Hot Yoga for the Alleviation of Post Acute Withdrawal
There is a growing body of empirical data that supports yoga as an ancillary treatment for recovery from mental health conditions. One of the greatest potentials of hot yoga is its ability to alleviate the symptoms of Post Acute Withdrawal Syndrome.
Terence Gorski points out that “as a culture, we have become very familiar with the suffering and loss associated with active substance use disorder and the acute detoxification stage. We are also quick to notice the psycho-biological symptoms associated with them. What we may not be as familiar with, and completely unprepared for, however, is the discomfort associated with Post Acute Withdrawal Syndrome.”
What is Post Acute Withdrawal Syndrome?
Post acute withdrawal syndrome refers to a cluster of abstinence-based symptoms that set in after a person in early recovery from a substance use disorder (or SUD) has completed acute physical detoxification. PAW can last from weeks to several months, depending on the extent of progression and substances used. PAW makes early recovery difficult to maintain because it is fraught with physical, emotional, and mental disturbances as the brain re-adjusts to a new state of equilibrium.
“The presence of brain dysfunction has been documented in 75-95% of the recovering individuals tested. Recent research indicates that the symptoms of post-acute withdrawal associated with alcohol/drug-related damage to the brain may contribute to many cases of relapse.”
Symptoms of PAW
How Hot Yoga Alleviates PAW
Depression.
Depression includes an inability to experience pleasure or joy (anhedonia); pessimistic and/or negative thinking; irritability; and anger.
Massachusetts General Hospital is in the middle of a comprehensive study on the effects of hot yoga on clinical depression. Preliminary results show a statistically-significant negative correlation between number of classes taken and depression symptoms.
During an informal “Sober Yogis Challenge” study at Blaze Yoga and Pilates and Steamhouse Yoga and Pilates, participants reported a two-thirds reduction of depression symptoms on the Beck Depression Inventory. Those who saw the greatest symptom reduction practiced more frequently.
Hyperthermia has been studied since the 1970’s for its positive effects on depression. Saunas have been used for centuries in northern climates to reduce the impact of seasonal depression. Common cultural wisdom has been validated by scientific research in regards to the association between heating up the body and reducing the symptoms associated with depression.
Limitations of current antidepressants highlight the need to identify novel treatments, such as hot yoga, for major depressive disorder. A prior open trial found that a single session of (WBH) Whole body hyperthermia holds promise as a safe, rapid-acting antidepressant modality with a prolonged therapeutic benefit. Future studies will be conducted to identify both the optimal temperature, number and timing of treatments likely to produce the largest and longest-lasting clinical response among patients. In hot yoga, we like it and keep it hot! For the full article published in the Journal of the American Medical Association, click here.
Anxiety.
Yoga trains the body, through focused breath work. This activates the parasympathetic nervous system, thereby decreasing anxiety.
During an informal study at Blaze Yoga and Pilates and Steam House Yoga and Pilates participants in early recovery involved in an 8 week hot yoga challenge reported a 67% average reduction in anxiety on the Beck Depression Inventory.
Sleep disturbances.
Sleep disturbances in recovery include using dreams and may range from insomnia to narcolepsy to sleep apnea. The most commonly reported problem is the inability to maintain a regular sleeping cycle. Individuals may wake several times during the night and they may not feel rested after sleep.
Because yoga decreases tension and anxiety, it improves the capacity for restful sleep.
Deep breathing techniques, savasana, and restorative postures in yoga strengthen the vagus nerve and decrease activation of the sympathetic nervous system, allowing the practitioner to fall asleep more easily.
Yoga helps to stabilize production of cortisol, a primary hormonal driver in sleep disturbance.
In one study, individuals who practiced 45 minutes of yoga three times a week for twelve weeks saw an average 31% reduction in the “stress hormone”, cortisol. Click here for more.
Inability to Process & Organize Thoughts.
In early recovery people often feel unable to solve simple problems, maintain focus on a specified task, or reason in the abstract.
Yoga increases focus, concentration, and attention through the practice of both concentration meditation and mindfulness meditation during postures.
The practice of yoga improves circulation in the entire body, including the brain, potentially leading to improved neurological function.
Yoga postures improve the movement of cerebrospinal fluid, bathing the brain with biochemicals and nutrition, and facilitating the removal of wastes.
Memory Problems.
PAWS causes people to have difficulty remembering what they learn and understand. Memories can fade and it may feel like they are not moving fluidly from short-term memory to long-term memory.
Yoga increases the movement of cerebrospinal fluid and increases blood flow to the brain.
Practitioners engage in breathing exercises that require rhythmic breathing in a group setting. Clinical studies on rhythm therapy utilizing this method of breathing show improvements in short term memory and facial recognition.
Lack of Initiative/Motivation.
Yoga creates a sense of wellness and self-acceptance.
Yoga increases energy
By making a commitment to, and participating regularly in challenging yoga classes, individuals in early recovery experiencing PAWS start to “do” what they mistakenly believed they could not. This generates further motivation to confront a painful and negative self-concept that developed as part of the substance use disorder. With a regular yoga practice, self-loathing is peeled away and replaced with a sense of accomplishment and a more positive self-concept.
Increased Sensitivity to Pain.
Yoga improves the practitioner’s self-awareness of the present moment. This increases proprioception and assists in the development of a more regulated experience of pain and injury. It also trains the practitioner to relax into a disturbance, rather than avoid it. Over time, this changes how one conceptualizes and experiences pain.
Yoga decreases inflammation, and as such, reduces the pain associated with arthritis, rheumatoid arthritis, fibromyalgia, and other autoimmune diseases.
Studies on fibromyalgia and yoga have shown more than a 50% reduction in perceived pain after initiating a yoga practice.
Yoga improves joint mobility, muscle strength and flexibility, skeletal alignment, and increases overall health.
Click here to see Dr. Rhonda Patrick and Joe Rogan: hot yoga vs. “exercise” for inflammation.
Emotional Overreactions or Emotional Numbing.
A newly recovering person may experience overreactions to situations that are benign, or have no reaction to very grave situations. This response, due to a dysregulated sympathetic system (fight/flight/freeze), is common for those in early recovery and also for those who suffer from PTSD. Many individuals in recovery also report trauma histories, and emotional overreactions and emotional numbing are also symptoms of PTSD. People with PTSD and SUDs often feel unsafe in safe situations. And people in recovery from SUDs and PTSD often do not have a sense of personal agency, or choice. This makes it difficult to feel comfortable in and in control of one’s body.
Yoga is the practice of being present within one’s body. As the practitioner begins to feel their body, part-by-part, they also learn to feel the emotions inside the body as well.
Yoga trains the practitioner to breathe calmly, even when uncomfortable. This allows the yogi to experience uncomfortable thoughts and emotions without triggering a fight-or-flight response, diffusing the challenging feeling.
Across the board, yoga students report a reduction in emotional overreaction that continues to grow the longer they continue the practice.
For yogis who have long suppressed emotions, accessing them through the body is sometimes the only way to “metabolize” and “release” these “stuck” emotions. This is a gentle way to release “content” without having it connected to “story,” memory, experience, or self-image.
People talk about a “yoga glow” which is a deep feeling of wellness after practice. A body that feels good is much easier to “be present” inside.
During the informal Sober Yogis study at Blaze Yoga and Pilates and Steam House Yoga and Pilates, participants reported an average reduction from “severe to mild” in symptoms associated with emotional lability with frequency and length of practice. Greater gains in symptom reduction were made by increasing the frequency of practice.
The decrease in emotional lability that was reported during the Sober Yogis Challenge is seemingly typical. At the Justice Resource Institute, a reduction in symptoms of PTSD has been formally documented in a large study on Trauma Sensitive Yoga funded by the Substance Abuse and Mental Health Administration. Those who practiced yoga more frequently saw more robust symptom reduction and a number of participants lost all of their symptoms (and diagnosis) by the end of the 10 week study.
Problems with Physical Coordination.
It is common to experience problems with balance, hand-to-eye coordination, fine motor skills, and impaired reflexes during early recovery.
Yoga postures begin by directing awareness to the breath and the body as a whole, and then move to more focused attention on specific areas. This allows practitioners to slowly introduce physical movement with depth and control.
The therapeutic practice of yoga improves coordination, balance, strength, flexibility, range of motion, joint health, circulation, and fine and gross motor skills.
Feeling Unable to Cope with Stress.
A low level of stress can cause an exaggerated reaction in the brain and nervous system during early recovery. A person also might feel stressed all the time without being able to articulate why.
The combination of damage to the nervous system caused by alcohol or drugs and the psychosocial stress of coping with life without drugs or alcohol can be overwhelming.
Yoga decreases stress, tension, and anxiety.
Yoga increases self-acceptance.
Yoga encourages the development of a healthy ego, the ability to see one’s self through the lens of the present moment, and see one’s self as evolving through all of life’s experience over time.
Yoga provides community. Individuals with social connections are not only healthier, but also cope with stress more easily. For more on the importance of social connections in early recovery, click here.
Cravings/Urges/Thoughts of Using.
Craving is a natural physiological response to substance use, and it usually continues on and off well after substance use stops, and any physical withdrawal from substances is complete. Craving is a desire for the substance that has been withdrawn. Cravings typically last from 5 to 30 minutes. They are one of the most frequent causes of relapse, even after long periods of abstinence.
Yoga helps to regulate and stabilize blood sugar and blood pressure (stress response), two factors involved in producing cravings.
The practice of yoga cultivates patience, self-control, determination, concentration, and detachment, all of which are important skills for the process of identifying craving triggers. Triggers include internal states such as depression and anxiety, or external cues, such as “people, places, and things.” Gradually being exposed to craving situations and NOT getting high, with the help of strong support, yoga, and good planning, can work to weaken and extinguish the craving triggers. The process of extinguishing the craving triggers associated with an SUD is called the “deactivation of craving.”
In hot yoga the sweat-factor, or heat therapy induces a feeling of relaxation and euphoria as the heated room improves and increases circulation. This, in combination with the therapeutic movement in the hatha series, helps the practitioner develop a healthy connection with “feeling good, ” or a new “natural high.”
Rating PAW.
Many individuals in early recovery find it useful to rate PAW symptoms on a weekly basis. With a regular yoga practice, one can reduce the the impact of PAW. People who rate symptoms on a scale of 1 - 10, notice that some symptoms are alleviated quickly; while others linger and then disappear; while some may appear out of the blue, seemingly without warning. It’s important to observe, breathe, and lean into what you notice, rather than panic or avoid exploring the discomfort.
Remember: PAW will be experienced differently by everyone. PAW is a natural and temporary aspect of healing from a SUD. Avoidance of distress is what kindled the SUD in the first place. Some discomfort will most assuredly be a part of any healing process, and brain changes during early recovery are disagreeable. In yoga we move, sweat, breathe, and, “get comfortable feeling uncomfortable.” During the process we create a positive and sustainable change and increase health and wellness.
Many find it helpful to rate PAW on a scale of 1-10, weekly or monthly. Over a period of time PAW may improve (regenerative PAW); may get worse (degenerative PAW); stay the same (stable PAW), or it may come and go (intermittent PAW). Information is power and protection against relapse. If symptoms are high, get to your yoga mat for some symptom relief.
Many find it helpful to rate PAW on a scale of 1-1o , weekly or monthly. Over a period of time PAW may improve (regenerative PAW); may get worse (degenerative PAW); stay the same (stable PAW),; or it may come and go (intermittent PAW).
Detoxification
The hardest part of recovering from an SUD is clearing toxins, both physical and emotional. In Hot Hatha Yoga, the body releases toxins and sweats out impurities. The more you sweat, the more toxins will be cleared. The liver, kidneys, lungs, and excretory organs are the most responsible for clearing toxins from the body. The skin is the largest organ in the body, and it is our skin that excretes sweat. Sweat is comprised of water and several important minerals, and studies have also shown that sweat contains heavy metals, fat soluble toxins, and urea in the same concentrations found in human urine. While sweat may not be a primary mover of wastes in the body, it does have the potential to reduce the detoxification burden on the liver. This is good news, as liver damage is very common for individuals with SUDs.
Vasodilation
Exercising in a heated environment causes immediate and complete vasodilation throughout the body. This process improves the ease with which the body can transport blood, waste, nutrients, and biochemicals, thereby increasing the speed of recovery and healing.
If You Want to Feel Better, GET HOT
If we support the body by increasing circulation, we simultaneously decrease the severity and duration of symptoms associated with PAW for those with SUDs.
For those new to exercise or recovering from a lifetime of illness or injury, practicing in a heated room allows for more movement with a drastically-reduced risk of injury. This makes the practice safe and effective for people of all levels of health and wellness.
Heat Speeds Healing
It feels good to move your body. It feels good to sweat. Completing a full-body workout like we do in Hot Yoga lends a sense of accomplishment and pride. Through a regular practice, we can rebuild our minds and bodies and set a solid foundation on which to build a new and satisfying life.
Click for Sober Yogis Media.
Acknowledgments.
Barbara Dugan, MDiv, MLADC, DOT/SAP with Sara Curry, Blaze Yoga and Hot Pilates, Portsmouth NH
Cover Photo: With permission. William and Christopher Dugan
Thank you, Sara and Jaylon Curry, Co-owners of Blaze Yoga and Hot Pilates for conceptualizing this program, and making it possible. Special thanks to Emily McIsaac, Steam House Yoga and Pilates, who implemented this program within months of opening her studio; to Pure Action/Yoga is Medicine for giving us a format to present the findings; to Ozgur Akbas, LMFT for compiling and organizing the findings; to Kevin Hall for help with design; and most especially to all the Sober Yogis who inspire us everyday with their stories of courage and hope from the mat.
For More on this Topic.
Terence Gorski’s Blog
Post Acute Withdrawal Syndrome: A Comprehensive Guide
Dan Wagner, MSW
Detoxing after Detox: The Perils of Post Acute Withdrawal Syndrome
Jeanne Heaton
Growing Up Chaotic/Bikram and Recovery
Humble the Resistance with Jeanne Heaton