What’s the Difference Between Yoga and Yoga Therapy?

“Yoga therapy is the professional application of the principles and practices of yoga to promote health and well-being within a therapeutic relationship that includes, personalised assessment, goal setting, lifestyle management and yoga practices for individuals or small groups.”

– International Association of Yoga Therapists (IAYT)

As an emerging and highly integrative health profession, yoga therapy is gaining recognition for its biopsychosocial offering within healthcare settings. To advance this mission, clarify its scope of practice and support health settings in the further adopting of yoga therapy, a clear distinction between yoga and yoga therapy must be expressed.

Whilst the use of yoga practices to alleviate physical and mental health conditions may well be as ancient as yoga itself, only in relatively recent years has yoga therapy come to the fore as an evidence-based treatment approach for chronic medical disorders. Whilst yoga and yoga therapy share the same origins and many important parallels, there are several crucial factors which distinguish yoga therapy.

Ancient Origins

The roots of the yoga tradition grew in ancient India, though its precise origins are widely debated. Academic estimates of the period in which yoga emerged range between three to five thousand years ago. The Indian Government’s Ministry of External Affairs cite that the earliest theory of yoga was developed by the Indus-Sarasvati Valley civilization in Northern India around 2,700 BCE. It was during this period that yoga was first mentioned in the Rigveda, the oldest known Sanskrit text believed to have been composed between 1500 and 1000 BCE.

Both the philosophical concepts and the practices of yoga were refined and developed over the centuries that followed, documented by Brahmans and Rishis (mystic seers) in a collection of scriptures known as the Upanishads. However, the concept of yoga as we understand it today did not appear until the Katha Upanishad (composed between the fifth and third centuries BCE), in which yoga is recommended as a path to self-knowledge (Muller, 1962).

Contemporary Yoga

From its origins in ancient India, yoga today has a truly global reach. It is important to recognise that there is no one unbroken lineage from those ancient times through to present day, and that what we now describe under the umbrella term of ‘yoga’ is actually an amalgamation of traditions and influences over thousands of years. Comprised of a multiplicity of schools, styles and approaches, contemporary yoga is as much a product of historical, political and cultural influences as it is of the ancient tradition from which it emerged.

These days, the term yoga is generally used to describe a collection of practices, often delivered from teacher to student within the broader context of yoga philosophy. Common yoga practices include asana (postures), pranayama (breathing techniques), chanting, relaxation and meditation, though lesser-known elements such as the yamas (moral observances such as non-violence) and niyamas (personal observances such as self-study) are also key elements of yoga. Both yoga and yoga therapy draw on this eclectic and person-centred toolbox.

The Birth of Yoga Therapy

Although the therapeutic benefits of yoga are chronicled in the classical Hatha Yoga texts (composed between the fifteenth and seventeenth centuries CE), yoga therapy is usually considered to be a relatively modern phenomenon, in which traditional yogic concepts and techniques are integrated with Western medical and psychological knowledge to improve health problems. It is often argued that the development of yoga as an intervention to treat specific health conditions arose during 1920s, when innovative yogis such as Swami Kuvalayananda and Sri Yogendra first placed yoga under the microscope. Swami Kuvalayananda is in fact credited with the establishment of the first yoga research centre called Kaivalyadhama in 1924, which continues this work today.

By applying modern medical science to the practices of yoga, these early pioneering experiments began to elucidate discrete physiological effects, initiating a new way of seeing yoga as mode of treating health problems based on the known effects of certain practices. This distinguished yoga from yoga therapy. Yoga is about self-cultivation; in its original sense, it offers liberation from all agitation of the mind in exchange for a sense of complete connectedness with everything. Yoga therapy, however, seeks to reduce suffering of specific health complaints based on a melding of both modern and ancient appreciations of the influence of specific practices. This may lead to less mental agitation and more connectedness, but initial goals may be less lofty—less physical pain, lower blood pressure, elevated mood or better balance, for example.

What is Yoga Therapy?

Swami Kuvalayanada’s work led to the coinage of yoga therapy as we understand it today; the application of yoga practices to alleviate physical and mental health conditions, promote self-care and improve overall wellbeing. Yoga therapists draw on the principles of yoga and the full range of yogic practices and assessment skills, underpinned by a foundation of biomedical and psychological knowledge. Sessions may include postures, breathing techniques, meditation, relaxation techniques and/or the promotion of behavioural changes. Unlike a typical yoga class, yoga therapy sessions are client-centred and require a thorough intake form, to be discussed between client and therapist and/or therapist and individual members of a small group, prior to initiating treatment.

In yoga therapy, health is viewed through the yogic kosha model, a theory of 5 sheaths of the self that govern all elements of experience: the physical sheath (annamaya), the energetic and breath sheath (pranamaya), the mental sheath (manomaya), the intuitive and discernment sheath (vijnanamaya) and the bliss sheath (anandamaya). When conducting a client intake, a yoga therapist will consider the how the primary health complaint influences all of these koshas, allowing the therapist to view the client holistically, rather than simply as a confluence of presenting symptoms.

When used as a diagnostic tool, the kosha model enables a multifactorial assessment of an individual’s needs, including diet, lifestyle, sleep quality, mobility, flexibility, strength, energy levels, quality of breath, psychological state of mind and connection to intuition, wisdom and what brings them a sense of joy. Yoga therapy therefore moves beyond one-dimensional treatment approaches, addressing not only the primary symptoms of suffering, but also aiming to improve function, prevent occurrence or re-occurrence of underlying causes of illness and increase self-care as a means of moving towards improved health and wellbeing overall.

Due to this highly individualised approach, yoga therapy generally takes place on a one-to-one basis, though group sessions can be facilitated with a focus on a particular health condition or group of conditions. For example, The Minded Institute’s Yoga Therapy for the Mind Course is a comprehensive program for anyone looking to reduce stress, anxiety and/or depression. This 8-week, evidence-based course draws on an overlap of yoga, mindfulness, physiology, and psychotherapeutic support, providing yoga therapy to small groups in a safe and compassionate setting.

Training & Scope of Practice

Within the context of yoga therapy emerging as a health profession, it is important to understand its scope of practice and to distinguish this scope from regular yoga teaching. The IAYT scope of practice (SoP) for yoga therapists is designed to bring clarity around how yoga therapy fits into the wider field of healthcare, highlighting the importance yoga therapists’ understanding of the boundaries of their expertise, as defined by their education, experience and competency. Under the SoP, yoga therapists are not allowed to advertise as licensed healthcare practitioners unless appropriately qualified through another profession, thereby limiting the use of certain therapeutic aspects found in other healthcare professions such as psychological counselling or the physical manipulations found in physiotherapy.

However, the SoP does delineate that yoga therapists may rely on the diagnoses of other qualified healthcare professionals to inform what they offer, in addition to receiving and providing referrals from and to other appropriate healthcare providers. This is a promising springboard from which yoga therapy and healthcare professionals can work together, allowing for the optimisation of client health and wellbeing outcomes.

Given that yoga and health professionals are more commonly coming together in multidisciplinary teams, one of the most important distinctions between yoga therapy and regular yoga teaching lies within the credentials of the practitioner delivering the intervention. Whilst a yoga teacher can be qualified in as little as a month through a 200-hour course, a yoga therapist should undergo specialised yoga therapy training over the course of several years, and is usually required to be an experienced yoga teacher or health professional prior to engaging in a yoga therapy qualification. Technically, yoga therapy is not a protected term and many yoga teachers use this term without proper training. Whilst this is unfortunate, it is increasingly accepted that only those with a qualification should be offering yoga therapy, and this message should be shared with the public.

Since yoga therapy can be applied to such a wide range of physical and mental health conditions, yoga therapists must have a comprehensive understanding of both the presentation and underlying mechanisms of such conditions. In order to effectively develop and implement a bespoke and efficacious treatment plan, yoga therapists must also recognize the effects of moving, breathing, meditation and lifestyle changes on the psychological, energetic, and biological aspects of any condition they are working with. Furthermore, in translating the benefits of yoga to healthcare professionals, it is imperative that yoga therapists have in-depth knowledge of yoga research, can use medical jargon, and thus can express how yoga may support the prevention, treatment and management of health conditions.

In recognition that such comprehensive knowledge requires specialised training beyond that of a general yoga teacher, the IAYT has also established a guideline of educational competencies for the training of yoga therapists. Whilst general 200-hour yoga teacher trainings provide a basic understanding of the teachings and philosophy of the yoga tradition, functional anatomy and the systems of the human body, such training is given in the context of safe yoga teaching rather than its relevant therapeutic application to health conditions. As such, the IAYT’s guideline recommends that in addition to this foundational understanding, yoga therapists must undertake a minimum further 155 hours on biomedical and psychological foundations, 140 hours on yoga therapy tools and therapeutic skills, 30 hours on professional practice (including ethical principles and regulatory issues pertaining to yoga therapy) and 180 hours of mentored practicum. Most yoga therapy training programmes offer much more as well.

Whilst the depth of biomedical understanding required clearly differentiates yoga therapists from yoga teachers, another key distinguishing feature of yoga therapy is a focus on the therapeutic relationship. Yoga therapists are trained to recognise and manage the subtle dynamics of a client/therapist relationship, whilst upholding the ethical boundaries required to maintain trust and safety within this context. This is arguably one of the most marked yet underappreciated differences between a yoga teacher and a yoga therapist, particularly as social media allows students to become more and more familiar with the personal lives of their teachers in many cases. As recognised in psychotherapy and counselling, dual relationships are potentially harmful to the therapeutic process, and yoga therapy therefore requires clear professional boundaries in order to provide clarity around the nature and purpose of the therapeutic relationship.

The Future of Yoga Therapy

Yoga has been long been recognised for its ability to improve a sense of wellbeing, but the growing evidence to support its distinct health benefits is propelling the new field of yoga therapy forward. The last thirty years has seen a surge of scientific studies into yoga, and the development of a congruent evidence-base that has helped to galvanise the emerging field of yoga therapy, clarifying this new discipline as distinct from regular yoga teaching.

Bolstered by this growing body of research and a general shift towards biopsychosocial and person-centred perspectives on health, yoga therapy is increasingly entering the mainstream of medical treatment. This is most clearly manifest in the Veterans Association in the USA, in India’s Primary Health Clinics, in Swedish health services via MediYoga and in the UK through social prescribing due to the pioneering work of the Yoga in Healthcare Alliance. In all these countries, yoga therapy is seen as something different from yoga and employed for improving public health.

As the profession continues to gain recognition in healthcare settings worldwide, it is vital that yoga professionals understand and uphold the distinction between yoga and yoga therapy in order to advance its use as a health intervention. With a clear scope of practice defined by the IAYT and increasing numbers of yoga and health professionals undertaking intensive yoga therapy training within IAYT’s educational competencies guideline each year, the future of yoga therapy as a distinguished discipline is bright.