Trauma-sensitive yoga

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Trauma-sensitive yoga is modern yoga, based on the postures called asanas, adapted from 2002 onwards for work with individuals affected by psychological trauma.[1] The goal of trauma-sensitive yoga is for trauma survivors to develop a greater sense of mind-body connection,[2] ease their physiological experiences of trauma,[2] gain a greater sense of ownership over their bodies,[1] and augment their overall well-being.[2]

Background[edit]

Trauma-sensitive yoga has been adapted from modern yoga, starting in 2002, an instance of the use of yoga for therapeutic purposes. It is a form of exercise conceptualized as a mind-body practice, which incorporates many forms and varies by class style. It typically includes techniques of body positioning, physical postures called asanas, with breathing exercises (pranayama), mindfulness, and meditation.[3][4] Research has demonstrated that traditional yoga can reduce stress,[1] enhance physical health,[1][5] and heighten one's sense of self.[6]

Trauma-sensitive yoga was first established at the Trauma Center in Brookline, Massachusetts by David Emerson and colleagues. It was designed to promote an enhanced feeling of safety for individuals as they engage in an exercise that is focused on body awareness, which may otherwise be overwhelming for a traumatized population.[1][7] Trauma-sensitive yoga addresses the need for a trauma-informed yoga practice that could identify and mitigate potentially triggering environmental and physiological circumstances,[7][8] while still providing the psychological and physical benefits that typical yoga practice offers.

Trauma-sensitive yoga has been formulated from five core domains which could produce adverse side effects under nonoptimal conditions among a traumatized population, potentially due to production of reminders of practitioners' traumas:[8]

  1. The environment. Trauma-sensitive yoga places greater emphasis on the environment as compared with traditional yoga, as trauma survivors must feel that the space is welcoming, safe, and comfortable, in order to minimize overwhelming feelings of vulnerability.[8]
  2. Physical exercise. While traditional yoga places a strong weight on achieving a particular posture, trauma-sensitive yoga highlights the importance of internal sensations in such postures to promote feelings of safety and self-acceptance.[8]
  3. Hands-on adjustments[8]
  4. Instructor style. Traditional yoga teachers are often directive and may provide hands-on adjustments to students' postures, whereas trauma-sensitive yoga instructors are encouraged to provide gentleness and space, and allow students to remain in control of their practice.[8]
  5. Non-directive. In contrast to traditional yoga instructors, trauma-sensitive yoga instructors pay particular attention to their directive language as traditional yoga verbiage could be a reminder of one's trauma.[8]

Rationale[edit]

Psychological trauma and the body[edit]

Psychological trauma occurs when an individual has experienced a traumatic event, which becomes lived and relived in the body and the mind.[9][10] Trauma can trigger a chronic stress response in the body,[6][11] which may manifest as an uncontrollable and constant state of heightened arousal and fear in the body.[2][6][12] 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.[9][10][13][14] Some research suggests that traumatized individuals often have difficulty soothing their overactive internal sensations without relying on external stimuli, such as food, substances, or self-harm.[6][15][16] Therefore, psychological trauma is not only associated with psychological disorders such as post-traumatic stress disorder, depression, and anxiety,[3] but also with somatic disorders.[3][17]

Though most evidence-based treatments focus on the psychological effects of trauma first and foremost,[3][9] attrition rates are still high, possibly due to heightened physiological arousal during the initial stages of exposure therapy.[3][18] Research has implicated mind-body approaches as an alternative to traditional psychotherapy, to allow traumatized individuals to reconnect with and identify their own physical sensations.[3][16] Mind-body approaches allow those with a history of trauma to work through their somatic trauma memories and feel safe enough to emotionally and verbally process their traumatic memories.[3][16] Such approaches involve increasing awareness of, and attention to, body sensations, while emphasizing present-moment experience to counteract dissociative responses.[19][20] Finally, mind-body approaches help the traumatized individual to nurture the body using internal resources.[6] 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.[6][21]

Physiological effects[edit]

The techniques of yoga alleviate effects on the body's nervous system.[6] 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.[6][22] The aspect of yoga geared toward breath manipulation helps to enhance capacity for emotion regulation.[6][23][24] Thus, yoga reduces the overall intensity of one's stress response and improve one's ability to self-soothe.[6][25]

Yoga is associated with a reduction in physiological and somatic complaints often attributable to post-traumatic stress disorder, such as pain and anxiety.[26] Research also suggests that yoga produces psychological benefits for individuals with post-traumatic stress disorder such as reduction of stress,[26][22] a decrease in depression as associated with the mindfulness component,[26][27] a greater sense of interconnectedness with others when practiced in group settings,[26][28][29] enhanced self-efficacy and self-esteem,[26] and a feeling of overall empowerment.[26][30]

Key features[edit]

Trauma-sensitive yoga is designed to begin gently, with a seated breathing exercise, followed by light movements.[1] While adhering to the conditions of the five core domains (i.e., physical environment, exercises, teaching style, adjustments, and language),[8] the instructor guides the class through a series of physical postures at a level of difficulty fitting the abilities of the participants.[1] In each posture, instructors encourage students to observe their internal sensations, without judgment, and to respond to them compassionately.[2] 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.[1] The class ends similarly to traditional yoga in a resting pose (Savasana).[1]

Safe-keeping[edit]

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 lights so participants can see their surroundings.[31]

For post-traumatic stress disorder[edit]

Mechanisms[edit]

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.[2] Throughout, instructors strive to create an environment that feels both physically and emotionally safe for the participants, thereby facilitating a healing atmosphere for traumatic individuals.[8] 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.[8][10] Once participants are at a mid-range level of arousal, they can learn to work with the physiological experiences of trauma in a more adaptive and less destructive manner.[2]

Victims of interpersonal violence[edit]

Trauma-sensitive yoga is effective for improving the psychological symptoms for women who have survived interpersonal violence.[8][18] Improvements may include a reduction in symptom severity of post-traumatic stress disorder,[8][31] reduction in severity of symptoms of depression and anxiety.[1][8] Survivors of interpersonal violence who engage in trauma-sensitive yoga have reported increased feelings of safety and agency,[1][18] higher self-esteem and self-compassion, decreased feelings of isolation, greater feelings of relaxation, and a greater sense of agency over their own bodies.[26]

Research[edit]

Research has highlighted the importance of utilizing trauma-sensitive yoga only as an alternative and complementary treatment to other evidence-based treatments (e.g., psychotherapy, medication) for trauma.[4][19] Classes are designed to vary, and thus efficacy has not been established.[19] Research has suggested the use of trauma-sensitive yoga as a primer to individual psychotherapy, as a means of preparing and grounding the body before uncovering stored traumatic memories,[2][4][22] and establishing a traumatized individual's buy-in for treatment.[4]

It may be important for consumers of trauma-sensitive yoga to consider the matter of confidentiality as it differs between trauma-sensitive yoga instructors and mental health professionals.[8] Though instructors are most often required to complete at least 200 hours of yoga instructor training with a focus on trauma, confidentiality is typically not the focus of training.[8]

References[edit]

  1. ^ a b c d e f g h i j k Nolan, C. R. (2016). "Bending without breaking: a narrative review of trauma-sensitive yoga for women with PTSD". Complementary Therapies in Clinical Practice. 24: 32–40. doi:10.1016/j.ctcp.2016.05.006.
  2. ^ a b c d e f g h Spinazzola, J.; Rhodes, A. M.; Emerson, D.; Earle, E.; Monroe, K. (2011). "Application of yoga in residential treatment of traumatized youth". Journal of the American Psychiatric Nurses Association. 17: 431–444.
  3. ^ a b c d e f g Nguyen-Feng, V. N.; Clark, C. J.; Butler, M. E. (2018). "Yoga as an intervention for psychological symptoms following trauma: a systematic review and quantitative synthesis". Psychological Services. April 2018.
  4. ^ a b c d Macy, R. J.; Jones, E.; Graham, L. M.; Roach, L. (2018). "Yoga for trauma and related mental health problems: a meta-review with clinical and service recommendations". Trauma, Violence, and Abuse. 18: 35–57.
  5. ^ Ross, Alyson; Friedmann, Erika; Bevans, Margaret; Thomas, Sue (August 2013). "National survey of yoga practitioners: Mental and physical health benefits". Complementary Therapies in Medicine. 21 (4): 313–323. doi:10.1016/j.ctim.2013.04.001. PMC 3721070. PMID 23876562.
  6. ^ a b c d e f g h i j Caplan, M.; Portillo, A.; Seely, L. (2013). "Yoga Psychotherapy: the integration of western psychological theory and ancient yogic wisdom". The Journal of Transpersonal Psychology. 45: 139–158.
  7. ^ a b Emerson, D.; Sharma, R.; Chaudhry, S.; Turner, J. (2009). "Trauma-sensitive yoga: principles, practice, and research". International Journal of Yoga Therapy. 19: 123–128.
  8. ^ a b c d e f g h i j k l m n o Nguyen-Feng, V. N.; Morrissette, J.; Lewis-Dmello, A.; Michel, H.; Anders, D.; Wagner, C.; Clark, C. J. (2018). "Trauma-sensitive yoga as an adjunctive mental health treatment for survivors of intimate partner violence: a qualitative examination". Spirituality in Clinical Practice: 1–17. doi:10.1037/scp0000177.
  9. ^ a b c Tzu, G.; Bannerman, B. (2017). "Transforming trauma into healing and being: a non-dual therapy approach". International Journal of Mental Health and Addiction. 15: 63–79.
  10. ^ a b c Ogden, P.; Minton, K.; Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: W. W. W. Norton.
  11. ^ Christopher, Michael (March 2004). "A broader view of trauma: A biopsychosocial-evolutionary view of the role of the traumatic stress response in the emergence of pathology and/or growth". Clinical Psychology Review. 24 (1): 75–98. doi:10.1016/j.cpr.2003.12.003. PMID 14992807.
  12. ^ Levine, P. A. (1997). Waking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.
  13. ^ van der Kolk, B. A.; McFarlane, A. C.; van der Hart, O. (2007). Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York: The Guilford Press. pp. 417–440.
  14. ^ Corey, G. (2013). Theory and practice of counselling and psychotherapy (9 ed.). United States: Brooks/Cole. ISBN 978-0534348236.
  15. ^ van der Kolk, Bessel A. (2002-06-17). "Posttraumatic Therapy in the Age of Neuroscience". Psychoanalytic Dialogues. 12 (3): 381–392. doi:10.1080/10481881209348674.
  16. ^ a b c van der Kolk, Bessel A. (2006). "Clinical implications of neuroscience research in PTSD". Annals of the New York Academy of Sciences. 1071: 277–293.
  17. ^ Afari, Niloofar; Ahumada, Sandra M.; Wright, Lisa Johnson; Mostoufi, Sheeva; Golnari, Golnaz; Reis, Veronica; Cuneo, Jessica Gundy (January 2014). "Psychological Trauma and Functional Somatic Syndromes". Psychosomatic Medicine. 76 (1): 2–11. doi:10.1097/psy.0000000000000010. PMC 3894419. PMID 24336429.
  18. ^ a b c van der Kolk, Bessel A.; Stone, L.; West, J.; Rhodes, A.; Emerson, D.; Suvak, M.; Spinazzola, J. (2014). "Yoga as an adjunctive treatment for posttraumatic stress disorder: a randomized controlled trial". Journal of Clinical Psychiatry. 75: 1–7.
  19. ^ a b c Pradhan, B.; Kluewer, J. D.; Makani, R.; Parikh, T. (2016). "Nonconventional interventions for chronic post-traumatic stress disorder: ketamine, repetitive trans-cranial magnetic stimulation (rTMS), and alternative approaches". Journal of Trauma and Dissociation. 17: 35–54.
  20. ^ Pradhan, B. K. (2014). Yoga and mindfulness based cognitive therapy--A clinical guide. Switzerland: Springer International.
  21. ^ Berg, A. L.; Sandahl, C.; Bullington, J. (2010). "Patients' perspective of change processes in affect-focused body psychotherapy for generalised anxiety disorder". Body, Movement and Dance in Psychotherapy. 5: 151–169.
  22. ^ a b c Follette, Victoria; Palm, Kathleen M.; Pearson, Adria N. (March 2006). "Mindfulness and trauma: implications for treatment". Journal of Rational-Emotive & Cognitive-Behavior Therapy. 24 (1): 45–61. doi:10.1007/s10942-006-0025-2.
  23. ^ Granath, Jens; Ingvarsson, Sara; von Thiele, Ulrica; Lundberg, Ulf (March 2006). "Stress Management: A Randomized Study of Cognitive Behavioural Therapy and Yoga". Cognitive Behaviour Therapy. 35 (1): 3–10. doi:10.1080/16506070500401292.
  24. ^ Brown, R. P.; Gerbarg, P. L. (2009). "Yoga breathing, meditation, and longevity". Annals of the New York Academy of Sciences. 1172: 54–62. doi:10.1111/j.1749-6632.2009.04394.x. PMID 19735239.
  25. ^ Harper, J. (2010). "Teaching Yoga in urban elementary schools". International Journal of Yoga Therapy. 1: 99–109.
  26. ^ a b c d e f g West, J.; Liang, B.; Spinazzola, J. (2017). "Trauma sensitive yoga as a complementary treatment for posttraumatic stress disorder: a qualitative descriptive analysis". International Journal of Stress Management. 24 (2): 173–195. doi:10.1037/str0000040. PMC 5404814. PMID 28458503.
  27. ^ 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.
  28. ^ Berrol, Cynthia F. (1992). "The neurophysiologic basis of the mind-body connection in dance/movement therapy". American Journal of Dance Therapy. 14 (1): 19–29. doi:10.1007/bf00844132.
  29. ^ Macy, Robert D.; Johnson Macy, Dicki; Gross, Steven I.; Brighton, Pamela (2003). "Healing in familiar settings: Support for children and youth in the classroom and community". New Directions for Youth Development. 2003 (98): 51–79. doi:10.1002/yd.44. PMID 12970987.
  30. ^ Cloitre, M.; Courtois, C.; Ford, J.; Green, B.; Alexander, P.; Briere, J.; van der Hart, O. (2012). "The ISTSS expert consensus treatment guidelines for complex PTSD in adults". ISTSS.
  31. ^ a b Price, M.; Spinazzola, J.; Musicaro, R.; Turner, J.; Suvak, M.; Emerson, D.; van der Kolk, B. (2017). "Effectiveness of an extended yoga treatment for women with chronic posttraumatic stress disorder". The Journal of Alternative and Complementary Medicine. 23: 300–309.