Yoga and PTSD

Hello, again, fellow Veterans! I hope all is well! I find myself constantly searching for knowledge and new things to help with life’s challenges and PTSD and help ease the day-to-day stress that encompasses our lives. I have found that Yoga can be an alternative solution for many. Please read more to understand better this alternative way to address PTSD and reduce the stress in your life.

Unfortunately, many people will encounter significant trauma at some point in their lives. For many, the long time being upset in the aftermath of a traumatic event will eventually pass, allowing them to move on. For others, the development of post-traumatic stress disorder stands in the way of their return to everyday life.

Yoga Therapy for Trauma and PTSD

Post-traumatic stress disorder is a challenging illness that can dominate the lives of those it affects, and various strategies are often required to manage the emotional and physical symptoms that usually define it. Evidence-based techniques from Yoga can aid in the recovery of PTSD, becoming a promising area for yoga therapy. This emerges scientific research towards several mechanisms through which Yoga can reduce symptoms of PTSD.

Yoga can be a successful treatment for PTSD because it works with both the mind and the body while helping to forge a sense of safety in the community where individuals can feel comfort and support. Along with medication and psychotherapy, yoga can be used for a person’s self-care and medical care.

By combining a comprehensive knowledge of neuroscience, psychology, and physiology of the trauma with yogic techniques, yoga therapists can gently guide people living with PTSD towards recovery in an informed and safe way. Furthermore, they can work into a broader treatment plan framework and help individuals fully engage with counseling or therapy.

Post-Traumatic Stress Disorder: A Background

Most of us are introduced to post-traumatic stress disorder in the context of the military. While there are written descriptions of symptoms of PTSD that go as far back as the Ancient Greeks, however, our comparable modern understanding of this illness first entered widespread realization through the common phrase “shell shock” – a term invented to characterize the long-term effects that trench warfare had on many soldiers during the First World War.

Since then, understanding and sympathy around PTSD have grown. Anyone frequently exposed to life-threatening or traumatic situations (such as soldiers, paramedics, and firefighters) is at risk of developing PTSD. Still, it can also affect those who have lived through traumatic incidents such as violent/sexual assault, serious accidents, or difficult labor.

PTSD affects one in three people who experience trauma. It is still unknown why some individuals develop this illness while others do not. Still, inadequate support in the immediate aftermath of experiencing or witnessing a traumatic event may elevate risks.

The symptoms of PTSD include:

· Re-experiencing the traumatic event through flashbacks, nightmares, and physical sensations.

· Avoidance of triggers that reminds the individual of the event. They also push away feelings and memories while experiencing emotional numbness and dissociation.

· Hyperarousal and constantly feeling “on edge” are often associated with hypervigilance, irritability, and insomnia.

· Co-occurring issues include anxiety, depression, alcohol/substance misuse, and relationship breakdown.

The Physiological Characteristics of PTSD

When the individual experiences or witnesses a life-threatening, violent, or a traumatic event, their nervous system will activate a defensive bio-behavioral response – an automatic “survival mode” – which can manifest itself in two disparate ways:

The fight/flight response, where an individual’s sympathetic nervous system (SNS) is activated to equip the body with the means to fight or run away from a threat.

The shutdown/freeze response is the activation of an evolutionarily older branch of the vagus nerve. This creates stillness (to avoid detection or play dead) and can induce dissociation.

While the trauma was probably unsafe, uncontrollable, and unpredictable, a person may perceive their body’s response as equally dangerous and unstable. The dissociation and inability to move induced by the “freeze” response can be extremely disturbing. At the same time, the rush of energy and shutdown of higher cognitive functioning associated with fight/flight may be remembered as a frightening loss of control.

This trauma – and the bio-behavioral response it provokes – can be overwhelming, leading to the memory of the event and its attendant images, sensations, and emotions becoming dissociated from everyday conscious experience. Then as we re-experience through flashbacks, nightmares, and an array of feelings, accompanied by the defensive reactions the trauma initially triggered.

PTSD causes the dysregulation of the body’s defensive response means they release higher stress hormones and react even in non-threatening situations as if they were under a threat. Experiencing a chronic activation of the fight/flight response, they exhibit hyperactivity in the amygdala (the brain area that meditates fear) and changes in the hippocampus, a part of the brain associated with memory and emotions. They may also experience the inability to feel pleasure and dissociation.

Why Use Yoga for Trauma as an Adjunct Treatment for PTSD?

Trauma affects individuals physiologically, cognitively, and emotionally, with the ramifications felt by their mind and body. Yoga therapy acts across all these domains, leading those with PTSD to increasingly turn to this mind-body practice in their journey towards recovery.

A key challenge for someone who has post-traumatic stress disorder is the inability to regulate their physiological survival response with an automatic and unconscious reaction. People can rationally know they are not in danger while experiencing hypervigilance or even panic. Achieving a stabilized state of the autonomic nervous system (ANS) through Yoga can help people engage with counseling and psychotherapy, allowing them to begin to process their trauma.

Yoga therapy may help people return to a baseline physiological state more quickly after a distressing memory is triggered. It is thought that regular yoga practice trains the ANS to be more dynamically adaptive and that mindfulness meditation (a unique component of Yoga) can lead to positive changes in neural functioning, including the reduction in the size of the amygdala and increased hippocampal volume.

Trauma survivors can experience the disconnection between mind and body and exhibit a lack of body awareness. This is a form of avoidance as they seek to circumvent any feelings or sensations that remind them of their trauma and result in hyperarousal that renders bodily reactions that are unpredictable and disconnected from conscious thought.

Body awareness is an intrinsic part of Yoga. It can help people “build skills in tolerating and modulating physiologic and affective states that have become dysregulated by trauma exposure,” associated with lesser symptom severity. In a yoga class, people can learn better cope techniques with the defensive responses that proceed to traumatic memories (or other triggers) that arise in the internal and external environment of nonreactive mindful awareness.

People experiencing PTSD are physiologically primed for threat, their ability to socialize and cope well with others can be severely reduced, and even their closest relationships can become stressed. In a self-directed and natural way, a yoga class allows them to find support among peers without expecting to engage beyond their current comfort zone.

Post-Traumatic Stress Disorder is an illness that often requires an individualized and multifaceted response, and no two people’s experience of trauma will be the same. Yoga therapy is an effective tool that addresses PTSD on various levels, allowing people to move forward and find a new purpose in life after trauma.

Post-traumatic stress disorder is possibly the most urgent problem facing the U.S. military today. The personal, social, and economic burden of soldier suffering, treatment costs, disability compensation, and productivity losses related to PTSD are significant issues facing American society.

Meditation

Studies have evaluated mindfulness training, mantra reciting, and compassionate meditation (Vipassana) for the beneficial effects on individuals experiencing PTSD. Mindfulness training reduces symptoms of PTSD when improved attention allows increased control over intrusive thoughts or memories. Patients who engage in mindfulness practice can be trained to shift attention from remembered fears to present-focused problem solving, improving coping skills.

The therapeutic benefits of mantra meditation have been found in the effects of repetitive chanting that reduces the overall levels of arousal, improving emotional self-regulation. Compassion meditation (Vipassana) reduces symptoms of PTSD by decreasing negative emotions and reactivity to stressful conditions. Enhanced coping is achieved through enhanced resilience and increased social connections while in group meditations.

Essential benefits of meditation as a treatment of PTSD include ease of training, low cost, and practical implementation in group settings. Accumulating research findings suggest that re-experiencing and psychic numbing symptoms may be less responsive to meditation than other PTSD symptoms. Researchers have examined the effects of training in transcendental meditation (TM) on PTSD. In a small twelve-week pilot study, military veterans diagnosed with PTSD trained in TM experienced significant improvements in overall quality of life and reductions in the severity of core PTSD symptoms.

In another small pilot study, sixteen Vietnam-era veterans diagnosed with PTSD completed eight weekly classes on a mindfulness meditation called ‘iRest’ reported reduced rage and emotional reactivity and increased feelings of peace, relaxation, and self-efficacy. A review of meditation practices addressed preventing PTSD found more evidence supporting mindfulness meditation than mantra reciting or compassionate meditation. A systematic review of ten trials on meditation for PTSD that included studies on mindfulness-based stress reduction (MBSR), Yoga, and mantra recitation, reported positive benefits for quality of life and anxiety.

Further studies are needed on the therapeutic benefits of meditation in PTSD to determine whether specific techniques are more effective when compared to others and evaluate the effectiveness of meditation in combination with conventional psychological approaches like mindfulness-based cognitive therapy (MBCT), exposure therapy, dialectical behavioral therapy (DBT), along with other therapies.

Yoga and other mind-body practices

Yoga and other mind-body practices treat PTSD in both civilian and military populations. A literature review of studies on mind-body practices used for treating PTSD found that many approaches were used to reduce the severity of core PTSD symptoms, including intrusive memories, avoidance, and emotional arousal. Individuals who regularly engaged in mind-body practices reported improvements in mental health issues associated with PTSD, including anxiety, depressed mood, and anger, resulting in improved coping with stress.

In a small seven-day study, military veterans diagnosed with PTSD randomized to daily three-hour sessions of a breathing-based Yoga showed reductions in PTSD symptom severity, anxiety symptoms, and respiration rate at the end of the study and one-year follow-up. Other studies with different groups of sixteen military veterans each diagnosed with PTSD who attended yoga sessions twice weekly reported significant improvements in sleep and other PTSD-related symptoms.

I hope you find this helpful. Having the proper tools to deal with stress and anxiety is the key to getting through the day. If you had asked me ten years ago to try Yoga, I probably would have laughed at you. However, now that I have tried it and have felt the effects of its application, I am a believer! What do you have to lose? Keep an open mind and give it a try. You need a healthy mind and body, right?! Yoga is the key! Well, it is time for me to go. You stay safe, and I will see you next month. Take care!

Dr. John Heintzelman

References:

Gallegos, A., Crean, H., Pigeon, W., and Heffner, K. (2018). Meditation and Yoga for Posttraumatic Stress Disorder: A Meta-Analytic Review of Randomized Controlled Trials. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5939561/

Image provided by Adobe Stock (April 2023).