ISSUE #013 - Apr 01, 2019

Guidelines for Teaching Nervous System–Informed, Trauma-Sensitive Yoga (NITYA) to Survivors of Psychological Trauma

Joann Lutz

My approach to trauma treatment through yogic interventions, Nervous System-Informed, Trauma-Sensitive Yoga, which I presented in Issue # 12 of TARKA, rests on specific guidelines for working in individual and group sessions.

These guidelines below, most appropriate for a group class, are organized around reducing the symptoms of trauma by regulating the functioning of the two branches of the autonomic nervous system (ANS), the sympathetic branch (SNS), and the parasympathetic branch (PNS), as well as information from polyvagal theory, which will be discussed in another article. This regulation can be most easily accomplished when the individual feels physically and emotionally safe. (Levine, 2010).

Some dimensions of safety which yoga can provide include grounding, boundary-making, and internal core support. When a client can feel their internal body sensations, such as the stretching of muscles in the back of the legs in the full forward bend; and their connection with the environment, such as the points of contact between the back of the body and a chair, they are well-grounded in their experience, and in a strong position to know and respond to their physiological needs. When they place their yoga mat on the floor, at a comfortable distance from the other mats, and give the instructor guidelines for how close the instructor can come, the client has defined a boundary, which can strengthen feelings of autonomy. Core support is strengthened in yoga poses, such as the seated mountain pose, with the arms are parallel and raised over the head, where the individual can focus on a place in the center of their body where they feel strong.

Please remember that, while I see these general guidelines a valuable, everyone is different, and their experiences affect them differently, so it is a good idea to implement them flexibly.  Here are the guidelines for a group yoga practice:

  1. Obtain the client’s consent to engage in yogic postures and/or breathing practices.
  2. Begin with a warm up consisting of a rotation of the joints to engage the body and focus the mind as well as lubricate the joints.
  3. As a general guideline, choose postures in the following order, from these categories. (The specific posture chosen is not important, as long as it is comfortable for the practitioner and fits into the appropriate category.):
    1. backward bending postures, such as the cobra pose, which open the chest, require muscular effort and stimulate the SNS (Shapiro, Cook, Davydov, Ottaviani, Leuchter, & Abrams, 2007; Satchidananda, 1970).
    2. forward bending postures, such as the full forward bend, which involve release, and increase PNS tone.
    3. twisting poses, such as the half-spinal twist, which sympathetically activate and release muscular or neurologic tensions in the spine.
    4. Meditative, relaxing poses, such as the relaxation pose, where the individual lies on their back, or sits, releasing their weight into the floor or chair.

This alternation of SNS and PNS activation can help reestablish the pattern of oscillation between these two poles, which is a sign of a healthy ANS.

  1. Demonstrate each pose before teaching it, to maximize use of the client’s “mirror neurons.” Mirror neurons refer to the capacity of certain brain cells to respond similarly when we perform an action and when we witness someone else perform the same action (Robin, p. 143), and prime the body for doing the posture.
  2. Include rest in the relaxation pose for one minute between each mat-based pose, which gives the body an opportunity to absorb the benefits of the poses and to bring the SNS and PNS into balance. This practice, known as “cyclic meditation,” has been the focus of a research study which concluded that cyclic meditation reduces nervous system arousal more than relaxation or stimulation alone (Telles, Reddy, & Nagendra, 2000). A shorter pause is recommended between chair-based poses.
  3. Teach the coordination of attention and movement. For example, moving one’s arm while watching TV has a different physiological effect than moving it when one’s focus is on the movement of the arm. This focus distinguishes yoga from exercise.
  4. Counsel the clients to move as slowly as is comfortable, and in coordination with the breath. Slow movement modulates SNS activation; can uncover a chronic physio-emotional-mental patterns, and can help train the observer part of the mind to remain present.
  5. Teach the same sequence of poses for at least 8 weeks to establish these movements in somatic memory, enhance the client’s ability to use them at home, and to minimize the possible stress that can accompany learning new material.
  6. Offer the client a point of concentration in the body for each pose, to steady the mind and promote present-moment awareness.
  7. Teach bi-lateral poses first to the right and then to the left, since a focus on the right side is activating to the SNS and a left-side focus increases PNS tone.
  8. Maximize safety for the clients by offering the session in a private, comfortable, quiet, welcoming space.
  9. Use invitational language and interoceptive language. Invite the client to make their own decisions about their practice, with phrases like “when you are ready” or “if you like.” Encourages the client to experience what is going on in their body, moment-to-moment. Phrases such as, “how does your body feel in that pose?”; or “track your sensations, noticing them as they move through your body”  can help with that process. (Emerson, D., Hopper, E., 2011; Emerson, 2015)
  10. Choose a space which is private, comfortable, and large enough to accommodate the individual or group.
  11. Be attentive to how you present yourself, always being punctual, well prepared, and welcoming, through physical gesture and tone of voice.

I see this use of yoga as healing in itself, as well as an adjunct to other forms of trauma treatment. Whichever form of treatment is used, it will be most effective if the individual feels internally stable and physically and emotionally safe. The use of yoga in trauma treatment can have the most impact early in trauma treatment, when the client is reconnecting with body sensations, and can be a resource throughout the course of treatment.

 

Emerson, D. (2015). Trauma-Sensitive Yoga in Therapy: Bringing the Body into Treatment. N.Y.: W.W. Norton & Co.

Emerson, D; Hopper, E. (2011). Overcoming Trauma Through Yoga. Berkeley, CA: North Atlantic Books.

Levine, P. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, Ca: North Atlantic Books.

Robin, M. (2009). A Handbook for Yoga Asana Teachers. Tucson, AZ: Wheatmark. Satchidananda, Swami. (1970). Integral Yoga Hatha. Holt, Rinehart, and Winston.

Telles, S., Reddy, S. K., & Nagendra, H. (2000, December). Oxygen consumption and respiration following two yoga relaxation techniques. Applied Psychophysiology & Biofeedback Journal. 25(4): 221–227.

van der Kolk, B. (2014). The Body Keeps the Score. New York: Viking Press.

*This article contains excerpts from an article which was published in the book, Proceedings of the Yoga and Psyche Conference (2014), edited by Caplan, M., published with permission by Cambridge Scholars Publishing.

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