Yoga Therapy for PTSD: A Multidimensional Approach

 The Minded Institute (TMI) is a world-leader in providing yoga therapy education and training to yoga and health professionals to work with mental and physical health conditions. The Institute is known for working at the interface between yoga therapy, mindfulness, neurophysiology, psychotherapy principles, and evidence based practice. TMI is also actively involved in lobbying for the inclusion of yoga therapy and yoga in the NHS.

Founded by Heather Mason, The Minded Institute grew out of her own personal experiences with deep depression, Complex PTSD, and anxiety. After years of practicing yoga and meditation, Heather experienced the profound effect these ancient disciplines can have on self-healing and so decided to devote her time to the creation of programs that had a positive effect on the psychological and physiological challenges that are inherent in a variety of mental and physical health issues. Combined with the extensive academic study of Buddhism, Psychology, Psychotherapy, Neuroscience, Yoga Therapy and Mindfulness, Heather effectively combined ancient mind-body practices with modern scientific insight and created The Minded Institute.

The Minded Institute are the only yoga therapy training organisation in the world to have diploma courses accredited by the British Council of Yoga Therapy, the International Association of Yoga Therapists and the National Council of Integrative Psychotherapists, and so we’re incredibly proud to be working with them.

In this guest blog from The Minded Institute, we look at the link between PTSD, C-PTSD, the nervous system, and how yoga can help support recovery from trauma.

WHAT IS PTSD?

“Trauma can be considered as an event which overwhelms our capacity to cope and respond, often leading to a sense of being helpless and hopeless. In the wake of a traumatic event, it’s common to feel on edge or ill-at-ease, a feeling often accompanied by disturbing memories or difficulty sleeping. The experience of trauma can strongly impact our sense of safety and trust, not only towards external situations and people, but also for ourselves and our own judgments.

Whilst it is estimated that 50% of people will encounter significant trauma at some point during their lives, for most, the short-term distress caused by a traumatic event will often fade into a memory. However, for 20% of people who experience a traumatic event, these symptoms can last for months or years, leading to a diagnosis of PTSD; a condition of complex symptomology that can topple a person’s ability to engage with life in a healthy and clear way.

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. Common causes of PTSD include sexual assault, combat, domestic abuse, living in war torn countries, childhood abuse, and micro-aggressions.

A specific form of PTSD is often diagnosed when people have lived through ongoing stress or fear, particularly if they endured trauma at an early age. Defined as complex post-traumatic stress disorder (or c-PTSD), this type of PTSD is most likely to affect those who have experienced multiple traumatic events or chronic trauma, such as in cases of childhood abuse. Notably, when complex trauma occurs in childhood, it is often termed developmental trauma, and negatively influences the neural psychological development of the young being.

THE NERVOUS SYSTEM AND PTSD

Trauma is well-known to influence the nervous system. PTSD is characterised by emotional distress, disturbing memories, flashbacks, disconnection from the body, reduced ability to regulate emotions, periods of feeling hyperaroused and periods where a person may feel frozen and disengaged. All of these symptoms relate to dysregulation within the nervous system. The part of the nervous system most commonly discussed when describing PTSD is the autonomic nervous system (ANS). Part of the peripheral (as opposed to the central) nervous system and composed of the brain and spinal cord, the ANS is compromised of two main branches: the sympathetic system known for mobilisation, and the parasympathetic system known for ‘rest and digest’ states. Recent iterations of the ANS include the perspective that parasympathetic system is better described as the vagal branch, so named as it is mediated by the tenth cranial nerve, the vagus. One aspect of the vagal branch, the ventral circuit, is responsible for calm, ease, and healing. The other aspect, the dorsal circuit is associated with the freeze response.

When we experience or witness a life-threatening, violent or otherwise traumatic event, our nervous system will activate a defensive survival response which can manifest itself in two distinct ways: the fight/flight response—in which an individual’s sympathetic nervous system is activated in order to prepare the body to fight or run away from a threat—or the shutdown/freeze response, in which the dorsal vagal circuit causes extreme stillness, akin to ‘playing dead.’ Whilst the freeze response may well be as useful to survival in a life-threatening situation as fighting or fleeing, it can also induce a disturbing disconnection from all sense of self known as dissociation.

When an individual with PTSD re-experiences or remembers a traumatic event, the frightening visceral experience that arose as a result of the nervous system response to the original trauma can come flooding back. For those living with PTSD, the memory of the trauma and its attendant images, sensations and emotions can stimulate visceral flashbacks, nightmares, and other sensations, accompanied by the defensive reactions the trauma originally triggered. These reactions, as noted above, may relate to hyperarousal—constantly feeling ‘on edge’, associated with hypervigilance, irritability, and insomnia—or hypoarousal—emotional numbness or dissociation—with some individuals even fluctuating between these extreme states.

Chronic activation of the fight/flight response in particular is associated with hyperactivity in the amygdala (the area of the brain that triggers the fear response) and changes in the hippocampus (a part of the brain associated with memory, resilience and generation of new neurons). Further, people with PTSD tend to have less activity and smaller volume in the prefrontal cortex, a part of the brain that is involved with reducing reactivity, reappraisal of situations and innovative thinking.  Taken together, these issues within the nervous system suggest that individuals are at risk of developing anxiety, depression, problems with memory and cognition, alcohol/substance misuse and relationship breakdown, all of which contribute to the already heavy burden of the disorder.

WHY USE YOGA THERAPY AS AN ADJUNCTIVE TREATMENT FOR PTSD?

The symptoms of PTSD clearly impact many layers of the human experience at a deep level. Given that the ramifications of the disorder are felt across physiological, cognitive, emotional and behavioural domains, PTSD requires a multidimensional treatment approach. Whilst pharmacological and psychological treatments for PTSD are well-established, there is growing evidence to suggest that approaches which integrate both mind and body are most efficacious in the long-term. According to research conducted by Bessel Van Der Kolk—eminent psychiatrist, author and researcher in the field of trauma—mind-body approaches such as yoga therapy hold great promise for reducing PTSD symptomology, with outcomes comparable to well-researched psychotherapeutic and psychopharmacologic approaches.

Yoga therapy takes a multifaced approach to health, through which PTSD can be viewed from all angles. In fact, the complex nature of PTSD is particularly suited to yoga therapy, an intricate process which begins with a broad assessment of physical, mental and emotional needs. A yoga therapy intake not only encompasses nervous system function and psychological state of mind, but also includes diet lifestyle, sleep quality, mobility, flexibility, strength, energy levels, quality of breath social/occupational factors and personal purpose. Drawing on this broad investigation, yoga therapists guide clients through bespoke programmes including postures, breathing techniques, meditations, guided relaxations and lifestyle advice.

Thorough such practices, yoga provides traumatised individuals with an avenue to explore the body in a healthy, grounded and safe way, allowing for the recontextualization of the terrifying sensations associated with PTSD. Via a process of gradual body awareness coupled with self-regulation skills, yoga therapy offers an opportunity for the body to be perceived as a vehicle of safety and security rather than a source of threat.

Body awareness is an intrinsic part of yoga, and can help people to develop skills in tolerating and modulating dysregulated physiological states. It is common for trauma survivors to experience a disconnect between mind and body, exhibiting a concurrent 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. Research shows that body awareness and self-regulation skills are associated with lesser symptom severity, translating to improved quality of life for those navigating the challenging symptomology of PTSD.

Through yoga, those with PTSD can also learn to better cope with the defensive nervous system responses that precede re-experiencing, allowing traumatic memories (or other triggers) to arise in an environment of nonreactive mindful awareness rather than debilitating fear. The physical postures practised in yoga are a prime example of how this awareness is developed; spending time in a posture exposes those with PTSD to uncomfortable bodily sensations in a context of safety, not only helping them to build tolerance to sensations, but also allowing them to develop a new relationship with the responses of the nervous system.

Additionally, research demonstrates that the slow controlled breathing used in yoga practice helps to modulate overactivity known to occur in the amygdala in individuals with PTSD. Over time, this helps to bolster connections between the amygdala and brain regions involved in cognitive control, in turn reducing fear-based reactions to triggering stimuli and providing greater regulation over processes that are dysregulated as a result of PTSD.

Yoga therapy can also help to stabilise the nervous system, helping people return to a baseline physiological state more quickly after a distressing memory is triggered. Research suggests that regular yoga practice trains the autonomic nervous system to be more dynamically adaptive, and that mindfulness meditation (a key component of yoga) can lead to positive changes in neural functioning, including the reduction in size of the amygdala and increased hippocampal volume. These physiological changes translate not only to a reconnection between body and mind within a context of safety, but they may also help people to engage with counselling and psychotherapy more effectively, thereby lending support in the processing of trauma.

Whether on a one-to-one basis or in a group setting, yoga therapy clearly holds great promise for treating PTSD. As quoted by Van der Kolk in reference to one of his research studies on yoga for PTSD, “we found that yoga was more effective than any medicine that people have studied up to now,” highlighting the potency of this approach. The individualised nature of private sessions allows a uniquely tailored exploration of an individual’s presentation of PTSD, important given that trauma manifests differently in different people. Nonetheless, the commonality in symptoms of PTSD allows yoga therapy to also be offered in a group setting, helping to forge a sense of safe community from which individuals can draw comfort and support. Since people with PTSD are physiologically primed for threat, their ability to socialise and cope well around others can be severely diminished. When offered in a group context, yoga therapy allows individuals the opportunity to socialise in a safe and self-directed way, finding support among peers without the expectation to engage beyond their current comfort zone.

YOGA THERAPY: THE FUTURE OF PTSD TREATMENT?

An understanding of the neuroscientific underpinnings of trauma and how they relate to PTSD symptomology is clearly vital for anyone working in the field of yoga and PTSD. Whilst trauma-informed and trauma-sensitive yoga describe approaches to the practice that address the specific sensitivities of trauma survivors in order to avoid triggering PTSD symptoms, yoga therapy substantially builds on this foundation to help those with PTSD both process trauma and improve self-regulation skills.

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 talking therapy and other treatment modalities.

Insights from neuroscientific research clearly underline the importance of body-based interventions in helping those with PTSD to process traumatic experiences, develop a new relationship with their bodies and enhance the resiliency of the nervous system. As an adjunctive treatment alongside medication and psychotherapy, yoga therapy can be a valuable part of a person’s medical care, offering a bright future in the treatment of PTSD. As an individualised, multifaceted and integrative approach, yoga therapy provides an effective tool that addresses PTSD on a variety of levels, allowing people to move forward and find a new life after trauma.

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FOR CURRENT YOGA TEACHERS AND HEALTH PROFESSIONALS: If you’re looking for a world-class professional training to bring evidence-based mind-body practices to your work with people who have experienced trauma and are presenting with PTSD, consider joining world expert in the field, Heather Mason, for her next Yoga Therapy for PTSD training, open to both yoga and health professionals

This professional development course not only provides participants with trauma-informed yoga skills, but does a deep dive into the neuroscience expounding on how different modes of moving and breathing can positively influence trauma at various stages of acuity and complexity. Yoga Therapy for PTSD will equip you with a toolkit of movement, mindfulness, and breath practices designed specifically for trauma, backed by an embodied understanding of neurophysiological mechanisms. 

The Minded Institute have also kindly given us a £150 discount for PTSD UK supporters, simply use the code ‘PTSD400’ at checkout on their website.