The physical practice of yoga based on Ayurvedic philosophy would balance the different constitutional types by emphasizing relaxation for vata, coolness for pitta, and invigoration for kapha. Specific pranayamas (breathing exercises) are utilized to cool “overactive” pitta, to energize “sluggish” kapha, and to calm “windy” vata imbalances. In addition to pranayama, there are various ways of moving through the asanas to correct the imbalances mentioned above. An example of this would be to have the kapha type student move at a faster pace to invigorate sluggishness and produce heat, while having the pitta type student move at a slower pace to lower heat, and having the vata type student move at the slowest pace to calm nervousness and anxiety.
Yoga therapy. Yoga psychology differs from Ayurveda when addressing anxiety and depression, even though Strohecker (1999) says that Ayurveda often recommends meditation, yoga, and specific forms of psychotherapy. Unfortunately, nothing was identified for the kind of psychotherapy Strohecker was referring to. In researching this further, it was found that Von Schmadel and Hochkirchen (1992) reported in The Journal of the European Ayurvedic Society that psychological disturbances relate to an imbalance of the doshas at the heart. Ayurveda, according to Von Schmadel and Hochkirchen (1992), does not distinguish between somatic, psychosomatic and psychological disease. This is because all diseases (including the psychological) reside in a vata, pitta, or kapha imbalance and they take a somatic approach to dealing with psychological symptoms. In the classical texts of Ayurveda and in contemporary Ayurvedic practice, the focus is clearly on therapeutic measures assigned to somatic treatment of the doshas (Von Schmadel & Hochkirchen, 1992).
Unlike classical Ayurveda, yoga psychology addresses anxiety and depression and combines well with Western approaches and spiritual growth. Pazhayattil (1985) used the combined approach of psychotherapy and yoga to determine if changes in growth and health correlate with changes in states of consciousness. Positive attitudinal changes were shown along with improved concentration, autonomy, and inner peace, coinciding with decreases in anxiety and nervousness (Pazhayattil, 1985). When subjects reported that they perceived a shift in identity from self to existential, and then to transpersonal identity (with an existential realism) Paxhayattil concluded that Western psychotherapy and Patanjali yoga are able to harmonize with each other.
Unlike psychotherapy, yoga psychology does not place extreme importance on the congruence of an individual’s behavior with society or on ego development (Rama, Ballentine & Ajaya, 1976). Yoga psychology, which is based on Patanjali’s classical system of yoga, refers to kleshas or patterns of suffering that result from even “normal thinking” as we know it. The five kleshas include: 1) avidya – ignorance; 2) asmita – limitation; 3) raga – attachment; 4) dvesa – aversion; and 5) fear of death. These kleshas prevent further growth and most likely cause anxiety and depression.
The kleshas as a pattern of suffering might apply to perimenopause as follows.
During perimenopause, a woman may be ignorant of her spiritual nature and therefore be limited in her capability to understand and control her symptoms. She may be attached to a view of herself as youthful and have an aversion to the natural aging process as signified by the menopausal transition, and likewise begin to fear death. If this is the case, anxiety or depression may accompany vasomotor symptoms.
If a woman stops growing spiritually at perimenopause because her attention and energy is directed towards maintaining her youth, she becomes attached at that level instead of redefining herself in her growth process. When any growth process is averted, anxiety and depression may result (Rama, Ballentine, & Ajaya, 1976). The menopausal transition may seem dreadful because there may be a perception of loss, but yoga psychology would say that the ego must surrender its present identity or existence in some way to make room for a new identity. Any attachment to a self-image may prevent further growth. To loosen an attachment requires a shift in the perception of reality, and sometimes reality forces that upon us, as discovered by those women who reported a sense of liberation at menopause (George, 2000).
It might be hypothesized that HRT was encouraged in U.S. culture because of our attachment to youth. HRT is prescribed to maintain estrogen levels as they were during the kapha-pitta stage of life. Whereas western society places a demand on women to maintain the physical attractiveness of the kapha-pitta stage of life, yoga therapy encourages growth beyond cultural expectations of youth and beauty. In spite of the Women’s Health Initiative study, which was very discouraging, most women can benefit from bioidentical HRT during menopause (not Premarin or Provera!). I have heard personal testimonies that if a woman has let a long period of time pass, for example, say that she had an early hysterectomy, it is dangerous to start hormones at an older age. To that end, there are benefits of yoga therapy to manage symptoms and, though there are other methods, the hope here is that women will choose the approach offered here over HRT whenever possible.