Review of a formal study:

     A compelling formal study was one on the use of yoga to treat PTS in survivors of the Tsunami in Asia entitled, ‘Effects of a yoga breath intervention alone and in combination with an exposure therapy for post-traumatic stress disorder and depression in survivors of the 2004 South-East Asia tsunami’which was published in the Acta Psychatrica Scandanavia 2009: 1-12.

     The findings were impressive. One-hundred eighty-three tsunami survivors were measured for post-traumatic stress, depression and quality of life at baseline before beginning the treatment, then again at six, 12 and 25 weeks.

     The yogic breathing techniques were developed by Sri Sri Ravi Shankar and included “three-stage Ujjayi (victorious breath), Bhastrika (bellows breath), chanting of OM and Sudarshan Kriya (SK) (Clear Vision through Purifying Action)” (5).

     Traumatic Re-exposure Intervention (TRI) is described as “…a one-on-one method which has been shown to reduce the negative effects of trauma… (and) requires the client to flood him/herself with cues associated with traumatic memories… (intended to inspire) a decline in painful affect and greater awareness of the full details of the event and its meaning… This process is repeated until the cues become less or non-aversive.” (5-6)

     The average baseline for the post-traumatic check-list in the yogic breathing group was 66.5. Within one week this measurement had been reduced to 27.5. At week 6 it was 23.9 and by 24 weeks it was 20.6. The baseline for the Beck Depression inventory for this group was 26.7. Within one week this measurement was reduced to 5.9. At week six the group average was 3.5 and by 24 weeks it was measured at 2.9.

     The measurements of the post-traumatic stress checklist for the yogic breath plus TRI group was a baseline of 64.1, 24.6 at six weeks and 19.6 at 24 weeks. The depression inventory baseline for the same group was a baseline of 27.3, 4.3 at 6 weeks and 2.9 at 24 weeks.

     These reductions were found to be statistically significant and thus a correlation can be posited between the yogic breath treatment alone, and the yogic breath treatment in conjunction with TRI and a reduction in Post-Traumatic stress symptomatology as well as a reduction in depression. However, the difference between the yoga alone treatment and the yoga plus TRI treatment was not found to be statistically significant, thus one could postulate that yoga alone would have been sufficient, or that TRI alone would be sufficient.

     It would be interesting to repeat this research with a control (wait listed) group, a yoga therapy alone, and a TRI or more traditional form of therapy alone, and a yoga group therapy along with a more traditional form of talk or re-exposure therapy.

     It is important to acknowledge that there is a major difference between Post-Traumatic Stress in reaction to a natural disaster and Post-Traumatic Stress in reaction to a trauma inflicted upon one human by another. There is an added dimension of betrayal, loss of trust, and loss of connection with one’s community when the trauma is inflicted on the survivor by another human being. 

     This trauma is compounded when the perpetrator was someone with whom the survivor was already familiar with, which is always the case when it comes to domestic abuse, and often the case when it comes to sexual assault.

     In addition, I would imagine, that with soldiers returning from war there would also be the added weight of having sometimes been a perpetrator of trauma- as well as the recipient. However yoga has been shown to be of support to returning soldiers in dealing with their traumatic stress.

     Please do not get me wrong- I am not blaming the soldiers, or any survivors- years ago I attended a conference on ‘the intersectionalities of oppression’ and my personal take away was that we have all been oppressed, and we have all been oppressors. Myself included. As a white woman I have access to certain privileges and these privileges have oppressed others. It is my intent to use my privileges to stand in solidarity with others- much like Marilyn Monroe used her privileges of beauty, fame, whiteness, and wealth to stand in solidarity with Ella Fitzgerald in getting the night club Mocambo to book Ella's shows. (For more info, go here.)

(Reading Paulo Freire's 'Pedagogy of the Oppressed' was insturmental in my views on solidarty. For more, read this)

Stages of Recovery and how yoga can help:

     Raymond Flannery begins his text on Post-traumatic stress and recovery from PTS with a discussion of the phases of PTS.

     The immediate acute phase is characterized by anxiety, fear, anger and “by immediate attempts to restore mastery, attachments, and some purposeful meaning in life” (8). Judith Herman concurs when she states, “The first principle of recovery is the empowerment of the survivor.” (133) Herman also lists healing relationships, reestablishing safety, remembrance and mourning (grieving), reconnecting and finding commonality as essential stages of healing from trauma.

     In my volunteer work as a legal advocate and volunteer yoga instructor for Safehouse Progressive Alliance for Nonviolence (SPAN) all of the women I were in the acute trauma stage, all had just escaped relationships with abusive partners. Thus, it was my goal to provide my clients with the support and encouragement they need in order to re-establish a sense of mastery and experience healing relationships. It was also my goal to create a space where my clients feel safe, where they can grieve, share their stories, and explore their similarities and differences.

     Of course, the first consideration for a survivor is to get away from the abuser, out of the abusive environment, and into a place of safety. Thankfully many women’s shelters do a wonderful job at creating this safe environment.

     Unfortunately, as I know from personal experience, once the survivor is in a safe space s/he often continues to experience hyper-vigilance and an exaggerated startle response.  As shown in the studies discussed above, Yogic breathing techniques can help decrease the symptomatology of hyper-vigilance. Engaging in mindfulness meditations while performing asana (the physical postures of yoga) can help to relieve stress by encouraging the survivor to be completely in the moment for the time s/he is on the mat. The survivor can then take these new perspectives and apply them off the mat. I often say things to my clients like,

“Who we are on the mat is who we are off the mat…. Listen to your thoughts. When you get frustrated on the mat, where does the mind go? Often survivors have incorporated the voice of the abuser into our internal dialogue. How much of what you tell yourself about who you are is the voice of the abuser, and how much of that internal voice is your own compass guiding you to your ultimate destination?” 

Another way in which I support my clients in their quest for safety is to encourage them to listen to their own bodies. Depending on the level of stress the individual clients are experiencing I might bring up an aspect of the trauma such as highlighting:

When we are abused we have lost control of our bodies. Someone else has used our bodies (and often our hearts, our compassion) as a weapon against us. Thus it is an essential part of your healing and empowerment that you listen to your body. If I suggest a pose that you are uncomfortable with, don’t listen to me, listen to your own body. (Emerson et al, 2009)

as trauma expert Bessel van der Kolk has stated, “Unless you befriend your body, you cannot become whole.”

          This perspective also helps to combat the tendency to dissociate when in pain. By encouraging survivors to listen to and respond to the needs of their own bodies the habit of dissociation is lessened. Sometimes this is the first time in years, if not a lifetime, that the client has been allowed to acknowledge and tend to his or her own physiological needs.

     The second concern of recovery is to restore a sense of masteryin the client. When working with my clients I do this by paying attention to their needs and creating a class that will be challenging enough to make them feel like they have achieved something and stretched their boundaries, and yet not so challenging that they end up feeling frustrated. This requires a great deal of attention to detail, and a certain amount of empathy and intuition.  Timothy McCall suggests that intuition is a key skill for a yoga therapist, stating:

“The ability to see student’s, I believe, comes directly from your cultivated ability to see yourself… Intuition is not like clairvoyance… It comes from a deep knowing, some of which may not be verbal but that can be accessed in a holistic way” (145).

In addition, I also try to find plenty of opportunities to praise my clients for something they do well… the key here is that it is honest feedback. Insincerity reeks to survivors, we can smell it a mile away! In addition and it will be triggering, as many abusers have two very distinct personalities, the public personality is very gregarious and kind, the other, more private personality, which often only the survivor is privy to, is the predatory self which is very scary and dangerous. If you are insincere survivors will not trust you.

     Unfortunately, because of the transient nature of the shelter population, I often was only able to work with the clients a few times in their stays, so I focused on giving them the tools to get them through the immediate crisis situation.

     It is my goal to also work with mental health professionals to create a long-term ‘yoga for trauma survivors’ support groups. The longer clients can practice yoga and mindfulness, the more they will see the changes in their focus, strength, flexibility (mental and physical), stress reactions, and stamina. Observing all of these changes will help to restore in the clients a sense of mastery.

     Longer-term group processes will also help to address the next concern of healing, restoring connections with other humans. Abusers work in solitude. As Herman elucidates,

As long as the victim maintains any other human connections, the perpetrator’s power is limited. It is for this reason that perpetrators universally seek to isolate their victims from any other source of information, material aid, or emotional support (79).

Thus reentering into relationships with trust-worthy and supportive people is essential to recovery.

     I know that from my recovery process that one of the most healing endeavors was participating in a recovery group. This was for two reasons. First, often many people who have not been abused don’t want to hear about it, they cannot bear to hear about the horrible things that humans can do to each other because it shatters their illusion that this is a safe and loving world.

     As a result of this they often blame the victim.

     The logic goes something like this; “I cannot believe that we live in a world where horrible things can happen to good people, thus she must have done something to deserve this treatment. To believe otherwise would be to acknowledge that the only thing that stands in between them and trauma or an abuser is luck.”

     Because “… the survivor needs the help of others who are willing to recognize that a traumatic event has occurred, to suspend their preconceived judgments, and simply to bear witness to her tale” (Herman, 68) a trauma survivors support group is an ideal place for a survivor to find a community that will recognize and witness his/her experience.

     The second way in which support groups can help the survivor is to let him/her know that they are not alone. Being with other survivors helps show the survivor that their reaction to the trauma is completely predictable and natural response to their treatment at the hands of an abuser (rapist, etc). Too often we pathologize the survivor and their responses.

     I am not denying that, because of the trauma, the survivor may adopt some coping mechanisms that interfere with their relationships with non-abusive people. Again Herman points out:

In the aftermath of an experience of overwhelming danger, the two contradictory responses of intrusion and constriction establish an oscillating rhythm… (the survivor) finds (him)herself caught in between the extremes of amnesia or reliving the trauma, between floods of intense, overwhelming feeling and arid states of no feeling at all, between irritable, impulsive action and complete inhibition of action. The instability produced by these periodic alternations further exacerbates the traumatized person’s sense of unpredictability and helplessness. The dialectic of trauma is therefore potentially self-perpetuating” (47).

However, these defense mechanisms are natural and predictable, which becomes apparent to survivors as they share their stories within the context of group sessions.

     In addition, “In the aftermath of traumatic life events, survivors are highly vulnerable. Their sense of self has been shattered. That sense can be rebuilt only as it was built initially, in connection with others” (Herman, 61). The establishment of longer term groups with regular participation by a consistent ‘cohort’ group will create a sense of community where survivors can connect with others, explore their commonality and process their grief.

     However trust must first be established in order to create a safe space where the survivors are able to share their experiences with the group. Once trust is established the group members can stand in solidarity with each other and assist each other in reconnecting with others and to learn that they are not alone in their reactions, both of which are essential parts of healing.

     In his book, Yoga and the Quest for the True Self, Stephen Cope discussesthe characteristics of transformational spaces he lists them as follows, they:

 create a quality of refuge;

create safety through consistency in relationship;

encourage creativity and experimentation, are organized around ‘transitional objects’ that are consistent and reliable;

yet do not deify the transitional objects, or themselves;

provide us with a way of finding out who we are;

do not have to be perfect;

and finally, they are open to, and support, other paths to development. (27-31)

     It is my belief, and Cope concurs as it was also his experience, that yoga groups, when practiced with a consistent group of people and under the guidance of a compassionate instructor, can create such a transformational space.

     It is within these transformational spacesthat survivors can gently come to recognize the coping mechanisms that helped to protect them at one time but that now are doing them and their relationships harm.

     I have also found that some of the coping mechanisms still have a place in my life, and can actually be identified as strengths, when used mindfully rather than reactively.

     For example, because I have access to dissociative states I can slip into a calm meditative state more easily than others might. I can also keep my cool in stressful situations because nothing I encounter on a daily basis now compares to the violence I have known. Also, because my boundaries were violated and I had to be in tune with the moods of my abusers I am highly empathetic and am able to intuit the emotional states of others more easily than people who have more rigid boundaries. (I am not saying that dissociation and meditation are the same thing-just that my experiences have helped me to calm my mind.)

     Through a mindful yoga practice, engaged in with a consistent group of people, where we have the time to discuss our experiences and those things we learn about ourselves when we observe the mind, we can learn how to mitigate the negative aspects of our coping mechanisms while learning to recognize and embrace our unique strengths.

     However, we need a safe space, a transformative space, in which to explore these paradoxes before we will ever come to know them.

     I think that the most difficult part of recovery is the final one, finding meaning in the events. For me, personally, I have made sense of the events by working with other survivors, and by using my experiences to practice compassion and to explore wisdom.

     I acknowledge that because of the trauma I have suffered I am more able to witness and join in solidarity with other survivors in order to support them in their healing. Had I not survived these experiences myself I may not have been able to meet the needs of the survivors that Herman discusses:

“… the survivor needs the help of others who are willing to recognize that a traumatic event has occurred, to suspend their preconceived judgments, and simply to bear witness to her tale” (68).

Conclusion:

         Because of my own personal experiences I am intimately aware of how movement, whether dance or yoga or equine therapy, and mindfulness, can help to alleviate the symptamotology of Post Traumatic Stress. I am also aware of how mindfulness can help survivors observe their triggers, become aware of the coping mechanisms that are no longer helpful, and also become aware of the strengths that we possess because of our experiences.

     I possess this knowledge in body and mind and am thus motivated to research the subject so I can support this personal knowledge with intellectual/scholarly knowledge.

     Although many studies have already been done on the subject matter, I believe more studies need to be done. It is my intent to work with mental health professionals to engage in said research. It gives meaning to my experiences when I share this knowledge through teaching others. Thank you for allowing me this honor.

Namaste.

(The divine in me bows to and honors the divine in you)

To start at part one- go here.

I am very open to feedback, or suggestions for edits!

Please feel free to go to my facebook page in order to do so.

Bibliography:

Scaer, Robert (2005). The Trauma Spectrum: Hidden Wounds and Human Resiliency. WW Norton, NY, NY.

Herman, Judith M.D. (1992). Trauma and Recovery: The Aftermath of Violence- from domestic abuse to political terror. Basic Books. NY, NY.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition. Washington, DC.

Emerson, Sharma (PhD), Chaudhry & Turner. Trauma-Sensitive Yoga: Principles, Practice, and Research. International Journal of Yoga Therapy; 2009;19,123-141.

‘Effects of a yoga breath intervention alone and in combination with an exposure therapy for post-traumatic stress disorder and depression in survivors of the 2004 South-East Asia tsunami’ Acta Psychatrica Scandanavia 2009: 1-12.

Flannery, Raymond B. JR, PhD. (1992). Post-Traumatic Stress Disorder: The Victim’s Guide to Healing and Recovery. Crossroads. NY, NY.

Kabat-Zinn, Jon PhD. (1990,2009). Full Catastrophe Living: Using the wisdom of your body and mind to face stress, pain and illness. Bantam Dell. NY,NY.

McGonigal, Kelly PhD.  A Conversation with Timothy McCall, Md. International Journal of Yoga Therapy; 2009,19,143-147

Cope, Stephen (1999). Yoga and the Quest for the True Self. Bantam. NY, NY.