ATSA Forum - Vol. XXVII, No. 2
Just the same, this reviewer has often been troubled by the attempts of programs to use cognitive-behavioral methods with people whose backgrounds of childhood adversity have left them mostly unaware of their own cognitions and behaviors, much less modify them. How can one change thoughts and behaviors that they can’t first observe? As one example, consider the client assigned to cognitive skills treatment who has memorized the curriculum, as well as the facilitator, but is seemingly powerless to refrain from talking back to authority figures and can only analyze his actions later when he is calm. His persistent failure keeps him back in treatment, experiencing shame, and his facilitators question whether he is simply unable to change.
Recent studies (e.g., Reavis, Looman, Franco, & Rojas, 2013; Levenson, Willis, & Prescott, 2014a; 2014b) have illustrated that rates of adverse and traumatic events are often highly prevalent among those who have abused others. Research from outside of our field has shown that such childhood experiences can have life-altering consequences in exactly the areas one needs to participate meaningfully in rehabilitative efforts: fragmentation of traumatic memories, somatic challenges, problems with interpersonal relationships, hypervigilance, and the list goes on.
Many treatment providers are aware of the clear benefits and strong research support for yoga and meditation in reducing anxiety, depression, and other problems in psychological functioning. What has received less discussion is the fact that yoga and meditation are largely based on self-observation. For clients who have spent their lives scanning their environments for threats and paying little attention to their internal physical and mental states, yoga and meditation can help people who have broken the law re-claim their lives. Until now, a major drawback has been that yoga and meditation can be very powerful tools; indeed, for people who have experienced trauma, many of the physical forms of yoga (and its accoutrements such as straps, chanting, etc.) can trigger traumatic memories and sensations. Even activities such as breath retention can be too much for people who have experienced adverse events. After leading a meditation class in which the reviewer taught breath retention techniques, two participants described how their breath and physical movements had been restricted by the people who had assaulted them. Clearly, there are dosage considerations in yoga and meditation. Too much can make matters worse.
In recent years, David Emerson has worked closely with internationally renowned trauma researcher Bessel van der Kolk at the Justice Resource Center in Brookline, Massachusetts. Not only have they developed an excellent yoga method for working with severely traumatized people, they have published an excellent randomized clinical trial on it (van der Kolk, Stone, West, Rhodes, Emerson, Suvak, & Spinazzola , 2014). They have found that their approach significantly reduces trauma symptoms while building interoceptive skills (i.e. observation of one’s physical sensations and states). They have concluded that trauma-sensitive yoga (TSY) can be an effective adjunctive treatment for PTSD. Emerson also co-authored an earlier book on this topic (Emerson & Hopper, 2011)
Trauma-Sensitive Yoga in Therapy is, simply, a masterpiece. It is remarkably easy to read and understand. Its straightforward language matches its accessible structure. Its simplicity belies a deep knowledge of neurological research and treatment practices. Professionals can use the practices in this book in therapy sessions or in specialized classes. Fundamental to TSY is that the practitioner simply notices their physical sensations and practices making choices based on what he or she notices. TSY may be more noteworthy for what it is absent: self-judgment, striving, and unnecessary complexity. It is this simplicity that actually makes it a years-long endeavor to understand deeply. The table of contents is as follows:
1 What Is Trauma-Sensitive Yoga?
2 Interoception: Sensing the Body
3 Bringing Choice into Therapy
4 Taking Effective Action
5 Being Present
6 Muscle Dynamics and Breathwork
8 A Portfolio of Yoga Practices
So how should professionals treating people who have abused understand TSY and its place in treatment? TSY can be an excellent adjunct treatment that aids responsivity by helping to establish the self-observational skills that empirically supported treatments such as cognitive-behavioral therapy build on. While it is not a stand-alone treatment, it has improved many lives. In the end, Gendreau and his colleagues almost threw the baby out with the bathwater. The question isn’t whether TSY can reduce problem behavior, it’s whether TSY is one component that sets the stage for change to happen.
Emerson, D., & Hopper, E. (2011). Overcoming trauma through yoga: Reclaiming your body. Berkeley, CA: North Atlantic Books.
Levenson, J. S., Willis, G., & Prescott, D. (2014a). Adverse childhood experiences in the lives of male sex offenders and implications for trauma-informed care. Sexual Abuse: A Journal of Research and Treatment. Advance online publication. doi:10.1177/1079063214535819.
Levenson, J. S., Willis, G., & Prescott, D. (2014b). Adverse childhood experiences in the lives of female sex offenders and implications for trauma-informed care. Sexual Abuse: A Journal of Research and Treatment. Advance online publication. doi: 1079063214544332
Reavis, J., Looman, J., Franco, K., & Rojas, B. (2013). Adverse Childhood Experiences and adult criminality: how long must we live before we possess our own lives? The Permanente Journal, 17(2), 44-48.
Van der Kolk, BA, Stone, L, West, J, Rhodes, A, Emerson, D, Suvak, M & Spinazzola, J. (2014). Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder: A Randomized Controlled Trial. Journal of Clinical Psychiatry, 75, e1-e7.