The utility of Pratipaksha Bhavana in the maintenance of sobriety.

The goal is to use Pratipaksha Bhavana to reduce cravings for and the use of opioid painkillers. We will measure progress using a journal; cravings and the client's response to them will be tracked daily. Our aim is to have positive self-reports of decreased cravings for and consumption of painkillers within 30 days.

The client is a 29 year old male. He deals with chronic lower back pain, opioid use disorder, and depression.

I planned to build our yoga therapy sessions around the concept of Pratipaksha Bhavana to support addiction recovery. I wanted to establish with the client that the cravings and disturbances he would experience when trying to quit opioids were not arising from his true self. My goal was to help him reverse the compulsive ways of thinking that kept his addiction alive by moving into a conscious building of new ways of thinking. I planned to work with him to create a dual vision of himself as being split into a higher and lower self, and then focus on strengthening his higher self through the therapeutic yoga practices. When cravings or disturbances might arise, he could conceptualize them as coming from his lower self and then practice adaptive asana, meditation, or pranayama to build the higher self, thereby replacing compulsive, addictive thoughts with intentional, healing thoughts.

We used Raja Yoga in our discussions about Pratipaksha Bhavana and Raja's philosophies. Pratipaksha Bhavana also comes from the Yoga Sutras. We also incorporated asana, pranayama, and meditation, which are branches of Raja Yoga. Hatha yoga was also used in our incorporation of asana and pranayama.
We used Bhakti Yoga in the sense that we developed a devotional attitude towards the higher self and worked to cultivate the emotion of faith. Faith and devotion would allow the client to persist through pain and cravings. We used Jnana Yoga in our attitude towards the lower self - I emphasized that the lower self is not us, and the higher self is existence, knowledge, and bliss absolute. We practiced continual identification with the higher self. We established a mantra - I am clean, serene, and living the dream! - that we used in terms of a Japa Yoga practice.

I found the client to be quite despondent by the time we were able to have our first yoga therapy session. He was recently laid off from his job, which added to his pain and lack of energy. Although he gave no indication that he was enjoying the yoga at all, he did mention that it seemed to help a little bit after the first session. We met weekly for 30 days, for four sessions total. By the end, he did seem to be in better spirits, although he was not yet totally abstinent from opioids. He found the asana and pranayama most helpful for his lower back pain and the Pratipaksha Bhavana most useful for his addiction. We worked together to visualize his lower self as a frail, hunched over, gollum-like creature that could only compulsively snatch at immediate pleasures. His higher self was pictured as a healthy, muscular, upright fellow with phenomenal self-control.

Opioid addiction is a difficult problem. As such, there are times when we must accept that if the problem is not getting worse, it is actually getting better. I would encourage the client not to be dismayed by the fact that he is yet to be totally off the opioids, especially because he is still dealing with physical pain. I would encourage the client to continue his asana and pranayama practices since they were so beneficial for his pain, and the pain is such a powerful trigger for opioid use. I would also tell the client to continue with his witnessing and visualization practices since they were beneficial. I would encourage him to explore other forms of yoga nidra, witness practices, guided imagery, guided meditation, and guided visualization practices on his own.
In terms of working with me, I would continue to guide him in empowering hatha yoga practices and yoga philosophy.

I did apply my intended plan once I met with the client. I would say that the goal was achieved, because the client found significant benefit in the application of Pratipaksha Bhavana. He explicitly said that the idea of assigning the cravings and disruptive thoughts to the lower self, and immediately replacing those thoughts with uplifting thoughts that belonged to the higher self, was one of the most useful things he had heard in addiction treatment. He came to view his yogic tools as tools to strengthen the higher self and widen the gap between his higher and lower self.
We used a journal to keep track of his cravings, and while his opioid use did not cease completely, there was a lessening in his cravings. At this point, I would refer him to an addiction specialist to aid him in tapering off the opioids. The yoga therapy lessened his physical pain, so we were successful in that.

For once, I did not have to make any major adaptations to in my plan, aside from modifications and additions to our asana practice that would lessen lower back pain. I learned that if someone seems despondent before we begin our yoga therapy session or they do not seem to enjoy the practices, that does not necessarily mean that they will not derive benefit. I also learned that beginning the yoga therapy sessions with a specific goal that is based in an important teaching - in this case, Pratipaksha Bhavana - seems to be a productive approach. The addition of the witnessing and visualization practices to the goal-focused approach took on a life of its' own and became the most positive force in the yoga therapy sessions, which was a big eye opener for me. I can imagine this approach working well with other clients as well. It is a great way to maintain focus and encourages growth.

I would approach things in a similar fashion, though I would change my expectations. I found myself a little disappointed that the client did not achieve total abstinence from opioids by the end of our sessions, even if the client did progress in other ways. I do think that focusing on the physical pain (or whatever issue might be underlying another person's addiction, like depression, anxiety, etc.) was a great approach to take. In terms of what I would have done differently, I would have referred the client to an addiction specialist from the start. I also would have re-referred them to a physical therapist. I would have also referred them to a psychiatrist. Though the client had been through physical therapy already, I would have referred them again if for no other reason than to make sure all bases were being covered. For a client like this, I would also start introducing homework, which only struck me after I was done working with him. Pratipaksha Bhavana and the cultivation of the higher self were working so well for him that I believe he would have been willing and excited to learn more about yoga philosophy, which would have strengthened his practice.