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01 July 2011

Trauma Sensitive Yoga: breathing the walking wounded, part 3

breath + movement = roots

Psychologist Babette Rothschild has said:

"Breath is a reminder of trauma. Sensory messages from muscle and connective tissue that remember a specific position, action, or intention can be sources of triggers. Accelerated heart rate and increased respiration can be implicit reminders of that same reaction that accompanied the trauma."

As we talked about the breath during the training, I thought about how fortunate I am to have studied directly in the Krishnamacharya lineage -- studying with Srivatsa Ramaswami, Desikachar, Mark Whitwell, and lately with Gary Kraftsow.  They all studied with Krishnamacharya and Krishnamacharya's yoga is all about linking breath with movement.  This aspect is crucial in teaching trauma sensitive yoga.

Donna Farhi has said that "breath is a dynamic system that most of the time runs on automatic, allowing input from internal organs to mange the rate and depth of breathing."

Trauma is stored in the body and body memories can override thinking.  Breath is the doorway to the nervous system -- trauma survivors have layers of physiological defenses in place that serve as psychological infrastructure and protection from implicit memories.  Removing these defenses too quickly can result in significant destablization.

Hearing this I thought about the yoga classes I've taken where pranayama is indiscriminately taught, seemingly for no purpose other than to fill space in the class (this is my experience, your mileage may vary.)  I became more aware of this after I returned from studying at the Krishnamacharya Yoga Mandiram the first time.

In that lineage yoga practice is asana-pranayama-meditation.  I remember being in a class after my return and the first thing the teacher did was kapalabhati breathing -- no explanation, no instruction, just do it.  It was very jarring (I started but did not finish) and I thought...HUH?   Does this teacher know everyone's dosha in the first place to be doing this?   If it did not feel at all right to my system, an experienced practitioner, I could only imagine what it felt like to the ones who were brand new to yoga in this class. 

If you've read the first two parts of this series, you'll know where I am going with this.  Breathing -- just doing it or hearing the breath of another student -- can be a PTSD trigger for trauma survivors.  Ujayi breath can be very scary; techniques such as kapalabhati and breath retention are out of the question in a trauma sensitive yoga class.

Trauma sensitive breathing should always be performed in the context of a muscular, physical form (asana) to facilitate grounding and present moment experience.  The movements are always initiated by the inhale or the exhale, because breath alone can trigger PTSD.

What are some breath practices for a trauma sensitive yoga class?  Simple breath awareness (constant attention to the breath); "add a little" breath; emphasizing breathing through the nose because some trauma survivors breath through their mouths; nadi shodana; and ratio breathing, i.e., different counts for the inhale/exhale.

The bottom line is helping people notice when their breath changes, helping them notice the quality of their breath so they can notice their experience in the present moment. Mindfulness. Just this, just here, just now.

As you may have determined, with so many PTSD triggers, being trauma sensitive in a "regular" group yoga class would prove difficult.  Although a trauma survivor may really want to experience yoga, the thought of walking into a public yoga class might be too challenging, too scary.  In his book Overcoming Trauma Through Yoga, our teacher Dave Emerson wrote about the experiences of trauma survivors in public yoga classes.  One woman said that just the experience of a teacher walking up to her slowly and silently as the woman was in child's pose was enough to make her run out and never return.  She did not feel safe at all.

Creating a yoga class exclusively for PTSD or trauma survivors creates community, a sangha.  We were advised not to do this work in a vacuum, but to connect with a mental health professional, a VA center, a domestic violence shelter, among others.  We were also advised not to work privately with students because of safety issues.  I feel confident enough to work privately with domestic violence and sexual assault survivors, but I might not feel secure with others, it would depend on the situation.  I am using The Trauma Center's protocols in working one-on-one with TS students: (1) the student must also be working with a psychologist, psychiatrist, or other mental health professional so we can work together as a team; (2) the student must continue taking their medication, if any; (3) the student must not have been hospitalized for any psychological issues within the last six months; (4) there can be no active psychosis.

At the start of our training, the question was raised: how must yoga in America change if 80% (according to a collection of research) of the population have experienced or witnessed trauma?  Trauma is defined by Dr. van der Kolk as being inescapable stress, heightened alertness (constant hyperarousal), or helplessness in response to an event.  Some responses to these states are detachment/disconnection from the body, self, or social relationships; insomnia; fight or flight responses; depression; chronic pain; constant intrusive thoughts; consistent feelings of anger and shame; substance abuse.

We were asked: do we need to return to a "simpler way" of yoga?

This training was one of the most influential trainings I've taken in my 10 years of teaching.  I hope I have helped both yoga teachers and trauma survivors in this three part series.

Krishnamacharya said that breath is central to yoga because it is central to life...and yoga is about life.  Trauma is a part of life, but we do not have to allow it to define us.  Yoga is about replacing old negative patterns with new positive ones, one step at a time.

Just this. Just here. Just now.

7 comments:

Carol Horton said...

Why do trauma survivors breathe through their mouths? Is it challenging to switch to nose breathing?

The 80% figure seems high. What percentage is estimated to have PTSD? I'm assuming this must be a subcategory of the larger trauma figure?

Great work and most definitely cutting edge! Thanks.

Kristin said...

I've read - and re-read - these posts and I admit to coming away conflicted (in a good way).

On one hand, this is really really amazing and facinating.

On the other hand, I'm wigged out now.

As a instructor, I would like people to have a positive experience in class, but if someone has PSTD or a trama that they are coping with, and cannot talk about, I can inadvertenty cause a trigger reaction. From *anything* I may do in class.

Scary stuff.

Thanks for posting on this topic, it's given me much to cogitate on (how I cue, breathwork, sequencing a class, etc).

Linda-Sama said...

don't be wigged out, Kristin! we all just teach what we teach, that's all we can do. I did NOT write this series to freak out any teachers -- I was just writing about what is out there in the "real world." you can't teach a class thinking "I am going to trigger someone."

that being said, after the training I have more compassion for those "difficult" people in class -- I know you know what I am talking about because we all have had them -- the student who won't close eyes and is all twitchy in savasana; the student who has no idea where her body is in space. know what I'm talking about?

As teachers, I think we all like to think that our classes are gentle, healing, relaxing, whatever. but to others, they may not be, they are something totally different. We can not ever prepare for everything that might happen in a class. like in everything else, we only do the best we can.

the point is: I made you think! ;) :)

Rebecca said...

Thank you, Linda. And thank you for your response to Kristin. I was have a similar response to her. I work a lot with people in trauma situations, but it is usually divorced from my yoga teaching. I have always wanted to find ways to provide them a yoga space, and this is giving me some wonderful ideas. If nothing else, this is great information to consider in a "normal" group class, one that is not specifically for any particular type of person. Thank you for all this wonderful information. I really do appreciate it.

treeluvr87 said...

Thanks so much for this series, Linda. The training sounds like it really gave you a new perspective, and your reports have given me insight into issues that have obviously gone unaddressed. Fascinating stuff!

svasti said...

It's so interesting to read all of this because every trauma survivor is different. My triggers were never about breath or someone walking too closely to me.

More things like a visual of my abuser's eyes tattooed on my retinas. Or having hypervigilence for people who looked like him - similar height, skin colour, hair etc. And being in crowds, having too much noise. At one point, it was about making sure I could always have an escape route - so I couldn't go somewhere in someone else's car. I had to be able to get there and back without interference.

So yoga was a place where I felt safe. That said, some of the poses would bring on very strong emotional or energetic experiences for me. So there would be lots of tears on occasion - a trauma safe class for me back then would be one where I could feel free to cry without anyone paying too much attention. But also - an opportunity at any point in the class to talk about what was going on if I needed to. Or for the teacher to be available after the class.

Finally, there would need to be understanding that if I act weirdly, or get withdrawn then that's ok. It doesn't mean anything about the yoga teacher most of the time. But those times might also be when a trigger is occuring and a person's internal world is imploding.

Basically - PTSD plays out in so many ways.

Also, totally agree about the breath. Some of my beginner students have trouble just breathing into their belly instead of their chest. So asking students to do a more forceful kind of pranayama could be troublesome...

Mijael "Yoga DVD" Brandwajn said...

I'm so glad you are writing about this. I've been speaking with and readying about trauma in yoga classes from different people, and I'm starting to feel the need to complete my Yoga Therapist Training with Gary Kraftsow (I'm only missing the last part, which is specifically about using yoga for the mind). Thanks for sharing, and for the comments.

I remember Gary talking about the word "Joy" being able to trigger someone whose ex-wife had that name.

While we can't walk on eggshells while we teach, understanding trauma can certainly diminish the instances of triggering people, and bring tons of compassion for those who for example, might not be closing their eyes.

Namaste!