July 13, 2013

Treating Trauma with Yoga. ~ Nicki Mosley

Photo: Nicki Mosley

Yoga provides a fragmented trauma survivor the opportunity to re-integrate body and mind—to yoke.

“In a real sense all life is inter-related. All men are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly affects all indirectly. I can never be what I ought to be until you are what you ought to be, and you can never be what you ought to be until I am what I ought to be. This is the inter-related structure of reality.”

~ Rev. Martin Luther King, Jr.

Yoga has been one of the richest and most humbling relationships in my life. The complex system of movement, breath, mantra and text sustains a never-ending journey of discovery fuelled by curiosity. My yoga practice provided a foundation to launch into a Masters of Social Work and lead me to a four-month internship with David Emerson; he is the Director of Yoga Services at the Trauma Center  in Boston and co-author of Overcoming Trauma Through Yoga. This has led to my present experience of seeing two complex worlds collide–trauma and yoga. I argue that the western-Eurocentric, allopathic capitalistic framework that guides mainstream trauma intervention needs to strengthen the integration of body-oriented approaches to recovery. The complexity of trauma must be re-evaluated in order to respond with appropriate interventions for healing. 

I invite readers to consider yoga, a complex system of applied knowledge, as an intervention tool for trauma recovery.

This technical approach responds to the intersectionality of traumatic experiences and their impacts on the brain and body of the survivor. Through attending the International Trauma Conference, it became apparent to me that a clear understanding of trauma remains evasive; complexity continues to both intrigue and mystify scientific researchers.

Clinicians and researchers typically categorize the range of symptoms experienced as a result of trauma. This supports clinicians through diagnostic processes using the Diagnostic and Statistical Manual of Mental Disorders (DSM) in addition in diagnosing and creating treatment plans for clients experiencing multiple disorders. 

There is recent research, spearheaded by Bessel van der Kolk, that demonstrates the challenge associated with compartmentalizing symptoms of trauma—something that is complex in nature—rather than demanding an intervention that is equally complex to mirror a recovery process. Trauma has been pervasive in the human experience since pre-historic times. The fight, flight and freeze responses to immediate life threats are imprinted on the human DNA.

The symptoms and outcomes of these responses have led humans to become increasingly curious about exploring the impacts and implications of trauma on the human body, mind and soul.

At the Trauma Center in Boston, researchers are investigating the different layers of interaction between the body and mind, acknowledging the complexity of trauma. Complexity is defined as, “natural patterns in life embedded in the notion that current conditions inform what will develop in the future” (Westley, Zimmerman, & Patton).

The notion of complexity—as the interaction of diverse threads informing the present moment to evolve into the future—is demonstrated within the portraits of soldiers pre-combat as well as during and post-combat.

The blog post of  Portraits of Soldiers Before, During, and After War, a project by photographer Lalage Snow, struck me as physical proof and evidence of the complex nature of trauma.

When the project, ‘We Are The Not Dead’ launched, the photographer received criticism regarding the play on lighting to shift the images. He responded in an interview with My Modern Met:

“Lots of people have criticized my use of light—saying that I have clearly stylized the ‘during’ shot to make the soldiers look better. Ha! If only I knew how to do that! I have never worked with artificial light—least of all in the middle of a desert in Southern Afghanistan. The before and after shots were taken in an army barrack room outside Edinburgh so the light is cold and Scottish. The light in Afghanistan is very special and a world away from Scotland. I come from a school of photography which does not condone heavy post production methods and trickery, either.” (Pinar, 2013)

This quote from the photographer provides proof that the delicate shifts we see are not due to the manipulation of light or technical airbrushing techniques. To me,these images of soldiers demonstrate the subtle yet profound impacts of trauma on the physical level. In addition, looking into the windows of their soul at the despair and vacancy offers evidence of impact on their layers–evidence of the complex nature of trauma. Emerson and Hopper state,

“Emotional pain and traumatic memories can be “stored” in the body long after exposure to a traumatic situation has ended…Storing traumatic memories, and the associated emotional tone, is evolutionary adaptive. We need to remember dangerous or threatening situations so that we can try to avoid these situations in the future. But holding these memories in our bodies, in a physical and emotional sense, can create a great deal of discomfort and distress.”

Emerson and Hopper speak to the stored traumatic memories we see within the soldiers images and the distress and discomfort that may be associated with the memories. Even the way the brain and body store explicit and implicit memories is complex in nature. There are experiences of trauma survivors who are unable to narrate their story of trauma due to parts of the brain being deactivated during a traumatic experience. This leads to the body being the container for somatic memory. According to Emerson and Hopper, the domino effect of a situation like this is that the body stores trauma memory through sensations, the sensations become increasingly alarming and the body slowly becomes an enemy for the trauma survivor. 

The complexity of trauma is not only evident within neurobiological impacts and outcomes and symptomology, it also demands a complex response to recovery.

Due to the complexity of a wounded past, if one chooses a pathway of healing, it may be a dynamic and challenging trajectory; the experience of isolation on this pathway slows and may diminish the recovery process. I believe if healing is not selected or accessible to a person, their wounded state ripples into the web of humanity impacting those directly and indirectly interacting with their lives. “People might experience their bodies as the “enemy”…not able to truly connect with others because [they] are not in touch with [them]selves.” (Emerson & Hopper)

The health care system and social services aim to support and carry the burdens of trauma survivors while corporate pharmaceutical companies thrive and prosper through providing drugs to relieve post-traumatic stress disorder (PTSD) symptoms; this is a far cry from healing. However, if attentive to the interconnected threads at play in trauma, healing requires a strong and complex network of internal and external resources to respond. In her book Trauma and Recovery, Judith Herman states, “recovery…is based upon the empowerment of the survivor and the creation of new connections. Recovery can take place only within the context of relationships; it cannot occur in isolation.”

The challenge for those who have survived trauma is to live in safety and comfort.

Evolving and developing coping mechanisms for living in a threatening and unpredictable environment and also developing healthy relationships are critical to ease this challenge. Judith Herman suggests a starting point for recovery from trauma is establishing a healing relationship in conjunction with solidifying internal and external safety. It is valuable to acknowledge that within many societies and world views, these starting points are common sense–incorporated into community systems, cultural belief and value systems and traditional healing methods.  However, within the western—Eurocentric—capitalist society, the process of unlearning some of the limited approaches to healing is just beginning. 

One of the tools being researched and accessed is yoga for recovery from trauma.

The health and social service professions are still in the early stages of embracing yoga as an intervention tool to serve those seeking a pathway of healing. The journey I walked with yoga has certainly brought me into relationship with body and the subtle layers of breath.

Instead of my body being an enemy housing pain, I watched my relationship with it evolve into one of compassion evoked through attentive listening and gentle action. I would be hard pressed to deny that this deepened ownership within being and body has not impacted the relationships in my external world—deeper listening and understanding within has prompted the same patterns to emerge in community.

As Rev. Martin Luther King Jr. boldly states in the opening quote for this article, “I can never be what I ought to be until you are what you ought to be, and you can never be what you ought to be until I am what I ought to be.”   

A 10-week trauma-sensitive yoga (TSY) program revealed a 33 percent decrease in PTSD symptomology.

Research findings demonstrate the role yoga may play to support a person become who they ought to be. (Emerson and Hopper)

The challenge for those living with PTSD to live in the present as, “shifting their orientation from the trauma to the now…it can be terrifying for many survivors to “let their guard down.”  Within complex trauma situations of repetitive long-term trauma, people develop chronic impairment with self-regulation and effective action. This is a reaction to a history of fight or flight responses not providing safety. Within this experience of trauma, some neurological pathways are activated and others are deactivated in order to deal with the environmental challenges being experienced. 

The activation and deactivation of pathways supports the person to cope and survive; over the long-term, however, these coping skills become ineffective within diverse contexts. For example, a traumatized person may have a hard time sustaining attention with focus and working memory–a challenge remaining in the present—due to consistent hyper-vigilance and hyper-arousal that were once survival skills in the traumatic environment. 

In addition, the ability to identify physical sensations in correlation with emotions and feelings becomes fragmented and often numbed. This contributes to limitations in vocabulary to express what they are feeling often leading to inappropriate behavioural reactions to express one’s emotions. Dr. Bessel van der Kolk explains, when a traumatized person is asked to focus on their internal emotions and feelings, a sense of being overwhelmed often ensues. 

With limited cognitive and social coping skills, survivors’ stress levels increase–all contributing to different health conditions. The outcomes of the ACE (adverse childhood experiences—childhood abuse, neglect and other traumatic stressors) study conducted by the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego,  demonstrates that two-thirds of the 17,000 participants reported at least one ACE. The short and long-term effects of these childhood exposures contribute to multiple health and social problems such as: alcoholism, depression, drug use, intimate partner violence, suicide attempts, sexual promiscuity etc..(Center for Disease Control and Prevention)

Trauma sensitive yoga invites a person in recovery from trauma onto a path of ‘mastery’.

According to van der Kolk, mastery is a physical experience where one has a feeling of being in charge, calm and able to engage in focused efforts to accomplish goals. This engages a person on a path of re-development and learning to master and ‘own’ one’s experience as part of the present—supporting a transition from living out their impulses (reflexes, movements, sensations) to an experience of having them, observing them and choosing responses. 

“Yoga is fundamentally a body-based activity, so we reach an impasse: how can we make this body-based activity accessible and tolerable when the body has become the enemy?” (Emerson & Hopper)

TSY supports those in recovery to explore their body mind connection that initiates a relational journey with their body and internal environment. Emerson states, “our focus is on the relationship to self and how does that fit into the context of trauma treatment and the process of healing.” Supporting a person to move through and heal from a complex internal condition demands an accessible response that offers a complex reflection.

Verily, the eight-limbed yogic system deems a lifetime of study and practice to gain insight into the subtle interactions of body, mind,and soul. One’s relationship with yoga is intimate and personal. Within the text, 21st Century Yoga, a collection of essays from leading yoga practitioners offering “critical perspectives on a contemporary practice”, there was no single definition everyone subscribed to; definitions were even contradictory at times.  

Feuerstein claims that yoga is spectacularly multifaceted and as such, it is difficult to define because there are exceptions to every conceivable rule. Each experience within yoga is personal; the interactions complex; the relationship—authentic.

The English translation of the Sanskrit term yoga is ‘to yoke, union’.

Therefore, why not invite a person fragmented by trauma into a system of practice which is defined as ‘union’ to support their process re-integrating their fragments? 

I think the application and further investigation of trauma sensitive yoga as an intervention for trauma recovery is the next responsible step within a therapeutic setting to reflect and support re-integration. After attending the International Trauma Conference, I reflected upon the multiple presentations on trauma. Within several different workshops, the concluding remarks were: to support change, we must change the relational experience.

Yoga provides a fragmented trauma survivor the opportunity to re-integrate body and mind—to yoke. As Rev. Martin Luther King, Jr was quoted by Peter Levine, “in a real sense all life is inter-related.  All men are caught in an inescapable network of mutuality, tied in a single garment of destiny…This is the inter-related structure of reality.”

The complex nature of trauma needs an intervention of equal complexity to support the journey of recovery.

Yoga can support a trauma survivor to unfold deep layers of memory through engaging in relationship with their body.

However, as a person embarks on this journey of re-integration, accessing talk therapy through the process will support a safe assimilation of the past.



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Assistant Ed.: Stephanie Sefton/Ed: Bryonie Wise

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