a) yoga as a complement to western medical knowledge has benefits for burn out
b) People may not know they have burn out as burn out just becomes part of your life
c) Secondary traumatization occurs when you work with trauma victims. Yoga helps you maintain your compassion but decrease your empathy so that you do not become traumatized.
This is episode 114 of Changing the Face of Yoga and I have a very interesting guest today. This is Dr Shailla Vaidya. She is a physician, a yoga therapist, and a compassionate change agent, practicing mind body medicine in Toronto, Ontario in Canada. She completed her MD at Dalhousie medical school, a residency in family and emergency medicine at the University of Ottawa and a master's of public health in health management and policy at Harvard. She has had her own experience with physician burnout and she created the yoga of burnout, recovery stress resilience program, which combines yoga practice and philosophy with the science of human functions, self-compassion and stress resilience.
Her current medical practice is focused on helping her fellow professionals and others with stress-related illnesses to regain their health and well-being. She's also certificant of the International Association of Yoga Therapists and teaches medically informed therapeutic yoga to yoga therapists internationally. Welcome. Shailla . I think this is an important topic. Is there anything else you'd like to add to that introduction?
02:16 No. I did change the name of the program to the yoga of stress resilience burnout recovery program only because burnout has so many things to prove that it's actually burnout you're fixing as opposed to stress. So it's actually the yoga stress resilience burn-out recovery program.
02:36 What exactly is burnout and let's as opposed to being stressed?
02:48 Burnout was first described by Dr Christina Matlock at the University of California Berkeley. And she described it as having three components. I think we all use burnout in a very colloquial way. But the three components are emotional exhaustion. So many of us had the experience of not being able to mentally handle yet another thing that we may not always recognize or acknowledge that state. So just being emotionally tired is one part of it.
The other part of it involves depersonalization and that's a fancy word to say that we go numb. We're, we're not really human anymore. We're not feeling as we used to feel. And that usually occurs when we're overwhelmed with a lot of the feelings that we face, a lot of the people that we come in contact with who are suffering with pain and grief and so many other things. As we get exposed to that over time, we may lose our ability to feel empathy for people who had that because we've been exposed to it so much.
And then the third thing is reduced personal accomplishment. And this is , the feeling that we're no longer active at our jobs. We start to view ourselves negatively in regards to our work and with the people we're working with. So we feel negative and we don't feel like we're accomplishing anything in our day. The World Health Organization also just recognize burnout as an actual thing. I don't know if it's a medical diagnosis, but they did give it an ICD 10 code. So a diagnosis and such, but mostly related to one's work. So that burnout is related to the jobs that we do. . And there are many, especially women, caregivers and other people who are caring for people in our community.
04:45 It's actually a very specific thing. I agree with you, that term gets bandied about a lot. But there are some ways that a person could say I'm having those kinds of issues. And if they do feel that maybe they are, what should they do?
05:07 Well, that's the big thing. We all say you need to take a break. You need self-care. That's a hard thing because we make that the job of the person who is experiencing the burnout and not everyone is really able to understand that or understand what they need to do to get out of this cycle of burnout. And essentially it happens when we've had chronic stress.
The big thing would they really have to do is start to release stress. And as yoga therapists and yoga teachers, we know that stress builds up in our body. And completing that stress response and then releasing stress from the body is a real big component in helping recover from burnout. Because there's some neurologic things that are happening when we hold stress in our body, we're sending signals up through our brainstem through our limbic system particular around the Thalamus. And of course this is far more complicated than the breakdown I'm giving right now. But our brain stem or thalamus and our limbic system can actually shut down those signals. So we don't actually know we're experiencing the beginnings of burnout until we're exhausted and we can't do anything. So yes, take a break but also do the things that help reduce or release stress from our body as we give ourselves that care. And there's so many components within that but yoga happens to be a fantastic technique to help people with burnout.
06:41 Let's explore that a bit more. Why don't you explain your program? I think that might be the easiest way to do it because it will give us specific information.
06:55 I get referred a lot of people with stress related illnesses from their family doctors and so they've had chronic stress their whole life. And actually when I do their histories and do their assessments, I also do adverse childhood experience scores. So the majority of the people I see also had stressing as a child. And so their nervous systems developed under stress and that may make them more stress responsive as they leave that environment and go on to the rest of the world. And what's so interesting is a lot of people who had stress as kids who survived that tend to be professions where they want to help other people. I always joke with them that no, you want to help other people the way you weren't helped as a kid or give back in that way.
It's very interesting. I can't generalize that to the whole population of burnout. I'm really only looking at the people that I see come through my door and so adverse childhood experiences is huge. The way I use yoga is yoga really helps us re-integrate the body. So we know that yoga is more than just the asanas that we practice. The Yoga Sutra says it's a process of slowing down, change the perceptions of our mind through this process. How do people come in who are just exhausted, their bodies can't take anymore. And then using a restorative approach and a bottom up approach to help release tension through the body and then work with breathing and meditation techniques so that they can, you know, exhale and start focusing their mind on other things.
It's very effective when we bring them to those places of concentration, meditation and maybe, hopefully bliss. But learning how, first of all to have compassion for the self and take care of the self because so many of us put others before we put ourselves. So my program really helps people come back to that self-care component, taken care of themselves. Actually stopping and moving and releasing the stress and breathing and then learning how to have compassion for the self. Much like they have compassion for the other people in their lives.
09:21 I noticed on your website that you have several supportive resources. I think you have a drop in where people can just come and meditate once a week or so. Is that correct?
09:37 I usually run that in the summertime for people to help them keep up with their practice. During the spring, winter and fall I'm usually busy with working at the medical aspects of Yoga. But I had that drop in because a lot of people after they'd gone through my program can't find a yoga class that is like what I teach. There's tons of people out there teaching yoga. To find a good restorative class, that's just what they need, but might not always be available to people or they might not feel comfortable going to their local yoga studio for whatever reason.
10:22 That happens a lot, unfortunately. When you've got someone who you have diagnosed as having burnout, are they open to coming to your program or does it take them a little while to really accept that that's what they have?
10:43 That's a great question. I work with a lot of family doctors who have assessed their patients over time and some of my patients have had you know, back pain or migraines or other stress related illnesses and they've seen specialists and a lot of other people who can't give them the quick fix or the understanding. So when they come and see me they're usually recommended by somebody that they trust - their family doctor.
Many of them have never tried yoga and so they are hesitant at first, but when they come and they meet me and they see the they see my set up, my room, my yoga room, and I explained to them the mind-body connection and why they may be feeling, what they're feeling. I get buy-in that way. I'll talk about anxiety and depression and sleep. I screen them for those things. I screen them for their disability score and as were going through the screens, I bring them to that. They start to realize, well, actually this is a problem for me and that is a problem for me and I'm not surprised that this is four on the clinical scale that I use. And then I actually tell them how yoga can work for that. When we release stress from our body, how that affects our physiology. So I'll teach them about their Vagus nerve, teach them about their heart rate, teach them about these other things and they get buy in because at that point they just want to see somebody who gets it.
When I can explain it to them that way, I think it gives them a sense of agency that they understand what's happening. And then when they actually come to the class, which I think is the biggest thing. I really build that trust with them or I hope I do when they come to the class and they realize my God, I'm not alone. Like there's other people who are going through the same thing who have maybe have had similar jobs or jobs I can relate to or are caregivers to elderly parents or have children who are also autistic. Once they see that group and they start the program and they feel like they have the experience of what it feels in their body to practice, that's when I really get the buy in.
13:08 It's really a combination of information and building trust and build a relationship with them. Is that a fair thing to say?
13:20 Yeah, I would say.
13:22 We have a general idea of what you do, but you say you also teach medically informed therapeutic yoga to yoga therapist. Is this in the burnout area or just more generally than that?
13:40 I'm a part of the Svastha Yoga therapy training program. When I was going through my training there would be medical things that I would bring up and offer advice around that type of thing. So we're building our yoga therapy training Svastha training. I'm not certain if you're aware that's led by Doctor Ganesh Mohan and his family.
14:06 I've heard of the Mohans
14:07 So it’s through the Mohans.
14:10 Your training is basically through this particular yoga training opportunity that's available.
14:19 I've done talks for the Montreal International Symposium of Yoga Therapy and I've also done a few things, it's a little bit more informal, but with licensed health care providers. You call them allied health here in Canada who have yoga teacher training background and they want to have some therapeutic yoga skills with their patient population. So that's the type of stuff I also do as continuing education. In that format, I often just call it mindfulness.
14:57 When you're helping professionals, like medical professionals, like yourself or others, do you find them open to yoga or did they take a little convincing?
15:13 You know by the time they get through my door, they're open. I'm sure family doctors who mentioned this to their patients and they might not be open. A lot of the people I get also come word of mouth. So they had a friend who had gone through my program and who was a social worker and their burnout. And so by the time they get referred, they have buy in already. So I think I probably have a biased population, but we know the science of this stuff. and also I think what's really fascinating, but the time that were at, I do have a lot of support from my medical community. Many, many physicians who are specialists find it very interesting and will start to refer to me. So I get referrals from neurologists and psychiatrists, cardiologist that have been interested. I think more than anything is the support I get from my medical colleagues to do this work. It shows that they are interested and that there is buy in.
16:18 I think that's great. My typical listener is either a yoga teacher or yoga therapist; what advice would you give to them if they think they might be experiencing burnout?
16:41 I would just tell them that it's real. A lot of yoga teachers are doing trauma informed practice now and a lot of yoga therapists are. Just to understand that there is such a thing as secondary trauma, vicarious traumatization, that we resonate emotionally with the people who we work with. And that's your neurons, our limbic system picking up on the emotions of others. And we are designed as people, as humans to do that so that we can feel another person.
But what the science shows is we actually feel that other person's pain as if it's affecting us. We're experiencing it. People should know that. This is real; you are feeling that heaviness. The person you're working with, you're feeling their heaviness, you're feeling that pain. We have science to show that; brain scans have shown that. The most important thing is that we as yoga teachers and yoga therapists also have a tool that we can use and that is fostering, developing compassion within. We can start to use those meta techniques to breathe in compassion for ourselves, to name the pain that we're feeling. Then we can start to reduce our own empathic distress and our own empathic resonance. We're still resonating with them, but we're dealing with what we're feeling. And then as we start to generate that compassion within, compassion works on a different neural network than empathy, we can actually hold space or be able to be there for our clients, for the people with whom we're working.
18:18 Great point. That actually working with people with trauma can have an effect on the teacher or the therapist. Do you see a lot of trauma training and I haven't taken it so I can't say, but I hope that they're also looking at the wellbeing of the person giving the yoga. So we're almost at the end of the podcast. Shailla. Is there anything that you would like to talk about in more depth or something that we haven't covered at all?
18:53 I think those are the biggest things. I think that what I would like to do for the people who are out there is just to know that there are techniques to read about even, you know, the mindful self-compassion program or compassionate listening programs so that they can start to employ those techniques when they're working with those who have trauma.
And to recognize that it might not appear the way they think it's going to appear in them or the others, Especially when you're working in a trauma informed practice to recognize that you may also be triggered by something and that's completely normal. As time goes on, you may start to get triggered simply by working with people who've had trauma. By hearing their stories, you may start to develop that secondary trauma pattern.
And you may actually also develop what we call moral distress or moral injury. Moral distress is when you know what to do for someone, but you can't do it. And moral injury is when you feel like the system within which you're working is not able to support what you feel needs to be done in that time. That these are things that helping professionals deal with and that are real and that lead to burnout and beyond. Right. So I think my basic thing is that people should have an understanding of who they're helping and why they're helping, but also the fact that it can happen.
20:21 Do you have any resources? I mean, we've touched on it very briefly, but it sounds like an important thing for people to understand and be able to handle
20:32 I know the Center of Mindful Self-compassion San Diego, California has a website on some of these thing. A fabulous author, Laura van Dernoot Lipsky did a Ted talk on secondary trauma. Babbette Rothschild wrote a book Helping the helpers. So there's resources out there. I think that people can explore around this.
21:08 That's great because I didn't realize that. I mean it makes perfect sense what you say but helping these people who have trauma could be very, it's very satisfying. But it can have some other things that you need to be aware of. This has been a great podcast. I learned so much. So thank you Shailla. You've done a great job and you're an excellent speaker. I think you're doing a really great job, especially this amalgamation of western medicinel and Yoga because I think they do go well together. They complement each other, but it's sometimes it's hard to do that. I congratulate you and thank you so much for being on the podcast.
22:08 Thank you so much. This is actually my grandfather's dream. My last name Vaidya means Ayurvedic physician. So he always wanted his grandkids or his kids. He wanted his kids. But that didn't happen. He wanted his grandchildren to blend the two, to not lose this culture. So much is lost under colonization and my uncles were jailed and great uncles were jailed as they were trying to keep these, these things alive. For me, it's really an honor to be able to speak on this stuff and to be able to combine these two. So thank you for having me.
Introduction to Sandra Gilbert and YCAT
2:00 Yoga taught in chemotherapy infusion suites, bedsides, waiting rooms, and for their carers. Yoga is available during diagnosis, treatment, survivorship and end of life and for caregivers. Would like to have yoga available during diagnosis and prevention of cancer. Yoga is good for stress management and decreases stress hormones. Yoga teaches body awareness and promotes a healthy lifestyle, a person can take control thru mind-body practices.
4:17 Yoga for Cancer Research: working with the medical profession. Originally started with yoga for the special child. Became a caregiver for family members with cancer. Began practices with mother who was hospitalised. Then found YCAT training.
5:41 Not trained as a medical progession but mentor was a nurse. Sandra accompanied her mentor to conferences and research meetings. She made connections and started building relationships. Her mentor told her that no yogis were not medial professionals but we should stand in our own expertise. Through relationships and connections, became part of a medical team. Must respect all members of the team for their expertise.
7:35 Sandra is involved in current research of yoga for women with breast cancer with or without lymphodoema. The research has not finished yet so no outcomes. They are measuring pain, psychosocial and emotional elements. Finding if yoga is helpful for those with lymphodoema. Will be finished in June.
8:33 No consistent response to cancer. Everyone’s journey is different. First evaluation very important to listens and meeting them where they are. Where they are with regard to their cancer treatment.
10:16 Foundation of work is building a relationship with person. Questioning/listening helps them clarify their thoughts. YCAT classes structure: awareness practice to begin to notice physical, emotional, thoughts, energy and breath. Very empowering to understand what the body and mind are feeling. They learn to check in with themselves. Learn tools to help them.
12:18 Provide yoga for the caregivers. – yoga empowers them to take care of themselves while caregiving. Educating caregivers to take a break; give them a yoga practice if they like. Learn what they need and how to give that to themselves. Creating relationship with someone so that each caregiver finds exactly what they need for self-care. Supporting someone in finding out what they need.
15:37 YCAT is based in Integral Yoga. Integral Yoga Class and YCAT class structure: awareness, asana, breathwork, yoga nidra, meditation. Dean Ornish based his work in Integral Yoga for improving heart disease and chronic conditions through a healthy lifestyle. Joy Devi did a lot of research in this area to show the benefits of yoga for heart disease and chronic conditions.
17:46 The YCAT founder died in 2017 and Sandra took over as director. YCAT as an organisation decided to include more grief training in their organisation and their training. YCAT curriculum helps with grief by recognizing and having people explore their own grief in there experiences.Someone who has received a cancer diagnosis feels grief over their old life. Their new life will be very different. People with the diagnosis need to be aware of how this affects them; it could be very different from person to person. Honoring each person’s process of grieving. YCAT offers support; but must accept where each person is. Can have hard discussions about loss if person is ready and wants to talk.
22:20 Future of YCAT: Sandra is starting to work with other providers of yoga for cancer training and IYAT to establish a set of guidelines for yoga for cancer training. YCAT is positioned as continuing education after receiving 1000 hour yoga therapy training. YCAT is also promoting mentoring for teachers. YCAT supports new teachers as they find the area in yoga for cancer – they learn about themselves and self-care. Trainers model self-care. And also thinking how to provide support for health care workers.
1:15 Introduction to Michael Lee
2:15 Michael explains why he has more faith in yoga than ever before. Mental health workers and therapists are now taking yoga therapy training as they see the benefits. Neuroscience research is now supporting the body/mind connection. Research on consciousness. Helping people come into the present and become aware of their own insights.
8:30 In the 1980's there was a great flourishing of yoga therapy (Dean Ornish's study on reversing heart disease with lifestyle changes including yoga, Michael Lee began Phoenix Rising Yoga Therapy and the International Association of Yoga Therapists began in 1989.) Michael explains his own deep experience with yoga that led to some important insights that he carried with him since he was a child. Michael and other well-known yogis knew that yoga could help even if they didn't know why.
17:05 About 10 years ago, neuroscience and psychological research started explaining why yoga can help people change. The connection of neuroscience, psychology, yoga philosophy, and Buddhism/mindfulness began to explain what everyone was experiencing.
18:42 The changes in Phoenix Rising Yoga Therapy training over the years. Started as very experiential and has gradually added knowledge components as the research start's clarifying the results of the experiential learning.
21:16 Michael recently talked to astronauts about the overview effect. As astronauts contemplate the earth when they are in space, they begin to change. They understand that there is one small blue marble that all of us live on and they become much more interested in environmental causes, or philanthropy because they understand the world's fragility.
25:38 What is the future of yoga? Yoga therapy is becoming much more accepted in the medical realm as it becomes a modality for helping cancer surgical patients recover and to help with the changes needed in patients and their caregivers.
Huge increase in interest in yoga therapy in Japan.
30:00 Difference between yoga and yoga therapy. In essence there is little difference but in practice yoga therapy requires deeper knowledge and the skills are quite different.
Bessel Van de Kolk: The Body Keeps Score
Stephen Porges: Polyvagal Theory www.stephenporges.com
Bruce Ecker: Memory Reconciliation to Facilitate Change www.coherencetherapy.com
Lorenzo Cohen: www.vyasahouston/yoga-research/yoga-for-cancer