Long story short- one has an evidence-base for reducing symptoms of PTSD while the others do not.
We are becoming increasingly aware of the prevalence of trauma. It's predicted that 70% of Americans and 57-70% of Australians will experience trauma over their lifetime. This has resulted in campaigns to increase trauma-awareness and trauma-informed care across a range of sectors including education and health.
Emotional trauma has physical symptoms. As a result, trauma is showing up in yoga studios and has resulted in a need for increased education. This has led to the rise of trauma-informed and trauma-aware practices.
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Trauma-Informed and Trauma-Aware Yoga
Trauma-informed or trauma-aware yoga is an approach that understands the prevalence of trauma and acknowledges that a proportion of people practicing yoga will have a trauma history. A yoga teacher that is trauma sensitive or trauma aware is more likely to recognise trauma symptoms and is aware of how this might impact a yoga practice.
What are some of the physical manifestations of trauma?
· Reduced awareness of body-sensations
· A feeling of being dissociated from one’s body
· Increased sensitivity to body sensation
· Triggering of trauma memories through body movements or sensations
· Anxiety or triggering when focusing on breath
· A long held defensive/protective posture, and difficulty releasing this posture.
· Hypervigilance in the space and physical symptoms of hypervigilance
· Increased blood pressure
· Increase heart rate
· Fatigue
· Muscle tension
· Nausea
Everyone's experience is unique, people with a trauma history can present with any number of the above experiences and others that are not listed. A yoga teacher who is trauma aware will adapt their teachings to provide space and support for trauma symptoms. The result is a yoga practice that can provide a sense of safety and acceptance.
However, trauma-sensitive yoga goes a step further, and while it also includes trauma-aware and trauma-informed practices, it is a therapy that can reduce symptoms of PTSD.
Trauma-Sensitive Yoga
Trauma-sensitive yoga is an evidence-base practice that reduces symptoms of PTSD and complex trauma. It was developed and tested at the Center for Trauma and Embodiment at the Justice Resource Institute, where their goal is to disseminate, evaluate, and advance trauma-informed practices and therapies. To distinguish trauma-sensitive yoga as an evidence-based therapy from other trauma-informed practices, developers referred to their method as Trauma Center Trauma Sensitive Yoga (TCTSY). They key here is that it is a structured method that has been tested, validated, pair reviewed by trauma experts, with results published in scientific journals.
So, what makes trauma-sensitive yoga an evidence-based therapy?
One key difference is the language used, with the goal to facilitate processes that can reduce PTSD symptoms, including:
Interoception, i.e., body awareness, and facilitating accuracy when noticing sensations.
Present moment awareness. Instead of focusing on our past experiences or predictions about the future.
Concrete concepts rather than metaphorical explanations that may be mentally distracting.
Physical and emotional empowerment through choice.
In addition, the practice is dosed and designed to meet the client where they are on the day and in their overall therapeutic process. Dosing is achieved through amount of choice and body awareness cues offered, and yoga poses or yoga shapes that are practice. Trauma can influence tolerance to choice and comfort level when noticing body sensations. It can also influence tolerance to different body movements and shapes.
Certified trauma-sensitive yoga facilitators (TCTSY-Fs) have also undergone over 300 hours of training in trauma-sensitive yoga methodologies, trauma theory, neuroscience of trauma, and attachment theory (i.e., very important understanding and working with developmental trauma). They are also supervised by the Center for Trauma and Embodiment, where they are required to complete continued professional development (CPD) hours and submit sample practice videos demonstrating their continued competencies in trauma-sensitive yoga methods.
The overall result is that trauma-sensitive yoga or more specifically TCTSY can offer a body-based therapy backed by scientific research showing reductions in symptoms of PTSD and complex trauma. I'll add some key publications below.
What is the best- Trauma-Sensitive, Trauma-Aware, or Trauma-Informed Yoga?
This is going to depend on what you are looking for. If you are after a general yoga practice that acknowledges the prevalence of trauma and can offer a safe and accepting space for people with trauma histories, then anything trauma aware or trauma informed could work well.
If you are looking for a therapeutic practice with an evidence-base for reducing trauma symptoms, then it's worth digging a little deeper and finding out whether your yoga teacher is a certified TCTSY-facilitator (TCTSY-F). They are trained to provide trauma-sensitive yoga as a therapy to facilitate recovery from PTSD and complex trauma.
About the Author
Kathie Overeem (PhD, Psychology) has 9 years experience working in trauma. Her MSc and PhD focused on how we form and express fear memories, since 2018 she has worked therapeutically with survivors of trauma using trauma-sensitive yoga (i.e., TCTSY).
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References
Kelly, U., Haywood, T., Segal, E., Higgans, M. (2021) Trauma-Sensitive Yoga for Post-Traumatic Stress Disorder in Women Veterans who Experienced Military Sexual Trauma: Interim Results from a Randamized Control Study. The Journal of Alternative and Complementary Medicine, 27, pp. S45-S59
Nguyen-Feng, V.N., Hodgdon, H., Emerson, D., Silverberg, R., Clark, C.J. (2020) Moderators of treatment efficacy in a randomized controlled trial of trauma-sensitive yoga as an adjunctive treatment for posttraumatic stress disorder. Psychol Trauma. Nov;12(8):836-846
Price, M., Spinazzola, J., Musicaro, R., Turner, J., Suvak, M., Emerson, D., van der Kolk B (2017) Effectiveness of an Extended Yoga Treatment for Women with Chronic Posttraumatic Stress Disorder. J Altern Complement Med. Apr;23(4):300-309. doi: 10.1089/acm.2015.0266
Rhodes, A., Spinozzola, J., van der Kolk, B. (2016) Yoga for Adult Women with Chronic PTSD: A Long-Term Follow-Up Study. J Altern Complement Med. Mar;22(3):189-96. doi: 10.1089/acm.2014.0407
van der Kolk B.A., Stone, L., West, J., Rhdoes, A., Emerson, D., Suvak, M., Sinazzola, J. (2014) Yoga as an adjunctive treatment for posttraumatic stress disorder: a randomized controlled trial. J Clin Psychiatry. Jun;75(6):e559-65