Approximately 10 million women in America have been physically assaulted at some time in their life. Yes, that’s a sobering statistic. But the far-reaching effects of violence against women are even darker. Over a third of these survivors experience Post-Traumatic Stress Disorder with increased rates of depression, obesity and heart disease.
So how do we even begin to approach the healing of such an overwhelming phenomena?
The answer is complicated. And I wish current treatment methods showed better results. In a recent large-scale clinical trial, 78% of patients who underwent prolonged exposure therapy failed to overcome their symptoms after 6 months. Less than half showed any clinical improvement whatsoever.
You have to understand that this is partly due to the high drop-off rate of patients, most of whom exhibit a heightened inability to regulate impulse. They can easily become flooded or dissociated from their feelings, which negatively affects the resolution of traumatic memories.
This hits at the core of PTSD treatment in a traditional sense.
But Bessel A. van der Kolk, MD, and a team from the Trauma Center at the Justice Resource Institute tried something novel.
From 2008 to 2011, they randomly assigned 64 women who were suffering from trauma-induced PTSD, half to a weekly women’s health support class (the control group), and half to a weekly trauma-informed yoga class.
Each treatment condition lasted 10 weeks. Patients were assessed at pretreatment, midtreatment and posttreatment using the Clinician-Administered PTSD Scale (CAPS) and the Davidson Trauma Scale (DTS). The researchers were looking for any differences in the resolution of trauma symptoms between the two groups.
What they found was surprising. The patients who attended the weekly yoga group, with its guided meditation and breathing exercises, were much better able to focus on the present moment and control their impulses. Now, this alone was a promising result.
But beyond that, their PTSD symptoms plummeted.
When they did the final CAPS assessment, 16 of 31 participants in the yoga group no longer met criteria for PTSD, compared to 6 of 29 in the control group.
Now here’s something interesting – – in the DTS assessment, both the yoga and the control groups showed identically significant improvements right up until the midway mark of the study.
But the yoga group maintained their gains to the finish, while the control group relapsed.
So how do we explain this? What can we learn from the practice of yoga and its long-term effects?
Yoga has three principle components: breathing exercises (pranayama), postures (asanas), and mindfulness meditation. If you’ve ever tried yoga, then you know that it is built upon the concept of body awareness and opening yourself to the transitory nature of one’s momentary experience.
Practitioners focus on internal sensory experiences, which isolates emotions and physiological reactions to triggers such as fear.
What this means is that, instead of avoiding unpleasant memories, the women in the yoga study group were better able to isolate their memories and address them in a non-threatening way.
One interesting component to this study is the fact that the control group showed continued improvement in their Depression scores even as their PTSD scores relapsed. It is theorized that the supportive nature of this group, which shared food and encouraged contact outside of formal sessions, may have contributed greatly to the overall mood of the participants.
This would suggest that it might be the physical and interoceptive aspects of yoga – and not the social makeup of the group – that was instrumental in the change in PTSD symptomatology.
We should point out that, even though the groups were randomly assigned, there were significantly more
participants in the yoga group who were employed than in the control group. (The education and family income levels of participants were about the same in both groups.)
I would like to see further studies with larger sample sizes, as well as studies that included different socioeconomic classes and genders.
You can read more about the study at the ClinicalTrials.gov site, using the identifier NCT00839813
But now I’d like to get your take on the findings. Have you ever used yoga with PTSD patients in your own practice? Is it something you would be willing to try? If you have any experience with this approach, we’d love to get your insights on the topic, along with how you incorporated yoga into an overall client treatment plan. Please leave us a note below and share your story.
I have practiced Astana yoga for 20 years. I started in my late 30s when finding it difficult to deal with accumulated depression and other issues. I also did psychotherapy, mainly CBT, exercise and am an occasional Catholic. I have a PhD in social psychology. For me, yoga enables a more labile emotional response which appears to be related to muscle stiffness. I agree that for me, trauma is held in the body, specifically muscles, and stretching them (gently!) releases it. It is not the whole answer, but it has and continues to give extraordinary benefits.
I am a Yoga Teacher since 1998 and developed a healing method called Body Mapping .
It is based on an experiential journeu into their ‘inner body’ and an artistic process based on.the principles of change of perspective.
I assist my students/patients to map out there body mind system in order to reinhabit it.
I use Emotional Freedom tapping to start, for
slower introduction of movements, breathing, & meditation state. I also do
a guided meditation that walks them through describing the vibration in the body. Heart rate, body temperature, Is it heavy, light, give it a color, And so on. This allows the client to explore emotions and feel safe doing so. Connecting the body experience with cognitive thought is shifting the control away from lymbolic.
After reading this study I’m going to be introducing yoga as a third phase.
Thank you! Very informative article.
I have experienced the healing effects of yoga combined with attending talk therapy sessions. Both were essential for me to be able to feel and heal. I am also a therapist. It took great courage and understanding for myself and from others to do this work of healing.
Thank you for your study.
I was a participant in the Yoga study at the Trauma Center. I was in the yoga group. I’m so glad I was able to do this because it was life changing for me. I went from feeling very out of control and afraid much of the time, struggling to stop self-injury, not sleeping much, lots of problems. By the end of the study, I was able to sleep at least 6 hours at a time at night. I no longer felt the need to self-injure. I learned breathing and coping skills for when I was feeling triggered to help me feel more grounded and notice that I was actually in a safe place. That was at least 10 years ago and I am still doing very well today. I’ve hit some trauma holes along life’s road but I’ve pulled out of them and I really attribute the specialized yoga study to my recovery.
I am a Yoga and Tai Chi instructor and have been for decades at wellness centers and at corporations. I have seen my patients/clients transformed through these practices. Thank you for this research. I will share it.
I just left The Meadows in Scottsdale AZ. I flew in from Boston. For Trauma, PTSD because of my childhood which caused Depression as an adult affecting me as a mother and as a wife I needed help.
One of my favorites groups at the Meadows was
“Trauma & recovery Yoga” this changed my whole way of thinking, breathing, and how to stay grounded with affirmations. this totally changed my life. I only wish the Boston area would have something like this. I think we need more yoga instructors who need to be trained in this it’s so important you have no idea. if you would like my import please email me @ dmdaisy@comcast.net
My Best,
Denise
That is very amazing and hopeful results.
This was an awesome read and has brought me closer to developing skills while practicing yoga.
I have been teaching yoga and strive to understand how to support my students who my be experiencing trauma.
I began teaching yoga as an avocation, in 1976. At the time, I also sold real estate and was raising two children by myself. In 1980, a mid-size bank in Denver, CO., hired me to develop their Business Development Department, selling commercial services, trust services and investments. I left banking, in the mid-80’s, to start my own import/export business, while still teaching yoga PT. In 1990, I was in a nearly fatal auto accident on a mountain pass during a late spring snow storm. I and two other yoga teachers nearly died!
One teacher lost her leg just below the knee and mine was a long protracted recovery. I sustained a TBI, internal injuries, a back injury, and deep psychological trauma, because I was driving the car!
I became certified in the Iyengar method of yoga, taught Buddhist meditation and received a diploma in Cranial Sacral Therapy. I offering all these services to accident and trauma victims. I owned and operated my own studio until 2010, then closed the studio and returned to university to get my masters degree.
Please feel free to contact me.
very nice post, i surely really like this website, go on it
I started with yoga because I wanted to have a good health, and i love yoga
Hi
I Am a school nurse working in an alternative high school school with students with multiple complex traumas and have taught meditation and yoga off and on… I have received many positive responses from students and teacher…”I was able to stay in class for the first time, I was able to focus, I felt so relaxed, I went home and did it and was able to go right to sleep,…”
The students eat it up!
I would love to expand the programs by bringing in professional teachers trained in trauma, yoga and meditation, but our school does not have any resources. Also think it would be a great opportunity to do a study on the effects of meditation and yoga on learning for students with complex trauma.
Does anyone have a pretest/ post test questionaire I just use to start collecting hard data so use to promote this to a larger population of our students? And the administration?
Thank you!
Great to be connected to others who see positive results!
Suzanne, my view also differ from Adele’s; however, as I understand it, one of the most important aspects of meditation (and the philosophy behind it) is developing a non-judgmental open mind. The current Dalai Lama, obviously one of the greatest teachers of this philosophy is quoted as saying: “Our prime purpose in this life is to help others; if you cannot do that, at least do not harm them.” Peace.
Hello
My daughter’s been diagnosed with paranoid schizophrenia. She does practice yoga and I am sure is beneficial to her. However, I think as part of her work she has been encouraged to go into heightened states of consciousness. I am concerned that this ‘training’ may have contributed to a recent psychotic episode that required her hospitalisation. I wonder if you can comment on this.
with grateful thanks
I am a psychotherapist trained in mindfulness ann in EMDR. Eye Movement Desensitization and Reprocessing is used by practitioners the world over with outstanding results. I agree that yoga is a wonderful therapeutic modality, but not all patients are willing to commit to doing yoga on a regular basis. Exposure therapy is not nearly so widely used as it was before EMDR began to be used more widely since the mid 1980s.
Many severely traumatized people resist joining any group. I use guided imagery and teach everyone the basics of mindfulness, encourage them to join a yoga class (many to choose from), but it is rare for anyone to follow through. Opportunities that are offered by familiar people are more often accessed, such as a women’s centre or health centre in an indigenous community. My own experience with meditation and yoga goes back 45 years, and I speak from experience, but it isn’t always enough to encourage clients to get involved.
I’m a Child Protection caseworker and really need to stay on top of self care because I definitely feel the affects of stress and secondary trauma. With yoga, I started to really pay attention to breathing into the areas on my body that felt stressed or where I could be storing emotional pain. When I’m in one of these poses I let my mind wander. I’m usually suprised by what surfaces and continue to breath and stretch through it. Paying attention to your own body helps reconnect the heart rate breathing variation which seems to help reconnect the mind.
My best friend finally left a verbally abusive marriage and yoga has been instrumental in her recovery.
I, on the other hand, am extremely stuck in my life. I live with my parents (I’m WAY too old to be living with my parents). I understand a lot about my situation on an intellectual level after reading many.many books about verbal abuse and “The Body Keeps the Score”.
I am stuck in some sort of freeze response and being financially unable to leave my parents house means that I experience more of my parents’ demeaning, shaming, hopeless and negative behavior on a daily basis. I am slowly getting worse. Especially financially. I made a lot more money after college but I now go for days without having the motivation to do my work. I usually have to wait for “deadline panic” to get any work done.
I have read a lot of books over they years because I can not afford therapy. I may be able to afford a yoga class so this is good news for me.
I was verbally/emotionally abused for many years in marriage. I was a believing, practicing Christian during those years. Any books, teaching tapes, sermons I found, only wanted you to pray, submit to my husband and trust that God would open him to becoming a good man. All I did was suffer his abuses and it got worse as the years rolled on. Finally, I simply didn’t care what GOD (and submissive wife teaching) thought, and I did leave and get a divorce. I am still a Christian, but now, I do chair yoga with modified poses, and I’ve learned qi gong; I do both of these disciplines with dvds at home. And I deal with stress, anxiety much better now. Christianity didn’t or still doesn’t deal with abuses as they should; but I’m open to any mind/body work that helps me to heal and become a more whole person.
Thanks for posting about your experience. I have had similar experiences in Christian churches that, I suppose, reflect the general public’s lack of awareness and understanding around abuse and trauma and theraputic approaches. I was afraid to do yoga for years bc many churches teach that it is practicing Hinduism.
Churches are influential for many people. I wish pastors, priests, and other leaders had basic training and knowledge about how to talk to these issues whether in sermons or lay counseling. To tell people it is good to seek professional help if they have been abused. It is irresponsible and unethical to use the bible to tell anyone to remain in an abusive situation. I am sorry you went through that. Some would call it spiritual abuse.
As a child, I was abandoned and psychologically abused at home and the church continually pressured me to forgive those who had hurt me. When I expressed anger about my abuse, which was a reasonable response, I was told God would not forgive me if I didnt forgive them. I really needed the opportunity to work through what had happened to me so I could get to the point of forgiveness, which I ended up doing later in life.
This is still a common theme in Christian teaching. I agree that compassion and forgiveness are the goal, but getting there is a process that cannot be ignored. It’s the journey of healing that leads us there. God doesnt just zap away the results of trauma.
I continue to hear Christian leaders teach unhealthy ideas about emotions, too. That any negative emotion should be supressed as a sign that the individual is not close to God. That Christians should always be at peace no matter their past if only they have enough faith. Even worse are the leaders who use the bible to enforce patriarchal control systems that are used to abuse people. I could mention a few names here but I won’t!
I work with all my clients using meditation, including those with PTSD. Yoga is the appetizer to the meal, which is meditation. I’ve witnessed many people completely transform their life with this practice. That’s why I co-created a program, Cornerstone Mindfulness, to share with as many people as possible.
I read this article with great interest and agree that Yoga is wonderful for body awareness etc and i myself have used yoga and meditation techniques since i was a young teenager throughout my life.
My word of caution around this is that abuse in Yoga organisations is rife, i lived in a yoga ashram in my teenage years and me and my many other young friends there were horrendously sexually abused and exploited and the good teachings of yoga and mindfullness were used to control, exploit and abuse both adults and children whilst the ashram gathered in the money.
The source of my and my friends PostTraumatic Stress is the world of Yoga. So as you can imagine it is hard for many to access these techniques when it is the source of their trauma.
I have been fortunate that i have been able to still access meditation and yoga in a form that suits me, i prefer to call it stretching and i call meditation “Being” as a result i have many skills to manage the PTS i experience, others tho just can’t go near Yoga due to their abuse.
It is not uncommon to hear of yoga teachers in many traditions taking advantage of students and people looking up to yoga teachers as “Gurus” is still very much out there
. So i would caution people to do Yoga and meditation by all means as they are wonderful life skills to have but be very aware that YOGA TEACHERS ARE NOT PSYCHOLOGISTS and have absolutely no training in the area of trauma in a psychological sense. Listen to them in terms of the physical side of treating stress in the body but never assume they know more than that and don’t confide in yoga teachers to talk about your trauma. Enjoy your yoga classes but don’t get sucked into yogic ashrams etc or follow people who tend to see themselves as Gurus….find a down to earth teacher who is not full of ego and reap the rewards of yoga and meditation and as you do also make sure you have a good registered psychologist trained in trauma to support you.
I feel it is essential in the growing field of Yoga that people go into it aware of the possible dangers of people who use it to promote their own self importance and to build their own empires. I have seen this first hand and feel it is a very important issue as there is so much abuse of power that goes on in the growing field of Yoga.
Thank you for this. Yoga teachers and other body workers sometimes go beyond their area of competency and mislead their clients who are looking for leaders and answers to their problems.
Thank you very well worded, and I am so sorry to hear of these sorts of experiences…abuse… It’s everywhere! For me it was in the Catholic Church and the word Jesus was a trigger for a long time. Today I am more comfortable with Jesus, it was him it was the people who tried to misconstrue his teachings, just like some yoga teachers do.
Keep healing! Peace
I would love to intergrate yoga with the treatment of trauma. I personally practice Bikram and feel the benefits of yoga both mentally and physically. This is a much needed modality for the treatment of trauma. Thank you guys for publishing this new practice.
Dr Rhonda Heise, PsyD
Aloha,
I have been a Yoga teacher for 44 years now. A few years ago I worked with veterans from WWII, Korean War, and the Gulf War. It was one of the most remarkable experiences of my career. The response and healing of the men, and occasional woman was amazing.
For the last 24 years I have served as the Yoga teacher for 4 adult prisons on Oahu, and for the Youth Detention Facility here on Oahu. Our organization is a (501)(C)(3) non-profit, and it is called the “Hawai’i Yoga Prison Project.” I have a tremendous amount of literature that the men and women have generated, describing in their own words the benefits of our Yoga classes.
Any further communication between us, I would happily share information with you,
Sincerely, Louisa (Lu) DiGrazia
I would love to talk and here how you collected the data and some of your findings!
Thank you
Christine
978-870-2955
…Si, estoy convencida que es una herramienta muy importante en el tratamiento con personas que quedaron comprometidas por experiencias abrumadoras, personalmente forma parte de mis estrategias a la hora de intervenir.
Sabemos que el trauma queda registrado en el cuerpo en forma de sensaciones somáticas, utilizar el yoga como una manera de recuperar el cuerpo es una parte importante de la intervención.
Pero también como practicante de yoga desde hace 30 años soy consciente que ha de ser un yoga dirigido, seleccionar las asanas….cuáles serán las más recomendables, dentro de los pranayamas …cuáles he de seleccionar: desde mi punto de vista se han de cuidar estos puntos antes de la exposición a esta experiencia.
I am not a trauma informed yoga therapist myself, but I have colleagues who are and I support my clients with trauma to take this specialized yoga.
Most find the experience very positive in that it’s another way to release trapped trauma. I agree with what some of the others who have commented — the yoga instructor needs this specialized training b/c of all the emotional feelings that clients can experience and the instructor needs to be trained to deal with how to quickly ground a client, etc.
Check out THE PEOPLEINMYHIPS Channel on Youtube.
I cured myself of crazy PTSD that I developed from doing Yoga. Funny, huh? Yes Yoga was instrumental to my recovery, and as you can see on the Youtube videos my PTSD was very very bad.
Yoga is a blessing but if there are emotional issue one needs an experienced teacher.
Staying in remembered pain that is manifesting in the present coming out of your body is NOT a good idea? go in, and then go out. Don’t stay in lost memories in your body of Trauma.
Hope this helps.
I am a psychologist who has treated patients with trauma for over 25 years. (and have followed Bessel Van der Kolk’s research since grad school in Boston) I am also a long term practicing yogi and meditator who has taken numerous trainings and retreats including teacher training. I often suggest specific yoga poses to patients during treatment and offer ways to find and utilize yoga classes in ways that empower rather than trigger. Yoga can be triggering and anxiety provoking if the patient isn’t provided some neurobiological reasoning for it and has some grounding and self regulation strategies. I am considering developing a psychoeducational yoga course for trauma survivors.
I would be very interested in the course
Christine 978-870-2955
For my own PTS issues, yes, I was a real Hatha Yoga enthusiast, and it helped me ignore the deeper problem. I think I never considered myself as having a *problem* with self-regulation…Besides yoga I used to run distance and this was a great distraction PLUS I got high on endorphins.
Pranayama breathing was and still is very difficult to discipline myself to do, especially the controlled out breath. It is almost impossible to let it out slowly and last. On a regular breath, it seems I breathe in often but very shallowly. And suddenly sometimes, out of nowhere, I realize I am holding my breath…like while playing the piano…and then I lose my place.
But all of this great exercise never brought me close to, or made me aware of defaulting to the primitive vagus…and this awareness came with SE, reading the Polyvagal Theory, and various forms of tracking myself–a sort of mindfulness–and NAMING what happened there.
My clients who practice Yoga tend to manage their PTSD symptoms better than those that don’t. They are able to self regulate and calm themselves and they have a solid strategy in Yoga when they find themselves relapsing. While I do not agree with the person who sees Yoga as a detrimental hidden Hindu practice, there are dangers in some spiritual practices that offer salvation or healing and tend to oppress people even more. Having spiritual beliefs tends to be helpful and it is supported by research. What is important is how my client experiences yoga practice and how she presents. Furthermore I encourage my clients, if they are comfortable, to use physical activity, exercise and body work practices to enhance their healing. Peter Levine and others believe we hold trauma in the body and the key to release is really not continuous talk therapy but body psychotherapy. We now know from neuroscience that Yoga works with the brain to heal trauma.
Yes I have used yoga with clients who have PTSD with good results. Visually I can see the difference at the end of a session. I trained with Joann Lutz to become certified as a yoga informed trauma therapist. I begin my sessions like the beginning of a yoga class. I also use psych education to empower my clients. Knowledge is essential.
Yoga would be a great exercise if it were not for its veiled worship of Hindu gods. To state that there is no spiritual aspect to yoga is misleading and incorrect. Most of the bodily positions are designed to be positions of worship to Hindu gods. Not to mention, the potential for triggering of these poses for people who have been raped (asses in the air??). Any positive feel-good effects of the exercises are temporary and the victim must continue to attend classes in order to maintain them, making them dependent upon something else outside of themselves in order to heal.
I’m sure this comment will trigger many of the die-hard teachers and new agers, but – for example – Hatha yoga is one of the six recognized systems of orthodox Hinduism’ and is at its roots religious and mystical. It is also one of the most difficult and potentially dangerous [spiritually] forms of Yoga. “The term hatha is derived from the verb hath, which means ‘to oppress.’… What the practice of hatha-yoga is designed to do is suppress the flow of psychic energies through these channels [“symbolic, or psychic, passages on either side of the spinal column”], thereby forcing the ‘serpent power’ or the kundalini force to rise through the central psychic channel in the spine (the sushumna) and up through the chakras, the supposed psychic centers of human personality and power. Westerners mistakenly believe that one can practice hatha-yoga apart from the philosophical and religious beliefs that undergrid it. This is an absolutely false belief. …You cannot separate the exercises from the philosophy.”
it’s not possible to “just do them as an exercise” when the so-called “exercises” aren’t just exercises.
To Unraveling the New Age Lies: Your perception of Yoga as a hidden worship of Hindu Gods couldn’t be more mistaken. I have taken yoga at a number of different places and have never heard of “worship of Hinduism”… what is your bias? To demonize yoga clearly is nonsense. Yoga engages your autonomic nervous system (the part of your nervous system that is “automatic”) which controls respiration, breathing, gastric secretions, the FIGHT OR FLIGHT SYSTEM and numerous other automatic bodily functions. Doing yoga engages your parasypathethic nervous system which slows your body and relaxes your body systems. People who have PTSD have overstimulated sympathetic nervous system which is why they can’t sleep, startle easily, have anger episodes, fear and anxiety and need RELAXATION. KNOW your science and how yoga works. It has nothing to do with RELIGION or having your ass in the air…..
To Unraveling the New Age Lies: I am a Christian pastor and a Certified Trauma Counselor, not a clinical psychologist but I deal with many who are helpful to my women suffering trauma or coming out of the jail system where I preach. My “psychic center of human personality and power” comes from my belief and submission to Jesus Christ. That said, I also attend yoga classes at a Christ-centered yoga practice. We meditate, breathe and pray at the beginning, we move through the exercises in forgiveness, joy of surrendering our fears/hurts, and end with relaxation and deep breathing in of the Holy Spirit. While I know the origins of yoga and the Eastern religions, the yoga practice that I attend (and recommend to others) is the farthest thing from idol worship or Eastern religion. It has been my experience that restful breathing and mindfulness is wonderful for those whose sympathetic nervous system has previously not allowed them to relax. It has helped both mental and emotional healthier development as well as physical healing. I believe yoga can be separated from Eastern forms of worship and can be used successfully in Christian worship as I have personally participated and observed it. Peace be with you.
Would love to know where you go sounds wonderful!
Responding to and I quote “Any positive feel-good effects of the exercises are temporary and the victim must continue to attend classes in order to maintain them, making them dependent upon something else outside of themselves in order to heal.”
The tradition of the practice of yoga is one studies with the teacher to learn and practices in their own space. The more they practice, the more proficient they become and eventually they no longer have need of the teacher. By then they have learned and practiced daily their lifelong practice which is usually done in solitude.
In western countries people often do yoga classes as a ‘social lifestyle’ using them as a way of socializing and rarely practice by themselves. I suggest that classes are usually utilized for that need and couldn’t be further from traditional practice.
I have practiced yoga solo since the age of fifteen steadily gaining proficiency in a small range of asanas. I suggest that there would be few people in their 50’s and 60’s in western countries who can sit in a half or full lotus to gain the inner peace and vitality that that particular position brings – I have quietly attained it over the last three years.
I suggest that it is only by having sincerely practiced yoga over a long period of time that one can comment where that practice can really take you.
Nowdays I am a beginner learner of Chi Gong – challenging but I feel the benefits already …
I have introduced gentle chair yoga classes into the inpatient psychiatry units at the urban county hospital where I work. Many of our patients suffer as a result of complex trauma. In my experience, patients seem to feel immediate results from pranayama and mindfulness practices. One patient in particular thanked me hours after he participated in the chair yoga class, stating, “Thanks again for yoga tonight. I had forgotten what it feels like to have a spirit.”
Yoga is powerful medicine.
I have encouraged clients identifying with BPD or PTSD to commence yoga lessons as there are not ant psychological services readily available as in small regional town. I have never done yoga but all my studies on emotional regulation led me to believe the centering / meditative part of yoga may be beneficial. Also I felt it would allow those who had difficulty socialising to be able to remain autonomous until ready to engage with others and I must say has been reported as very helpful to those who elected to join classes so thank you for sharing this research.