by Kambria Kennedy-Dominguez

​We just wrapped up our very first art therapy series at Flourish, and it was a great success. We found the physical and emotional expression of painting images, shapes, and colors on canvas to be a soothing exercise. Painting, drawing, and creating are ways to do something with emotional experience. Counseling is often about defining what you feel. And often clients ponder this question out loud, "so I know what I feel, what do I do with it?" Most often I answer, "accept". You don't need to do anything with the feelings, except acknowledge and accept.

What you do is better based on what you value, not on what you feel. 

Still, sometimes we need some kind of release, expression, resolution, and way to cope with the myriad of emotions that most of us feel every day. Anger, sadness, worry, regret, indifference, fear...to name only a few....are difficult to sit with. So if we can take a walk or a run, go a yoga class, snuggle with our partner or our pet, read a good book, take a warm bath, or paint a picture, these activities may help us endure and sit with the feelings. 

Because of the success of the first art therapy 5 week series, we are offering it again, and hope to make it a staple of our services at Flourish. During the series, participants will learn how to use art as a relaxation exercise, how to incorporate meditation into the creative process, and how to build self-compassion. Part of our mission is to help others find what healing practices work for them, whatever that happens to be! Check out all of our groups here.

I regularly encourage clients to develop a "self-care" plan as a way to manage the challenges and difficulties that life regularly presents to each of us. Self-care can be anything that provides a sense of ease and comfort, and varies depending on each individual. Sometimes we identify things like exercise, meditation, joining social groups, reading, watching movies, aromatherapy, hiking.

​Because my personal and professional experience tells me that yoga is an effective tool for self-care, I often encourage clients to try it and sometimes I teach them yoga during our sessions. Likewise, I often hear clients say that they find a sense of peace in the outdoors, I encourage them to go to natural places as regularly as possible, as much as our urban environment here in Dallas allows. 

​This past week, I came across two articles about these very things. 

This article in Medical News Today outlines three new research findings that support the use of yoga as a supplement to treatment for depression. They each followed patients who scored high on depressive symptoms prior to starting a yoga program (Bikram in one study and Hatha in the other two studies) and found significant symptom reduction at the end of the program. In one of the studies, symptom reduction lasted for at least four months after the end of the program.

​These study results are no surprise for those who have personal experience with the mental benefits of a regular yoga practice. We are learning more and more that empirical research findings support it as well.

The Japanese call it taking a "nature bath", referring to the practice of fully immersing oneself in the sights, sounds, smells and textures of natural places. What a wonderful way to describe the common feeling of peace that many of us experience when hiking, camping, swimming, and discovering beauty in nature.

​This article in Time magazine outlines how connecting to "green space" can improve mood and wellbeing for many of us. It highlights that the quality of greenspace is more important than quantity. For instance, cleanliness, accessibility, and the ease of connecting to others are more important factors than the size of the greenspace. So for those of us that live in urban environments, local parks, walking trails, and tree lined neighborhoods are resources to our mental health.

So... if you're finding your mental health challenged today, if you're feeling down or anxious or stressed or angry... break out that yoga mat and do some downward facing dogs and sun salutations. Take a walk to your local park and circle it a few times. Take some deep breaths of the soft breeze. Watch the birds, and listen to them. Feel your heart beating as you move and know that you are giving yourself a wonderful gift!

Bright and early a few days ago, I had the fantastic opportunity to teach a workshop about yoga to counselors from across our state at the Texas Counseling Association annual conference in Dallas. It was a great time! I shared a presentation, then led the group through a yoga practice so they could experience it for themselves. We ended our morning circling up for discussion.

In the session, we talked about the ancient roots and philosophy of yoga, the different types of yoga classes found in many communities today, and how specific approaches have been developed to use yoga for trauma recovery and mental health. You can learn more about all of these ideas in the complete Powerpoint presentation.

Here are a few key slides that may be very helpful when considering starting a yoga practice. First, a description of some of the terms used to describe types of classes.​

Then some findings of researchers. There's a lot of data that points to the benefits of yoga.

But yoga is not to be used without caution. Here's my advice for choosing the right yoga class:

1. ​Know what type of class you are best suited for, and seek that out. Know the class descriptions above and search for those in your community. If you can't find a class, try yogaglo.com for online streaming.
2. If you are a trauma survivor, be especially selective about your yoga class. Choose a class that is "trauma-sensitive" if you are just beginning to process your traumatic experiences. Know that some teachers provide "physical assists" or adjustments that involve them touching you. If you do not want to be touched, communicate that to your teacher prior to class.
3. Hot yoga (100 degrees +) can be counter-productive if you are overwhelmed by heat or have medical conditions. You should have an established practice of good hydration before you attend hot yoga classes. As an alternative, many vinyasa classes offer a warm room (85 degrees +).
4. Look for teachers that offer modifications of difficult poses and encourage acceptance of your body as it is today.
   

What to know before you go:

1. ​Yoga is usually practiced barefoot.
2. It's best to practice on a mostly empty stomach. You will be more comfortable with heat, vigorous sequencing, or twisting if you haven't just eaten a meal.
3. Some studios will have mats to borrow, or you can bring your own. For sweaty classes, a towel placed over your mat keeps you from slipping. You can use a towel from home, or there are special ones made to go on top of yoga mats.
4. Most studios have a place for your belongings outside of the yoga room. They are usually secured by the teacher locking the outside door before class begins.
5. Studios have differing policies about talking inside the yoga room. Some observe silence and others welcome chatting before class.​

​Here's to finding the best yoga experience to reap the benefits of this ancient practice!

Let's give anxiety some consideration today. You've likely experienced it over and over. You may have heard about certain types of anxiety like phobias and panic attacks, or diagnoses like Generalized Anxiety Disorder or Panic Disorder. There are lots of levels and experiences of anxiety, and sometimes even different definitions of anxiety from person to person. Anxiety is essentially worrying, feeling afraid, overthinking, and sometime panicking.

The common thread is that anxiety exists and is real for all of us, because it stems from an innate human emotion...Fear.

The DSM 5 (the manual we look at to classify symptoms and diagnose) draws a distinction between fear and anxiety like this:

 The autonomic nervous system, referenced above, pays a particularly important role in anxiety, and has two distinct parts. It revs us up (courtesy of the sympathetic system), then stabilizes us (thanks to the parasympathetic system), when there is a perceived threat in our environment. Imagine a bear chasing you...your heart rate increases, breathing rate increases, blood flows to limbs, pupils dilate, digestion slows, muscles tense. Sometimes tunnel vision and hearing loss occur, as well as relaxation of the bladder and colon. This very physical response to danger has a purpose. Muscles tense to ready themselves for action, blood flows to limbs to enable us to move quickly away from danger. Then, the nervous system slows and reverses this response once danger has passed, initiating relaxation. Our breathing and heart rate slow down, our muscles relax, our body comes back to homeostasis.

Both humans and animals alike experience this stress response cycle. Animals and humans differ, however, in the ability to reason, classify, predict, and analyze. We humans can thank our bigger brains and cerebral cortex for that. An animal might encounter that same bear, have a fight or flight response, be able to escape from danger, then quickly stabilize and move on. The cerebral nature of our human brains don't allow us to move on in the same way. We would likely have persistent fear or worry after an episode like that. We may feel afraid of bears, the place it happened, what we did right before it happened, that we may not protect ourselves from it happening again, or that it will happen to someone else. You can see how the human mind's ability to analyze gets us in a pickle here. 

We can get stuck with our fear in the "on" position, even in response to more innocuous stimuli like work or school demands, relationships, financial issues, health concerns, parenting, and other aspects of daily life. Our reasoning and predicting minds create future scenarios to worry about, and sometimes with good reason. If you lost a job in the past because you were late, you may be well served to worry about being late in the future. So in this way, anxiety is a helpful and useful tool that reminds us to pay attention to something specific like not being late to work. However, as we know, anxiety can become problematic when it immobilizes us in everyday life, keeps us from making decisions, disengages us in things we'd like to do, or impedes relationships.

Here's how I describe the anxiety continuum. Remember, fear and anxiety are related to paying attention to our environments and paying attention is a good thing.

​It may be helpful to outline the different types of anxiety disorders listed in the DSM 5.

• ​Generalized Anxiety Disorder. This is a general worry that underlies experience and gets in the way of daily functioning. It may be hard to pinpoint exactly what you are worried about, or it may seem like you're worried about everything. You may feel tense quite a lot and find your mind racing, jumping to conclusions, and thinking of the worst case scenarios. 
  • ​Fear is is generalized to everything.
• Social Anxiety Disorder. This is anxiety specific to social situations. You may worry about what others are thinking of you, that you'll embarrass yourself, that others will reject you, and avoid social situations in which you are likely to have to interact. 
  • ​Fear is about social interaction.
• Specific phobia. This is anxiety specific to a particular object, activity, or situation. Common phobias are of heights, flying, insects, blood, animals. You may feel intense immediate anxiety when seeing or thinking about your phobia, and actively avoid it.
  • Fear is related to something very specific.
• Panic Disorder. This occurs when panic attacks perpetuate themselves through anticipation of another attack. Panic attacks can occur with other anxiety disorders, depression, post traumatic stress disorder, and many other mental health conditions. Panic attacks are episodes of terror that occur for no apparent reason, in which one may feel shaky, sweaty, racing or irregular heartbeat, difficulty breathing, the sensation of choking, chills or hot flushes, and/or nausea. (Remember the fear response to the bear described above...a panic attack is almost just like that, minus the actual danger). Most panic attacks involve a fear of passing out, fear of going crazy, and/or fear of dying. Merely having a panic attack doesn't warrant a Panic Disorder diagnosis, however.  Panic Disorder emerges when the anticipation of more attacks and the avoidance of places or situations that may cause another attack interferes with everyday life. 
  • Fear is of having another panic attack. 
• Agoraphobia. This occurs when there is a persistent fear of public places or situations, including using public transportation, being in either open or enclosed spaces, standing in line or being in a crowd, or being outside of home alone.  Usually thoughts accompanying this fear are "I can't get out of here" or "no one will help me."
  • Fear of a particular situation, usually in public. 
• Substance or Medication Induced Anxiety Disorder. This occurs when anxiety is attributable to the effects of a specific drug, legal or illegal. 
  • Fear occurs as a side effect of a drug.

The body's natural ability to balance itself in response to stress is powerful. Just knowing that the nervous system is able to balance chronic anxiety is the first step. Then, learning and practicing tools that enhance our body's natural ability to balance, will help us move beyond fear and anxiety that might be crippling us. 

In counseling, there are many approaches to working with anxiety. I've found three approaches most helpful:

1. awareness of the breath
2. mindful meditation
3. awareness of habitual, unrealistic or unhelpful thought patterns.

For more information on how we incorporate these approaches into therapy, please contact us! We are happy to help you learn more about how counseling can work to manage fear and anxiety.

Yoga is an ancient practice that originated far away. It has made its way around the globe in a wave of both physical healing and spiritual awakening, while simultaneously becoming a multi-billion dollar industry in the US.  Some of the yoga teaching in the west has been simplified to a mostly physical practice by this commercialization and popularization, however yoga's philosophical foundation as a way to live a good life endures as well. These days, yoga is practiced not just in affluent studios, but also in schools, prisons, hospitals, and apparently on aircraft carriers (love this picture.)

Thanks to modern science and research, we also know much more about how yoga impacts physical and mental health than ever before. Let's explore some things we know about how yoga helps, and then describe how this knowledge can be incorporated into a traditional talk therapy session. 

From Ross, A., & Thomas, S. (2010). The health benefits of yoga and exercise: A review of comparison studies. Journal of Alternative & Complementary Medicine, 16(1), 3-12. doi:10.1089/acm.2009.0044 

Physical Effects

• Powers down the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) stress response which leads to disease
• Decreases cortisol, blood sugar levels, heart rate, blood pressure, inflammation
• Increases immunoglobulin A and immune response
• Decreases sleep disturbance
• Increases strength and flexibility
• Depending on type of yoga, may or may not improve physical fitness

Emotional Effects

• Decreases symptoms associated with anxiety, depression, schizophrenia
• Increases sense of well-being
• Decreases fatigue and experience of physical pain

Psychosocial Effects

• Increases social and occupational functioning
• Increases quality of life

Here's a description of how I combine yoga and counseling. Other therapists/yoga teachers may do it differently, and chances are, my own style will keep evolving the more I learn from my clients what works best.

Individual Sessions

Individual counseling sessions can include yoga, if and only if, the client thinks it will be helpful. Yoga in session can range from simple seated stretches, to intentional work with the breath, to standing and seated poses on the floor. In the intake and beginning phases of counseling, personal goals are identified, and as we explore these goals through talk therapy, I will be thinking about how certain yoga postures or sequences may be helpful. We will talk about using yoga in this way, then plan a time to incorporate it, or go ahead and use it at that moment. The way that yoga is used in counseling is always up to the client, and my suggestions as counselor are just that... suggestions.

For instance, a client who is struggling with self-image may be asked to try a yoga sequence that feels familiar and accessible, and notice their self-talk during the movement. How compassionate are their thoughts toward self? Are thoughts about self-image coming up? Are they critical? Then the client may be cued to work through a more challenging sequence and notice how the self-talk changes. After a few minutes of yoga (usually 15-30 minutes during an hour counseling session), I will sit with the client either on our yoga mats in an adjacent studio or back in the counseling office to discuss their experience, share what internal self-talk arose, describe how their physical or emotional state changed in response to the movement, and so on. 

Another example is a client who is experiencing social anxiety. The client may have a goal of learning new ways to manage anxiety so that it doesn't stop them from going out with friends. The client may notice a tightness in the chest or throat when thinking about going out with friends. So to address it, I might ask a client to imagine that they are about to go out with friends, notice in detail the sense of constriction or tightness they are experiencing in the chest and throat, then use some guided breathwork and throat opening stretches, while seated in the counseling room to work with the sensations. 

Group Sessions

We can also work with yoga in group sessions. My ideal way to combine yoga and counseling in a group is to use a mixture of both physical yoga postures and discussion and/or personal reflection. My experience of vinyasa flow sequences is that often emotional "stuff" will come up as we move the body. As we work into the creaky, rarely accessed parts of our joints and tissues, an emotion may arise. Then from that emotion, a chain of thoughts may arise: memories, anticipations, judgments, regrets, etc. Taking time after a yoga practice to reflect on these emotions and chain of thoughts can help to move through them, put them away, or take more time attending to them. This can be accomplished through internal self-reflection, group discussion, or both. 

​In this upcoming group yoga workshop, we will practice a one hour vinyasa flow class, then we'll take a short break and come back together to process our experiences. I will provide some paper and pencils to help participants process their yoga experience through writing or drawing. I will provide some prompting questions to help participants explore their wellness in several core areas shown below. I like this "Indivisible Self" model because it prompts us to think globally about what impacts wellness. (Myers, J. E., & Sweeney, T. J. (2005). The indivisible self: An evidence-based model of welIness (reprint). Journal of Individual Psychology, 61(3), 269-279. )

After we've processed internally, I'll offer a chance for participants to share and discuss their self-reflections. This part is absolutely optional, as some might prefer to keep their reflections private. A very important component of using yoga with group counseling is that all members agree to keep one another's shared thoughts and feelings confidential.  Maintaining confidentiality is a key guideline and expectation for the participants in this type of group.

In summary, we know that a regular yoga practice is helpful for many different conditions, ranging from chronic illnesses, to mental illnesses, to adjustment-related problems, to general stress and anxiety. We also know that talk therapy is helpful for these conditions. Combining yoga and counseling involves, first and foremost, respect for the client's autonomy and ability to choose the direction of therapy, along with gentle reminders toward self-compassion, self-acceptance, and an attitude of self-exploration in both body and mind. 

-Kambria 

This week we move on to downward facing dog, Adho Mukha Svanasana (pronounced Aw-do Mew-hah Shf-vah-nah-sah- nah... wow that's tricky). 

It's the keystone pose of so many sequences in a vinyasa-based practice, and it's great to practice anytime you need a little time-out and energy boost. This pose elongates and releases tension in the entire back of the body, including the calves, ankles, hamstrings, lower back, upper back, neck and top of the head. It is an accessible way to turn yourself upside down, too. Placing the head below the heart keeps the circulatory system toned and running in top form. When the blood flows vigorously, the mind clears, resilience is nurtured, and heavy emotions may lighten. In addition to the back body stretching, downward facing dog allows the mind to behold the world from a new perspective and we see ourselves in a new way.

See the two pictures below for an example of positioning in this pose. 

Physical Cues: There are lots of ways to get into downward facing dog, but here's my favorite. Come into Uttansana, standing forward fold. Check out the Week 2 blog for specifics on how to get into it. Bend the knees as deep as you need to place the hands flat on the ground and step both feet back until you are in the shape of an upside down V, usually about 3-4 feet depending on your height. The hands press down firmly into the mat, spreading out through all ten fingers. The head is in line with the biceps, and the neck is relaxed. The shoulder blades press flat against the back and together slightly, to engage the upper arms. The hips lift high toward the sky while the heels search toward the floor. Your heels most likely will not reach the floor yet, and it's ok! The calves and Achilles tendons will open more over time. Take at least 4-5 long inhales and exhales, and feel the back body stretch and open.  To come out, I love to set the knees down on the floor, then set the hips to the heels, bringing the upper body to rest on the thighs and forehead toward the ground (Child's Pose). But you can also walk the feet back up to Uttansana, or just come to seated. Lots of options!

Mental Benefits: Have you ever felt stuck in a rut, moving through life in a way that is familiar but unexciting? Maybe you've also had the experience of shaking things up, trying something new, and challenging yourself in a way that brought back energy and excitement in your life? This energy may come from a new job, a new relationship, a new home, a new project, a new daily routine, a new hobby, or anything else that is "new" to you.  I liken downward facing dog to that sense of "newness" that brings fresh energy into our lives. This pose gets the circulation flowing, so that fresh energy is carried throughout the body, especially to the brain. Turning ourselves upside down, we literally see the world differently and feel differently about it.  We may be able to shift a mood of indifference to interest, or from anger to tolerance. Also, this pose wakes up our physical foundation, the back body. Think about how the back body is intricately engaged in all movements you make throughout the day, whether it's walking, running, resting, or sitting. Your back constantly holds you up and allows you to carry out the tasks required in your daily life. Taking time to invert, stretch, lengthen, and nurture the back also encourages this fresh new mental energy to emerge. 

So there we go, downward facing dog. It's a beautiful shape to take!

Next week, let's move on to down dog's complimentary and opposite pose, upward facing dog, or Urdvha Mukha Svanasana.  

Happy Wednesday, all! Here's your pose for the week, Utkatasana (Ewt-kah-tah-sah-nah), or chair pose. It's a staple of most yoga practices. As the name implies, the action is sitting down into an imaginary chair. Chairs, of course, are a symbol of comfort, rest, relaxation, and ease. And in this pose, we learn to balance ease with effort. 

You may get so overwhelmed you shut down and say nothing. You may say "I don't know." You may leave the room in a panic. You may get angry at them for asking and go on a rant about something else. You may try to answer without making sense. You may feel awful about yourself. You may tell yourself you failed.

Or...before saying or doing anything else, you may remind yourself to breathe. You might take a deep breath and repeat the question to be sure you understand. You might breathe some more, and find that your shoulders relax. You might notice that your breath nurtures you, and the panic might subside.  You might suggest further action to take. You might remind yourself that you are worthy, you are prepared, and that it's ok not to know all the answers. You might engage collaboratively with those around you to work toward a common goal.

Utkatasana makes me think of business meetings and how terribly uncomfortable we can sometimes be in chairs! This pose allows us to practice becoming comfortable in an uncomfortable situation. Becoming and transforming are the important actions. Breathing with awareness is what transforms the situation, whether your situation is a tense meeting or is simply standing in Utkatasana.

Physical Cues:
Stand tall in mountain pose. Find strength in the belly by tucking the tail bone under. Slowly bend the knees, moving the tail bone down toward the floor. Keep tucking the tailbone, and engaging the belly. If you'd like, raise the arms above the head with the palms facing one another, while keeping the shoulders relaxed down away from the ears. If your shoulders are tense and uncomfortable, keep the hands at your chest, palms together. Sit as low as you can, while keeping the chest upright, with crown of the head and spine reaching toward the ceiling, rather than forward. Stay for as many breaths as you can breathe calmly. Then straighten the legs for a few breaths, maybe take a standing forward bend (last week's pose, Uttansana), and repeat if desired.

Mental benefits:
As I described above, Utkatasana offers us a reflection of how we handle static, tense, anxiety- provoking situations. When we are anxious but confined, like in that business meeting (or in traffic, in class, etc), panic can set in. When you practice Utkatasana, challenge yourself to stay in the pose to the point of discomfort just momentarily. Then, take note of your emotional reaction to your discomfort. Using the breath to manage that emotional reaction prepares you for life outside your yoga practice, off the mat. Your next business meeting or traffic jam is fertile ground to apply your breath and emotional awareness.

Namaste! Next week, let's talk about arguably the most widely known yoga pose, downward facing dog. In Sanskrit, it's Adho Mukha Svanasana (say that three times fast! :) 

I've been hearing a lot about stress and anxiety from clients lately. So I decided to record a guided meditation today with a little intro on the basics of meditation. Enjoy! Please let me know if it's helpful/not helpful, etc. I'd love to hear feedback.