Yoga for Stress Management Program asa Complementary Alternative Counseling

Resource in a University Counseling Center

Colleen K. Milligan

AYoga for Stress Management Program (YSMP) that served as a complementary alternative therapy resourcewas successfully implemented at a midsize, predominantly undergraduate university. It v/as offered in addi-tion to traditional treatments for student mental health. Counselors, Residence Life staff, and faculty foundthat the program v/as useful for their students/clients, who reported many benefits from participation.Participants in thisYSMP included students and faculty/staff. Logistics of setting up aYSMP are outlined.

The innovative practice program of focus is a Yoga for Stress Manage-ment Program (YSMP), first implemented in the fall of 2001. Theprogram has been used since then as a complementary alternative

therapy designed to help students cope with stress (Long, Huntley & Ernst,2001; Rubin & Feeney, 1986). This program was developed and has beenused with the intention of providing preventive, psychotherapeutic, anddevelopmental assistance to students (Keeling, 2005). In this article, I in-troduce the concept of a YSMP, consider therapeutic uses of yoga, anddescribe the basic logistics of creating and implementing such a program.

Overview and Rationale for the YSMP

University counseling centers are serving a more psychologically di-verse student population who present with more severe issues thanever before. Furthermore, students are less likely to persist academi-cally in the face of distraction and difficulty, and most of those wholeave college report difficulty with chronic health problems, sleep,anxiety, and depression. Often, counseling center financial, physical,and personnel resources do not increase in proportion to increasedstudent needs for services (Kitzrow, 2003; Levine & Cureton, 1998a,1998b; Sharkin, 1997, 2004; Wilson, Mason, & Ewing,1997). Theuse of primary prevention and health promotion groups can be an ef-ficient, creative, and diversity-enhancing way of meeting students' stress-management needs. These groups can help students become more awareof their own mental and physical health and provide many teachablemoments, thereby improving their capacity to self-assess and managetheir health (Keeling, 2005).

Colleen K. Milligan, Central Michigan University Counseling Center. Correspondence concerning this article should be

addressed to Colleen K. Miiiigan Central Michigan University Counseling Center, 102 Foust Hail, Mt Pleasant, Ml 488S9

(e-mail: miili1ck@cmich.edu).

© 2006 by the American Counseling Association. All rights reserved.

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The YSMP is designed as a skill-based group therapy technique. It is designedto help promote normal developmental growth potential by increasing self-awareness and self-acceptance and by teaching stress-management skills. Theseyoga-based skills can help to prevent student stress from leading to develop-mental delays or declining mental and physical symptoms. For centuries. EastIndian cultures have incorporated yoga into their psychological mind-bodytherapies and often use yoga with the assumption that it is helpful to those withmental, emotional, and physical problems (Ram, 2005; Sinha, 1984). Themany physical and mental benefits of general yoga practice in helping clientshave been reported anecdotally and are empirically supported (Jensen & Kenny,2004; Malathi, Damodaran, Shah, Patil, & Maratha, 2000; Mishra & Sinha,2001; Naveen, Nagrathna, Nagendra, & Telles, 1997; Nespor, 1993; West,Otte, Geher, Johnson, & Mohr, 2004). The National Institute of MentalHealth (NIMH) has suggested that mild exercise or yoga may have a positiveeffect on various aspects of mental and physical health (NIMH, 2005).

In my YSMP counseling center group, I integrated physical yoga exercises(asana) and breath work (pranayama) with Eastern psychology, mindfulness,meditation, and traditional stress-management principles. The mission of theprogram is to provide stress-management and relaxation skills, which assistparticipants in improving their ability to relax at will, to focus their atten-tion, to reduce anxiety and depressive symptoms, and to enhance theiroverall wellness. Because stress can be crippling to natural abilities, studentsin the YSMP are encouraged to realize that stress is the body's naturalinternal communication, which cannot and should not be disregarded oreliminated entirely. Rather, stress must be worked with effectively in orderto increase self-awareness. The YSMP provides information about how thebody and mind interact and increases understanding of how to care for thebody and mind using techniques taught in group meetings.

Logistics

Publicizing the YSMP

The most effective methods for publicizing the program for students werereferral by counselors and Residence Life staff, invitation by fiiends, and theuse of fiyers. Using an electronic mailing list was the best method of advertisingthe program among faculty and staff, who were periodically e-mailed announce-ments about the YSMP during the semester. Students were given flyers toshare with fiiends who might also find the program useful. Many faculty mem-bers who received the announcement via an electronic mailing list were willingto announce the YSMP in classes. Flyers were provided to all instructors of FirstYear Experience fi-eshman orientation courses, increasing awareness of not onlythe YSMP but also the university counseling center's resources in general. Asthe facilitating therapist, I made many campus presentations to counseling cen-ter personnel, to faculty/staff groups, and to registered student organiza-

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tions. Student Health Services was given flyers and posted them each semester.Residence Life staff were given flyers each semester.

Participants

Both students and faculty/staff were included as program participants. Thiswas done in the hope of increasing interest in the program and increasing thenumber of participants. In addition, it was hoped that faculty/staff might act asmentors and role models for students by using the YSMP to manage their ownstress. Although faculty and staff do not receive counseling services at theuniversity counseling center, the administration determined that there was noconflict of interest in allowing interested faculty/staff to attend the group be-cause individuals were not expected to disclose personal information duringYSMP sessions. An unexpected multigenerational effect was noted. Studentsfound it encouraging to see faculty of various ages achieve, or struggle toachieve, the yoga postures, much hke the students themselves. They also en-joyed getting to know the faculty and staff as "real people."

Participants indicated a variety of motivations for attending the YSMP, in-cluding relief from stress associated with being a student, a desire to learn andexperience a new exercise, invitation by friends (social or recreational motiva-tion), referral by counselors and other campus professionals, or trying to over-come the negative impact of stress (academic or social struggles) on one'scollege career. Goals that participants stated they hoped to achieve by attend-ing the YSMP included relaxation, stress relief, desired increase in energy,improved flexibility, mental focus, health and fitness, greater body awareness,gaining peace and patience, having fun, and attempting to establish a routine.

Location and Scheduling

A local campus ministry had an especially pleasant open space for gatheringsand was asked for a loan of the room to the counseling center for the groupmeetings. The campus ministry did not choose to charge for the roombecause the YSMP was a service offered to students free of charge. Othercampus rooms have been used at times but were not available on a regularbasis. When trying to fmd a place to hold group meetings, both on-campusand off-campus locations (within walking distance) can be considered.

A number of scheduling options were attempted at the beginning of the pro-gram. The Thursday morning (8 a.m.), once-a-week program showed the bestattendance compared with a twice-weekly program. Many participants said theypreferred a late-in-the-week schedule because it helped them decompress stressaccumulated earlier in the week, and many wanted to de-stress before the week-end. A schedule of two sessions per week was also tried with one session at 8a.m. on Mondays and one session at noon on Thursdays. This program becamespottily attended on both days. Attendance at the noon session dropped becausepeople felt more rushed than they did in the Monday morning session and be-

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cause more noon classes are now being offered by the university. Students,faculty, and staff have frequently requested a night program.

Finding the YSMP Facilitator

Some university counseling centers may not have a staff member who istrained in yoga or interested in facilitating a YSMP. One way of procuringa qualified person to facilitate such a program is by co-opting a yoga-trainedmember of the university health or athletic facility who may already lead ayoga class. Counselors could then collaborate with the athletic/physicaleducation professional, sharing stress-management concepts and develop-ing affirmations (or using existing affirmation materials) appropriate forpromoting mindfulness and relaxation. Affirmations would be used duringasana practice and breath/mindfulness portions of the sessions. Attendanceat yoga seminars by yoga-interested faculty or extending invitations forprofessional development to yoga experts to make presentations at theuniversity may be ways of finding a YSMP facilitator and ultimately encour-aging buy-in from the counseling staff once they may have experiencedsome yoga and learned something about it. Community yoga centers andhealth clubs may also be considered as resources for finding individualsspecifically trained in teaching yoga with whom counseling staff can consultor collaborate in developing a YSMP.

Program Considerations

The YSMP is not entirely different from general yoga classes that are heldat fitness facilities or yoga centers. One does not necessarily have to have aproblem with stress to attend because yoga has a preventive as well as areparative focus. The YSMP differs from general yoga because the affirmationsused during asana, guided meditation, and relaxation are infused with typi-cal examples of age- and stage-appropriate case considerations. The YSMPcapitalizes on openness, relaxation, and teachable moments created by theyoga practice. Some examples of issues that can be infused into yogaaffirmations are body/self acceptance issues, feeling overwhelmed, socialjudging and being judged by others, finding balance between activity andstillness, overcoming feelings of anxiety or depression, instilling hope, moti-vation, increasing one's ability to focus the mind, and beliefs about confi-dence or empowerment over a situation in one's life. Other more specificstress-management principles include awareness of physiological changes whenanxious, breathing or muscle tension awareness, consciously letting go ofcontrol, becoming aware of beliefs and releasing unwanted thoughts, instill-ing the belief that thoughts control emotions, and increasing awareness ofsupportive or unsupportive self-talk. Metaphors are frequently used by yogateachers during guided meditation exercises to help provide a framework forunderstanding the self For example, a yoga teacher may teach students to

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view uncontrolled emotions as wild horses pulling in various directions,which they can learn to tame. In this way, students develop the belief thatthey control their mind and are not controlled by it and that situations havesolutions that may be hidden deep inside the individual and that can beaccessed through stillness. Breath and meditations may also be depicted asa silken thread, a string, and finally a rope, which can then be used to escapethe tower of doubt, fear, and anxiety that has entrapped the individual. Insum, each instructor must use his or her own personal/clinical experienceand imagination to develop affirmations or metaphors. There are varioustexts that instructors can consult, and variations of affirmations and meta-phors can be created depending on the group being facilitated (see Yee &Zolotow, 2002, for examples).

For the purposes of the YSMP, the yoga teaching level should remain at agentle beginning level of physical challenge and should be made accessible toall students, regardless of ability. It is important to emphasize that individualsneed to be aware of their limitations when attempting to perform yoga pos-tures and breath work and must listen to their bodies, remembering not tocompete or compare themselves with others in the group. This tenet shouldbe strongly promoted in YSMP programming. The YSMP must not be aforum for competition or comparison. Individuals of any physical ability canperform many of the relaxation techniques, breath practices, and asana pos-tures. However, individuals should consult their physician with concerns priorto participation. Persons with physical disabilities can perform the proceduresfrom a seated posture (on the floor or in a wheelchair) and can use the mindto envision the completion of the posture to afford the energetic and stress-management benefits of yoga.

Conclusion

The YSMP can be considered as an innovative approach for addressing stu-dent stress problems and increasing the diversity of services offered by uni-versity counseling centers. A student who is reluctant to seek traditionalcounseling may see this type of therapy as an acceptable alternative. Barriers(e.g., shame for seeking help) and stereotypes held by some students aboutseeking mental health services can be overcome by offering such an alterna-tive type of therapy service. Yoga tends to be viewed as an enjoyable way tocope with stress.

This counseling center program has become a favorite among students andfaculty who wish to manage stress in a natural and alternative fashion. How-ever, at least three considerations need to be made prior to beginning such aprogram. First, buy-in from counseling staff is crucial for a program to besuccessful. Also, because this type of program may be considered a departurefrom traditional counseling center services, informing the campus communityof the potential benefits of such a program and garnering interest and support

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are an initial challenge. Presentations must be developed discussing thehistory, applications, and usefulness of yoga and its potential applications tomanaging stress. Contacts with interested parties are made in this manner.A second challenge in setting up a YSMP is locating available staff who havean interest in yoga and who have developed expertise in stress manage-ment or in the relationship of exercise to mental health. The YSMP canfunction as a natural extension to traditional stress-management programs.A third challenge is assessing and gaining administrative support and ex-amining policy and liability issues related to this type of programming. Inmy experience, the most essential components are a willing and interestedcounseling center staff and the support of the administration. Discussingspecific programming ideas with colleagues may increase the likelihood ofreferrals and also reduce misunderstanding about the purposes, risks, orbenefits of such a program. Each counseling center is unique in its missionand core values in providing services to its campus community. Interestedcounseling centers must determine whether or not a YSMP will work intheir setting. In some cases, the feasibility of a YSMP may not seem prom-ising based on an analysis of setting, personnel, budgetary resources,administrative support, and flexibility of programs. In cases where a full-fledged program is deemed unlikely to succeed, some simple yoga tech-niques may be easily learned and implemented by counselors as an adjunctto their usual individual sessions. Use of simple yoga techniques in ses-sions for relaxation and calming may be appropriate for clients who havedifficulty using traditional mental health strategies for managing stress.Simple yoga techniques may allow clients to calm themselves and ulti-mately function more effectively, both in and outside of sessions. In con-clusion, the use of a YSMP as a complementary alternative counselingresource in university counseling center settings is a promising innovativepractice. It is hoped that practitioners will explore the potential benefits ofthis program on their own college and university campuses.

References

Jensen, P. S., & Kenny, D. T. (2004). The effects of yoga on the attention and behavior ofboys with attention-deficit/hyperactivity disorder (ADHD). Journal of Attention Dis-orders, 7, 205-216.

Keehng, R. P. (2005, November). Prevention in higher education: What is college healthabout? Student Health Spectrum, 3-8.

Kitzrow, M. A. (2003). The mental health needs of today's college students: Challenges andrecommendations. NASPA Journal, 40, 167-181.

Levine, A., & Cureton, S. (1998a). What we know about today's college students. AboutCampus, 3{\), 4-9.

Levine, A., & Cureton, S. (1998b). When hope and fear collide: A portrait of today's collegestudent. San Francisco: Jossey-Bass.

Long, L., Huntley, A., & Ernst, E. (2001). Which complementary and alternative therapiesbenefit which conditions? A survey of the opinions of 223 professional organizations. Comple-mentary TherapiesinMedicine, 9,178-185.

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Malathi, A., Damodaran, A., Shah, N., Patil, N., & Maratha, S. (2000). Effect of yogic prac-tices on subjective well being. Indian Journal of Physiology and Pharmacology, 44, 204-206.

Mishra, M., &Sinha, K. R. (2001). Effect of yogic practices on depression snd anxiety. JournalofProjective Psychology and Mental Health, 8,22,-27.

National Institute of Mental Health. (2005). Depression: What every woman should know.Retrieved August 18, 2006, from http://www.nimh.nih.gov/publicat/depwomenknows.cfm

Naveen, K. V., Nagrathna, R., Nagendra, H. R., & Telles, S. (1997). Yoga breathing througha particular nostril increases spatial memory scores without lateralized effects. PsychologicalReports, 81, 555-561.

Nespor, K. (1993). Twelve years of experience with yoga in psychiatry. International Journalof Psychosomaties, 40(1-4), 105-107.

Ram, R. (2005, November). Self management of exeess tension for total health seminar. Semi-nar sponsored by the Indian Yoga Institute, Bangalore, India, and presented at CentralMichigan University, Mt. Pleasant.

Rubin, D. C , & Feeney, C. (1986). A multicomponent stress management program for col-lege students. Journal of Counseling & Development, 64, 531.

Sharkin, B. S. (1997). Increasing severity of presenting problems in college counseling cen-ters: A closer look. Journal of Counseling & Development, 75, 275-281.

Sharkin, B. S. (2004). College counseling and student retention: Research fmdings and im-plications for counseling centers. Journal ofCollege Counseling, 7, 99-108.

Sinha, A. K. (1984). Eastern and Western psychotherapies. Indian PsyehologiealReview, 27(\-4), 1-16.

West, J., Otte, C , Geher, K., Johnson, J., & Mohr, D. C. (2004). Effects of Hatha yoga andAfrican dance on perceived stress, affect, and salivary cortisol. Annals of Behavioral Medi-cine, 28, 114-118.

Wilson, S., Mason, T., & Ewing, M. (1997). Evaluating the impact of receiving univer-sity-based counseling services on student retention. Journal of Counseling Psychology,44, 316-320.

Yee, R., & Zolotow, N. (2002). Toga: The poetry of the body. New York: St. Martin's Griffin.

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