Yoga for Trauma
The resource below was contributed by Lauren Rubenstein, a clinical psychologist and yoga teacher (RYT-200) with experience teaching yoga to outreach populations and consulting to non-profits. She has a private practice in Chevy Chase, where she offers integrative psychotherapy and stress management. Dr. Rubenstein can be reached at DrLRubenstein@aol.com.
What is Trauma? Psychological trauma occurs when an actual or perceived threat of danger overwhelms a person’s usual coping ability. The danger can come from a single stressful event, such as a car accident, or a series of events such as war or repeated sexual, physical or emotional abuse.
All traumas are stressful, but not all stress is traumatic. For many reasons, individuals differ in their response to threat or acute stress. As a general rule, however, intentional human causes seem to be the most difficult to recover from, while acts of nature tend to resolve more quickly.
Neurophysiology of Stress Most people have heard stories about superhuman strength in the face of stress — e.g., a mother lifting a car off of her trapped child. This is due to the body’s fight or flight response to life-threatening situations. The surge of stress hormones enables us to mobilize enormous energy in preparation to fight or escape. Once the body has discharged energy and the danger has passed, the stress hormones subside.
When we are unable to discharge this excess energy by running or fighting, the brain continues to release stress hormones, and the body remains on high alert.
Freezing, or immobility, is the third, lesser-known survival tool in response to threat. Peter Levine uses the example of a cheetah stalking an impala. When the cheetah catches its prey, the impala falls to the ground and plays dead, which reduces its chances of being devoured. Even if it is killed, numbness will attenuate the pain or terror that normally would ensue.
Fighting, escaping and freezing are all normal responses to extreme threat. What becomes problematic is when these responses persist in the body after the danger has passed. Bessel van der Kolk, an expert on traumatic stress, describes trauma as “hijacking the body.” Brain, mind and body remain in a state of high alert (fight or flight) or under-arousal (freeze). This scheme is helpful in understanding the complex symptoms of Post-Traumatic Stress Disorder, or PTSD.
Post Traumatic Stress Disorder (PTSD) Defined
The Diagnostic and Statistical Manual of Mental Disorders (“DSM-IV”) outlines six criteria for a diagnosis of PTSD:
Exposure to Stressor. Intense fear, helplessness or horror experienced in the face of event(s) involving actual or threatened death, serious injury, or bodily violation.
Event Re-experienced through intrusive memories, distressing dreams, feeling as if the trauma were recurring, intense distress when exposed to cues symbolizing an aspect of the trauma, or physiological reactivity when exposed to cues.
Persistent Avoidance and Numbing. At least three symptoms are required from a list including avoidance of internal or external stimuli that arouse memories of the trauma; inability to remember an important aspect of the trauma; diminished interest in formerly pleasurable activities; feelings of detachment; and restricted range of affect.
Persistent Symptoms of Increased Arousal. At least two of the following: difficulty falling or staying asleep; angry outbursts or irritability; difficulty concentrating; hyper vigilance; and exaggerated startle response.
Symptoms persist for more than one month
Life Disrupted / Functioning Impaired
As yoga teachers, our intention is to make our classes as warm, inviting and non-threatening as possible. We are likely to succeed more often than not for the average student. For the traumatized student, however, even our most heartfelt efforts can easily go awry. By hijacking the nervous system, trauma robs its victims of a sense of basic safety and security. On the other hand, trauma-sensitive yoga practice can help people “befriend their bodies,” which van der Kolk says is such an important aspect of trauma recovery.
Trauma Aftermath On the Mat
There are unlimited possibilities as to how the aftermath of trauma might show up on the yoga mat. Some common pitfalls that may trigger reactions include:
Turning out lights for savasana
Bending over in front of other
Sexually provocative poses, e.g. happy baby, cat/cow
Lack of structure or too much quiet time in a restorative pose might prompt dissociation
Use of language with potentially sexual or aggressive meaning (see below)
Physical assists can startle or trigger flashbacks of unwanted touch
Making Yoga Safe
During the course of practice, most yoga practitioners naturally come to know their most comfortable poses, which they can use as a touchpoint or resting pose when they need a time out during class. Trauma survivors can be quite disconnected from their bodies and sensations. Teach some common resting poses, with the instruction that they are welcome to come into these poses any time they need to during class. Depressed or dissociative students might find comfort in child’s pose, while hyper-aroused students might prefer an upright seated pose with their back against a wall, so they can continue to monitor what is happening in the room.
Inviting students to “take some time and follow your own flow,” or “do any postures that their bodies need” runs the risk of losing students who are prone to dissociation. It is probably better to err on the side of more specific instruction, repeated often.
Trauma-Sensitive Language
Language commonly used in yoga class can be unwittingly provocative. Here are some instructions to avoid, and suggested alternatives.
“I want you to….” → “If it’s comfortable/available to you…”
“Claw the mat like you’re trying to tear it in half” → “Plant/root your fingers into the ground”
“Stick your butt out” → “move your hip creases back”
“Close your eyes” → “Gaze softly down at the floor in front of you, or close your eyes if you’d like”
“nail your fingers/toes into the mat,” → “knit/root your fingers/toes into the fabric of the earth”
Trauma can result in a wide range of vulnerabilities and behaviors that might seem odd — to the survivor as well as the observer. Understanding trauma as a mind-body reaction to extreme stress provides a framework within which these behaviors make sense. For a more in-depth understanding, consult the resource list. Emerson’s guide is particularly helpful for yoga teachers, and Peter Levine’s work is refreshingly jargon-free.
Reading List: Psychological trauma
Cope, Stephen (1999). Yoga and the Quest for the True Self. NY: Bantam Books.
Emmerson, David (2011). Overcoming Trauma through Yoga
Emerson, David (2009). Toward Becoming a Trauma-Sensitive Yoga Teacher: A best practices guide from the trauma center. Order from www.traumacenter.org.
Fisher, Janina, “The Work of Stabilization in Trauma Treatment,”
“Addictions and Trauma Recovery.” www.janinafisher.com/resources.php
International Society for Traumatic Stress www.istss.org
Levine, Peter A. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley: North Atlantic Books (2005).
Healing Trauma (includes CD). Boulder: Sounds True(1997). Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences.
Ogden, Pat (2006). Trauma and the Body New York: WW Norton
Rothschild, B. (2010). 8 Keys to Safe Trauma Recovery. New York: WW Norton (2000).
The Body Remembers: The psychophysiology of trauma and trauma treatment. New York: WW Norton. (2003).
The Body Remembers Casebook: Unifying methods and models in the treatment of trauma and ptsd. New York: WW Norton. (2004).
“Applying the Brakes.” Family Therapy Networker. Available at Home.webuniverse.net/babette/brakes.html. Website with newsletter at http://www.8keys.webs.com/
Scaer, Robert (2001). The Body Bears the Burden: Trauma, Dissociation and Disease. Binghamton: Haworth Press.
Schiraldi, Glenn R. (2000). The Post-Traumatic Stress Disorder Sourcebook. Los Angeles: Lowell House.
Talbot, Margaret (2009). A Reporter at Large, “Nightmare Scenario,” The New Yorker, November 16, p. 43. http://www.newyorker.com/reporting/2009/11/16/091116fa_fact_talbot#ixzz187d4DC8E
Trauma Center at Justice Resource Institute. “Developing Trauma-Informed Services for Families Experiencing Homelessness: An Interactive DVD and Guide.” Order at http://www.traumacenter.org/products/homelessness_video.php
van der Kolk, Bessel, “The Body Keeps the Score: Memory and the Evolving Psychobiology of Post-Traumatic Stress Disorder.” www.trauma-pages.com
van der Kolk, Bessel et al. (2006). “Clinical Implications of Neuroscience Research in PTSD.” [Includes results of study using yoga to change heart rate variability.] Annals of N.Y. Academy of Science 1071:277-293.
Van der Kolk, Bessel et al. (2006). Traumatic Stress: The effects of overwhelming experience on mind, body, and society. NY: Guilford Press.(2007).
A Randomized Clinical Trial of Eye Movement Desensitization and Reprocessing (EMDR), Fluoxetine, and Pill Placebo in the Treatment of Posttraumatic Stress Disorder: Treatment Effects and Long-Term Maintenance Journal of Clinical Psychiatry, 68.
Wills, Denise Kersten . “Healing Life’s Traumas.” Yoga Journal, June 2007. www.yogajournal.com/health/2532.
