Trauma-sensitive yoga

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Trauma-sensitive yoga is yoga as exercise, adapted from 2002 onwards for work with individuals affected by psychological trauma. [1] [2] Its goal is to help trauma survivors to develop a greater sense of mind-body connection, [3] to ease their physiological experiences of trauma, [3] to gain a greater sense of ownership over their bodies, [2] and to augment their overall well-being. [3] However, a 2019 systematic review found that the studies to date were not sufficiently robustly designed to provide strong evidence of yoga's effectiveness as a therapy; it called for further research. [4]

Contents

Background

Psychological trauma and the body

Psychological trauma can follow from the experience of a traumatic event. Battling PTSD (4949341330) (cropped).jpg
Psychological trauma can follow from the experience of a traumatic event.

Psychological trauma occurs when an individual has experienced a traumatic event which becomes lived and relived in the body and the mind. [5] [6] Trauma can trigger a chronic stress response in the body, [7] [8] which may manifest as an uncontrollable and constant state of heightened arousal and fear. [3] [7] [9] Those with a history of trauma may also interpret this chronic stress response as a threat to their sense of self and relation to the world. [5] [6] [10] [11] Traumatized individuals often have difficulty soothing their overactive internal sensations without relying on external stimuli, such as food, substances, or self-harm. [7] [12] [13] Therefore, psychological trauma is not only associated with psychological disorders such as post-traumatic stress disorder (PTSD), depression, and anxiety, [4] but also with somatic disorders. [4] [14]

Though most evidence-based treatments focus on the psychological effects of trauma first and foremost, [4] [5] attrition rates are still high, possibly due to heightened physiological arousal during the initial stages of exposure therapy. [4] [15] Mind-body approaches offer a complementary method to traditional psychotherapy, allowing traumatized individuals to reconnect with and identify their own physical sensations. [4] [13] Mind-body approaches allow participants to work through their somatic trauma memories and feel safe enough to emotionally and verbally process their traumatic memories. [4] [13] Such approaches involve increasing awareness of, and attention to, bodily sensations, while emphasizing present-moment experience. In this way, they seek to counteract dissociative responses. [16] [17] Finally, mind-body approaches attempt to help traumatized individuals to nurture their bodies. [7] In this way, messages from the physical body may provide information for traumatized individuals about their identities and help individuals regain ownership over their internal responses. [7] [18]

Postural yoga

Postural yoga teachers may respectfully adjust a pupil's body hands-on, whereas trauma-sensitive yoga requires giving space to participants. International Therapeutic Yoga Federation.jpg
Postural yoga teachers may respectfully adjust a pupil's body hands-on, whereas trauma-sensitive yoga requires giving space to participants.

Postural yoga is a mind-body practice with many forms and styles. It typically includes physical postures called asanas, breathing exercises (pranayama), mindfulness, and meditation. [4] [19] Postural yoga can reduce stress, [2] enhance physical health, [2] [20] and heighten one's sense of self. [7]

Physiological effects

The techniques of yoga alleviate effects on the body's nervous system. [7] The mindfulness and meditation aspect of yoga allows the mind to maintain objective awareness on the body's physical sensations, while maintaining a state of calm. [7] [21] The aspect of yoga geared toward breath manipulation helps to enhance capacity for emotion regulation. [7] [22] [23] Thus, yoga reduces the overall intensity of the stress response and improves the ability to self-soothe. [7] [24]

Yoga is associated with a reduction in physiological and somatic complaints often attributable to post-traumatic stress disorder, such as pain and anxiety. [25] Research also suggests that yoga produces psychological benefits for individuals with post-traumatic stress disorder such as reduction of stress, [25] [21] a decrease in depression as associated with the mindfulness component, [25] [26] a greater sense of interconnectedness with others when practiced in group settings, [25] [27] [28] enhanced self-efficacy and self-esteem, [25] and a feeling of overall empowerment. [25] [29]

Description

Trauma-sensitive yoga is a form of yoga as therapy, adapted from modern postural yoga. It was developed at the Justice Resource Institute's Trauma Center in Brookline, Massachusetts, in 2002 by David Emerson and colleagues. It was designed to promote an enhanced feeling of safety for traumatised individuals as they engage in an exercise that is focused on body awareness, which might otherwise be overwhelming for them. [2] [1] It addresses the need for a trauma-informed yoga practice able to identify and mitigate potentially triggering environmental and physiological circumstances, [1] [30] while still providing the psychological and physical benefits that typical yoga practice offers.

Trauma-sensitive yoga has been formulated from five core domains which if nonoptimal could produce adverse side effects among a traumatized population by reminding them of their traumas: [30]

Five Core Domains [30] Trauma-sensitive yoga Modern postural yoga
EnvironmentSpace is welcoming, safe, comfortable for vulnerable studentsAny suitable space
Physical exerciseInternal sensations important, for feelings of safety, self-acceptanceAchieve particular postures
AssistsAllow space between teacher and pupilPolite hands-on acceptable
Teacher qualitiesGentle, students stay in controlOften directive
LanguageNon-directive instructionsDirective language acceptable

Key features

Themes

David Emerson has identified four clinically informed key themes in trauma informed yoga practice that have been beneficial for the trauma survivors. These include: 1) experiencing the present moment (which addresses the trauma survivors' predicament of being unable to be fully present in the moment or in their bodies); 2) making choices (which addresses the issue of lack of choice and helplessness that trauma survivors experience during a traumatic event); 3) effective action taking (which addresses the inability to escape the traumatic event that trauma survivors have experienced during the trauma incident), and 4) creatingrhythms (which addresses the issue of feeling disconnected that trauma survivors continue to experience in relation to others and themselves). These themes can be integrated by the teacher all in one class, or may be used individually as a focal point of a particular class. [31]

Approach

Trauma-sensitive yoga is designed to begin gently, with a seated breathing exercise, followed by light movements. [2] While adhering to the conditions of the five core domains (i.e., physical environment, exercises, teaching style, adjustments, and language), [30] the instructor guides the class through a series of physical postures at a level of difficulty fitting the abilities of the participants. [2] In each posture, instructors encourage students to observe their internal sensations, without judgment, and to respond to them compassionately. [3] Throughout, participants are encouraged to make choices for themselves about what feels comfortable and safe in their bodies, and instructors spaciously invite students to modify any posture as needed. [2] The class ends similarly to ordinary postural yoga in a resting pose (Savasana). [2]

Certain conditions remain constant to ensure that participants feel safe, including consistency of room appearance and class structure, instructors' reminders to participants of where the exits are located, and bright lighting so that participants can see their surroundings. [32]

Mechanisms

Individuals who have experienced psychological trauma often view their internal body sensations as dangerous and foreign, and form destructive habits as a means of coping with their internal experiences. [3] Therefore, instructors strive throughout to create an environment that feels both physically and emotionally safe for the participants, thereby facilitating a healing atmosphere for traumatised individuals. [30] When students feel increased levels of safety and groundedness in their environment, they are said to be at an appropriate mid-range level of arousal for working with their traumas effectively. [6] [30] In that state, they can learn to work with the physiological experiences of trauma in a more adaptive and less destructive manner. [3]

Confidentiality

Consumers of trauma-sensitive yoga may need to consider the matter of confidentiality as it differs between trauma-sensitive yoga instructors and mental health professionals. [30] Though instructors are most often required to complete at least 200 hours of yoga teacher training with a focus on trauma, confidentiality is typically not the focus of training. [30]

Evidence

Trauma-sensitive yoga is effective for improving the psychological symptoms for women who have survived interpersonal violence. [15] [30] Improvements may include a reduction in symptom severity of post-traumatic stress disorder, [30] [32] reduction in severity of symptoms of depression and anxiety. [2] [30] Survivors of interpersonal violence who engage in trauma-sensitive yoga have reported increased feelings of safety and agency, [2] [15] higher self-esteem and self-compassion, decreased feelings of isolation, greater feelings of relaxation, and a greater sense of agency over their own bodies. [25]

Practitioners state that trauma-sensitive yoga should be used only as an alternative and complementary treatment to other evidence-based treatments (e.g., psychotherapy, medication) for trauma. [16] [19] Classes are designed to vary, and thus efficacy has not been established. [16] Trauma-sensitive yoga can be used as a primer to individual psychotherapy, as a means of preparing and grounding the body before uncovering stored traumatic memories, [3] [19] [21] and establishing a traumatized individual's buy-in for treatment. [19]

A systematic review in 2019 failed to find strong evidence that yoga was effective in PTSD, depression, or anxiety after trauma, as the studies examined were of low quality with a "high risk of bias"; they provided what would if confirmed be strongly beneficial effects with effect sizes in the range of ds=0.40—1.06. The reviewers called for further studies with "more rigorous design". [4]

Related Research Articles

Neurosis is a term mainly used today by followers of Freudian thinking to describe mental disorders caused by past anxiety, often that has been repressed. In recent history, the term has been used to refer to anxiety-related conditions more generally.

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Dissociation is a concept that has been developed over time and which concerns a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a loss of reality as in psychosis.

Psychological trauma is an emotional response caused by severe distressing events such as accidents, violence, sexual assault, terror, or sensory overload.

Somatic experiencing (SE) is a form of alternative therapy aimed at treating trauma and stress-related disorders, such as PTSD. The primary goal of SE is to modify the trauma-related stress response through bottom-up processing. The client's attention is directed toward internal sensations,, rather than to cognitive or emotional experiences. The method was developed by Peter A. Levine.

<span class="mw-page-title-main">Yoga as therapy</span> Yoga in the use of physical and mental therapy

Yoga as therapy is the use of yoga as exercise, consisting mainly of postures called asanas, as a gentle form of exercise and relaxation applied specifically with the intention of improving health. This form of yoga is widely practised in classes, and may involve meditation, imagery, breath work (pranayama) and calming music as well as postural yoga.

<span class="mw-page-title-main">Complex post-traumatic stress disorder</span> Psychological disorder

Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e. commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

Vicarious trauma (VT) was a term invented by McCann and Pearlman that is used to describe how working with traumatized clients affects trauma therapists. Previously, the phenomenon was referred to as secondary traumatic stress coined by Dr. Charles Figley. The theory behind vicarious trauma is that the therapist has a profound world change and is permanently altered by the interaction of empathetic bonding with a client. This change is thought to have three conditional requirements: empathic engagement and exposure to graphic and traumatizing material, the therapist being exposed to human cruelty, and reenactment of trauma within the therapy process. This change can produce changes in a therapist's sense of spirituality, worldview, and self-identity.

Bessel van der Kolk is a psychiatrist, author, researcher and educator based in Boston, United States. Since the 1970s his research has been in the area of post-traumatic stress. He is the author of The New York Times best seller, The Body Keeps the Score. Van der Kolk formerly served as president of the International Society for Traumatic Stress Studies and is a former co-director of the National Child Traumatic Stress Network. He is a professor of psychiatry at Boston University School of Medicine and president of the Trauma Research Foundation in Brookline, Massachusetts.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

<span class="mw-page-title-main">Transgenerational trauma</span> Psychological trauma

Transgenerational trauma is the psychological and physiological effects that the trauma experienced by people has on subsequent generations in that group. The primary modes of transmission are the uterine environment during pregnancy causing epigenetic changes in the developing embryo, and the shared family environment of the infant causing psychological, behavioral and social changes in the individual. The term intergenerational transmission refers to instances whereby the traumatic effects are passed down from the directly traumatized generation [F0] to their offspring [F1], and transgenerational transmission is when the offspring [F1] then pass the effects down to descendants who have not been exposed to the initial traumatic event - at least the grandchildren [F2] of the original sufferer for males, and their great-grandchildren [F3] for females.

<span class="mw-page-title-main">Internet-based treatments for trauma survivors</span>

Internet-based treatments for trauma survivors is a growing class of online treatments that allow for an individual who has experienced trauma to seek and receive treatment without needing to attend psychotherapy in person. The progressive movement to online resources and the need for more accessible mental health services has given rise to the creation of online-based interventions aimed to help those who have experienced traumatic events. Cognitive behavioral therapy (CBT) has shown to be particularly effective in the treatment of trauma-related disorders and adapting CBT to an online format has been shown to be as effective as in-person CBT in the treatment of trauma. Due to its positive outcomes, CBT-based internet treatment options for trauma survivors has been an expanding field in both research and clinical settings.

<span class="mw-page-title-main">Narrative exposure therapy</span>

Narrative Exposure Therapy (NET) is a short-term psychotherapy used for the treatment of post-traumatic stress disorder and other trauma-related mental disorders. It creates a written account of the traumatic experiences of a patient or group of patients, with the aim of recapturing self-respect and acknowledging the patient's value. NET is an individual treatment, NETfacts is a format for communities.

In psychology, Trauma-informed feminist therapy is a model of trauma for both men and women that incorporates the client's sociopolitical context.

Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.

Being exposed to traumatic events such as war, violence, disasters, loss, injury or illness can cause trauma. Additionally, the most common diagnostic instruments such as the ICD-11 and the DSM-5 expand on this definition of trauma to include perceived threat to death, injury, or sexual violence to self or a loved one. Even after the situation has passed, the experience can bring up a sense of vulnerability, hopelessness, anger and fear.

Trauma- and violence-informed care (TVIC) describes a framework for working with and relating to people who have experienced negative consequences after exposure to dangerous experiences. There is no one single TVIC framework, or model, and some go by slightly different names, including Trauma Informed Care (TIC). They incorporate a number of perspectives, principles and skills. TVIC frameworks can be applied in many contexts including medicine, mental health, law, education, architecture, addiction, gender, culture, and interpersonal relationships. They can be applied by individuals and organizations.

References

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  26. ↑ Schreiner, Istvan; Malcolm, James P. (September 2008). "The Benefits of Mindfulness Meditation: Changes in Emotional States of Depression, Anxiety, and Stress". Behaviour Change. 25 (3): 156–168. CiteSeerX   10.1.1.452.7892 . doi:10.1375/bech.25.3.156.
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