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  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
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