draws more than five thousand patients to the Duke center each year. They come for help with chronic conditions such as high blood pressure, cardiovascular disease, and diabetes, or to seek a holistic approach to cancer recovery or pain management. Some come simply to invest in themselves and their health. A visit to the center is called a “health immersion,” and patients can choose to spend half a day, a full day, or a week at the center. For local patients, the center offers a flat-fee annual membership that provides unlimited consultation with an integrative physician, ongoing personal support, gym membership, cooking classes, stress reduction programs, and more.

Whatever the health challenge or goal, and no matter how short the visit, every patient at Duke Integrative Medicine has their own core team of health care providers, including a physician, nurse, and health coach, who will help the patient select the services and specialists that meet their needs. The patient’s health immersion begins with an intake that might last ninety minutes and assesses all areas of the patient’s life. The patient then has a series of appointments with other specialists, such as a nutritionist or a health psychologist, and receives complementary therapies like massage, acupuncture, or reiki.

Every patient is also introduced to the concept of mindfulness and the body–mind relationship. “Mindfulness is at the core of everything we do,” Brantley says. “We believe that the more mindful people can be as they face health challenges, the healthier they will be.” The center also offers mindfulness-based stress reduction classes to health care professionals, and all of their care providers and health coaches are trained to bring mindfulness into their interactions with patients.

Before the end of the immersion, the full team of core and complementary care providers meets to chart a plan individually tailored for the patient. The patient walks away not only with a list of recommendations for supporting his or her own health, but with established relationships with a team of health professionals. Health coaches follow up with patients by phone on a monthly basis to support their progress. “It’s not just about experts giving information and advice,” Brantley says. “The power of the individual to shape the trajectory of their own health is one of the main principles at Duke. It’s a core shift in paradigm. We partner with patients to help them be the single most important element in their own health and healing.”

Can We Afford It? Ford Says Yes

Programs like Duke Integrative Medicine are incredibly appealing—who wouldn’t prefer a dedicated team of medical professionals, and a full spectrum of complementary care, instead of a ten-minute rushed appointment with an overworked physician that ends with a single prescription and a lot of unanswered questions? But in debates about the practicality of integrative medicine, one question always comes up: Is integrative medicine—which requires more time, more health care providers, and a broader scope of services—financially feasible in a health care system that is straining to contain costs?

Kenneth Pelletier, MD, is on a mission to answer that question. As director of the University of Arizona’s Corporate Health Improvement Program (CHIP), Pelletier helps companies evaluate and implement a range of integrative health interventions in the workplace. The CHIP program is designed to address two of the most common objections to integrative medicine: One, it’s too expensive, and two, there’s not enough evidence that it works better than standard care.

Pelletier started CHIP in 1980 as a small health promotion project with IBM. When that program was bought by Johnson & Johnson, a light bulb went off for Pelletier. “I realized corporations have a vested interest in health. They need high-performing, healthy people. Their products depend on it. If you want to demonstrate the clinical and cost-effectiveness of an approach, this is the place to do it.” Thirty years later, even in the midst of health care reform, large companies recognize they are still going to be on the hook for their employees’ health care. This, Pelletier says, makes them very open to preventive and integrative interventions. “It does not matter to them if something is conventional or alternative medicine. Once these companies see something that works, they act, very decisively.”

One such company is Ford Motor. A few years back, its medical director came to CHIP with a very specific problem. Ford was spending eighty to ninety million dollars a year managing back pain. In addition to the cost of covering employees on disability, Ford was running its own fully-staffed health clinics in plants across the U.S. The company estimated that the cost of employees’ back pain alone was adding $400 to the price of every car Ford sold; medical costs in total were adding $2300. Since this was far more than foreign competitors like Toyota were spending, back pain had become a major barrier to remaining competitive. So the medical director asked CHIP: Is there a way Ford could better manage back pain that would cost less?

CHIP helped Ford implement an integrative approach to back pain at a randomly selected engine assembly plant in Kentucky. The approach included the usual care offered at Ford’s clinics, plus onsite clinical acupuncture, mindfulness-based meditation and body mechanics training, and referral to chiropractic services when appropriate. Pelletier wasn’t sure how blue-collar assembly line workers would respond to the less conventional therapies. “When we first went to Louisville, we had to meet with the unions and Ford’s medical team. The very first person said, ‘What’s this acupuncture?’ And I thought, we’re in trouble. But the good news about companies is that they are agnostic. They want to get people healthy and back to work, so they can save money. They’re very practical, and they set aside bias. They’re not against any form of medicine as long as it is safe, effective, and cost-effective.”

The results of the study were impressive. Use of prescription opiates went down by nearly 60 percent among participants in the integrative program. This, Pelletier points out, has significant economic consequences. Employees cannot work on the assembly line if they are taking prescription opiates, even if their pain is controlled. A 60 percent reduction in use translates into a huge return to work and saved money on disability costs. The study has already had a big ripple effect at Ford. The approach is being replicated in all of their health clinics, and Ford’s insurance companies are covering the costs, thanks to the power of Ford’s demands.

Pelletier was surprised to find that the single best predictor of improvement was participants’ use of a guided meditation CD, the component they thought might be the least appealing to the plant workers. Use of the CD predicted significant improvements in back pain-related disability, job performance, and physical and mental well-being. “We went back six months later, and twice as many workers were using the meditation CD than any other modality for back pain.” Findings like this demonstrate the feasibility of bringing less conventional modalities into communities that may not currently have access to or familiarity with them.

Programs like CHIP are also building the evidence base required to demonstrate the economic feasibility of integrative medicine. At the 2009 IOM Summit on Integrative Medicine, Pelletier presented an analysis of the cost effectiveness of integrative medicine interventions in the workplace. He found 153 relevant reports of worksite interventions, all of which showed positive health outcomes and related benefits in short-term disability, long-term disability, absenteeism, employee retention, productivity, and performance. Sixty-three studies addressed financial outcomes, and all but one reported positive cost-effectiveness, cost-benefit ratio, or return on investment. Pelletier estimates that the typical return on investment is actually between 3.5 and 4.9, but that it takes about three years to fully realize the financial payoff. At a minimum, integrative medicine programs break even, despite the upfront costs, but convincing employers and insurers to adopt such programs will require both vision on the part of those footing the bill, and more hard data confirming the long-term economic rewards.

The Power of Lifestyle

On February 26, 2009, Dean Ornish, MD, went to Washington to testify before the Senate Committee on Health, Education, Labor, and Pensions, chaired by the late Senator Edward M. Kennedy. Ornish is the founder and president of the non-profit Preventive Medicine Research Institute in Sausalito, California, and the bestselling author of books such as Dr. Dean Ornish’s Program for Reversing Heart Disease. He made ten key recommendations to the committee for health care reform, including funding more scientific studies in integrative medicine, changing farm subsidies, incentivizing food companies to make and market healthier foods, putting mandatory physical education back in schools, and incentivizing a focus on wellness rather than illness in health plans and at corporate worksites.

Ornish’s own studies over the last thirty years have shown that when people make major lifestyle changes, extraordinary benefits are possible, including reversing or slowing the progression of cardiovascular disease and cancer. His program, laid out in bestsellers like The Spectrum, includes a wide range of health-supporting behaviors, such as moderate exercise and a low-fat, plant-based diet. It also emphasizes stress reduction, through yoga and meditation, and social support. “Part of what I’ve learned is the need for connection,” Ornish says. “It’s a primal human need. People who are lonely and depressed die sooner. This is the real epidemic, the breakdown of social networks. We create environments that feel safe for people to talk about what’s going on in their lives. When you can meet an unmet need, this is very powerful. Intimacy is healing.”

Many studies have demonstrated both the clinical success and cost savings of Ornish’s program. For example, a trial using patients at eight hospitals found that almost 80 percent of individuals with cardiovascular disease who were eligible for bypass surgery or angioplasty could avoid these surgeries through lifestyle changes. The estimated savings per patient was $30,000.

The most recent studies of Ornish’s program have used some high-tech, cutting-edge measures to demonstrate the power of these low-tech, common-sense lifestyle changes. A 2008 paper in the Proceedings of the National Academy of Sciencesanalyzed the expression of over 500 genes in the prostate cells of men with prostate cancer. After patients followed Ornish’s program for three months, many genes that promote cancer, heart disease, and inflammation were downregulated, while many health-promoting genes were upregulated. This suggests that lifestyle changes, social support, and stress reduction have a measurable impact on something as concrete as our genes. A 2008 study published in The Lancet Oncologyreported that the same participants showed an increase in telomerase, an enzyme that helps preserve telomeres, the bits of DNA at the end of chromosomes. Previous research has shown that shortened telomeres is a significant predictor of disease and mortality. The Ornish study is the first to demonstrate that any intervention has a positive effect on telomerase, and, by extension, may increase lifespan.

Many in the medical profession applaud Ornish’s findings but question whether patients will really make these kinds of comprehensive changes. After all, it’s easier to take a pill than change your diet and make time for exercise and meditation. To these skeptics, Ornish argues that compliance rates for drugs like Lipitor are actually abysmally low. “People don’t want to take a pill to prevent something so horrible they don’t want think about it,” he told me. “But our data shows that most people are able to make and maintain these lifestyle changes because they feel so much better so quickly. Feeling better is sustainable. Joy of living is a much better motivator than fear of dying.”

Follow the (Insurance) Money

Ornish believes that one of the most critical aspects of health care reform is the reimbursement of integrative medicine practices that have been demonstrated to be safe and effective. Insurers are currently much more likely to reimburse costly surgical procedures and medications—the American Heart Association puts the price of coronary bypass surgery at $99,743—than inexpensive lifestyle changes that could, according to Ornish, prevent ninety percent of cardiovascular disease. At places like Duke Integrative Medicine, the vast majority of patients pay out-of-pocket for services. Brantley compares the cost of a health immersion or annual membership ($2,995) to a vacation—a reasonable expense for many but an unaffordable luxury to others. Having to pay out of pocket will keep many people from investing in their health, leading to higher personal and societal costs in the long run.

Reimbursement also drives physicians’ medical decisions, Ornish says, even more than evidence. “We could do a thousand studies, but until something is reimbursed, the practice of medicine won’t change.” He points to a large study published in 2007 in The NewEngland Journal of Medicinewhich found that the most common surgical procedures for heart disease—angioplasties, stents, and coronary bypasses—do not prolong life or prevent future heart attacks for 95 percent of patients who receive them. “You’d expect that once that study came out, the number of angioplasties and stents would go down. Instead, it’s increased—because it’s paid for.”

Ornish has spent sixteen years working to get his lifestyle intervention for cardiovascular disease reimbursed by Medicare. At times, he met what seemed like illogical resistance to the common sense and evidence-backed recommendations of his program. “In 1995, the Administrator of Medicare told me, ‘Before I’ll consider doing a Medicare demonstration project, you need to get a letter from the director of the National Heart, Lung, and Blood Institute of the National Institutes of Health stating that your program is safe.’ I asked him, ‘You want me to get a letter saying that it’s safe for older Americans to walk, meditate, quit smoking, and eat fruits and vegetables?’ He said yes.”

Ornish secured the letter, and Medicare now covers his program of lifestyle intervention for heart health. He hopes reimbursement for this and other integrative medicine programs will change not only medical practice, but also medical education. This is a critical step, because one of the biggest challenges facing integrative medicine is the medical culture. Today’s health care providers haven’t been trained in the kind of wellness-focused interventions and collaborative care—especially between conventional and complementary providers—demanded by integrative medicine. Incorporating these principles into medical education could eventually transform health care by creating a generation of doctors who value and know how to deliver an integrative approach.

Those working to promote the field of integrative medicine agree on one thing: they would be thrilled to see the word “integrative” disappear completely. “Even in the beginning,” says Jeffrey Brantley, “we weren’t trying to be at odds with conventional medicine. We’re not trying to be renegades and rebels. We think we’re part of medicine. Now the paradigm is shifting.” He recognizes that integrative medicine is viewed by many as a challenge to conventional medicine, and there are some who have a vested interest in not changing the current system. But he hopes that in time, the distinction between integrative and conventional will dissolve.

“At Duke, our dream is that one day there won’t be integrative medicine,” he says, “because all medicine will be practiced the way we practice it. Treating the whole person, using an evidence-based approach, and bringing mindfulness into every aspect of health care—this will be standard medicine.”

Kelly McGonigal, PhD, Editor in Chief of the International Journal of Yoga Therapy, shares research trends on how yoga and meditation support mental health and recovery from anxiety, depression, addiction, chronic pain, and trauma. Presented at the 2011 International Symposium on Yoga Therapy and Research in Asilomar, CA. (30 min)

Yoga Offers New Hope for Chronic Pain by Kelly McGonigal

This article originally appeared in Yoga International, and is an adaptation of material from the book Yoga for Pain Relief: Simple Strategies for Calming Your Mind and Healing Your Pain (New Harbinger).

There are few things more frustrating to a person with chronic pain than hearing someone say, “Your pain is all in your mind.” But if you’re one of the estimated 50 to 75 million Americans living with chronic pain, these words might actually be the key to relieving your suffering. Chronic pain is in the mind—but this does not mean what you think it means. The experience of pain is real. Pain has a biological basis. It’s just that the source of pain isn’t limited to where one feels it or thinks it is coming from.

For decades, scientists and doctors thought that pain could be caused only by damage to the structure of the body. They looked for the source of chronic pain in bulging spinal discs, muscle injuries, and infections. More recent research, however, points to a second source of chronic pain: the very real biology of your thoughts, emotions, expectations, and memories. Most chronic pain has its roots in a physical injury or illness, but it is sustained by how that initial trauma changes not just the body but also the mind-body relationship.

The complexity of chronic pain is actually good news. It means that trying to fix the body with surgeries, pain medications, or physical therapy is not your only hope. By first understanding chronic pain as a mind-body experience and then using yoga’s toolbox of healing practices—including breathing exercises and restorative poses—you can find true relief from pain and begin to reclaim your life.

The Protective Pain Response

Understanding the difference between acute pain and chronic pain will be critical to your ability to reduce and manage your pain. Let’s begin by examining the basic steps of the pain response: sensation, stress, and suffering.

The protective pain response begins when the body experiences some physical threat, such as a cut, a burn, or an inflamed muscle. This threat is detected by specialized nerves and sent through the spinal cord and up to the brain where, among other things, the threat signals are transformed into pain sensations. Emotion-processing areas of the brain also get the message, triggering a wide range of reactions, from fear to anger. Combined, your thoughts and emotions about the physical sensations of pain make up the suffering component of the full pain experience.

To help you take action, the threat signals have been simultaneously routed to the areas of your brain that help the body launch an emergency stress response, coordinating the actions of the nervous system, endocrine system, and immune system. The emergency stress response triggers a cascade of physiological changes that give you the energy and focus to protect yourself from life-threatening danger.

Even after the threat is gone, the pain response is not over. The mind and body are very interested in making sure you know how to protect yourself from this threat in the future. So the nervous system begins the process of learning from this experience. Any kind of injury or illness, even one that is short-lived or appears to be fully healed, can change the way the nervous system processes pain.

Understanding Chronic Pain

Chronic pain differs from acute pain in three important ways. First, the body can become more sensitive to threat, sending threat signals to the brain even when the threat is minor or non-existent. Second, the brain can become more likely to interpret situations as threatening and sensations as painful, producing pain responses that are out of proportion to any real danger. Finally, with repeated pain experiences, the boundaries between the many aspects of the pain response—sensation, suffering, and stress—get blurred. In most cases of chronic pain, the mind and body have learned all too well how to detect the slightest hint of a threat and mount a full protective response in all its glory.

So the things that make pain so effective at helping us survive acute emergencies and handling short-term pain are the very things that make chronic pain so complex and persistent. The pain you feel may reflect a protective mind-body response that has become overprotective.

Pain Again

Why does past pain make you more sensitive to future pain? You can thank one of the great wonders of our nervous system: its ability to learn in response to experience. This ability is called neuroplasticity. Through the repeated experience of pain, the nervous system gets better at detecting threat and producing the protective pain response. So unfortunately, in the case of chronic pain, learning from experience and getting “better” at pain paradoxically means more pain, not less.

Both modern science and yoga share this idea: present pain and suffering have their roots in past pain, trauma, stress, loss, and illness. Modern science uses words like neuroplasticity to describe the process of learning from past experiences; yoga uses the word samskara. Samskaras are the memories of the body and mind that influence how we experience the present moment. Samskaras keep you stuck, feeling the same emotions, thinking the same thoughts, and even experiencing the same pain.

Samskaras do not always lead to suffering—they also lead to positive change. Just as trauma, illness, pain, and stress leave traces on the body and mind, so do positive experiences. What you practice, you become.

Learning is lifelong, and none of the changes you’ve learned have to be permanent. Neuroplasticity can be harnessed for healing. Your mind and body have learned how to “do” chronic pain, and your job is to teach it something new.

Unlearning Pain Through Relaxation

The best way to unlearn chronic stress and pain responses is to give the mind and body healthier responses to practice.

By helping you transform chronic pain-and-stress responses into “chronic healing” responses of mind and body, yoga helps reduce your suffering of chronic pain. Your mind and body have built-in healing responses that are just as powerful as their protective pain-and-stress responses. Whether it’s a meditation on gratitude, a relaxation pose that puts the body and mind at ease, or a breathing exercise that strengthens the flow of energy in your body—they all share the benefit of bringing you back home to your natural sense of well-being.

Relaxation specifically has been shown to be healing for chronic pain. It turns off the stress response and directs the body’s energy to growth, repair, immune function, digestion, and other self-nurturing processes. The relaxation response unravels the mind-body samskaras that contribute to pain and provides the foundation for healing habits. Consistent relaxation practice teaches the mind and body how to rest in a sense of safety rather than chronic emergency. Below, we will look at a breathing practice and several restorative yoga poses that promote the relaxation response.

These simple relaxation practices will lead you on the path of ending your suffering. Yoga can teach you how to focus your mind to change your experience of physical pain. It can give you back the sense of safety, control, and courage that you need to move past your experience of chronic pain.

Breathing the Whole Body

Breathing the body is a visualization practice adapted from the traditional practice of yoga nidra (yogic sleep) and the body-scan practice taught in Jon Kabat-Zinn’s mindfulness-based stress reduction program for people with chronic pain. Start in any comfortable relaxation pose such as shavasana (corpse pose). Place your hands on your belly and feel the movement of the breath. Notice the belly rising and falling, and notice the breath moving in and out of your body.

In this practice, you will imagine that you can inhale and exhale through different parts of your body—as if your nostrils were moved to that part of the body. Start with your feet. Imagine the breath entering your body through the soles of your feet, and exiting your body through the soles of your feet. Notice any sensations there. Feel, or imagine, that flow of energy in the feet as you breathe. Now repeat this visualization for other parts of your body: Your lower legs, knees, and upper legs. Your hips, lower back, middle back, and upper back. Your belly and chest. Your shoulders, upper arms, elbows, lower arms, hands. Your neck. Your forehead and the crown of your head.

When you get to an area that feels tense, uncomfortable, or painful, don’t skip it. There are several things you can try that may make you feel more comfortable. First, stay with the visualization and direct the breath right at the sensations of discomfort or pain. Imagine that the breath is dissolving or massaging the tension and pain. Imagine the solidity of the tension or pain softening. Find the space inside the pain. Second, try moving your attention back and forth between the uncomfortable area and a more comfortable area. For a few breaths, breathe into the painful area; for the next few breaths, breathe into another area. Switching back and forth like this can teach the mind how to give the uncomfortable sensations less priority. You are practicing a healthy kind of distraction: intentionally shifting your focus while still being present in your body.

When you have worked your way through the whole body, let yourself feel the breath enter the body through your nose, mouth, and throat. Imagine the sensation of breathing through your whole body, as if the body were gently expanding as you inhale and contracting as you exhale. Feel, or imagine, the flow of energy through your whole body.

Restorative Yoga

Restorative yoga turns on the healing relaxation response by combining gentle yoga poses with conscious breathing. Below you will learn four restorative yoga poses that may be practiced on their own or in a sequence.

There are several factors that make restorative yoga so relaxing. First, each pose is meant to be held for longer than a few breaths. You can stay in a restorative pose for 10 minutes or even longer. The stillness allows the body to drop even the deepest layers of tension. Second, restorative poses use props to support your body. Props can include the wall, a chair, a couch, pillows, blankets, towels, or bolsters designed especially for restorative yoga practice. The right support in a pose will make it feel effortless, so your body can fully let go.

You shouldn’t feel strong sensations of stretch or strength the way you might in a more active yoga pose. Stretching and strengthening, although healthy, are both forms of tension in the body. They are a kind of good stress on the body, asking the body to adapt to the challenges of a pose. But restorative yoga is all about letting go of tension and stress.

Although these poses may look as though you are doing nothing, this is far from the truth. Restorative yoga rests the body but engages the mind. The breathing elements of each pose make restorative yoga an active process of focusing the mind on healing thoughts, sensations, and emotions.

The order of poses presented here is just one possible sequence. As you explore the poses, you may find that your body prefers a different sequence or that you would rather stay longer in one pose than practice several poses for shorter periods. You can also integrate restorative poses into an active yoga session.

Nesting Pose

Nesting pose creates a sense of security and nurturing. It may also be a position you are comfortable sleeping in, making it an excellent posture to practice if you have insomnia or other difficulty sleeping.

Lie on your side, legs bent and drawn in toward your belly. Rest your head on a pillow, and place a pillow or a bolster between your knees. Rest your arms in whatever position feels most comfortable. If available, another bolster or pillow may be placed behind your back for an extra sense of support.

Rest in the natural rhythm of your breath, observing each inhalation and exhalation as it moves through the body. Take comfort in the simplicity and effortlessness of this action.

Supported Bound Angle Pose

This pose relaxes tension in the belly, chest, and shoulders that otherwise can restrict the breath. Lean a bolster on a block or other support (such as telephone books). Sit in front of the bolster with your legs in a diamond shape. Place a pillow or a rolled blanket under each outer thigh and knee, making sure that the legs are fully supported without a deep stretch or strain in the knees, legs, or hips. Lean back onto the bolster so that you are supported from the lower back to the back of the head. Rest your arms wherever is most comfortable.

Now notice the whole front of your body relax and gently open as you inhale. Follow this sensation and feel the ease in the front of the body as you breathe.

Supported Backbend Pose

Supported backbend is a heart-opening pose that reinforces your desire to embrace life and not let challenges—including pain—separate you from life. This pose also works magic to release chronic tension in the back and shoulders, undoing postural habits that come from spending too much time at a desk, at a computer, or driving.

Sitting, place a bolster or a stack of pillows or blankets under slightly bent knees. Place one folded pillow or rolled blanket or towel behind you; when you lie back, it should support the upper rib cage, not the lower back. If you need extra support underneath the lower rib cage and lower back, roll a small towel to support the natural curve of the spine. Place a rolled towel or a small blanket to support your head and neck at whatever height is most comfortable.

This pose improves the flow of the breath in the upper chest, rib cage, and belly. Allow yourself to feel this movement as you inhale and exhale. Imagine breathing in and out through your heart center. Visualize the movement of breath from your heart to your lungs as you inhale, and from the lungs back out through the heart center as you exhale.

Supported Forward Bend

This pose relaxes the hips and back, unraveling the stress of daily activities on the spine. Hugging a bolster and resting your head on its support provides a natural sense of security and comfort.

Sit cross-legged on the floor. Lean forward onto the support of a sofa, a chair, or a stack of pillows, blankets, or cushions. If you have a bolster, place one end in your lap and the other end on the sofa, the chair, or the stack of support. Rest your head on whatever support is available. If you are using the bolster, you can hug it in any way that feels comfortable, turning your head to the side. Be sure that whatever support you are using is high enough and sturdy enough to support you, without creating strain in the back or hips. If you feel a strong stretch that is uncomfortable to hold, you need more support.

In this pose, the belly, chest, and back all expand and contract with each breath. Feel the movement of the whole torso as you inhale and exhale. Feel your belly and chest gently press into the support of the bolster or pillows as you inhale. Let the sensation of your breath deepen the sensation of being hugged.

This holiday season, help me celebrate one of my favorite non-profit organizations, ScholarMatch.

If you donate to Scholar Match through my fundraising page, your donation will be matched in full.

ScholarMatch is an organization that allows donors to support college students who need assistance paying their college tuition. The students are from the San Francisco Bay Area, and many are first-generation college students. They have been nominated by the ScholarMatch‘s community partners, such as teachers, college counselors, and college access organizations and selected by a committee to become scholars. Scholars don’t just get tuition funding. They are supported in many ways, to make sure they succeed. ScholarMatch looks out for their needs — even simple things finding a sponsor to provide winter coats to California students headed to the Midwest or East Coast. ScholarMatch also provides college readiness services to students in the 7th grade and up

ScholarMatch is a wonderful opportunity to make a difference in the lives of individuals and pay back the benefits we’ve received from our education. As a donor, you can specify the kind of student you want to support (e.g. intended major, interests and extracurricular activities,  college attending) or let ScholarMatch choose a specific student for you. You will be sent periodic updates about that student’s progress in school throughout that academic year. (The letters I get from my matches are funny and inspiring — they bring me right back to what it was like to be a college student, having my world views challenged and horizons broadened.)It’s fun to browse the students’ profiles. (My first donation was to support a young woman who intended to study psychology and journalism — just like I did as an undergraduate.)

I received a full tuition scholarship for four years, the only way I would have been able to afford a private university. It’s a privilege to support young students and remember with gratitude those who paid my way.

Check out this video of a ScholarMatch scholar talking with The Office’s John Krasinski (he donates!) about how the organization has helped her and her family. (The comedy starts at 3:04 — what else do you expect from Krasinski?)

The following resources are intended to help those new to yoga research find and explore existing research; get small, low-cost projects off the ground; and find opportunities to communicate research to key audiences, including potential funders, professional organizations, and the general public. Prepared by Kelly McGonigal for the Yoga Service Council/2012 Yoga Service Conference.

If you have ideas for other resources that should be added to this list, please include the information in a comment on this page!

Slides from talk

McGonigalYSCResearchSLIDESHOW (best for viewing on computer)

McGonigalYSCResearchHandoutSlides (6-slides-per-page handout, easier to print)

General Resources

Finding Research

Create an account with PubMed, then conduct a search for a key term (e.g. “yoga” or “mindfulness meditation”). Click “save search,” which will then allow you to set preferences for receiving email updates for new research. Create as many alerts as you want this way, or use Advanced Search.

Search for research in progress at to find out who is running funded studies now.

Places to Publish/Present or Learn About Research

The International Association of Yoga Therapists publishes both a magazine and peer-reviewed research journal, and welcomes submissions of articles and reports that describe interventions and early-stage research (e.g. feasibility and pilot studies). IAYT also hosts the annual Symposium on Yoga Research (June 11-13 2013 in Boston).

Research Raven is a database of conferences and calls for presentations/papers by a wide range of groups related to trauma, at-risk populations, mental health, social work, medicine, psychotherapy, etc. Find conferences to attend and submit your work to.

The Yoga Service Council plans to put out a call for both presentations at the 2013 conference at the Omega Institute and articles for their forthcoming online journal.

Conducting Research

Informed Consent

The following websites provide examples of informed consent forms you can adapt to your own research project.

Self-Report Measures/Surveys

The following websites provide the items and scoring instructions for validated measures of outcomes relevant to yoga and mindfulness/meditation research. Before administering scales, especially to at-risk populations or children, be sure you understand the ethics and have obtained informed consent and relevant permissions.

Yoga Program Evaluation Surveys developed by Yoga Activist (survey participants, volunteers, and partners’ satisfaction and feedback; use as is or use as sample)

Stress-Related Scales from Sheldon Cohen (perceived stress, perceived social support, stressful life events, childhood stress, physical health symptoms, some translated into other languages)

Mindfulness Scales from the Mindfulness Research Guide (also includes lists of published research & other resources)

Pain-Related Scales from the UAB School of Medicine (pain, disability, physical function, etc.)

Trauma-Related Scales for Adults and for Children from the US Dept of Veterans Affairs

Compassion-Related Measures from the Compassionate Mind Foundation (compassion, self-criticism, social comparison, etc.); Compassion for Others and Self-Compassion Scales from Kristen Neff

Social Anxiety-Related Scales from Mark Leary (including anxiety related to appearance)

Child Mental Health Scales from The Reach Institute (anxiety, depression, ADHD, aggression)

Hospice, Caregiving, and Aging-Related Scales (depression, pain, fatigue, function, caregiver burden, etc.)

These are just some examples of measures to get you started.

If you are looking for validated scales on other topics, there are two main strategies. One is to do a Google search for “________ scale” and see what comes up. The second is to obtain published studies that have looked at the outcome you are interested in and see what measures they use.

Remember you can also ask the groups/administrators you are working with what outcomes they are already measuring that you might get access to.

Tools for Research Design and Analysis

Absolutely fantastic collection of articles, advice, and online tutorials about how to conduct research/surveys to evaluate programs/interventions, from planning your evaluation to reporting your results, and even what it takes to claim a program is “evidence-based.” Compiled by Wilder Research, in partnership with the Minnesota Department of Human Services.

How We Design Feasibility Studies. This article provides good advice and justification for conducting the simplest type of study on a new intervention/program.

Random Assignment Generator (for a randomized controlled trial).

Online Statistics Tool. This website contains calculators to conduct a wide range of analyses (e.g. descriptive statistics, t-tests, correlations) without understanding the math behind them! However, you still need to understand what analyses to run and how to enter the data. Many universities’ statistics departments offer free stats consulting to non-profit organizations; check your local university.