Teenagers

Yoga? I'm not doing no yoga! Not enough testosterone! Yoga's for girls! It's just not me!

These were the kind of comments thrown at me when I first introduced a yoga/meditation/relaxation (YMR) group to 15 adolescent boys. Now, three years later, when a new boy joins the program, I still hear the same lines of protest. But before I can open my mouth, one of the older residents will say, "No, you have to do it. It's not so bad. I didn't want to do it when I first came, but it's straight. You'll see - you'll like it. And the best part is the relaxation. She hypnotizes you." Thwarting any questioning of my powers, he quickly adds, "She levitates, too."

The new boy generally looks puzzled. The guys informing him that he'll like yoga are pretty tough looking; they don't appear to be lacking in testosterone. So despite his skepticism, he bows to peer pressure and gives it a try.

The boys in my now twice-weekly YMR group have been placed at a 90-day residential facility for adolescents with substance abuse and other co-occurring disorders. I started the group because I wanted to find a means for the boys to calm themselves. Most of these adolescents' relationships are filled with conflict. They are fighting with their families, are doing poorly at school, have serious legal charges and are on probation. They carry a lot of stress, which shows up in their distractibility, their impulsivity and the hair-trigger nature of their anger - if these boys were thermometers, their temperature would rise from 1 to 100 in a couple of seconds.

I began thinking about a group that would teach these adolescents techniques for self-regulating and managing their stress more effectively. I needed something that would work with both body and mind while also being fun. I knew firsthand about yoga and meditation's ability to counteract stress as a practitioner myself for more than 30 years. But how could I present it effectively to a group of adolescent boys?

Initially, the boys were extremely resistant, almost to the point of mutiny. To name a select few of their diversionary tactics: The guys wouldn't leave their shoes outside the room; they would tell me it was against their religion to do yoga; many of them suddenly developed "scoliosis"; everyone dropped onto their mats as soon as they had them and refused to get up; they wouldn't even try the yoga postures, and if someone ventured an attempt, the others would laugh and insult him until he stopped; they threw things at each other; they pushed each other; someone would mimic my voice during the relaxation, and someone else would shout, "Shut the (expletive) up!"; two guys would be playing cards, while another would be listening to his iPod and handing one of the earphones to his neighbor so he could also listen as they tapped in time to the music.

There were many times when I said to myself, "This just isn't working. I can't do another one of these sessions." But I always did, and over the years, I learned from the adolescents what worked for them and what didn't. Along the way, the hour-long group developed a life of its own.

The process

Before the group begins, the boys help me get the mats. They leave their shoes outside the group room and assume a standing position on their mats. The adolescents complete the residential program at different times, so I describe the YMR group again whenever a new resident arrives, explaining that the group is divided into three parts: yoga to relax the body, meditation to relax the mind and a guided body scan to relax both body and mind.

I begin the group by asking the boys to rank on a Likert scale how they are currently feeling, with 1 being the least relaxed and 10 the most. I note the responses and then lead group members through a series of yoga postures. The postures begin very vigorously with Sun Salutes. By the time this exercise is completed, the boys have released some of their tension, are feeling more relaxed, are more accepting of the subsequent poses and are forming some group cohesion. We then do a series of balancing exercises. Because we have to concentrate to stay balanced, these exercises make us more focused. The remaining poses are designed to be calming. By the time we come to the shoulder stand, which heralds the end of the yoga session, the guys have released enough tension to move on to the next and most demanding section of the group - seated meditation.

I tell the boys that starting now, they must focus only on themselves. There is to be no side talking. After they have settled into a seated posture, I explain the technique, which is to focus on the breath. I talk a little about how the mind tends to wander, finding it extremely difficult to concentrate on the breath. I liken the mind to a wild horse that must be tamed, instructing the group members to simply return to the breath when they realize they are thinking about other things. Finally, I tell them I am going to stop talking and we are going to practice the technique for five minutes. I used to guide the group throughout the entire meditation until one of the boys said, "I can't concentrate if you talk all the time. I think you should stop talking and let us do it on our own." He was right, and I am moved each time by how good they have become at doing this very difficult thing. After the meditation, we have a 10-minute discussion about what it was like for them to engage in this practice.

Some extraordinary therapeutic moments have emerged from these discussions. I recall one young man from the inner city who exhibited a very tough exterior. His friend had been killed less than a year before. The other group members considered this boy a leader and tried to emulate his walk and style of dress. He talked softly and sparingly to his peers and refused to speak in group. "It's just not me," was his stock answer.

But when I invited responses after a YMR group, he said, "It was weird. I was listening to your voice, and when you said 'Breathe in darkness,' I could see me and my boys fighting the other boys. I was fighting in the corridor, then everyone was running away. I went back to where the fight started. They were all gone, and my boy was lying on the floor bleeding. I took off my shirt and sat down with him and tried to stop the bleeding, but I couldn't, and he died. Then I breathed out light, and I knew he was OK. He's in heaven, and I don't have to worry about him."

For the first time since meeting him, this young man was looking me directly in the eye. Then he asked, "Can we do meditation again tomorrow?"

The boys like the last part - the guided relaxation - best. They sit or lie on their mats, eyes open or closed according to what is most comfortable for them. I then guide them through a detailed body scan using the breath to induce deep relaxation. After this final section of the group, I commonly hear comments such as, "I wasn't asleep - I could hear your voice - but I wasn't awake either. It's like dreaming but being awake."

After the body scan, I again ask them to rank on a Likert scale how relaxed they feel at that moment. Generally, there is a significant difference between the first and second Likert scale. The first time, about 80 percent of the boys will rate their relaxation level as a 4 or a 5; the second time, their relaxation level will jump 4 or 5 points. It is not unusual for the boys to report 10s. The other 20 percent of the boys will begin at 0, 1 or 2 and jump to a 4 or a 5 on the second scale. Regardless of where they began, they experience a significant decrease in tension.

Evidence of positive results

The boys' reports of being more relaxed are reflected in their behavior. This has been noted anecdotally by direct-care staff, who report that after the YMR group, the boys are "easier to deal with, not as demanding and nicer to each other." Significantly, no incidents are reported that day following the YMR group. Parents or guardians do not directly acknowledge the benefits of YMR, but they sometimes comment they are amazed that their son is doing yoga and seems to enjoy it. When graduating from the residential program, the boys often talk about how much they grew to like the YMR group.

According to a study published by George Parks and Alan Marlatt in 2006, a meditation program involving severely addicted drug and alcohol users serving sentences at a prison in Washington state showed decreases in alcohol-related problems and psychiatric symptoms as well as increases in positive psychosocial outcomes. According to studies conducted in 2007 by Farris Tuma, the practice of yoga produced notable reductions in stress and post-traumatic responses in veterans suffering from post-traumatic stress disorder. Bessel van der Kolk, medical director of the Trauma Center outside of Boston, has recently received a National Institutes of Health grant to study the effect of yoga on traumatized women considered to be treatment resistant. Evidence is increasing that yoga and meditation are viable tools for relieving stress. That has certainly proved to be the case with the adolescents in my program.

As clinical director of the residential treatment facility, my emphasis is on providing a multidisciplinary approach to addiction and other co-occurring disorders. Ninety days is not a long period of time to work with disorders that have been a long time in the making, so our aim is to provide these young men with as many different approaches to care as we can.

In group therapy, we tend to lean toward the expressive therapies. For example, every youth in our program makes a body map while he is with us (the maps line the walls and are both aesthetically pleasing and instructive). Literature and poetry readings form the basis of other groups, while yet another describes the steps to recovery through an art project.

More traditional counseling is provided in individual and family sessions, which take place once a week. Here, too, YMR proves to be very helpful. I often begin both individual and family sessions with a brief guided meditation, having found that it defuses stress and allows clients to talk more easily about their problems. If clients are extremely tense, I do a few simple yoga postures with them. This tends to decrease their tension level and makes them more willing to engage. I even assign some clients "homework" - a five-minute meditation every morning when they wake up. They write a few sentences about what this was like for them, and during our next individual session, we go through their notebook together. Other clinicians in our program report that their clients have talked about how they use YMR to calm themselves. In particular, some of these clients have shared that if they do the relaxation part of the process, it helps them to fall asleep at night.