Teaching Trauma-Sensitive Yoga: A Practical Guidetraumasensitiveyoga.ca/upload/620691/documents/881EDE3... · 2018-09-15 · fulfilled life. This is part of the promise of teaching

CONTENTSTitle Page

Copyright

Dedication

Foreword by Mark Stephens

Preface

Acknowledgments

1: Trauma Is a Fact of Life

The Ever Increasing Prevalenceof Trauma

Can Yoga Help?

TSY and Yoga for TraumaTreatment

2: Understanding Trauma

Trauma: What Exactly Is It?

Main Symptoms of Trauma

Degrees of Trauma

Where Trauma Happens: TheMind-Body

Understanding How TraumaHappens

Vicarious Trauma

Stages of Trauma Recovery

3: Yoga and Trauma

Patanjali’s Perspective

Koshas: Mind, Body, and More

Why Yoga Works: A PlausibleExplanation

Let’s Talk about Ganesh

What Kind of Yoga Is Right forTrauma?

4: Trauma-Sensitive Yoga

Trauma-Sensitive Yoga Criteria

A Trauma-Sensitive YogaFramework

A Trauma-Sensitive Approachto Any Yoga Pose

Pranayama: Breath Is Life

Yoga Nidra: An All-in-OnePractice

5: TSY for the General Population

Planning a Safe Offering

Language and Cueing

You as a Teacher

Other Characteristics ofTrauma-Sensitive Yoga

What Not to Do

What to Do When

An Example of a RegulationTechnique

6: TSY for the Clinical Population

The Clinical Population

TSY for Trauma: A Team-Based Approach

Connecting to Your Clients

A Logical TreatmentProgression

Forming and Working inGroups

Building Commitment: Keeping

Them Coming

What to Do When

Making It Happen

7: Choosing a TSY Offering

Degrees of Trauma-SensitiveYoga

Trauma-Sensitive PublicOffering: Yoga Focus

Trauma-Sensitive PublicOffering: Trauma Focus

Public Offering: Session-Basedor Closed Group

8: Teaching Your First Class

A Two-Dimensional Approach

Suggested Yoga Sequences

Conclusion

Afterword by Margaret A. Howard,MFA, LCSW

Endnotes

Bibliography

About the Author

About North Atlantic Books

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Teaching Trauma-Sensitive Yoga

A Practical Guide

Brendon Abram

Foreword by Mark Stephens

Afterword by Margaret A. Howard,MFA, LCSW

Copyright © 2018 by Brendon Abram. All rightsreserved. No portion of this book, except for briefreview, may be reproduced, stored in a retrieval system,or transmitted in any form or by any means—electronic,mechanical, photocopying, recording, or otherwise—without the written permission of the publisher. Forinformation contact North Atlantic Books.

Published byNorth Atlantic BooksBerkeley, CaliforniaCover art © iStockphoto.com/GelatoPlusCover design by Daniel TesserInterior design by Happenstance Type-O-Rama

Printed in the United States of AmericaMEDICAL DISCLAIMER: The following information isintended for general information purposes only.Individuals should always see their health care providerbefore administering any suggestions made in this book.Any application of the material set forth in the followingpages is at the reader’s discretion and is his or her soleresponsibility.

Teaching Trauma-Sensitive Yoga: A Practical Guide issponsored and published by the Society for the Study ofNative Arts and Sciences (dba North Atlantic Books), an

educational nonprofit based in Berkeley, California, thatcollaborates with partners to develop cross-culturalperspectives, nurture holistic views of art, science, thehumanities, and healing, and seed personal and globaltransformation by publishing work on the relationship ofbody, spirit, and nature.North Atlantic Books’ publications are available throughmost bookstores. For further information, visit ourwebsite at www.northatlanticbooks.com or call 800-733-3000.Library of Congress Cataloging-in-Publication data isavailable from the publisher upon request.

North Atlantic Books is committed to the protection ofour environment. We partner with FSC-certified printersusing soy-based inks and print on recycled paperwhenever possible

http://www.northatlanticbooks.com

To Colin, the soldier who set me onthis path. You are my inspiration, you

are my motivation, and you are myhope.

IForeword by Mark

Stephensn Shakespeare’s Hamlet, Poloniusquipped that “brevity is the soul of

wit.” It can also be the heart of clarity, aswe find in this succinct yet no less deeplyinsightful and practical book fromBrendon Abram on teaching trauma-sensitive yoga.

When teaching workshops or trainingsfor yoga teachers, I often ask how manyplan to teach prenatal yoga. Typically,about 10 percent of participants raise theirhand. Then I ask how many plan to teachpublic classes, to which nearly everyonereadily responds with an affirmative hand.

My response is that everyone who teachespublic yoga classes will be a prenatalteacher, if only because pregnant studentswill be in their classes, adding that it istherefore incumbent upon all public yogateachers to have at least a basic knowledgeof common conditions of pregnantstudents along with at least someunderstanding of relevant indications,contraindications, risks, and modificationsby trimester and in postpartumreintegration.

It is no different with trauma. Trauma isan issue for at least one-third of people inmodern society, and many students cometo yoga classes with deeply internalizedtrauma. Yet trauma is rarely or only veryobliquely addressed even among most ofthe very best yoga teacher trainingprograms.

A couple years after I completed myfirst teacher training in 1995, I started aprogram to bring yoga into Los AngelesCounty juvenile institutions. While I had acomfortable basic knowledge of generalprinciples, methods, and techniques forteaching postural yoga, I was utterlyunprepared for what I experienced inteaching yoga to incarcerated youth at theheight of the LA gang wars, this despitemany years of working with gangs on thestreets and in the same institutions. Myyoung students were both victims andvictimizers, most with emotional issuesrooted in early childhood abuse andabandonment and nearly all with a historyof substance abuse (indeed, many wereborn addicted to cocaine). It was only withthe guidance and support of dedicatedclinical staff that I started to learn how to

adapt yoga practices, including asana,pranayama, and meditation, to make yogaaccessible and meaningful to thesestudents. As we developed this project intoYoga Inside Foundation and expanded intohundreds of trauma-intensive settingsacross North America, we learned alongthe way that with each new setting andcondition we had far more to learn.

Fortunately, we now have theconsidered and distilled experience,knowledge, and wisdom of Abram to offerpractical guidance to those stepping intothe intensity of serving students whoseevery breath, thought, and movement isaffected by traumatic experience, includingan increasing number with PTSD.

Abram seems to come to his work inwriting about teaching trauma-sensitiveyoga with a humble and light-hearted

sense of being, but his insights arise fromdeep personal experience of trauma and itsemotional, interpersonal, and socialconsequences. Abram is a thirty-yearveteran of the Canadian Forces who servedwith the United Nations in El Salvador andNATO in Bosnia, places where the terrorsof war and violent social conflict offeredup daily traumatic events in the lives of thelocal population as well as those likeAbram sent there to protect them.

Abram grew up with the difficulties ofan alcoholic father and a mom whostruggled with mental illness. He toobecame an alcoholic and before findingAlcoholics Anonymous was well on hisway to perpetuating the cycle of sufferingin his own family. With sobriety came anew lease on life, one informed by apersonal understanding of what it is to

suffer, and struggle, and then suffer andstruggle some more. From this personalexperience, he also became sensitive to thesuffering of others, and he discoveredyoga.

In the latter years of Abram’s militarycareer, when soldiers started coming backfrom Afghanistan, he saw the horribleeffects that PTSD was having on them andtheir families. It struck deep to the bottomof his heart. There was one young soldierin particular, Colin—to whom hededicated this book—in whom he tookspecial interest. He taught Abram a reallyimportant lesson: that we can never “fix”another person, but only (and inestimablyimportantly) show them the tools and helpset the conditions for them to do their ownwork. Embracing this idea, and now into apersonal yoga practice, Brendon expanded

his knowledge of trauma and trauma-sensitive yoga through workshops withDavid Emerson and Daniel Libby as wellas through collaboration with a student inone of his yoga classes who invited him towork with her to incorporate mindfulnessinto her clinical practice.

Through his devotion to this work,Brendon started teaching workshops ontrauma-sensitive yoga, then wrote a studymanual for these workshops, leading to thetimely gift of this important book thatshould be read by every yoga teacher whocares about the overall health and well-being of his or her students.

Brendon fully appreciates that thediversity of students’ conditions andintentions invite teachers to offerappropriately individualized practices, allthe more so when one’s students are living

with trauma. Rather than prescribing a setapproach to every student, a central themeof this book is that each unique studentshould feel safe and comfortable in doingyoga, further underlining the sensibilitythat yoga teachers are more guides andfacilitators than authoritative sources oftransmission. In providing guidance in thisway, Abram gets and conveys that yogateachers are playing a potentially vital role—a therapeutic role—in helping studentsto discover the truth of their own being,and with it deeper and lasting inner sourcesof living with a sense of inner peace andempowerment in their lives.

“Therapy” and “therapeutic” havestrong medical connotations, causing muchconcern among yoga teacher and yogatherapy organizations when one mentionsyoga and therapy together. To wit, the

etymological root of therapy, the Greektherapeuin, means “minister to, treatmedically,” but we also find the Greekterm therapeia, “healing,” which does notnecessarily involve a medical degree orlicense, especially as healing has the addedmeaning “to make whole.” We heal inmany ways, potentially and hopefullyrestoring the wholeness of being that ispresent in our DNA and all too oftendisturbed by experiences on the path oflife.

We also make choices in healing thatcan be distinguished from those that mightbe fully curative or medical in nature. Aconcept coined by TiramulaiKrishnamacharya and popularized by hisson T.K.V. Desikachar, yoga chikitsa,means “yoga therapy,” and is said to relateto all practices of yoga that help us

cultivate wholeness in our lives. Whereverone is on the continuum, from deep traumaand suffering, to mild stress, to a sense ofwholeness and healthy connection in life,we can engage with yoga therapy to heal,accept the intrinsic beauty and inviolableworth of ourselves, and share in a morefulfilled life.

This is part of the promise of teachingtrauma-sensitive yoga. Deep bows toAbram for helping to show us the way.

—Mark Stephens, April 2018Mark Stephens is the author of four

textbooks, Teaching Yoga, YogaSequencing, Yoga Adjustments, and YogaTherapy.

APreface

s a former military officer, I haveobserved firsthand the devastating

effect that a trauma-related disorder suchas post–traumatic stress disorder (PTSD)can have on men, women, and theirfamilies. As a recovering alcoholic whogrew up the “hard way,” I have someunderstanding of the suffering that comeswith living with trauma. As a yoga teacherI have witnessed the remarkable benefitsthat the application of yogic principles andpractices can achieve when employed ineither a clinical setting or a public yogastudio. Over the last five years I haveworked to apply what I learned from theteachings of David Emerson from theTrauma Center in Boston and Daniel

Libby from the Veterans Yoga Project.Through this work, I have gainedexperience that has helped me turn theoryinto practice. It has not always been easy. Ihave made mistakes, misjudged people andsituations, had to readjust my approach, orin some cases, start all over again. Witheach mistake came a valuable lesson. Witheach lesson came a deeper conviction thatyoga can help those living with trauma.

The purpose of this book is to offer apractical guide for teaching, sharing, orpracticing trauma-sensitive yoga. In it Ihope to convey three important lessonsthat can be incorporated into any yogaoffering. First, it is the basic principles ofyoga that bring power to the practice.Breath, mindful movement, focusedawareness, and acceptance of the present-moment experience are the foundation of

any yoga offering.

Second, each person is a uniqueindividual and will interpret the applicationof these principles based on their ownworldview. There are many differentperspectives about what yoga is and how itshould be delivered. No single perspectiveis completely right for all of the people allof the time. I like to think that thousands ofyears ago, yoga started as an exploration ofself, where yogis and yoginis moved not tocreate a pose that looked a certain way butto discover an internal, sensation-basedexperience. The emphasis was on internalexperience versus external appearance. Asthe practice evolved, they found thatdifferent poses led to different experiences,each ultimately contributing to an overallsense of peace and contentment. From thisperspective, every single style of yoga or

yoga derivative has something to offer.

Third, trauma-sensitive yoga for theclinical population and trauma-sensitiveyoga for the general population are twodifferent things; however, there isdefinitely a place for trauma-sensitive yogain a studio setting. During my first twotrauma-sensitive teacher trainings, greatimportance was placed on deliveringtrauma-sensitive yoga in collaborationwith a clinical professional. In the contextof the training, that made a lot of sense.The implicit assumption that underpinnedall of our discussions was that we weretalking about using yoga in therapy for aclinical population that had diagnoseddisorders and was under medical care fortheir condition. This is a completely validperspective; however, it excludes themajority of people who may not have a

diagnosis or may not have affordableaccess to clinical care. The reality is thatmany of these people will find their way toa yoga class, and it is therefore importantthat they have an opportunity to safelypractice yoga in a studio setting when theyget there. During my time in the military, Ilearned the value of situational leadership.The concept is simple. You adjust yourstyle and approach based on the situation. Ithink we can apply the same philosophy toteaching trauma-sensitive yoga and cancreate offerings that are suitable to all,based on their respective situations.

In the beginning, this book was intendedfor yoga teachers. As time progressed andwe used it at numerous workshops, Irealized that it would be useful for anyoneinterested in helping those with trauma,whether they be mental health workers or

trauma caregivers in general. I have cometo understand that you do not need to be ayoga teacher to share trauma-sensitiveyoga. If anything, this book will challengesome yoga teachers to unlearn much ofwhat they have been taught and accept thatany movement we make, any breath wetake, can be yoga if it fosters an internalexperience to which awareness can bedirected and maintained. Taken from thisperspective, almost anyone can learn andemploy trauma-sensitive yoga. Mythoughts on trauma-sensitive yoga arebased on my interpretation of what I haveread, what I have been taught, and my owndirect experience. As a teacher, all I canoffer is my perspective. It is my hope thatyou will use it with discrimination toinform your own.

IAcknowledgments

would like to acknowledge all thosewho contributed either directly or

indirectly to this work. To Tiffany andKristof, who asked me to deliver aworkshop that became a book. To DavidEmerson and Daniel Libby, whose teachertrainings got me started, and whosewisdom is reflected throughout. ToPatricia, my trauma mentor, whose insightand guidance gave me direction, helped memaintain perspective, and kept me ontrack. To my teaching partner, Kellie,whose innate kindness, compassion, andknowledge of yoga helped inspire many ofmy ideas. Charlotte Bradley(www.yogaflavoredlife.com) for the use ofthe stick figures that illustrate the gentle

http://www.yogaflavoredlife.com

hatha and the flow sequences, andDeborah Hackett whose stick figuresillustrate the chair yoga sequence. Mychildren, Paul and Allie, who edited mywriting for a change. My wife, Leslie, whoalso edited, and who was my model forpatience, tolerance, and understanding. Aword of special thanks to the men andwomen with whom I have shared theexperience of yoga. Without a doubt I havelearned the most from you. Not only abouttrauma, but about me and about the world.

The Guest House

This being human is a guest house.Every morning a new arrival.A joy, a depression, a meanness,some momentary awareness comesAs an unexpected visitor.

Welcome and entertain them all!Even if they're a crowd of sorrows,who violently sweep your houseempty of its furniture,still treat each guest honorably.He may be clearing you outfor some new delight.The dark thought, the shame, the malice,meet them at the door laughing,and invite them in.Be grateful for whoever comes,because each has been sentas a guide from beyond.

—Jelaluddin Rumi

1Trauma Is a Fact of Life

Chitta vritti nirodha (cessation of mindturbulence)

—PATANJALI

The Ever IncreasingPrevalence of Trauma

The relatively recent recognition of PTSDhas highlighted the prevalence of traumaamong the North American population as awhole. American and Canadian militaryveterans dealing with the devastatingsymptoms and effects of PTSD havereceived international attention, which hashelped reveal that trauma is a much largerpublic health issue and has been for a verylong time. The Canadian Mental HealthAssociation estimates that 8 percent ofpeople will experience PTSD in theirlifetime.1 This figure does not, however,recognize that many people experiencelasting trauma without developing adiagnosed condition such as PTSD. A

more accurate representation of theprevalence of trauma suggests that one inthree people who come to a yoga class hasexperienced some degree of trauma duringthe course of their life.2Although traumarates seem to vary across differentsegments of society and may be differentdepending on race, age, gender, andsocioeconomic status, the bottom line isthat no group is immune.3 Whether one isrich or poor, male or female, young or old,they could find themselves living withtrauma.

It is unlikely that trauma rates willdecrease. In In an Unspoken Voice: Howthe Body Releases Trauma and RestoresGoodness, Peter Levine says that humanshave never before lived in a time wheretrauma-induced stresses are so prevalent.4If anything, until we learn to adopt

measures to deal with the stressful worldwe have created, trauma-related conditionswill become more prevalent, and the needfor interventions to counter theseconditions will be even more necessary.

Can Yoga Help?There are many different systems andstyles of yoga; almost all schools,however, hold the basic elements ofbreath, movement, and meditation asfundamental to the practice. Pioneers likeJon Kabat-Zinn have incorporated thesecore elements into programs such asmindfulness-based stress reduction(MBSR) to very effectively mitigate stress-related conditions.5 A careful review of itsfoundational principles suggests thatMBSR is essentially the application ofclassical yoga in a contemporary setting.

Increasingly, studies support thepremise that these core elements canindeed help people manage the symptomsand effects of trauma in a healthy way,

reducing dependency on drugs and othercoping mechanisms that often havenegative side effects. What is reallysignificant, though, is that these studies arebeing recognized and afforded greatercredibility through publication inmainstream journals. For example, theJournal of the American MedicineAssociation recently published an articlethat clearly demonstrates the value andbenefits of mindfulness practices.6Andthere are many others. Many of the sourcescited in this book address research of thistype. There is now sufficient credibleliterature to support the contention that the“right” kind of yoga delivered under theright circumstances can be a very effectivecomplement to other modalities ofaddressing trauma. As Desikacharobserves in The Heart of Yoga, “Anybody

who wants to, can practice yoga. Anybodycan breathe; therefore, anybody canpractice yoga. But no one can practiceevery kind of yoga. It has to be the rightyoga for the person.”7

With a little reflection, it is notsurprising that yogic principles are soeffective in addressing trauma. Theessence of trauma is dissociation,8disconnecting from self and others andmoving away from reality. Yoga is aboutconnection. It is self-realization, findingthe truth about what we are, who we are,and why we exist. In this respect, it is thepolar opposite of trauma. Perhaps, to moveaway from trauma, we simply need tofollow the path of yoga, step by step. Thefirst step is to become grounded andcentered in undistracted awareness of thepresent moment. The next step is to accept

what we perceive with equanimity. Finally,having perceived the truth of self, we areable to understand the ultimate truth. Weare not disconnected at all. We alwayshave been, and always will be, part of allthat is. As we will see, the most popularconception of trauma recovery alsoinvolves three steps. These are often citedas overcoming dysregulation, coming toterms with traumatic memories, andreintegration and moving on.9 The parallelsbetween the path of yoga and traumarecovery are compelling.

We shall learn that yoga’s greatest valuein addressing trauma-related conditionsmay be stabilizing state of mind throughthe regulation of emotion and mood. Whilethe trauma experience can lead to a varietyof different diagnoses, some degree ofmood dysregulation is present in most

trauma-related disorders. Very often, mooddysregulation prevents or limits theefficacy of clinical treatment of trauma-related conditions, slowing or evenpreventing healing from happening.

At its heart, yoga is about changing stateof mind. It is about moving away fromsuffering. Patanjali’s definition of yoga is“chitta vritti nirodha,” Sanskrit for“cessation of mind turbulence.”10 Whileyoga is seldom prescribed to directly treatthe trauma-related disorder, it is ofimmense value in regulating state of mindand setting favorable conditions forclinical treatment to take place. Yoga canhelp diminish the dysregulation that causestrauma-related suffering.

TSY and Yoga for TraumaTreatment

An important distinction must be madebetween trauma-sensitive yoga (TSY)taught in the studio for the generalpopulation, and yoga applied in a clinicalsetting to a clinical population.11 Althoughthe concepts and principles that govern theyoga may be the same, the context andapplication are markedly different. How isthis so? Why is this distinction important?

First and foremost, in North America,the words treatment and therapy generallymean care given to a patient for an illnessor injury in a medical or clinical setting.The condition is diagnosed and thetreatment is prescribed by an appropriately

licensed practitioner. In North America,yoga is not legally recognized as treatmentand, for now, is not prescribed to remedy adiagnosed disorder. It is, however, widelyrecognized as having therapeutic value toaddress conditions where high levels ofmood dysregulation are present among aclinical population. Therefore, under theright circumstances, yoga may beemployed as a clinical intervention.12Having said this, it is reasonable toconclude that, from a legal and ethicalperspective, when yoga is used as aclinical intervention, its application shouldbe supervised by a professional who islicensed to treat the condition in question.

Notwithstanding, there is still a place forTSY in yoga studios. In fact, it has beenargued that trauma training is essential foryoga teachers.13 Yoga has the capacity to

reach so deeply into our psyche that allyoga teachers need to have someunderstanding of the nature of trauma andits symptoms. They should be able to teachyoga that respects the fact that for everyperson diagnosed with PTSD, another twoor three may be living with many of theeffects and symptoms that can result fromtrauma. Too often these people do not haveeasy access to affordable clinical care. Insome cases their general practitionersuggests they try yoga as an alternative. Isometimes wonder how often these peoplecome to a class that is not trauma sensitiveand have a negative experience. Maybethey were directed to adopt a pose that feltunsafe, or words were used that triggereddysregulation. For these people, “all yoga”is defined by that one experience wherelittle or no trauma sensitivity was shown.

How would their perception have differedif they were offered a “safer” kind ofyoga?

What is the distinction between TSY asa studio offering and yoga as a clinicalintervention? If a student comes to yourclass because their doctor told them itcould help their trauma, are you crossingthe line if you teach them? As we come toknow our students better, and as ournatural compassion motivates our actions,the line can get a bit blurry. Maybe it isuseful to think of the difference in terms ofintent and context. My perspective is thatin a studio, TSY can be offered in a styleand under conditions intended to minimizeor eliminate the risk of exacerbatingexisting trauma while fostering a peacefulstate of mind. In a clinical setting, yoga isoffered with the intent of improving the

client’s ability to independently andconsistently regulate mood. This in turncan support the clinician's overalltreatment plan to address the diagnosedtrauma condition. As yoga teachers, withproper education and training, we arequalified to engage in the former; but, ifwe are working with a clinical population,we should do so within the boundaries ofthe clinical setting.

Yoga has an amazing ability totranscend cultural and societal boundaries.In the fullness of time, the value of yogawill prove itself in the domain of Westernmedicine. In the meantime, there is roomto make it work within our society’s legal,medical, and ethical frameworks. And atthe end of the day, making it work for thepeople who need it should be our primaryconcern.

Chapter Summary

Trauma is prevalent and knows noboundaries. While only 8 percent ofpeople who have lived through atraumatic experience develop atrauma disorder such as PTSD, asmuch as 30 percent of thepopulation experiences and livesthrough some degree of trauma-related symptoms.

TSY can be delivered to two maingroups. The clinical population,with a diagnosed condition and whoare under the care of a medical orclinical professional; and thegeneral population, who are livingthrough a trauma experience that

has not become, or has not beendiagnosed as, a disorder. PracticingTSY in a clinical setting is differentthan delivering TSY in a studiosetting.

T

2Understanding Trauma

Trauma affects the entire humanorganism body, mind and brain.

—BESSEL VAN DER KOLK

he field of neuroscience is movingforward at a rapid rate. Almost every

day we know more about the brain andbody, and how they interact to form mind.Coupled with continuing behavioralscience research, these new insights afforda “better than before” understanding oftrauma. Understanding the nature oftrauma is important if you wish to teachTSY or if you act as a caregiver to

someone who is living with a trauma-related condition. Remember, though: asyoga teachers, our role is not to becometrauma experts. For what we will be doing,it is more appropriate to learn enoughabout trauma to empathize with those wholive with it, and to clearly convey to themthe important concepts that will empowerthem to heal. This chapter defines trauma,how it happens, its effects and symptoms,and the conditions necessary to recoverfrom the trauma experience.

Trauma: What Exactly Is It?The term psychological trauma has beenapplied in so many contexts by so manypeople that it has lost some of its meaning.Often, trauma is used to refer to both theevents that produce distress and to thedistress itself. Technically, trauma refersonly to the event, not the reaction.1 Thereis significant disagreement betweenexperts regarding what is and what is nottraumatic.

We often hear the term trauma usedsynonymously with various disorders,including PTSD, complex PTSD, disordersof extreme stress not otherwise specified(DESNOS), complex trauma, anddevelopmental trauma disorder (DTD).From the practical perspective of a TSY

practitioner, the debates regardingdiagnostic definitions are largelyacademic. Suffice it to say that an event istraumatic if it is extremely upsetting and atleast temporarily overwhelms theindividual’s internal resources.2 Thisbroader definition is useful since peoplewho experience major threats topsychological integrity can suffer as muchas those traumatized by physical injury orlife threatening events. They can alsorespond equally well to trauma-focusedinterventions. So, while trauma may beassociated with numerous diagnosabledisorders, trauma itself is not a disorder.Consequently, it can be legitimately andcredibly addressed outside of a formaldiagnosis by evidence-based clinicalinterventions, such as TSY.3

There are few human conditions that are

so diversely described as stress, crisis, andtrauma.4 Before moving on to a closer lookat trauma, it is relevant to understand it incomparison to the other most commonlycited forms of distress: stress and crisis.All of these conditions have the potentialto dysregulate the mind-body away fromhomeostasis, a state of physiological,cognitive, and emotional balance.

Stress is a response to an environmentalsituation, an environmental challenge, orthe relationship between environmentaldemands and the ability to meet thosedemands. It is a “particular relationshipbetween the person and the environmentthat is appraised as taxing or exceeding hisor her resources and endangering well-being.”5 Crucial to this definition is theappraisal and coping resources of theindividual, as stress represents the

individual’s subjective perceptions andinterpretations more than an objectiveexistence of a negative event or situation.Thus, the cognitive, behavioral, oremotional outcome of perceived stress mayrun along a continuum of its own, rangingfrom none to somewhat or mild toextremely severe.6

Some individuals will move along thecontinuum such that an event they perceiveas stress will develop into a perception oftrauma. This has been referred to as asudden intense surge of anxiety, secondaryto some external event, that exceeds thesubject’s ability to cope and to defend.Hence, the perceived trauma developswhen the individual understands, throughthoughts or feelings, that a physical orpsychological injury is present in his or herworldview.7

A person in a crisis state hasexperienced a threatening or traumaticevent, is in a vulnerable state, and hasfailed to cope and lessen the stress ortrauma through customary copingstrategies, and thus enters into a state ofdisequilibrium. For crisis to be present, theindividual’s trauma perception mustprogress to a place of understoodinstability and disorganization due to anunresolved acute or chronic perceivedstress.8

When a person is faced with apotentially threatening situation, theirresponse could be initiated anywhere alongthe spectrum between homeostasis andcrisis. For example, the person may startoff in a state of relative homeostasis. Theevent happens. It could lead to a subjectiveexperience of stress, trauma, or crisis, or

the person could remain in homeostasis.There could be some degree ofdysregulation followed by a return tohomeostasis, or the development ofsymptoms that result from the state ofdistress the mind-body is enduring. Theseverity and nature of the symptoms wouldinform the diagnosis of a disorder thatcould range from general anxiety ordepression to PTSD, complex PTSD, orothers. In the event of trauma, theindividual becomes trapped in a cyclewhere they continuously relive theexperience and associated dysregulation.In its efforts to return to homeostasis, themind-body may create and endure evenmore stress and develop more severe andmore numerous psychological,physiological, and physical symptoms.

Two notable points emerge from the

preceding discussion. Trauma is a stress-related experience, and it is important todistinguish between an event and thesubject’s experience of the event. Thefollowing is a relevant definition of traumathat distinguishes between the event, thesubsequent distress, and any disorder thatmay result:

Psychological trauma is the uniqueindividual experience of an event, orenduring conditions,9 in which theindividual experiences a threat to life,bodily integrity, or sanity.10 The threatis sudden or unexpected, and may bepresent over prolonged periods, anindividual’s ability to integrate his orher emotional experience iscompromised. The individual may feelemotionally, cognitively, andphysically overwhelmed, and the

individual is unable to exercise control,or is incapable of taking effectiveaction to resolve the event.11

This definition recognizes that trauma ismore than just an event; it is an experience.It allows for the fact that the event neednot be life-threatening, that trauma canalso arise from events that are life-altering.It provides for the possibility that while theevent is over, the trauma experience, andthe reaction to it, may continue. Finally, itallows the possibility that while the traumaexperience may cause distress, this distressdoes not always result in a diagnosablemedical disorder. Let us look at each ofthese defining points in turn.

Trauma is subjective. To think oftrauma only in terms of the event itself,and that one thing is more traumatic than

another, is an objective, but not anaccurate, interpretation. Trauma has asubjective component, and it is thissubjective experience of the event thatcreates the trauma experience in theindividual. The degree of danger in thesituation is not as relevant as howdangerous the subject believes it to be.12What is trauma-inducing for one personmay have no discernible effect on anotherand vice versa.

The experience can be life-threateningor life-altering. Normally, when weenvision traumatic events, we think ofpowerful one-time incidents like accidents,natural disasters, crimes, surgeries, deaths,and other violent events, or responses tochronic or repetitive experiences such aschild abuse, neglect, combat, urbanviolence, concentration camps, battering

relationships, and enduring deprivation.13Since trauma is a subjective experience,events don’t necessarily need to be life-threatening to create a trauma experience.For some, life-altering events such as thedivorce of one’s parents, or the loss of aloved one, could very well contribute tothe creation of a trauma experience. Otherexamples of life-altering, trauma-inducingevents could include living with diseasessuch as cancer.14

The experience continues when theevent is over. Trauma is not just an eventthat took place sometime in the past; it isalso the imprint left by that experience onthe mind, brain, and body. This imprint hasongoing consequences.15 For the personliving with trauma, the trauma experienceis always present. Sometimes it is justbelow the surface, just around the next

corner, but it is always there. It has a directand constant effect on the way that personthinks, on the way they behave, and onhow they react to their environment.16 Inessence, the trauma experience changes anindividual’s state of mind. This state ofmind is often reflected by psychologicaland physiological symptoms.

In summary, trauma is an individualexperience defined by the subjectiveperception of the person who is livingthrough it. It is precipitated by life-threatening or life-altering events. Itoverwhelms any or all of the individual’semotional, cognitive, and physicalresources. It is characterized by a loss ofcontrol over, or inability to resolve, theevent. Even when the event is over, thetrauma experience can continue, producingan altered state of mind that negatively

affects a person’s thinking, behavior, andpsychological and physiological well-being. While trauma itself is not a medicaldisorder, the resultant symptoms may begrouped together and diagnosed as one ofthe many trauma- and stress-relateddisorders in the Diagnostic and StatisticalManual of Mental Disorders.17

Main Symptoms of TraumaThe four main symptom groups of traumaare: negative alterations in cognitions andmood, avoidance, intrusion, and arousaland reactivity.18

Negative alterations in cognitions andmood refer to symptoms that includepersistent and distorted blame of self orothers; a persistent negative emotionalstate; perceptions of ineffectiveness orbeing permanently damaged, feelings ofguilt, responsibility, and shame; the sensethat nobody understands; and efforts tominimize.19

Perhaps the most troubling of all traumasymptoms is avoidance, because it oftenprevents trauma sufferers from committing

to heal. A 2010 report on 49,425 veteranswith PTSD from the Iraq and Afghanistanwars who sought care from VeteransAffairs showed that fewer than one in tenactually completed the recommendedtreatment.20

Often dramatic, and intenselyfrightening to the trauma sufferer,intrusion, flashbacks, and reliving are insome ways worse than the trauma itself. Atraumatic event has a beginning and anend. But for people who experiencetrauma, a flashback can occur at any time,whether they are awake or asleep. There isno way of knowing when it’s going tohappen again or how long it will last.21

Hyperarousal and hyperreactivity is astate of increased psychological andphysiological tension marked by effects

such as reduced pain tolerance, anxiety,exaggeration of startle responses,insomnia, fatigue, and accentuation ofpersonality traits. It has also beendescribed as a chronic state of fight orflight.22 Alterations in arousal andreactivity, including reckless or destructivebehavior, may also be present.

Degrees of TraumaNot only is trauma a subjective experience,it affects different people to differentdegrees. It can be acute or chronic. It canleave people functionally symptomatic, orseverely symptomatic. Acute trauma isrecognized as trauma caused by a singletraumatic event that causes extremeemotional or physical stress.23 Chronictrauma describes trauma that is the resultof more than a single event. It happenswhen an individual experiences multipletraumatic instances, such as reoccurringphysical or sexual abuse, neglect, orcombat experience, or a buildup ofmultiple traumatic experiences throughoutone’s life.24

Most functionally symptomatic people

are capable of managing in the externalworld. They may be employed and mayparticipate in what they perceive to be safesocial situations; however, for many, largegroups in unfamiliar settings can be veryunsettling. They benefit from stabilizationtype practices and respond well to breath,movement, and in some cases, meditation.There is some level of avoidance, but forthe most part they have come to a placewhere they have a good degree of self-awareness and are motivated to advancetheir recovery.

Whereas functionally symptomaticpeople can move through the world, it is achallenge for severely symptomatic peopleto leave the house, let alone go to a publicplace where they will encounter largenumbers of strangers. It is very unlikelythat they would ever show up at a public

yoga class. In a clinical setting, theyrequire coaching by the clinician to trynew things, and it takes them a long timeto develop a relationship of trust. They arevery easily triggered. Avoidance is often aprimary symptom, and they seem unable topractice and tolerate self-awareness. Thesepeople tend to suffer from complex andchronic trauma. Most have high levels ofdissociation with low insight.

Where Trauma Happens:The Mind-Body

From a yoga perspective, self-realizationand the accompanying sentiments of peaceand contentment are possible when there isno separation between mind and body. Infact, a popular definition of yoga refers tothe union of mind, body, and spirit.Neuroscience also describes a model thatrecognizes the integration of mind andbody, a model that very clearly suggeststhat trauma disrupts the continuum. Itsevers the important connections betweenmind and body that permit them tofunction as an integrated whole.

While we don’t need to beneuroscientists to practice TSY, a

basic understanding of the functionand physiology of mind and body andhow it is affected by trauma willfacilitate dialogue with any clinicianswe may work with. It can also bringsome measure of reassurance to thoseexperiencing trauma to understandthat there is a tangible explanation forwhat is happening to them.

The brain is the center of traumaresponse. The primary job of thebrain is to ensure our survival.25Three basic parts of the brain worktogether to perform this function.These are the primitive or reptilianbrain, the limbic system or emotionalbrain, and the cortex or rational brain.It would be oversimplifying mattersto view these parts as completelyseparate and distinct, as they are

interconnected by numerous differentpathways.

The primitive brain is located in thebrain stem just above where the spinalcord enters the skull. It is responsiblefor all of our basic functions: eating,sleeping, waking, crying, breathing,feeling temperature, hunger, wetness,pain, and ridding the body of toxins.From a trauma perspective, thefunction of this primitive system issurvival. It is responsible for theflight, fight, or freeze response.26

The emotional brain, or limbicsystem, is the seat of emotions, themonitor of danger, the judge of whatis pleasant or scary, and the arbiter ofwhat is or is not important forsurvival. Its main purpose is

attachment or social connection. Itplays a central role in managing oursocial interactions and can recordmemories of behaviors that haveproduced agreeable and disagreeableexperiences.27

The rational brain comprises twohemispheres that govern language,abstract thought, imagination,consciousness, and the ability tolearn. This part of the brain makeschoice possible and is the seat ofempathy. It plays a critical role inregulating the trauma response.28 Itgives humans, as conscious beings, anawareness of self.

The autonomic nervous systemcontrols involuntary body functionsthat take place in the internal organs

and some muscles and glands. Itregulates functions such as heartbeat,metabolism, body temperature,respiration, digestion, and urination.Its two main parts are the sympatheticnervous system (SNS) and theparasympathetic nervous system(PNS). Its main responsibility is tokeep all systems balanced andworking together. This state ofbalance is often referred to ashomeostasis or coherence, meaningall parts are working together tocreate a unified whole.

The sympathetic nervous system isresponsible for the fight or flightresponse to a perceived threat. Itprepares the body for action byaccelerating heartbeat, raising bloodpressure, increasing adrenalin

production, and a number of otherphysiological changes.

The parasympathetic nervous systemis responsible for what is sometimesknown as the rest and digest response.It brings the body back towardhomeostasis29 by slowing heart rateand reactivating the digestive processand other glandular activity. It alsoactivates the freeze response.

Understanding How TraumaHappens

This section begins with a summary ofimportant concepts, provides a simpleexplanation for how trauma happens, andcomments on the physiological andpsychological impact of trauma.

Important ConceptsFight or flight or freeze or fawn. A fightresponse is triggered when a personsuddenly responds aggressively tosomething threatening. A flight response istriggered when a person responds to aperceived threat by fleeing. A freezeresponse is triggered when a person,realizing resistance is futile, gives up,numbs out into dissociation, or collapses

as if accepting the inevitability of beinghurt. A fawn response is triggered when aperson responds to threat by trying to bepleasing or helpful in order to appease andforestall an attacker.30

Polyvagal theory. Developed byStephen Porges, this theory recognizes theimportance of social connection in how werespond to perceived threats. It centers onthe function of the vagus nerve, whichserves the autonomic nervous system andis instrumental in our ability to self-regulate. The vagus nerve has two distinctparts. The first is connected to ourprimitive brain structure and oversees ourprimary defensive survival strategies. Itdrives the immobilization or freezeresponse. The second part of the nerve is alimbic-based (emotional) system thatmodulates sympathetic arousal through

social engagement. It alerts us to safetythrough connection. It supports the abilityto communicate via eye contact, facialexpressions, tone of voice, and through theability to listen. It can also dampenreactivity in the sympathetic nervoussystem by calming the heart. As theheartbeat slows, we feel calmer andbecome more available for connection.31>Whenever we feel threatened, we attemptto employ social engagement to establishsafety. If it is not possible, we revert to themore primitive way to survive, that beingfight or flight or freeze32 or fawn.Polyvagal theory is important because itunderlines the importance of socialinteraction when addressing trauma. Manypeople living through trauma areuncomfortable in social situations and willoften isolate. Part of dealing with the

trauma condition involves finding ways forthe person to once again feel safetythrough social engagement.

Attachment theory. Attachment is adeep and enduring emotional bond thatconnects one person to another across timeand space. Attachment is characterized byspecific behaviors in children, such asseeking proximity with the attachmentfigure when upset or threatened.Attachment behavior in adults toward thechild includes responding sensitively andappropriately to the child’s needs.33 Froma trauma perspective, those who did nothave this basic need met during childhoodmay be more susceptible to trauma later inlife.

A Healthy Response to a PerceivedThreat

Normally the three parts of our brain worktogether to create a balanced response to aperceived threat. As we have learned, atrauma event can overwhelm the mind-body on the physical, emotional, andcognitive levels. The reptilian brain reactsto threats to physical safety, and the limbicsystem reacts to emotional dangers. Therole of the rational brain is to govern ormodulate the reaction to produce a healthyresponse to a perceived threat.

Sensory information is received by theemotional brain. It is screened and thencollated to form a message. The message issent to two destinations. The first is theamygdala in the primitive brain, and thesecond is the rational brain. The amygdalareceives the message first and processes itmuch more quickly than the rational brain.It compares the message to stored memory

and then automatically initiates apreplanned fight, flight, or freeze response.In the meantime, the rational brain hasbeen processing the same message withmore discrimination. If it perceives thatthere is no real danger, it interrupts theautomatic response of the primitive brain.The parasympathetic nervous system isactivated and the mind-body returns tohomeostasis. If the rational brain perceivesdanger but is able to regulate the response,the threat is perceived as over and themind-body returns to normal.

Trauma Happens When …Trauma happens when the mind-body isoverwhelmed and a normal response to aperceived threat cannot be completed.There does not seem to be an in-depthunderstanding of why or exactly how it

happens, but we are beginning tounderstand what happens within the mind-body to create trauma. The followingsimplified summary of the traumamechanism has been adapted from Van derKolk’s The Body Keeps the Score.

Trauma happens when the amygdalagoes into overdrive. Its response toperceived danger is so strong, or sopersistent, that it overwhelms the rationalbrain. Or the filtering from the rationalbrain is so slow or weak it cannot interruptthe automatic response of the emotionaland primitive brain. Part of the rationalbrain shuts down. Context and meaningdisappear, and the brain loses its capacityto relate to the past or future. Normalmemory processing disintegrates and timefreezes, trapping the individual in anexperience that seems to have no end. The

emotional brain stops acting as a sensoryfilter, and sensory overload is experienced.Even after the event is over, there is nocoherence. New inputs are experienced asisolated sensory inputs accompanied byintense emotion. The mind-body movesfrom homeostasis or coherence to a state ofemotional, rational, andpsychophysiological imbalance. Ratherthan working together to maintain aunified whole, regulatory systems work atcross purposes. This impacts the state ofmind in a number of ways. These impactseventually lead to the development oftrauma symptoms.

Physiological Impact of TraumaThe effects of being in a state of trauma fora short or a long time are many and varied.The following examples provide a good

idea of what these effects are and whatphysiological mechanisms are responsiblefor them.

Increased tendency to dysregulate.Living in a trauma state increases theindividual’s tendency to dysregulate. Theirthreshold to stress has diminished, andtheir nervous system is operating at a levelclose to their tolerance limits. The mind-body is out of balance, and seeminglyneutral inputs can lead to dysregulation.

Decreased cognitive ability. Inresponse to external danger, emotionalprocessing shifts from the frontal cortex,responsible for focused attention,motivation, and monitoring of goals, to theposterior cortex, which is responsible forvigilance. Intense emotion and stress-related illness are often accompanied bycognitive complaints such as impaired

memory, diminished concentration, anddifficulty thinking coherently.34

Physical illness and injury. In chronicstates of high autonomic arousal, elevatedlevels of cortisol can impair the immunesystem, contribute to ulcer formation, andcause damage to bodily tissues in theviscera and cardiovascular system. Highemotional arousal can also trigger physicalsymptoms of anxiety and panic, such asmuscle tension, heart palpitations,increased blood pressure, and difficultybreathing. In turn, the autonomicdysregulation of the lungs and intestinalfunction may play a role in conditions suchas asthma and irritable bowel syndrome.35

Impaired communication. Broca’sarea is the part of the brain responsible forcommunication. Without a functioning

Broca’s area, we cannot put our thoughtsand feelings into words. Research suggeststhat Broca’s area goes offline whenflashbacks take place.36

Impaired interoception. Interoceptionis an attentional capacity that centers onour ability to feel the activity of ourinterior self, that is, the activity containedwithin our skin. There is evidence tosuggest that parts of the brain associatedwith our ability to interocept are deeplycompromised by trauma.37

Psychological Impact of TraumaAs we have seen from our discussion onthe symptoms and degrees of trauma, thepsychological impact of this condition isprofound. Looking ahead to the nextsection, where we will be introduced toJudith Herman’s three stages of trauma

recovery, it is useful to consider thepsychological effects of trauma under threebroad categories.

Feeling unsafe. The person isimmobilized by fear, feels trapped, feelsthat choice has been removed and that thesituation has no end.

Resisting the trauma state. The personexperiences anger and aggression, maydevelop substance addictions, could beprone to behavioral addictions, engages inself-harming behaviors, has difficultyregulating emotions and impulse, and mayreenact abusive patterns in currentrelationships.

Feeling isolated. The personexperiences emotional numbing, episodesof dissociation, feels powerless,experiences shame and guilt, and distrusts

others.

Vicarious TraumaTrauma is contagious. As noted by JudithHerman, “In their role as ‘witnesses’ todisaster or atrocity, therapists are oftenemotionally overwhelmed and mayexperience, to some degree, the sameterror, rage, and despair as the patient. Thisphenomenon is known as vicarioustraumatization.”38

Not only therapists are susceptible tovicarious trauma. It is the negative effectsof caring about and caring for others. It isthe cumulative transformation that resultsfrom empathic engagement with anyoneexperiencing trauma.39 Anyone in the roleof caregiver could become traumatized.Consequently, they should have a soundunderstanding of vicarious trauma and

self-care strategies, and should be able torecognize risk factors and indicators.

Vicarious trauma risk factors.Possible factors that may contribute to theonset of vicarious trauma can be groupedto include aspects of the work situation,aspects of the helper, and socioculturalcontext.40

Aspects of the work situation. Thesemay include relational dynamics betweencaregiver and client, exposure to horrificexperiences that those living throughtrauma disclose and discuss, interactionbetween stories on the one hand and theconfidentiality demands of the work on theother, and the overall amount of traumawork or exposure.

Aspects of the caregiver. These mayinclude: personal history, coping style,

current life stressors, and attachment style.

Sociocultural context. These mayinclude social realities such as racism,sexism, poverty, and injustice, which areoften elements of trauma, clients’traumatic experiences, and recoveryenvironments.

Vicarious trauma indicators. Expertsin the field stress the importance ofmonitoring yourself for signs that you maybe experiencing vicarious traumatization.Potential indicators include: emotionalnumbing, social withdrawal, work-relatednightmares, feelings of despair andhopelessness, loss of a sense of spirituality,developing a more negative view of theworld, a reduced sense of respect for yourclients, loss of enjoyment of sexualactivity, no time or energy for yourself,feeling that you can’t discuss work with

family or friends, a sense of disconnectionfrom your loved ones, an increased senseof danger, an increased fear for the safetyof children or loved ones, a sense ofcynicism or pessimism, increased illness orfatigue, greater problems with boundaries,difficulties making decisions, reducedproductivity, reduced motivation, loweredsense of competence, and difficultiestrusting others.41

Vicarious trauma self-care. Self-carebegins with self-awareness. Caregiversneed to remain aware of the presentmoment and the fact that they are aresponsible party in a trauma relationship.Accepting the inevitably of some degree ofvicarious trauma can be helpful, as canaccepting personal and professionallimitations. Appropriate boundarymanagement is important and includes

remembering your role, treating the personliving through trauma with respect, andseparating your role as a caregiver fromother aspects of your life. At the sametime, when we are acting as caregiver, it isessential to participate authentically whilekeeping the welfare and needs of theindividual with trauma in focus.

Caregivers must listen with respect andan open mind and heart, and engageempathically while respecting boundaries.This means letting the traumatized personknow through words and actions that wecare deeply about the harm they haveexperienced and their struggle to recover.42In addition to the self-care ideas providedabove, caregivers are advised to considerthe importance of maintaining a strongbase of social support, to accessprofessional consultation when

appropriate, and to engage in activities thatpromote spiritual renewal.43 It is especiallyimportant to remember that personal efforttoward self-care is just as important tothose they are caring for as it is tothemselves.

Stages of Trauma RecoveryRecovery from trauma begins the momentthe traumatic event ends. The humanorganism’s natural response to any injuryis to heal itself. That response beginsalmost immediately after the injury issustained. In the case of trauma, thisrecovery can stall. The main role of traumatherapy is to help the traumatizedindividual restart the recovery process bysetting the conditions for healing to takeplace. Setting the conditions involveshelping them find perspective,empowering them with concepts and toolsthey can use to advance their recovery, andhelping them foster the attitude andcommitment to do so.

There are several different models that

break the process of healing from traumainto stages. Some have three stages, somehave five, some have more. The modelpresented below is an adaptation from theseminal work of Judith Herman.44

Stage 1: Safety and Stabilization:Overcoming Dysregulation

Stage 1 involves understanding what ishappening and finding safety and stability.

Understand. Individuals are educatedto comprehend the effects of trauma and torecognize its common symptoms. Theybecome familiar with and understand themeaning of overwhelming bodysensations, intrusive emotions, anddistorted thought patterns.

Find safety. Individuals establish asense of bodily safety and are able to

abstain from self-injury and establish asafe environment. This could include asecure living situation, nonabusiverelationships, regular income, and otheradequate supports.

Find stability. Individuals findemotional stability. They have the abilityto calm the body, regulate impulses, self-soothe, and manage post-traumaticsymptoms triggered by mundane events.The goal of this stage is to create a safeand stable life in the here-and-now. Thissets the conditions to facilitate the saferemembrance of the trauma withoutreliving it.

Yoga is particularly helpful during thisstage, as it can teach individuals the self-regulation skills they need to find safetyand stability in the present moment.

Stage 2: Coming to Terms withTraumatic Memories

The focus is to overcome the fear oftraumatic memories so they can beintegrated. The individual comes to acceptthat they may not be the same person as aresult of the trauma. Effort is made toensure individuals don’t become “stuck” inavoidance or overwhelmed by memoriesand flashbacks. Since remembering is notnecessarily recovering, the goal is to cometo terms with the traumatic past.

This stage is primarily the domain ofclinical therapy, however. An integral partof the yoga practice is acceptance.Fostering the capacity for acceptance isessential in coming to terms with thetraumatic memory.

Stage 3: Reconnection, Integration,and Moving On

In this stage, work begins on decreasingshame and alienation, developing a greatercapacity for healthy attachment, and takingup personal and professional goals thatreflect post-traumatic meaning-making.Overcoming fears of normal life, healthychallenge, change, and intimacy becomethe focus. As life becomes reconsolidatedaround a healthy present and a healed self,the trauma feels farther away. It becomespart of an integrated understanding of selfand no longer a daily focus.

Once again, yoga can assist theindividual during this stage of recovery byproviding a safe venue to practiceconnecting to the external world.

Trauma Treatment: The MiddlePath

From the days of Freud, cognitive basedapproaches, or “talk therapy” haverepresented the main approach to dealingwith psychological illness. For a time,medicine seemed to have drawn a line andfocused all efforts to resolve psychologicalconditions such as trauma by working“above the neck.” Fortunately thisparadigm is shifting. There is compellingevidence that traumatic memory is storedin the emotional brain and can therefore beaccessed through the body.45

Consequently, traditional cognitiveapproaches that aim to access traumamemories through the rational brain maynot always be effective because the traumamemory may not be there. To complicate

matters, the connection between therational and emotional brain may very wellbe impaired. As a result, the concept ofemploying somatic-based therapies toaccess the emotional brain through themedium of the body is becoming moreaccepted. This approach forms the heart ofBessel van der Kolk’s message in TheBody Keeps the Score and is the centralthrust of David Emerson’s Trauma-Sensitive Yoga in Therapy.

Accepting that it is possible to accesstrauma through the body validates the useof somatic-based approaches in traumatreatment. In light of this, the implicationsof using yoga as clinical intervention toaddress trauma appear even more striking,since yoga permits trauma to besimultaneously approached from the topdown and the bottom up. This approach

may provide a more comprehensive andholistic strategy for addressing trauma thaneither stand-alone cognitive or somaticbased modalities.

Chapter Summary

Trauma is a subjective experienceprecipitated by life-threatening orlife-altering events. It overwhelmsthe individual and is characterizedby a loss of control. Even when theevent is over, the trauma experiencecan continue, producing an alteredstate of mind that negatively affectsa person’s thinking, behavior, andpsychological and physiologicalwell-being.

A trauma condition develops whenthe mind-body is unable to return toa normal range of nervous systemregulation. Trauma can be acute orchronic. The four main symptoms

of a trauma condition are negativealterations in cognitions and mood,avoidance, reexperiencing, andarousal and reactivity. People withtrauma may be functionallysymptomatic, or severelysymptomatic.

The three stages of trauma recoveryare safety and stabilization, comingto terms with traumatic memories,and reconnection and integration.Trauma memories may be stored inthe limbic system, which, in thetraumatized brain, may not beaccessible through the rationalbrain. This validates the conceptthat a “bottom-up” somaticapproach may be a valid strategyfor addressing trauma conditions.

T

3Yoga and Trauma

The intellectual and practical activityencompassing the systematic study ofthe structure and behavior of thephysical and natural world throughobservation and experiment.

—OXFORD DICTIONARYDEFINITION OF “SCIENCE”

he remarkable similarities betweenWestern-based science and yogic

wisdom have always fascinated me. Thedefinition of science quoted above couldeasily be offered as a definition for yoga.Western science provides one framework

through which we can perceive ourselvesand the world. The science of yoga offersanother. Both are systems forunderstanding and making sense of whatis. What I find really exciting is that thereare many areas where the two disciplinesseem to converge. Trauma is one sucharea.

We have learned that trauma can resultin an altered state of mind-body thatnegatively affects a person’s thinking,behavior, psychological, and physiologicalwell-being. We have also learned thatleading behavioral and neuroscientists arecoming to understand that the traumacondition can be addressed through thephysical doorway of the mind-bodycontinuum. A short comparison ofclassical yogic wisdom with science-basedtrauma fundamentals will help us

understand why yoga is so naturally suitedto promote recovery from trauma, and willset the foundation for the development of atrauma-sensitive style of yoga.

Patanjali’s PerspectiveThere are so many different styles andsystems of yoga in existence that onecould very easily become lost in thedifferent perspectives and nuances of each.Of all the figures who have taught yogaover the millennia of its existence, themost widely recognized is Patanjali. In theYoga Sutras, Patanjali teaches that yogacan bring about a state of mind that is freeof turbulence and ultimately results inunion with all that is. Yogic wisdom holdsthat states of mental turbulence happenwhen chitta (mind) is clouded by avidya(incorrect comprehension).1 Avidya arisesas a result of the kleshas, which includeasmita (ego), raga (attachment), devisah(aversion), and abhinivesah (fear). Over

time, avidya creates samskaras (mentaland emotional patterns).

If we consider this in terms of what wehave learned about trauma, it would seemthat homeostasis can be construed asunion, and trauma is very much likesamskara. But rather than grooves ofconditioned thought created over time,trauma happens suddenly andunexpectedly, like a flash flood cutting adeep chasm across the landscape of mind-body. We can become trapped in thischasm. Every event that happens from thispoint forward is perceived from within itsshadowy landscape and is influenced bythe thoughts, feelings, and emotions thataccompanied the original event. Avidyaand the kleshas sound a lot like “reactionsto experiences.” These reactions can leadto one of the main symptoms of trauma:

negative alterations in cognition and mood.It is not a big stretch to conclude that thesenegative alterations lead to dysregulation,or in yogic parlance, chitta vritti (mindturbulence). Samskara or trauma evokesconditioned responses to triggers thatmanifest in terms of the remaining majortrauma symptoms of intrusion, avoidance,and arousal.

Koshas: Mind, Body, andMore

Some yogic texts describe the body interms of layers called koshas. Startingfrom the outside in the layers are anamayakosha, the physical body; pranamayakosha, the energetic body; manomayakosha, the cognitive and emotional body;vijnanamaya kosha, the rational body; andanandamaya kosha, consciousness or theseat of awareness.

The koshas offer a good model forconceptualizing how TSY can work onmind and body. The concept ofapproaching the mind-body throughanamaya kosha (the physical layer) isconsistent with the bottom-up approach we

have already discussed. We know thatbreath exists within the realm ofpranamaya kosha, our energetic body. Thepractice of pranayama helps us to regulatethe flow of prana (life force) within. Whenprana is balanced, we feel balanced.2 Fromthe Western perspective, when we regulatebreath, we regulate the autonomic nervoussystem, which leads to coherence, which inyoga we could consider to be union.Manomaya kosha is the layer at whichthoughts and emotions are managed. Whenit is clouded by illusion, deeper wisdom orrational thought is clouded as well. Interms of our previous description of themind-body continuum, manomayaresembles the interaction between thecognitive brain and the limbic system (theemotional brain) that is so central to thetrauma mechanism. The role of

vijnanamaya kosha is almost exactly thesame as that of the rational part of themind. It knows, decides, judges, anddiscriminates between this and that,between useful and not useful. When itgets comingled with memories and isclouded over by the manas, it loses itspositive strength. Anandamaya kosha isthe center of consciousness. It is a state ofsimply being. It represents what we havetermed calm abiding, or being in a state ofpresent-moment awareness.

It is reasonable to suggest that yogaoffers a framework for perceiving theinteraction between trauma and the mind-body that is consistent with that describedby behavioral science and neuroscience.Yoga recognizes that our reactions to ourexperiences (kleshas) are influenced byconditioned thought (samskara) and cause

misperception of what is really happeningin the present moment (avidya). Thisresults in mind turbulence or trauma(chitta vritti). We can influence state ofmind (chitta) through the mind-body(koshas) starting from the bottom(anamaya kosha) up. We can do so byusing yogic techniques and practices(asana, pranayama, and pratyahara,among others) for finding our center(anandamaya kosha) and some degree ofcalm abiding (samadhi).

Patanjali summarized this whole processof finding freedom from mind turbulencein an eight-step process. The first twosteps, yama and niyama, are essentially aset of moral precepts that assist us inpracticing kindness and compassion toourselves and others. Steps 3 and 4 addressbreath and mindful movement. Steps 5 to 7

describe a meditative process that creates astate of pure awareness, a state from whereit is possible to take the final step to self-realization; where all aspects of mind-bodyare working together in a state of union;where we learn who and what we are andhow we are connected to all that is.

Why Yoga Works: APlausible Explanation

Having reviewed the interaction of yogaand trauma from a classical perspective,what follows is a plausible contemporaryexplanation for why yoga works. Yogahelps with trauma in three main ways. Itgrounds us in the present moment, itbroadens our window of tolerance toregulate mind-body, and it fosters a senseof internal and external connection.

First, it gets us grounded in present-moment awareness. It moves ourawareness away from where it is stuck in apast event experience into the experienceof an event that is happening in the presentmoment. By paying attention to the

sensations associated with our present-moment experience, whether they aregenerated by breath or movement, we freeourselves from the imprint of the traumaexperience, from the samskara ofsomething that happened in the past. Whenwe stop reliving the trauma experience, werestart the natural process of healing. Weovercome dysregulation to experience adegree of safety and stability.

Second, it teaches us how to expand ourwindow of tolerance to regulate physical,emotional, and cognitive sensation. Weuse asana to stress the mind-body in ahealthy and controlled way, and we usepranayama (breath) to bridge body andmind to regulate the stress response. Asour practice deepens, we broaden ourwindow of tolerance for “autonomicdysregulation.”3 We become familiar with

our boundaries and understand how to livecomfortably and contentedly within. Wefind the capacity to come to terms with andaccept reality. We learn that while thetrauma experience has become part ofwhat we are, it does not define who we are.We are able to remember it withoutreliving it.

Third, the ultimate end of yoga is union,or a sense of connection. The entireprocess supports this end. This meansfeeling part of something. It meansreconnecting to family, friends, and societyat large. For some, it may mean developingand practicing a concept of spirituality.

Let’s Talk about GaneshGanesh is an elephant, and many timeswhen we practice yoga, there is anelephant in the room. That is spirituality.For many, the word spirituality is a loadedterm. It comes with connotations ofreligion and all sorts of different conceptsof god. I like to think of spirituality as theessence of connection. It is the force thatdraws us closer together, that makes usfeel like we are part of something largerthan ourselves. I hope that a basic,inclusive definition such as this does notpreclude any other systems of belief. Ithink spirituality is very relevant to trauma,because as we have seen, stage 3 of traumarecovery is finding a way to reintegrateinto the whole. In this regard, spirituality is

key.

More and more clinicians, and evenmedical doctors, are advocating some formof spiritual practice as a path to holistichealth. For some people, spirituality is anintensely personal matter, so it may not beadvisable to point out the elephant the veryfirst day. It might be better to talk aboutconnection in general terms and allowpeople to sense it for themselves. Thelanguage we use, and the concepts wepresent, can set the conditions for peopleto notice Ganesh on their own. Phrases like“inner essence” and “life force” seempalatable to most. As we come to know thepeople we are working with better, we willget an appreciation for what it is that offersthem a sense of connection. Maybe it’snature, maybe it’s church, maybe it’s apuppy, or maybe it’s just being in the same

room as someone else. What it is, exactly,isn’t that important. The point is to set theconditions for them to find and followtheir own spiritual path, to experience theawe, delight, and contentment that comeswith seeing the elephant along the way.

What Kind of Yoga Is Rightfor Trauma?

It is often said that all yoga is good yogaand, in general, this is true. It is also true,however, that some types of yoga are notsuitable for all people. This is probablywhy there are so many schools and stylesof yoga in existence today. Which of theseis the best for trauma? There are also manymainstream yoga derivatives beingpresented as effective methods foraddressing trauma and trauma-relatedconditions. The more well-known includemethods such as MBSR, somaticexperiencing, iRest Yoga Nidra, andHeartMath. Which of these works the best?

This may be an oversimplification, but

perhaps the different systems of yoga andmainstream derivatives are just that:methods that are all underpinned by thesame basic precepts and core elements ofyoga. Although they are often presented asunique or innovative, more thanrepresenting new ideas they representdifferent views on the same theme,different applications of the samefundamental elements and principles.

The best yoga is the yoga that yieldsresults and is understandable andacceptable to the people we are workingwith. So rather than taking a cookie-cutterapproach, we should be willing to adaptwhatever styles, methods, and techniquesare available to meet the needs of thetraumatized person.

Chapter Summary

Yoga’s main role in addressingtrauma is to help with thestabilization stage, where the clientlearns to self-regulate. The practiceof acceptance, and emphasis onconnection, is also useful for stages2 and 3 of trauma recovery, whichinvolve coming to terms with thetrauma experience and reintegratingit into life. Some concept ofspirituality can greatly facilitatestages 2 and 3.

Yoga helps with trauma in threemain ways. First, it takes ourawareness away from a past eventexperience and into an experience

of an event that is happening in thepresent moment. Second, it teachesus how to expand our window oftolerance to regulate physical,emotional, and cognitive sensation.Third, it encourages us to explorethe concept that we are connectedto something greater than ourselves.

The best kind of yoga for trauma isthe one that works. It needs to meetthe needs of the person living withtrauma and be conveyed to them ina way that is understandable andacceptable. Our role as TSYpractitioners is to help the personwith trauma find a practice thatworks best for them.

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4Trauma-Sensitive Yoga

Breath is the bridge which connects lifeto consciousness, which unites yourbody to your thoughts. Whenever mindbecomes scattered, we can use ourbreath as the means to regain control.

—THICH NHAT HANH

e have learned that the traumaexperience can lead to an altered

state of existence. The mind-body is nolonger coherent or in harmony with itsenvironment. Recovery from trauma is aprocess of reunifying the self andreconnecting to the external world. It’s

about restoring balance between the mind-body functions governed by the primitiveand emotional brain and those controlledby the rational brain. It is about bringingthe human organism back to homeostasis.Having established a basic understandingof the trauma condition, an idea of whatrecovery from trauma entails, and knowingthat yoga has the potential to help peoplerecover from trauma, the next question ishow?

Trauma-Sensitive YogaCriteria

Remembering that there are no cookie-cutter approaches to trauma-sensitive yoga,how can we confirm that an intendedapproach is valid? What are the featuresthat distinguish TSY from other schoolsand systems of yoga? Based on thepreceding discussions of trauma,recovering from trauma, and what yogahas to offer, I propose that TSY shouldemphasize a bottom-up approach, beconsistent with the accepted stages oftrauma recovery, be needs-based, beadaptive versus prescriptive, maintain aphysical focus, employ appropriate stylesand poses, and place special importance onbreath. Each of these criteria is explained

in the paragraphs that follow.

Bottom-up emphasis. Due to the verynature of the trauma condition, TSYshould emphasize a bottom-up, somatic-based approach, especially in the earlystages of recovery. As Peter Levineasserts:

In the initial stages of restorative work,bottom-up processing needs to bestandard operating procedure. In otherwords, addressing a client’s“bodyspeak” first and then, gradually,enlisting his or her emotion,perception, and cognition is not merelyvaluable, it’s essential.1

Consistency with stages of recovery.Whether it is offered in a studio or in aclinical setting, TSY should work withinthe boundaries of, and remain consistent

with, the three widely accepted stages oftrauma recovery. It should be safe andsupportive, should promote self-acceptance, and should foster connection.

Needs-based. TSY should be designedand delivered based on the needs of thoseliving through trauma, and should not bedelivered with the intent of promoting oradvocating any specific style or type ofyoga, or any other somatic or mindfulnessbased yoga derivative. This criteria alsoimplies that the type of yoga offered be asaccessible as possible.

Adaptive versus prescriptive. Thetrauma population is far fromhomogenous. This diversity in conditionand need is further complicated in the caseof public TSY classes, where sometimesanonymous people living through traumaare mixed with the general population.

Under these conditions, it is unrealistic tothink we can prescribe a specific type ofyoga for a given situation. A TSY teachershould be flexible enough to change theirteaching methods as required. This type ofworking environment means thatprescriptive plans will be less effectivethan adaptive plans. The ability to planadaptively is greatly facilitated by the useof a conceptual framework. The nature ofsuch a framework is the topic of the nextsection.

Physical focus. While trauma mayoriginate in the mind, it often comes to restin the body. Most TSY literatureemphasizes keeping the practice asphysical as possible and to avoid focusingon less tangible sensations such as thoseassociated with the energetic body. Whilea sense of connection is essential in

recovering from trauma, and spiritualitycan assist in this regard, how it is broachedis more important than what kind ofspirituality it is. Mystical, esotericconcepts of spirituality can be dangerousand could lead to dissociation or spiritualbypass. In Psychology Today, IngridMathieu says:

Spiritual bypass is a defensemechanism. Although the defenselooks a lot prettier than other defenses,it serves the same purpose. Spiritualbypass shields us from the truth, itdisconnects us from our feelings, andhelps us avoid the big picture. It ismore about checking out than checkingin—and the difference is so subtle thatwe usually don’t even know we aredoing it.2

Appropriate styles and poses. Manyschools of yoga, most notably Iyengar andDesikachar, promote yoga as a form ofmedicine. Different poses affect the bodyin different ways, working not only on themusculoskeletal system but on thecardiovascular system, the endocrinesystem and, well, the entire body. In thetwo TSY teacher trainings I attended, therewas also emphasis placed on specific posesand set sequences that may be mostappropriate for releasing trauma. While Ipersonally believe that yoga can becustomized to treat specific conditions,when I actually started working withtraumatized people, I quickly realized that,in many cases, it would have beencompletely detrimental to stick to thescript. In fact, for more than half of theclients I saw, chair yoga was the most

appropriate style of yoga to use. Inretrospect, this makes a lot of sense.

As we will see, one of the first things wewant to do in a TSY class is to establish asense of safety and support. In thebeginning, the simpler the yoga, the betterthe yoga. What poses we do are not nearlyas important as how we do them. Movingwith the intent to create and experiencesensation (or no sensation) should be thepurpose of every pose. Another point toconsider is the vastly different body typesand physical boundaries of individuals. Asyoga teachers we see this all the time.When working with the trauma population,these differences are amplified by chronicpain and fear of the unfamiliar. The bodyhas tremendous capacity to heal itself. Inthe case of trauma, yoga unlocks thispower and provides the medium for the

mind-body continuum to reunite. As theunification process happens, we find spaceto explore deeper, to rediscover forgottenconnections. When this happens, recoveryhas begun.

The indisputable power of breath.Breath is an especially powerful tool inworking with trauma. Not only is it thequickest route to the present moment, it isone of the most effective ways to self-regulate, to bring the mind-body back tohomeostasis. It is well known thatemotional arousal can cause the autonomicnervous system to trigger physicalsymptoms such as anxiety and panic,muscle tension, heart palpitations,increased blood pressure, and difficultybreathing.3 We cannot use our rationalmind to directly control the autonomicnervous system, but we can access it

through breath. Breathing is one of the fewbody functions under both conscious andautonomic control.4 It is a major factor inregulation and in reforging connectionsbetween mind and body.

A Trauma-Sensitive YogaFramework

Numerous somatic and psychosomaticmethods are being employed as treatmentapproaches to trauma. We also know thatthe tradition of yoga offers a multitude ofsystems and techniques that can be used toaccess the mind-body continuum. Veryoften, considerable effort is made todifferentiate techniques within bothpsychological therapies and systems ofyoga, many times with the intent ofdemonstrating that one way is better thananother to achieve the desired result.Through my own personal experience, andfrom conversations with clinicians, I havecome to believe that no one approachworks for all the people all the time. There

is no silver-bullet solution, and if therewere, we wouldn’t find it by focusing onwhat’s different: we would more likelydiscover it through consideration offundamental concepts and principlesshared across diverse perspectives.

Therefore, rather than prescribing aspecific system to teach a TSY class, or aprecise approach to TSY as a clinicalintervention, I suggest instead a generalframework that can be used to create TSYthat is relevant to the people it is intendedto serve, a framework that facilitates anadaptive versus a prescriptive approach.The TSY framework has five components:intention, guiding principles, coreelements, appropriate techniques, and arepeatable process. Each of these isdiscussed below.

Intention. To do anything, we need

intention. We need some concept of howwe would like things to be at some point inthe future. For the person living throughtrauma, the ultimate intention is to movefrom a turbulent to a peaceful state ofmind, from a state of dissociation to one ofconnection. This may not, however,happen in a straightforward manner. Theroad to recovery is twisting and hilly, andrecovery is often facilitated by focusingmore on the direction of travel than onmeasuring daily gains. In yoga we aremuch more comfortable setting intentionsthan objectives for our personal practice,and for good reason. Setting an objectivecan create expectation. When expectationsare not met, disappointment can follow.

When we are working with someonewho is struggling to find their way,especially in a clinical setting, I think it is

beneficial to help them see objectives asintentions, to “move in a direction” thatwill eventually lead to a greater sense ofacceptance, or gratitude, or commitment,or empowerment. Therefore, in the interestof fostering recovery, it is important tohave intent. In a clinical setting, we couldset this based on a treatment objective. In aclassroom setting, we could ask ourstudents to state the intent to themselves,or if they wish, say it aloud. Sometimes Iask them to write it on a piece of paper,and I use this input to help me deliver theclass.

Guiding principles. Principles areimportant guidelines that can help us directour approach and maintain our focus. Wecan check back on them from time to timeto make sure we remain true to our intent.With this in mind, I propose a set of

principles that reflects the TSY criteria andrecognizes the important concept of safetyand support.5 In principle, TSY is safe andsupportive, needs-adaptive, and bodyfocused.

Safe and supportive. TSY isdelivered in a safe and supportiveenvironment, and in a safe andsupportive manner. It honors theprecept that the client has choice andthe right to control her or his ownbody. As a clinical intervention, TSYrespects clinical practices andtreatments. Choice, control, andpredictability are essential to theestablishment of safety. In a journalarticle, David Emerson andcolleagues offer five aspects of ayoga class that require specialconsideration: environment,

exercises, teacher qualities, assists,and language. They also identify theimportance of choices andcommunity.6 Consideration of all ofthese elements is crucial to create asafe and supportive yoga offering.

Needs-adaptive. TSY is based onthe needs of the person living withtrauma. It is adaptive, notprescriptive. While it employstechniques from various styles andsystems of yoga, it need not adhereto a specific approach.

Body-focused. TSY emphasizes, butis not restricted to, a bottom-up(somatic) approach. It focuses onawareness of