Do your stretch: Yoga as a rehabilitative intervention
Dr John Sinclair
Yoga Education in Prisons Trust, Churchill Fellow 2017
Dr John Sinclair has worked in the Beehive, the Treasury and a number of other government departments. Now Auckland-based, he is a management consultant, company director and yoga teacher. He co-ordinates volunteer programmes in prisons and community correctional settings for the Howard League for Penal Reform, teaches weekly yoga classes in two prisons, and is a trustee of the Yoga Education in Prisons Trust. He is a Winston Churchill Memorial Trust Fellow for 2017, studying the use of volunteers in prisoner rehabilitation and the governance of penal-sector NGOs.
The movement to regard wellbeing as relating to the whole person, not just the physical, is well-established in New Zealand. Sir Mason Durie’s health model of Te Whare Tapa Whä embraces a holistic view of wellbeing incorporating the physical, mental, spiritual and family/whänau elements of a person’s life. Yoga enhances wellbeing and enables those who practice it to relax both physically and mentally.
Yoga is taught by volunteers at some prisons in New Zealand in order to support those in prison from a different perspective. The most recent initiative has been the introduction of yoga programmes on the Corrections television channel in the three women’s prisons. Yoga mats have been provided to enable the women to practice yoga at night and enhance their sleeping and wellbeing.
When it slips out in conversation that I teach yoga classes in New Zealand prisons, there are two responses: either eyes rolling and a sarcastic, “What next? Foot massages and aromatherapy?” or a look of puzzlement followed by, “Great idea – I bet they need a bit of calming down”. In the past few years, yoga practice has become a regular feature in a number of New Zealand prison units (between 15 and 20 group classes are held each week across the prison estate, and a growing number of prisoners are studying and practicing yoga in their own time), and it is an increasingly common educational and recreational programme in prisons around the world. Which raises the question: is yoga a “nice to have” activity that helps take the edge off what can be a challenging environment, or can it make a contribution towards the long-term purpose of the correctional system, facilitating rehabilitation and reducing re-offending?
Before we look into the question of “why yoga in prisons?” and “what should a prison yoga programme look like?”, it’s helpful to clarify what we mean by yoga.
Yoga is now well-established in mainstream Western culture with a plethora of styles and traditions. It has been embraced by high-performance athletes seeking peak fitness and resilience, and people of all ages looking for health, well-being, and stress-release. A growing body of scientific evidence, including randomised control trials (the gold-standard of research), is confirming and refining what yogis over the centuries have been saying about the benefits of stretching, breathing, balancing and moving mindfully.
Part of the attraction of yoga (and why it can be particularly suited to prison populations and environments) is that it presses a number of buttons simultaneously:
- As a form of exercise it offers a mix of cardio-vascular training, muscle strengthening, joint stability, balance and co-ordination, and the intensity can be varied for different levels of ability and to take account of age, illness and injury.
- As a treatment modality:
- it helps in alleviating many common health issues such as musculo-skeletal injury, joint pain, insomnia, hypertension, digestive problems and headaches; and
- with appropriately trained instructors, it is increasingly used to assist people suffering post-traumatic stress disorder (PTSD) or depressive illness or attempting to overcome addiction.
- As a group activity it can foster camaraderie amongst prisoners, and encourage other pro-social values, such as team-work, shared learning and empathy, while avoiding the downsides of competitive, hyper-masculine exercise regimes.
- As a body-centred mindfulness practice it teaches techniques for removing stress from the body, releasing patterns of muscular tension (which often lead to poor posture and chronic weakness and pain), and reducing the agitation and aggression that can lead to prisoners being easily triggered by the hard edges of prison life.
- As a technical skill with layers of progressive complexity and an emphasis on self-awareness and overcoming limiting self-beliefs, it helps develop a sense of mastery and agency, better impulse control, and a more positive frame of mind with which to address challenging circumstances.
What’s more, it requires minimal space (a prison cell, at a pinch) and almost no equipment (a sticky mat is standard, but not essential).
The form of yoga best known in the West is what is called hatha yoga (literally: sun and moon), which seeks to develop mastery of the body and the ability to withdraw the mind from external objects and enter deep states of meditation. Traditional hatha yoga has eight “limbs”, two of which are reasonably well-known:
- Asana (physical postures, usually held for a period of time to develop muscle memory, stamina and
- Pranayama (techniques to control the breath and hence the flow of energy through the body).However, there are six more. Two limbs relate to ethical behaviour (surely relevant to a prison environment):
- Yamas (moral restraints or “don’t dos”):
- Ahimsa (non-harming)
- Satya (truthfulness)
- Asteya (not-stealing)
- Aparigraha (non-possessiveness)
- Brahmacharya (control of vital energy, including sexual energy).
- Niyamas (principles for right living or “dos”)
- Tapas (discipline)
- Santosha (contentment)
- Saucha (purity)
- Svadhyaya (self-study)
- Ishvara pranidhana (surrender to a higher power).
The next two relate to mindfulness practices:
- Pratyahara (withdrawal of the senses)
- Dharana (mental focus).
And the last two limbs relate to deeper states of connection:
- Dhyana (meditation)
- Samadhi (usually translated as bliss or connection to a higher reality).
Even though in the West yoga is encountered primarily through the first two limbs, it is important to bear the others in mind, because the purpose of the practice is to make better connections between the physical, energetic, mental, ethical and spiritual layers of our being. (The word “yoga” comes from a root meaning “connection”.) Practice one limb and you’ll find you’re naturally starting to practice the others as well. Yoga seeks to stretch the body, but also the mind and the spirit.
Why yoga in prisons?
Most of the benefits of yoga practice, such as those listed above, are shared by any well-structured physical exercise regime delivered in prisons. But there is an emerging body of research into yoga in prison contexts that points to additional benefits, mostly arising from the way combining physical discipline with breath control (and both with elements of mindfulness) can address criminogenic risks, encourage receptivity and support the difficult work of personal change. Three recent studies illustrate this:
- A 2013 Oxford University study in UK prisons (Bilderbeck et al, 2013) randomly assigned prisoners to either a 10-week yoga programme or a control group, and reported that “Participants in the yoga group showed increased self-reported positive affect, and reduced stress and psychological distress, compared to participants in the control group. Participants who completed the yoga course also showed better performance in a cognitive-behavioural task, (which assessed behavioural response inhibition and sustained attention) compared to control participants”.
- In 2012, the Swedish prison system studied its “Krimyoga” programme, in which prison staff are trained to deliver four standardised yoga sequences, avoiding the need for external teachers (Kerekes, Fielding & Apelqvist, 2012). Researchers assigned participants randomly either to 10 weeks of yoga or to a metabolically-equivalent exercise programme. The yoga participants reported less stress, better sleep-patterns, increased psychological and emotional wellbeing, lower levels of aggression, self-harm and anti-social behaviour. They also performed better on a computerised attention and impulsivity test. The difference between the groups was most significant when it came to the changes in impulsivity, anti-social behaviour and attention.
- Cambridge University researchers undertook a meta-analysis of a number of studies of yoga and mindfulness in prisons and found a small, but significant, increase in both psychological well-being and behavioural functioning, noting that benefits were more significant in programmes of longer duration and lower intensity (Auty et al, 2015).
Yoga has also proven helpful in addressing two very common risk factors that affect many, if not most, New Zealand prisoners: addiction and post-traumatic stress disorder (PTSD). A recent review article (Khannaa & Greeson, 2013) noted that:
“… the skills, insights, and self-awareness learned through yoga and mindfulness practice can target multiple psychological, neural, physiological, and behavioural processes implicated in addiction and relapse.”
Recent New Zealand research (Indig, Gear & Wilhelm, 2016) confirms PTSD affects 52 percent of female prisoners, and 40 percent of male prisoners . Bessel Van Der Kolk, one of the first researchers of the phenomenon of PTSD and effective therapeutic responses, identifies two practices that help reverse the neurological patterns frequently caused by trauma (particularly the “fear and flight” mechanism in the nervous system): long distance running (a little impractical in most prisons!) and yoga. He also conducted a randomised control trial assigning volunteers with PTSD symptoms to either an 8-week yoga programme or Dialectical Behaviour Therapy (a form of CBT) and found yoga more effective in addressing symptoms which hamper well-being
and receptivity to treatment (Van Der Kolk, 2014).
Re-examining the importance of the body in rehabilitation theory
What this research suggests – and also my own perception from several years teaching yoga to prisoners and people in addiction recovery – is a need to ensure our approaches to prisoner rehabilitation are not so focused on “head-space” (that is, on using cognitive techniques to “flip the narrative”) that we lose sight of the fact that for many (perhaps most) people in the corrections system, their unhelpful narrative is embodied in physical, energetic and emotional patterns, or, as Bessel Van Der Kolk says, “the body keeps the score”. Our history becomes our biology.
This aligns with one of the teachings of traditional yoga, which is that much of our perception and behaviour is driven by what are called “samskaras”; habits of action and thought or “subliminal activators” that get deeper with repetition, like grooves in a muddy track. Samskaras can either promote well-being or undermine it. As modern brain research illustrates, “what fires together wires together”, and characteristics like hyper-vigilance, aggression, withdrawal and submissiveness become embedded in our posture, how we move, how we breathe, how we rest and how we instinctively react to others and to challenges in our environment. Any therapy that fails to address the body will struggle to have any lasting impact on the mind and the behaviour.
This is not to dispute the value of cognitive behavioural therapies, only to note that many prisoners may lack cognitive ability, be resistant to therapy, have limited English language ability, or be distracted by PTSD symptoms or the challenging physical, emotional and social environment of a prison. As with the submerged body of an iceberg, perhaps we need to consider rehabilitative interventions that work sub-consciously, through the body, wordlessly, pre-cognitively, rather than through the mind. As the great yoga teacher, BKS Iyengar, often said: “I can talk to you for an hour about releasing stress, or I can put your body into a posture that will relax you in five minutes.” At some levels, yoga can function as a form of behavioural therapy that just happens to use the body and the breath to change instinctive, potentially criminogenic, patterns of behaviour.
How to use yoga effectively in prison
The multiplicity of prison environments (remand, high or low security, women’s prisons, units specialising in addiction, sex offenders or prisoners with mental health diagnoses) each present unique challenges in terms of designing, implementing and evaluating any kind of educational or therapeutic programme. Details often matter a great deal. Yoga is no exception. Nevertheless, there is some collective wisdom that can be brought to bear.
The Yoga Education in Prisons Trust (YEPT) has, for almost a decade, supported yoga and meditation in New Zealand prisons by facilitating teacher-led classes, offering a yoga correspondence course to prisoners and, more recently, training prisoners to become peer instructors so they can run yoga sessions within prison units. A number of key design features emerge out of this experience:
- Supportive staff: Yoga programmes work best where unit staff understand the benefits of yoga practice, can encourage prisoners to “give it a go”, and establish a professional dialogue with external teachers. As noted above, yoga is more than “just exercise” and can help prisoners deal with stresses and challenges and practice better emotional regulation and impulse control. Staff benefit too from a less stressful and safer work environment, and on occasions (thus far quite rare) have been known to join in! So it is helpful if staff can share with instructors relevant contextual information on prisoner group characteristics, issues with routines, scheduling and individual prisoner challenges, such as physical injuries.
- Skilled teachers: Although prison yoga teachers focus on safe, “entry-level” yoga postures and practices, yoga is not risk-free, especially for a prison population. An experienced teacher learns to “read” bodies, and will be alert to injuries or other risk-factors (such as prisoners who want to “go hard” beyond their ability, are desensitised to their own pain, or attempt to disrupt others). They can ensure that the practice is both safe and enjoyable, which builds motivation for students to access the more subtle aspects of the discipline, such as maintaining a steady breath during challenging long-holds. YEPT regularly runs specialist training in “trauma-sensitive” yoga, enabling its teachers to recognise the symptoms of PTSD and to modify their teaching accordingly. Skilled teachers can also ensure that the various cultures represented in the class are respected. Although yoga comes originally from India, it is non-sectarian and seeks to support the belief systems and spirituality of its students. Teachers often invite students to relate the values implicit in the practice (stability, balance, flexibility) to their sense of a higher (spiritual) purpose, however they may express that.
- Encouraging self-practice: Teachers can instruct and inspire, but are not essential, once prisoners have learned the basics. Prison yoga is “Yoga 101”. It helps greatly if the prison environment can facilitate prisoners practicing in their own time, for example, by allowing access to yoga mats and to audio-visual material (such as the current initiative to screen yoga videos on the internal TV system in women’s prisons) or providing photocopying for printed materials (such as the YEPT correspondence course). A little yoga practised often (with the regular support and knowledge of an experienced teacher) is what brings the benefits over time.
- A clean, safe and (preferably) quiet space: Although prison yoga teachers get used to making do in busy, noisy environments, it helps greatly to identify a regular space for yoga practice that is uncluttered, clean and (semi) private. Yoga practice benefits from creating a “sacred space”, and many teachers will begin a session with a solemn greeting (perhaps inviting one of the prisoners to bring a karakia) and end with a period of silence or a guided meditation to help the students integrate the benefits of the practice. Silence is hard to achieve, but is definitely worth it, and it’s helpful if unit staff can assist.
- Using yoga as a motivator for prisoner education: Yoga practice frequently prompts an interest in health and well-being as prisoners come to appreciate how much they have been trapped in an unhealthy cycle of drugs, depression, compulsive behaviours and a general disrespect for their own bodies (and those of others). The impulse to “get clean and get healthy” is a useful motivator for educating prisoners about healthy living (diet, exercise, mindfulness) both for their own benefit, and as a skill relevant to ongoing employment, for example in the health and fitness industry.
- Evaluation and research: Although, as noted above, the research into yoga in prisons is generally positive, more is needed, especially research in the New Zealand context, which may differ from that in the various studies cited. For teachers and for YEPT it is helpful to have both informal, evaluative dialogue with prisoners and prison staff and more formal evaluation in order to refine teacher training and recruitment and inform written materials and the detailed design of yoga programmes. There are also larger questions deserving research, such as how yoga (or similar body-mind disciplines) can work alongside other therapeutic responses to addiction recovery, anger management, sex offending or PTSD.
Conclusion: Reflecting on stress in prisons
Implementing any educational or recreational programme into the life of a prison makes demands upon prison staff and systems. Like many of my colleagues, I have been fortunate to work with some outstanding prison staff, both at management level and on the unit-floor, who have grasped the potential benefits of yoga for prisoners and done their best to facilitate and encourage. I trust that the journey has proved worthwhile, both because of the range of benefits yoga can cram into a relatively simple package, and because yoga practice can get to the heart of what prisons are about: freeing the body and the mind from destructive patterns.
Some years back, one of my students at MECF wrote on a feedback form, “This is the only hour in my week when I have any sense of control over what I am experiencing in here.” The comment prompted me to think about stress in the prison environment which is, on the one hand, something we want to minimise and manage because of its harmful impact on prisoners and staff but, on the other hand, something that is essential to the goals of the criminal justice system. The public has an expectation that prisoners will at some stage “stand in the fire” and confront their offending and do the “hard labour” of addressing their attitudes, actions and addictions.
Behind the eye-rolling first response to yoga in prison (see above) is the recognition that stress is an element in rehabilitation, and that prisoners would benefit from learning skills that improve their resilience so they can engage, rather than evade, the challenges they face.
As many of the prisoners who try out yoga classes attest, yoga is not easy (“I thought this was just for girls,” is a common refrain in men’s prisons, between gasping for breath, “but it’s a lot harder than it looks”). Indeed, one of the disciplines of yoga (see the first “yama” mentioned above) is “tapas”, which means literally “an internal fire”, or the heat that is generated from moving against the habitual flow. While yoga practice can be soothing and relaxing, it is also designed to build resilience, to dislodge habits and to strengthen body and mind, not in a hyper-masculine way, but in the context of increasing self-knowledge and self-awareness. Therein lies the benefit of encouraging prisoners to “do their stretch”.
Auty, K., et al (2015) (Prisons Research Centre, Institute of Criminology, University of Cambridge), A Systematic Review and Meta-Analysis of Yoga and Mindfulness Meditation in Prison: Effects on Psychological Well-Being and Behavioural Functioning, International Journal of Offender Therapy and Comparative Criminology 1–22
Bilderbeck, A., et al (2013) Participation in a 10-week course of yoga improves behavioural control and decreases psychological distress in a prison population, Journal of Psychiatric Research, 1e8
Indig, D., Gear, C., and Wilhelm, K. (2016) Comorbid substance use disorders and mental health disorders among New Zealand prisoners, New Zealand Department of Corrections
Kerekes, N., Fielding, C., and Apelqvist, S. (2012) Kriminalvarden, Sweden, Yoga Pa Anstalt: En Randomiserad Kontrollerad Studie
Khannaa, S., and Greeson, J., M., (2013) A narrative review of yoga and mindfulness as complementary therapies for addiction Complementary Therapies in Medicine, Volume 21, Issue 3, June 2013, pp.244-252
Van Der Kolk, B., (2014) The Body Keeps the Score, Penguin