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.

Trauma Sensitive Yoga: the walking wounded, part 2

A trauma survivor can be an adult survivor of childhood abuse, a domestic violence survivor, a survivor of sexual assault, someone who was in a horrible car wreck or natural disaster, or a returning soldier with Post-Traumatic Stress Disorder (PTSD.)

Basically, anyone who walks into your class. As teachers, we never know what a student’s story is, either physically or psychologically.

A “trauma sensitive” yoga class is taught very differently from the yoga class with which we are familiar — soft music, altars, incense, physical adjustments. A typical yoga class may not be comfortable place for a trauma survivor and in fact may feel very dangerous. Merely saying the word “relax” can be a PTSD trigger if the person was told to relax and then was abused.

For someone who has been abused, a physical assist can be a severe trigger for PTSD. Many teachers say, “but I always ask first.” Think about that statement. For someone who has a history of abuse and was not allowed to say no (so has issues with power and control), assists are problematic.

Dr. Bessel van der Kolk is the recognized authority on PTSD and heads The Trauma Center in Brookline, Massachusetts. He has said that “the goal of treatment of PTSD is to help people live in the present without feeling or behaving according to demands belonging to the past.”

The Trauma Center has begun to establish empirically that yoga is helpful for people with PTSD (van der Kolk, 2006). Along with feedback such as, “I feel like I can use my body again,” the groundbreaking study that the Trauma Center conducted in 2004 showed that yoga changes core brain physiology related to PTSD and trauma.

In a brain subjected to trauma, parts of the brain can be underdeveloped; parts of the brain can be atrophied; a compromised neocortex (the “thinking” brain) can not regulate the lower brain (the limbic brain is the emotional center of the brain); there is a lack of synaptic connections. The amygdala is the alarm clock of the brain, it is the site of stored memory and bodily sensations. It becomes engorged and overactive in PTSD. The corpus callo is the fibrous material beneath the cortex that transmits information between the two hemispheres of the brain — in PTSD this can atrophy. The right side of the prefrontal cortex can atrophy in PTSD. These are just three examples of structural changes in a traumatized brain.

This makes recent research on how the brain can change (neuroplasticity) huge. The research is out there, you can google it: via yoga and meditation, new synaptic connections are made, old pathways are reactivated and there is neurogenesis. The Trauma Center’s research has shown that a 60 minute yoga class once a week in a 10 week session begins to reduce PTSD symptoms.

So how do you make your class “trauma sensitive”? As teachers we naturally think our classes are healing in a certain way, but some aren’t. We were told how Iyengar yoga classes, for example, because of the language used and the way many are taught can be problematic for trauma survivors. Seeing yoga straps lined up on a wall is not a good environment for someone who was tied down and abused.

Since much of trauma was caused by physical manipulations, physical assists for the most part are out of the question. At the root of trauma/PTSD is an extreme lack of choice. With specific yoga shapes (don’t say “pose”), trauma sensitive yoga teachers invite people to begin to make choices again in a direct relationship to their experience. All these choices are about safety, comfort, and ease.

Environment is important: smells, mirrors, exposed windows, closets, temperature, and lighting can all be PTSD triggers to someone.

Do you see where I am going with this? ANYTHING a yoga teacher does can be a trigger for PTSD. How many teachers are equipped to handle stress responses that may come up such as hyperarousal, hypoarousal, disassociation, or flashbacks? If a stress response happens, one key is to start moving the large muscles like gluts or quads because those muscles use up the stress hormone cortisol (Warriors, forward bends.)

For a trauma survivor in a yoga class, it’s about reclaiming their body, not about a teacher manipulating a student into a shape. As teachers we need to cultivate our ability to offer verbal assists. In trauma/PTSD, survivors have “lost” their bodies. Our teacher gave an example of how one of his students said she felt like she had a hole where her stomach should be. As yoga teachers it is not our job to “fix” a student, but to help them begin to trust their bodies again. It’s about helping students use their bodies and breath as resources for self-regulation, calming themselves down if need be. Physical assists create dependency.

In a trauma sensitive yoga class, language must change: no absolutist, commanding language; use concrete and visceral language; no woo-woo “out of body” language, no metaphors. It is the invitatory language of inquiry that directs attention to the body and invites mindful movement and breathing. The teachers advised us not to say “be gentle with yourself” because that comes across as a challenge that can set people up for failure — trauma survivors don’t know how to be gentle with themselves. Even the word “play” (saying “play with the pose” is not a good idea) is a loaded word. Emphasize choice: “as you are ready”; “if you like”; “you decide”; “you choose.”

Use non-intimate language for body parts: sternum v. chest; base of spine v. tailbone; seat v. butt or pelvis. However, ANY word can be a trigger and a teacher must be able to handle triggers.

Use non-aggressive language. How many of us have been in a yoga class with a drill sergeant instead of a yoga teacher — “you SHOULD look like this.” An abuse victim interprets your words differently than a soldier would with PTSD. The body is not a combat zone…for any of us.

Some of the loaded poses (for obvious reasons) are Happy Baby, hip openers, chest openers. Powerful bodily sensations can create powerful emotions so these poses must be taken slowly, in increments. Bookend a new pose with a familiar pose.