article summary

FULL CATASTROPHE

LIVING Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness THE PROGRAM OF THE STRESS REDUCTION CLINIC AT THE UNIVERSITY OF MASSACHUSETTS MEDICAL CENTER

Jon Kabat-Zinn, Ph.D.

rt• De It a Trad e Pape rba c ks

6 Cultivating Strength,

Balance, and Flexibility: Yoga Is Meditation

As you have probably gathered by now, -~nging mindfulnes~o any activity transforms it into a kind of meditation. Mindfulness dramatically amplifies the probability that any activity in which you are engaged will result in an expansion of your perspective and of your understanding of who you are. Much of the practice is simply a remembering, a reminding yourself to be fully awake, not lost in waking sleep or enshrouded in the veils of your thinking mind. Intentional practice is crucial to this process because the automatic- pilot mode takes over so quickly when we forget to remember.

I like the words remember and remind because they imply connections that already exist but need to be acknowledged anew. To remember, then, can be thought of as reconnecting with mem- bership, with the set to which what one already knows belongs. That which we have forgotten is still here, somewhere within us. It is access to it that is temporarily veiled. What has been forgotten needs to renew its membership in consciousness. For instance, when we "re-member" to pay attention, to be in the present, to be in our body, we are already awake right in that moment of remembering. The membership completes itself as we remember our wholeness.

The same can be said for reminding ourselves. It reconnects us with what some people call "big mind," with a mind of wholeness, a mind that sees the whole forest as well as individual trees. Since we are always whole anyway, it's not that we have to do anything. We just have to "re-mind" ourself of it.

I believe that a major reason why the people in the stress clinic take so quickly to the meditation and find it healing is that the

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practice of mindfulness reminds them of what they already knew but somehow didn't know they knew or weren't able to make use of, namely that they are already whole.

We remember wholeness so readily because we don't have far to look for it. It is always within us, usually as a vague feeling or memory left over from when we were children. But it is a deeply familiar memory, one you recognize immediately as soon as you feel it again, like coming home after being away a long time. When you are immersed in doing without being centered, it feels like being away from home. And when you reconnect with being, even for a few moments, you know it immediately. You feel like you are at home no matter where you are and what problems you face.

Part of the feeling in such moments is that you are at home in your body too. So it is a little peculiar that the English language doesn't allow us to "rebody" ourselves. It seems on the face of it to be just as necessary and useful a concept as to remind ourselves. In one way or another all the work we do in the stress clinic involves rebodying.

Bodies are subject to inevitable breakdown. But they do seem to break down sooner and to heal less rapidly and less completely if they are not cared for and listened to in some basic ways. For this reason, taking proper care of your body is of great importance in both the prevention of disease and in the work of healing from illness, disease, or injury.

Step number one in caring for your body, whether you are sick or injured or healthy, is to practice being "in" it. Tuning in to your breathing and to the sensations that you can feel in your body is one very practical way to work at being in your body. It helps you to stay in close touch with it and then to act on what you learn as you listen to its messages. The body scan is a very powerful form of "rebody- ing," since you are regularly checking in with and listening to and relaxing every region of your body systematically. You can't help developing greater familiarity with and confidence in your body when you do this.

There are many different ways to practice being in your body. All enhance growth and change and healing, especially if they are done with meditative awareness. One of the most powerful in terms of its ability to transform the body, and most wonderful in terms of how good it feels to do it, is hatha yoga. ·

Mindful hatha yoga is the third major formal meditation tech- nique that we practice in the stress clinic, along with the body scan and sitting meditation. It consists of gentle stretching and strength-

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ening exercises, done very slowly, with moment-to-moment awareness of breathing and of the sensations that arise as you put your body into various configurations known as "postures." Many people in the stress clinic swear by the yoga practice and prefer it to the sitting and the body scan. They are drawn to the relaxation and increased musculoskeletal strength and flexibility that come from regular yoga practice. What is more, after enduring the stillness of the sitting and the body scan for several weeks, it allows them at last to move!

But mindful yoga does far more than get you relaxed and help your body to become stronger and more flexible. It is another way in which you can learn about yourself and come to experience yourself as whole, regardless of your physical condition or level of "fitness." Although it looks like exercise and conveys the benefits of exercise, it is far more than exercise. Done mindfully, it is medita- tion just as much as the sitting or the body scan is.

We practice the yoga with the same attitude that we bring to the sitting meditation or the body scan. We do it without striving and without forcing. We practice accepting our body as we find it, in the present, from one moment to the next. While stretching or lifting or balancing, we learn to work at our limits, maintaining moment-to-moment awareness. We are patient with ourselves. As we carefully move up to our limits in a stretch, for instance, we practice breathing at that limit, dwelling in the creative space be- tween not challenging the body at all and pushing it too far.

This is a far cry from most exercise and aerobic classes and even many yoga classes, which only focus on what the body is doing. These approaches tend to emphasize progress. They like to push, push, push. Not much attention is paid to the art of non-doing and pan-striving in exercise cl~ses, nor to ~nt ~ that ~tter, nor to the mind. In exercise that is totally body-oriented, there tends to be little explicit care given to the domain of being, which is just as important when working with the body as when doing anything else. Of course anybody can come upon the domain of being on their own, because it is always here. But it is a lot harder to find if the atmosphere and attitude are diametrically opposed to such experiences.

Most of us need to be given permission to switch from the doing to the being mode, mostly because we have been conditioned since we were little to value doing over being. We were never taught how to work with the being mode or even how to find it. So most of us need at least a few pointers on how to let go into it.

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It's not all that easy to find the being mode on your own when you are exercising, especially in a class that is very doing and achievement oriented. On top of that, it is also difficult because we carry our mind's usual agitations, reactivity, and lack of awareness around with us when we are exercising.

To find the domain of being, we need to learn and practice mobilizing our powers of attention and awareness during exercise. .Professional and even amateur athletes are now realizin less

as the body, they are dis- re ardmg an entire realm, of personal r that can make a critical · 1 erence m performance.

- Even physical therapy, which is specifically oriented toward teaching and prescribing stretching and strengthening exercises for people who are recovering from surgery or who have chronic pain, is usually taught without paying attention to breathing and without enlisting the person's innate ability to relax into the stretching and the strengthening exercises. Often physical therapists undertake to teach people to do healing things for their bodies while neglecting two of the most powerful allies people have for healing; the breath and the mind. Time and again our patients with pain problems ;eport that their physical-therapy sessions go much better when they use awareness of breathing as they perform their exercises. It's as if a whole new dimension of what they are being asked to do is revealed to them. And their physical therapists often comment on the dramatic changes they seem to have undergone.

When the domain of being is actively cultivated during slow and gentle stretching and strengthening exercises, such as yoga or physical therapy, what people think of traditionally as "exercise" is transformed into meditation. This allows it to be done and even enjoyed by people who could not tolerate the same level of physical activity in a more accelerated and progress-oriented context.

In the stress clinic, the ground rule is that every individual has to consciously take responsibility for reading his or her own body's signals while doing the yoga. This means listening carefully to what your body is telling you and honoring its messages, erring on the side of being conservative. No one can listen to your body for you. If you want to grow and heal, you have to take some responsibility for listening to it yourself. Each person's body is different so each person has to come to know his or her own limits. And the only way to find out about your limits is to explore them carefully and mindfully over an extended period of time.

What you learn from doing this is that, no matter what the

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state of your body, when you bring awareness to it and work at your limits, those limits tend to recede over time. You discover that the boundaries of how far your body can stretch or how long you can hold a position are not fixed or static. So your thoughts about what you can and can't do shouldn't be too fixed or static either, because your own body can teach you differently, if you listen carefully to it.

This observation is nothing new. Athletes use this principle all the time to improve their performances. They are always exploring their limits. But they are doing it to get somewhere, whereas we are using it to be where we already are and discover where that is. We will find that we get somewhere, too, but without the relentless striving.

The reason it is so important for people with health problems to work at their limits similar to the way athletes do is that when there is something "wrong" with one part of your body, you tend to back off and not use any of it. This is a sensible short-term protec- tion mechanism when you are sick or injured. The body needs periods of rest for recuperation and recovery.

But often the short-term solution evolves into the long-term life-style. Over time, especially if we have an injury or a problem with our body, a restricted body image can creep into our view of ourself and, if we are unaware of this inner process, we can come to identify ourselves that way and believe it. Rather than finding out what our limits and limitations are by directly experiencing them, we d~clare them to be a certain way, on the basis of what we think or what we were told by the doctor or by family members concerned for our well-being. Unwittingly we may be driving a wedge between ourselves and our own well-being.

Such thinking can lead to a rigid and fixed view of ourself as "out of shape," "over the hill," or as having something "wrong," perhaps even as being "disabled," reasons enough to dwell in inactivity and neglect our body in its entirety. Maybe we have an exaggerated belief that we have to stay in bed just to get through the day or that we can't go out of the house and do things.

Such views lead readily to what is sometimes referred to as "illness behavior." We begin to build our psychological life around our preoccupations with our illness, injury, or disability, while the rest of our life is on hold and unfortunately atrophying, along with the body. In fact even if there is nothing "wrong" with your body, if you do not challenge it much, you may be carrying around a highly restricted image of what it (and you) are capable of doing.

Physical therapists have two wonderful maxims that are ex-

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tremely relevant for people seeking to take better care of their bodies. One is "If it's physical, it's therapy." The other is "If you don't use it, you lose it." The first implies that it's not so much what you do that is important, it's that you are doing something with your body. The second maxim reminds us that the body is never in a fixed state. It is constantly changing, responding to the demands placed upon it. If it is never asked to bend or squat or twist or stretch or run, then its ability to do these things doesn't just stay the same, it actually decreases over time. Sometimes this is called being "out of shape," but being out of shape implies a fixed state. In fact the longer you are "out of shape," the worse shape your body is in. It declines.

This decline is technically known as disuse atrophy. When the body is given complete bed rest, say when you are recuperating from surgery in the hospital, it rapidly loses a good deal of muscle mass, especially in the legs. You can actually see the thighs get smaller day by day. When not maintained by constant use, muscle tissue atrophies. It breaks down and is reabsorbed by the body. When you get out of bed and start moving around and exercising your legs, it slowly builds up again.

It's not just the leg muscles that atrophy with disuse. All skeletal muscles do. They also tend to get shorter and lose their tone and become more prone to injury in people who lead a seden- tary life-style. Moreover, protracted periods of disuse or underuse probably also affect joints, bones, the blood vessels feeding the regions in question, and even the nerves supplying them. It is likely that with disuse, all these tissues undergo changes in structure and function that are in the direction of degeneration and atrophy.

Twenty-five years ago extended bed rest was the treatment of choice following a heart attack. Now people are out of bed and walking and exercising within days of a heart attack because medi- cine has come to recognize that inactivity only compounds the heart patient's problems. Even a heart that has atherosclerosis responds to the challenge of regular, graduated exercise and benefits from it by becoming functionally stronger (even more so if the person goes on a very low fat diet, as we shall see in Chapter 31).

Of course, the level of exercise has to be adjusted to the physical state of your body so that you are not pushing beyond your limits at any time but are working in a target range for heart rate that produces what is called a "training effect" on the heart. Then you gradually increase your exercise as your limit recedes, in other words as your heart becomes stronger. Nowadays, it's not unheard

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of for people who have had a heart attack to build themselves up to the point where they can complete a marathon, that is, run 26.1 miles!

Yoga is a wonderful form of exercise for a number of reasons. To begin with, it is very gentle. It can be beneficial at any level of physical conditioning and, if practiced regularly, counteracts the process of disuse atrophy. It can be practiced in bed, in a chair, or in a wheelchair. It can be done standing up, lying down, or sitting. In fact, the whole point of hatha yoga is that it can be done in any position. Any posture can become a starting place for practice. All that is required is that you are breathing and that some voluntary movement is possible.

Yoga is also good exercise because it is a type of full-body conditioning. It improves strength and flexibility in the entire body. It's like swimming, in that every part of your body is involved and benefits. It can even have cardiovascular benefits when done vig- orously. But the way we do it in the clinic is not as cardiovascular exercise. We do it primarily for stretching and strengthening your muscles and joints, to wake up the body to its full range of motion and potential for movement. People who need cardiovascular exer- cise walk or swim or bike or run or row in addition to doing the yoga.

Perhaps the most remarkable thing about yoga is how much energy you feel after you do it. You can be feeling exhausted, do some yoga, and feel completely rejuvenated in a short period of time. Those people who have been practicing the body scan every day for two weeks in a row and found it difficult to feel relaxed are thrilled to discover in the third week of the stress clinic that they can easily achieve a deep state of relaxation with the yoga; it's almost impossible not to unless you have a chronic pain condition, in which case you have to be particularly careful of what you do, as we will see in a moment. At the same time these people find that they stay awake during the yoga and get to taste feelings of stillness and peace that they did not experience in the body scan because they were unable to concentrate, or fell asleep. And once they have had an experience of this kind, many come to feel more positively toward the body scan as well. They understand it better and have an easier time staying relaxed and awake while doing it.

I do yoga almost every day and have for over twenty years. I get out of bed and splash some cold water on my face to make sure I'm awake. Then I work with my body mindfully by doing some yoga• Some days it feels like my body is literally putting itself together

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I practice. Other days it doesn't feel that way. But it always feels like I know how my body is today because I have spent some time with it in the morning, being with it, nourishing it, strengthening it, stretching it, listening to it. This feeling is very reassuring when you have physical problems and limitations and are never quite sure what your body is going to be like on any given day.

Some days I'll do fifteen minutes, just some basic back and leg and shoulder work. Sometimes I'll do half an hour or an hour. My yoga classes are usually two hours long, because I want people to take their time and to luxuriate in the experience of centering themselves in their bodies as they practice exploring their limits in various postures. But even five or ten minutes a day can be very useful as a regular routine. However, if you have embarked on our eight-week training program in mindfulness training or are think- ing about doing so, we recommend that you practice for forty-five minutes per day, starting in Week 3, alternating yoga with the body scan daily, as described in Chapter 10.

• Yoga is a Sanskrit word that literally means "yoke." The prac-

tice of yoga is the practice of yoking together or unifying body and mind, which really means penetrating into the experience of them not being separate in the first place. You can also think of it as experiencing the unity or connectedness between the individual and the universe as a whole. The word has other specialized meanings, which do not concern us here, but the basic thrust is always the same: realizing connectedness, realizing wholeness through disci- plined Practice. The image of the yoke goes nicely with our notions of re-minding andre-bodying.

The trouble with yoga is that talking about it doesn't help you to do it, and instructions from a book, even under the best of circumstances, can't really convey the feeling of what it is like to Practice. One of the most enjoyable and relaxing aspects of doing Y<>ga mindfully is the sense of your body flowing from one posture to the next and through periods of stillness while lying on your back or on your belly. This cannot be achieved when you are going back and forth between the illustrations and descriptions in a book and Y<>ur body on the floor. It always exasperated me the few times that I ~ to learn yoga from a book, no matter how good the book was . . d hat ts Why we strongly recommend that if you are drawn to the 1

ea of Practicing mindful yoga, you use the practice tapes to get

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started. Then all you have to do is play one of them and let it guide you through the various sequences of postures. This allows you to put all your energy into moment-to-moment awareness of your body, your breath, and your mind. The illustrations and the in- structions in this chapter can then be used to clarify any uncertain- ties you may have and to supplement your own understanding, which will grow mostly out of your personal experiences doing it. Once you know what is involved, you can do it without the tapes and make up different sequences of postures for yourself.

We have already seen that posture is very important in the sitting meditation and that positioning your body in certain ways can have immediate effects on your mental and emotional state. Being aware of your body language and what it reveals about your attitudes and feelings can help you to change your attitudes and feelings just by changing your physical posture. Even something as simple as curling up the mouth into a half smile can produce feelings of happiness and relaxation that weren't present before the facial muscles were mobilized to mimic the smile.

This is important to remember when you are practicing yoga. Every time you intentionally assume a different posture, you are literally changing your physical orientation and therefore your inner perspective as well. So you can think of all the positions in which you find yourself while doing yoga as opportunities to practice mindfulness of your thoughts and feelings and mood states as well as of your breathing and of the sensations associated with stretching and lifting different parts of your body.

For example, sometimes rolling up into a fetal position, upside down on the back of your neck and shoulders (position 21 in Figure 6), can provide a welcome change in perspective and can result in a positive mood change. Even such simple things as what you do with your hands when you are sitting, how you position them, whether the palms are open to the ceiling or are facing down on your knees, whether the palms are touching in your lap or not, whether the thumbs are touching or not, can all have an effect on how you feel in a particular posture. They are a very fruitful area for developing an awareness of energy flow in your body.

When you practice the yoga, you should be on the lookout for the many ways, some quite subtle, in which your perspective on your body, your thoughts, and your whole sense of self can change when you adopt different postures on purpose and stay in them for a time, paying full attention from moment to moment. Practicing in this way enriches the inner work enormously and takes it far beyond

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the physical benefits that come naturally with the stretching and strengthening.

HOW TO GET STARTED ============

1. Lie on your back on a mat or pad that cushions you from the floor. If you can't lie on your back, do it some other way.

2. Become aware of the flow of your breathing and feel the ab- domen rising and falling with each inbreath and outbreath.

3. Take a few moments to feel your body as a whole, from head to toe, the "envelope" of your skin, and the sensations associated with touch in the places your body is in contact with the floor.

4. As with the sitting meditation and the body scan, keep your attention focused in the present moment and bring it back when it wanders, noting what drew it away before letting go of it.

5. Position your body as best you can in the various postures illustrated below and try to stay in each one while you focus on your breathing at the abdomen. Figures 6 and 7 give you the sequences of postures we do on the yoga sides of the two mindfulness practice tapes: "Guided Yoga 1" and "Guided Yoga 2." On the tapes some of the postures are repeated at various points. These repeats are not included in the drawings. When a posture is pictured as being on either the right side or the left side, do both, as indicated.

6. While in each posture, be aware of the sensations that you are experiencing in various parts of your body, and if you like, direct your breath in to and out from the region of greatest intensity in a particular stretch or posture. The idea is to relax into each posture as best you can and breathe with what you are feeling.

7. Feel free to skip any of the postures that you know will exacer- bate a problem you may have. Check with your doctor or physical therapist about particular postures if you have a neck problem or a back problem. This is an area in which you have to use your judgment and take responsibility for your own body. Many of the people in the stress clinic who have back and neck problems report that they can do at least some of these postures, but they do them very carefully, not pushing or forcing or pulling. Although these exercises are very gentle and can be healing, they are also deceptively powerful and can lead to muscle pulls

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and more serious setbacks if they are not done slowly, mind- fully, and gradually over time.

8. Do not get into competing with yourself, and if you do, notice it and let go of it. The spirit of yoga is the spirit of self- acceptance in the present moment. The idea is to explore your limits gently, lovingly, with respect for your body. It is not to try to break through your body's limits because you want to look better or fit into your bathing suit better next summer. That may happen naturally if you keep up the practice, but if you tend to push beyond your limits of the moment instead of relaxing into them, you may wind up injuring yourself. This would just set you back and discourage you about keeping up the practice, in which case you might find yourself blaming the yoga instead of seeing that it was the striving attitude that led to your overdoing it. Certain people tend to get into a vicious cycle of overdoing it when they are feeling good and enthusi- astic and then not being able to do anything for a time and becoming discouraged. So it is worth paying careful attention if you have this tendency and erring on the side of being con- servative.

9. Although it is not shown in the sequences of postures illus- trated in Figures 6 and 7 simply in the interests of space, you should rest between postures. Depending on what you are doing, you can do this either lying on your back or in another comfort- able posture. At these times be aware of the flow of your breathing from moment to moment, feeling your belly as it gently moves in and out. If you are lying on the floor, feel your muscles let go as you sink more deeply into your mat or pad on each outbreath. Ride the waves of your breathing as you relax and sink more deeply into the floor. You can relax in a similar way as you rest standing up between standing postures; feel the contact your feet make with the floor and let your shoulders drop as you breathe out. In both cases, as your muscles let go and relax, allow yourself to let go of any thoughts you might be having and continue to ride the waves of the breath.

10. There are two general rules that will help you if you keep them in mind as you do the yoga. The first is that you breathe out as you do any movements that contract the belly and the front side of your body and you breathe in as you do any movements that expand the front side of your body and contract the back. For example, if you are lifting one leg while lying on your back

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(see Figure 6, posture 14), you would breathe out as you lift it. But if you are lying on your belly and lifting the leg (Figure 6, posture 19), you would breathe in. This applies just for the movement itself. Once the leg is up, you just continue observ- ing the natural flow of your breath.

The other rule is to dwell in each posture long enough to let go into it. The idea is to relax into each one. If you find yourself struggling and fighting with it, remind yourself to let go into your breathing. In the beginning you may find that you are unconsciously bracing yourself in many areas while you are in a particular position. After a while your body will realize this in some way, and you will find yourself relaxing and sinking farther into it. Let each inbreath expand the posture out slightly in all directions. On each outbreath sink a little more deeply into it, allowing gravity to be your friend and help you to explore your limits. Try not to use any muscles that don't need to be involved in what you are doing. For instance, you might practice relaxing your face when you notice that it is tense.

11. Work at or within your body's limits at all times, with the intention of observing and exploring the boundary between what your body can do and where it says, "Stop for now." Never stretch beyond this limit to the point of pain. Some discomfort is inevitable when you are working at your limits, but you will need to learn how to enter this healthy "stretching zone" slowly and mindfully so that you are nourishing your body, not damaging it as you explore your limits.

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FIGURE6

SEQUENCE OF YOGA POSTURES (TAPE 1, SIDE 2)

low back pressed against floor low back arched ; pelvis stays on floor

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FIGURE7

SEQUENCE OF YOGA POSTURES (TAPE 2, SIDE 2)

raise up

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shoulder rolls: do in forward, then backward directions

squeeze together in front

let drop

neck rolls: do in one direction, then the other

squeeze together in back

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both sides

both sides

repeat 22 to 24 on other side