Location: Boston, USA
Name: David Emerson
Email: [email protected]
Date of profile: May 2012
Intervention: Yoga Program
Aim: To use an adapted, trauma-sensitive yoga program to reduce the symptoms linked with Post Traumatic Stress Disorder (PTSD). To help individuals feel comfortable in their bodies, to learn self-regulation skills, and to improve their ability to direct attention away from ruminative thought processes.
Background and context
Despite the acknowledgement that traumatic stress disorders can affect the link between the mind and body, there are very few treatments available that seek to address this. The majority of treatments for PTSD focus, to a large extent, solely on the mental barriers in an individual’s mind that prevent them from coming to terms with, and overcoming trauma. Although it is essential to address the mental needs of a trauma survivor to overcome PTSD, individuals also need to find a way to feel safe once again in their own bodies and to regain control over their body. Yoga therapy has been designed to target both the mind and the body as both are considered to be important elements in overcoming PTSD.
The Trauma Center Yoga Program at the Justice Resource Institute began in 2002 working with individuals displaying severe and complex trauma, most often survivors of intrafamilial abuse and neglect.
Trauma-sensitive trained yoga instructors work with individuals or all male or all female groups of individuals.
Students are in control over what they are doing with their body at all times and the instructor is there to provide safe, professional guidance and to help individuals focus on particular elements such as the muscles they are using and the breath.
In this space yoga allows individuals to safely experiment with having a body through:
The whole purpose is to provide students with a non‑clinical period of time where there is no trauma processing (talking about the trauma as a story) but where they can just focus on feeling, sensing, moving their body and their breath safely. The breathing exercises and gentle movements in the yoga practice give trauma survivors the tools to create or re-create a positive relationship with their bodies.
Target group and scale
The Yoga Program has been used with different groups of individuals, both male and female, suffering with trauma. The sessions are run in a number of locations including at the Trauma Center, veterans centres, residential schools for teenagers, domestic violence shelters, rape crisis centres, and various community centres (Emerson et al, 2009).
In residential treatment facilities, instructors work one-on one with young adolescents aged between 12 to 21 years of age. These young people have experienced various forms of physical and sexual abuse and exploitation.
The Yoga Program has worked with over 2500 students since 2002 in a variety of settings.
In working with different individuals and in a variety of settings, there have been noticeable changes in reducing symptoms of traumatic stress. In addition to feedback being collected after every session to measure an individual’s progress, a number of research studies have also been undertaken to measure the effects of yoga on PTSD symptoms.
In the first evaluation to assess the effects of the Yoga Program, sixteen women aged between 25 and 55 were assigned to either the Yoga Program or a standard therapeutic intervention. After 8 weeks of both groups attending sessions, those who had participated in the yoga sessions revealed a greater reduction in the PTSD symptoms compared to the other group (Emerson et al, 2009).
The Trauma Center at the Justice Resource Institute received a first of its kind grant from the National Institute of Health in the United States to study yoga with severe, complex trauma in women between 18-58 years of age. The results of this study showed a clinically significant decrease in PTSD symptom severity. (The results of this study are currently unpublished but for more information please contact Dave Emerson, demerson(at)jri.org).
Another article published in the Journal of the American Psychiatric Nurses Association, includes two case studies which illustrate how yoga therapy can significantly reduce the number of behavioural incidents and improve integration with peers amongst young people living in residential centres.
Non‒discrimination and Individual Response
The Center strives to make the classes accessible to everybody regardless of physical ability.
Every individual is dealt with on a case by case basis and sessions are tailored to individual needs. The goal of the session is to give individuals back the control in their lives.
Sessions may be delivered with only one or two students (this is the favoured model when working in residential settings) or in a group (with veterans this has been the preferred model as helps mitigate isolation). The process therefore depends on the dynamics of those individuals involved.
In the residential schools, young people work with their yoga instructor at the beginning of every session to plan that particular session. Yoga instructors use a number of cards with different postures on them and the individual is asked which postures they want to practice. Again this means that the individual is able to make a choice and be in control of everything they do during that session.
When working with other groups, yoga instructors lead a series of postures but students “practice leading themselves” by making choices in direct relationship to their own body experiences.
At the end of every session the individual or individuals are asked the same three questions about their experience of the session. Their feedback is recorded and progress monitored.
All yoga instructors are qualified and have received training in trauma sensitive yoga.
During sessions, special care and attention is given to the; environment, exercises, qualities of the teacher, assists and language. These considerations together with the classic elements of yoga create a session that is appropriate and can meet the needs of trauma survivors.
Yoga is a lifelong practice that individuals can take with them wherever they go. Maintaining a safe, healthy relationship with one’s body is an ongoing practice that may always include trauma – sensitive yoga but may also take on many other forms: walking, horseback riding, wind surfing – anything physical that is done with awareness and attention to one’s felt experience.
Sustainability is a priority. A portion of the proceeds from trainings, the sale of manuals and a DVD go into a scholarship fund that helps adults to access classes.
The same principles and practices are applied when working with teens, adults, war veterans, rape survivors, younger children and families, and others. Staff from the Yoga Program believe that anyone or any group, where significant trauma is a factor, can benefit from these same principles and practices. Key elements to be mindful of include (for full details see Emersonet al, 2009):
Environment – creating a space where participants feel safe and less vulnerable.
Exercises – trauma-sensitive yoga is more about the “how” than the “what” however certain postures may be particularly difficult for trauma survivors, particularly hip openers.
Teacher qualities – teachers should be welcoming, positive, approachable and engaging. They must also be open to make changes and welcome feedback.
Assists – physical assists should be treated with great care and attention. Physical assists are often not offered for many months, if at all.
Language – how he or she delivers instructions is of utmost importance. Avoiding certain terms and using ‘invitatory language’ is important.
Community and choice – the process of being traumatised involves a lack of choice. Having choice is therefore central in the yoga practice. In addition, trauma survivors can feel isolated and the supportive presence of peers who have had similar experiences can be beneficial.
It is very difficult for people who have been deeply abused to find it safe to feel themselves and it requires tremendous patience and support.
Creating opportunities for students to make real choices in their bodies is very important. The word “choice” is used as much as possible.
Students must have full control of how they move their bodies and rather than doing hands on assists, instructors should let students take control.
It is possible for people with severe trauma histories to find a way to safely feel their body and to use their body effectively in order to more fully participate in and enjoy their life.
Following preliminary studies, further research will be focussed on examining brain scans to determine which parts of the brain are affected by yoga practice.
Links to publications related to this work
Trauma-Sensitive Yoga: Principles, Practice, and Research published in theInternational Journal of Yoga Therapy in 2009(http://www.traumacenter.org/products/..%5Cproducts%5Cpdf_files%5CIJYT_article_2009.pdf)
Application of Yoga in Residential Treatment of Traumatized Youth published in the Journal of the American Psychiatric Nurses Association in 2011(http://www.traumacenter.org/products/APNS_2011.pdf)