SAFE + OTPF-4: “SAFE” Yoga Principles Meet the Occupational Therapy Practice Framework, 4th edition

sliced red onion on a ceramic plate
— by

Back in 2020 when I presented my first yoga workshop for healthcare professionals, I sought to find a way to operationalize a framework for yoga to be used as a modality that is part of a rehabilitation plan of care.

I chose to turn to what many consider to be one of the original instructional books on yoga, the yoga sutras by Patanjali and I created the “SAFE” principles based on sutras from the text.

The SAFE principles are intended to be a blueprint and a guide for creating yoga interventions for clients in a purposeful and intentional way to support goal-directed yoga activities in therapy settings.

After a few years and dozens of conversations with colleagues later, an idea sparked to align these SAFE principles with the Occupational Therapy Practice Framework, 4th edition (OTPF-4).  The notes below are the beginning of this connection and conversation.

Sutra translation is from T.K.V. Desikachar, in his book, The Heart of Yoga.  

SAFE PrincipleYoga SutraOTPF-4
S = Safe for the body (comfortable)Sutra 2.46 – “Asanas (physical poses) must have the dual qualities of alertness and relaxation.”Alertness is part of consciousness which is considered under global mental functions under mental functions under body functions under client factors.  State of alertness is also discussed under interoception under sensory functions under body functions.
Relaxation is discussed under rest under the rest and sleep occupations.  Further, “relaxation” is described as an activity that can “restore energy and calm and renew interest in engagement”. (AOTA, 2020, pg. 32).
A = Appropriate for the activity (e.g. preparation, focus, strengthening)Sutra 2.29 – “There are eight components of Yoga.  These are: 1. Yama, our attitudes toward our environment.2. Niyama, our attitudes toward ourselves.3. Āsana, the practice of body exercises.4. Prāṇāyāma, the practice of breathing exercises.5. Pratyāhāra, the restraint of our senses.6. Dhārāna, the ability to direct our minds.7. Dhyāna, the ability to develop interactions with what we seek to understand.8. Samādhi, complete integration with the object to be understood.”Our interventions must be appropriate for our clients.  
1-2. Attitude is discussed under environmental factors under contexts (AOTA, 2020, pg. 38).3. Physical activity is discussed under “Health Management” under “Occupations” (AOTA, 2020, pg. 32).4. Intentional breathing exercises are referenced under “Self-Regulation” under “Intervention Type” under “Interventions to Support Occupations” (AOTA, 2020, pg. 60).5. The discrimination of senses is described under “Perception” under “Specific mental functions” under “Mental functions” under “Body functions” under “Client factors” (AOTA, 2020, pg. 52).6. The OTPF-4 lists “Thought” under “Specific mental functions” under “Mental functions” under “Body functions” under “Client factors” (AOTA, 2020, pg. 52).7-8. These higher level yoga activities are described as “higher level cognitive functions” including concept formation, metacognition, cognitive flexibility, and insight.  These are listed under “Specific mental functions” under “Mental functions” under “Body functions” under “Client factors” (AOTA, 2020, pg. 52).  
F = Functional (relates to the goal) Sutra 1.2 – “Yoga is the ability to direct the mind exclusively toward an object and sustain that direction without any distractions.”The interventions should be goal-oriented toward client-centered outcomes.
“Creating goals in collaboration with the client that address the desired outcomes” is a part of synthesizing the occupational therapy evaluation process (AOTA, 2020, pg. 16).  Outcomes should be “Congruent with the client’s goals” (AOTA, 2020, pg. 17).
E = Engaging (for the client) Sutra 3.9 – “The mind is capable of having two states based on two distinct tendencies.  These are distraction and attention.  At any one moment, however, only one state prevails, and this state influences the individual’s behavior, attitudes, and expressions.”The OTPF-4 defines “Engagement in occupation [to mean] performance ofoccupations as the result of choice, motivation, andmeaning within a supportive context (AOTA, 2020, pg. 5).

I would LOVE feedback about this table, let’s keep the conversation going!

In Light and Love,

Heidi Ana OT


American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 74124100

Desikachar, T.K.V. (1995). The Heart of Yoga. Inner Traditions International.



Our latest updates in your e-mail.

Leave a Reply

%d bloggers like this: