- Yoga Therapy for Trauma and PTSD
- Post-Traumatic Stress Disorder: A Background
- The Physiological Characteristics of PTSD
- Why Use Yoga as an Adjunct Treatment for PTSD?
Thought to be caused by a dysregulation of the autonomic nervous system, PTSD affects the survivors of trauma. With growing evidence to suggest that yoga can aid in PTSD recovery, this guide offers an introductory exploration of yoga’s potential as an adjunct treatment for post-traumatic stress disorder.
It’s an unfortunate fact that many people will encounter significant trauma at some point during their lives. For most, the weeks or months of upset in the aftermath of a traumatic event will eventually pass, and they will be able to move on. For others, however, the development of post-traumatic stress disorder stands in the way of a return to normal life.
Yoga Therapy for Trauma and PTSD
Post traumatic stress disorder is a challenging illness that can come to dominate the lives of those it affects, and a variety of strategies are often required to manage the emotional and physical symptoms that define it. The use of evidence-based techniques from yoga and mindfulness to aid in the recovery of PTSD is a promising area of yoga therapy, where emerging scientific research points toward several mechanisms through which yoga can reduce symptoms of PTSD.
“The fact is, all of us are living with the invisible wounds of some kind of war. Yoga helps you to let go of the things that don’t serve you anymore.”Dan Nevins, yoga ambassador and US Army veteran
Yoga can be such an efficacious treatment for PTSD because it works with both the mind and the body, while also helping to forge a sense of safe community from which individuals can draw comfort and support. Alongside medication and psychotherapy, yoga therapy can be a valuable part of a person’s medical care – as well as a self-care tool they can fall back on in their own time.
By combining a comprehensive knowledge of the neuroscience, psychology and physiology of trauma with yogic techniques, yoga therapists can gently guide PTSD sufferers towards recovery in an informed and safe way. Furthermore, they can work within the framework of a wider treatment plan and help individuals fully engage with counselling or therapy.
Post-Traumatic Stress Disorder: A Background
“After a traumatic experience, the human system of self-preservation seems to go onto permanent alert, as if the danger might return at any moment.”Judith Lewis Herman, psychiatrist
Most of us are introduced to the idea of post-traumatic stress disorder in the context of the military. While there are written descriptions of symptoms that are analogous to our modern understanding of PTSD as far back as the Ancient Greeks, the illness first entered popular consciousness through the phrase “shell shock” – a term invented to characterise the long-term effect trench warfare had on some soldiers during the First World War.
Since then, understanding and sympathy around PTSD has grown. Anyone who is frequently exposed to life-threatening or traumatic situations (such as soldiers, paramedics and firefighters) is at risk of developing PTSD, but it can also affect those who have lived through traumatic incidents such as violent/sexual assault, serious accidents or a difficult labour.
PTSD is thought to affect one in three people who experience trauma. It is still unknown why some individuals will develop this illness while others do not, but it is thought that inadequate support in the immediate aftermath of experiencing or witnessing a traumatic event may elevate the risk.
The symptoms of PTSD include:
- Re-experiencing the traumatic event through flashbacks, nightmares and physical sensations.
- Avoidance of anything that reminds the sufferer of the event. They will also push away feelings and memories, and can experience emotional numbness and dissociation.
- Hyperarousal and constantly feeling “on edge”, often associated with hypervigilance, irritability and insomnia.
- Co-occuring issues such as anxiety, depression, alcohol/substance misuse and relationship breakdown.
A variant form of PTSD can also appear when people have lived through ongoing stress or fear, which is defined as complex post-traumatic stress disorder (or c-PTSD). People are more likely to develop c-PTSD if they endured trauma at an early age, have experienced multiple traumas or if their trauma lasted a long time, such as in cases of childhood abuse.
The Physiological Characteristics of PTSD
When we experience or witness a life-threatening, violent or otherwise traumatic event, our nervous system will activate a defensive biobehavioral response – an instinctive “survival mode” – which can manifest itself in two disparate ways:
The fight/flight response, where an individual’s sympathetic nervous system (SNS) is activated in order to equip the body with the means to fight or run away from a threat.
The shutdown/freeze response, which is the activation of an evolutionarily older branch of the vagus nerve. This creates stillness (in order to avoid detection or play dead) and can induce dissociation.
While the trauma itself was likely to have been unsafe, uncontrollable and unpredictable, a person may also perceive their body’s response to it as equally dangerous and unstable. The dissociation and inability to move induced by the “freeze” response can be extremely disturbing, while the rush of energy and shutdown of higher cognitive functioning associated with fight/fight may be remembered as a frightening loss of control.
This trauma – and the bio-behavioural response it provokes – can be overwhelming, leading to the memory of the event and its attendant images, sensations and emotions becoming dissociated from normal conscious experience. It is then subsequently re-experienced through flashbacks, nightmares and other sensations, accompanied by the defensive reactions the trauma originally triggered.
For those living with PTSD, the dysregulation of their body’s defensive response (1) means they release higher levels of stress hormones, and react even in benign situations as if they are under threat. Experiencing a chronic activation of the fight/flight response, they exhibit hyperactivity in the amygdala (the area of the brain that meditates fear) and changes in the hippocampus, a part of the brain associated with memory and emotions. They may also experience anhedonia (the inability to feel pleasure) and dissociation.
Why Use Yoga for Trauma as an Adjunct Treatment for PTSD?
“Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going inside ourselves.”Bessel A. Van Der Kolk, psychiatrist and author.
Trauma affects individuals physiologically, cognitively and emotionally, with the ramifications felt in both mind and body. Yoga therapy acts across all these domains, leading those with PTSD to increasingly turn to this mind-body practice in their journey towards recovery.
A key challenge for someone suffering with post-traumatic stress disorder is the inability to regulate their physiological survival response. As an instinctive and unconscious reaction, a person can rationally know they aren’t in danger while still experiencing hypervigilance and even panic. Achieving stabilization of the autonomic nervous system (ANS) through yoga can help people engage with counselling and psychotherapy, allowing them to begin to process their trauma.
Yoga therapy may help people return to a baseline physiological state more quickly after a distressing memory is triggered. It’s thought that regular yoga practice trains the ANS to be more dynamically adaptive (2), and that mindfulness meditation (a component of yoga) can lead to positive changes in neural functioning, including the reduction in size of the amygdala and increased hippocampal volume (3).
Trauma survivors can experience a disconnect between mind and body, and exhibit a lack of body awareness. This is both a form of avoidance as they seek to circumvent any feelings or sensations that remind them of their trauma, and a result of the hyperarousal that renders bodily reactions unpredictable and disconnected from conscious thought.
Body awareness is an intrinsic part of yoga, and can help people “build skills in tolerating and modulating physiologic and affective states that have become dysregulated by trauma exposure” (4), which is associated with lesser symptom severity. In a yoga class, people can learn to better cope with the defensive responses that proceed re-experiencing, as traumatic memories (or other triggers) arise in the internal and external environment of nonreactive mindful awareness (5).
As people with PTSD are physiologically primed for threat, their ability to socialise and cope well around others can be severely diminished, and even their closest relationships can become strained. A yoga class gives them the opportunity to socialise in a self-directed and natural way, finding support among peers without the expectation to engage beyond their current comfort zone.
Post-Traumatic Stress Disorder is an illness that often requires an individualised and multifaceted response, and no two people’s experience of trauma will be the same. Yoga therapy is effective tool that addresses PTSD on a variety of levels, allowing people to move forward and find a new life after trauma.
To find out more about the science behind yoga for PTSD, order your copy of Yoga for Mental Health.