Trauma-Informed Yoga Therapy for PTSD
“Overcoming the effects of trauma is a process of reclaiming the body through a sense of agency in the body, support a healthy functioning of the nervous system, and connection” -David Emerson, Co-Director for The Center for Trauma and Embodiment at JRI
Post Traumatic Stress Injury (PTSI)*, or clinically understood as PTSD, is a chronic, often debilitating, mental and physical health disorder that can occur to anyone who has experienced or witnessed a single or multiple traumatic event(s) such as, but not limited to: accidents, natural disasters, terrorist act, war/combat, ER trauma, prolonged exposure to distressing events, rape or other violent personal physical, sexual and verbal assault, and other adverse experiences. After exposure to distressing circumstances or events, it is normal for people to experience post-traumatic stress response (PTSR). Not everyone will develop PTSI, however, when these reactions become persistent (longer than 1 month), one may develop posttraumatic stress disorder (PTSD) and would be diagnosed by a doctor or psychiatrist. It’s also important to note that sometimes symptoms may not appear until years after the event. [1]
PTSI significantly impairs everyday functioning and quality of life with a spectrum of symptoms, most commonly reported: chronic anxiety, depression, hypervigilance, avoidant behaviour, sleep disturbances, apathy/numbness, flashbacks of event(s), intrusive thoughts, loss of trust in the self or others, suicidal ideations, negative changes in thought and mood, chronic pain and inability to feel joy. For current treatment, both pharmacological and psychological interventions have been more commonly used. Despite their effectiveness, a meta-analysis of psychotherapy for PTSI showed that these interventions have high rates of incompletion, and many individuals, veterans and civilians included, continued to have residual symptoms, high dropout rates, and worsening of symptoms. [2] Because of this, other adjunctive or alternative body-based treatments and therapies including trauma-informed yoga have been proposed, researched, and considered.
“Treatment for trauma must consider the person as a whole and addressing the broad ranging effects of trauma on an individual.” -David Emerson
Dr. Bessel Van der Kolk, a leading psychiatrist and researcher in the field of trauma, explained in an interview “PTSD causes memory to be stored at a sensory level—in the body.” [3] Therefore, to support people who are struggling with PTSI, the body cannot be ignored in treatment. The many aspects of yoga and its combination of personalized physical postures (asana), breathing techniques (pranayama), meditation/concentration practices (dharana), and relaxation has shown promise in research as an acceptable adjunct and even a standalone therapy to support symptoms of PTSI. [4] Studies show that trauma-informed yoga is an effective complementary therapy for PTSI symptoms considering it can help traumatized individuals experience improvements in physical and mental regulation, decrease reactivity to stressful stimuli, improves sleep, and dramatically improves participants' relationships to their bodies. Studies claim that trauma-informed yoga can significantly reduce PTSI symptomatology, with effect size comparable to well-researched psychotherapeutic and psychopharmacological approaches. [5]
A strong hypothesis as to why yoga may be effective for the symptoms of trauma due to it being shown to increase interoceptive awareness. Interoceptive awareness is the ability to perceive internal physiological sensations and is thought to be abnormal in clinical conditions such as PTSI. [6] Interoception has been proposed as key to resiliency because the accurate interpretation, processing, and response of internal bodily states promotes a faster and more adaptive ability to self-regulate and restore homeostatic balance within the nervous system. [7] The ability to feel body sensations, maintain awareness of the sensations (mindfulness) and self-regulate physiological arousal are important components in healing PTSI [8] and can be linked to why the aspects of Yoga can be considered a comprehensive methodology because of its bottom-up (body to brain) and top-down (brain to body) approaches.
From a physiological perspective, given the symptoms, this injury can also be seen as a compromised autonomic nervous system (ANS). The primary function of the autonomic nervous system is to regulate bodily functions to ensure survival and safety. It is a contributing factor to emotional states and behaviour thus shaping the way in which one experiences life. When one is exposed to sole or repeated traumatic events or stressors, the threat response in the ANS may be altered and the way in which the nervous system evaluates and scans relative danger and safety in one’s outside and internal environment may become compromised. Research has indicated that people with PTSI show a more reactive autonomic nervous system, lower HRV (heart rate variability), and a sensitized neuroendocrine system dominantly in its defense responses. [9] When the ANS is in its defense response for protection, the ability to access states of connection, safety, healing, growth, restoration, and trust within the body and in a relationship are neurologically thwarted. And when this becomes the normal and dominant response, one’s ability to heal is prevented and “true” safety, trust and rest can actually feel unsafe to a system that has become maladaptive.
“Habitual response patterns can be interrupted and new patterns can be created.”- Deb Dana, writer and clinician specialized in working with complex trauma
Through the lens of understanding the physiological effects of PTSI, the treatment is to support the system’s capacity and patterning to come back to neurological states of healing and create a flexible and adaptive nervous system to promote recovery and resiliency. Through personalized body-based practices, re-inhabiting agency over the body, learning self-regulating and a compassionate therapeutic relationship, trauma-informed yoga therapy can be a supportive adjunct therapy to create and empower meaningful change in one’s life.
The journey forward can take some time and cannot be done solely alone. If you are interested in exploring 1:1 trauma-informed Yoga Therapy or would like to bring group programming to your members or community, please reach out, and let’s discuss how to move through and forward, together.
*In this article the term Post Traumatic Stress Injury (PTSI) is used primarily instead of Post Traumatic Stress Disorder (PTSD) as the word “disorder” can cause stigma and prevent folx who are experiencing symptoms to seek help.
This article was adapted from a research paper I wrote on the efficacy of trauma-informed yoga therapy for PTSD.
Works Cited:
Ford, Julian D., Christine A. Courtois. “Understanding Psychological Trauma and PTSD.” Second Edition. Science Direct. August 7, 2015. https://www.sciencedirect.com/science/article/pii/B9780128012888000017
Bradeley, R., Greene J, Russ E, Dutra L, Westen D. “A multidimensional meta-analysis of psychotherapy for PTSD.” PubMed. February 2005. https://www.ncbi.nlm.nih.gov/pubmed/15677582 . Abstract.
Traumacenter.org. “Yoga and Post-Traumatic Stress Disorder (interview)”. Online PDF. Date unknown. Pg. 2
Avery, K Timothy. Yoga and PTSD: A Primer on Symptoms and Potential Mechanisms of Change. YTTYoga Therapy Today Winter 2019, International Association of Yoga Therapy. Pg 14-16
Van der Kolk, Bessel, Stone L., West J, Rhodes A, Emerson D. ”Yoga as an Adjunctive Treatment for post-traumatic stress disorder: a randomized controlled trial.” Journal Clinical Psychiatry. June 2014. https://www.ncbi.nlm.nih.gov/pubmed/25004196
Dana, Deb, Stephen W. Porges. Clinical Applications of the Polyvagal Theory. New York. LSC Harrisonburg. 2018. Pg. 4
Sullivan, Marlysa B., Matt Erb, Laura Schmalzi, Steffany Moonaz, Jessica Taylor, Stephen W. Porges. “Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience.” Maryland University of Integrative Health. Feb 27, 2018. Pg. 4
Traumacenter.org. “Yoga and Post-Traumatic Stress Disorder (interview)”. Online PDF. Date unknown. Pg. 2
Emerson, David, Elizabeth Hopper. Overcoming Trauma through Yoga: Reclaiming Your Body. Berkeley, North Atlantic Books, 2011. Pg. 20