Yoga Nidra Efficacy for addiction and trauma: a preliminary research study
What is Yoga Nidra?
Yoga nidra is a potent ,specific guided meditation entraining aware relaxation at each level of the koshas (layers of consciousness in the yogic/ayurvedic system) systematically and utilizing the neurological stages of sleep to engage the participant’s natural capacity for self healing , balancing brain chemistry, improving sleep , mood regulation and much more. While there is a recent body of research applying yoga nidra to PTSD for use in VA hospitals, the practice has untapped potential to be relevant in the treatment of addiction, which is typical accompanied by a history of significant trauma -even if not always manifesting as PTSD.
Lineages
To this author’s knowledge, as of just a couple years ago there were only four distinct but overlapping approaches to yoga nidra that are rooted in identifiable ancient lineages traceable to specific individuals who brought these teachings forward in the USA beginning in the 1960s. (This author has training in all four and significant training and credentialing in 1 and 2 below):
1. Amrit IAM Yoga Nidra ; Gurudev Shri Amritji ( aka Yogi Amrit Desai)
2. Himalayan Institute : Swami Rama ;Swami Tunaigait ;Rod Stryker
3. Behar School of Yoga Nidra ;Swami Satyananda Saraswati
4. iRest (Integrity Restoration),combines yoga nidra with MBSR; Dr Richard Miller PhD and Jon Kabat Zinn MD , as well as other psychological techniques.
Ancient Source Texts
One of the earliest source texts that mentions Yoga Nidra as “Mystic Slumber” is the Brahma Samhita . There are myriad iterations of the Story wherein The Creator Vishnu (aka Narayan aka Bhagwan ) takes shelter of Yoga Nidra. , mystic slumber, and where he then dreams the material worlds into being. Yoga Nidra is also understood and know as the Goddess, Yoga Nidra.
Stages of sleep known in contemporary science are accurtely described in the ancient Mandukya Upanishads.
There are specific descriptions in ancient texts of two of the fundamental yoga nidra companents: 61 points and 45 breaths practices.
Context of Yoga Nidra Efficacy Preliminary Study
This author had the opportunity to share Yoga Nidra over a 5 month period Jan 2018-May 2018 , at a rehab center for substance addiction and trauma.
Sample Population: Participants participated optionally. (They were given a choice of another program to attend that 90 minute block)).They were all post medical detox by anywhere from 6 days to over 160 days, between ages 18–66, all genders, multiple races. Substances of choice and length of use varied greatly. The group size varied from 6 -18. The make up of group participants varied daily. Some participants experienced yoga nidra only once, others as many as 8 times. Participants had available props of yoga mats, bolsters and eye . Nidra was offered at 9 in the mornings,twice a week Tuesdays and Thursdays in a spacious yoga room, facilitated by this author. The Amrit IAM Yoga Nidra approach to yoga nidra was used consistently and with dedication.
Every effort was made to create a context of safety. For instance , participants were always given the option to sit up during the practice, open their eyes, opt out, or stop at any point, even leave the room. Participants always had sufficient space so no one was physically touching anyone or any wall . Participants were always given a brief explanation of the practice , it’s purpose and known, evidenced based efficacy in treating PTSD in VA hospitals. The majority of participants had never practiced any meditation before coming to rehab and none had an established meditation practice. None had heard of ,or practiced, yoga nidra previously.
Development of The Research Tool
The Yoga Nidra Self Assessment Scale (YNSAS) was developed by myself, Dr. Hanna Chusid ,Ed.D in October 2017, while working with clients in a rehab treatment program for substance addiction and underlying trauma.
YNSAS is a Likert -like scale of measures that includes the “loudest”, most recognizable symptoms of addiction: 1.Cravings 2.Anxiety 3.Depression. In addition, clients were asked to score their feelings of hope, as a measure of resilience . The client/participants were asked to complete this YNSAS all four measures pre and post experience of yoga nidra. The purpose of the self-evaluation tool was initially to provide the Yoga Therapist (in this instance , the author) with client feedback to use in clinical documentation. Other benefits were discovered in the process as described below:
Pros to the YNSAS Research Tool
1.Various layouts of YNSAS were tried before settling on one page, two-sided sheet of paper.It is easy to administer and cost effective to duplicate.
2. There is no significant investment required from the Yoga Therapist or the organization.
3. YNSAS can be easily replicated in various settings due to its concise and clear instructions
4. YNSAS can be readily adapted to other client populations and foci of concern
5. YNSAS provides immediate feedback to the client, the practitioner,the treatment team and insurance providers
6.The concrete feedback provided facilitates Yoga Therapist/team identification of instability/red flag concerns , supporting triage and immediate intervention after yoga nidra, as needed.
7. A self-assessment format invites self-reflection and empowerment of the client.
8. Clients addressing addiction /trauma often present with difficulty in recognizing and regulating their emotions. This tool is an intervention in itself, as it invites clients to observe, notice and assess incremental sensate /emotional change. The tool provides gentle structure for entrainment of self observation.
9. The tool provides documentation required by organizations for billing and insurance claims. Yoga nidra is commonly provided in a group setting,with insufficient time for depth verbal sharing/feedback from all participants. This tool aids Yoga Therapist ‘s client notes .
10. For this study the tool was HIPPA compliant since someone other than the data collector /an assistant codified the results ,leaving off names
Cons to the YNSAS Research Tool
1. In developing the YNSAS , the practitioner understood the importance of including the strengths-based perspective. However, including a measure of hope posed a challenge. Since this was viewed as the only positive attribute (as compared to symptoms of anxiety, cravings, and depression), clients had difficulty using the same rating scale. Lower ratings of symptoms were intuitively viewed as “good,” while higher rates were viewed as “bad.” Some clients felt the measure of hope should be rated inversely, with higher rates as “good.” Clients were confused by this measure and often unintentionally reported low rates of hope. The tool was reformatted various times in an attempt to highlight this difference. In addition, the practitioner highlighted this matter verbally in each session. The collected data on “hope” was so corrupted by this confusion that it was not included or tabulated in final analysis.
2. Another source of confusion was the rating scale itself. The rating scale was listed from 1–10, with 1 being the lowest amount and 10 being the highest amount. Some clients hand wrote in a 0, to reflect no amount of symptoms. In the future, the tool may be revised to allow for a 0 rating, as a current hand written rating of 0 contaminates the data. These few hand written in YNSAS were eliminated from the data base.
3. Self-assessments are inherently flawed due to their subjectivity and lack of experimental reliability or validity. Therefore, YNSAS is recommended for all the Pros listed above but is not sound enough to help understand the long-term effect/impact or draw causative conclusions.
The Yoga Nidra Self Assessment Scale
The same rating scale was completed by participants both prior to and immediately after experiencing yoga nidra. After several variations , the final version provided the same scale (and opportunity for comment — providing qualitative data ) on a two sided one page sheet. It was not possible to reproduce the exact image of the scale as it appears on a paper hand out, for this article in this on- line format. The summary below provides a clear indication of the YNSAS . Contact this author to request the actual formatted YNSAS tool.
Instructions: Rate how you feel for each scale from 1–10, with 1 being the BEST (NO symptoms) and 10 being the WORST (most symptoms)
YNSAS SIDE 1: BEGINNING OF SESSION.
CRAVINGS (none to crawling out of your skin with cravings)
ANXIETY (none to incapacitation and/or panic)
DEPRESSION (none to deep despair/suicidal )
HOPE (none to extremely optimistic an hopeful)
Anything else you want to share from the BEGINNING:
YNSAS SIDE 2 : END OF SESSION /Exact same scale as above with differing writing cues:
IN THIS SESSION What was the most useful, helpful, or encouraging thing you….
Learned:
Practiced:
Heard:
Shared/Expressed:
YNSAS Preliminary Study Data Analysis
Credit: Statistical calculations and preparation of graphs by Katie Abelson MSW, ASW supervised by Dr. Hanna Chusid, Ed.D
Repeated Measures T-Test
The Yoga Nidra Self Assessment Scale (YNSAS) uses self-evaluation before and after the yoga nidra intervention. The four measures include cravings, anxiety, depression, and hope. During the study, the measure of hope appeared to confuse participants. All self-ratings for hope were discarded from the study. Incomplete evaluations were also discarded, resulting in a total sample size of n=64. While analyzing the data, 15 outliers were noted. These outliers consisted of participants who rated themselves with higher cravings, anxiety, or depression after the intervention. Although one would expect the data to be contaminated by these outliers, the statistical analysis proved that the results were the same with outliers included or excluded.
To measure the effects of yoga nidra, the researcher used a repeated measures t-test. This statistical calculation compares the same sample before and after the intervention. Using a p-level of 0.05 means that there is 95% confidence that the sample mean reflects the population mean. Upon testing each measure (cravings, anxiety, depression), the level of significance, or p-value was p < .00001. This means that the confidence level is greater than 99.9% and the sample is reflective of the total population. Differences in self-assessment before and after the intervention are statistically significant. Visual bar graphs of this data are available by contacting the author.
The Repeated Measures T-Test measures the whole sample (n=64) before and after yoga nidra. Self-report of cravings, anxiety, and depression were all significantly lower after the intervention.
When calculating for before and after cravings, the value of t is -5.101410. The value of p is < 0.00001. The result is significant at p ≤ 0.05. While examining changes in anxiety, the value of t is -9.862010. The value of p is < 0.00001. The result is significant at p ≤ 0.05. Finally, calculations for differences in depression resulted in a value of t at -6.864510. The value of p is < 0.00001. The result is significant at p ≤ 0.05.
T-Test for Two Independent Means
The YNSAS was administered at an intensive outpatient program for addiction treatment. The clients stay in treatment for varying amounts of time and participate in a variety of therapeutic modalities. While some clients experience yoga nidra multiple times, some clients experience it only once. While n=22 participants received the intervention once, n=42 participants received the intervention multiple times. The study did not explore differences in amount of sessions within the multiple sample group.
To measure differences between the two sample groups, the study utilized a t-test for two independent means. This statistical analysis is used to compare two independent groups, the one-time versus multiple times yoga nidra participants. Using a p-value of 0.05, the differences in cravings, anxiety, and depression were not statistically significant between groups. The positive short-term effects of yoga nidra can be seen after the first session; however, the YNSAS does not measure long-term effects of continued yoga nidra practice.
The T-Test for Two Independent Means was used to compare two samples: participants who received yoga nidra once and participants who received yoga nidra multiple times. The one-time intervention group had a sample size of n=22, while the sample that received yoga nidra multiple-times was n=42. When comparing the mean self-assessment for each measure after the intervention, there was no statistically-significant difference between the groups. Although there are many known benefits of long-term yoga nidra practice, this study does not measure the effects over time.
When comparing ending cravings, the t-value is 0.11013. The p-value is .912431. The result is not significant at p < .05. Calculating between group differences in anxiety resulted in a t-value of 1.1923. The p-value is .23475. The result is not significant at p < .05. Comparing difference in depression ratings found a t-value of -1.33702. The p-value is .182941. The result is not significant at p < .05. (A visual line graph of this data is available by contacting the author)
Quantitative Data: a Sampler of Client/Participant Comments Following Yoga Nidra
note: The large majority of participants had no prior exposure to meditation and no one had established meditation practices:
” I sat with my SELF, accepting all my feelings.”
“I had a rough morning emotionally. Through yoga nidra I learned sadness is ok”
”I felt empowered and Alone -but good Alone… Alone WITH mySELF”
“I experienced that I can be content in the moment”
“ I inwardly heard ‘I AM SUCCESSFUL’. It gave me a big boost to my motivation”
“I began negative, agitated, angry, frustrated, tense. After, I was calm: 1,000,000,000 xs better!”
“I had a rough few days … then ..in yoga nidra I had that big ‘Ahh~ What a Blessing this Precious Life!”
“I learned to practice patience. A new experience for me”
I felt safe in my body, maybe for the first time ever in my life”
“I began very agitated. I ended very very calm. I learned I can change my mood — without alcohol”
“I REALLY liked that. NOW I have hope I can figure out …sobriety”
”I heard my inner voice saying ‘everything’s gonna be alright’”
“I cannot remember ever feeling that relaxed even using”
“Now I see I am not taking away from anyone else to want something better for myself “
“My sorrow lifted. It is still in me but not taking over. Just…there.”
“I still have a lot of reality stressors, but now I feel calm about dealing with them”
“ I feel RELEASED from my old self image. Now I have a sense of limitless possibilities!”
“I came with many conversations from the day whirling in my head. Now I am totally peaceful”
“…. a sense of completion. My healing work of the past 3 months cycle is now complete. I am at peace”
“I feel ready to make amends to my wife and child “
“the headache I had at the outset is gone. I feel forgiving of myself & others”
Yoga Nidra 1st Timer: “I am feeling hopeful.I don’t have to settle for living miserable. I am seeing the importance of Intention”
”That was great! I feel energized & now I know I have what it takes to heal myself!”
Summary
The results suggest that the YNSAS is an effective tool to measure participants’ self-perception about their internal changes after each yoga nidra practice experience. Data analysis of this preliminary study indicates Yoga Nidra appears to have efficacy for participants in addiction recovery. The results are statistically significant ,warranting further research with a randomized subjects and a control group to further explore the efficacy of yoga nidra practice.
Limits of the Study and Areas for Needed Future Research
This preliminary research does not delve into the differences within the sample. Is there a difference if the participant is addicted only to alcohol? Only to opiods? Opiods and another substances? ..to meth? Does the type/nature/severity of root trauma matter ? Are there significant differences in efficacy between gender? Would the results be the same with another yoga nidra facilitator? …with a recorded yoga nidra experience? What differences would there be if the yoga nidra experience was with the same group of participants consistently over time?
Future research may seek to differentiate between length of sobriety and type of addicting substance. In addition, a measure of pain can be easily added to the YNSAS. Yoga nidra appears to be an effective remedy for pain, which many clients experience during medical detox and the period after. The self-assessment measures can be modified based on the population being served. Although this study was done with clients in addiction recovery, the scale can be adapted for use in many settings and with many populations.
~BE STILL and BE GRATEFUL~
Dr Hanna Chusid Ed.D Lic Psychologist, Yoga Therapist, C-IAYT, Amrit IAM Yoga Nidra ,Artist lives Los Angeles and is available in person and on line . www.mindful-selfcare.com
