1. Holistic Treatment: Using Yoga in the Treatment of Trauma Brad A. Imhoff, PhD, LPC Sarah E. Acker, CT Matthew D. Black, CT

2. Before We Begin  A Minimally Interactive Presentation  Introductions & Our Interest in the Topic

3. The Prevalence of Trauma In the United States:  1 in 5 people was sexually molested as a child  1 in 4 beaten by a parent to the extent a mark was left on the body  1 in 3 couples engages in physical violence

4. Trauma Survivors Admirable & Resilient  Endured an intolerable, unbearable experience  Deal with daily life, often with an agonizing secret and the memory of terror  A secret that relives itself at random, often with no warning

5. Living with Trauma It’s not over when it’s over.  Primitive part of our brain  Easily reactivated at the slightest hint of danger  Continually and excessively secretes stress hormones  Result? Pain. Then numbness.  Intense physical sensations, unpleasant emotions, and impulsive and aggressive actions

6. Living with Trauma It’s not over when it’s over.  Can’t “get over it” and have to live with the consequences  Constant discomfort  Push it out of mind, avoid it  Begin to feel damaged to the core and beyond redemption

7. Changes in the Brain Trauma results in physiological changes:  Increase in stress hormone activity  The brain’s alarm system is recalibrated  Shut Down of the Thalamus

8. Changes in the Brain Stress Hormones Typical response: 1. Stress hormones release with fearful stimuli, then quickly return to normal. 2. Cortisol, a type of stress hormone, sends an “all-safe” signal

9. Changes in the Brain Stress Hormones In individuals with PTSD: 1. Stress hormones don’t regulate; they continue being released despite safety. 2. Levels of Cortisol are abnormally low.

10. Changes in the Brain Stress Hormones Result? Prolonged state of flight, fight, or freeze Increased agitation, fear, and panic Increased blood pressure and heart rate (long-term health problems)

11. Changes in the Brain Stress Hormones  Ongoing dilemma  “Marsha’s” Car Accident  Reactivates the amygdala  alarm reaction & stress hormones  Flashbacks, triggers, telling the story, etc.

12. Changes in the Brain Alarm System Amygdala – “The Smoke Detector” Medial Prefrontal Cortex – “The Watchtower”

13. Changes in the Brain Alarm System  Amygdala – “The Smoke Detector”  Warns of danger faster than we can even process it  Trauma increases the chance of it misinterpreting stimuli

14. Changes in the Brain Alarm System  Medial Prefrontal Cortex – “The Watchtower”  Assesses the situation  Restores balance and aborts the stress response  Mindfulness – hovering calmly and objectively over our thoughts and emotions  Breakdown in this alarm system = reactivity, intense emotions, hypervigilence, etc.

15. Changes in the Brain Thalamus “The Cook”  Takes the ingredients from the eyes, ears, and skin (touch) and creates the soup that is our autobiographical memory  Filter – what information is relevant and irrelevant?  Breaks down during trauma  Not a story, but fragments of intense sensory input  Constant sensory overload without the filter  Desire to shutdown

16. Changes in the Brain Implications for Treatment  Revisiting the past should only occur when people are firmly grounded in the present and feeling as calm and safe as possible.  The challenge is not to simply accept what happened, but to gain mastery over one’s internal sensations and emotions.  Desensitization may equal less reactivity, but treatment must focus on living fully and securely in the present

17. Neuroplasticity Three approaches to utilizing it: 1. “Top down” – talking, processing memories, connecting with others, gaining insight 2. Taking medications that shut down or activate certain different brain activities 3. “Bottom up” – having physical experiences the contradict the helplessness, lack of control, rage, and collapse that come with trauma

18. Talk Therapy Necessary, but Insufficient?  “Marsha’s” Car Accident  Not only activates the amygdala (stress hormones and alarm), but shut down “Broca’s area”  Broca’s Area  Responsible for speech production  Aids in putting thoughts and feelings into words  Recounting and retelling the event becomes challenging  Not just shame and secrecy, actual challenges from changes in the brain

19. Talk Therapy Necessary, but Insufficient? Right-brain and Left-brain  Right: Stores memories of sound, touch, smell, and the emotions they evoke  Left: Analyzes, remembers facts, helps us logically explain our experiences and put them in order During Trauma triggers  Right-brain reacts as though it’s happening in the present  Left-brain deactivates

20. “At the end of the day people won't remember what you said … they will remember how you made them feel.” -Maya Angelou

21. Talk Therapy Necessary, but Insufficient?  Traumatic events become fragmented pieces of emotions, pictures, sights, and sounds  “Cover stories” for public consumption  A narrative with a beginning, middle, and end is hard to produce “I pray you believe what I have said. I reported what I saw and heard, but only part of it. For most of it I have no words.” -Ed Murrow, CBS Correspondent

22. Medications Helpful, but Masking the Issues?  Displacing therapy  “Quick fix” culture  Financial considerations  Best considered adjuncts in treatment

23. Takeaways  Trauma changes the way our brain functions  Stress Hormones  Alarm system is recalibrated  Traumatic events are relived as though happening in the present  Talk therapy can be hindered by brain functioning  Mindful awareness of the body and using movement may be the most effective first-step in treatment

25. Source: http://traumahealing.org/

30. Why Yoga?

31.  Acknowledge the holistic effects of trauma  Not only effects the psyche, but the body and mind as well  Yoga:  A way to make peace with your body (and reclaim your body)  Learn that your body can body can be effective again (through strengthening)  Learn to confidently make decisions  Strengthen relationships with others and with self

32. What We’re Dealing With  Intrusive Symptoms  Triggers  Flashbacks  Avoidance Symptoms  Dissociation

33. The Goal of Treatment “The goal of treatment of PTSD is to help people live in the present, without feeling or behaving according to irrelevant demands belonging to the past.” – Dr. Bessel Van Der Kolk

34. Staying Present  Mindfulness / Grounding  Standing Mountain Exercise  Breathing  Notice breathing  “Add a little breath”

36. Trauma-Sensitive Yoga  Bottom-Up Model  Somatic experience as an entryway to psychological experience  Balancing embracing current self while utilizing sense of empowerment to change  Key differences between TSY and other practices  Students are guided by their own experience

37. Considerations For Clinicians  Reject the “Guru” mentality  Props or no props?  Physical Assists or none?

38. Some Tips  Take a few yoga classes first  Do the exercises with the client  Find your “yoga voice”  Debrief after each session

39. In Helping to Tolerate Discomfort…  Use words to challenge like:  “Notice” “Investigate” “Experiment” “Curious”  The power of choice  Start to challenge the thought that there is nothing we can do about pain

40. Let’s Try It!

41. Additional Resources Overcoming Trauma through Yoga – David Emerson and Elizabeth Hopper Waking the Tiger: Healing trauma - Peter Levine The Body Keeps the Score - Bessel van der Kolk