The Impact of Therapeutic Viniyoga on State Change

Jennifer Vasquez ^1,*, Michele Quintin Quill ², Chase Bossart ³

1. School of Social Work, Texas State University, San Marcos, Texas, United States

2. Independent Researcher, Austin, Texas, United States

3. Independent Researcher, Friday Harbor, Washington, United States

* Correspondence: Jennifer Vasquez

Academic Editor: Peta Stapleton

Special Issue: Evidence for Yoga and Meditation as a Pathway toward Well-being

Received: May 30, 2024 | Accepted: September 18, 2024 | Published: September 23, 2024

OBM Integrative and Complementary Medicine 2024, Volume 9, Issue 3, doi:10.21926/obm.icm.2403054

Recommended citation: Vasquez J, Quill MQ, Bossart C. The Impact of Therapeutic Viniyoga on State Change. OBM Integrative and Complementary Medicine 2024; 9(3): 054; doi:10.21926/obm.icm.2403054.

© 2024 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

1. Introduction

Previous research has demonstrated that yoga therapy interventions can cause positive emotional and physiological state changes in individuals [1]. By the nature of their work, yoga therapists strive to answer the question what aspects of a yoga intervention are most helpful and how to apply these interventions in real world, heterogeneous conditions. A distinction must be made between yoga teachers and yoga therapists. Yoga teachers teach individual and/or group classes, with the intention of teaching students how to practice established yoga techniques. In contrast, yoga therapy sessions are almost always conducted individually. Yoga therapy concentrates on addressing a client's specific needs and symptomatology in order to improve functioning and provide relief from suffering. A fundamental goal of the yoga therapist’s work is to create a practice of yoga techniques specific to their client’s presenting issues that the client can practice regularly by themselves [2].

Just as there are different types of yoga practices, there are different types of yoga therapy approaches. Viniyoga is an individualized form of yoga developed by Krishnamacharya, who is considered the father of modern yoga [3]. The word Viniyoga can be translated from Sanskrit as meaning correct adaptation of yoga tools [4]. Yoga therapists describe utilizing client’s self-report information on health, functioning, and presenting problems as well as therapist observation and inference based on client’s responses and presentation to create a baseline for client’s health and well-being and analyzing this information using the pañcamaya model. The pañcamaya model is a 5-dimensional model that considers a client’s structure (annamaya), physiology (pranamaya), mind (manomaya), personality (vijnanamaya), and emotions (anandamaya) [4]. These 5 dimensions are inextricably linked. Yoga therapy practices can overtly address a particular pañcamaya dimension. Changes in one dimension impact the others.

Over time, Viniyoga practices are adjusted, refined, and expanded upon based on client’s progress and feedback. Viniyoga therapy is used to help clients deal with all manner of physical, psychological and even spiritual challenges. The goal is that by engaging in these practices the client will experience beneficial changes in their pañcamaya and reduced suffering [4]. This manuscript provides a deep dive into how Viniyoga therapists in the tradition of Krishnamacharya think of state change as a foundational goal and central tool in the therapeutic process. State change helps explain how and why Viniyoga therapy works.

When someone attends one yoga class, it is likely they feel different during and at the end of the class than they did before the class started. Their body may feel more relaxed, their mind may feel more focused, calmer, they might emotionally feel good. Their state changed in a number of ways. Perhaps they can notice and describe some of what changed. Perhaps scientific instruments could measure some of what changed. It was a temporary change whose effects will quickly fade. When a Viniyoga therapy client is given a personalized, custom practice the state change impact is likely to be stronger because the experience was tailored to the client’s human system [5]. The practice is targeted to immediate physical-psychological-spiritual needs and goals of the client. Particular aspects of state change are sought. And as the client continues to do their practice on their own, the effects persist for longer and the client feels empowered to influence their own health and well-being. When the client is stabilized and capable of new aspects in their practice, the Viniyoga therapist evolves the practice, supporting the client and helping them realize and appreciate what is changing. State change is an overarching lens that describes this range of processes and outcomes.

This study examines the professional experiences of yoga therapists practicing Viniyoga therapy. Research questions investigated Viniyoga therapist experiences observing and helping guide state change in their clients. Previous research has demonstrated that the practice of yoga can influence both physiological and psycho-emotional markers, indicating a state change has occurred [6]. For the purpose of this study, state change is defined as either a physical or psychological change that improved well-being, ameliorated suffering, or increased insight for the client. The results are a qualitative analysis based on interviews with 14 Viniyoga therapists. Using Interpretive Phenomenological Analysis (IPA) data analysis, a robust definition of Viniyoga therapy and five core themes emerged.

2. Literature Review

Previous studies have sought to define and understand the various elements of yoga practice that contribute to state change. Sullivan and colleagues [7] propose an exploratory framework for defining yoga therapy which focuses on addressing illness, pain, and disability, in order to achieve consensus for exploring yoga therapy as a methodology. A later publication expanded this framework and postulated how traditional yoga wisdom correlates with polyvagal theory, which is an accepted theoretical framework for explaining state change related to psychological interventions [8]. Bhavanni and colleagues [9] coined the terms salutogenesis, defined as client care that targets the root causes of health and well-being, and eudaimonia, defined as a well-lived life that provides individuals with meaning and purpose, both of which are goals of yogic practice. Heeter, Allbritton, and Bossart [4] describe the individual experiences of Viniyoga practitioners using Viniyoga meditation to contribute to health and well-being using the metaphor of an ocean. Sullivan and colleagues [10] explored the shared ideas between Evidence-Informed Practice and Samkhya philosophy, emphasizing how these commonalities can lead the field of yoga therapy to develop a clinical reasoning framework that is based on modern medical practices.

A meta-analysis of different studies of yoga therapy conducted by Schmazl and Blom [1] demonstrated state change in a variety of markers, including physiological parameters, body awareness, self-reported emotional states and stress, and cognitive functioning. The authors noted that individual components of yoga were not separated, and common limitations were small sample sizes, vague protocols, and lack of mechanistic hypotheses. Another meta-analysis by Jeter and colleagues [11] identified 217 peer reviewed articles involving yoga. This analysis revealed that yoga has been identified to contribute to positive health benefits, although more evidence-based research is needed.

An earlier study by Park and colleagues [12], which studied yoga practitioners’ perceptions of yoga’s positive and negative effects, reports that teachers and students alike describe overwhelmingly positive perceptions of yoga, with minimal negative effects reported. The positive effects most frequently reported included overall health, fitness, and relaxation.

Other prior studies have researched the effects of yoga for addressing psychological issues in a variety of settings. Telles and colleagues [13] conducted research on various aspects of state change during yoga therapy and observed changes in autonomic functions and breath rate during dhyana, an effortless state of meditation in yoga. The authors assert these changes were all suggestive of reduced sympathetic activity and/or increased vagal modulation. Heeter and colleagues [14] explored the effects of a 6-week meditation program, based on the principles of the Krishnamacharya-Desikachar approach to yoga therapy, in preventing burnout in healthcare professionals. The participants reported heightened attention to bodily sensations, increased awareness of the connection between physical sensations and emotions, and improved self-regulation, as well as increased motivation to meditate. These results were replicated in a follow-up study in 2020 [15]. Fitzgerald and colleagues [16] reported that therapeutic yoga was a catalyst for change in marginalized populations, by reducing anger, confusion, depression, fatigue, and tension while significantly increasing relaxation.

Chad-Friedman and colleagues [17] concluded that a single session group yoga intervention produced short term mood benefits and enhanced perceptions of treatment quality amongst residents of a short-term Partial Hospitalization Program. A study by Martin and colleagues [18] found that a 12-week yoga program created positive changes in self-efficacy and motivational regulation for women suffering from PTSD symptoms. However, not all findings reached statistical significance, emphasizing the need for further inquiry into state changes as a result of yoga therapy. Gains attributed to yoga have not been limited to psychological markers. Wen and colleagues [19] found that The Mind Sound Resonance Technique (MSRT), a yoga-based meditation method, effectively reduced significantly reduced blood glucose levels and state anxiety scores in a single session.

There have been several studies on the effects of yoga interventions with college students. Hayes and colleagues (2022) conducted a cross-sectional study of college students that found that, although increased yoga practice contributed to relief in pain and anxiety, most college students were not motivated to continue yoga practices [20]. The authors ascribed this lack of motivation to the Multi-Theory Model of health behavior change. In a study also using college students who participated in an 8-week yoga program, Forseth and colleagues [21] concluded that students who had the lowest activity levels before the program reported the most improvement in stress and depression symptoms. Another study of the effects of a 2022 yoga therapy intervention on college students found that a yoga therapy intervention outperformed a cognitive based program in improving stress management [22]. Earlier studies by Jung et al. [23] in 2014 and Park et al. in 2017 [24] also both endorsed yoga as an effective intervention to increase interoception and emotional regulation skills. While both of these studies also noted positive gains when using Cognitive Based Stress Management (CBSM) techniques, the group that received the yoga intervention in both studies had the largest positive gains over time, at 4 months following basis, compared to CBSM techniques. This positive effect may be influenced by participants’ perceptions. Interestingly, a recent study by Agarwal et al. concluded that as participants’ positive perceptions of yoga increased, so did their mental well-being scores [25].

Earlier research has also experimented on the effects of yoga therapy versus other interventions. Streeter and colleagues [26] concluded that yoga therapy was more effective than walking in improving mood and decreasing anxiety. It did not find any significant correlation between yogic practice and pain reduction. Ray and O’Connor [27] similarly concluded that yoga was correlated with a reduction in anxiety but not pain. Van der Kolk and colleagues [28] found that the results of a 10-week yoga therapy intervention outperformed a supportive therapy group in alleviating symptoms of Post-Traumatic Stress Disorder, with effect sizes that were comparable to well-researched psychotherapeutic and pharmacologic approaches.

Previous studies have explored the demographics of participants in both yoga and yoga therapy. In 2012, Riley et al. conducted a survey of 638 college students reported that yoga participants were 61% Christian, 75.2% White, 8.1% Hispanic, and 77.7% female. The authors noted these demographics were similar to national samples [29]. Similar demographics exist for yoga therapy participants. Moonaz et al. reported in their study of 70 yoga therapy clients that a majority of the sample was both female (73.9%), White (82.9%) and Not Hispanic or Latinx (81.4%), as well as being highly educated [30]. As both of these studies examined participants who self-selected utilizing yoga and yoga therapy, questions still remain on how the efficacy and appeal of yoga and yoga therapy techniques apply across ethnic, gender, and educational backgrounds.

While all of these studies have contributed to the knowledge of state change based on yogic interventions, there is a research gap addressing 1) The relationship between yoga therapy and aspects of long term state change, 2) How yoga therapeutic interventions can be applied on an individualized basis to address a client’s functioning in multidimensions of health, 3) What aspects of the yoga intervention are most helpful, and 4) The efficacy of therapeutic yoga interventions in real life conditions. Our study aims to fill in these knowledge gaps by drawing on the wisdom of therapeutic Viniyoga therapists who have applied short- and long-term yogic interventions to a variety of clients with various presenting problems.

3. Methodology

3.1 Ethics Statement

This research protocol #9143 was approved by the Texas State University Institutional Review Board on October 27, 2023, and was conducted in an ethical manner. Informed consent was obtained by all study participants prior to data collection.

3.2 Research Design

This study was conducted using an Interpretive Phenomenological Analysis (IPA) research method to investigate how Viniyoga therapy impacts client state change from the perspective of the Viniyoga-trained yoga therapists. This study intended to determine common themes in the perceived effects of therapeutic Viniyoga on client state change. Utilizing the IPA method allowed researchers to gather a deeper understanding of exactly how therapeutic Viniyoga impacts state change and contribute to research by elaborating on the construct of state change as a desired outcome of yoga therapy. The IPA method focuses on finding a deeper understanding through the use of interviews and smaller sample sizes. IPA was selected because of its idiographic focus which allows researchers to understand how the participants authentically make sense of their direct observation of the impact of therapeutic Viniyoga on their clients. IPA allows researchers to understand the meaning Viniyoga therapists make of the experience of state change in their clients. Adhering to IPA reveals the essential qualities and unique aspects of therapeutic Viniyoga from the perspective of Viniyoga therapists.

3.3 Procedures

Upon receiving IRB approval, the researchers recruited participants via an email sent to yoga therapists who have been trained in the Viniyoga tradition and had experience applying therapeutic Viniyoga. Viniyoga therapists were invited to participate in this research study voluntarily and there were no exclusionary criteria, no incentives, and no consequences for not participating or discontinuation. A purposive sample of 14 Viniyoga therapists was selected to participate. Participants reflect the tradition of Viniyoga therapy in the tradition of TKV Desikachar and Tirumalai Krishnamacharya. The researchers used an in-depth semi-structured interview while utilizing open-ended questioning (see Table 1). A thorough examination of related literature and careful creation of the interview guide in consultation with two subject experts provided consideration for context sensitivity. The interview guide included questions that explored the general description and goals of therapeutic Viniyoga, specific examples of clients the Viniyoga therapist has worked with, questions about health and healing, and the role of the Viniyoga therapist and client. The individual interviews ranged from forty-five minutes to one and a half hours long, exploring the lived experience of experts in the field to understand their perception of how Viniyoga therapy impacts state change among yoga therapy clients. Interviews were conducted via Zoom to accommodate participants’ varied locations. Interviews were recorded for transcription.

Table 1 Semi-Structured Interview Questions.

After the interview process was completed, the interview recordings were transcribed and analyzed in NVivo 12 software using Interpretive Phenomenological Analysis (IPA) procedures. The researchers then identified the themes that arose from the analysis and selected quotes from participants to express the themes. Allowing the participant's quotes to express the themes created authenticity and personalized data expressions.

IPA procedures require great attention to commitment and rigor. The researchers addressed commitment and rigor through careful examination and reexamination of data and themes as well as in-depth studies of the themes looking for connections and patterns. Two of the researchers had familiarity with the field as Viniyoga therapists and provided a unique scope for examining and determining themes, while an additional researcher with no Viniyoga experience provided an external perspective to support objectivity in identifying themes and minimizing bias. The perceptions of the participants were identified through strict adherence to the seven steps of IPA data analysis.

3.4 Sample

The 14 participants for this study were Yoga Therapists trained in the Viniyoga tradition of Sri Tirumalai Krishnamacharya and TKV Desikachar (see Table 2). Twelve of the participants are International Association of Yoga Therapists Certified Yoga Therapists (IAYT-C) and two are not. Two participants completed their yoga therapy training at American Viniyoga Institute, three participants completed their yoga therapy training as private students of Mr. Desikachar, two participants completed their yoga therapy training from Krishnamacharya Yoga Mandiram, three participants completed their yoga therapy training at Yoga Well Institute, two participants completed their yoga therapy training at Krishnamacharya Healing and Yoga Foundation, and two participants completed their yoga therapy training at Yoga as Therapy North America (YATNA).

Table 2 Demographics.

Five participants have been studying yoga between 31-35 years, five participants have been studying longer than 40 years, one participant has been studying yoga between 26-30 years, one participant has been studying yoga between 21-25 years, one participant has been studying yoga between 16-20 years, and one participant has been studying yoga between 11-15 years. All 14 participants practice yoga daily, 11 of them under the guidance of a personal mentor.

Participants ranged from 31-80 years old with one participant between 31-40 years old, three participants between 41-50 years old, three participants between 51-60, three participants 61-70 years old, and four participants between 71-80. Thirteen participants identified as Caucasian, one as Asian/Pacific Islander. Six of the participants were male and eight were female. All participants identified as heterosexual. Two participants hold a Doctoral degree, seven participants hold a master’s degree, five participants hold a Bachelor’s degree. Five participants were from the South, three were from the West coast, two were from the Pacific Northwest, one was from the southwest, one was from the Midwest, one was from the Northeast, and one was from Europe.

Nine participants work as a yoga therapist full time while five participants work as a yoga therapist part time. All fourteen participants see clients both in person and online. Participants work with clients experiencing physical, physiological, mental & emotional health ailments including cancer, chronic pain, anxiety, depression, and stress related illnesses. Seven participants reported working with greater than 31 clients in the last 12 months, three participants worked with 25-30 clients in the last 12 months, three participants worked with 6-10 clients in the last 12 months, while one participant worked with 16-20 clients in the last 12 months.

Six participants see yoga therapy clients monthly; five participants see clients 2-3 times a month, and two participants see clients weekly. One participant provides intensives and then sees clients for follow up on an as needed basis. Five participants have more than 26 years of experience as a yoga therapist, five participants have 11-15 years of experience, two participants have 21-25 years of experience, one participant has 7-10 years of experience as a yoga therapist, and one participant has 1-3 years as a yoga therapist.

3.5 Data Analysis

The data analysis plan incorporated a seven-step method described to identify core themes and excerpts that best convey the experience of the participants in relation to the phenomenon. The seven steps include reading and re-reading, taking initial notes, developing emergent themes, looking for connections across themes, moving to the next case, looking for patterns across cases, and interpretation [31]. Using the framework for IPA research as a guidebook to support validity and rigor, the seven data analysis steps outlined in IPA were followed and repeated until themes naturally arose from the text. Adhering to the seven steps of IPA supported the researchers in their ability to make sense of the lived experience of the study participants as well as gain a deeper understanding of the phenomenon under investigation in the study [31]. The use of multiple investigators in data analysis enhanced commitment and rigor. Bias was minimized by the strict adherence to the seven step IPA method, the use of open-ended research questions, involving multiple researchers in the data analysis process, member testing, and conducting an external peer review. The interviewer acknowledged their positionality as a Viniyoga trained IAYT-C Yoga Therapist and bracketed their own experiences and perceptions during the interviews and during data analysis to understand the experiences described by the participants. A co-investigator without experience in Viniyoga further minimized researcher bias.

4. Results

The Viniyoga therapists interviewed described how they defined Viniyoga therapy by expanding on different aspects of therapeutic Viniyoga, including adaptability, differentiation between yoga and yoga therapy, utilizing a holistic perspective, and providing experiences to create change. Almost every participant interviewed emphasized the adaptable nature of Viniyoga therapy in their definition. Participant 12 said, “Therapeutic Viniyoga applies the tools of yoga specifically to the individual's needs and their capacity in order to direct their entire system towards a state change or a state of balance.” Participant 9 detailed the difference between Viniyoga therapy and yoga, explaining “It's applying the body of knowledge of yoga and the tools of yoga in a therapeutic way whereby the focus is on the health issues, the health and wellness issues of the client and the yoga is adapted to that. So, it doesn't necessarily suggest, unless the client or patient desires it, a kind of focus on teaching yoga.” Participant 8 discussed the holistic perspective of Viniyoga therapy, “Viniyoga is an approach which respects the individual differences and assumes that there will be steps of progression or logical progression of steps, first this and then that and then when that is applied to therapeutics what it means is that you treat the person and the improvement in the condition almost follows secondarily,” stated another participant. Participant 1 included in their descriptions the intent of using experiential techniques to support positive state changes, “Therapeutic Viniyoga is the use of experiences to change the way the person's system is operating by asking it to operate in ways that are known to be alike optimal operation.” These definitions elaborate on the dynamic ways Viniyoga therapy can create state change. As Viniyoga therapists elaborated on the ways they have witnessed state change through their work, five important themes emerged (see Table 3).

Table 3 Data Analysis from Individual Interviews.

4.1 Theme #1: Viniyoga Empowers Clients to Participate in Their Own Process of State Change by Training Their Self-Observation Skills and Providing Tools for Influencing Their State

Viniyoga empowers clients. Empowerment means the ability to self-observe one’s own state and then influence it toward balance through enacting self-generated experiences like gentle movements, intentional breathing, and specific directed focus. In this way, clients are trained to participate in their own healing and through repeated experience gain confidence in their ability to influence how they feel, behave, think, etc. The way Viniyoga therapy empowers clients to participate in their own process of state change was identified as a key theme from the perspective of Viniyoga therapists. Describing client empowerment, participant 1 shared, “The first goal is to empower the client to participate in their own healing. So, we're trying to give the client ways that they can help themselves. We're wanting to empower the person to participate in their own healing. This is one of the main goals.” Participant 4 explained, “you do something different than your patterning and in that you discover things about yourself and also the patterns and what may need to change. It's a very self-empowering kind of system, but it does really require some support along the way so that you have a mirror, you have someone reflecting back what they're seeing, you have somebody who understands how development happens along these lines and can say like thumbs up, keep going, that sounds right.”.

The Viniyoga therapists interviewed described how client empowerment is key to state change. This is the theme that was most frequently expressed by the Viniyoga therapists interviewed in this study. Participant 6 described, “I want them to feel empowered and feel some agency in their own healing process so that they don't feel dependent on me. And I want them to, you know, my goal is for them to feel empowered in their own health and healing, knowing that they can do these practices on their own, in their own homes, et cetera, and that they're responsible, that they have that big, they're a big component of their own healing. I'm just the vehicle, I'm just the postman, passing it on, but they're doing it.”.

Viniyoga therapists described state change that profoundly affected their client’s lives, including their capacity to trust. Participant 8 shared, “Confidence is an aspect of the deep vijnanamaya mind, you know, Shraddha. Confidence implies that you have found something you can trust, and everything in life is changing and untrustworthy in a certain way, but you have found something that you can trust, and it can be found again. That changes your whole approach.” Sraddha is defined as having faith or confidence in, believing in or trusting [32]. Other therapists discussed specific state changes they noticed develop over time with their clients. Participant 10 reported, “What I would say is they felt more empowered and able to manage their own condition and had tools that they could use. And then over time, they began to embrace the reality of impermanence and instead of resisting it, so that there could be more fullness in her experience as she approached the end of life.” Participant 11 described how empowerment supported their Viniyoga therapy client experience state change: “they had increased capacity to manage their health and condition and self-regulate, which was empowering for them.”.

Viniyoga therapists in this study overwhelmingly expressed that their clients experienced empowerment. As Participant 1 remarked, “And this self-empowerment process where you know that the person starts to believe in themselves, why is this so important? It's because yoga begins from the premise that people have inside them already all the answers to their issues. We're not helping them to do anything. We're just helping them to find and to believe and to be able to have the courage to follow through on the answers that arise for them.”.

This theme was described more consistently throughout the interviews than any other theme. Learning how to empower themselves through their Viniyoga practices benefitted clients even when facing chronic health conditions. Participant 3 described, “they can understand that they can actually begin to have some control even over, you know, something as debilitating as anxiety.”.

4.2 Theme #2: Intentionally Engineered Experiences Are the Tools of Viniyoga

Viniyoga is an experiential modality. It aims to generate specific experiences within the client, and it is these experiences that are the tools that influence the state change within the client. By teaching the client to move, breath, make sound and focus in specific ways, the therapist is training the client to self-generate specific bodily and mental modalities within themselves. These changes within the client’s body and mind which bring about the State Change in the individual.

Participant 1 explained the phenomenon of state change in Viniyoga as “a science of experience where the client is given things to do, which will ask their system, their body, their breath, their mind, their emotion, to operate in a way that is consistent with optimal operation.” Viniyoga utilizes experiences “to change the way the person's system is operating by asking it to operate in ways that are known to be alike optimal operation” through the use of different methods such as breathing techniques, says participant 1. A Viniyoga therapist must use their knowledge and skill set to tailor methods and techniques to the client’s specific needs in order to allow space for the experiences that create state change.

The methods and techniques used by Viniyoga therapists are vital to creating and shaping experiences for clients. Participant 6 states that the word Viniyoga means “applying the right tool for the right job” in Sanskrit. Participant 5 states that by using these techniques and the principles of yoga the therapist is able to “create change in the practitioner's life and state and hopefully promote healing. “The individuality factor of Viniyoga is what promotes the intentionally engineered experiences that create state change.

The Viniyoga therapists touched on individuality throughout the interview process, highlighting how important it is. Participant 6 states that a therapist has to adapt the “various tools of yoga to best support the individual's unique needs regardless of ability, background, experience, what not.” Participant 11 echoed this thought by stating that Viniyoga is “an approach of helping someone with a health condition or problem using the approach and tools of yoga in the way that is personalized for the individual.” Participant 12 had similar suggestions on the topic, saying “therapeutic Viniyoga applies the tools of yoga specifically to the individual's needs and their capacity in order to direct their entire system towards a state change or a state of balance.”.

4.3 Theme #3: Viniyoga Takes a Highly Individualized Approach to Supporting State Change

The importance of a highly individualized approach was an additional theme study participants described as key to understanding state change from the perspective of Viniyoga therapists. Because the experience of the individual is paramount, the emphasis in Viniyoga is on finding or modifying the tools so that they generate the experiences that the therapist expects to be useful for the client.

The individualized approach means each person needs different tools and support in the therapeutic process. Because each client starts in a different spot in relationship to balance, what will help the person to develop State Change and indeed, the specific State Change that they need, will be different. Hence, there is no single standard approach that is possible. Participant 1 shared how they observe the development of state change as a Viniyoga trained yoga therapist, “So, what is important for the Viniyoga therapist to do is to tailor the techniques to the capacity of the person, the interests of the person, etc. so that they're able to actually have the experiences.” Participant 2 remarked, “(Viniyoga) is meeting the individual where they are and listening to their concerns and needs. I think it's very personal. It's very individual.”.

Viniyoga therapists tailor their approach to each client to help facilitate state change. They do not merely tailor the approach because of unique personal characteristics, interests, and capacity of the client. They also tailor the approach to the presenting issues. Participant 3 stated, “it's not only to manage symptoms, but be aware of them, understand them, and then learn the tools of yoga that they can use to manage them, and so there's sometimes a specificity of approach there, using most effective tools for them, individualized to them. It's such an individual experience.” Participant 5 reflected, “the primary tools are relationship, breath, movement, meditation, sound, and so all of those can be used but are individually tailored. I mean, I think that's a really important part of Viniyoga is that it's individually tailored to meet a particular person's needs and that that changes over time. I think healing is really individual.”.

The importance of personalized practice in creating state change is emphasized early on. There are particular state changes that are desirable and important for a particular client at a particular time. The personalized practice provides specific yoga practices that will support the particular needs of each individual client. Participant 6 explained, “Adapting the tools of yoga, whatever they may be, various tools of yoga to best support the individual's unique needs regardless of ability, background, experience, what not.” They went on to describe, “I'm going to adjust the practice to each of your individual needs as much as I'm able.” Highly individualized practice for each client was expressed by Viniyoga trained yoga therapists to be very helpful to their yoga therapy clients experiencing state change through Viniyoga therapy.

Personalized practice helps clients connect to their own capacity to influence state change. Participant 7 described it as, “it's unique to the person, what it looks like, but I certainly don't want to... I don't want to pass up that the really important part is that state change moves in a direction towards a trust in something so that the obstacles fall away and then the system knows how to be and that's healing.” Participant 8 related, “the idea of Viniyoga is that it is individual, each person is different. Each person has unique features. It's a very established, very Indian, very inclusive point of view that the person in front of you is themselves” and “Viniyoga is an approach which respects the individual differences and assumes that there will be steps of progression or logical progression of steps, first this and then that and then when that is applied to therapeutics what it means is that you treat the person and the improvement in the condition almost follows secondarily.” Participant 9 explained, “the change unfolds differently with the individual.” Participant 10 relayed, “implicit with the teaching is help an individual learn what they can do through their own practice to influence their condition in a positive way. Viniyoga trained yoga therapists expressed that an individualized practice increased their clients’ capacity for self-attunement, which positively impacted state change over time.

Most of the yoga therapists interviewed endorsed the ability to create a practice specific for each client as central to the therapist’s capacity to help others. Participant 11 stated, “I would describe it as an approach of helping someone with a health condition or problem using the approach and tools of yoga in the way that is personalized for the individual” and “that means that there inherently has to be variability in how Viniyoga is applied because each individual is different.” Participant 12 echoed this sentiment, noting, “Therapeutic Viniyoga applies the tools of yoga specifically to the individual's needs and their capacity in order to direct their entire system towards a state change or a state of balance” and “So state change is everything- it is the North Star that is guiding us through how a practice is developed for an individual.” By personalizing client practices, Viniyoga therapists are able to facilitate state change in a positive direction for their clients.

4.4 Theme #4: The Relationship between the Client and the Viniyoga Therapist Itself Promotes State Change and Is Very Important to the State Change Process

The relationship itself is understood to be an important tool in helping the client to develop self-regulation capabilities. The relationship is understood to include: the feeling one has in the physical presence of the other; the trust and force of the positive belief of the therapist in the principals and tools of Viniyoga, the therapeutic process and in the client themselves; and the support and accountability provided by the therapist’s regular interaction with the client regarding their life and circumstances. Another important theme that emerged was the expansive way that Viniyoga therapists defined health and healing, thereby allowing for positive state changes even if physical symptoms or disease remained. The western model traditionally defines health as a reductionist model where all systems can be explained by the functioning of smaller parts of the system. In this model, healing is perceived as restoration to a normal physical/emotional state by treating malfunctioning parts of the system [33]. In contrast, Viniyoga therapists' perception of health is holistic and describes more than physical or emotional wellbeing. It can also mean feeling a wholeness, connected to oneself, to others, and being free from suffering. Healing is described as a process that happens on multiple levels and is possible even when physical healing is not attainable, such as with a terminal diagnosis.

Viniyoga therapists emphasized the importance of client’s feeling connected to themselves and feeling confident in facing whatever challenges arise. They also mentioned that they saw their goal as helping clients connect to their body’s own healing capabilities and innate sense of wholeness and well-being. This type of healing does not rely on external factors such as medication or other invasive procedures. In this way healing and improvements in well-being can be achieved by all.

Participant 1 explained, “[H]ealing is about doing things, including relinquishing, that encourage the proper operation of our system, and that over time result in partial or even complete recovery of capabilities, including [on] an emotional level, joy, and happiness, etc. So healing is also possible even when physical cure is impossible.” Other participants echoed this sentiment, with participant 8 stating, “Health is a wholeness…Another way I think is that the state of health is inherent, is inborn. And it's like a sludge or dirt or whatever is around that causes the trouble. And…we can just clear away some of the obstructions, some of the dirt, some of the things holding people down, constricting people.” Participant 5 remarked, “Our culture is so goal oriented around health, [through Viniyoga therapy] we can remove the suffering that comes from being unwell.”.

Relating this mind shift to their clients is a powerful way that Viniyoga therapists encourage people in diverse states of wellness and being to connect with health and healing. As Participant 3 put it, “I think it is critical clients come away from yoga therapy understanding how they can change their state, their physiological responses, that they can actually change the condition of say, chronic muscular tension in their neck, that they can begin to have some control even over something as debilitating as anxiety can be. [T]hey can have tools that actually help them change their state.” This perspective shift was a significant factor that impacted state change as reported by the Viniyoga therapists.

4.5 Theme #5: State Change Is Foundational to the Healing Process of Viniyoga

Viniyoga therapists reported that state change is foundational to Viniyoga. In Viniyoga the client’s behavior, feeling sets, thoughts and even physiology are considered to express differently depending upon the state that the client is in. Consequently, a major focus of Viniyoga’s healing process is influencing the state of the client. By changing the state of the client, the client’s behaviors, emotions, thoughts and physiology naturally also change. The Viniyoga therapists interviewed reported that facilitating state change is critical to their work. Participant 1 said of state change, “I think it's foundational. I think it's the first stage. You know, I think it's what needs to happen is people need to get, they need to find that state change is possible. You know, they need to understand that it's a possibility. And then, that serves as the foundation for what is possible, not what is possible, but it's the foundation for influencing how their system functions.” Therapists described the importance of state change to the healing process. Participant 7 reported, “it's like the main game. It's the main role. I mean, in order to do all those things, we've been talking about, you're a human who has been living a life that shifts you this way and that all the time all over the place. So, state change undoes all that stuff life does to you and when you are able to connect to something that's beyond all that material construct within the system, you know, it heals” and “so state change is like helping your material controlling self to step out of the way, like the obstacles we talked about earlier. And when those things can be removed and stepped out of the way, there's healing.”.

Viniyoga therapists described state change as “foundational” (participant 1 & 11), “critical” (participant 3 & 10), “central” (participant 4 & 5), “huge” (participant 6), “fundamental” (participant 8), “everything” (participant 9), and “the whole thing” (participant 12). Participant 8 stated, “so the experience of what state change really is and how widespread the manifestations are, I think is one of the best, it's an amazing thing that we can give people.” Participant 9 described, “it's everything. I mean, what we're trying to do, we're using this practice and these methods and techniques, and this understanding to bring about a change, both time of and overtime in the person's system. And what we're really trying to do is to help their system function differently.” Viniyoga therapists agreed that state change is fundamental to Viniyoga therapy.

5. Examples of Viniyoga Therapy State Change

During the interview process, the Viniyoga therapists were asked to share specific client experiences and what state change arose for those clients. By allowing the therapists to express their perception of client experiences there is a broader picture of how Viniyoga experiences impact state change. The following are examples of client experiences as told from the perspective of the Viniyoga therapist.

Participant five discussed a client who came to them with emotional turmoil that they did not know how to work through. The client quickly progressed and “started to have more clarity about what her goals were.” The client was able to determine how she wanted to feel early on in the process. Participant 5 explained this by saying the “things that were frustrating to her and obstacles. It's like, there's a way through, there's a path.” Participant 5 explained their perception of state change in the client by saying “there was the change from feeling very disconnected to feeling connected and especially feeling like in the divine no separation. So that's a huge change in state.” Other ways the client experienced state change related to “feeling really in despair” and then moving toward feeling “solid”. Participant 5 stated that “on every level” there was “a lot more stability.”.

Participant 7 discussed one client who had “knee pain from a recent knee surgery” as well as some physical limitations upon the initial session. Participant 7 described the client as having “a competitive push” and being a “no pain, no gain, type of person.” The goal that the therapist quickly determined was that the client's “personality needed to shift and have a lot more space specifically in relationship to the healing of her knee.” Participant 7 described how they structured a practice to meet the needs of this client. Participant 7 “slowed down the inhale so that there was samana breathing and I paired that to movements appropriate to her physical situation. One thing we recently left with is exploring the difference between moving the leg towards extension with exhale and moving the leg towards extension with inhale because you could do it both ways.”.

The client progressed quickly and after the first session participant 7 stated that “she came back already and said, I walked with a normal gait to a basketball game at the big university. Some steps, long walks, and she had no pain, normal gait” which was not possible before. The client was also able to shift their mindset towards a gentler approach to healing. Participant 7 stated that the client “was like explaining to me how she had shifted her perspective to being a little more kind to her body.”.

Participant 8 discussed a client who also had physical pain related to the knee and walking. Participant 8 stated that this client came in with a “bone-on-bone type of arthritis in the knee” but wanted to avoid surgery. Participant 8 employed gentle movement techniques “because whenever somebody has a problem, especially part of it is the upsetting and part of it is the pain itself of the problem or whatever, but the upsetting factor too, the muscles tend to tense” which allows the client to hold space. Participant 8 described the physical change as “so stunning to me. I never forgot it” when the client’s pain swiftly dissipated.

Participant 8 described the state change in this client by expressing how the client “was relieved and happier and more confident and sort of had their life restored to them kind of feeling that they had where possibilities were open to them in their life and their functioning rather than windows closing because the impression you get is here you are this is old age it's only downhill from here, it's a more open, a more buoyant, a more stable, calm kind of.” Participant 8 described this client’s Viniyoga practice as an anchor in their busy life.

Participant 9 described a client who struggled with anxiety and had “challenges with respect to attention and being attentive in relationships and in life.” The client’s anxiety was “interfering with work performance and personal and professional relationships.” Participant 9 stated that the client was interested in yoga therapy and therefore practiced regularly “significantly reduced the level of his anxiety in the person.” Participant 9 stated that “what I'm also trying to do all the time is I'm wanting the better the relationship the person has with their practice, the more effective it's going to be. And the more motivated they are, the better it's going to be.” Participant 9 was able to explain the practice and techniques in a more technical manner, which increased the client’s interest and thus motivation. Participant 9 stated that the client responded, “much more effectively to the subtle, less movements” and was “soaking it up like a sponge.” Participant 9 expressed that “this client state changed dramatically. They, I would say like a 50% reduction in level of anxiety.”.

Participant 10 discussed a client “who had graft-versus-host syndrome, which was an autoimmune rejection of bone marrow.” The client also had leukemia, like their husband who had already passed away. This client’s condition was very complex and “it impacted her at a multidimensional level, at every level.” Participant 10 started by giving the client “some very simple joint movement with breath and then with chanting, because that helped her with her memory, chanting and movement and kind of contralateral things.” Participant 10 also “gave her some contralateral structural movement you know right brain, left brain integration process.”.

Participant 10 described this client’s progress by saying “she kind of almost became the cheerleader for her body, praying for support and empowering the alchemy within her own body to find new balance. And she became empowered, and she was a cancer coach. She became a cancer coach nationally and relied a lot on the breathing.” Another important technique for this client was the use of meditation. Participant 10 stated that the client shifted the meditation “from what she can do to restore balance and strength and stability to how to prepare for the inevitable end of life. So, meditations on what's truly important and that her true worth and value is not dependent on anything external or even in her own condition and her ability to function.” This was important so that the client could “prepare for the inevitable end of life so that she could reach that day with kind of a sense of completion, contentment, not fear and anger.” Participant 10 described this state change as the client “felt more empowered and able to manage their own condition and had tools that they could use. And then over time, they began to embrace the reality of impermanence and instead of resisting it, so that there could be more fullness in her experience as she approached the end of life.”.

Participant 11 described a client that had difficulties regarding sleep. Participant 11 stated that “this client had trouble falling asleep because they were thinking about stressors particularly family issues and is older, so were thinking about sort of negative things like what happens if I die? Who's going to manage my money? What's gonna happen to my stuff?” Participant 11 described the main goal as “redirecting the mind and creating a practice that made them sleepy” using “predominantly breathing and mediation techniques.” Participant 11 described this client’s progress by saying “this client…halfway through the practice they would fall asleep and had improved sleep overall.” Participant 11 described the state change in the client as having more energy and being less fatigued.

Participant 12 discussed a client with “very intense pelvic pain” who had “a very high demanding job” and was a “very, very smart person.” The client was frustrated with the challenges the pain posed in her life and “with her body in general.” Participant 12 began sessions by “exploring how to have movement without pain or without any additional pain.” The primary goal starting out was “about bringing her state down because she was also quite active mentally, quite, you know, red faced, really pretty expansive in her, like, loud talking, pretty intense in her presentation of herself. And so, the first goal was just how can I give her something that will help calm her down that is challenging enough but doesn't also aggravate the symptoms.” Participant 12 stated that “as we progressed, we were able to find a practice that she was really happy with and solid and able, and she's a self-disciplined person, so she's doing it every day. And she had some really awesome milestones, you know, I would say in the first few months, her pelvic pain completely eliminated, which was huge.”.

Participant 12 described some dramatic state changes in this particular client. Participant 12 described the state of the client as still being “power, but it’s so different.” The client went from “I hate my body and it's killing, like my body is being mean to me” to “oh, my body is just telling me something that I can pay attention to” which participant 12 described as a huge state change. Participant 12 stated that the client was “much more calm” and had “much more space inside herself and connection to what's important to her.”.

6. Discussion

6.1 The Lived Experiences of Viniyoga Trained Yoga Therapists

This study examined how Viniyoga therapists view state change in their client work. State change can be both a tool used to support clients (i.e. a Viniyoga therapist may introduce a breathing practice to help their client feel more calm if they present to session agitated) as well as a goal clients may want to work on in yoga therapy (client may want to work on how to have more energy to get through their day). Viniyoga therapy is used to support state change on all levels of the pañcamaya model and a change in one level may impact other areas. For example, providing a client movement coordinated with breath (asana) to address back pain (physiology or pranamaya) may positively impact their state of mind (emotions or anandamaya). This is an example of how state change and Viniyoga therapy work.

The state change perspective is one way to understand how and why Viniyoga therapy can be applied to so many different physical and psychological challenges. The pañcamaya model, a 5-dimensional model that considers a client’s structure (annamaya), physiology (pranamaya), mind (manomaya), personality (vijnanamaya), and emotions (anandamaya) explains how Viniyoga therapy can be used to effectively address presenting problems across the human system.

The theory that Viniyoga serves to support the clients’ state change was supported by Viniyoga trained yoga therapists during the interviews. In depth interviews with this very select yet diverse group of fourteen practicing Viniyoga therapists in the tradition of Krishnamacharya offered invaluable insights. Restricting participation to this specific lineage revealed clarity and shared understanding about state change. Using the framework for IPA research as a guidebook to support validity and rigor, the steps outlined in IPA were followed and repeated until five themes naturally arose from the text. The researchers used the words of the participants to illustrate how the themes organically expressed themselves in the study.

The themes are key to revealing how Viniyoga supports state change from the perspective of Viniyoga trained yoga therapists. The five themes identified were: Viniyoga empowers clients to participate in their own process of state change by training their self-observation skills and providing tools for influencing their state, Intentionally engineered experiences are the tools of Viniyoga, the relationship between the client and the Viniyoga therapist itself promotes state change, Viniyoga takes a highly individualized approach to supporting state change, and State change is foundational to the healing process of Viniyoga. Study participants shared detailed and meaningful examples from their client work to illustrate how they have witnessed the impact of Viniyoga on state change among their yoga therapy clients.

The adaptable, holistic model of Viniyoga therapy creates individualized ways for clients to create state change. Viniyoga therapists use both the depth of their training on yoga principles and their interactions with clients to create a daily practice that allows clients to establish and even maintain state change over time. As clients practice therapeutic Viniyoga in a personalized daily practice designed by their Viniyoga therapist, they learn how to implement tools to change their state independently. State change achieved through Viniyoga therapy interventions has a positive impact on a variety of physiological and psychological conditions. Viniyoga therapy demonstrates the potential to serve as a complementary and integrative health approach. Viniyoga therapy can support traditional approaches such as psychotherapy, psychopharmacology, and allopathic interventions.

The implications of this study in yoga therapy practice supports the development of a strong alliance between the client and therapist and the importance of using holistic, experiential methods in order to create state change. Viniyoga therapists are encouraged to view their yoga therapy training as a foundation for creating state change, while emphasizing individualization, adaptability and empowerment in developing practices for clients. As a result, Viniyoga practices can be helpful for a wide range of conditions and facilitate healing on more than one level.

The results of this study expand on earlier work by Heeter et al. on the effects of a Viniyoga meditation for participants over the course of 2 months’ time [4]. While an earlier study by Yoshihara et al. showed that the long-term practice of yoga resulted in lower mental disturbance, tension-anxiety, anger-hostility, and fatigue scores [6], this study demonstrated these positive effects, and more, can result from Viniyoga therapy that targets specific conditions and is adapted to clients’ individual needs. Sullivan et al. [8] explored the effects of yoga therapy on resilience and self-regulation, while emphasizing a holistic approach on health and healing. This study expanded on this framework with specific examples of how yoga therapy positively benefited clients, as well as narrowing the focus from yoga therapy in general to Viniyoga therapy.

While the qualitative nature of this study allowed for deep exploration of the participants’ experiences as Viniyoga therapists, the sample size of fourteen, while sufficient for IPA research, is small. Further research could be done to explore using other schools of yoga therapy and similar disciplines compared to Viniyoga therapy. Kepner et al. compared the results of utilizing Viniyoga therapy versus Phoenix Rising Yoga Therapy and the Feldenkrais Method^® to improve lower back pain [34]. Future research could elaborate on the effectiveness of different methods on some of the conditions discussed here, including physical conditions such as knee and pelvic pain and psychological/emotional conditions such as anxiety and grief. It could also be helpful to explore clients’ perceptions of Viniyoga therapy using a similar structured interview process and compare/contrast these results with Viniyoga therapists’ perceptions. While our study focused on the successes of Viniyoga therapy, it could be useful to explore factors that hinder successful state change, in order to counteract them.

Acknowledgments

I thank Carrie Heeter for her expertise and assistance in developing the semi structured interview guide and Graduate Research Assistant Cheyenne Williams for writing and editing assistance.

Author Contributions

The conception, design of experiments, and data acquisition in this study was completed by Jennifer Vasquez. Data analysis, drafting, and revising the manuscript was completed by all authors.

Funding

Authors received no funding for this research.

Competing Interests

The authors have declared that no competing interests exist.