This is a article for inclusion in my forthcoming book:
Yoga Mindfulness and Trauma
Yoga and Mindfulness as Tools for Healing
Lisa Danylchuk is a psychotherapist and yoga instructor with a passion for cultivating resilience in individuals and communities. Over the past 15 years, Lisa has served as a therapist and teacher to some of the most at-risk youth and adults in prisons, schools, juvenile halls and community programs across the US. Having graduated from innovative educational programs at UCLA and Harvard University, Lisa a leader in the movement to increase mental health in high risk communities through prevention, early intervention, and advocacy for those coping with complex trauma. She is a licensed Marriage Family Therapist in the state of California and teaches internationally on using integrative methods to heal the profound impacts of psychological trauma. Find out more about upcoming trainings and retreats at: www.lisadanylchuk.com
Mindfulness and yoga are simple tools available to reduce stress, increase attention, and improve overall health; for this reason yoga and mindfulness are equally helpful for survivors, caregivers and clinicians alike. As with any tools we employ in life, it is crucial to be aware of how and when to utilize these tools to maximize benefit and minimize harm. The paragraphs that follow will explore the uses of yoga and mindfulness and offer suggestions for all parties involved with the healing journey.
Yoga, Mindfulness and Trauma
Researchers in the field of psychological trauma are becoming increasingly aware of the impact of trauma on the brain and body. In 1889 Pierre Janet observed that patients who had endured trauma seemed to react with emergency responses to stimuli relevant to the original threat, even after the event had long past. He postulated that intense and overwhelming emotions can cause memories to be stored as visceral sensations in the body or as visual images in the mind. Yoga and mindfulness techniques, when offered in appropriate doses, can allow individuals to witness the mental, physical and emotional sensations of the overwhelming experience and allow the body and mind to complete the process of digesting the traumatic experience.
An important component of healing is reducing stress, both as is relates to traumatic experiences and as it is experienced in current time. Yoga has been found to modulate stress response systems, reducing an individual’s perceived stress and anxiety and research indicates that yoga and mindfulness techniques can significantly impact stress levels and can be beneficial for health and healing. Reducing an individual’s perceived stress decreases physical arousal reducing heart rate, decreasing blood pressure and encouraging full respiration (Harvard Medical School, 2009). These effects can help soothe the bodies and minds of those working to process trauma.
The effects of yoga and mindfulness on nervous system function are also conducive to healing trauma. Chronic hyper-arousal and hypo-arousal are common in people who have endured trauma (Liz & Keane, 1989). Individuals stuck in these states often exhibit a dysregulated nervous system, which can vacillate easily between over-stimulation and under-stimulation and can be stuck in one, or both, of these extreme states (Levine, 1997). Yogic techniques can help to reduce autonomic sympathetic nervous system activation, allowing the nervous system to regain balance and bring survivors into a healthy window of function where memories and experiences can be explored (Emerson, Sharma, Chaudhry & Turner, 2009).
Yoga and Mindfulness in Therapy
Mindfulness can occur in many forms, one can be mindful while driving, walking or counting beads and there a myriad of practices to reflect the many forms of mindfulness. Below are suggestions for seated mindfulness exercises and gentle yoga sequences. The instructions offered below are a simple starting point for personal practice; once a clinician or caregiver has a sense of mastery of basic practices and has explored the philosophy and practice, they can begin to incorporate it into work with others. It is important to remember that practice always starts within: to lead a grounding exercise one must first find the ground themselves.
Grounding exercises are a good starting point for most. Grounding involves feeling the part(s) of your body in contact with the earth, the chair, or the floor, and is usually instructed with deep breathing. Keep in mind that the body can hold intense memories anywhere – perhaps in the feet, the seat, the lungs – so only direct attention to an area that feels relatively safe and/or comfortable for a client. Examples of grounding exercises include, “I invite you to feel your seat in the chair” or “Take a deep breath, feeling your feet on the floor and the earth supporting you.” Use language that is authentic and offers the client power of choice and the ability to moderate the depth of the practice.
Yoga was designed to stretch and strengthen the body so it could sit and be still for meditation. Many people find yoga easier than seated meditation because it allows the mind to focus on the body and the breath in a way that is engaging and demands attention – it is much easier to drift off in a still seat than it is balancing on one leg! Simple poses can be done sitting in a chair and are appropriate for clinical settings, as well as others.
Forward bends in yoga are known to reduce anxiety, cool the body and calm the mind and nervous system and they have the added benefit of broadening and relieving tension in lower back. Start seated in a chair with the feet on the floor hip distance apart. Set up an identical chair in directly facing the first and stack pillows until the forehead and arms can comfortably reach the pillows (there is no “correct” height of pillows). Keep the forehead in contact with a pillow and hold this position for about thirty seconds. If discomforts arise discontinue the pose. This pose can be held for up to a few minutes.
Twisting postures are known to invigorate and bring heat and energy to the body, thus are known to be stimulating. Seated in a chair facing forward, twist first to the right, holding the right arm or back of the chair as a guide. Sit tall and use each inhale to lengthen the body, reaching up through the crown of the head, and each exhale to envision the twist deepening. Never crank the body open, make sure to maintain breath and a sense of relative ease in this posture. A chair twist is energizing, using the core muscles of the body and increasing flexibility in the spine. This pose is best used to awaken the body and engage the mind and should not be used during periods of intense anxiety.
Back-bending postures, also described in the yoga community as “heart-openers,” are known to be uplifting and therefore are helpful for people experiencing depression. Think of the classic posture of depression: shoulders hunched forward, head dropped, sunken chest; backbends create the opposite effect in the body. Sitting in a chair one can backbend by simply bringing the shoulders back and down, lifting the chest toward the ceiling and looking up. The back of the chair can be used for support if necessary. Backbends also bring movement to the lungs, so, as with any yoga, make sure breathing is full and deep, as feels comfortable.
Using each these movements as preparation for meditation is recommended as they help open and prepare the body to sit while practicing concentration and mindful movement. Mindful stillness is considered, for all practitioners, an advanced part of mindfulness practice and may take significant time to prepare for.
There are endless ways to present and practice meditation, the approach outlined here includes breath meditation and simple visualization. When teaching to beginners it is important to offer regular guidance and instruction and to leave the control in the hands of the practitioner. With survivors of trauma, be sure to use language that enhances the experience of present time, as past memories or future fears can arise and become quickly overwhelming.
Begin by making the environment as safe, contained and comfortable as possible. Start with short time periods and offer a fair amount of instruction and guidance (without too much silent time) when introducing this to clients. While we typically see people meditating with closed eyes, remind participants that eyes can stay open; focusing on a point is an easy alternative to closing the eyes. It may help to start with guided visualization, inviting the participant to imagine a serene setting that feels calming and comforting. Then invite the client to observe their breath as it enters and leaves the body through the nose – this may be enough. As clients feel ready they can begin to take deeper, fuller breaths into the chest and belly and explore the effects on the rest of the body. Start with 30 seconds or less and work up to one minute, 2-3 minutes, 5 minutes and so on. Clients may stay at one time span for months or years; there is not ultimate goal to be reached, this is an ongoing practice. If clients are comfortable gazing at a small light or a positive image, this can be a helpful tool for creating structure in the meditation. First, have them look at the image, and then have them close their eyes and visualize it. Offering structure and connection to present time helps to keep the experience manageable for survivors who experience unpleasant memories or feelings.
This valuable mindfulness tool can be helpful throughout these practices and is particularly useful for those experiencing overwhelming sensation. Orienting helps maintain the connection to present time through observation of the five senses; think of it as the smelling salts to bring back awareness of the present moment. In a clinical setting use your judgment and open dialogue to help find the senses that are most useful for each individual. Visual and auditory orienting seem to be the least threatening for most: hearing the sounds in the immediate environment, observing the colors on the wall or observing detail in the room. Grounding can also be a powerful orienting tool, for those who feel comfortable experiencing the body in this way.
A Note to Survivors
Yoga is a helpful way for people to connect with their bodies and it is important for survivors to know that this can be a difficult experience for many people, not only for survivors of trauma. Yoga and mindfulness techniques offer us an opportunity to still the mind, to minimize distractions and to eventually tune down the volume on our thoughts to find a sense of peace. Notably, before we find any sense of peace we are challenged to bare witness to what has been stored inside our minds, bodies and hearts. This is an ongoing challenge for everyone who engages in these practices and can be particularly confronting for those who have suffered trauma.
Humans are impressively resilient and we find endless ways to cope with difficulties presented to us in life; some of our coping skills are healthy, some can be detrimental to our physical, mental and social health over the long term. Many experience smoking, for example, as a stress-relieving habit, and while it may help relieve stress initially we now know that the physical ramifications can be life threatening. Yoga and mindfulness are healthy practices that allow us to pause, take deep breaths, enjoy the moment and choose to be healthy to the best of our ability as we move forward.
A Note to Caregivers
One of the most helpful things we can do for others is take excellent care of ourselves. When we are cared for we can be present, listen, care and attend to the needs of other more easily and more readily. Yoga and mindfulness, then, are primarily a toll for you to care for yourself.
As you practice mindfulness you may become more aware of dynamics in your relationships, including the survivor you are connected to. You may notice how behaviors can trigger you to move toward or away from others in your life you’re your own patterns in relationship may become more apparent. Becoming aware of these patterns a step toward healing for both you and the survivor you are supporting. Being mindful often means discovering new layers of our relationships and ourselves, which offers the opportunity for growth and can be a wonderful contribution to therapy.
For Clinicians and Teachers
For clinicians and teachers of these practices, self-care and personal practice are the first step. One can never lead another further than they themselves have gone, so it is important to practice and experience mindfulness and yoga practices before integrating them into treatment.
When teaching mindfulness and yoga to survivors of trauma, there are many important considerations to take into account. First we need to recognize that asking anyone, particularly survivors of trauma, to feel their bodies and observe their thoughts can be threatening and triggering. Above all we want to ensure that our clients feel safe, supported and resourced. The beautiful thing about yoga and mindfulness is that, while they can be inherently triggering, they also provide many resources that can be valuable in overcoming the triggers. Following are some suggestions from seasoned teachers for facilitating yoga and meditation:
- Be patient and respectful of resistance – it is healthy, in many cases.
- Avoid any sudden movements or gestures while instructing
- Avoid poses that may trigger sexual trauma (supine or open legged positions)
- Encourage clients to remain in present time through connecting with visual or auditory cues in the immediate environment (colors, sounds). As participants learn skills grounding and centering can help prevent overwhelming feelings associated with traumatic memory as well.
- If there are publicly exposed windows, cover them. Lighting should be soft, but not too dark.
- Mirrors can be an unhelpful distraction. There may be mirrors present, but you can arrange the class space so that participants are not facing them.
- Make sure that no one will be walking in and out of the room inadvertently during the class (e.g., UPS or maintenance).
- Make sure you have enough props for everyone, including chairs for any chair-based work.
(Adapted from Emerson et al, 2009)
Mindfulness and yoga are inexpensive, easily transportable tools that can help survivors, caregivers and clinicians stay present to the truth of each moment. In the presence we make can honor, process and make sense of our past and invite in a healthy future.
Emerson, Sharma, Chaudhry, Turner (2009). Yoga Therapy in Practice. Trauma-Sensitive Yoga: Principles, Practice, and Research. International Journal of Yoga Therapy, 19; 123-128.
Harvard Medical School (2009, April) Yoga for Anxiety and Depression. Mental Health Newsletter, retrieved October 26, 2009 from https://www.health.harvard.edu.
Janet, Pierre. L’Automatisme Psychologique. Paris, Alcan, 1889.
Levine, Peter A. Waking The Tiger. Berkeley, CA: North Atlantic Books, 1997
Litz, B, Keane, T (1989). Information processing in anxiety disorders: Application to the understanding of post-traumatic stress disorder. Clinical Psychology Review, 9:243-257.
Van der Kolk (1994) The Body Keeps the Score: Memory and the evolving psychobiology of post traumatic stress Trauma Information Pages. Retrieved 4/24/2009 from website http://www.trauma-pages.com/vanderk4.htm.