Trauma therapy puts yoga into practice

According to the 2012 Yoga in America study, approximately 20.4 million Americans practice yoga for a variety of reasons including increased flexibility, general conditioning, physical fitness, overall health benefits and stress relief.

Recent research has demonstrated yoga can be an effective complementary therapy to psychological intervention.

Thirteen years ago, David Emerson, E-RYT, director of Yoga Services at The Trauma Center at the Justice Resource Institute (JRI), created trauma sensitive yoga (TSY) as an adjunctive treatment for those who have suffered chronic childhood physical and/or sexual abuse and neglect.

He explained that parts of the brain that connect awareness to the body are severely under-activated in the presence of trauma.

“It’s a dissociative experience. There is a need for some somatic intervention,” he said. “[Trauma sensitive yoga] is best for inter-relational trauma and stems from trauma theory in general. Therapists can use something like this in the office and integrate it into treatment.”

The philosophy of neuroscientist Bessel van der Kolk, M.D. who attempts to help people with posttraumatic stress disorder “be present,” influenced Emerson in the development of TSY.

He explained that TSY embraces specific themes or tenets, including choice making, being in the present moment, taking effective action and creating rhythms.

To explore the credibility of yoga, the National Institutes of Health funded a study, one of the first on yoga, and results were published in the Journal of Clinical Psychiatry in 2014.

The findings support the theory that yoga can “increase affect tolerance and decrease PTSD symptomatology.” Jennifer West, Ph.D., private practitioner in Boston’s Back Bay and co-author of the study, conducted qualitative interviews at the end of the 10-week trial.

“The women had an increased sense of gratitude and self-acceptance. They had reconnected with their bodies and achieved centeredness, increased empowerment and felt they had a voice,” she said.

A follow up study showed that the gains were maintained if the participants continued doing some type of yoga, West said.

“Trauma sensitive yoga focuses on recovery and healing. But a piece of that is not just symptom reduction or getting back to baseline, but ‘how do you help with personal growth?’” according to West.

Psychologists trained in TSY learn about complex trauma and how it causes a disconnect from the body, leaving the patient unable to manage exposure to trauma.

“Psychotherapy uses a top down method. You use the brain to make sense of your feelings,” West said. “TSY focuses on understanding what happens in the body without connecting to the past. It’s very ‘present moment.’ The client learns to take effective action, to move in a way that feels good. He learns ways to make choices.”

TSY employs a language of invitation and language of interoception. That is, clients are never instructed to take a certain position, but rather are invited to do so, said West.

“Commands can take away the sense of choice. Also in TSY, we don’t use the word ‘pose.’ There is an inherent negative meaning in the word. Rather, we say ‘form.’ It’s not about teaching physical movement, but encouraging introspection, self-awareness and the ability to tolerate feelings in the body. The person has control over the way they move their body.»

According to Laurie M. Edwards, Psy.D., private practitioner in Branford, Conn. and faculty member at the Yale School of Medicine, the literature on the neuropsychology of yoga provides the theory behind what happens.

“The research shows that the cranial nerve enervates the organ systems, the lungs, heart, diaphragm and other systems. It sends sensory information to the brain and back. Research shows practicing yoga increases vagus nerve tone, which is important in regulating the autonomic nervous system in stress situations. It activates the hormones that regulate the fight or flight response.”

Breath work and self-compassion also factor into trauma sensitive yoga. “A healthy breath pattern gets reversed through trauma,” she said. “Learning basic breathing techniques can be powerful.”

Elizabeth K. Hopper, Ph.D., director of Project REACH at JRI, which serves victims of human trafficking across the U.S., does not profess to be a yoga teacher, but does integrate yoga as part of her practice, tailoring techniques to each individual client.

“It’s not a set approach, but emerges more organically. We – the patient and I – co-create the practice,” she said.

Hopper uses yoga in her practice as a means of regulation. “A lot of survivors’ bodies are a source of pain. Their bodies betrayed them during the pain of trauma and repeatedly afterward,” she said. “Yoga takes a bottom up approach and thematically accesses internal experiences. Using body-oriented techniques helps to be more in the moment, helps the person notice what’s going on and tries to tolerate feelings.”

For clients who practice yoga in a general setting where pushing the body and competing with others in the class is emphasized, the experience might open up access to trauma-related emotions.

Hopper takes a slower pace with these clients. “Working together in the therapy office, they have the opportunity to do a little piece and then check in. It allows us to slow down the process and provide moment-to-moment support and helps bring the body back into synchrony,” she said. “In the therapy office, we work on developing a sense of agency over self and your own body so they can create safety.”

Hopper pointed out that yoga complements, but does not replace psychological intervention. In fact, those who practice TSY at JRI are required to be concurrently undergoing counseling.

As a psychologist who uses TSY techniques, she recognizes “more and more the importance of how someone is in the body at the current moment and how it affects their emotional station. It helps me be more present and focused in a therapy session instead of focused more on the larger narrative. It’s a new way of looking at trauma.”

Together with Emerson, Hopper helps train psychologists and yoga instructors in TSY. “[Emerson’s] body-oriented training informed my work. My experience comes from a therapy perspective. I’m using yoga as a tool to access someone’s current somatic state,” she said.