Tried everything and still suffering? How to think like a yoga therapist and begin to heal

Updated: Jul 26

Perhaps you have come to accept that physical pain, emotional suffering, or mental anguish are a burden you must learn to endure. You’ve tried all the usual interventions, visiting a doctor and the appropriate specialists, telling the same story again and again. No obvious solution arises. Nothing has worked. The interventions might even seem worse than the problem itself.



So here you are, still suffering and losing hope. Many people in this situation find ways to cope, even sneakily unhealthy ways, such as moving around less or drinking too much. As we try not to feel this unpleasant feeling, we hope that ignoring it will make it tolerable. We fantasize that with enough apathy, this suffering might go away like an unwelcome houseguest that has finally taken the hint. But pain and suffering are the very worst tenants.


Yoga therapists specialize in helping people with physical pain, emotional suffering, or mental anguish to help themselves begin on a path to relief and self healing. While it is not always possible to heal a physical ailment or disease, it is almost always possible to help you feel better.


The feeling better itself is often a catalyst for many other changes that lead to better overall health and comfort. A person who feels better is a person more capable of making a myriad of small but beneficial choices that can cumulatively over time have medically significant physical health outcomes. For those with emotional or mental issues, feeling better can similarly create a positive cycle of mental wellness, as well as impact physical health through supporting healthy nervous system function.


If you experience suffering of any kind, know that there are options for feeling better no matter your current condition.


“Okay, okay! I’m suffering here. Just tell me how to feel better!”, you say.


Before we roll up our sleeves and learn how to think like a yoga therapist and begin to heal ourselves, let’s consider what yoga philosophy has to say about suffering.


Yoga Sutra 2.15 describes to us the cause of our suffering. It is loosely translated to state: “To the discerning one, (who knows the Self and the non-Self), all suffering is due to fluctuations of the gunas (the three qualities of the physical world, which are action, inaction, and equilibrium), anguish in change, and sufferings of samskaras (subconscious imprints, such as past experiences or traumas).” This is basically saying that when we know ourselves to be more than our thoughts, we become aware that our suffering arises from our inability to adapt to external circumstances, our inability to accept change, and our inability to let go of the impact of the traumas we carry with us.


“Yes, that’s very heady, thanks!”


Doesn’t sound actionable? That’s often the case with philosophy. Let's now look at some real-world suffering and think like a yoga therapist to find some practical relief.


As a yoga therapist, I work with all sorts of client complaints. Everyone fears their problem is the worst type, and people want to know how bad it is compared to everyone else: "Do others have this too? Or is it just me?"


The truth is that no, nobody suffers in exactly the same way as you. But yes, everyone suffers, just like you.


And the beginning of the healing journey is a desire to heal oneself. That is the only prerequisite.


I’ve worked with powerful public speakers with uncontrollable rage. I’ve worked with dads that can’t play with their kids due to excruciating neck pain. I’ve worked with caregivers that have had no time to grieve loss and are experiencing debilitating chronic fatigue. I’ve worked with outwardly healthy-looking gym rats with uncontrollable stress tremors. I’ve worked with pregnant career women with demobilizing pelvic pain. I’ve worked with business owners with panic attacks. I’ve worked with people struggling through life transitions due to a deep sense of shame. I’ve worked with people living in chaos due to devastating childhood trauma.


What do they all have in common?


Each of my clients has expressed a desire to heal themselves. As a yoga therapist, when a client comes to me with this intention, I assess that person’s condition utilizing a framework that is unique to yoga therapy, called the Five Koshas Framework. I then work with the client to select practices to most effectively and easily target the kosha or koshas that are presenting with symptoms of dysregulation.


Let’s take a look at what the five koshas are and how we can use them as an assessment tool to build a strategy for alleviating our own suffering.


The five koshas are a way of viewing the aspects of the Self. The five koshas include 1) the physical body, 2) the vital body, 3) the mind, 4) subconscious mind, and 5) the spirit, also described as the macro-connected Self. Each kosha, or layer of the Self, is an outer expression of the true inner Self, which is said in yogic tradition to exist beyond these five layers.


A yoga therapist helps a client balance themselves by identifying dysregulation within any one kosha or within multiple koshas. Having selected a kosha or koshas to work with, the yoga therapist then prescribes practices to bring awareness to experiences within this kosha. Yoga theory posits that we are all naturally blissful and regulated in our purest state of consciousness, so therefore the practice of consciously directed awareness has the natural effect of self-regulation. Through skill-building with practices such as moving and breathing, chanting, study, meditation, lifestyle choices, and symbolic practices, the client is then able to bring new awareness to the body’s autonomic processes and bring balance across all five koshas.


All the koshas are interconnected, so dysregulation in one kosha will often affect others. A classic example of cross-kosha impact is stress-related disorders resulting in physical symptoms. As we explore each kosha, let’s discover how an area of dysregulation in one kosha can lead to problems in another. This is the key to a yoga therapist’s particular magic: often, the solution to a specific problem can be found in a totally different aspect of the Self.


Let’s explore how a yoga therapist might choose a strategy to work to regulate the koshas and relieve suffering using the Five Kosha Framework.


The first kosha is the physical body. The most tangible aspect of the Self, your physical body can be seen and touched, making it the most obvious litmus of health. If you have a condition such as disease, there is probably dysregulation within the physical aspect of the Self. Often, the distress caused by physical conditions extends into mental anguish, anxiety, or even depression. These mental conditions can then cause additional physical discomfort due to mounting stress, even leading to further pathology.


Common yoga therapy techniques addressing the physical body alone might include moving and breathing to support healthy joint function and range of motion, and strengthening weak muscles, and stretching of tight muscles to balance functional movement.


Pain is often due to a physical problem, but using the Five Koshas Framework, a yoga therapist may look elsewhere for the source of the problem. In the case of chronic physical pain with no identifiable cause, the yoga therapist may choose to work with the mind (the 3rd kosha) rather than the body (the 1st kosha) to re-educate the neural pathways that are signaling pain.


Pain, though useful in preventing injury, can become less useful when experienced chronically. Chronic pain becomes a learned sensation, and sometimes the brain can get very good at sensing pain. Pain might begin to travel throughout the body beyond its source. In this case, the yoga therapist would work with the physical body and the mind at the same time, training the mind to become more specific and aware of localized pain signals. I have seen this type of work result in a reduction of the client’s subjective experience of pain by as much as 80%.


In another example, a client might present with a non-physical primary complaint, and the solution may involve working with the physical body. Consider a client that comes for depression. While at first glance this may appear to be a mental problem (3rd kosha), using our framework we discover that the source of the problem is actually physical (1st kosha).


Let’s say this client has had a hip replacement that went badly, resulting in asymmetrical weakness and decreased mobility. He says his inability to get around easily has limited his social interaction, and he can no longer take his boat out on the water. He has lost his sense of freedom and connectedness with nature and friends he once enjoyed. A yoga therapist in this case would work to increase strength in atrophied muscles and improve balance in order to restore mobility, with the goal of reintegrating the client into enjoyable activities that can accommodate his current physical limitations. This approach addresses depression differently than a psychologist or primary care physician might, illustrating how a yoga therapist utilizes the Five Kosha Framework to address the primary complaint of depression using physical practices.


The second kosha is the vital body (or pranic body). The vital body can be sensed as the nervous system, the breath, or the ways we can perceive energy being exchanged within our body’s systems, as well as between our body and the environment. In yoga we refer to energy as prana. From physics we know that energy is not created or destroyed, but rather changed from one form to another. Energy in the body takes many forms, including chemical, electrical, radiant, mechanical, and thermal. In a fascinating mind-body experiment at Harvard Medical School, Tibetan monks demonstrated an ability to heat and cool their skin through advanced meditation practices. This experiment was an important contribution to the field of mind-body medicine and yoga therapy, proving that through awareness we are able to co-opt our body’s processes governing energetic exchange.


Dysregulation in the vital body is commonly felt as anxiety, fear, agitation, anger, depression, or fatigue, though there are many other possibilities. Vital body dysregulation bridges the divide between symptoms of the physical body and the mind, often with a chicken-or-egg cycle of discomfort.


Anxiety and fear is a classic example of pranic dysregulation. In the case of anxiety, accumulated mental stress (3rd kosha) or subconscious trauma (4th kosha) can lead to physical body symptoms (1st kosha) such as a fluttering heart, a tight chest, a queasy stomach, or a lump in the throat. Which kosha would a yoga therapist pick in this case? Often, using breathwork to regulate the vital body can impact the other affected koshas. Lengthening exhales and holding the breath out can calm a dysregulated autonomic nervous system stuck in sympathetic (fight or flight) mode.


However, there are always exceptions, such as when a client has experienced complex trauma or PTSD. In these cases, breathwork may be contraindicated and a gentler non-breath-based approach would be warranted, such as working with the physical body and bringing awareness to grounding the feet (but that is a topic for another post.)


The third kosha is the mental body, or the mind. Most of us are aware that we have thoughts. Contrary to popular belief, the goal of mind-based yoga is not to stop having thoughts, but rather to become more connected to the part of ourselves that exists outside of our thoughts. This awareness of our thoughts is called witness consciousness.


Let’s consider a client who says she is tormented by thoughts of her ex-husband with a new partner. She is unable to sleep due to racing obsessive thoughts each night. She has tried talk therapy, and while helpful, it has not allowed her to experience a full night’s sleep. She has tried sleeping pills and they leave her feeling foggy and depressed. She is desperate to alleviate her insomnia and move on with her life. While a talk therapist may wish to discuss the circumstances of the divorce, what led up to it, and the client’s feelings about it, a yoga therapist would think about this case differently.


A yoga therapist would address the problem of too much unwanted mental activity by training the mind to be more sattvic, or placid. To do so, we avoid arguing with the mind. Arguing with the mind is much like a well-intentioned friend telling the client she is better off without him. The client heartily agrees, yet there she is, still up all night thinking about him with that other woman. Another form of arguing with the mind is going at the problem too directly with positive affirmations, such as “I am doing great on my own.” Repeating this to herself, the client’s mind counters readily with statements such as: “No you’re not, you’re miserable on your own, and in fact, you will always be miserable!” Clearly, affirmations are not working.


Instead, let’s think like a yoga therapist and borrow evidence from neurology. Neurology teaches us that through neuroplasticity, we are capable of changing the brain with new experiences. A yoga therapist might teach the client to chant “Om Namah Shivaya” in Sanskrit, which loosely translates to mean “I bow to my own heart, my inner teacher.” The chanting itself busies the mind, occupying the mind with the doing of the chanting, and the feelings created by the vibrations it causes, as well as the sounds. Chanting has been clinically shown to create new mind states and new thought patterns. Chanting leads to a sattvic mind state that can be felt and experienced in the present moment by our client. With repeated practice, new neural pathways are traced and the experience of mental ease becomes normalized.


Over time, new mental states begin to emerge, tempering the obsessive tendencies of the client’s mind. With experience, the client might be able to tolerate the practice of becoming aware of her own thoughts by sitting still and observing them. Through doing so, she discovers that she is still present and conscious in the moments that occur between her thoughts. This is the discovery of the Self beyond thought, and with this discovery, freedom from suffering is found. Eventually, she is able to sleep soundly, correcting what is often considered a physical problem.


The fourth kosha is the subconscious mind. Remember that the Yoga Sutras say suffering can be attributed to samskaras. Samskaras are subconscious imprints on the mind, such as past experiences or traumas. Samskaras are not necessarily good or bad, just impressions that leave a trace that remains with us.


PTSD is one example of a samskara at the root of present suffering. Once considered only to affect combat veterans, we now know that PTSD is quite common, affecting 7-8% of people at least once over the course of their lifetime. People with PTSD have intense, disturbing thoughts and feelings related to a past traumatic experience that last long after the event or events have ended. People with PTSD may avoid situations or people that remind them of the traumatic event or events, and they may have strong negative reactions to experiences, called triggers. Triggers cause the mind to re-experience the past trauma as if it were occurring in the present moment.


Meditation is the primary tool used to address samskaras. However, a yoga therapist will often identify a problem in the 4th kosha such as trauma, but will choose to work with the 1st kosha, the physical body, instead. Trauma triggers can prevent a client from feeling safe being present within the deeper realms of the Self. Additionally, a person with a vital body dysregulation may not find meditation tolerable due to high feeling states that feel dangerous or out of control to the client.


The 2014 release of the book The Body Keeps the Score has illuminated the relationship of the mind-body connection in healing trauma (a 4th kosha problem), positing that the body is a gateway to restoring balancing within the subconscious mind.


Meditation is often prescribed as a 4th kosha practice after work regulating other koshas, such as the physical and vital bodies, is complete. Luckily, there are dozens of meditation techniques available, most of which do not require sitting still and attempting to empty the mind of thought.


“How do I know if I am carrying past trauma and have dysregulation in my subconscious mind?”


If you believe you may be suffering due to past experiences, you may have dysregulation in the subconscious part of your mind. This can lead to patterns of behavior that are repeated even though we wish we could avoid them. For example, you may find yourself in multiple abusive relationships that are unhealthy and wonder why this keeps happening to you. Or, you may have trouble letting go of feelings of anger or resentment despite your wishes to move on. Or, perhaps you are caught in a cycle of addiction or other coping behavior you would like to cease.


Yoga philosophy lays out a philosophical path for how to release ourselves from self-harming patterns. Sutra 2.7 states that attachment is the dwelling upon pleasure, and Sutra 2.8 states that aversion is the dwelling upon pain. Both states contribute to suffering. We can bring an intention of being present with both pleasure and pain without becoming overly identified with either experience. Sutra 2.11 tells us that we can reduce or overcome the influence of these experiences on our psyche through meditation.


Meditation is simply having a present-centered experience that can be felt and experienced subjectively in the here and now.


Through regular practice and experience being present with either pain or pleasure, we come to identify less with them and experience deeper peace. This peace then releases us from our suffering, though not necessarily from our pain. Yoga Sutra 2.15 tells us that samskaras can contribute to our suffering, so it is in our best interest to bring awareness to these hidden parts of our subconscious as a prescription for relief from any kind of suffering we are experiencing presently. Through meditation, we gain access to our subconscious as we become more and more comfortable feeling our feelings and getting to know our own minds.


“Wow, that’s a lot. You said there were five koshas. Are we there yet?”


Yes, we’ve arrived at the fifth and final kosha.


The fifth kosha is the spirit, or the macro-connected Self. This part of the Self is experienced in uniquely different ways by different people. One person feels connected to nature on a hike, while another feels connected to others upon holding a new grandchild. Yet another person might feel connected while watching the Olympics, or at a cultural ceremony or during a holiday tradition. There are so many ways to feel a sense of connection. One way involves gesturing surrender, such as bowing or honoring something greater than ourselves. Another way might be donating to a cause that is important to us for the benefit of others.


Dysregulation in the spirit is often experienced as depression. Suffering can happen when we become disillusioned and disconnected from ourselves. This inner connection can be lost through trauma, no matter how outwardly minor that trauma may seem to others. The resulting lack of connection to the spirit can result in low self-esteem or fear. The outer connection can be lost when we sever ties to community, such as with retirement, moving to a new place, or through grief, deep betrayal by oneself or by others, or through loss of routine.


Yoga therapists help clients with disconnection in the spirit to generate feelings of connection in the most accessible way possible, and to repeat those experiences often. This might mean joining a new community or getting outside more often. It might mean setting up a special place for reflection and adorning it with symbols or pictures that evoke connection. Work in this area is highly personal, yet connects us all in our desire to experience that which we all share. Yoga practices such as these may not look like downward facing dog, but be assured, these practices are still yoga and they can have a profoundly transformative effect.


We did it! We took a tour through the five koshas, or layers of the Self.


You might now ask yourself: In what ways is my suffering manifesting as dysregulation? Is it manifesting physically? Energetically? Mentally? Perhaps there are some deep rooted troubling aspects of your subconscious mind emerging? Or are you lacking a deep sense of connection to yourself or others?


Answers to these questions might give clues to the types of practices you may need. Here are some types of yoga practices that will generally address issues in each of the five koshas:

  1. Physical body: moving and breathing, yoga postures with strong holds and static stretches

  2. Vital body: breathwork

  3. Mind: chanting, yoga philosophy contemplation

  4. Subconscious mind: meditation

  5. Spirit: personal or cultural ritual, gestures of surrender and gratitude, spending time in with others or in nature, expressions of unconditional love

The mind-body connection one facet of the Five Koshas Framework which is receiving more attention in mainstream Western medicine. However, the field is still relatively young. Yoga therapists are at the forefront of the new frontier of complementary medicine. Yoga therapists offer classical treatments for chronic conditions through an individualized framework-based, rather than prescriptive, approach. The Five Kosha Framework is just one framework yoga therapists use to choose practices. It empowers the client to participate in the formation of a strategy for moving toward wellness.


I hope you have enjoyed learning what it means to think like a yoga therapist. As you explore your path of self-healing, remember that you can reach out for help from others and get the support you need along the way.


Yoga philosophy tells us that contentment is our birthright. Peace is our natural state. Thinking of your healing process as a journey leading you back to this inner sanctuary.


You deserve to feel better. And you have everything you need within.


Namaste,

Christine




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