How Viniyoga Supports Health and Healing

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

1. Texas State University, 601 University Dr, San Marcos, TX 78666, USA

2. Independent Researcher, Austin, TX, USA

3. Independent Researcher, Friday Harbor, Washington, D.C., USA

* Correspondence: Jennifer Vasquez

Academic Editor: Peta Stapleton

Special Issue: The Effect of Yoga Therapy on Human Health

Received: January 17, 2025 | Accepted: March 09, 2025 | Published: March 14, 2025

OBM Integrative and Complementary Medicine 2025, Volume 10, Issue 1, doi:10.21926/obm.icm.2501014

Recommended citation: Vasquez J, Quill M, Bossart C. How Viniyoga Supports Health and Healing. OBM Integrative and Complementary Medicine 2025; 10(1): 014; doi:10.21926/obm.icm.2501014.

© 2025 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

Health and healing are an integral part of yoga therapy. They are often thought of in union, however, there are some differences between what health and healing mean. The World Health Organization (WHO) broadly defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity [1].” The WHO frames health as a human right and approaches health from the standpoint of government, justice, and a holistic need for society to contribute to everyone's health [1].

Healing involves concepts of the mind, body, and spirit [2]. Healing can be defined as movement toward wholeness [2]. It embodies the entire individual and their journey. Healing focuses on the dynamic, incremental process of recovery and restoration of wholeness of the individual including aspects of physical, emotional, intellectual, social, and spiritual dimensions [2]. There are many different avenues for healing, but this study focuses on therapeutic Viniyoga.

Yoga is rooted in Eastern philosophy and originated over 3,000 years ago in India [3,4]. Yoga is a spiritual and philosophical discipline [5]. Yoga interventions are diverse and may incorporate physical movements, breathwork, mindfulness, mantras, and meditation to create balance and internal awareness by focusing on the mind, body, and spirit [3,5,6]. Yoga offers approaches for mental, physical, and spiritual healing bringing body and mind together toward a unified wholeness and connection [4].

Yoga is a holistic treatment option designed to unify the body and mind while enabling individuals to see life with greater awareness [4,5]. Yoga addresses physical health and also mental health [3]. Yoga has shown promising results as a complementary approach to healing for a multitude of health and mental health conditions [5,7]. The objective of this study is to uncover themes identifying how Viniyoga therapists perceive their work as supporting the health and healing of their clients.

2. Literature Review

2.1 The Philosophy Underlying Therapeutic Viniyoga

Viniyoga, or therapeutic Viniyoga, is a particular approach to yoga that takes the concepts of yoga and uses them to create a therapeutic intervention for a variety of needs based in practices such as breathing, mediation, and physical postures. Practicing Viniyoga fosters a progressive change in an individual’s life and behaviors [8]. Personal and spiritual evolution are supported [8]. The process of Viniyoga includes developing awareness of different sensations, images, thoughts, and emotions [9]. Practicing awareness facilitates detachment and peaceful distancing from the senses [10]. Through this process, the individual gradually gains access to greater interior stability [8]. The Viniyoga practice of self-knowledge is meant to be integrated into the daily life of the individual [11].

The therapeutic application of Viniyoga seeks to meet the individual exactly where they are and build a pathway for therapeutic change [10]. The techniques and objectives go beyond the physical well-being and relaxation of the client [11]. The experiential piece of therapeutic Viniyoga- of practice with awareness during yoga and in life- is essential [9].

2.2 Goal(s) of Therapeutic Viniyoga

The overall goal of therapeutic Viniyoga is to reduce suffering and promote physical, mental, and spiritual health. There are several interpretations of how to do this. Laurin proposed that the goal is to achieve a focused, peaceful mental state [9]. Marechal described a state of balance and relaxation accompanied by peace and awareness [12,13]. He also suggested that the ultimate goal is self-realization [14]. Desikachar stated that the goal from a human perspective is persistent happiness that is much deeper than satisfaction [10]. Bräutigam stated that the goal is purification [15]. The steps for purification include three components of kriya yoga: tapas, svâdhyâya, and Îshvara-pranidhâna which mean self-discipline, self-study, and surrender [15].

2.3 How Does Viniyoga Define Health?

Viniyoga can help people understand health and healing. Viniyoga offers approaches to disease prevention, chronic illness, and achieving health [14]. Marechal stated that health is the consequence of Viveka, which is distinguishing between what is good and bad for the body [11]. Assessing health involves understanding the body, its systems and structures, and how they work together cohesively. Health relies on balance in these systems and structures [16].

2.4 How Does Viniyoga Define Healing?

Healing is a related but distinct concept to health. Healing is the holistic reduction of suffering that may address any of the five interconnected dimensions of the human system (structure, physiology, mind, personality, and emotions), within the person and in their daily life [17]. Healing addresses the whole person, not just a presenting symptom. Patanjali, in the Yoga Sutra, lists eight limbs of yoga that are disciplines to follow on a pathway of healing and liberation [16]. Marechal explains his perspective as having devotion to God, when the mind has achieved a state of balance and discernment, can heal the mind and overcome disease and other obstacles [18]. The spiritual aspect of Viniyoga is said to lead to profound healing [18].

2.5 Stages for Healing

Reducing suffering, or Vasana, is an ongoing aspect of the healing journey [19]. Therapeutic yoga practices and stages for healing are unique to the person, respecting their limitations, interests, circumstances, and capacities. Appropriate progression for an individual may address some stages while omitting others [20]. The starting and ending point and the order of the stages are unique to the person [20].

Asana, or postures, and pranayama, or the breath, are often important tools in the therapeutic process that are selected, adapted, and sequenced for the specific individual, and practiced to bring about healing [21,22]. Asana and pranayama can be considered therapeutic processes in which healing can occur [21]. Meditation is a very important stage for healing, represented in 3 of the 8 limbs of yoga [23]. There are many stages in the realm of Viniyoga where healing can occur. One example is Pratipaksha-Bhavana [24]. These and other practices can be applied to support healing.

2.6 Therapeutic Viniyoga Research

2.6.1 Adapting the Yoga to the Person

A core premise of viniyoga stipulates that the yoga should be adapted to the person [17,20]. One size does not fit all. An analysis comparing self-reported experiences of advanced practitioners doing identical viniyoga meditations revealed that movement, breath, and chanting steps of the meditations and the meditation objects were experienced differently by every individual [25].

For some participants the steps and sequencing of a practice worked well. For others, the complexity or lack of complexity did not align with the state of their system and their attentional capacity, impeding their ability to focus. What showed up during the meditations was personal and unique. The researchers identified four of the factors that influence how an individual responds to a meditation practice: (1) Current circumstances in their life; (2) the state of their mind, body, and breath right before the meditation; (3) personal familiarity with, affinity for, aversion to, and other personal responses to steps and instructions; and (4) prior experiences in meditation and in life with the object of meditation [25]. These findings affirm the importance of designing therapeutic Viniyoga practices specifically for an individual.

2.6.2 Therapeutic Viniyoga and State Change

According to Viniyoga therapists, state change is the engine for healing [26]. State change is defined as a physical or psychological shift in a beneficial direction that enhances well-being, alleviates suffering, or reveals insight [26]. It is a change in a person that drives the healing process and allows for health and healing to occur. State change can occur along any dimension of the human system. State change can be small and temporary or significant and persistent. State change occurs throughout the healing process and facilitates healing.

An analysis that focused on questions related to state change from in-depth interviews with Viniyoga Therapists identified five central themes. 1) Change occurs through the healing process and reflects healing. 2) Clients are empowered and participate in their own experiences of state change through self-observation and practices they do to influence their state. 3) Yoga therapy brings about state change through intentionally engineered experiences. 4) An individualized approach is essential for considering appropriate state change. 5) The client-therapist relationship promotes state change [26].

3. Methods

3.1 Research Design

This study relies on the same transcripts from 15 hours of interviews with practicing Viniyoga therapists that were used in the state change study [26]. The current analysis examines responses related to health and healing. Interpretive Phenomenological Analysis (IPA) research method to explore how Viniyoga therapists define and approach health and healing. The IPA method incorporates intentional interviewing, small sample sizes, and purposive sampling of a specific group with expertise on this phenomenon [27]. By utilizing the IPA method, researchers were able to uncover themes and gather a deeper understanding of how yoga therapists use Viniyoga to support health and healing.

3.2 Procedures

Once the researchers received IRB approval, participants were recruited via email. The third author was a longtime student of Mr. Desikachar and has offered Viniyoga therapist training for over a decade. He made introductions to 16 practicing yoga therapists that he knew to be actively engaged in Viniyoga therapy. Twelve participants were recruited this way and four did not respond. A teacher in Viniyoga therapist training was asked for help generating additional participants. He provided three more contacts and two participated in the study. In total 19 were invited and 14 agreed to participate. This purposive sample of 14 Viniyoga therapists were chosen to participate in the study.

The researchers utilized an in-depth semi-structured interview style while employing open ended questions [26]. Examination of the literature and creation of the interview questions in consultation with two subject experts allowed for context sensitivity. The interviews ranged from forty-five minutes to one and a half hours long and were conducted over zoom to accommodate participants in various locations. Interviews were recorded for transcription and analyzed in NVivo 12 software using IPA procedures to capture the perceptions of the participants. The researchers identified themes and selected quotes from the participants that best showcased the themes. Using participant quotes to describe the themes allows for a more personalized expression of the data.

3.3 Data Analysis

The seven-step IPA method includes reading and re-reading, taking notes, developing emergent themes, looking for connections across themes, moving to the next case, looking for patterns across cases, and interpretation [27]. IPA was used to support validity and rigor by thoroughly examining the data and themes, identifying connections and patterns that arose. The data analysis steps outlined by IPA were followed and repeated to uncover the themes of the study. By utilizing the IPA framework, the researcher gained a deeper understanding of the phenomenon under investigation through the lived experiences of the study participants [27]. As a Viniyoga Therapist, the primary researcher conducted the IPA analysis, providing a unique capacity for evaluating themes.

3.4 Sample

The 14 study participants are yoga therapists trained in the tradition of Viniyoga of Sri Tirumalai Krishnamacharya and TKV Desikachar [26]. Twelve of the fourteen participants are International Association of Yoga Therapists Certified Yoga Therapists. The participants completed their training through various institutions and teachers including American Viniyoga Institute, Krishnamacharya Yoga Mandiram, Yoga Well Institute, Krishnamacharya Healing and Yoga Foundation, Yoga as Therapy North America (YATNA) and three of the participants were private students of Mr. Desikachar.

The participants have studied yoga from 11 to over 40 years. Five participants have studied yoga longer than 40 years, five have been studying between 31-35 years, and one participant has been studying between 26-30 years. One participant has studied 21-24 years, one for 16-20 years, and one has studied yoga for 11-15 years. All of the participants have a daily personal yoga practice. Eleven of the participants are under the guidance of a mentor.

Participants ranged from 31-80 years old. Participants identified as White and Asian/Pacific Islander. Of the 14 study participants, six were male and eight were female. All of the participants reported that they identify as heterosexual. Two of the study participants hold a doctoral degree, seven hold a master’s degree, and five hold a bachelor’s degree. Participants come from across the United States, including the South, the West Coast, the Pacific Northwest, the Southwest, Midwest, and Northeast. One participant was from Europe.

4. Results

4.1 Themes

Three themes were described by the participants in this study that elucidate how therapeutic Viniyoga defines and impacts health and healing, based upon their training and experiences working with clients. The themes uncovered in this investigation are 1) The definition of health is particular to each person 2) Healing involves change in a positive direction, 3) Healing occurs in stages.

4.1.1 Theme 1: The Definition of Health Is Particular to Each Person

Participants generally defined health as a multifaceted, optimal functioning of the human system related to the individual’s capacity. Health is viewed, not as an objective possibility applying equally to all people, but rather as the best functioning possible for a particular person. Moreover, many participants specified different dimensions of health, such as physical, mental, emotional, spiritual, that they viewed as related to each other but distinct. Therefore, it might be possible to have good mental health at the same time as poor physical health, and vice versa.

Participant 10 explained “a healthy body is one in which the body is balanced, and the systems of the body are functioning in a relatively efficient way and there's vitality, energy, you sleep well, you have energy throughout the day, there's a lack of pain.” When it comes to therapeutic Viniyoga, Participant 3 explained, “it's a process that we apply things to promote optimal health.” Participant 2 also noted that health is, “very personal, very individual” and Participant 6 said it is, “very subjective.” Participant 12 stated, “I think about health and healing all the time…I think about health as a path towards wholeness.” Participant 1 noted that, “health can be measured in different ways. There's physical health, mental health, behavioral health, emotional health, spiritual health.” Health is a complex conversation, and several participants stated that it is a process, “a wholeness” or “a zone, not a destination.” Participant 11 stated, “as a Viniyoga therapist, I think a lot of what we do is help people identify ways to engage and manage their health better.”

Participants discussed the different aspects of health. Participant 4 explained, “health is more than just being physically well. I think that a person's state and a person's perspective on life, if there's a sense that they're connected to something larger, or that there's a sense of well-being and purpose.” Participant 9 stated “health relates more to people's physiological state and mental state in terms of functioning effectively and not inhibiting or in some way constraining their life, their living.” Participant 4 stated that health includes “being able to function as well as you can, given your system… health also includes things like being able to affect change, so that you have sort of the best environment and circumstance for your system to function at its best, even if that includes challenges or managing pain or managing an illness.”

4.1.2 Theme 2: Healing Involves an Accumulation of Changes in a Positive Direction

Among the participants, healing was generally considered to be an accumulation of changes in a positive direction, of one or more of the different dimensions of the human system. All dimensions may change, or one aspect may change while the others remain unchanged. For instance, there may be positive change (healing) on an emotional dimension despite a worsening of the physical. Since the change is within the individual, it is measured against the previous condition of the individual, not an outside objective standard applying to all people. Healing is a process or a journey that clients are going through in Viniyoga. Participant 12 described healing as “a lifelong quest… (it isn’t a) linear thing, we do this and then we're healed.” Participant 5 also stated that “healing is really individual… I think health and healing are both goals of yoga. And so, removing the suffering that comes from being unwell.” The importance of individuality was again highlighted by one therapist saying, “I believe that healing happens at multiple levels. I believe it's very unique to each of us.” Participant 11 stated that “I think that’s part of Viniyoga is recognizing the individuality and diversity in clients and so even health and healing can mean something different for different people.”

Participant 1 described the process of healing as the “recovery of capacities” and “thinking about the recovery and the moving of the operation of the person's system back towards those manifestations.” Participant 4 described healing as “the process of developing that state of mind or sense of well-being. Healing also includes cultivating the internal environment, the way that one’s system functions. The things that help, learning about that, starting to develop those patterns in one's life.” Participant 10 described healing as reaching “a place of clarity and balance and contentment, no matter what's going on” regardless of condition. Participant 10 explained that a healthy body is one in which the body is balanced and the systems of the body are functioning in a relatively efficient way and there’s vitality, energy, you sleep well have energy throughout the day, there’s a lack of pain.” They added “you can be healed even when you have a disease.

4.1.3 Theme 3: Healing Occurs in Stages

Most participants agreed that there are stages involved in healing and that healing looks different for every client. Participants 4 and 12 described a model of approaches to yoga depending upon the situation and capabilities of the practitioner: Chikitsa or treatment for people whose health is in jeopardy, Rakshana or practicing yoga to maintain health and strength, and Shiksana or yoga in the fullest form which requires energy and no limits, obstacles or restrictions. Participants 1 and 8, described Shamanam, or pacification, a healing treatment used to rejuvenate and restore balance and Shodhanam, or purification and detoxification as different approaches to healing based upon the needs and capacities of the client. Participants 4, 5, 9 and 11, described the stages of healing as beginning with an understanding or awareness and pacification of the problem or symptoms, followed by stabilization and then an action phase, a phase of growth. Overall, the participants agreed there are stages on the healing journey, while the specifics varied between therapists. Participant 9 stated, “I believe understanding healing and its overall process is an area that is ripe for discovery, research and learning.”

4.2 Case Studies

The yoga therapists in this study shared specific examples of clients they’ve worked with during the interviews. They provided client cases containing rich and deep descriptions of how therapeutic yoga has impacted the health of the clients they work with. Four case studies were selected that illustrate how yoga therapists perceive their clients’ experiences of healing. Yoga therapists observed the health of their clients improve through the application and practice of Viniyoga. The researchers link case study observations to the three themes.

4.2.1 Case 1

Julie, a client of participant 1 came to yoga therapy presenting with back pain. In the initial session, the Viniyoga therapist noticed that certain physical movements paired with breathing provided some relief from the physical issues Julie was experiencing. In the initial session, the therapist developed a practice for her where she was lying on the ground with some movement of the arms and legs in a supported manner. Julie had her legs up on a chair and moved her toes coordinated with breathing and focusing on exhale. Along with this she was working to develop ujjai and the whispered ah (types of pranayama or yogic breathing techniques where the throat is gently constricted during exhale, slowing exhale down and focusing attention on exhale). As therapy continued, it came to be seen that the physical pain Julie was experiencing seemed to be a manifestation of a recent shift in her life and the loss of her partner. In the initial session, this was not clear but rather came to light over time. At the next session, Julie expressed to her therapist that when she did her practice, it made her sad. She said she felt a lot of grief when she was doing the movements. Her practice was modified to include expression of grief to allow her to be present and encourage her to express the grief. This involved a water meditation of bringing water in and returning water out. Julie appeared to experience physical improvements, and she no longer needed the chair to support her legs. Instead, she was able to do the movements with her feet on the floor and continue to develop her breathing. Finally, it turned out that there were specific things Julie wanted to communicate to her partner that she had lost. The therapist gave her a rose petal meditation where Julie was able to inhale, visualize picking up a rose, exhale, offer the rose petal, and communicate something with her partner. Over the progression of therapy, Julie’s back had improved to the point that she was able to do standing postures. These standing postures were able to help her to strengthen her back, and not just relieve the physical pain.

Considering health, healing, and stages of healing, Julie’s presenting health issue was physical. She was experiencing back pain. The therapist tailored a practice for her involving gentle movements surrounding and attention to the area of back pain and related musculoskeletal system as well as calming breath to begin to help her system move toward balance. Goals for this stage of healing were to engage and relax the back region and to calm her human system. In subsequent sessions the therapist observed that some persistent state change had occurred. Julie was now able to do the movements with her feet on the floor rather than on a chair. The therapist changed Julie’s to have feet on the floor – an incremental new stage of healing. Furthermore, conversation about the practice revealed involvement of Julie’s emotions, of grief about the loss of her partner, that appeared to be related to her back pain. This opened a new stage of healing and a goal of experiencing and releasing grief was incorporated into her practice in the form of a meditation. A subsequent stage of healing addressed things Julie wanted to communicate to her partner. Along this pathway of healing, physical improvements continued to occur along with the emotional healing. How long each stage lasted and the addition of new stages for healing emerged from observation of how her practice was working.

4.2.2 Case 2

Heidi, a client of participant 6 came to yoga therapy with a unique situation. She was a young medical student. Heidi had been misdiagnosed with a different kind of cancer, and the misdiagnosis came from colleagues at the hospital where she was a resident. She had undergone treatment and surgery for this incorrect cancer, which she really did not need. During the surgery, they had accidentally damaged her diaphragm. After the surgery, the damage caused Heidi to have extremely shallow and labored breathing. In the initial yoga therapy session, Heidi was barely able to inhale or exhale for two seconds. She was also unable to breathe without coughing and she could hardly get a breath in. Heidi was extremely weak at this point. After the incorrect treatment and surgery Heidi received, her doctors determined the correct diagnosis, and she received the correct treatment. Heidi was able to heal from the cancer but was left with the repercussions of undergoing surgery. When she first came to yoga therapy, she was unable to do much of anything without wheezing and she was barely able to walk across the room. Physically, she was severely depleted. Heidi was also in a state of mental and emotional crisis.

The yoga therapist started with super small steps. The therapist used Krama and saw Heidi regularly. Heidi was able to progress quickly. In the beginning, she was unable to lie down without coughing, so her practice was completed in a seated position. They began with slow, mellow, arm movements working on connecting movement and breath, trying to use the Krama (pauses) to strengthen her breath. Each session Heidi expressed that she was having less and less coughing, and her breath was much longer. Within a few months, she was able to start jogging again. She began doing sun salutations (a sequence of yoga movements) and her interest in yoga led her to participate in yoga workshops. Viniyoga appeared to help reverse her physically, mentally, and emotionally and appeared to reverse the existential crisis that she was facing.

Considering health, healing, and stages of healing, Heidi’s presenting health issues were physical (damaged diaphragm, shallow and labored breathing, extreme weakness) as well as physical and emotional distress. The therapist tailored a seated practice for her involving gentle arm movements coordinated with breath, and brief pauses partway through the movement. The goal was to begin to strengthen the breath. Gradual improvements were observed and the practice intensity gently increased when the client seemed ready. For Heidi healing the body was accompanied by mental and emotional healing as she became able to return to an active life.

4.2.3 Case 3

Jane, a client of participant 10, presented with a complex, multidimensional condition that manifested in skin rashes, infections, digestive distress, poor sleep, and memory loss. Initially, her therapist worked with her on simple joint movements linked with breath and chanting, which helped with her memory. The therapist used contralateral structural movement in Jane’s practice that integrates right and left-brain processes. The chanting was with mantras about the inner alchemy, and Prana (life energy). Jane became the cheerleader for her body, praying for support and empowering the alchemy within her body to find a new balance.

In the beginning, Jane struggled to remember the chants. The therapist recorded them performing the chant so that Jane could refer back to the recording. Once Jane coordinated the chant with movement, she could remember it thereafter. Throughout Jane’s time in therapy her meditation began with what she can do to restore balance, strength, and stability and evolved towards how to prepare for the end of life. The therapist had her meditate on what is important to her, and that her worth and value are not dependent on external factors, her condition, or her ability to function. Jane reported that the meditations were extremely helpful.

Jane felt empowered to manage her condition with the tools that she had learned. She became a national cancer coach. She relied on her breathing practice, especially Brahmana (energy management) for her energy. She used Pranayama and lengthening of exhale to help her manage her stress and ease her anxiety.

Her therapist noticed that she always wore an infinity necklace, so the therapist integrated this into her practice. They used infinity, the image of unending infinite potential as a theme for her practice to help bring her body and mind into balance. She felt empowered to manage her condition with the tools that she had learned. Over time, she began to embrace the reality of impermanence, allowing for more fullness in her experience as she approached the end of life. This was so that she could reach that day with a sense of completion, and contentment, and without fear or anger.

Considering health, healing, and stages of healing, Jane’s presenting health issues were terminal and included cognitive as well as various physical issues. Despite a terminal prognosis, yoga therapy enabled Jane to experience many stages of healing. Carefully engineered simple practices began to help with memory and bringing her body closer to balance. Successful experiences with state change empowered Jane to participate in and champion her own healing. Meditation supported several stages of healing including her own role in bringing her mind and body into balance, her internal self-worth, and facing the end of life. Healing is possible from a Viniyoga perspective, even with a terminal diagnosis.

4.2.4 Case 4

Bailey, a client of participant 12, presented with extreme depression, suicidal ideation, and exhaustion from cancer treatment, chemotherapy, a high-powered job, and having multiple kids. In general, she was feeling very overwhelmed and suffocated by life. She also had a trauma history. In the initial session, her breath was observed to be short and shallow and localized to the abdomen. The therapist began working with simple awareness of breath and intentional slowing and lengthening of the breath. The therapist also gave her a meditation of imagining that she was on top of a mountain. These practices seemed to be beneficial. They appeared to provide relief but also allowed her to process and digest the things she had been through.

Bailey met with the therapist once a week because she did not have time at home for practice. The first couple of months were very emotional for Bailey and the sessions seemed to give her a sense of relief. She also developed an awareness that she had never given any attention to herself. Over the course of therapy, things stabilized, and she began feeling much better. Her depression was alleviated, even though life was still overwhelming. Bailey quit her job which allowed her to have space for herself and for her family. Over the next few months, she worked on digesting things she had been through, using breathing and mountain meditation. After around six months, Bailey hit a wall and was unable to continue forward putting attention on herself outside of sessions. Bailey and the therapist took a break until she was ready to resume and continue forward.

When Bailey returned to yoga therapy, the therapist continued to focus on restoration and nourishment of her system. Bailey started in a new job that was significantly less intense. She was using the therapeutic tools and techniques at home. She began doing a practice before bed which she said greatly improved her sleep. Previously she was only doing extreme physical workouts as a way of being out of her body and pushing through. After resuming yoga therapy, she was able to do active practices while staying connected to herself. Bailey has improved greatly and is now able to calm her system and feel nourished. She is also able to give herself and her emotions space and allow emotions to come and go. Bailey reports being much more relaxed and no longer struggling with overwhelm and her state has stabilized.

Considering health, healing, and stages of healing, Bailey’s presenting health issues included a complex mix of psychological, physical, and life challenges. The therapist initially focused on breath awareness, breath lengthening, and a spacious meditation object. These practices had the potential to bring stability and balance to her system, provide comfort and nourishment, and yield insight and self-knowledge. The therapist noted that doing the practices were a form of self-care, and the client realized she never gave attention to herself. Yoga therapy with Bailey was a long process with a practice that the therapist continually evolved over time and Bailey healed. It is interesting that Bailey took a break after 6 months, then resumed yoga therapy when she was ready to commit to it again. This is part of being responsive to the client’s needs and circumstances. Life changes as well as psychological and physiological improvements were reported over the course of the therapeutic relationship.

5. Discussion

Although some research studies have demonstrated the effectiveness of specific yoga therapy interventions [28], studying the subjective experiences of Viniyoga therapists reveals processes and holistic approaches yoga therapy uses to support diverse mental and physical health and healing. Therapeutic Viniyoga perspectives can broaden the treatment options for individuals suffering from a wide variety of ailments [3,4,5].

Viniyoga is unique compared to other Yogic traditions, even those with common roots. Viniyoga, Ashtanga and Iyengar yoga disciplines all owe their roots to the yogi Krishnamacharya [29]. All three types were developed by different disciples of Krishnamacharya. Both Ashtanga and Iyengar yoga make use of set yoga pose progressions. Ashtanga yoga highlights utilizing a set sequence of postures that are linked by breath and movement. Iyengar yoga stresses precision and is known for the use of props and for holding postures for long periods of time. In contrast, Viniyoga is the only one of the three that encourages molding the practice to the practitioner and individualizing the practice [29]. A study distilling the effectiveness of different aspects of yoga concluded that incorporating multiple aspects of yoga outperformed simple interventions, and that the benefits of each component differed based on clinical presentation and/or symptoms [30]. This suggests a need for customized programs, which Viniyoga therapy provides.

5.1 Yoga Therapy as an Integrative and Complementary Health and Wellness Approach

The included case vignettes demonstrate how yoga therapy appears to improve clients’ well-being even when other medical interventions prove inadequate. The clients suffered from both physical and psychological challenges, some of which were not curable. The interventions used by yoga therapists addressed holistic needs of the clients. Many of the techniques were designed to bring about gradual, step by step improvements. Healing goals included the client’s empowerment and reduction of distress, not just the amelioration of symptoms. Yoga therapy allows for therapist and client to collaborate on identifying needed areas of concentration and adapt interventions to the changing needs of the client.

In the four case vignettes, clients suffered from both physical and psychological distress. The holistic interventions of the yoga therapists interviewed appeared to help their clients heal physically and emotionally. In some cases, this healing led to better health outcomes. However, even in the case study with a terminally ill cancer patient, the healing achieved through yoga therapy ameliorated suffering and empowered the patient. Patient empowerment also leads to their own healing, which is also associated with positive treatment outcomes [31].

Although there are cross-sectional studies endorsing the effectiveness of yoga therapy [28] the personalized nature of the yoga interventions makes it difficult to standardize the approach. While this may be considered a weakness in the traditional medical model, it can be a bonus to clients who have needs unmet by established medicinal interventions and who benefit from an individualized approach. The emphasis on self-empowerment in yoga therapy does not foster dependency in these individuals. Rather, clients are able to integrate the methods modeled in the therapy sessions even after yoga therapy is complete.

5.2 Yoga Therapy Compared to Other Complementary Health Interventions

Research comparing other complementary health interventions such as Mindful Based Stress Reduction (MBSR), Ayurveda, and Tai Chi suggests that yoga therapy is just as or more effective than these other approaches. MBSR and yoga therapy have been shown to be equally effective at reducing physiological and psychological distress [32,33]. However, a meta-analysis of MBSR and yoga therapy also noted that programs longer than 8 weeks were more effective than shorter programs [34], which supports Viniyoga’s emphasis on an individualized approach that the practitioner can utilize for as long as needed.

The research on Ayurveda and Tai Chi as alternative interventions compared to yoga therapy demonstrates more support for yoga therapy interventions. One study on diabetic patients concluded that a mix of Ayurvedic and yogic practices was effective for improving pain intensity and quality of life [35]. However, another study on heart patients concluded that herbal remedies supported by Ayurveda were ineffective as a stand-alone treatment, but that yoga therapy did yield positive effects [36]. Two studies comparing Tai Chi to yoga therapy interventions concluded yoga therapy was much more effective for treating depression and diabetes mellitus [37,38].

5.3 Multidisciplinary Collaboration

Yoga therapy may be an effective intervention alongside other mental and physical wellness approaches, such as physical therapy, psychotherapy, and pharmaceuticals. The adaptive nature of Viniyoga allows for tailoring the treatment to individual needs and adjusting practices over time as the client’s needs change, often with more client feedback and flexibility than offered by other wellness approaches. Far from eschewing other medical models, Viniyoga therapists reported they often consulted providers of other disciplines and/or encouraged clients to supplement their yoga therapy with other approaches. In addition, yoga therapists reported that their clients were often referred to them by other medical professionals, such as medical doctors, psychotherapists, and physical therapists who recognized yoga therapists’ capacity to help ease suffering.

Collaboration with yoga therapists can help other health practitioners provide additional treatment options to individuals whose needs they cannot fully meet. In addition to the possible gains in symptom reduction, offering alternative treatment options, including for ailments that are incurable, provides hope. A greater sense of hope is positively correlated to better physical and mental health outcomes [39].

5.4 Limitations

Primary data were collected using a purposive sample; therefore, voluntary response bias may be present because participants chose to respond to the requests for interviews. A larger sample size than 14, and/or a call for participants through different sources, might reveal more nuances in the information collected. Most of the therapists interviewed worked as independent practitioners to clients who sought them out, leading to limited knowledge of how effective yoga therapist techniques are to clients who are skeptical or unfamiliar with yogic practices. While participating therapists described case studies where they perceived their work as being very effective, this study did not ask about cases where yoga therapy did not appear to work. A single researcher conducted the interview analysis, so the findings are not corroborated by other analysts.

5.5 Recommendations for Future Research

Further study could help illuminate the efficacy of yoga therapy in more diverse populations. Gathering qualitative data from yoga therapy clients can distinguish what aspects of the experience were most useful to the recipients. Using quasi-experimental and experimentally designed study designs to examine the effectiveness of yoga therapy on client outcomes is suggested for future study as well. Developing longitudinal studies on yoga therapy could provide helpful information on how the efficacy of treatment holds up over time, and when brief or long-term interventions are most effective.

6. Conclusion

The holistic, individualized practice of therapeutic Viniyoga appears to favorably influence both health and healing [3,5]. While health and healing are often thought of in tandem, healing can occur even in the absence of good health [2]. Viniyoga therapy’s individualized approach can potentially achieve improvements in perspective and health behaviors even with terminal or chronic conditions. Viniyoga therapy can be used as a stand-alone therapy or in conjunction with other medical interventions [28]. Yoga therapy may be an option for clients seeking a more dynamic, expansive, and versatile approach to healing than offered solely through traditional medicinal means.

Acknowledgments

I thank TKV Desikachar for transmitting Viniyoga, the lineage of his father Krishnamacharya. I thank 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 conflicts of interest exist.