ISSUE #016 - Jul 09, 2019

Contraindications of Pranayama as it applies to Trauma Survivors

Caitlin Lanier

“Many of our patients are barely aware of their breath, so learning to focus on the in and out breath, to notice whether the breath was fast or slow, and to count breaths in some poses can be a significant accomplishment.” – Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

In the context of trauma, breath work can be a double-edged sword; an incredibly powerful tool that can be both beneficial and harmful. In my opinion, it’s naïve at best and harmful or dangerous at worst to assume that any and all yoga practices, including breath work, are inherently healing and helpful for trauma survivors.

Some of the core features of experiencing trauma are lack of bodily autonomy, lack of choice, and disrespect for boundaries. In Yoga and the Quest for the True Self, Stephen Cope describes some of what happens physiologically when the body’s needs have been suppressed in the aftermath of trauma: suppression of breath, abdominal inhibition and core strength diminished, and locked jaw—all of these are physiological indicators which end up inhibiting breathing (p. 225-226).

I distinctly remember an experience I had during a guided dirgha pranayama practice in a yoga class years ago when I suddenly felt intense rage and anger surge up within me seemingly from nowhere and I remember thinking thoughts directed at the teacher like, “For the love of God, fu*k off and stop telling me how to breathe!” I chose to stop breathing in the commanded/controlled way and felt an immediate sense of relief as well as a slight sense of satisfaction in rebelling and not doing exactly as I was told.

As it turns out, that’s a pretty normal reaction and what can happen when yoga teachers are bossing around their students and telling them how to breathe. I’ve lost count of the numbers of times I’ve attended yoga classes and teachers have started out their classes with some sort of pranayama practice with no preamble giving students permission to stop or take a break from the practice for any reason.

When we think of trauma on a very simple level, it involves loss of control and lack of choice. Zabie Yamasaki, founder of Transcending Trauma Through Yoga, says “for people who’ve experienced trauma, the breath can be linked to triggers associated with the trauma including: holding the breath, accelerated heart rate, constricted breathing, inability to breathe, shortness of breath, and suffocation.” Despite the challenges of breath work, Yamasaki also points to some potential benefits of breath work for people who’ve experienced trauma such as increased awareness of breath patterns, decreased anxiety, making contact with self, self-regulation, feeling energized and/or calm, and a way to feel better in the body.

Additionally, when we think of specific traumas that can occur in the context of breath, like attempted strangulation, someone is literally controlling and affecting the ability or lack thereof for someone else to breathe and therefore live. And we as yoga teachers in using breath work with our students can unintentionally recreate power conditions similar to an abusive individual controlling their partner’s ability to breathe/not breathe. We can talk about how the breath is an effective means to regulate the nervous system and point to “how to” articles about techniques to manage anxiety, but we must first consider the breath’s connection to life. The word pranayama is a Sanskrit compound and has been defined by various authors. V.S. Apte defines “prana” as life force or energy and “ayamah” meaning restrain, control, or stop.  If we cannot breathe, we cannot live. In some ways, our controlling of the breath through pranayama brings us face-to-face with our own mortality. By choosing to breathe, we are also affirming life. In Yoga & Mindfulness Therapy, Workbook for Clinicians & Clients, C. Alexander Simpkins writes, “Each breath you take links your inner experiencing with the outer world. Breathing is also the gateway to emotions and influences thinking, and so learning to work with the breath can have a strong influence on your psychological adjustment.”

In David Emerson’s book, Overcoming Trauma through Yoga, he writes about the different ways trauma affects our breathing and how our breath can be adaptive post-trauma. Emerson writes, “When the survival response is activated, breathing often becomes more rapid and shallow, increasing oxygen throughout the body. Survivors of chronic trauma often develop shallow breathing patterns, consistent with anxiety, hyperarousal, and panic states. When they are triggered or overwhelmed, many trauma survivors also tend to hold their breath, often unconsciously. Holding the breath is defensive and can be a protection against overwhelming emotion. However, these breathing patterns leave our bodies in a state of tension and dysregulation and may add to the overall sense of unease in the body that many survivors experience. Breathing can be a way of making contact with the self ” (p. 108).

In Zabie Yamasaki’s training, she offers these guidelines for yoga teachers using breath work in yoga classes:

  • Most importantly: remind survivors to listen to their bodies and stop breath work if they feel uncomfortable for any reason.
  • Invite students to breathe in ways that feel natural and comfortable potentially using this verbiage:
    • “Notice the connection of the breath to the movement in your body.”
    • “I invite you to breathe in and out in ways that feel comfortable for you.”
    • “Maybe explore getting reacquainted with your own breath.”
  • The goal of breath work should be to: focus on grounding and present moment experience.

Molly Boeder Harris, founder of The Breathe Network, suggests a way to create the initial conditions in yoga classes by inviting students to attend to the breath in a way that doesn’t require modifying the breath and to invite students to gradually explore lengthening the breath as the class progresses.

David Treleaven, in Trauma-Sensitive Mindfulness, offers multiple ways for students to stay within their window of tolerance (feeling stable, present, regulated) and use resources to maintain regulation. These resources could be helpful in breath work practices as well.

  • Invite student to develop mindful gauges/somatic markers- a way to evaluate one’s response to different stimuli in the present moment (body sensations, moods, or feelings).
  • Invite students to apply the brakes- purposefully slow the pace of yoga practices in order to feel safe/stable (open eyes, take breaks, take a few slow, deep breaths, soothing self-touch, focus on resourceful, external object in environment, shorter practice period).
  • Offer psychoeducation for students to use arousal scales.
  • Invite students to use stabilizing anchors of attention- finding point a focus that supports one’s window of tolerance– creating stability in the nervous system, a neutral reference point that helps support mental stability. (An anchor could be the sensation of out breath coming in and out of the nostrils or the rising and falling of our abdomen or physical sensations like hands resting on thighs or feet, buttocks, back, hands on the ground or using the senses of hearing, smelling, or sight. This could also be a soft blanket, a candle, or walking meditation).
  • Invite students to reorient/shift attention to something different if feeling dysregulated (i.e., maintain stability in the body).
  • Invite students to attend to the environment (open eyes, look around).
  • Invite students to focus in, then widen out (observing environment without trying to focus our attention).
  • Invite students to focus on resilience (purposefully turning our attention toward what brings us energy and joy, taking in the good).
  • Leave people with choice.
  • Incorporate movement into practice.
  • Utilize exteroceptive sensations for grounding (senses).
    • Touch: bring in a grounding/stabilizing object.
    • Taste: carry small food item with pleasant, intense taste.
    • Smell: equip selves with essential oil or hand lotion.
    • Hearing: use sounds around them to ground in present moment.
    • Seeing: notice/name objects in surrounding environment.
  • Be flexible with posture– it’s okay to move between postures.
  • Respect physical boundaries- don’t walk up or linger behind people, stay within view of people and let them continually assess for safety.
  • Shift attention to support stability: shift focus away from traumatic stimuli during yoga/mindfulness practice (open eyes/pay attention to surrounding environment or stabilizing anchors).

In summary, I hope to leave you with a few main takeaways and a script that can be used to introduce basic breath awareness. The breath is a powerful tool for transformation. As yoga teachers, we have been trained with a unique skillset of powerful pranayama practices. Please continue to share these powerful practices with your students with these considerations in mind:

  • Informed Consent—let students know that breath work is a powerful tool that can affect the nervous system.
  • As a basic tenet of trauma-informed care, offer your students options and choice in the practice of breath work.
  • Don’t underestimate the power of basic breath awareness, not changing/altering the breath, but simply of receiving the experience of breath.
  • If students opt not to partake in the breath work practice you’re offering or they try it and stop– Affirm their right to take that exit—these students just made an autonomous choice in congruence with the wisdom from their bodies and we as teachers should be celebrating this and respecting our student’s individual practice of yoga and innate capacity for healing.

Basic Breath Awareness Script:

I invite you to first notice where you are and where you feel supported. One option is to directly bring your hands to the body starting with the belly. Another option is to bring your awareness to the body starting first at the belly. You might gently inquire to yourself—“Is it easy to breathe in my belly?” As your attention is here in the belly, you might invite a gentle exploration of the breath filling the belly. You may or may not feel something here and there’s no right or wrong way. PAUSE.

When it feels complete, I invite you to either move your hands up and separate them to the mid-section of your thorax or bring your awareness to the mid-section of the thorax. Invite mid-section breathing and inquire, “Is it easier or harder than belly?” PAUSE.

When it feels complete, I invite you to move your hands or your awareness to the upper chest and see if you can detect how much the body expands when taking an in-breath. PAUSE.

Next, I invite you to bring one hand to the belly while the other stays on the chest. Notice which part of your body rises first on your inhale. PAUSE. Then, I invite you to shift attention to the exhale and notice which section of the body descends first. PAUSE.

When that feels complete, I invite you to place your hands or your attention wherever you like and just enjoy the restorative quality of easy breathing.

References:

Cope, S. (2001). Yoga and the quest for the true self. New York: Random House International.

Dillion, Jeanne (2014, June). Basic Breath Awareness Script from Viniyoga Teacher Training at Yoga for Wellness, Boise, Idaho.

Emerson, D. and Hopper , E, (2011). Overcoming trauma through yoga: reclaiming your body. California: North Atlantic Books.

Harris, M. B (2016, April). Somatic experiencing and trauma-informed yoga. Presentation at The Breathe Network Training, Boulder, Colorado.

Simpkins, C. A., & Simpkins, A. M. (2014). Yoga and mindfulness therapy workbook for Clinicians & Clients. Eau Claire, WI: Pesi Publishing & Media.

Treleaven, D. (2018). Trauma-sensitive mindfulness: practices for safe and transformative healing. New York, NY: W. W. Norton and Company, Inc.

van der Kolk, B. (2014). The body keeps the score: brain, mind, and body in the healing of trauma. New York, NY: Penguin Books.

Yamasaki, Z. Transcending sexual trauma through trauma-informed yoga teacher training manual.

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ISSUE #016

On Prāṇa & Prāṇāyāma
Image: On Prāṇa & Prāṇāyāma

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