I am writing this article on a flight from New York to Tokyo and was inspired to use the title, “The world is waiting for yoga therapy.” I love jazz and perhaps this title is not unlike “the world is waiting for the sunrise.” The world really is, however, waiting for yoga therapy.

This trip to the United States was to attend the Symposium on Yoga Research (SYR), organized by the International Association of Yoga Therapists (IAYT). I have been attending this symposium for the past five years. Every year I attend SYR, I am impressed by the researchers’ investigations into how yoga changes physiology and symptoms in patients. I have also seen yoga research on the impact of yoga practice on telomere length and gene expression. It is incredible. Yet this research being conducted by researchers around the world is completely insufficient in the eyes of those who it may be best to call “clinical yoga therapists” who interact with clients every day. This is because the entire process of yoga therapy is either not spelled out or is completely missing from the research. Doctors, for example, must ask each individual patient about their symptoms, make a diagnosis, obtain informed consent and begin providing treatment to relieve the symptoms. Such procedure is necessary in yoga therapy as well, but instead, what often happens in research is that a single predetermined yoga therapy program is given to research participants to practice and then only those results are examined. It seems to me that this lends to the notion that simple application of yoga techniques to a medical diagnosis constitutes “therapy.”

In Japan, we are seeing increasing numbers of yoga workshops with titles such as “yoga for back pain” or “yoga for menopause” and other health concerns. They essentially teach how to adapt yoga techniques for application to medical diagnoses. But is this enough to warrant the use of the term “yoga therapy” if yoga instructors are not familiar with fundamental procedures such as intakes, assessments and informed consent? Is “yoga therapy” safe for people with medical conditions if the yoga instructors are not able to answer questions from medical professionals regarding the theory behind such procedures? I feel very strongly that more international discussion is needed to address these questions, which is why I invited yoga therapists from many different countries to gather in Japan, leading to the establishment of the Global Consortium on Yoga Therapy in July 2018.

If yoga therapy is misunderstood to simply be the application of yoga techniques to medical diagnoses, the world will miss out on the incredible depth and healing potential that yoga therapy has when it is grounded in 5000 years of yogic wisdom. The Yoga Sutras of Patanjali identifies ignorance of one’s true Self as the cause of all miseries in life (Chapter 2-4) and provide ways to dispel this ignorance. If yoga therapy is based on the wisdom of traditional yoga, it has the potential to go to the cause of illness, deeper than addressing only the symptoms that are rooted in this ignorance. It is possible that those who are unfamiliar with the traditional teachings of yoga, from the Vedas onward, are not aware of the tremendous depth that these texts provide in giving detailed explanation of human psyche, psychology and physiology from an integrated understanding of the mind-body. Part of this may be due to the religious nature of many of these texts [1].

It is very important for the continued development of yoga therapy as a profession that we develop a shared theoretical framework for yoga therapy. There are others who also see this need. The need for a comprehensive theoretical framework is explained and they begin to formulate one based on the top-down neurophysiological and bottomup neurocognitive mechanisms [2]. Sullivan et al. also point out the lack of a shared theoretical framework and began formulating a framework based on yoga’s philosophy and the practice’s ability to bring about eudemonic wellbeing [3].The above papers show that there are efforts underway to create a theoretical framework and I laud these efforts. In order to articulate a theoretical framework that will be both acceptable to the diverse yoga therapy community and last over time, however, an international discussion among experts is required. It is of vital importance that the framework is not based only on the physical dimension of human existence. For yoga therapy to fulfil its potential as a therapy that addresses all aspects of human existence based on the oneness of body, mind and spirit, we must establish a commonly understood theoretical framework and procedures for yoga therapy that respect the fundamental scriptures of traditional yoga, such as the Upanishads, Yoga Sutras of Patanjali and the Baghavad Gita. Inclusion of Ayurveda is also important, as the Charaka Samhita contains many teachings related to yoga and the connection between body and mind.

In Japan, yoga therapy clients must be assessed based on a basic understanding of traditional teachings and then yoga therapy instruction provided based upon the assessment and informed consent. A client’s condition will change with the yoga practice, so upon seeing these changes and re-assessing the client’s condition, instruction is again provided based on the new assessment.

A broadly shared understanding of what constitutes yoga therapy is also needed in order to protect the safety of those who turn to yoga and yoga therapy to address health issues.

In 2014, the Japan Yoga Therapy Society received a grant from the Japanese government to conduct research with the Psychosomatic Medicine Department of Kyushu Medical University. We conducted a nation-wide survey and found that of the approximately 2500 students who participated in the survey attending yoga classes throughout Japan, 53.5% had some type of chronic disorder and 1063 (42.3%) were receiving outpatient care at a hospital or clinic [4]. This paper has also been posted on Harvard Medical School’s Guide to Yoga.

This study revealed that there are people with a wide variety of health disorders mixed in among healthy participants in yoga classes and they actually make up more than half. We believe that this is probably true in other countries as well. We can also assume that if interviews were done among the healthy participants, we would find that many of them previously suffered from health problems in the past and had turned to yoga to improve their health. It is not an overstatement to say that almost all people in yoga classes are there because at some point they were concerned about their health and hoped to address it with yoga.

This actually makes perfect sense. If we look at the thousands of years of history of ascetics practicing traditional yoga, they had intense desire and determination to find answers to spiritual questions. Although they had the strength and prowess necessary to cross frozen areas of the Himalayas, they were also mentally conflicted to the extent that they were unable to be satisfied living an ordinary life. Seeking liberation from worldly life, there was strong desire to find the great teachers and sages of each era to heal their spiritual longing, so in a sense they can be considered to be spiritually ill. This basically means that the thousands of years of yoga history can also be said to be a history of yoga therapy for those seeking an answer to spiritual illness. Even today, there are many people who are going into the Himalayas looking for healing of the three bodies, i.e. the physical body (sthula sharira), subtle body (sukshma sharira) and the causal body (karana sharira).

My guru, Swami Yogeshwarananda Paramhansa, was the founder of Yoga Niketan, which is located in Munikireti of Rishikesh, an area well known for yoga in the State of Uttarakhand. More than thirty years have elapsed since his death and it is very sad that there are now no direct disciples in India who can teach the asana, pranayama and dhyana (meditation) techniques that my guru passed on. This is why I have been going regularly to the Yoga Niketan Ashram since 2017 to teach the Raja Yoga that I learned from my guru. My guru began his spiritual training in his early teens and learned hundreds of asana and pranayama practices, as well as dharana, dhyana and samadhi which enabled him to sit for days at a time. He taught us all he knew and upon doing so, chose a few of his disciples and ordered them to teach Raja Yoga. I was among them and it all started from there. People began coming to me and asking me to teach them yoga.

Teaching at Yoga Niketan in Rishikesh, I can see clearly that the situation of yoga in the world has changed drastically from the time I and other fellow disciples studied under my guru. One of the differences is that the general population in India has started practicing asana, pranayama and meditation. When I first went to India and began learning asana and pranayama, I rarely met ordinary Indian people who practiced Raja Yoga. From about the year 2000, however, may Indian people from the general public have begun practicing asana, pranayama and other yogic techniques. When I was studying under my guru, no people from China were coming to Rishikesh to study yoga. Now, however, there are Chinese from Singapore, Malaysia and Taiwan, as well as people from Korea, Russia and even from as far away as Brazil and Argentina who come to my yoga and meditation classes in Rishikesh.

I think one of the factors in yoga’s popularity is the stress that comes with economic development. It seems that many people are coming to yoga as a way to relieve that stress and find reprieve from their busy minds. Even now, therefore, many Europeans, Americans and Japanese are going to Rishikesh and many people from newly developing countries are also going to various parts of India to practice yoga. It is easy to understand this global situation, as well as the situation that I wrote of in the beginning of this paper about many people with stress related disorders and chronic psychosomatic illnesses going to yoga studios looking for relief. Those of us who are involved in yoga teaching must be well aware of this situation and this is why it is of urgent importance to propagate yoga therapy. The world is waiting for yoga therapy.

As I wrote above, I first started teaching Raja Yoga that I learned directly from my guru to students in Japan. Yoga instructors who studied under me began to ask me questions, such as, “what and how can I teach a student who has breast cancer?” Or, “a pregnant woman came to my class. How should I teach her? It was at this time that I began to understand the need to begin adapting yoga techniques for people with various health disorders and I established the Japan Yoga Therapy Society in 2003, as a yoga organization registered under the Japanese government.

After networking with medical professionals, I also heard their doubts about the viability of yoga therapy, I also began to understand the need for yoga therapy’s own “diagnostic” and “treatment” theories. Doctors in Japan asked me to explain how yoga therapists decide what issues to address and how they know what techniques to use in regard to various disorders. They were questions that I initially had difficulty answering.

With my experience studying with my guru, I knew that his instruction as not haphazard. He always listened to his disciples, asking what it was they wanted to know. Then with his immense wealth of knowledge in traditional yoga, he was able to make his own assessment of the barriers each disciple was facing and provide instruction to help the disciple move forward. Looking back, I now see that he was essentially doing an intake interview, conducting an assessment based on traditional yogic teachings and then providing instruction, also based on traditional yogic knowledge. I realized we needed something systematic like this in yoga therapy in order to be taken seriously by the medical establishment and bring yoga therapy into healthcare.

Fortunately in Japan, we have a long history of development in psychosomatic medicine. In addition, Japanese doctors have been engaged in Ayurvedic research since the 1960s, in particular, Japanese medical professionals who started the Japan Ayurveda Society. Their expertise is in “rational therapy,” one of the three therapies explained by Charaka, which is the rational administration of diet and medicines. Then those of us in yoga therapy are in a position to provide the remaining two types of therapies, which are spiritual and psychological therapy. In this way, here in Japan we have built the foundation for both a holistic theory and system of yoga therapy instruction using 5000 years of traditional yogic knowledge connected with modern psychosomatic medicine that also recognizes the interrelatedness of body and mind.

We have published books in both Japanese and English in regard to the traditional teachings in Ayurveda and yoga and how they form the basis of yoga therapy as well as the psychological theory of how yoga can heal disorders. I wrote Yoga Therapy Theory: Modern Methods based on Traditional Teachings of Human Structure and Function [5]. This book cites traditional yogic texts—primarily the Yoga Sutras and the Baghavad Gita—that explain the structure of human existence as five sheaths, as well as how the different components of this structure interact. Using a horse-drawn chariot model from the Bhagavad Gita makes it clear how the human body is not simply flesh and bones, but is an integrated system of the physical body, mind and spirit.

The second book I would like to introduce was written by Dr. Minoru Kamata, entitled Yoga Therapy Darshana: Key Skills for Communication and Facilitating Personal Transformation [6]. This book is groundbreaking in that Dr. Kamata combines his knowledge of traditional yoga with Adlerian psychology to create a system for use in one-on-one settings between yoga therapists and their clients. The beauty of yoga therapy is how it treats the complete human system as an integrated whole and this involves clients becoming aware of their own painful misinterpretations and overcoming ignorance using the standards provided in traditional yogic texts. Dr. Kamata makes it clear how this can be done. We hope that many will read these books and that they can become catalysts for broader discussion on developing an internationally shared theoretical framework for yoga therapy.

Yoga therapists certified by the Japan Yoga Therapy Society are working with doctors and researchers of modern medicine dealing with psychosomatic diseases to help people with psychiatric disorders such as schizophrenia and depression, as well as eating disorders and drug and alcohol dependency. Japan is said to have the fastest growing aging population and our yoga therapists are working in many senior citizen facilities for a range of issues, from preventing falls to addressing dementia. It is said that many countries, including China, will also face challenges with aging societies and low birth rates, but in Japan we are already starting to address this with yoga therapy. Furthermore, yoga therapy instruction is being provided in correctional facilities such as prisons and yoga therapy is also being used in evacuation centers after the many natural disasters we have in Japan such as earthquakes, tsunami and typhoons to prevent economy class syndrome and address PTSD. Conventionally, disaster relief provides relief goods and local medical professionals take care of injuries, but yoga therapy can be used to address PTSD and other support is also possible. For example, since 2009, we have provided support every year for victims of the Chernobyl nuclear disaster who now reside in Kiev in the Ukraine and we have trained yoga therapists in Kiev. After the earthquake in Nepal in 2015, we worked together with local yoga teachers and conducted health restoration activities and provided yoga therapy practice to survivors of the earthquake for three months. In 2016, there was a large earthquake in Kumamoto Prefecture in Japan and based on a survey that we conducted, it became clear that there were people who showed Post Traumatic Growth (PTG). There was a group who had been educated in the wisdom of traditional yoga beginning two months before the earthquake. A survey of these people showed that none of them showed any negative psychological reactions even after experiencing damage from the quake.

In 2019, we will begin training yoga therapists in Cuba, a country that also suffers from natural disasters and an aging population. In Japan, our yoga therapy is being used as mental training for artists and athletes. One of the social issues facing Japan is the increase in rare and difficult diseases for which modern medicine cannot find the causes. We are supporting ongoing research involving yoga therapy for these diseases. Last year, a paper from one of the research projects we were involved in was chosen by Springer Nature as part of their Change the World, One Article at a Time initiative [7].

The link [8] is for a page on Springer Nature’s website where one can access more than 250 articles on a variety of topics that the Editors-in- Chief selected for published findings in 2017 that they believed have an impact on pressing social problems. Our article is located in the field of “Medicine and Public Health.”

A private insurance company in Japan has recognized these activities by yoga therapists and now contracts with individual yoga therapists to cover up to approximately one million US dollars for an annual fee of 30 US dollars. Also, the Japan Yoga Therapy Society requires its yoga therapists to report any adverse events in daily yoga classes to the Society. Any certified yoga therapist has access to a site with this information on adverse events, thus helping to prevent other adverse events from happening.

In this way, we have been developing yoga therapy in Japan, being very careful not to lose the essence of traditional yoga and it is being practiced both in Japan and in other countries. We are providing the wisdom that the world is waiting for in order to address the many health challenges being created by the stresses of modern society.

It is my sincere hope that people reading this article will be inspired to study the essence of yoga therapy and contribute to society with this knowledge. In Japan, we currently have approximately 1,500 therapists certified by the Japan Yoga Therapy Society. For certification, people are required to complete a three-year yoga therapist training course, after which they can use yoga therapy to contribute to society. Each therapist’s qualifications are reviewed for renewal every four years after initial certification. Therapists must accumulate a certain number of continuing education points, which include study in traditional yoga and topics related to yoga therapy. In this way, the Society is creating standards and a system to ensure that the quality of yoga therapists is held to the highest degree possible.

The Japan Yoga Therapy Society organized a gathering of yoga therapists and yoga therapy organizations from all over the world in Sendai, Miyagi Prefecture, Japan in July 2018. There, we launched the Global Consortium on Yoga Therapy (GCYT) with the adoption of the Sendai Declaration.

Sendai declaration 2018

In the interest of developing and promoting yoga therapy around the world to contribute to the health and wellness of our communities we call for the following:

Developing a shared theoretical framework for yoga therapy that respects the teachings of traditional yoga.

Information sharing among yoga therapists around the world.

International cooperation to conduct yoga therapy research.

International Cooperation to promote yoga therapy worldwide.

To do this, we support the establishment of a Global Consortium on Yoga Therapy!

The second meeting will be held in Amsterdam on May 12th. We expect yoga therapists from Europe to also gather and we will discuss issues such as developing a shared theoretical framework, definitions of yoga therapy and international standards.

As people from all over the world are turning to yoga, motivated largely by a desire to maintain or improve physical and mental health, the world is ready and waiting for yoga therapy. In Japan, we have developed a system of yoga therapy that uses the teachings of traditional yoga to assess clients and identify the root causes of psychosomatic disorders in the mind and then provide practices to address the causes and symptoms of the disorders. It is a system that can fulfill the needs of modern society in the areas of health and wellness. In cooperation with modern medicine, education and other fields and working together with other yoga therapy organizations around the world, we believe that yoga therapy has the potential to heal from the individual to the national and international levels.