“If your legs let you down you can still dance with your hands and reach those forgotten parts of living in the process. Rosetta Life at St Michael’s Hospice, Hereford,UK.”
Nathan Allen loves the colour blue.
His T-shirt is blue, the blanket wrapped around his knees is blue, and his eyes, bright under his baseball cap, are blue.
Nathan was referred to the hospital’s new on-staff art therapist to help him cope with his emotions. And when Jennifer Bassin came to visit recently week with her case of supplies, he chose the colour blue to start on a sculpture of a car.
“Shocking,” jokes his mom, Judy Chapman.
Nathan was diagnosed with a bilateral Wilms’ tumour, a rare cancer of the kidneys mostly affecting children, at age 5. He started chemo and radiation and had a partial nephrectomy in both kidneys. His left kidney never worked properly again, and after almost five years of remission, cancer returned to his right kidney.
Now he undergoes chemo once every three weeks and dialysis five days a week. That’s a lot of poking and prodding for an 11-year-old who would prefer to be playing defence on the Georgina Blaze novice hockey team and cuddling his 3-year-old beagle, Daisy, at home in Keswick, Ont.
After three more chemo treatments, Nathan can go home. His parents are training to do at-home dialysis and counting down the days until Nathan can receive a new kidney. His mom is praying she can eventually donate one of her own.
Until then, he looks forward to his weekly sessions with Bassin. She visits during the two-and-a-half-hour dialysis process, and they paint or sculpt while the machine whirs in the background.
“It absorbs some of the time,” Nathan says. “I like to build stuff.”
Bassin has brought something called a 3Doodler — a cross between a hot glue gun and a tiny 3D printer, which can make plastic sculptures. This day, after he makes the car, she asks Nathan to make something that resembles his idea of cancer.
“A big, black, blob,” he says.
Nathan is an outpatient but most of Bassin’s patients are long-term in-patients at Sick Kids who have chronic illnesses, complex medical histories or have faced traumatic injuries.
Since the program started in May, she does art therapy just two days a week and sees between four and eight children aged 4 to 18. Psychiatric patients have benefited from art therapy at Sick Kids in the past, but this is the first year the new program, which is entirely funded by donations, has been extended to medical patients.
“Art therapy is taking the language children already speak and meeting them at that level,” Bassin said. “You don’t have to be good at art to participate in art therapy. It doesn’t have to be about the painting or about the drawing. It’s more about finding something they enjoy that we can use as a tool to explore how they’re feeling.”
One patient, who had recently been in a traumatic boat accident, sculpted a vessel out of clay — and then smashed it against the wall in a moment of catharsis. Some enjoy the physicality of painting big murals, and some like to rip up what they’ve drawn. Another drew a landscape so she could imagine herself outside the hospital, at a picnic.
“When you create something outside of you, you can really treat it like it’s at a distance, and it makes it safer for us to explore a little bit.”
Making art helps young patients take back some control in their lives, if only for an hour. Some patients are content with their creation, and others want to delve deeper into their feelings, Bassin says.
Nathan’s family hopes he can go home in late September, when he can rejoin his classmates in Grade 6 and go back to being an annoying older brother to his sister Emma, 7. He’s still quiet, but less withdrawn after a session, his mom says.
As he paints a mask green, with blue lips and black eyes, Bassin asks Nathan if he has a plan.
“Nope,” he says. “Just going step by step.”
I often work with groups using lists. In movement therapy as well as psychotherapy, educational and process oriented groups lists are a great structure for groups to explore thoughts, and/or feelings. Here is a list that often comes up in groups ten suggestions about feelings.
1. Become emotionally literate. Label your feelings, rather than labeling people or situations.
Use three word sentences beginning with “I feel”.
Start labeling feelings; stop labeling people & situations
“I feel impatient.” vs “This is ridiculous.” I feel hurt and bitter”. vs. “You are an insensitive jerk.”
“I feel afraid.” vs. “You are driving like an idiot.”
2. Distinguish between thoughts and feelings.
Thoughts: I feel like…& I feel as if…. & I feel that
Feelings: I feel: (feeling word)
3. Take more responsibility for your feelings.
“I feel jealous.” vs. “You are making me jealous.”
4. Use your feelings to help make decisions
“How will I feel if I do this?” “How will I feel if I don’t?”
“How do I feel?” “What would help me feel better?”
Ask others “How do you feel?” and “What would help you feel better?”
5. Use feelings to set and achieve goals
– Set feeling goals. Think about how you want to feel or how you want others to feel. (your employees, your clients, your students, your children, your partner)
– Get feedback and track progress towards the feeling goals by periodically measuring feelings from 0-10. For example, ask clients, students, teenagers how much they feel respected from 0 to 10.
6. Feel energized, not angry.
Use what others call “anger” to help feel energized to take productive action.
7. Validate other people’s feelings.
Show empathy, understanding, and acceptance of other people’s feelings.
8. Use feelings to help show respect for others.
How will you feel if I do this? How will you feel if I don’t? Then listen and take their feelings into consideration.
9. Don’t advise, command, control, criticize, judge or lecture to others.
Instead, try to just listen with empathy and non-judgment.
10. Avoid people who invalidate you. While this is not always possible, at least try to spend less time with them, or try not to let them have psychological power over you.
Certain meditation techniques can promote creative thinking, even if you have never meditated before. This is the outcome of a study by cognitive psychologist Lorenza Colzato and Dominique Lippelt at Leiden University, published in Mindfulness.
The study is a clear indication that you don’t need to be an experienced meditator to profit more from meditation. The findings support the belief that meditation can have a long-lasting influence on human cognition, including how we conceive new ideas. Besides experienced meditators, also novices may profit from meditation.
Different techniques, different effects
But the results demonstrate that not all forms of meditation have the same effect on creativity. Test persons performed better in divergent thinking (= thinking up as many possible solutions for a given problem) after Open Monitoring meditation (= being receptive to every thought and sensation). The researchers did not see this effect on divergent thinking after Focused Attention meditation (=focusing on a particular thought or object.)
Setup of the study
40 individuals participated in this study, who had to meditate for 25 minutes before doing their thinking tasks. There were both experienced mediators and people who never meditated before. The study investigated the influences of different types of meditative techniques on the two main ingredients of creativity:
- Divergent thinking Allows for many new ideas to be generated. It is measured using the so-called Alternate Uses Task method where participants are required to think up as many uses as possible for a particular object, such as a pen.
- Convergent thinking Convergent thinking, on the other hand, is a process whereby one possible solution for a particular problem is generated. This is measured using the Remote Associates Task method, where three unrelated words are presented to the participants, words such as ‘time’, ‘hair’ and ‘stretch’. The participants are then asked to identify the common link: in this case, ‘long’.
Lorenza S. Colzato, Ayca Szapora, Dominique Lippelt, Bernhard Hommel. Prior Meditation Practice Modulates Performance and Strategy Use in Convergent- and Divergent-Thinking Problems. Mindfulness, 2014
Yoga is a mind and body practice in complementary medicine with origins in ancient Indian philosophy. Part two of evidence based Yoga:
Carpal tunnel syndrome A randomized, single-blind controlled trial of 42 patients with carpal tunnel syndrome assigned subjects to either a yoga treatment group or a wrist splint group, each 8 weeks in duration. Twice a week, the yoga group practiced postures specifically designed to strengthen and stretch each joint in the upper body. Yoga participants showed improvement in grip strength, pain levels, and Phalen’s sign when compared to the wrist splint group. Nerve conduction studies were not performed.15 A Cochrane review of 21 trials that evaluated the clinical outcome of nonsurgical treatment of carpal tunnel syndrome reported that 8 weeks of yoga practice significantly reduced pain as compared to wrist splinting. The yoga was described as having a “significant short-term benefit,” though the duration of this benefit is unknown.16
Depression A 2004 review of five RCTs that evaluated yoga-based interventions for depression and depressive disorders showed some positive outcomes and no adverse effects on patients’ mild to severe depressive disorders. However, poor study design and incomplete methodologic reporting makes this interpretation preliminary.17 An RCT studying 7 weeks of yoga training in a group of breast cancer survivors showed positive changes in emotional function, depression, and mood disturbance.18 “Yoga and stress management” (in the online version of this article) provides more information on this study and others involving the effects of yoga on stress.
Irritable bowel syndrome In an RCT, treatment with loperamide (Imodium) was compared to treatment with a series of 12 yoga postures practiced twice a day for 2 months in a small sample of patients with clinically diagnosed irritable bowel syndrome. Patients underwent measurement of surface electrogastrography, and trait and state anxiety tests were administered before, during, and up to 2 months after treatment. Both intervention groups demonstrated a decrease in bowel symptoms and state anxiety.19
Menopausal symptoms In a recent pilot study, 14 postmenopausal women reported via interview and questionnaire a decrease in the severity and frequency of hot flushes after 8 weeks of 90-minute “restorative yoga” classes. Although this initial finding sounds encouraging, this trial had no control group or objective parameter measurements.20 An RCT studying postmenopausal sleep quality divided 164 women into groups who participated in either 4 months of low-intensity yoga, a moderate-intensity walking program, or a wait-list control group. This study reported no statistically significant interventional effects of any treatment on total sleep quality or on any individual sleep quality domain.21
Multiple sclerosis An RCT of 57 subjects with clinically defined multiple sclerosis were assigned to weekly Iyengar yoga class plus home practice, a cycling program, or a wait-list control group for 6 months. Results showed that both active interventions produced significant improvement in perceived levels of energy and reduced fatigue; however, the specific effects of the yoga practice were not isolated.22 Osteoarthritis In a pilot study, 11 deconditioned, yoga naive subjects with a clinical diagnosis of knee osteoarthritis showed improvements in pain and knee stiffness after 8 weeks of yoga training. The group performed modified Iyengar yoga sessions once a week.23
Seizure disorders In 2000, a systematic review of the published literature revealed that only one study was able to meet the selection criteria for reliable research design. The reviewers concluded that no available evidence pointed to yoga therapy as an efficacious treatment for epilepsy.24
Strength and flexibility In a recent study on the fitness related effects of hatha yoga, 10 yoga-naïve and previously untrained subjects aged 18 to 27 years participated in 85 minutes of pranayama and hatha yoga practice twice a week for 8 weeks. These subjects showed significant improvement in upper and lower body muscular strength, endurance, and flexibility. No statistically significant change in body composition or pulmonary function was observed.13
In a partial RCT with a longer time frame, 54 subjects aged 20 to 25 years participated in either 5 months of yoga instruction or no activity. After that time period, both groups practiced yoga for an additional 5 months. The group practicing 10 months of yoga showed significant improvements in shoulder, trunk, hip, and neck flexibility, as well as a reported improved performance during submaximal exercise testing.25
A well-executed study compared subjects who underwent 24 hours of hatha yoga classes over 8 weeks with a control group. The yoga training group showed a 13% to 35% improvement in flexibility, balance, and muscular endurance. The authors concluded that hatha yoga practice has significant effects on balance and flexibility.26
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2. Carrico M. Yoga Journal’s Yoga Basics: The Essential Beginner’s Guide to Yoga for a Lifetime of Health and Fitness. New York, NY: Henry Holt and Company; 1997.
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4. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review.J Am Board Fam Pract. 2005;18(6):491-519.
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7. Jensen PS, Kenny DT. The effects of yoga on the attention and behavior of boys with attentiondeficit/ hyperactivity disorder (ADHD). J Atten Disord. 2004;7(4):205-216.
8. Kirkwood G, Rampes H, Tuffrey V, et al. Yoga for anxiety: a systematic review of the research evidence. Br J Sports Med. 2005;39(12):884-891.
9. Krisanaprakornkit T, Krisanaprakornkit W, Piyavhatkul N, Laopaiboon M. Meditation therapy for anxiety disorders. Cochrane Database Syst Rev. 2006;(1):CD004998.
10. Sabina AB, Williams AL, Wall HK, et al. Yoga intervention for adults with mild-to-moderate asthma: a pilot study. Ann Allergy Asthma Immunol. 2005;94(5):543-548.
11. Vendanthan PK, Kesavalu LN, Murthy KC, et al. Clinical study of yoga techniques in university students with asthma: a controlled study. Allergy Asthma Proc. 1998;19(1):3-9.
12. Sherman KJ, Cherkin DC, Erro J, et al. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2005;143(12):849-856.
13. Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of Hatha yoga practice on the healthrelated aspects of physical fitness. Prev Cardiol. 2001;4(4):165-170.
14. Clay CC, Lloyd LK, Walker JL, et al. The metabolic cost of Hatha yoga. J Strength Cond Res. 2005;19(3):604-610.
15. Garfinkel MS, Singhal A, Katz WA, et al. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA. 1998;280(18):1601-1603.
16. O’Connor D, Marshall S, Massy-Westropp N. Nonsurgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003(1):CD003219.
17. Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depression: the research evidence. J Affect Disord. 2005;89(1-3):13-24.
18. Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S. A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psycho Oncol. 2006;15(10):891-897.
19. Taneja I, Deepak KK, Poojary G, et al. Yogic versus conventional treatment in diarrheapredominant irritable bowel syndrome: a randomized control study. Appl Psychophysiol Biofeedback. 2004;29(1):19-33.
20. Cohen BE, Kanaya AM, Macer JL, et al. Feasibility and acceptability of restorative yoga for treatment of hot flushes: a pilot trial. Maturitas. 2007;56(2):198-204.
21. Elavsky S, McAuley E. Lack of perceived sleep improvement after 4-month structured exercise programs. Menopause. 2007;14(3, pt 1):535-540.
22. Oken BS, Kishiyama S, Zajdel D, et al. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology. 2004;62(11):2058-2064.
23. Kolasinski SL, Garfinkel M, Tsai AG, et al. Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study. J Altern Complement Med. 2005;11(4):689-693.
24. Ramaratnam S, Sridharan K. Yoga for epilepsy. Cochrane Database Syst Rev. 2000(3):CD001524.
25. Ray US, Mukhopadhyaya S, Purkayastha SS, et al. Effect of yogic exercises on physical and mental health of young fellowship course trainees. Indian J Physiol Pharmacol. 2001;45(1):37-53.
26. Boehde D, Porcari JP, Greany J, et al. The physiological effects of 8 weeks of yoga training. J Cardiopulm Rehabil. 2005;25(5):290.