by Michelle J. Fury
Michelle Fury, Founder and Owner of Rhythms Yoga Training, licensed professional counselor (LPC), Yoga Therapist (C-IAYT), and a pioneer in the field of pediatric yoga therapy, shares her knowledge with The Minded Institute on how to use Yoga Therapy to Improve Youth Mental Health.
The Problem
The following is a composite based on the author’s clinical experience, and is not a real person:
Mia was 12 years old when she started feeling low and stressed “24/7.” Her grades slipped, and she lost interest in lacrosse, her favorite sport. The worst part was she couldn’t identify what was bothering her. Sometimes her panic caused her to hyperventilate. But she felt powerless to do anything about it.
Mia had been through a lot. Her family moved in 2020 just as the COVID-19 pandemic started. This took her away from all her friends and familiar teachers. She was just 15 years old, and transitioning from primary to secondary school.
As her feelings of overwhelm continued, she shared with her loved ones that “I felt really weird in my stomach, like something bad was about to happen.” Mia was left feeling confused and alone. She didn’t understand that her feelings were a normal reaction to all the changes that occurred at such a critical stage of her development.
Sadly, Mia’s experience is far from uncommon. Around the world youth mental health has been steadily declining for more than a decade. The pandemic only worsened it. In 2017 the National Health Service (NHS) reported that 10.8% of children between the ages of 5 and 16 in England suffered at least one mental health issue (Khunti et al., 2023). That number climbed to 16% in July 2020 across age, gender, and ethnic groups during the pandemic (Newlove-Delgado et al., 2021). In the US the number of adolescents who reported feeling “so sad or hopeless for at least two weeks … that they stopped engaging in their usual activities” almost doubled (26% to 42%) between 2009 and 2021 (Stone, 2023). And in October 2023 the Guardian reported that “More than a third of young Australians experienced mental health disorder” in a 12-month period (May, 2023).
The Causes
Some have attributed social isolation and academic disruption during the pandemic, ongoing racism, sexism, sexual orientation and/or gender identity (Abrams, 2023; May, 2023; Stone, 2023) as possible causes for this growing epidemic in youth mental health. In addition, the American Psychological Association cites that “Growing concerns about social media, mass violence, natural disasters, climate change, and political polarization—not to mention the normal ups and downs of childhood and adolescence—can feel insurmountable,” (Abrams, 2023). The youth of today are increasingly aware about making a positive impact on the planet.
Social Media
Social interaction fuels healthy overall development and brain functioning in youth (Blum et al., 2022; Perry & Winfrey, 2021). Neuroscientist and child psychiatrist Bruce Perry says “connectedness” (e.g., the health of our social interaction) can counteract a lot of adverse experiences: “(Y)our connectness to family, community, and culture is more predictive of your mental health than your history of adversity” (Perry & Winfrey, 2021). So, unsurprisingly, The US Surgeon General highlights concern about the negative impact of social media on youth in a 2023 report, noting how scrolling social media can increase the risk that a child will isolate from friends, become anxious and/or depressed, develop negative perspectives of diverse groups, and increase polarized views. Its impact is worth further examination because it magnifies the many stressors from social media weighing on youth.
An Integrative Solution
Yoga can reduce mental health issues for all youth.
Yoga is uniquely positioned to tackle youth mental health issues, and some of its underlying causes. First, by its nature, yoga offers social interaction between teacher and student. Of course, oftentimes youth are introduced to yoga in the school setting, which automatically expands that social network of interactions. Several school-based yoga programs show improvements in children’s anxiety, psychosocial interactions, and stress management (Wei, 2016; Bazzano et al., 2018; Khunti et al., 2023). Psychiatrist, author and yoga teacher Marilynn Wei says, “A growing body of research has already shown that yoga can improve focus, memory, self-esteem, academic performance… and can even reduce anxiety and stress in children aged 6 – 12” (2016).
Though scant, research on the benefits of yoga for adolescent mental health is also promising (James-Palmer et al., 2020). My own experience is that adolescents receive enormous mental health benefits from yoga. As the yoga therapist at Children’s Hospital Colorado (CHCO) for 15 years, I spent most of my time in mental health units. I led countless groups for our in- and outpatient programs for kids struggling with anxiety, depression, psychosis, eating disorders, autism, and ADHD, to name a few. Though I saw both children and adolescents, I received more requests for individual yoga therapy from my adolescent patients than children. I continued to see many of those teens long after they were discharged from the hospital, and still see some of them today in my private practice. While I was still at CHCO, I was also part of a monthly integrative headache clinic where I led one-hour yoga therapy classes. In a retrospective chart review, the majority of participants reported that the yoga practice decreased their stress and increased their optimism. They loved it so much that I eventually created a laminated set of yoga cards so they could continue to practice their “headache” yoga sequence on their own.
The difference between yoga and yoga therapy
I gained this knowledge as a yoga therapist, and so the difference between yoga and yoga therapy should be clarified. What distinguishes the two is that yoga therapy prescribes yoga techniques to treat an individual’s symptoms and optimize their health and well-being. “Yoga therapists prescribe specific regimens of postures, breathing exercises, and relaxation techniques to suit individual needs,” according to Robin Monro, founder of Yoga Biomedical Trust (International Association of Yoga Therapists website, Accessed 2023).
The ability to “prescribe” yoga techniques requires proper training through an accredited yoga therapy training program such as The Minded Institute. Yet the youth mental health epidemic requires action sooner rather than later. So this distinction should not deter a yoga professional from offering the tools for which they are qualified.
How Can a Yoga Teacher Help Childrens’ Mental Health?
If a yoga teacher is asked to teach yoga at a school to help children’s stress, they should feel empowered to do so within the scope of their practice. Such a teacher can offer themed group classes for calming or stress-reduction or focus, just as they would at a yoga studio.
Another way that yoga professionals can respond to the need for yoga for youth mental health is to collaborate with qualified mental health care providers in their area.
What Is Not In a Yoga Teachers Scope Of Practice?
“Prescribe” yoga for an individual student’s panic attacks or suicidal ideation.
When offered as integrative medicine, yoga maximizes mental health treatment.
There is a second, compelling reason that yoga is an excellent integrative solution to the youth mental health crisis. Children and even adolescents are still in the midst of language acquisition. Thus, traditional talk therapy alone can miss them for two reasons:
One, youth have a hard time expressing what they feel in words.
Two, they have a hard time understanding what’s being asked when communicated verbally.
If you ask an adolescent, “how are you feeling?” the answer is usually, “I don’t know.” To adults this answer can sound insolent or resistant. But more likely than not, it’s simply true.
Instead of talk therapy, a better approach is to:
offer a feelings chart for children 5 – 12 years old.
Use an opening exercise like the Rose-Bud-Thorn for adolescents..
The ability to label our feelings and emotions with words is hard for everyone. Think about the last time you felt upset or vulnerable. How easy was it for you to talk about it? Unless you’re very practiced in putting your emotions into words, it is a hard task. This is because feelings and emotions are felt in the body not thought about in the mind. According to psychiatrist, author and trauma research pioneer Bessel van der Kolk: “Emotions are about physical sensations. So you feel joy in your chest, joy in your movements” (2022, 1:37). In his youtube video “How Yoga Helps Heal Trauma,” van der Kolk says that yoga has had the “best reception” with traumatized individuals because it allows them to tolerate distressing feelings yet feel safe in the process.
“Yoga makes it safe for you to experience yourself even though your experience may not be that great” (van der Kolk, 2022, 4:13). In other words, yoga helps an individual tolerate distressing feelings and body sensations. Of course, once an individual feels safe enough to experience those challenging emotions, they need a place to process them. This is why it’s also critical to collaborate with qualified mental health professionals (unless you yourself have those qualifications). When yoga is combined with traditional mental health therapy it can maximize the benefits of both.
Yoga Therapy in Practice
What does yoga therapy for paediatric mental health look like in practice? Let’s consider 15-year-old Mia again. When she shared with her school counselor that she’d started coping with her panic by self-harming (cutting on her legs), she was referred to me. I obtained permission from her parents to speak with the school counselor and started working with her weekly. She expressed doubt that yoga could help. I assured her she didn’t need to do anything that didn’t work for her. Without calling what we were doing “yoga,” I began introducing her to different breathing and calming techniques. I used what I call a “yoga therapy sandwich”—we’d talk at the beginning of each session, do the calming technique, and then talk afterwards about how it changed her mood. She said she liked the techniques and used them on her own to focus and “clear my head.” Eventually she became more receptive to explicitly yogic techniques, like Sa Ta Na Ma. Now Mia reports that she no longer cuts, and remembers to use her yoga tools when she does feel the urge.
Getting Started
While this scenario presents 1:1 yoga therapy, most of us start off leading groups. Below you’ll find some tips from my February 2024 Online CPD: Yoga Therapy for Child and Adolescent Mental Health through the Minded Institute on how to create safety in a group yoga setting.
Yoga for Youth Mental Health: Create A Safe Space
Youth need a space where they feel safe and accepted to open up. What makes each age group feel safe and accepted is different. In other words, what makes a 9 y.o. child feel safe is different than their 15 y.o. sibling. Not surprisingly, simply telling youth they’re safe and accepted isn’t enough. We must show them. Yoga Therapy for Child and Adolescent Mental Health goes into detail about how to approach these differences. But here is a list of essential components needed to offer youth a safe space where they’ll feel comfortable to be themselves and be receptive to yoga:
Be on time
Early = on time/ on time = late/ late = no go
Develop a schedule
Eg: same time every week
Use trauma-informed language (ex: “I invite you to notice your breath.”)
Develop a familiar routine
Teach foundational tools that you use every session
Forecast expectations
Forecast changes
Offer choices
Do you want to do _______ or __________?
Don’t give endless choices—two choices empowers kids, more than that is confusing
Youth mental health is a concern for all of us. Our children and adolescents deserve to grow up with the skills that help them become healthy, balanced adults. But right now, they are suffering.
Yoga therapy is an excellent integrative medicine solution for this problem. If you are a yoga teacher or yoga therapist who wants to integrate youth mental health into your professional practice, or if you are a mental health provider who wants to learn how to integrate yogic techniques into your clinical work, Yoga Therapy for Child and Adolescent Mental Health is the training for you. In addition, the course will give some insight into my upcoming book that I am co-authoring the book Yoga Therapy for Complex Trauma (to be released in 2025) with Ayala Homossany. Stay tuned on our facebook page for our book’s website. In the meantime, we hope to see you in February!
References
Abrams, Z. Kids’ mental health is in crisis. Here’s what psychologists are doing to help. Retrieved from https://www.apa.org/monitor/2023/01/trends-improving-youth-mental-health. Accessed 30 December 2023.
Bazzano AN, Anderson CE, Hylton C, Gustat J. Effect of mindfulness and yoga on quality of life for elementary school students and teachers: results of a randomized controlled school-based study. Psychol Res Behav Manag. 2018 Apr 10;11:81-89. doi: 10.2147/PRBM.S157503. PMID: 29695937; PMCID: PMC5903833.
Blum R W, Lai J, Martinez M, Jessee C. Adolescent connectedness: Cornerstone for health and wellbeing. Retrieved from BMJ 2022; 379 :e069213 doi:10.1136/bmj-2021-069213. Accessed 31 December 2023.
James-Palmer A, Anderson E., Zucker L, Kofman Y, Daneault JF. Yoga as an intervention for the reduction of Symptoms of anxiety and depression in children and adolescents: A systematic review. Retrieved from: https://www.frontiersin.org/articles/10.3389/fped.2020.00078. Frontiers in Pediatrics. 2020 Mar, Vol 8. doi:10.3389/fped.2020.00078. Accessed 31 December 2023.
Khunti K, Boniface S, Norris E, De Oliveira CM, Nicola Shelton. The effects of yoga on mental health in school-aged children: A Systematic Review and Narrative Synthesis of Randomised Control Trials. Clin Child Psychol Psychiatry. 2023 Jul;28(3):1217-1238. doi: 10.1177/13591045221136016. Epub 2022 Oct 27. PMID: 36302735; PMCID: PMC10280666.
May, Natasha. More than a third of young Australians experienced mental health disorder in past 12 months. Retrieved from https://www.theguardian.com/australia-news/2023/oct/05/abs-national-study-of-mental-health-and-wellbeing-report-results-released-young-people-australia-bureau-statistics. Accessed 30 December 2023.
Newlove-Delgado T., McManus S., Sadler K., Thandi S., Vizard T., Cartwright C., Ford T. (2021). Child mental health in England before and during the COVID-19 lockdown the lancet psychiatry. Lancet Psychiatry, 8(5), 353–354. 10.1016/S2215-0366(20)30570-8
Stone, M. Why America has a youth mental health crisis, and how schools can help. Retrieved from EducationWeek at https://www.edweek.org/leadership/why-america-has-a-youth-mental-health-crisis-and-how-schools-can-help/2023/10#:~:text=Whether%20it%27s%20from%20stress%2C%20anxiety,19%20pandemic%20exacerbating%20the%20trend. Accessed on 30 December 2023.
Wei M (2016). More than just a game: Yoga for school-age children. Retrieved from Harvard Health Publishing at https://www.health.harvard.edu/blog/more-than-just-a-game-yoga-for-school-age-children-201601299055#:~:text=Yoga%20and%20mindfulness%20offer%20psychological,anxiety%20and%20stress%20in%20children. Accessed on 30 December 2023.