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2019 – Trauma Centre Trauma Sensitive Yoga (TCTSY)

TRAUMA CENTRE PROJECT

Phoenix Support and Advocacy Service facilitated the opportunity for this Trauma Centre Trauma Sensitive Yoga (TCTSY) research project. The project was co­ordinated by Coby Greer, Phoenix senior counsellor and yoga instructor as an aspect of a 300-hour train­ing course Coby was undertaking with TCTSY with the support of Phoenix. The purpose of this study was to explore the experiences of six women who participated in an 8-week trauma-sensitive yoga (TCTSY) program at Phoenix as one aspect of Phoenix’s innovative and holistic Trauma Transformation program, and the part it played in their healing and recovery process. The proj­ect ran over 2 x 4-week blocks, in conjunction to the ongoing therapeutic services the women received from the Phoenix clinical team.

To know ourselves we need to feel and interpret our physical sensations, increase the awareness of what our bodies need so that we can take care of ourselves and navigate through life in a safe and stable way. People living with complex trauma chronically feel unsafe in their bodies and need to learn how to re/connect by feeling and accepting their physical sensations and in­ner landscapes (van der Kolk, 2014). Van der Kolk (2014, p.275) states that once you start approaching your body with curiosity rather than with fear, everything shifts.

According to Rhodes (2015, p.247) women who have ex­perienced childhood trauma often feel a disconnection to their bodies which fractures the development of ‘self’ and relationship to others. Through their body women manage their traumatic stress symptoms, such as flash­backs, nightmares, intrusive thoughts and overwhelm­ing emotional responses, often developing conscious and unconscious avoidant behaviours. Trauma-sensitive yoga is a tool that can support women to reconnect to their body and emotions, within a safe and supported structure, held by a qualified practitioner.

The participants were chosen from clients already par­ticipating in one on one counselling at Phoenix and following a group readiness screening process to as­sess their suitability to attend the 8-week program. The majority of the participants engaged throughout the program. Four of the six women who commenced the 8-week program provided self-reported feedback, all participants completed evidence-based measures for distress, anxiety and PTSD, one participant irregularly attended the 8-week program and one participant with­drew from the 8-week program after the second week.

The TCTSY approach is based on invitational language, choice-making, non-coercion, shared authentic experi­ence and Interoception which promotes empowerment and agency to participants. Judith Herman (1997, p.159) states that trauma robs the victim of a sense of power and control and so it is imperative that recovery is based on the restoration of power and control and a sense of personal safety. Herman (1997) identifies that safety and control needs to start from within the body before it can be established outwardly in the environment.

The TCTSY project quickly developed a sense of safety and group cohesiveness. The reasons for this are varied including; anecdotal reports of the women forming a connection as participants of psychoeducational groups conducted by Phoenix and participation of a Phoenix counsellor in the weekly yoga practice. The participants reported;

“I could not feel any safer. Thank you.”

“[I most liked] the beautiful feeling of being cared for and self-caring.”

“My body can be a safe place and also be a place of relaxation.”

“[Increased awareness of] how much I neglected myself by resisting being aware of my body. I was able to relax and feel peace.”

One of the learnings from neuroscience is that a sense of self can only be realised through the vital connection with our bodies (van der Kolk, 2014). TCTSY supports participants in developing a relationship with their body through the process of Interoception and choice-mak­ing by interacting with what is happening in their bodies at that present moment. The impact of the neurobiolo­gy of Interoception in relation to the practice of TCTSY is on the function of the anterior and posterior insular cortex in the brain (seminar 10 November 2018). The anterior insular cortex relates to survival, self-awareness and internal states of being which is of most interest to TCTSY, whilst the posterior insular cortex relates to the interpretation and perception of these sensory experi­ences, which ultimately formulates our self-identity and belief systems (seminar 10 November 2018).

In this study there were significant changes in the par­ticipants’ level of distress through the 8-week program. The K10 and DASS21 are non-diagnostic quantitative measures for distress and depression, anxiety and stress respectively. These self-reporting assessments are sug­gestive of a client’s level of distress for the counsellor. The combination of measurement tools and self-report­ing feedback was used in evaluation. These results were mixed across the cohort. Quantitative results showed no significant change to distress levels over the 8-week TCTSY program. However, some participant’s qualita­tive feedback indicated that Participant 1 (P1) made significant connection to her body resulting in the ac­tivation of her parasympathetic nervous system stating;

“How good it feels to tune into your body, and having feelings of belonging, acceptance and total relaxation.”

Participant 2 (P2) showed a significant reduction in her anxiety score through the 8-week program. With P2 re­porting that she practiced being in her body at home between yoga sessions. Self-reported feedback sug­gests consistency and predictability of the practice each week helped manage her anxiety;

“I like hearing repetition as I forget things such as in­formation about the body being rigid is not the natural state and the body gets shocked if raised too quickly.”

“[I’m] feeling present in my body even though other thoughts were intruding.”

“[My biggest learning is] how my mind perceives things [that] my body experiences that I didn’t know.”

Participant 3 (P3) had score increases indicating higher stress levels and anxiety through the 8-week program. During this time P3 was triggered by noteworthy life events, as well as nightmares and flashbacks. P3 report­ed that the TCTSY practice was generally not impacting her connection with self. P3 did not appear to make any linkage to TCTSY and her recent flashback experiences and reported that she engaged in some self-harming activities to manage her anxiety over part of this time. However, the practice of working with the body can im­pact participants on an unconscious level. Noticing sen­sations for the first time and making new neurological pathways can be potentially triggering and distressing, and this may precipitate flashbacks and somatic re-en­actments (van der Kolk, 2014).

Participant 4 (P4) demonstrated a discernible reduction in her K10 and DASS21 scores. P4’s self-reported feed­back concurs with outcomes of Rhodes (2015) study where participants experienced an improved sense of agency and control over their lives.

“[I] feel a lot less anxious when attending this class and [I’m] not letting my brain lead [I’m] going with what my body wants.” P4 reported she was practicing TCTSY regularly at home to supporting her with the triggers and stressors, ceased taking her anti-depressant med­ication under the supervision of her GP, and feels that the combination of counselling, her positive shift in atti­tude and yoga can sustain her sense of well-being.

Dissociation refers to the compartmentalisation of ex­perience (van der Kolk & Fisler, 1995, p.4). This is where traumatic memories are not integrated as a whole due to the extreme emotional arousal of the initial event/s and therefore, cannot be recalled and translated in­to personal narratives; rather traumatic memories are stored as sensory and emotional fragmentations of the initial event/s, such as visual images, sounds, smells and physical sensations, and can manifest as flashbacks and nightmares (van der Kolk, Hopper & Osterman, 2001; van der Kolk, 2005). These flashbacks and nightmares are somatic re-living of the initial trauma such as fight, flight and freeze responses (van der Kolk & Fisler, 1995). Dissociation and the lack of integration of traumatic memories are core symptomology of post-traumatic stress disorder (PTSD). Herman (1997) suggests that avoidance and constriction are strong features of PTSD. A positive outcome of the TCTSY program is that two participants demonstrated a ‘choice’ to move towards their sensory experiences leading them both to practic­ing yoga outside of the studio. Their reflections include;

“I am important. Recognising big chunks of time where I have been existing in the window of tolerance while motivated to do uncomfortable things in the days in be­tween”,

“Noticing my individual needs”, “Not letting [my] brain lead going with what my body wants” and

“[My biggest learning was my] parasympathetic nervous system [and] how you can switch it on and off with dif­ferent moves.”

Herman (1997) states that this sense of avoidance re­lates to every aspect of a person’s life, from sensations to relationships. Interestingly during the TCTSY pro­gram P4 has not only been deepening her connection to self but also to her partner and son. P4 reported that she has started to express her needs and having con­versations with her partner about intimacy and how she would like that to look. P4 reported being more reflec­tive and noticing how some of her behaviours may have contributed to some barriers in the relationship. P4 stat­ed that she has noticed a positive change in her son’s behaviour since she has become more regulated result­ing in her feeling more energised and less depleted. P4 seems to have developed a greater capacity for self-ob­servation and a tolerance to hold inner discomfort. This was not the experience of all the participants, P1 had a slight increase in her PTSD symptoms whereas P3 re­ported increased incidents of PTSD symptoms. How­ever, the majority of participants reported the positive outcomes for them;

“I came to this session today feeling like ‘I didn’t want to be here’. The old feeling of ‘wanting to run’ is quite strong at the moment. Nice to stop and purposely ‘cen­tre’ oneself again. Thank you.

‘Survival’” and “[My biggest learning is] how much physical pain is trapped in my body.”

P3 reported in the first half of the TCTSY program that she was experiencing a life-affirming shift towards self-acceptance where she was letting go of the un­realistic expectation of how she should be; letting go of wearing a mask and playing a role. Over the festive season and during the second half of the program P3 experienced some significant life events resulting in her dissociation and operating outside of her window of tolerance. P3 reported that she wasn’t sleeping and experiencing flashbacks and nightmares with themes of disintegration and disconnection.

Interestingly it appeared that the therapeutic alliance intensified during this time where P3 made some shame-related disclosures about her identity and sexu­ality which she had never revealed previously in session. Herman’s (1997, p.194) suggests that this is P3’s frag­ile beginning of compassion for herself. As P3 mourns and connects with her shame and true identity she may perhaps experience a sense of renewal where nothing needs to be hidden any longer.

“That when I felt [a] choking feeling recognising it was because of [the] movement I was making.”

“[I had] a brief sense of being in my body looking through my eyes.”

Whilst this sample was too small [8] to conclude the effectiveness of TCTSY for all clients of Phoenix Sup­port and Advocacy Service, it does provide the posi­tive aspects of the program for these participants. The self-reported feedback clearly indicates increased un­derstanding and cognitive awareness of participants.

Outcomes: What this study did provide was an informed narrative of the women’s healing journey by drawing meaning from their weekly evaluations and therapeu­tic interventions. TCTSY did provide the women with a new way of experiencing and making choices for them­selves, and for some, developing empowerment and agency for the first time in their lives. Simply noticing what you feel can foster a sense of who you are.

COBY GREER SENIOR COUNSELLOR ACCREDITED TRAUMA SENSITIVE YOGA FACILITATOR

References

• Australian Bureau of Statistics, 2016, Personal Safety, cat. No. 4906.0, viewed 16 February 2019, https://www.abs.gov.au/ausstats/abs@.nsf/ Lookup/4906.0main+features12016.
• Emerson, David. Interoception. 10 November 2018, Boston.
• Herman, Judith. (1997). Trauma and recovery – The aftermath of vio­lence – From domestic abuse to political terror. New York, NY: Basic Books.
• Kinniburgh, Kristine Jentoft, et al. Attachment, Self-Regulation and Competency. Psychiatric Annals, vol.35, no. 5, May 2005, pp. 424-430.
• McCarthy, Linda, et al. Assessment of Yoga as an Adjuvant Treatment for Combat-Related Posttraumatic Stress Disorder. Sage Journals, March 2017, https://journals.sagepub.com/doi/ abs/10.1177/1039856217695870.
• Rhodes, Alison, et al. Yoga for Adult Women with Chronic PTSD: A Long-Term Follow-Up Study. The Journal of Alternative and Comple­mentary Medicine, vol. 22. No. 3, 2016, pp. 189-196.
• Rhodes, Alison M. Claiming Peaceful Embodiment Through Yoga in the Aftermath of Trauma. Complimentary Therapies in Clinical Prac­tice, vol. 21, 2015, pp. 247-256.
• van der Kolk, Bessel A. Editorial Introduction: Child Abuse and Victim­ization. Psychiatric Annals, 2005, pp. 374-378.
• van der Kolk, Bessel., & Fisler, Rita. Dissociation and the Fragmentary Nature of Traumatic Memories: Overview & Exploratory Study. 1995. http://www.trauma-pages.com/a/vanderk2.php.
• van der Kolk, Bessel A., Hopper, James W., & Osterman, Janet E. (2001). Exploring the Nature of Traumatic Memory: Combining Clin­ical Knowledge with Laboratory Methods in Trauma and Cognitive Science. New York, NY: Haworth Press.
• van der Kolk, Bessel. (2005). The body keeps the score – Brain, mind, and body in the healing of trauma. New York, NY: Penguin.

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