RESEARCH INTO THE EFFICACY OF TRAUMA SENSITIVE YOGA

Please note: 

 - in a number of these studies, where the generic term 'yoga' is used it should be understood that the protocol being delivered is Trauma Sensitive Yoga as developed at the Trauma Center, Boston.  

- because PTSD is the only DSM recognised trauma diagnosis, research proposals necessarily cite PTSD. However, the inclusion/exclusion criteria for subjects is intended to recruit people with Complex &/or Developmental Trauma. 

overview

Post-traumatic stress disorder (PTSD) is a debilitating condition that can have a significant impact on the quality of life of those who have experienced traumatic events. Yoga is a form of mindful movement that has been shown to be effective in managing the symptoms of PTSD. Trauma Sensitive Yoga is a therapeutic approach that has been developed to meet the needs of individuals who have experienced trauma. This type of Yoga is designed to be safe and non-threatening, and it emphasizes the use of breath and body awareness to help individuals regulate their emotions and reduce symptoms of PTSD. 

One of the hallmarks of PTSD is a heightened state of arousal, characterised by hypervigilance, anxiety, and irritability. Trauma-sensitive yoga can help to reduce these symptoms through practices such as deep breathing, gentle movement, mindfulness and meditation. These techniques have been shown to help participants learn to regulate their nervous system, reducing the impact of traumatic memories, allowing them to feel more in control of their body-mind and promoting relaxation. 

Trauma Sensitive Yoga is also an effective tool for addressing the physical symptoms of PTSD, such as chronic pain, stiffness, and tension, caused by a constant state of muscular readiness to ‘fight or flee’ at the slightest sign of danger, since a brain in the grip of PTSD views many things as threatening in the world that many of us would not find at all threatening. The gentle movements and stretches help to release tension and promote flexibility, which can improve overall physical function, pain perception and quality of life. 

PTSD AND TSY RESEARCH

Dr Bessel van der Kolk, a leading expert in the treatment of PTSD, and the team at what was previously called the Trauma Center, Boston, now called the Justice Resource Institute, have been pioneers in the development, application and academic study of trauma sensitive Yoga (TSY).

“What strikes me, and why I gave my book the title ‘The Body Keeps the Score,' is that if it's in the body, the treatment should be in the body. Body treatment is somewhere, like, way on the periphery of the world. Instead, we sit in a chair and we talk to people, somehow trying to magically make people safe in their body.

I did the first National Institutes of Health-funded study on Yoga. It is more effective for chronic PTSD than any drug with people I've ever studied. I didn't see a single drug-selling firm turn into a Yoga studio after we published this data. But this data was serious. If you learn how to really inhabit your body and learn to feel comfortable moving your body and being in your body, something starts shifting.”

Dr Bessel Van Der Kolk

This first study that van der Kolk mentions is this one, published in the Journal of Clinical Psychiatry in 2014: Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder: A Randomized Controlled Trial.  Over 10 weeks, 64 women with chronic, treatment-resistant PTSD were randomly assigned to either a TSY group or a group that received a supportive weekly class on women’s health education. Yoga significantly reduced their PTSD symptoms - to the same degree observed in drug- and psychotherapeutic approaches. They hypothesised that TSY may help traumatised individuals to tolerate physical and sensory experiences associated with fear and helplessness and to improve ‘affect regulation’. This is the ability of an individual to modulate their emotional state in order to adaptively meet the demands of their environment, or in other words to function effectively and not lose control or shut down despite the presence of difficult emotions and sensations.

The same research team followed up these findings with more studies. Published in the Journal of Alternative and Complementary Medicine in 2016, this study: Yoga for Adult Women with Chronic PTSD: A Long-term Follow-up Study found that the longer Yoga is practiced, the greater the benefits in terms of symptom reduction. And given Yoga’s low cost and the relative ease of access to community-based classes, suggested it should be considered as a long-term complement to therapeutic intervention for those struggling with the legacy of prolonged interpersonal trauma (caused by abusive person-to-person relationships rather than an accident or natural disaster). This study - Trauma Sensitive Yoga as a Complementary Treatment for PTSD - published in the Journal of Stress Management, also in 2016, is a qualitative descriptive analysis of the experiences of some of those who took part in the team’s other studies, and provides some really interesting (and moving) comments and reflections that reflect the day-to-day human impact of the Yoga practice behind all the clinical observations. For example:

“If something is hurting, I think ‘hmm, why is that hurting’...instead of being like, ‘that doesn’t hurt, I’m just being weak.”

“…starting to think that I ought to give myself a little credit for all I’ve survived...I ought to like myself…”

“…appreciate how huge it is that I was able to survive…made me appreciate the level of trauma.”

“Being able to sit with myself [in yoga] allowed me to stay in myself when people tried to be affectionate... there’s more closeness in relationships, especially physical comfort.”

SEXUAL TRAUMA

TSY was very recently explored as an intervention with a group of 152 women who had experienced military sexual trauma (MST). The Journal of Alternative & Complementary Medicine published Trauma-Sensitive Yoga for Post-Traumatic Stress Disorder in Women Veterans who Experienced Military Sexual Trauma: Interim Results from a Randomized Controlled Trial in 2021.

Research has shown that women veterans MST are particularly vulnerable to developing PTSD and other mental health conditions, and this study looked at how effective an intervention Trauma Sensitive Yoga may be. It split the owmen into two groups, one receiving a 60 minute weekly TSY session, and the other weekly 60-minute cognitive processing therapy administered by clinicians in the veterans clinic. The paper outlines several key components of TSY that make it effective for women veterans who have experienced MST.  

In addition to reducing symptoms of PTSD, TSY helped to develop a sense of empowerment and agency. Many women veterans who have experienced MST report a sense of powerlessness and vulnerability. Yoga facilitated a deeper connection to body and an opportunity to tap into a sense of inner strength, which helps to counteract these feelings. 

Moreover, the TSY was found to facilitate symptom improvement more quickly, have a higher retention rate and a more sustained effect than cognitive processing therapy.

TRAUMATISED YOUTH IN THE JUSTICE SYSTEM

Many youth who are involved in the justice system have experienced significant trauma, including physical and emotional abuse, neglect, and exposure to violence. These experiences can lead to a range of mental health issues, including anxiety, depression, and post-traumatic stress disorder (PTSD). They may also have difficulty trusting adults or authority figures, and may have difficulty regulating their emotions and behaviour. Traditional forms of therapy may not be as effective for this population, as they may have difficulty connecting with traditional forms of talk therapy.

Yoga, on the other hand, can provide a non-verbal and non-threatening way for youth to explore and process their experiences. The physical aspect of yoga can also help release tension and stress in the body, which can be beneficial for individuals with PTSD, and the mindfulness component can help develop greater self-awareness and interoception or inner sensing of physiological states, which is so vital for self-regulation, a sense of embodiment and overall feelings of wellbeing.

However, traditional Yoga interventions may not be appropriate for youth in the justice system, as they have differing needs and face different challenges compared to adults. Therefore, studies – particularly the work of the Yoga Services team at the Trauma Center at Justice Resource Institute in Brookline, MA, who in 2021 published a pilot study in the International Journal of Yoga Therapy - have shown that it is important to adapt a yoga intervention specifically for this population. I summarise key points from their paper below.

Above all it is important to establish a safe and non-judgmental environment. This can be done by providing clear boundaries and expectations, explaining the benefits of the practice, incorporating trauma-sensitive language and by creating a sense of community and belonging among the participants. It is also important to be aware of the potential triggers that may arise during the Yoga practice and to have a plan in place for addressing these triggers in a supportive and non-judgmental way.

The Yoga practice itself may include a combination of physical postures, breathing exercises, and mindfulness practices and should be tailored to the needs and abilities of the youth. This may include incorporating elements of play and creativity, as well as providing plenty of options for both seated or standing postures. Postures such as ‘child's pose’ (a kneeling forward fold, with the head resting on the ground) and ‘mountain pose’ (steady, standing pose with both feet on the ground) can be used to support feelings of groundedness and stability, while breathing exercises like alternate nostril breathing can be taught as a means to help them regulate their emotions. Mindfulness practices such as body scanning and loving-kindness meditation can be used to develop self-awareness and compassion.

In addition to the Yoga practice itself, it is important to provide support and resources to the participants outside of the sessions. This may include connecting them with counselling services, mentoring programs and educational opportunities. It is also important to involve families and caregivers in the process, as they can provide support and continuity.

IN SUMMARY

Yoga has never been a one-size-fits-all practice, and it is especially important to be mindful that things many of us may not even notice in a Yoga class – a particular posture that could be construed as sexual or suggestive, revealing clothing, the type of music chosen, a scent, for example perfume or room scent, stern and directive teaching or feeling that leaving the room is not allowed - can be very upsetting for someone living with the imprints of trauma in their nervous system. 

Trauma Sensitive Yoga should be practiced in a safe and supportive environment, led by a trained instructor who understands the unique needs of individuals who have experienced trauma.