Continuing our interview with Dr Lisa Marzilli, head of Applied Clinical Research and Education for Dominion Diagnostics, we discuss her explorations of yoga as a powerful component in recovery treatment, and as a recognized evidence-based practice. The ancient Indian practice can help the body, through controlled movement and breathing, return to a more balanced state without drugs.
DARRYL: Hello and welcome once again to the CNS Podcast I am Dr. Darryl Inaba. Today I'm here in Providence (Rhode Island) with Dr. Lisa Marzilli and she is, in addition to her Pharm.D and chemistry and everything she does, is a practitioner and advocate of yoga - especially as it applies to the recovery field. There is a good solid research that yoga is an evidence-based practice. It does help people deal with craving and their relapse issues and it helps promote long-term recovery. So, what do you think about all this, Lisa?
LISA: Well, it’s interesting. …I got involved in yoga about 10 years ago. So pharmacist.... yoga teacher they were like almost the antithesis of each other. In fact, very shortly after I began practicing yoga, I went to Santa Barbara for a one month immersion training and you know, I was kind of the odd man out. And interestingly as the month progressed, most of the folks there were very entrenched, where I was just learning and it was interesting to see, you know, life’s not about polarities. You have Western medicine, you have Eastern medicine and for my thought process there are different roads to wellness and recovery. I would say back in the 2000’s, that was probably a little more farfetched than today and I see that the more I learn and become involved in the whole study and arena of addiction. It’s been very interesting to see that now yoga is being incorporated in a lot of 12-step programs. For me, I can’t say that I’m thoroughly surprised because like anything in life, if you want to underscore one’s differences, you’ll find many, but in essence, there are a lot of similarities and I’ve found that to be true in Western medicine and Eastern medicine. Eastern medicine looks at energy systems, which is your spinal column - in Western medicine, we talk about your central nervous system. So some of the esoteric things about yoga, and yoga breathing and the stimulation of the parasympathetic nervous system, I could see in my mind’s eye, 10, 12 years ago how this could not only promote internal wellness, but would manifest in very obvious ways. So, you know, I’m not very familiar with the research that you’re talking about as it relates to…you had mentioned the study with GABA….but intuitively, I can see where this could all channel into one because, again, it’s different roads to wellness. And I believe that when you’re talking to clients in the recovery process, any tool, especially a healthy tool that they can add to their box will be something that can be synergistic to bringing recovery…behavioral recovery and wellness as a whole.
DARRYL: You’re absolutely correct and that was one of the challenges I am finding as we try to implement more yoga practices in our treatment recovery center in Oregon. There seems to be a strong perception that yoga is a religion rather than a health practice not just among our clients, but I think western populations as a whole. How do you deal with people who say no, I’m Christian…or that’s against my belief in God or something?
LISA: Well, that’s an interesting question because I frequently get that with new yoga practitioners and when I’ve presented yoga philosophy at medical schools or pharmacy schools right here at the University of Rhode Island. Yoga is actually one of the 6 Indian philosophies, it is not a religion. It is a means to one’s higher self. So, really, it is the development of the sophisticated mind and because, you know, the way society is today, not many people can go off in the woods like Siddhartha and find their way to enlightenment through a quiet meditation. It’s not feasible to interface with the world that way. So the practice of yoga and the postures are a metaphoric way to help ourselves find higher enlightenment. The ancients used the postures, the breathing and the movement to do and burn what’s called tapas, so cleansing from the inside out. So it really is a philosophy to get to self actualization.
DARRYL: You know, I hate to bring it back into traditional western medicine, especially pharmacy….
LISA: I always try to overlap them when I teach, I have to tell you. I mean in my…
DARRYL: But, you know, to me there’s somewhat…one of the components of addiction, to me, is allostasis, where the brain develops an imbalance of natural brain chemistry. The brain is a chemical organ and when it functions out of balance because of drugs or compulsive behaviors, the person must continue the use in order to remain functional. So when they enter recovery, all of a sudden they don’t have the synthetic substance replacing their natural chemicals which have now been depleted or changed and their brain is out of balance - they’re stuck with… tremendous amounts of negative feelings and cravings and all kinds of things and I think yoga is one of the ways that helps push the brain to start rebalancing itself into its natural state. That’s my thinking and that’s why I’m looking forward to research that links yoga and other practices to changes in brain chemistry. Does it actually change GABA levels? Does it affect endorphin levels? Does it affect catecholamine levels? That’s what I’m interested in - have you done any work on that?
LISA: Well, again, using the intuitive scientific mind, the basis of yoga movement or meditation is to draw one’s attention back to breath. So if we’re concentrating on filling our lungs from the base up rather than breathing aggressively in the chest all day long because we’re always in a hurry, clearly we’re going to maximize the efficiency and efficacy of our lung volume. So what does that mean if you consider the whole body? Your oxygenating your red blood cells so …your hemoglobin can carry more around. So that in and of itself, as far as brain health or body health, if you can oxygenate more effectively and expel CO2 more efficiently, right there, number 1, you are cleansing. The other thing that I think…and I’m not saying that this turns people off to yoga… you mentioned the religious aspect, but some people think of yoga as being very contortionistic, very physically extreme when the reality is, I’ve taught it to people in wheelchairs. It’s all in the expression of a particular posture. And the reason I say this is because it’s the same with meditation. Where yoga can be viewed extreme, meditation can be viewed the same. The example I used was Siddhartha. Any time we can step outside of the mind, even if we can’t quiet the mind when, let’s say, we begin a yoga practice and we’re focusing on our breath. If one can’t quiet the mind, try to become the observer. So if my mind won’t stop, I’m an outside observer and just by doing that - you are moving further into a meditative state, increasing your alpha waves and quieting. So, it’s the stimulation of the parasympathetic nervous system and the fact of that we can reduce the adrenaline response. It makes sense that we can access the endocannabinoids, the bliss chemicals. And it’s not something that’s going to happen overnight. It’s something that we have to retrain ourselves to come back to. And an example I often use when I’m teaching class and teaching someone a yoga breath, I will say…it’s a breath we unlearn. Because if you watch an infant breathe or a puppy breathe, you see the belly rise and fall and rise and fall. But we’re taught to hold the stomach in, so we’re breathing just in the chest. So a lot of the breathing in yoga practices are things that are innate in and of ourselves when we’re in our purest state, which is entering the world. I know that I’m kind of jumping around a little bit, but it makes sense to me that the physiological response from breathing with awareness, oxygenating the blood, quieting the mind would help to bring brain health back to functioning. So, it wouldn’t surprise me that through the different techniques, again whether it be Tai Chi or breathing…anything that can, with intention, quiet our lives and quiet our minds, would be beneficial.
DARRYL: Now you’ve raised so many…
LISA: I know…
DARRYL: No, they’re great things! I have so many questions in my mind about the things you bring up. The state of Oregon mandated in 2009 that we have to be trauma-informed caregivers in the behavioral health system and that we have to look at the neurosequential development of human beings and - especially with addiction - there’s so much early childhood trauma, affecting from the automatic parasympathetic system - which is made up of the diencephalon and lower brain stem - and even the unconscious limbic system are key reasons why people develop an uncontrolled compulsion to use drugs that their conscious brain, neocortex, can’t control. So, because we are aware of the trauma in our clients' lives, we are trained to do different things that aren’t called yoga. We help our clients who are in crisis, who are craving, who are reacting to stress …by things like rhythmic movement, just rhythmic movement like a little child would do - a child's brain …their neocortex isn’t fully developed, so the brain stem… parasympathetic and diencephalon - are impacted and we can help bring someone back into control or stabilization by implementing things that access the subconscious. I think that’s part of yoga. I think that’s part of what yoga has tapped into. A lot of what we do is subconscious. But that just raised my... I don’t know if you even feel that way.
LISA: Yes, I would have to believe that…as you said …memory, trauma, things that impact and mold our personalities and behaviors at a young age. We can access the subconscious mind, but it’s connection with the prefrontal cortex … I have to believe that if we bring awareness to that space of the conscious mind, the prefrontal cortex and try to improve the sophistication, we can then tap into - even though it’s so deep - the subconscious. That provides a better chance to recover those traumas or tap into them in a safe way. I believe the future will present us with more and more evidence to talk about these esoteric ways of getting there. You know, one path isn’t the only way. There are a plethora of ways to get to the next space.
DARRYL: I’ve always loved that word, plethora! Very glad you used it!
LISA: Yes, different…different tools in the tool box. It’s not going to be any one thing. That’s why when I mentioned my first yoga training, it was - "she’s a pharmacist, she’s a yoga teacher"…these seemed paradoxical to the yogi’s…I would say to them, "if you need your appendix out, are you going to sharpen a rock and cut it out yourself?" No, you’re going to lean on our Western medicine in that situation. In traditional medicine in the U.S., there is an opening of minds and today we see more integrative care whether it be, Reiki, massage, …everyone’s formula to health is going to be a little different. It’s a matter of opening our mind and finding more and different ways because what combination works for you might not work for the guy next to you and so on. But the more healthy tools that we can provide for those with an addicted brain, or someone who has a brain diseased with mental illness…I think everything needs to be reframed in this medical model and approached in a slightly different manner.
DARRYL: You know you mentioned all the misperceptions about yoga and one of those misperceptions is that you get contorted into these weird positions which are impossible if you have arthritis or something is sore. I have to confess that was one of my misperceptions as well. So, I kinda shied away from it and finally got talked into participating in a yoga session and it was so remarkable and so relaxing and I think I fell asleep. I don’t know if you’re supposed to, but I fell asleep at the end and then…I’m just talking about my first session…and then for that whole day and I think for the whole week, I felt so good. I can’t explain it unless I go back into my old pharmacy brain. It must have really activated …either endorphins or some GABA or some endocannabinoids or something that is an inhibitory neurotransmitter because it just made me aware and relaxed and more centered, I guess, and more focused. So, I’ve become an advocate and big fan of yoga and I still believe that we’re going to someday show that it has the ability to really change brain chemistry in a healthy way. And that’s what is necessary for people with chemical addictions and even those with process addictions, gambling, sexual addictions, hoarding…well not hoarding. Hoarding is considered a subset of obsessive compulsive disorders, but the major process addictions, Internet addictions. Their brain, by a process, is being put out of balance and I have a feeling that yoga is going to be one of the main ways to help promote the re-homeostasis or rebalance of the brain. Anyway…I should be asking you more questions.
LISA: No…I have to agree. The GABA theory and the endocannabinoids… it would seem very reasonable that the quieting or the calming anti-anxiety type of effect that just conscious breathing - breathing with awareness - can bring you down. Think of the last time you were really angry and somebody was ready to yell - you or someone else. If you take a deep breath in and calm yourself, it immediately moves you from reacting to acting. It helps to remove impulsivity, so it certainly would make sense that the GABA neurotransmitter would be involved in that calming.
DARRYL: Thank you so much Dr. Marzilli, it’s wonderful just to be here with you again. And thank you all for listening to another CNS podcast and if you have any interest or questions, please visit us on our website. But definitely we’re going to have to come out here or have you come out to Oregon to follow up on many of these ideas.