By Mary Horne

PTSD or Post-Traumatic Stress Disorder is much in the news these days.  We hear more and more how the trauma of war and other life-altering events take its toll on an individual, a family, and on society.  Symptoms of PTSD may occur in response to many types of trauma—natural disasters, car accidents, physical and or sexual assault, domestic abuse, childhood abuse—in addition to combat trauma.

Since the inclusion of the diagnosis of PTSD in the DSM (Diagnostic and Statistical Manual of Mental Disorders) in 1980, the mental health field has been working to learn how to treat the set of symptoms that are now classified as PTSD.  Helpful, well-researched therapies such as EMDR, Prolonged Exposure Therapy, and Cognitive Processing Therapy are becoming much more available to those seeking treatment for PTSD.  These treatments have been shown to be very effective. Many people are also exploring ways in which holistic therapies can support and enhance a person’s healing process, allow them to maintain progress made and continue to evolve and grow. Yoga is one of these therapies that is finding widespread support and use as a method of healing.

There are several reasons why yoga just makes sense as a lens through which the symptoms of PTSD can be viewed, understood and addressed.   The DSM-V describes four sets of symptoms that make up the “picture of PTSD”:  intrusion symptoms, alterations in arousal and reactivity, avoidance, negative cognition, and mood.  All occurring after and in response to a traumatic event.*

Intrusion Symptoms

The past frequently captures the attention of the individual with PTSD in the form of intrusion symptoms, which are repeated thoughts, images, memories, and dreams of the traumatic experience.  Because the past is so very present, the sense of fear and danger that were part of the trauma are also present in the emotional body and thus the physical body as well.  As a result, persons with PTSD are frequently preoccupied with the future, worrying about what could or might happen and working out ways to prevent further harm.  This leaves very little attention left over for present moment awareness.   The practice of yoga is in many ways synonymous with the term present moment awareness.  In fact, the word yoga means “to yoke” or “to join.”

The practice of yoga asana or posture practice first and foremost brings the student into direct experience of the body in the present moment, “yoking” the attention through sensation.  For example, a common starting place in asana practice is directing attention into and activating the feet.  This action provides a very concrete, tangible anchor for the attention.  Guiding the student’s attention toward exploring sensations in the body, by activating various places through subtle and gross movements, the student is also invited to and more able to feel and experience themselves as a whole.

Alterations in Arousal and Reactivity

Often, due to the repetition of trauma-related emotions, there are alterations in arousal and reactivity, which manifest as feelings of anxiety, jumpiness, nervousness and irritability. The inability to sleep well is also common due to what is often called hyper-arousal.  The body becomes a source of discomfort.   Additionally, if there is physical pain related to injuries from the trauma, or if the trauma was sexual, people can experience a sense of alienation from their body.  Fragmentation can occur in which individuals cannot connect to certain parts of their bodies.  Directing one’s attention to the body in a curious and exploratory way, a befriending of the body can begin to occur.  Movement performed with intention and attention in concert with the breath engages the parasympathetic nervous system, which is responsible for the relaxation response.  As a result students often report feeling relaxed or calm, something that eludes them elsewhere in life.   Students begin to learn that they have the ability to regulate their nervous system and their emotions through practice.  A sense of genuine empowerment takes root.

Avoidance

Because the practice of yoga asana (posture practice) and pranayama (breath work) by their very nature bring us into contact with the present moment, the habitual reaction of avoidance that is a symptom of PTSD is countered. Showing up on one’s mat suggests a willingness to be present with one’s self, which may mean coming into contact with unwanted thoughts, feelings, memories and body sensations.  Many students find that as they learn to respond rather than react in their yoga practice, they carry that into their daily lives.  When a student notices reactivity in their practice, and they can breathe in the moment, they often report an increased ability to see reactivity off the mat, and to use what they’ve learned in the practice of yoga to respond rather than just react.

Negative Cognitions and Mood

The practice of linking movement with breath is another way in which the attention is anchored in the present.  When movement and breath are connected the attention shifts from a mostly outer-focused awareness to one that includes a deep inner-focused awareness.  Retraining the attention to be flexible, able to see inwardly and outwardly at the same time, is part of what makes posture practice yoga. Rather than, just stretching or exercise, and provides a way of being in movement that returns one to balance.  When the student can have the arrow of attention point in both directions simultaneously, it is as if the window of seeing is being wiped clean.  Distortions in thinking and the resulting afflictive mood states may be seen more clearly when one learns to look inward and outward.  The mind begins to let go and with that letting go, beliefs that may have been embedded, ingrained and clung to can be seen for what they are:  products of the mind.  This is true for all students, not just those with symptoms of PTSD.

I sometimes describe PTSD as the human condition turned up to 10.  Taken as a composite, the symptoms of PTSD are symptoms of disconnection.   I have not met anyone in my life that is unfamiliar with feelings of disconnection.  I have also not met anyone who has practiced yoga for even a short time who has not experienced some sense of connection through the practice.   Yoga is a practice for the human condition.  Try it and see.

Suggestions and Resources 

If you, or someone you know is experiencing symptoms of PTSD and is interested in exploring the role that yoga might play in the healing process, here are some suggestions:

Being around new people in a new environment can be stressful for someone experiencing symptoms of PTSD.  Practicing yoga may be very beneficial, but going to a yoga class can be just as stressful to someone with PTSD as going to a large rock concert.  Here are some tips:

Contact the studio first and get some information about the studio and the classes.  Most studios offer a variety of classes to meet different needs.  Some questions you might ask:

  •    What classes offered are appropriate for someone new to yoga?
  •    What is the usual size of the class that you will be attending?
  •    Does the instructor have any knowledge or experience in working with individuals with trauma?
  •    Does the instructor play music? What kind?
  •    Is it a “hot” yoga class?  If you are new to yoga and have symptoms of PTSD, a hot yoga class is likely to be too stimulating.
  •    What is the usual male/female ratio? This might be important for persons who have experienced a sexual trauma.

Other tips: 

  •    Look for words like gentle, restorative, level 1.  These will be classes that are more suited to someone looking for the calming aspects of yoga or someone new to yoga asana.
  •    Try going with a trusted friend or family member the first few times until you feel comfortable.   Who knows, it might develop into a fun, shared activity!
  •    Get there early so that you can find a comfortable spot and be able to settle in.
  •    If possible, let the instructor know that you are new to yoga and somewhat nervous.  You don’t have to say anything about trauma/PTSD, but this will help the teacher be sensitive to your needs.
  •    The issue of touch:  Sometimes in yoga, a teacher may offer an adjustment to help you be safer in a pose or to experience it more fully.  If you do not want to be adjusted or touched, it is okay to let the teacher know.  Many teachers are taught to ask first, but even the most experienced teacher might forget, sometimes.  Remember, it’s always okay to ask for what you need.

For veterans with PTSD, the Outpatient PTSD Clinic at the NLR VA at Fort Roots offers yoga as part of their programming.   You must have a referral from your Primary Care Physician or provider in the Mental Health Clinic to participate.

* A traumatic event is defined as exposure to death, threatened death, actual or threatened serious injury or actual or threatened sexual violence.  This could be direct exposure to, witnessing first hand, indirectly learning that a close friend or relative has been involved in a violent or accidental death or injurious event, or repeated exposure to details of traumatic events, e.g. through professional contact as a first responder or therapist. Exposure through media is not considered a traumatic event.

Reference

  1. S. Dept. of Veterans Affairs, PTSD: National Center for PTSD, DSM-V Criteria for PTSD: http://www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_ptsd.asp

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This article was originally published in Ozark Mountain Yoga Mindful Living Magazine.


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