December 9, 2004

Low-Income Patients Beat Stress With Yoga

MIDDLETOWN, Conn. (AP) -- He's a Vietnam vet who wears clunky metal rings on nearly every finger and builds computers for fun, but lately the only place David Wilson wants to be is on his yoga mat.

The 50-year-old is homeless, struggles with post-traumatic stress disorder and has chronic pain in his neck and back. And until recently, a good night's sleep meant just two hours of solid snooze time.

But since enrolling in a stress reduction class at the Middletown Community Health Center, Wilson says he's finally sleeping through the night. Through yoga and meditation sessions, he is controlling his pain and has learned to focus his breathing.

The concept of mind over matter is nothing new to the medical world. Doctors have been prescribing meditation as a form of pain management for years, but now a few pioneers are working to spread the theory into poorer neighborhoods.

They are posting fliers in waiting rooms, getting doctors to promote the program and are recruiting people by phone and mail.

Their mission is to debunk the myth that yoga is only for the rich and very flexible.

"There are a lot of stereotypes that people who are not rich wouldn't be smart enough, wouldn't be motivated enough, wouldn't be interested enough. Meditation wouldn't be somehow as relevant to them," said Beth Roth, a nurse practitioner who teaches the program in Middletown.

Then, Roth says, there are patients like Wilson, who has started holding regular meditation sessions with his roommate in a shelter. There's also Cynthia Green, an unemployed 44-year-old parent who takes a 10-mile bus ride from Meriden each week to make the class in Middletown.

Still, there are only five patients enrolled in Roth's eight-week class in Middletown. She wants to get the word out that the program exists and that it is often covered by health insurance.

Medicaid and even private insurers may pick up the cost under new health behavior billing codes, Roth said. For those who don't have health insurance, most clinics will offer big discounts based on family incomes.

Courses range in price. Roth's class costs nearly $400, while classes taught in the Santa Cruz, Calif., area are priced around $250-$300.

In El Paso, Texas, one woman is leading a campaign to teach stress reduction to Spanish-speaking women on the Mexican border. Through a small grant, Jane Poss intends to offer the class for free.

"I want to offer them something that is a good option to help them manage their own stress or anxiety without relying on medication. This serves them over the long term," said Poss, a nurse practitioner and a professor at the University of Texas-El Paso.

Roth's eight-week program involves basic yoga exercises and meditation with patients concentrating on becoming more "mindful" of the moment. During a recent class, she asked her students to keep their eyes closed and "feel the breath" as they inhaled in and out, almost in unison. Patients are encouraged to practice at home with audiotapes.

"When I get upset, I just do the body scan and ask myself, 'Where do I actually feel the discomfort?'" said Green, who used to have a substance abuse problem and now battles depression, anxiety and arthritis.

Mindfulness-based stress reduction was developed in 1979 by Jon Kabat-Zinn at the University of Massachusetts Medical Center in Worcester, Mass. There are about 200 programs worldwide with only a few targeted toward low-income people.

Fernando de Torrijos led one of the first clinics in the 1990s that offered free treatment, child care and transportation. The Worcester clinic was forced to close in 2000, but de Torrijos has since recruited 50 patients for a new class in Worcester beginning in January.

Advocates hope more medical research will help gain state and federal funding. Studies at the University of Wisconsin that examine how the brain reacts to meditation may open some doors, Roth said.

During one of Roth's recent classes, she started a group discussion by asking how the meditation tapes were helping the patients cope.

Wilson raised his hand and said he'd been listening to the tapes while also jamming to some Bob Dylan and Carly Simon. The pain that usually starts in his neck and then makes its way down to his fingers had started to subside, he said.

"If I put it out of my mind, you know it's there, but it's not something I focus on anymore," he said, smiling.


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