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‘The time has come for the integration of yoga into child mental health treatment.’

In her foreword to Michelle Fury’s newly published book Marianne Z. Wamboldt, MD, RYT, Professor of Psychiatry and Pediatrics, University of Colorado, School of Medicine, explains her belief and experience that it is time for yoga to be recognised as a valuable and effective skill and tool for therapists seeking to lead children and young people with mental health challenges along a ‘healing path’. We are delighted to share Marianne’s foreword with you here.

Using Yoga Therapy to Promote Mental Health in Children and Adolescents is not only a guide to strategies that have been created and tested through trial and error, but a harbinger of changes to come in public health. This is a groundbreaking summary of work that will only continue to grow.

The rise of mental and behavioral health problems in children in the United States, and in much of the western world, is unprecedented. In the United States today, over one in every three youths will have a significant mental health problem before they turn 18 years of age (Costello et. al., 2003). Visits to both pediatric primary care settings and pediatric emergency departments for mental health problems have increased markedly in recent decades, and now account for up to 25% to 50% of primary care and 5% of pediatric emergency department visits (Chun et. al, 2013). Clearly, there are more children in the United States with mental health problems than can be treated with traditional medical services.

While the pathogenesis of mental health problems is still poorly understood, we do have some evidence for risk factors. Genes that are associated with higher risk are slowly being identified, but each of these at best explains a small percentage of the variance. Genes and environment interactions may be one key to understanding the causes of mental health problems, but genes do not mutate or change so quickly as to explain the large increase in prevalence of mental health problems. Rather, it is likely that changes in the environment are the salient risk factors for increased prevalence of these disorders. Environmental influences include in utero toxic exposures and stressors, early life traumas and losses, socio-economic disadvantage, and family dysfunctions (Copeland, 2009). The numbers of these risk factors present in childhood are reliably associated with increased rates of mental health problems across the lifetime (Dube et al., 2001.).

Where, then, does yoga therapy for youth fit in? The types of environmental precipitants of poor mental health are ubiquitous, most children and youth are exposed to them in some form, and they are difficult to undo. The hope for yoga therapy is that it may provide children with a strategy to help them cope better with the stressors in their current environment, as well as potentially reverse some of the maladaptive stress responses of their physiological system. Yoga, practiced regularly, improves the hypothalamic-pituitary-adrenal (HPA) response to stressors, which is tied to a variety of chronic mental and physical disorders such as depression, diabetes and heart disease (Sharma, 2014). Yoga therapy promotes a state of mindfulness, which has been scientifically shown to improve adult mental health (Hoge et. al., 2013). While there are a number of interventions to teach and promote mindfulness, the age-old mind and body awareness teachings of yoga have much to offer in enticing youth into a more mindful state.

Fury figure 5.1

As Michelle Fury so aptly describes in this book, traditional yoga starts with the teaching of codes for living – correct behavior and attitudes, which is helpful for youth who have not been otherwise given this structure in their life. The yoga path then continues with the learning of physical postures, practices that are often fun and engaging for children, but also strengthen the body, teach discipline, and develop endurance. Many children progress to learn how to control the breath, and with this practice lessen their physiologic arousal, fear states, and bouts of depression. Children become more mindful with each of these steps, and as they advance they become more and more comfortable with deep relaxation as well as meditation.

It is no wonder then, that, as prior Chair of the Department of Psychiatry and Behavioral Sciences at a large academic children’s hospital, I was delighted to welcome yoga therapy into the “toolbox” of strategies we use to help children struggling with mental health problems. We are fortunate to have two yoga therapists, and have incorporated yoga therapy into all of our clinical programs, from acute inpatient care through routine outpatient care. Michelle Fury has had the longest and most varied clinical yoga experience with children and teens in our psychiatry programs. She has developed her own wisdom from years of engaging with youth who bring a variety of challenges to yoga. Michelle has exercised creative persistence coaxing these youth into trying yoga and helping them progress in the practices. I have been amazed to see how she has led many of them to successes through yoga.

It is truly my joy and pleasure to introduce this book, full of wise strategies gleaned by Michelle during her many years of working with our patients. I hope that from it, yoga therapists and yoga teachers will learn ways in which to engage psychologically challenged youth in this healing path, and help them to mitigate the multitude of stressors that contribute to their problems. The need is high, the chance of success is great, and the time has come for integration of yoga into child mental health treatment.

Marianne Z. Wamboldt, MD, RYT
Professor of Psychiatry and Pediatrics, University of Colorado, School of Medicine

References
Chun, T. H., Katz, E. R., & Duffy, S. J. (2013) Pediatric mental health emergencies and special health care needs. Pediatric Clinics of North America. 60(5). p. 1185–1201.
Copeland, W., et al. (2009) Configurations of common childhood psychosocial risk factors. Journal of Child Psychology and Psychiatry. 50(4). p. 451–459.
Costello, E. J., et al. (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry. 60(8). p. 837–844.
Dube, S. R., et al. (2001) Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. Journal of the American Medical Association. 286(24). p. 3089–3096.
Hoge, E. A., et al. (2013) Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity. Journal of Clinical Psychiatry, 74(8) p. 786–792.
Sharma, M. (2014) Yoga as an alternative and complementary approach for stress management: a systematic review. Journal of Evidence-Based Complementary & Alternative Medicine. 19(1). p. 59–67.