Movement-Based Therapies for Resettled Refugee Populations in the United States by Gayathri S Kumar, Gwen Soffer & Danielle Begg
International. Journal of Yoga Therapy (2021)
Trauma Sensitive Yoga By Dr Colette Johnston
Most of us will experience trauma at some point in our life. However not all of us who have suffered trauma will experience the symptoms of Post Traumatic Stress Disorder (PTSD.)
Trauma can result in a profound rewiring of the way mind and brain manage perceptions, In other words: it changes the way we think, what we think about but also our capacity to think.
What happens Normally when Faced with Danger
When we are faced with danger our brain alarm system is turned on, automatically triggering pre-programmed physical escape plans in the oldest parts of the brain. As our limbic system takes over, and our amygdala – (think of it like the central control within this part of our brain detecting danger) -notes the perceived threat, it activates the sympathetic nervous system of our autonomic nervous system ( the part that fires us up and acts as the body’s accelerator) and our fight/flight/freeze response comes into play.
By the time we are consciously aware of the danger situation – our body might already be on the move form the perceived threat. If the response elicits a successful outcome and we escape danger we recover our internal equilibrium and gradually “ return to our senses”. A surge in cortisol (stress hormones) will result in our parasympathetic nervous system been activated (the part of our nervous system that controls our rest and digest functions – think of it as the body’s brake system ); the heart rate slows, our breathing rate slows and deepens once more, our blood pressure drops, muscles relax and the body returns to a state of calm.
Being able to move from danger is a critical factor in determining the extent of scars post trauma for PTSD sufferers
If for some reason the “normal on/off control response” is blocked – ie people are held down or trapped or prevented from action needed, such as in a war zone, scene of domestic violence, rape, abuse etc, - the brain keeps secreting stress chemicals. Long after the actual event has passed the brain keeps sending signals to the body to escape a threat that no longer exists .
So even though our rational mind may have learnt to ignore the messages from the emotional brain – the alarm smoke signals from our inherent smoke dictator the amygdala do not stop – PTSD ensues. This can result in a myriad of symptoms, from anxiety, poor sleep, panic attacks, flashbacks, nightmares, to dissociation and numbness, lethargy and failure to engage in nurturing relationships .
Trauma is held in Peoples bodies
After trauma the world is experienced with a different nervous system.
The attempt to maintain control over unbearable physiological reactions can go unabated until they demand attention often expressed as illness; fibromyalgia, chronic fatigue and other autoimmune diseases to name but a few.
This is why it is critical for trauma treatment to engage in the sum of what makes us – well “us” really: body, mind and brain.
Trauma really is stored within the Mind and Body it seems.
As long as we can register emotions primarily in our head, we can remain pretty much in control.. When persistent and unabated firing of our sympathetic nervous system - as in PTSD - results in that sensation of an elephant sitting on our chest or the sucker punch right in the gut - sensations become unbearable.
Many of us will do anything to make these visceral sensations go away; clinging to another human, or rendering ourselves numb with drugs or alcohol or cutting oneself to replace overwhelming emotions with definable sensations.
Neuroscience and PET scanning in PTSD
The advent of PET scanning has been instrumental in advancing the understanding of what exactly happens in the brains of PTSD patients. Through neuroscience we now know that:
(1) The amygdala – (part of our limbic system – the seat of survival instincts and emotion) – lights up intensely when sufferers of PTSD are exposed to images/sounds/smells related to a particular experience. This is the part of our mammalian brain that alerts us to impending danger and activates the body’s stress response.
(2) The area of our brain that allows us to communicate thoughts and feelings into words – Broca’s area within the left frontal lobe of cortex – significantly under-fires in the brains of PTSD sufferers, effectively shutting down when a flashback is triggered.
(3) The primary region within our visual cortex that registers raw images when first enters the brain – Broadmans area 19- lights up super strongly in the brains of PTSD victims. In other words, its primary role of filtering incoming messages and sending them to the appropriate area of the brain that interprets this input appears to malfunction. The images appear to be held up…a misfiring of brain electrical circuitry - as if trauma is actually reoccurring.
(4) We also now know that the left side of the brain is significantly deactivated in the brains of PTSD patients when exposed to images of past trauma activity.
Broadly speaking, the left side of our brain is thought of as the seat of rational, logical and analytical processing, whereas the right side is seen as the centre of intuitive, emotional visual and tactial processing. The left side processes imprints from the past in facts, statistics and a vocabulary of events. We call on it explain past experiences. The right side of the brain develops first in the womb, carrying the non- verbal communication between mother and infant. It stores memories of sound, touch, smell and emotions evoked. What the right side recalls feels like the intuitive truth.
Under normal circumstances both sides of the brain work together more or less smoothly- if one side shuts down, even temporarily this can be most disabling.
Deactivating the left side of the brain as occurs in PTSD suffers may render people incapable of sequencing past events and identifying cause and effect of events.
Trauma therefore effectively cuts us off from our language and rational thinking centres within the brain
For real and meaningful change to take place, the body and mind need to learn that the danger has passed and to live in the reality of the present. Finding ways to tell the story doesn’t necessarily alter the automatic physical and corresponding hormonal physiological response of the person who remains hypervigilant, in a state of hyper-arousal prepared to be assaulted or violated at any time. Reliving the trauma repeatedly in therapy may reinforce preoccupation and fixation.
We therefore need to find additional ways to allow the mind to heal
The fact we have the ability to regulate our own physiology – including some of the so called “involuntary” functions of the body and brain through basic activities such as breathing, moving and touching is nothing short of phenomenal, and is overlooked by the use of pharmacological agents alone.
Mind-Body Practice as part of a Multi-factorial treatment for PTSD
The bidirectional communication between the body and mind has been largely ignored by western science until fairly recently – whereas for thousands of years has been central to traditional healing practices in many parts of the world – including India and China.
Mind-body practice is now transforming our understanding of trauma and recovery.
Trauma victims become hypersensitised to their memories of the past, therefore it seems logical that the best treatment options is to allow for some form of desensitisation – ie: dampen down the amplitude of the biological response. In essence this would allow the PTSD sufferer to realise and remember that “that was then and this is now” – rather than reliving the experience over and over.
“Nerve cells that wire together, fire together”
Neuroplasticity and our inherent ability to rewire our own nervous system is well established within neuroscience.
Hebbs rule states that nerve cells that “fire together wire together.” In other words – if you repeatedly activate the same nerve cells then each time they turn on – it will be easier for them to fire and function together.
As we train muscle groups at the gym; for strength, size, mobility and explosive power gains, regions of the brain can become larger and stronger the more we train them - and unused nerves become weaker – and gradually degenerate.
Knowing that what is practiced and repeated strengthens brain firing clusters and more so with repetition – neural structures can alter, yoga offers potential to help remodel the nervous system of a PTSD sufferer.
The first time we move into a yoga pose – it feels undoubtedly awkward and uncomfortable. We are often astounded at our lack of balance and whole body integration – but gradually, with practice, the experience transforms as our body opens and becomes more receptive to the input of messages it is receiving and the neurological connections within our brain associated with the body in that position become stronger.
Yoga and Body Awareness
For some people who have experienced trauma , they can become cut off from connecting to sensations in the body . If the PTSD sufferer can be gradually made aware of body sensations, it is believed that one is less likely to stay lost or stuck in the past traumatic events. (Rotchschild, 2000)
Body awareness is the subtle awareness of the precise body sensations that can anchor one in the present, here and now. Yoga will over time open the practitioner to heightened awareness of sensation within the body. We all hold tension in parts of the body as a result of past experience. With attention and body awareness through practising yoga we can actually unlearn these patterns. The practice of yoga can also bring with it a sense of grounding and orientation in the here and now – often sensations that PTSD sufferers have become desensitised towards, that skillfully need to be cultivated and may be done through the mind-body practice of yoga.
Pranayama (breathwork) – its benefits within PTSD.
We now know that the parasympathetic nervous system – the body’s brake system is key to taking PTSD sufferers from a state of exhaustive hyper-arousal and agitation to a sense of embodied calm through slowing the heart rate, breath rate and oxygen demand on the body.
Research has noted that the most effective way to modulate the parasympathic nervous system is by breath regulation than by prolonged asana practice and meditation. (Khalsa et al, 2016)
Slow and rhythmic breathing will promote parasympathetic nervous system dominance, which is often enough at the introduction of yoga and breath work to PTSD sufferers. Three part breathing, the lengthening of exhalation and alternative nostril breathing introduction with their enhanced capacity for parasympathetic activation can be introduced at a later stage to PTSD suffers when they are more comfortable with breath regulation.
Role for Trauma Sensitive Yoga within our UK NHS health care System
Studies carried out thus far have noted a range of physical, psychological and social benefits for the participants in refugee yoga therapy projects and yoga projects involving war veterans. (Begg et al., 2017) (Mitchel, 2014; van der Kolk, 2014) (Carter and Byrne, 2004) and (Johnstone et al, 2015).
Within the UK however – we have a service struggling to provide the care for our PTSD, anxiety and depression patients. Waiting lists for EMDR (current desensitisation therapy offered) – often run at >12months wait for patients – and often longer for our refugee populations, who are more than 12 times likely to suffer with PTSD symptoms .
Isn’t it time we seriously considered offering trauma sensitive yoga within a primary care setting as part of a multi-faceted approach to this condition? Apart from the amazing work of @ourmala based in London offering trauma-sensitive yoga therapy to its refugee population - there is little in the way of such therapy been offered systematically across the country to patients.
It really is time to change the system and think more expansively about the incredible and well established benefits that the mind/body practice of yoga can offer within the healthcare setting .