“I do not view post-traumatic stress disorder as a pathology to be managed, suppressed, or adjusted to, but the result of a natural process gone awry. Healing trauma requires direct experience of the living, feeling, knowing organism.” – Peter Levine, Ph. D.
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“The goal of treatment of PTSD is to help people live in the present, without feeling or behaving according to irrelevant demands belonging to the past.” – Dr. Bessel van der Kolk
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Our bodies are programmed to automatically respond to physical threats by fighting or fleeing. An experience becomes traumatic when is it so overwhelming that this natural fight or flight defense mechanism cannot play itself out, and we cannot cope or respond to the threat.
PTSD (post-traumatic stress disorder) is a mental health condition of persistent mental and emotional stress triggered by a terrifying event — either experiencing it or witnessing it.
Trauma can cause chemical changes in the brain, as well as other physiological, emotional, mental, and behavioral challenges. Unresolved trauma impairs the integration of the brain and fragments it.
PTSD symptoms can cause significant problems in social or work situations, in relationships, and can also interfere with the ability to go about normal daily tasks.
A normal stress response
In a normal response to a stressor, the sympathetic nervous system (also known as the “fight or flight” response) would ramp up the heart rate, and the stress hormones adrenaline and cortisol would be produced to prepare the body to deal with the stressor.
We’d feel our heart pounding, we’d start to sweat, our breathing would become shallow, hands would start to shake, and so on. Our body would be primed and ready for action. Running or fighting would use up this energy, completing the stress response.
At this point, the body would get the message that the stressor had been dealt with, the response would be completed, and then the parasympathetic nervous system (also known as “rest and digest” response”) would take over, producing the brain chemicals dopamine and serotonin, allowing the body to come back to homeostasis (balance).
Often though, instead of fighting or fleeing, we have a freeze response instead. During a traumatizing experience, when we realize there is nothing we can do to stave off the inevitable, we simply freeze.
During this time, the mind usually shuts down, but the bodily sensations associated with helplessness in that terrifying moment will carry the memories of having had no control.
The freeze response keeps the aroused stress state lodged in the body. If this activation energy from the freeze response is not physically discharged in some way, our physical system can remain dysregulated, disassociated, and detached. This dysregulation can result in an elevated, inappropriate response to any minor irritation in life, and an inability to regain a sense of safety and relaxation.
Prey animals are exposed to traumatic stress daily, yet they do not exhibit PTSD symptoms like humans. When animals need to discharge the activated energy (like a rabbit who was chased by a predator but managed to escape harm’s way), they either run a little further than they need to or shake their bodies when they finally come to a stop.
Since humans have no such instinctual discharge mechanism, we literally carry the stress in our bodies, which manifests in a slew of unwanted symptoms.
Trauma lives in the body
Stress literally stays alive in the body long after exposure to the stressor is gone. The trauma is a thing of the past, but the body keeps reacting as if there is an imminent danger, and it continues to feel the physical sensations of the trauma: crushing feelings in the chest, churning anxiety and burning pain in the stomach, agonizing tension in the shoulders, and so on.
This can make us feel crazy. We know the danger is over, but the sensations inside the body keep warning of impending doom. Instead of being an ally on the road to recovery, the body can become the enemy.
Individuals who experience this can learn to brace themselves against unacceptable physical sensations. People who feel scared all the time can inadvertently develop their bodies to become ready for the next assault. Muscles stiffen, preventing them from relaxing or going with the flow. The tension may translate into muscle spasms, headaches or migraines, fibromyalgia, and chronic pain.
Someone who is always preoccupied with the next assault likely has a torrent of thoughts related to survival, including worry and rage. These thoughts automatically reinforce the feedback loop within the body, maintaining a constant attack or defense mode.
Sense of conscious self is linked to the body
Contemporary neuroscience research shows that our sense of ourselves is anchored in a vital connection with our bodies. An area of the brain called the insula is where bodily sensations are transmitted into conscious awareness. Brain imaging studies of traumatized people show decreased activation in the insula and other areas related to self-awareness.
Trauma literally changes the brain.
Most therapy focuses on the interplay between thoughts and emotions, asking, “So how do you feel about that?” or “Let’s reflect on that and see if we can make sense of it.” But this downplays or ignores the shifts in people’s inner sensory world: emotional states as connected to the body’s chemical profile, the state of the internal organs, and the contraction of the muscles.
Because of this, people who are traumatized need to have physical and sensory experiences to unlock their bodies, tolerate their sensations, activate healthy fight or flight responses, and cultivate new patterns of thought and behavior.
Yoga as a tool to manage the symptoms of trauma
Because trauma affects the body, and because traumatic memories are often stored physiologically, it is becoming increasingly clear that trauma treatment must incorporate the body. People can spend years in talk therapy and still never access important elements of their inner experience.
Body-oriented therapies like yoga first make the connection at the somatic (body) level and then move from that point to addressing emotions and thoughts. Using a series of physical postures and breathing techniques, individuals can start to build a connection to their inner self.
Those who practice yoga cultivate the ability to remain present, to notice and tolerate their inner experience with curiosity and non-judgment, and to develop a new relationship with the body. This has a ripple effect on emotional and mental health.
Learning to tolerate and be curious about negative physical sensations without being overwhelmed gives people a sense of mastery. Also, the realization there is a natural flow in and out of emotions — that any sensation or feeling does not last forever and will pass — opens people up to deeper healing.
Bessel van der Kolk, author of the book “The Body Keeps The Score” spent over a decade doing research on the impact of trauma on the body at the Trauma Center in Brookline, MA. In partnership with yoga teacher David Emerson, the Trauma Center Yoga Program was created and extensive research was conducted on the effectiveness of yoga as a treatment modality for trauma and PTSD.
It was my great honor in April 2018 to attend a trauma-informed yoga teacher training offered by the Trauma Center Yoga Program. That training, as well as several others, have changed the way I teach yoga forever, in all my classes, not just to specifically traumatized populations.
The thing is: you never really know what people have been through before they step foot in your class. Anyone may have experienced trauma in their past, and you just don’t know about it. Teaching through a trauma-informed lens just makes sense to me, with every student.
What is “trauma-sensitive” yoga?
Here’s the rub: for yoga to be effective, people have to practice it, which can be a challenge for many survivors of trauma who feel disconnected from their bodies, and for whom the body can be a dangerous place. Yoga is fundamentally a body-based activity, so how can we make yoga accessible and tolerable to those for whom the body is their enemy? How can we help individuals find a way to befriend the body through yoga?
The Trauma Center Yoga Program identified four key themes of trauma-sensitive or trauma-informed yoga:
- experiencing the present moment
- making choices
- taking effective action
- creating rhythms
Experiencing the present moment
Often yoga classes can focus on the way a position is supposed to look. As a trauma-informed teacher, I encourage students to focus on the way it feels, noticing what’s going on in and around their bodies.
One resource to keep us linked to the present moment is awareness of the breath. In my classes, I help students draw their attention to their breath, maintain awareness their of inhalations and exhalations, notice the quality of the breath (whether it’s deep or shallow), or if they notice if and when they may be holding their breath.
Deep, rhythmic breathing is not only a focal point to experience the present moment, but deep breathing also has a direct impact on our physiology. Deep breathing can slow the heart rate, lower blood pressure, and cue the parasympathetic nervous system back to the calmer “rest and digest” state.
Another resource we can use is visualizing grounding or rooting through the part of the body that is touching the floor. We can notice where the physical body meets the chair or the floor, creating a feeling of support, anchoring, and security.
We can also use our five senses to orient ourselves to our external environment, as well as what’s going on within the body. We can notice the sounds and colors around us, feel sensations in the nostrils, upper lip, and belly as we breathe in and out, identify textural differences around us (the smoothness of the wood floor, the roughness of the carpet), and more.
Traditional yoga classes can sometimes feel prescriptive, with very specific directives and demands like “lift your right leg” or “turn your head.” After my trauma-sensitive training and teaching in a trauma-sensitive way for some time now, more traditional classes can even feel a little “bossy” with the instructor literally telling us what to do every step of the way!
Trauma is an experience of having no choice. Part of the grip of trauma comes from the loss of power during the time the traumatic event was happening. Therefore, in order to heal the trauma, the individual needs to feel a certain sense of power over self, being the director of their own experience and making choices for themselves.
In a trauma-sensitive class, you’ll hear instructors use invitational language and offer choices through variations and modifications, and encouraging that everything is optional. Instead of “lift your right leg” you might hear “when you feel ready, you can lift your right leg.” Instead of “turn your head” the instructor might say “You’re welcome to turn your head if that feels right for you. If at any point it is painful, you can stop or you can change what you are doing.”
Trauma-informed yoga teachers usually reiterate multiple times throughout a class that students always have a choice of what to do with their bodies and how far to go, or to do nothing at all if that’s what feels appropriate right then. Their personal power is restored, even if just in that moment.
Trauma is also usually characterized by extreme violence, and trauma survivors need to find ways to be in their bodies in a gentle, nurturing way. Trauma-sensitive yoga is self-paced and invites survivors to make choices that are kind, gentle and caring — all elements that were missing during the trauma.
Learning to listen to one’s body and make healthy choices based on the signals from the body takes practice, and individuals who have experienced trauma cannot be reminded enough that they decide what to do and how far to go, every step of the way.
Taking effective action
Remembering the “freeze” response from earlier, often those in a traumatic situation are stuck in some way, and cannot take effective action during the moment of the trauma. Long after the trauma has passed, they repeatedly find themselves in frozen states in which they are unable to engage their bodies and minds to confront stressful situations.
A trauma-informed yoga teacher might invite students to notice some characteristics of their present experience, asking them: how do you feel in your body? Do your arms feel restless, tense, heavy, relaxed? Is there an area of discomfort somewhere in your body? Are you cold or hot? Are you thirsty?
The teacher can then encourage self-efficacy, asking: is there one thing you can do to make yourself feel better? For example, shifting your physical position in some small way, or standing up and getting a blanket from the pile in the corner if you are cold, or walking to the water fountain if you are thirsty.
Often those who have experienced trauma or are suffering the symptoms of PTSD feel disconnected, out of sync, out of rhythm, and out of the flow of life. Many trauma survivors report feeling out of step with other people and at odds with themselves.
Dissociation can create a sense of disconnectedness with our own bodies, or with the world around us. Trauma survivors often feel they are living behind a veil that cuts them off from the rhythmic exchange in human relationships.
Yoga encourages a sense of feeling at ease in your body, as well as calming the arousal state that sometimes can lead to overwhelming emotions. It encourages intrapersonal rhythms within our own body, where we match our own movements to our breath.
Yoga is also a way that individuals can experience interpersonal rhythms, being in synchrony with other people through breath, through movement, and through shared experience.
Resources for a trauma-informed home yoga practice
So how can you start to incorporate some of the key components of trauma-informed yoga in your own life?
- Observe without judgment, using sensory input around you to just notice what’s going on in your environment. You can do this when you’re seated, or walking, or doing any activity in your life. Use your five senses to notice what’s going on in and around you, and allow yourself to sit with any sensations that may come up.
- Deep breathing is an excellent way to bring yourself into the present moment, and down-regulate your nervous system to a calmer state. Also, the sound of the breath in your ears or the sensation of the breath expanding and contracting your ribs can also be a focal point for observation.
- Be gentle with yourself. Meet yourself where you are. Life beats us up enough; if twisting or turning hurts or feels uncomfortable at any point, just back off a little. Change something to make it more comfortable. You are in control, and you only need to go as far as you choose to go. Self-compassion is the goal.
- Ground yourself through the points of contact with your seat if sitting or the floor if standing. Feel the stability and support of the seat or floor underneath you. You can even imagine yourself sending roots down and drawing up strength and stability from below.
- Sometimes trauma can cause us to dissociate from our bodies. One exercise to remind yourself of the “container” that is your body is to place one hand over your heart and one hand over your belly. You can take a few deep slow breaths here, feeling centered by the gentle grounding force of your own hands.
Yoga is an ancient practice that has offered us a rich toolbox of resources for thousands of years. Combined with contemporary neuroscience research, the evidence is clear: yoga is an effective treatment modality for PTSD and stress. Yoga heals.
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If you have any questions about trauma-sensitive yoga, please leave a comment below or contact me for more information or to set up an appointment. I look forward to hearing from you!
You can also learn more about free trauma-sensitive yoga classes for veterans, active military, first responders, and their families and support networks, offered by Connected Warriors.