Friday, July 15, 2016

Yoga informed treatment

The topic of using yoga as an adjunctive treatment for traumatized people has recent come up on ATSA’s listserv and at a number of conferences (e.g., the National Adolescent Perpetration Network, the Massachusetts Adolescent Sex Offender Coalition). In case it helpful, I am summarizing some recent discussion for this blog.

In 2014, Bessel van der Kolk and his colleagues produced a fascinating randomized controlled trial on a specific kind of yoga practice for people who have experienced trauma. There has been increased empirical attention to the use of movement therapies such as yoga and tai chi, as well as mindfulness and meditation in recent years, and many within these fields have noted that the work of van der Kolk and his colleagues has moved the field forward a little more. Despite this empirical attention, it may be more helpful to consider yoga more as a source of practice-based evidence than an evidence-based practice. By this, I mean that yoga is clearly not for everyone; in the experience of many, when it is helpful it can be extraordinarily helpful. If it’s not for you, it’s probably best not to practice it.

My involvement with trauma-sensitive yoga (TSY) in treatment goes back about 10 years to when I was overseeing the front end of treatment at Wisconsin’s civil commitment program, Sand Ridge. Much has changed there since, but at the time I was frustrated by the fact that we had clients in treatment who could do all the cognitive exercises in the world and run groups about cognitive skills better than many facilitators. The problem was that they could examine their cognitions and actions after the fact, but they just couldn’t observe them in the moment as they were happening.

In many cases, they came by this honestly. Years of abuse, neglect, and other trauma, sometimes before they could even talk, left them in the states you might expect: scanning their environment for threats, scanning the staff for evidence of bad intent, and never scanning themselves. One ATSA-lister quipped with me that this apparent absence of curiosity in many of our clients can seem to disprove the Socrates dictum that the unexamined life is not worth living. In fact, it seems that many of our clients have never had the opportunity to develop self-observation skills because they were too busy surviving.

On top of this, it has become obvious to many of us treating adults and adolescents that not only do our clients very often not examine their thoughts and actions, many of them outright hate their lives, their futures, their sexuality, and their own bodies. In the programs where I’ve worked, this has been evident way beyond the periodic self-injurious behaviors that programs often experience. A turning point for me was the day that a client who knew more about cognitive-behavioral treatment than most of the clinicians left group and impulsively assaulted a uniformed staff. He was as surprised as anyone by the assault; in essence, he knew the words but not the music about managing his behavior.

Rob Longo, Kevin Creeden, John Bergman and I worked together some years back on using brain-based interventions in the treatment of trauma and violence. Reviewing the research inevitably led to an interest in yoga and other movement therapies as a means to deepen the impact of therapy. In my case, I joined up with Bessel van der Kolk’s JRI group and became one of their first certified instructors. We’ve used a specific form of trauma-sensitive yoga (see in our programs, on and off, for some time now with positive overall results. I mention some key points below.

Yoga, like other movement therapies and many forms of meditation can be an excellent means by which people can develop the self-observation skills that will make it easier to access treatment. Many have found it to be a transformative start to reclaiming their bodies and their lives. I park it under the responsivity principle generally, but note that for some people it can have dramatic effects beyond being merely an adjunctive treatment.

Trauma-sensitive yoga generally eschews some of the more obvious pitfalls of doing yoga in settings such as those in which many of us work. Simply bringing in a teacher and hoping for the best is unlikely to work out very well. Not only can many of the usual trappings actually become distracting from its purpose (lavender oil, eye pillows, etc.), some of them can be triggering (e.g., the use of straps and many of the “poses” such as happy baby and down dog).
Ultimately, key elements in the way that we use this kind of yoga include:

1)      Just noticing…

2)      …and practicing making choices based on what one notices (e.g., if stretching your neck feels different on one side or another, you might try altering how how you stretch)

3)      An investigation of each experience

4)      Being highly sensitive to dosage. Getting in touch with body sensations can be much scarier than most of us realize. For people who are traumatized, even a focus on the breath can be triggering.

5)      This is judgment free: This is not about trying to do anything better, comparing yourself to others, etc.

6)      This kind of yoga should never, ever be compulsory. Directing people to do yoga without it being completely their choice is itself an abuse dynamic. All too often, we’ve been stymied by the past experiences of clients who have been hospitalized and gently coerced into yoga by staff who remind them that it will help them earn points, levels, privileges, etc. Bad practice.

My colleague David Emerson and I have noticed that although we’ve worked with similar groups of adolescent clients we tend to use different formats. I have no problem teaching classes of 35-40 minutes, while he often gets better results from very brief individual interactions. I’ve chalked this up to small differences between us more than differences in clientele.

I urge all readers to look further into the possibility of movement therapies and meditation practices as adjunctive treatments for trauma!

David Prescott, LISCW


1 comment:

  1. I am a recreation therapist, I have been offering a relaxation focused yoga program with Violent Sex Offenders for over 3 years. Many of the participants have continued practicing yoga on their own after completion and show appreciation for the benefits gained. I use information from the prison yoga project as well as other yoga websites such as the Yoga Journal. In hopes to improve this program, I am interested in what resources other clinicians are using for these programs.