The short answer is, it’s complicated.
We spoke with John Kepner, executive director of the International Association of Yoga Therapists (IAYT), and Courtney Butler-Robinson, stress management specialist and yoga therapist for the Dean Ornish Reversal Clinic at Saline Heart Group in Benton, Arkansas, to find out why yoga therapy is largely uncovered by health insurance companies. Dean Ornish, MD, made headlines in 2010 for convincing insurance companies that yoga and meditation, when combined with proper diet and exercise, could reverse heart disease. To date, yoga therapy is covered only under the Ornish Reversal Program for heart disease, but some affiliated clinics, such as Saline Heart Group, are beginning to offer cancer care.
Yoga Journal: With all of its proven benefits, why is it so hard to get yoga covered by insurance?
John Kepner: That’s the big question. IAYT is a self-regulated organization—it’s all voluntary. We have standards and an accrediting body, continued education, certification, and an enforceable code of ethics, but we don’t yet have a certification exam. All professional health fields have some kind of exam. IAYT has just launched that effort, and I expect it will take another two years to complete. Those are necessary but not sufficient pillars when you’re talking about insurance. In most cases, but not all, insurance coverage extends to licenced health care fields.
Courtney Butler-Robinson: We are a wellness center and offer different programing. We recently extended into cancer care. The Ornish Reversal Program is the only program I know of where the whole thing, including yoga therapy, is covered by Medicare. Oftentimes, people who have cancer or have been given chemo will end up with heart problems, and in that case, we can often bill under that.
JK: One of my personal goals is yoga therapy insurance coverage for people recovering from cancer care. Their bodies have been wrecked by chemo. They need something to bring body and mind back to well-being. There’s a lot of research showing yoga can help with that. IAYT is connected with the Society for Integrative Oncology, which is seriously exploring yoga now.
See also Why More Western Doctors Are Now Prescribing Yoga Therapy
YJ: How do you see this goal coming to fruition? Will insurance-covered yoga therapy be siloed by illness or ailment, beginning with cancer and heart disease?
JK: I just don’t know. We are feeling our way. As mentioned, the Society for Integrative Oncology has two committees looking to yoga. For now, they are working independently of us, although we communicate with them. We are also developing a way to have insurance cover yoga therapies by health condition. My personal thought is that cancer is a good disease to start with. There is a lot of research and general sympathy. Heart disease is already addressed by the Ornish program.
CBR: I think Ornish will get prostate cancer covered in the next five
years. We just need to prove to insurance that this therapy will save them money.
JK: There are plenty of creative possibilities for financing yoga therapy in a health care setting beyond insurance. I wrote about it in 2005, but it’s still relative today. Anyone interested can look to my paper, “Financial Support for Yoga Therapy: A Montage of Possibilities,” published in the International Journal of Yoga Therapy.
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How to Use Ayurvedic Psychology to Help You Through Trauma
Find bliss through ayurvedic psychology (not two-day shipping or instagram likes.)
Ancient sages understood that the true path to bliss is the journey inward. That way, established in who you are, you can take aim at your duties and desires from an embodied space of pure intentions. Connected to this place, you are secure, purposeful, and joyful. From the significant stuff, like starting a new relationship, to seemingly frivolous acts like ordering another pair of sneakers, you are conscious of, and clear on, what you add to your proverbial (and literal) cart—and why.
However, because of trauma, injury, or day-to-day stress, it’s all too easy to detach from this center. In Ayurveda, the 5,000-year-old sister science of yoga, the word for feeling separate—from one’s self, from others, from the universe’s unlimited source of love—is called prajnaparadha, or “mistake of the intellect,” which is also deemed a root cause of disease. We often lose touch with our inner worlds, where we find true contentment, says John Douillard, Ayurvedic expert and founder of LifeSpa, a Boulder-based wellness clinic and online shop. We trade in our bliss for superficial pursuits instead.
As a result, we compensate by lacing the body and mind with ego—so physique, wit, or career end up defining us; material consumption (two-day shipping) and instant gratification (Instagram story views) are the only activities that spark a pulse of feeling at all.
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“The pendulum in our lifetime has swung in the direction of reward chemistry and being satisfied in a temporary way by some type of sensory stimulation,” says Douillard. “Of course, what goes up must come down. Overstimulation leads to a crash, which results in a deep state of exhaustion and discontent. Then your brain chemistry craves that reward high all over again, since it’s become so addicted and accustomed to the feeling of stimulation.” And so the cycle goes.
Unfortunately, this downward spiral is all too common. According to the World Health Organization, depression is the leading cause of disability worldwide, while 1 in 13 people suffer from anxiety. On the whole, an overzealous desire for more contributes to maya, the “illusion” of reality.
“Everyone is focused externally, seeking or grasping for pleasure, status, and fame,” says Larissa Hall Carlson, an Ayurvedic practitioner and mindfulness teacher. “None of this gives lasting satisfaction or contentment.”
See also 1 in 5 Adults Live with Mental Illness. These Yogis Are Breaking the Stigma
What Is Ayurvedic Psychology?
A vast collection of ancient Indian texts called the Vedas (meaning “knowledge”) outlined spiritual wisdom and rituals, including yoga. Ayurvedic psychology is a modern label for the holistic strategies it provided to dissolve these illusions and addictions, and help lead you back to the joy and bliss at your center.
“The whole point is to stop being distracted by your mind and stop needing to be loved, approved, and appreciated by everyone else,” says Douillard. “It’s about actually taking a risk to be the love, versus need the love, and allowing the delicate petals of your flower to open in order to let out something real, authentic, and permanent.”
This was a common theme in canonized Indian literature, albeit in a vastly different setting, according to Douillard. In the Bhagavad Gita—the iconic story of a warrior, Arjuna, paralyzed on a battlefield because he doesn’t want to face his friends and family in combat—Lord Vishnu materializes as Arjuna’s chariot driver and their conversation unfolds into timeless guidance for self-actualization: confront duty, and abandon attachment to the outcome. “Of course, the battlefield is a metaphor for what’s happening in our minds—fighting against our illusions,” says Douillard.
See also Yoga Transformed Me After Depression
Similarly, Dhanurveda (Bow Knowledge) is a Vedic text that is sometimes considered literally as a military science. In fact, it is a spiritual archery that calls on us to adopt a state of restful awareness, says Douillard, which he describes as being both the eye of the storm and the winds of the storm.
“If you’ve got that bow string pulled back, you’re moving it around, and you release the arrow, you have no idea where it’s going to land, which is dangerous,” says Douillard. “But if you pull back that bow from that inner place of composure and calm, in heightened awareness, you take transformational action when you shoot the bow. You take your true self into your actions throughout your day, and that is a permanent experience of satisfaction that is owned by you.”
See also 5 Ways to Radically Love Yourself Today
The Three Maha Gunas
Training yourself to operate from the eye of the storm first requires an awareness of your current state of being. You can start with an understanding of the three maha gunas, or “great qualities”—tamas (inertia, heavy, dark), rajas (dynamic, agitated), and sattva (pure, balanced).
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The gunas exist in all matter on earth and in everything you experience, including food, entertainment, the weather, and your thoughts. To get a deeper sense of them, consider how they may play out in water. A pond, opaque, stagnant, and thick with algae, is tamasic. Choppy rapids, relentlessly plowing down a river, are rajasic. A calm bay that produces a mirrored surface is sattvic.
“The maha gunas are not good or bad. They can be in a supportive state or they can be in an excess or a deficient state,” says Carlson. “The path is very much about clearing out the excess rajas and tamas that keep us stuck in patterns, so we can get to the truth and move through our lives from a place of interconnectedness.”
The Five Koshas
There is a road map to the bliss and love at the core of who you are. The five koshas are sheaths that encircle your soul like nesting dolls: annamaya kosha (physical body); pranamaya kosha (life force body); manomaya kosha (mental body); vijnanamaya kosha (wisdom body); and anandamaya kosha (bliss body).
The journey inward is a deep exploration and purification of each layer, which ultimately allows you to access your true self. But first, you must recognize your tendencies and eliminate imbalances of tamas and rajas in your outer layers.
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“In the physical body, tamas can show up as feeling grounded and steady. Because it’s an inert, heavy energy, it helps us stay asleep and keeps us still on a meditation cushion,” says Carlson. “However, too much tamas shows up as heaviness and lack of physical motivation.”
On the other hand, rajas in the physical body helps us pop out of bed and head out for a hike; in excess, it ramps up the system, leading to clumsiness and restlessness. “We want to get to a balanced state, so we feel grounded and steady and also energized and active in our lives,” says Carlson.
See also 6 Poses to Open Your Energy Channels & Boost Prana Flow
This similar balancing act takes place in the remaining outer koshas. “When there’s too much tamas in the life force body, there isn’t enough of a sense of pep or aliveness flowing through the energetic channels, so people feel sluggish,” says Carlson. On the flip side, extra rajas results in jittery, uncontained energy—crashing into quiet gatherings like a tsunami.
Finally, in the mental body, too much tamas looks like mental dullness or an inability to process information. “The mind won’t be interested or curious. Instead, it’ll feel dull and intellectually blah, getting stuck watching reruns or having the same conversations,” says Carlson. The mind spinning with a surplus of rajas, however, jumps from topic to topic, unable to focus or complete tasks.
See also 12 Yin Yoga Poses to Awaken Dormant Energy and Recharge Your Practice
“In Ayurveda, there are different treatment protocols. One approach is to, rather than worrying about rajas and tamas, focus on boosting sattva,” says Carlson. “The other approach to working with the maha gunas is to counter excess tamas with a little bit of rajas or to reduce excess rajas with a little bit of tamas.”
Once you balance your outer koshas by using food, lifestyle modifications, and yoga practice (such as the sequence on the following pages) you can begin to propel prana (life force) not only throughout your physical body but into your mental body as well to create a heightened state of consciousness.
“Once you have an awareness of the behavioral patterns that aren’t serving you,” says Douillard, “you can take transformational action based on your real, true self, which lies on the other side of the great barrier sheath, the vijnanamaya and anandamaya koshas—wisdom and bliss.”
See also 5 Practices Energy Healers Use to Clear Themselves
Want to disrupt patterns and find bliss? Join John and Larissa’s six-week online course, Ayurveda 201. Learn more: yogajournal.com/ayurveda201.
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