Yoga - a Unique and Empowering Way to Work with Trauma

Yoga can be a unique and empowering way to work with trauma; in terms of addressing both the behaviours and the experiences relating to trauma. For example, in PTSD (Post-Traumatic Stress Disorder), which is an anxiety disorder caused by frightening or distressing events, these are often relived through flashbacks and nightmares and can cause feelings of isolation, lack of self-worth and guilt. This can impact a person’s day-to-day life immediately afterwards, or weeks, months or even years later.

There are currently three main treatment approaches for PTSD that the NHS uses; watchful waiting, antidepressants and talking therapies. Although not mainstream, yoga offers another approach; a way for those with PTSD to learn to inhabit and become comfortable in their body. This is not addressed by other types of trauma treatment. Yoga uses the body, attention to breathing and skilful awareness practices to offer present moment connection to the body, development of self-regulation skills, a place to make conscious choices and to begin the processes of trust in oneself and others.

Bessel van der Kolk, author of ‘The Body Keeps the Score’, analysed the behaviours and experiences of those who have PTSD, and highlighted four key patterns: -

• There are automatic physical and emotional responses to present-day reminders of the past trauma.

• There are apparent impairments in memory, concentration, and engaging in the present moment.

• Experiencing emotions, cognitions and physical sensations becomes overwhelming and unmanageable.

• There is a feeling of helplessness because of being unable to prevent the trauma from happening.

Van der Kolk proposes that for successful trauma treatment, each challenge must be addressed. Trauma treatment must support survivors to develop a relationship with their present moment internal experiences and sensations. There should be an accessible way to cultivate skills for self-regulation allowing the survivor to take deliberate actions to address their present moment needs.

Van der Kolk also suggests that mindfulness-based treatments such as yoga, which incorporate awareness of breath, movement and physical sensations may prove more successful in treating the symptoms of trauma than traditional talk- and exposure-based techniques.

It is of the utmost importance though that when yoga practice is used to address trauma, the yoga must prioritise its application to the individual.

Trauma is a very broad term and each person is different meaning that one set of yoga practices or one methodology will not be applicable, appropriate or beneficial to all. Careful case history taking is needed in all cases.

Trauma survivors face different challenges. In situations where yoga is offered to groups or individuals where the group aim is to specifically address trauma, the yoga offered needs more defined approaches to meet those challenges.

There needs to be a safe environment for practice and where the teacher or therapist has an engaging, open and welcoming attitude. Even though this should apply to all yoga classes, in practice yoga is offered in all manner of spaces and places, so it is worth reminding ourselves of the importance of this requirement in this context.

Invitational language demonstrates to the individual that everything offered in the yoga session is an invitation to explore. It is never a command or expectation. Specific qualifiers are prescribed before any yoga or mindfulness cue, for example “if it’s comfortable for you” “you might begin to notice your breath” or “when you’re ready, you’re welcome to move ….” Language is used to encourage interoception, the internal perception of sensation. Language is also a therapeutic tool which can encourage choice and personal control over how one moves their body. It directs their awareness, gentleness, curiosity and non-judgement in a way that respects the individual trauma.

Most traumas occur in the context of interpersonal relationships involving boundary violations, loss of autonomous action and loss of self-regulation and therefore the precise use of language is hugely important.

Assisting a student in a posture or any other hands-on assists are obviously not used.

Postures need to be offered in accessible forms so that they are suitable for a wide range of practitioners and with minimal risk of causing injury. Yoga asanas and associated movements are generally presented at a slow pace with variations commonly offered and modifications with or without the use of props are encouraged to increase accessibility. This supports students in moving away from physical, emotional pain or discomfort that they cannot yet tolerate.

Over time, the practitioners develop their ability for interoception, the internal perception of sensation. This helps individuals to become more familiar with their body sensations and cues; to pinpoint and describe specific physical sensations in specific areas of the body, to become aware of impulses to move or act based on sensed experience, in particular impulses to improve comfort and safety.

Yoga can facilitate a “structured, supported and self-paced medium for those with trauma to make choices in relation to their bodies and their experience that are kind, gentle and caring - all of the things that were missing during the trauma.” [3] There is then the opportunity to take safe, effective action to regain a sense of self-efficacy, noticing their current experience and taking action to improve it. The yoga practice leads to the ability to self-regulate.

With a slowing down of practice and an awareness of the present moment, the skills develop to access the potential freedom found in a “safe positive body-based present moment experience.” [4]

Where there are feelings of disconnection or alienation from the body, physical sensations may feel uncontrollable, confusing or dangerous, or are perceived as coming from the outside, or may feel generalised throughout the body. In these situations, it is helpful to become aware of muscle dynamics as internally generated, to notice the physical changes from movement and breath and to focus on specific parts of the body rather than on the whole body at once.

Rhythm and connection ideas use repetitive and rhythmic movements, first independently and then in sync with other students, to help restore a connection to the body’s natural biorhythms (e.g., pain, hunger, sleepiness) as well as to connect to the internal sense of self and ultimately to other people.

These applications are also applied in other areas of yoga and yoga therapy work but in the context of trauma, it is absolutely necessary to use yoga carefully. For the practices to be helpful and therapeutic in supporting those affected by trauma, individual assessment and personalised appropriate adaptation of the practices is imperative.

1. Research Study: The Influence of Trauma-Informed Yoga on Emotion Regulation and skilled Awareness in Sexual Assault Survivors. International Journal of Yoga Therapy

2. ‘The Body Keeps the Score’, Bessel Van Der Kolk

3. ‘Trauma Sensitive Yoga in Therapy: Bringing the Body into Treatment’, David Emerson

4. ‘Overcoming Trauma Through Yoga’, D Emerson and E Hopper