Trauma is much more than a clinical diagnosis. It is fundamentally communal, political, and relational. Healing is about creating a peace defined by justice, dignity, right relationship, and opportunity to flourish as much as it is about transforming the effects trauma has on individuals.
While clinical perspectives provide an incomplete - and often problematic - view of trauma and healing, they offer one layer of understanding and hope as well as insight into how and why TCTSY can be helpful in healing.
Why not just any yoga class?
Trauma Center Trauma Sensitive Yoga: Theoretical Underpinnings
TCTSY as an Adjunctive Treatment
Ways to Collaborate
Often, we feel the continuing effects of our traumatic experiences even though they seem beyond the reach of words and rational explanation. This is because trauma lives in our bodies. The parts of our brains that are responsible for language processing, problem-solving, and memory recall are disrupted or disconnected from traumatic experiences. Consequently, much of the aftermath of trauma is stored in our bodies out of reach of most therapeutic modalities.
Yoga has the potential to access the places where our trauma lives and to release it from our systems. When offered responsibly, yoga can help to process trauma stored in our bodies, and to build body awareness, present-moment connection, and the relational safety required to establish a therapeutic alliance. While conventional therapy can help people to think about, talk about, and imagine what healing would be like, a yoga practice can offer a felt sense of empowerment, safety, and connection.
When offered as an adjunct to conventional therapy, yoga can create a more complete therapeutic plan, address areas blocking progress, and increase clients' sense of safety in their own bodies, enabling fuller participation in therapy and in life.
See Yoga for Trauma Resiliency for more on the relationship between yoga and trauma recovery.
why not just any yoga class?
Trauma has very complex effects on the whole human organism and how we relate to the world around us. Because trauma lives in our bodies and our bodies are directly targeted in so many traumatic experiences, a yoga practice will likely initiate heightened trauma reactions such as dissociation, flashbacks, and hyper-vigilance. Many yoga offerings, even if 'trauma-sensitive' or 'trauma-informed,' integrate practices (for example: group dynamic, language choice, music, teacher qualities, assists) that can be explicitly triggering for trauma survivors and distract from the potential therapeutic benefits.
Yoga itself has a history of 'correcting' people's bodies, breath, and internal states and a tradition of powerful or sensationalized teachers. In these practices, students' attention is oriented toward pleasing an external authority (the teacher). Even in classes with trauma sensitivity in mind, the desire for students to achieve trauma-related outcomes, such as 'self-regulation' or 'peacefulness,' can feel like coercion. These patterns can easily subtly be brought into 'trauma-sensitive' classes, replicating trauma dynamics in ways that teachers might be unaware of but survivors will be highly attuned to.
Trauma Center Trauma Sensitive Yoga: Theoretical Underpinnings
Trauma Center Trauma Sensitive Yoga (TCTSY) is an empirically validated, clinical intervention for complex trauma or chronic, treatment resistant post-traumatic stress disorder (PTSD). TCTSY was the first yoga program to be listed nationally as an evidence-based program or practice for treatment of psychological trauma by the Substance Abuse and Mental Health Services
Administration (SAMHSA).* In addition to yoga, TCTSY has foundations in Trauma Theory, Attachment Theory, and Neuroscience.
*Please note that in 2018, the American Government removed the federal listing of evidence based practices and replaced it with a general reference to yoga as a "complimentary therapy" for PTSD.
Beyond stress, chronic stress, or PTSD, TCTSY was designed for complex trauma or treatment-resistant PTSD.
Complex trauma develops when people live with longitudinal and relational coercion, abuse, or neglect.
Disturbances in attention or consciousness
Disturbances in self-perception
Disturbances in relationships
Disturbances in meaning systems
Treatments that have had great success with single-incident traumas or adult-onset trauma, such as EMDR, have shown limited success with childhood or multiple-incident trauma.
Traumatic memories are often fragmentary, nonlinear, inconsistently available to conscious awareness, and encoded and recalled as sensory fragments of the traumatic event, sometimes in the context of generalized memory impairment.
Traumatic memories live in the body. Involving the body in treatment is necessary.
Cultivating agency and empowerment are critical in healing.
It is through our relationships, particularly our primary caregiver relationships during early development, that we form our basic sense of safety in the world and within ourselves:
If I cry and my caregiver comes to me, I learn that I am real.
If I cry from feeling hunger and my caregiver feeds me, I learn that my internal experience is valid and I can affect my reality.
If I cry from feeling hunger and my caregiver feeds me, I learn that I am worthy of care.
If my caregiver consistently feeds me when I cry from hunger, I learn that others are trustworthy.
If I consistently receive food when I feel hunger, I learn that the world is predictable.
Across the lifespan, we develop agency in the context of relationships. We internalize and embody being responded to, having our needs met, and being cared for.
Complex trauma is the internalization of neglect, chaos, and abuse - the world is not safe; my body is not safe; and there is nothing I can do about it. It is the opposite of relational safety.
It is crucial to create relationship dynamics that are consistent, attentive, and responsive in the healing process.
If people are unable to effectively respond to a traumatic event or establish safety, we may experience prolonged toxic levels of stress hormones intended to temporarily mobilize us for self-protection. This can lead to long-term struggles with reactivity, overwhelm, and panic.
Similarly, the nervous system becomes dysregulated, inhibiting rest and relaxation.
Trauma disrupts frontal lobe activity, leading to reduced self-awareness, play, curiosity, imagination, and exploration, and increasing flight-fight-freeze reactivity even to seemingly non-threatening stimuli.
Due to breakdown in the thalamus, traumatic memories are encoded as images, emotions, and sensory fragments rather than as coherent narratives situated in linear time.
The Broca’s area, the speech center of the brain that is responsible for putting thoughts and feelings into words, goes ‘offline’ when people are triggered or recall traumatic events, limiting the ability to subsequently verbally process trauma.
Trauma deactivates our interoceptive capacity - our ability to receive sensory information from our bodies in order to have a felt sense of our reality. (For example, I might have difficulty locating pain in my body or might not feel hunger or temperature).
Implications for treatment:
Effective treatment accesses trauma content and provides care and transformation without relying on verbal processing and reasoning.
We must involve the body and in ways that help people to gradually meet and respond to physical sensations fraught with danger and distress.
It is crucial to help people have physical, felt experiences of agency and empowerment.
Treatment should work with the nervous system from the bottom up and top down, both helping people to establish safety in their bodies and cultivate present-moment attention and self-awareness from which to act.
From its inception, TCTSY has valued the rigor and accountability mechanisms required by working within academic and Western medical frameworks. TCTSY intentionally partnered with clinicians and researchers in the design, implementation, and monitoring of their programs. They invited professionals not affiliated with the Trauma Center or their work to hold us accountable so that claims we make about the effects of TCTSY are grounded in evidence and based on best practice.
The first pilot study for TCTSY took place in 2003; the first randomized-controlled trial in 2009; and the first peer-reviewed publication in 2014. Thousands of hours of dedication by professional yoga instructors, yoga students, clinicians, graduate students, study participants, and others led to SAMHSA recognition in 2017.
For qualitative and quantitative studies with TCTSY, see Research.
Yoga as an Adjunctive Treatment
TCTSY is designed to assist folks living with complex trauma. Beyond a single-incident traumatic experience, complex trauma results from chronic and relational coercion, violence, abuse, or neglect. Drawing from trauma theory, attachment theory, and neuroscience, TCTSY is designed to support trauma recovery by cultivating agency, empowerment, interoception (awareness of internal and sensory states), and present moment experience.
TCTSY offers a complement to other therapeutic modalities. It provides the opportunity to build distress tolerance (particularly because symptoms are often experienced somatically), to strengthen connection to the present-moment, to cultivate a sense of safety in one's own body, and to process trauma in the parts of the brain and body where trauma is held but is not accessed verbally.
TCTSY can be most useful for people coping with:
disempowerment related to disability
systemic oppression (such as: racism, sexism, homophobia, xenophobia, etc.)
war or other civil violence
*TCTSY is not an alignment-based practice. Clients should consult their physician and consider their own knowledge of their body's needs and risks and their comfort making choices to support their individual physical safety.
*TCTSY is not advisable for individuals with trauma-related hospitalization in the past six months.
Ways to Collaborate
Refer clients to TCTSY group series
Refer clients for individual sessions
Integrate TCTSY into support groups
Integrate TCTSY into individual or couple’s therapy sessions
Stand-alone TCTSY groups at your clinic or center
*The level of communication with one's therapist can be tailored based on the client's preference and on the therapeutic plan.