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28 June 2011

Trauma Sensitive Yoga: the walking wounded, part 1


"The body keeps the score." - Dr. Bessel van der Kolk

According to the teachers at my recent Trauma Sensitive Yoga training, 70-80% of the population have experienced some type of trauma, whether being in a war or a catastrophic car accident. This statistic comes from a collection of the clinical literature currently out there. Keeping that statistic in mind, think of your yoga class. In many cases abuse is caused by physical manipulation of the body. Now think about what those yoga adjustments are doing to a trauma survivor with PTSD who was held down during their abuse. Even chanting and Sanskrit can be triggers for someone who suffered cult abuse.

Anything a yoga teacher does can be a trigger. Anything. Telling someone to be still and watch the breath can be a trigger, especially to a woman who was raped and the last thing she heard before she disassociated from the attack was the rapist's breath in her ear. The word "pose" can be a trigger, especially for an adult survivor of childhood sexual abuse who was made to POSE for pornography.

How will you teach your classes? Whether as teachers or students, we know that yoga heals, that is a purpose of yoga. But for many trauma survivors, walking into a yoga class is impossible. If you were that child who had been tied up, think how seeing a yoga strap would make you feel. Trauma survivors are stuck in a body/breath/mind that is still relating to past conditions. Time is frozen in the trauma survivor's brain, we're stuck in a loop. I know what my triggers are.

Approximately 88% of men with Post-Traumatic Stress Disorder met lifetime criteria for one or more disorders such as depression and anxiety. Seventy-nine percent of women with PTSD met the criteria for one or more. Eighty percent of people with PTSD met criteria for another psychiatric disorder (Solomon and Davidson, 1997.)

In a word, my training at the Trauma Institute was amazing. I consider it one of the most influential trainings I've done in my almost 10 years of teaching. Forty yoga teachers and clinicians from all over the United States and some from Europe came for four days to learn about the ground-breaking research being done (scientists and researchers are finally catching up to what yogis intuitively knew thousands of years ago) and to learn how to create trauma sensitive classes. A "trauma sensitive" class is not your mother's yoga class. It MUST be taught differently, even as to word choice and environment.

Many of us in the training were survivors, including me. Many felt that a true community was being created, much more so than a regular yoga teacher training. On the last day I sat in a small group and heard how just listening about trauma and PTSD was a trigger for some. Many of us had jangly nerves, as one woman described it, but all left empowered and ready to take this healing into our communities. One woman said she was proud to be a survivor and I nodded my head in agreement.

We learned much about the different parts of the brain that are literally physically damaged during trauma. Prolonged abuse damages the brain even more -- parts of the brain can atrophy and shrink and the connection between our "reptilian brain" and our "thinking brain" short-circuits. There are now many studies on trauma survivors via brain scans that show the physical changes. But the fact is that it does not have to stay damaged. The fairly recent concept of neuroplasticity is huge. It was previously thought that the adult brain can not change, but brain scans show that it can change and repair itself from trauma. One of the most important things we learned was that while talk therapy is effective, it can only go so far because it is head/mind oriented and trauma/abuse is so body-based. The Trauma Institute's soon to be published research shows that the body-centered activity of yoga combined with talk therapy is much more effective in treating PTSD and trauma survivors. Why? Because the body keeps score, the body has memory. Next year the Trauma Institute will begin a 5 year study of the effectiveness of Jon Kabat-Zinn's Mindfulness Based Stress Reduction techniques v. yoga on trauma/PTSD. The research will utilize brain scans.

We heard about "Trauma Theory for Yoga Instructors", "The Neurobiology of Trauma as it Relates to Yoga" (presented by Heather Mason), and also heard from Bill, a Viet Nam war vet who suffered from PTSD. He told us his story about how he was a hospital corpsman in the Marines and his PTSD did not manifest until his own children were born years later. "Life became gray," he said. The birth of his children triggered his PTSD because when he saw his babies he remembered all the dead Vietnamese children he saw. He said he constantly feared for his children, he was stuck in the loop that something terrible would happen to them, at any time, he was sure of it.

In both 2001 and 2002 he suffered a neurological episode where his left side stopped working -- PTSD and traumatic brain injuries affect the same part of the brain. He attributed his neurologic damage that showed up years later to the herbicide Agent Orange telling us that the body reacts to herbicides in a very specific way: "we were eating it and drinking it." Bill was fortunate enough to connect with Dr. Bessel van der Kolk as his psychiatrist who told him to try yoga for his PTSD and neurologic symptoms. Bill told us that yoga managed his symptoms and have grounded and centered him. Bill is in his 60s and he told us that he has been told that he should be in a wheelchair or in a nursing home but yoga has saved his life.

Bill has been doing Bikram yoga three or four times a week and has been doing it for about five years. He says he has tried other types of yoga but Bikram is it for him. Bikram is not considered "trauma sensitive" yoga but it helps Bill because of the consistency of the routine, the same thing every day, every class. We learned that consistency is one of the top three requirements of a trauma sensitive yoga class: BE SAFE, BE PREDICTABLE, BE CONSISTENT. Bill gave us his opinion about why consistency is important:

in the last 45 years America's warfare has been ill-defined, ambiguous, with poorly stated goals, and all have been counter-insurgency wars. In wars such as these, soldiers can never create a pattern, nothing is ever repeated, you can't go down the same road twice because you might get killed. Bill asked us to think how it feels to have our neurological system disrupted if we don't have patterns -- it is disruptive to the emotional system that is connected to our physiological well-being. For Bill, Bikram yoga via its repeated patterns serves as his ground.

However, for someone else, Bikram yoga with its commanding teachers could be a trigger. The yoga remedies for trauma and PTSD are definitely not one size fits all. For example, Richard Miller worked with the Walter Reed Army Medical Center in a famous study of the effects of yoga nidra on soldiers with PTSD. Yoga nidra was found effective on this population. Bill told us that soldiers with PTSD like the feeling of deep relaxation that yoga nidra gives just by virtue of how "on" they had to be while in the field. Yoga nidra is a relief to them, it's "heaven" just to be able to relax, Bill said. But for someone else, such as the survivor who was constantly told to be still and don't move, deep stillness for so long would be a severe PTSD trigger.

6 comments:

leela said...

i greatly appreciate the insights to reflect upon... thank you...

Svasti said...

Oh wow, this post makes me want to jump on a plane for the next time they run this training. Yes, I want to be a part of this community of survivors who are also yoga teachers!

Thank you so much for sharing this Linda. This post and this work is powerful. Every time there's a tragedy (bushfire, cyclone, flood) or a story about returned soldiers with PTSD, I just want to help them. Bring them yoga.

I'm so excited to learn that there's a training module I can do. I am inspired! :)

Rebecca said...

Wow, thank you, Linda. I have thought about this before in my "other" life - a family law lawyer, and I have thought about it fleetingly in my life as a yoga teacher, but I feel that I do not have the skills to effectively address it. For a long time, I have thought that we, as yoga teachers, need to be more open about the real effects yoga can have, especially the release of emotion that can happen with different postures. I feel we do a poor, poor job of explaining that. But the trauma issue is so much deeper, and so much more difficult because it is so unpredictable. Thank you for the reflection and for the information. Thank you so very, very much.

Theresa said...

Lots of questions from this thoughtful piece, Linda, but two stand out for me.

First, does this experience change your perception of Bikram as yoga or a path to yoga? Second, with all the different triggers is it possible to have one class that is "safe" for all?

Anna Guest-Jelley said...

Thanks for sharing your experience! I was very inspired by their book and definitely thought it resonated with my experience of working with survivors. I'd love to participate in this training some day!

Karin Bartimole said...

this is such an amazing post - thank you for sharing about your experience and the powerful information you've gathered. it makes so much sense to me, and affirms the sense that i've had about healing from my own trauma of ongoing abuses that began in infancy. i feel there is much brain based healing left for me to do, and i know my body holds many of the keys to unlocking that healing... gratefully, with love, k