Mindful Yoga Based Acceptance and Commitment Therapy

Simple Postures and Practices to Help Clients Achieve

Emotional Balance

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“This book is a brilliant contribution not only to the contextual
behavioral science literature, but also to the acknowledgement
that there are other forms, besides language, to address human
struggles. The authors did an incredible job integrating ACT, yoga
practices, and a rounded approach to general well-being into a
very creative, unique, and step-by-step process. This is certainly
a timely book when we have failed to acknowledge the role of our
body in our general well-being, and within the field of empirically
supported treatments. This book will help all clinicians to expand
a repertoire of interventions when working with all clients. A highly
recommended book, whether you practice yoga or not!”
—Patricia E. Zurita Ona, PsyD, coauthor of Mind and
Emotions, and author of Parenting a Troubled Teen and
Escaping the Emotional Rollercoaster
 Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the
subject matter covered. It is sold with the understanding that the publisher is not engaged in
rendering psychological, financial, legal, or other professional services. If expert assistance or
counseling is needed, the services of a competent professional should be sought.
In consideration of evolving American English usage standards, and reflecting a commitment to
equity for all genders, “they,” “them,” and other similar pronouns are used to denote singular
persons.
Distributed in Canada by Raincoast Books
Copyright © 2019 by Timothy Gordon, Jessica Borushok, and Steve Ferrell
Context Press
An imprint of New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup
Interior design by Michele Waters-Kermes
Acquired by Elizabeth Hollis-Hansen
Edited by James Lainsbury
All Rights Reserved

Library of Congress Cataloging-in-Publication Data on file

For Michael Stone: Yours is a light that will never go out.
—TG, JB, SF
 Contents

Introduction
Chapter 1: Understanding Human Suffering

Part 1: Seeing the Other Side

Chapter 2: ACT Through the Life Map
Chapter 3: What You Need to Know to Teach Yoga

Part 2: The MYACT Protocol

Session One: Dharana
Session Two: Samskara
Session Three: Dhyana
Session Four: Karma
Session Five: Svarupa
Session Six: Vipassana
Session Seven: Karuna
Session Eight: Samadhi

Part 3: Adaptations and Troubleshooting

Chapter 4: Weaving MYACT into Individual Therapy Sessions
Chapter 5: Scope of Practice Considerations for Non-Mental-Health
Professionals
Epilogue
Continuing Your Journey with MYACT
References
Index
 Introduction

Yoga is an ancient practice more than three thousand years old, and
recently it has been the subject of significant empirical research, with
good findings, especially for people who suffer from anxiety, stress,
chronic pain, or depression. Even people suffering from severe mental
health problems, such as schizophrenia, can benefit from this practice.
However, health care professionals have been slow to adopt yogic
practices, while yoga teachers who want to use yoga to help mental
health populations are uncertain of which yogic practices and processes
actually work. Adding to the confusion, the yoga community comprises
a large range of styles, practices, and even spiritual or theoretical ideas,
which makes learning the best practices challenging, to say the least.
As a result, there is an understandable distance between the everyday
evidence-based best practices of clinical health care professionals and
yoga practitioners.
While there is a plethora of empirical support suggesting yoga can
benefit mental health issues, researchers have placed little focus on
understanding the specific yoga processes and practices that work. For
example, research studies rarely distinguish what type of yoga is being
looked at or which specific breathing techniques, mindfulness
directions, or asanas (structural poses) account for any benefits, let
alone do they incorporate mediational analysis to isolate the effective
components of yoga. This has led to a cacophony of theories, opinions,
and anecdotes about yoga with little grounding in science. And, frankly,
this approach is dangerous. Health care professionals and yoga
practitioners (us included) have been so excited by the evidence that
we forgot to slow down and understand why or what works before
rolling out claims that yoga can help those who suffer.
This is where this book—and, more specifically, mindful yoga-
based acceptance and commitment therapy/training (or MYACT)—
comes in. In it, we will introduce you to the practices of yoga,
acceptance and commitment therapy/training (ACT), and the whole
health approach to the mind-body connection. You’ll learn how to
harness yoga’s rich wisdom tradition and practices through the lens of
modern scientific advances for alleviating suffering. From the
perspective that the body and the mind are linked, and that healing
psychological suffering requires treating the whole person, MYACT
helps therapists and yoga instructors guide clients toward emotional
balance and wellness at all levels—physical, psychological, emotional,
and spiritual. It does this by melding philosophy with science, and by
isolating only the practices that are backed by science, to effectively
help those who struggle with painful experiences create a meaningful
life.
Yoga teachers and health care professionals are similar in that both
arrived at their careers strongly valuing helping others. Both hope to
inspire emotional balance and wellness in clients who are suffering, but
problems can arise when these professionals struggle or feel restricted
in their abilities to effectively target the turbulent minds of those who
suffer with mental health–related problems.
Many people do not respond to talk therapy or seated meditation
despite the plethora of documented benefits of these approaches
(Eisendrath, Chartier, & McLane, 2011), and movement practices alone,
such as those found in yoga classes, are not sufficient to address the
emotional and psychological needs of some participants. This book and
the protocol within are designed to target these people and present a
way to increase psychological flexibility—that is, the ability to connect
with the present and choose how to act based on what’s important to
that person in that moment, regardless of what painful content shows
up. The protocol uses specific evidence-based practices in yoga as an
active form of mindfulness in order to train people how to engage these
core processes of health and well-being. Health care professionals and
yoga teachers alike will come away from this book with a new way to
promote emotional balance, valued living, and general wellness in their
clients.
MYACT combines the framework of ACT with the core scientifically
identified components of yoga that work to heal. ACT helps people to
recognize that trying to avoid or escape painful experiences does not
work, and that learning how to accept painful content can help them live
a more meaningful, connected life. ACT is already a well-established
therapy for increasing psychological flexibility and for helping people
achieve emotional balance, both of which it does by encouraging
creativity and flexibility. In the case of MYACT, yoga is the tool through
which clients are trained in ACT processes, yet it is more than simply
learning a few yoga poses. MYACT is understanding how the wisdom
and traditions of yoga meld with the science and clarity of ACT to
become one. We do not call our protocol “yoga plus ACT” because we
view the whole as greater than the sum of its parts.
On its own, yoga provides a physical practice with a rich wisdom
tradition that prescribes how practitioners should live their lives. And on
its own, ACT provides an evidence-based approach to increasing
psychological flexibility and well-being, but it is still very much a seated
practice of talk therapy. When used together, however, ACT adds
context to the prescriptive wisdom traditions of yoga to create more
flexibility and autonomy in how one chooses to approach life,
suggesting that what matters to each person is unique. Yoga adds
techniques and practices (asanas, mantras, meditations) to ACT that
can reach those who don’t respond to seated meditation or talk therapy
or who are interested in a novel, less stigmatized way of healing. Yoga
is an experiential way of teaching ACT through movement, helping
people connect with and notice sensations in their bodies and any
thoughts or feelings that arise. The last piece of the MYACT puzzle,
whole health, helps us choose, based on who and what matter to us,
which behaviors and habits we want to strive for in our efforts to find
emotional balance and wellness.
Yoga teachers and health care professionals will both gain wisdom
from this book. On one hand, yoga teachers will learn how to use yoga
appropriately with mental health populations. They’ll learn which
practices are evidence based and actually help clients, and which
practices to avoid—those that may sound good or are considered
“general wisdom” but in reality can be harmful to clients. Yoga teachers
will also learn about the principle of psychological flexibility, a measure
of emotional balance that may help them deal with emotional or
psychological issues that can manifest in class or individual sessions.
Health care professionals, on the other hand, will learn how to
incorporate yoga practices into their current talk therapy, to use the
eight-week MYACT protocol, and to relate to painful cognitive content
through the body. They will expand their therapy repertoire with physical
relating, and they may be able to reach those who otherwise may not
respond to treatment.

About This Book

In this book, we first offer a conceptual understanding of human
suffering and provide a strong theoretical foundation for MYACT,
followed by three parts. Part 1 covers three distinct subjects:
acceptance and commitment therapy/training (ACT), the evidence-
based psychological intervention used in MYACT; yoga, including its
physical practice and philosophical lineage as organizing principles for
ancient teachings and wisdom; and whole health, a modern approach to
integrating empirically supported best practices in nutrition, movement,
self-care, sleep, and health behavior change. In part 1, we dive deeply
into ACT, as epitomized by the ACT matrix and life map. We conclude
with an overview of how to safely practice and teach yoga, including
information about anatomy and functional movement.
In part 2, we present the MYACT protocol the way we do it, step-
by-step, in its most current evolution. Each section in part 2 is a guide
for using MYACT in groups. Melding the trifecta of ACT, yoga, and
whole health is a large undertaking, which is why we developed the
eight-week MYACT protocol. Our hope is that this protocol will provide
you with a starting point from which you can weave this practice into
yours. The protocol affords plenty of opportunities for creativity and
modification along the way so you can make it something uniquely your
own that will work with your own client population. We have also made
all the worksheets for the program available for download at the website
for this book: http://www.newharbinger.com/42358.
Part 3 covers scope of practice considerations for professionals not
working in the mental health field. We include information about and
skills for implementing this protocol or specific yoga practices in a
variety of settings (yoga studio, outpatient groups, inpatient settings)
and with individual clients. All health care professionals can incorporate
these skills into their practice regardless of whether they have the
structural capacity or support to run the full eight-week protocol.
Before You Jump In
Whether you are new to yoga or ACT, or both, this book will provide you
with the tools and foundational understanding needed to integrate
MYACT into your practice. All information presented in this book is
backed by science and informed by the perspectives of a social worker
and yoga instructor (Tim), psychologist (Jessica), and yoga instructor
(Steve). Our hope is that this book will allow you to view yoga, ACT, and
the whole health approach through a unique, unifying lens, revitalizing
your personal and professional practice and providing you with the
wisdom and knowledge necessary to bring MYACT to your clients and
community.
 Chapter 1
Understanding Human Suffering

This chapter is dedicated to understanding and connecting with the

experience of suffering, as it is only through leaning in to our full lived
experience, even the painful parts, that we can move forward with a
meaningful life. Using the science of acceptance and commitment
therapy (ACT) and the wisdom of yoga, we explore how and why
people suffer, drawing on the philosophies that support each. In the
following journey through the history of the work we do in MYACT we
cover a range of topics, from broad foundational ones to specifics of
what we choose to do with our pain in any given moment. We finish the
journey with a discussion of the whole health model, an approach to
living that connects us with the tangible behaviors that move us toward
what matters most to us.

Suffering and Psychological Flexibility

ACT therapists and yoga teachers may define suffering differently, but
the spirit of healing defines each vocation. And through both personal
and professional experience, yoga teachers and ACT therapists
understand that all beings on this planet struggle with painful, aversive
experiences, and always will. We can no more guarantee the
elimination of pain for our clients than we can control when the sun
rises each morning.
Suffering, however, emerges as we attempt to avoid, escape, or
control painful experiences, rather than sitting with the knowledge that
pain is a part of life. The more we fight with ourselves, the harder the
struggle becomes and the greater the suffering. A therapist might find
herself sitting across from a person who describes a tiny life in which
they feel trapped by crippling anxiety. In their desire to not feel pain, the
client explains how they no longer drive, go out to see friends, or
engage in the activities that once enriched their life with happiness. In a
yoga class, a teacher might see a student stay in the back of the class,
not attempt more challenging poses, and make self-deprecating
comments about not having a “yoga body” due to painful thoughts and
memories rather than actual ability in the class. In these situations,
suffering comes not from the anxiety one feels, or from the body’s
inability to bend a certain way, but from the way we try to escape a
feeling or sensation we don’t like.
If suffering is the result of our attempt to control or avoid pain,
rather than the experience of pain itself, then an openness to the truth
that pain will always be there and the flexibility to meet that pain and
continue forward in our journey are the ways through suffering. When
we refuse to come into contact with pain, our world becomes very small
and rigid, one focused solely on escape. In ACT, we call this
psychological inflexibility, which is the opposite of psychological
flexibility, our model of healing and emotional balance.
We define psychological inflexibility as attempts to avoid, control, or
escape a painful experience that limit one’s repertoire (what one does
when pain shows up) and negatively impact long-term quality of life.
Psychological inflexibility is about what someone does in a specific
situation and how well that behavior works. An ACT therapist is
interested in the things people do to try and limit their contact with the
thoughts, feelings, sensations, and memories they don’t want, and to
understand how their attempts to limit that contact may also be
impacting their connection to what matters most in life. It is normal to try
to protect ourselves from pain and perceived threats. However,
attempts to escape, avoid, or control painful experiences become
problematic when they interfere with a life well lived (for example,
avoiding relationships or intimacy for fear of rejection, working long
hours to escape downtime when upsetting thoughts pop up). Note that
this definition does not suggest that escaping, avoiding, or attempting to
control painful experiences is purely pathological. Sometimes
avoidance is helpful! Our focus is on understanding which behaviors
don’t move people toward the life they want to live, whatever that may
be.
 A person suffering from anxiety may not be able to overtly explain
to you their psychological inflexibility, but if you listen closely and watch
what happens when anxiety shows up in the form of panic attacks,
worrisome thoughts, self-reported heart pounding, or sweating, you’ll
see psychological inflexibility in their attempts to escape what they don’t
want to feel. This presentation may look different for different people.
One person may stop driving in response to fear or a panic attack. In
response to thoughts that they have to keep up to avoid looking foolish,
others might force themselves deeper into yoga postures than is safe in
an attempt to mimic what they see around them in the studio rather than
using the feedback from their body to guide their practice. Another
person might avoid social situations or places, or stay in a job that they
hate, rather than trying something new or chasing a more meaningful
life. When it comes to psychological inflexibility, the point is not what we
see people doing but how what they’re doing works in their situation.
Remember, the goal is not to remove pain. The goal is to halt
unworkable attempts to escape or avoid pain that lead to suffering, to
be flexible rather than rigid in the presence of pain. Yoga and ACT
perceive pain similarly: not as a disease to be cured but a source of
information. Physical pain informs yoga practitioners. It tells them to be
gentle and to listen to their body, to notice how muscle groups
compensate, to be cautious, and to be aware of how the nervous
system communicates through breath and sensation. Emotional or
cognitive pain informs ACT practitioners. Painful mental content
(thoughts, feelings, memories, physical sensations) is related to
something important, so they know to listen closely to this pain in order
to understand what matters.
Humans have a unique ability to bring pain into awareness, even
when painful experiences are not present. A wolf may be cold and
hungry, but as soon as it has food in its belly and it is curled up and
warm in a cave with other wolves, the wolf does not think about its next
meal. But a warm, safe, and satiated human can ruminate on where the
next meal might come from. This last point is extremely important:
humans have a unique ability to experience pain, even when they are
not directly presented with it. Through thoughts and memories we can
bring painful experiences into any moment and dream up potential
future problems. This ability can cause unlimited suffering, and it can
take people out of the moment they are actually living. Advances in
behavioral science explain why.
Relational Frame Theory (RFT) and Yogic
Sādhanā
Relational frame theory (RFT) is a scientific, empirically supported
theory that posits that language, the things we think and feel, is a
behavior, and that this behavior occurs within a relational network of
thoughts, feelings, memories, physical sensations, and experiences. It
further suggests that this relational network can be linked to others,
thereby creating complex connections between experiences that may
not seem obvious or apparent. This ability to create relational networks
and complex connections between experiences is what allows us to
create symbolic meaning for objects. For example, it’s how a piece of
paper becomes valuable through its representation as currency. It’s also
what allows us to connect places, objects, and people with thoughts
about future worst-case scenarios, trauma memories, and labels about
our abilities or the roles we have. It’s how worry about a future meal can
show up when we’re safe, well fed, and warm.
Once these networks and connections are made, they cannot be
removed; we cannot unlearn or erase a painful memory or upsetting
thought. The only option is to make more connections. This is important
to understand: although people may attempt to avoid, control, or escape
their most painful private experiences, that pain is permanently
inescapable. There is no delete button for what shows up inside of us.
No matter how hard we try, we can never permanently remove or delete
painful experiences from our relational networks—they are a part of our
experience, and we can no more stop a painful thought from popping up
than we can stop the sensation of physical pain when we break a leg.
When we begin to recognize the unworkability of attempts to avoid,
escape, or delete painful content, we can change our focus, or create
flexibility, in the presence of this pain and the networks it creates.
One way we can create flexibility is to see ourselves as being
separate from our experiences. We are the observers of all these
connections and experiences. For example, there is a you behind your
eyes reading the words on this page, taking in the information, and
working through what it means in the form of thoughts in your mind. By
understanding the impact this has on our life, and by noticing our drive
to escape or avoid, we can instead choose to behave in a different way.
Rather than reacting automatically, unsuccessfully running away from