April 22, 2019

Mindfulness & Trauma-Informed Yoga to Incarcerated Men, Women & Youth

A conversation with Karen Kwass, Research Assistant to Dr. Byron Good and Dr. Mary Jo Good, Department of Global Health and Social Medicine, Harvard Medical School

Juliana Restivo Q. Could you describe the Prison Yoga Project to the community? 

Karen Kwass Answer: The Prison Yoga Project (PYP) is an organization that brings Mindfulness and Trauma-Informed Yoga to incarcerated men, women and youth in prisons, youth detention centers, county jails and other correctional facilities across the country, Canada, Mexico and Europe. Based on yoga and mindfulness research studies that show physical and emotional benefits, founder James Fox developed a program of best practices and developed prison specific trauma informed training for yoga teachers. The curriculum includes lessons in Restorative Justice (RJ), a theory of justice that emphasizes repairing the harm caused by crime. It is best accomplished through cooperative processes ‘circles’ – facilitated meetings between victims, offenders, and other persons. This theory is incorporated into our yoga practice through increased awareness of their body, emotions and negative patterns of thinking that led them to their crime. In prison the offenders take responsibility for the harm they committed, acknowledge their accountability and make amends for this harm. The men in the restorative justice classes asked for a mind/body class to help deepen and embody their healing process. As leaders in the RJ classes the men established criteria that required completion of two restorative justice classes prior to enrolling in the yoga and mindfulness class. The men are actively involved in running the RJ programs in conjunction with outside facilitators. 

Q: Tell us about a moment when you realized that this was making a difference in their lives?

A: With 13 men, me and my formerly incarcerated and experienced RJ facilitator we started the first Restorative Justice Yoga and Mindfulness project in this facility two years ago. The men love it, it improves their physical body, decreases stress, increases self-awareness and compassion. I frequently hear how much they look forward to class each Sunday, it is one of their favorite programs. We are a sangha – a group practicing yoga together and in prison it becomes a safe space, an opportunity to laugh together, cry and share in a deeply personal, meaningful way in a supportive community. This creates a way of life, and studies show yoga in prison can lead to reduced recidivism. 

Q: Where do you see the biggest impact being made? 

A: The men state that increased awareness is one of the biggest benefits they have gotten from the yoga; it is the only time they dare to lay down and rest. Yoga has become their sanctuary, feeling safe, respected and relaxed. Some struggle with dark thoughts in meditation, others love the inner peace, as prison is never quiet. Yoga has a significant impact on them; they always express their gratitude for the class, for the bond & brotherhood which develops, that we come back each week, for release of pain in their body, and the sense of peace and acceptance. They come with physical pains, ‘I didn’t think much of yoga, but my back is much better’; ‘after hip openers I have much less pain there than I ever had’. J says ‘nobody comes to visit me, you coming in every Sunday is my family visit’. ‘A corrections officer pissed me off, I felt my body tense up like during my crime, I took a breath and didn’t react. I am grateful for learning breathing to induce the PNS and make a better choice’. 

Q: What are the biggest lessons learned or takeaways from your experience?

A: When I walked in to the prison as the yoga teacher and only woman I had no idea of what to expect, no idea of what it was like in a prison or what the men would be like. Oddly enough, I was never afraid. Prison is not what I thought. In many ways it is worse; de-humanizing, and punitive. Getting to know these men has been one of the most rewarding experiences in my life. I have respect for how these men face their wounds, take responsibility for what they have done, move forward in healing themselves and helping others to not have to go through what they have. The trauma runs deep for many: raised by drug addicted parents, bullets lodged in the body, poverty, gangs-filling a void of not belonging, drugs, shame. This shows up in bodies holding trauma and stress, in unhealthy environments and often a lack of medical and mental health care. We do yoga to release trauma in the body, become aware of how our body responds, how negative self-talk, old wounds can lead to behaviors we regret. 

March 25, 2019: Student Spotlight: Dani Poole

Doctoral Candidate in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health.

Q. Could you describe to us a little about your research? 

A. My work overall addresses the mental health of forcibly displaced persons. In a recently conducted study among Syrian refugees in Greece, we found a high prevalence of major depressive disorder (43%). Despite the urgency of mental health surveillance and treatment in humanitarian emergencies, there has been little evaluation of instruments that keep response burden to a minimum. We aimed to evaluate a sequential screening process for the detection of major depressive disorder that improves the efficiency of screening-confirmation procedures using the two-item and eight-item Patient Health Questionnaires (PHQ-2 and PHQ-8, respectively) in a refugee population. We found that, using a cut-off score of ≥2, the sequential screening process is 90% sensitive using the PHQ-8 classification as the reference standard with a 100% negative percent agreement, meaning there were no false negative classifications. The sequential screening process eliminated the completion of the full PHQ-8 instrument for 34 respondents (25%). I recently presented these findings at the 10th Consortium of Universities for Global Health,and am engaging in discussions about next steps with implementing stakeholders. 

Q: What are the biggest lessons learned or takeaways from this experience/work? 

A: The greatest lesson I learned from this study is the importance of in-transit stressors on forced migrant health. Much of the existing research on the mental health of displaced populations focuses on pre-migration trauma-related stressors, with some literature examining post-migration stressors. However, time in-transit will only increase as more people are forced to migrate due to the changing nature of conflict and compounding effects of climate change. This period of time represents both a critical exposure, as well as an opportunity for intervention.

Q: What advice would you give to someone looking to become involved in this? 

A: There are many opportunities to get involved in this research! Most importantly, I advice everyone interested in studying health during displacement to stay up-to-date on the policies, recommendations, and challenges relevant to forced migration. Specifically, aligning your research agenda with the needs of implementing partners, including governments, intergovernmental agencies, and non-governmental agencies, ensures that any evidence generated can inform decision-making. 

Q: Was there a moment/experience in your work that stands out to you?

A: There were many moments that stand out over the course of listening to peoples’ stories while collecting data, but those stories aren’t mine to tell. The most memorable moment of my experience as a researcher was when I ran the code showing evidence of an increase in depression associated with increased time spent in the refugee camp. This finding contradicted my assumptions about what life might be like during the asylum process – I had wrongfully assumed that having fled Syria, people would become increasingly better off. Instead, the data suggest that mental health, or at least depressive symptoms, are exacerbated by lengthy periods of time spent in camp settings. While this finding should be evaluated in other settings and over time, the possible adverse impact of increased time in a camp and mental health necessitates urgent consideration by humanitarian actors.