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Therapeutic efficacy of yoga in individuals with varied traumatic stress histories

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Therapeutic efficacy of yoga in individuals with varied traumatic stress histories

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Exposure to trauma can lead to debilitating health conditions that are not effectively addressed by the current standard treatments, which include medication and psychotherapy. Mind-body practices such as yoga have demonstrated therapeutic efficacy in treating effects of traumatic stress but have primarily focused only on symptoms of post-traumatic stress disorder (PTSD) and on yoga programs that emphasize the physical exercise and postural aspects of yoga practice. The current study addresses additional measures of health and well-being that are relevant in trauma recovery, evaluating the impact of an 8-week individual yoga therapy intervention on symptoms related to cognition, emotion, relationships, pain, and physical health in fifteen adults with various traumatic stress histories. The yoga protocol used here does not focus on physical exercise or postures but on the relationship between the teacher and student and on empowering the student's agency over their own body and encouraging self-focus. We find support for the therapeutic efficacy of this type of yoga intervention for treating traumatized individuals, with significant improvements in five domains of functioning (cognitive, psychological, emotional, rel-ational, and physical). We conclude these benefits result from a combination of building a trusting, supportive relationship with the yoga teacher and from the practice itself in facilitating a mind-body connection that promotes trauma resilience and recovery.
Content may be subject to copyright.
Brain, Body, Cognition 2018;8(3):267-277 ISSN: 2643-5683
© Nova Science Publishers, Inc.
Therapeutic efficacy of yoga in individuals with varied
traumatic stress histories
Apryl E Pooley1, Sam J Striker2,
and Kintla Striker3,
1Neuroscience Program, Michigan State
University, East Lansing, MI, USA
2Hollin-Pheonix Consulting, East Lansing, MI, USA
3Kintla Yoga, LLC, East Lansing, MI, USA
Corresponding Author: kintla@kintlayoga.com
Abstract
Exposure to trauma can lead to debilitating health
conditions that are not effectively addressed by the current
standard treatments, which include medication and
psychotherapy. Mind-body practices such as yoga have
demonstrated therapeutic efficacy in treating effects of
traumatic stress but have primarily focused only on
symptoms of post-traumatic stress disorder (PTSD) and on
yoga programs that emphasize the physical exercise and
postural aspects of yoga practice. The current study
addresses additional measures of health and well-being that
are relevant in trauma recovery, evaluating the impact of an
8-week individual yoga therapy intervention on symptoms
related to cognition, emotion, relationships, pain, and
physical health in fifteen adults with various traumatic
stress histories. The yoga protocol used here does not focus
on physical exercise or postures but on the relationship
between the teacher and student and on empowering the
student’s agency over their own body and encouraging self-
focus. We find support for the therapeutic efficacy of
this type of yoga intervention for treating traumatized
individuals, with significant improvements in five domains
of functioning (cognitive, psychological, emotional, rel-
ational, and physical). We conclude these benefits result
from a combination of building a trusting, supportive
relationship with the yoga teacher and from the practice
itself in facilitating a mind-body connection that promotes
trauma resilience and recovery.
Keywords: post-traumatic stress disorder, anxiety, depr-
ession, yoga, mind-body, resilience, trauma
Competing interests: The senior author, Kintla Striker, is
CEO of Kintla Yoga LLC and a program author with
the Integrative Medicine division of Unitus Therapy
Intelligence.
Introduction
Exposure to trauma can lead to debilitating conditions
such as post-traumatic stress disorder (PTSD). Most
people in the general US population (90%) experience
Apryl E Pooley, Sam J Striker, and Kintla Striker
268
at least one traumatic event in their lifetime, and
a substantial portion (9-12%) develop PTSD after
trauma (1). However, PTSD is not the only potential
deleterious outcome of experiencing trauma. Well-
documented sequalae of repeated or severe trauma
also include dissociation, affective disorders, relation-
ship disturbances, substance use disorders, and
somatic symptomatology (headache, gastrointestinal
disturbance, autoimmune disorder, non-epileptic
seizure, heart disease, and chronic pain), and 88% of
people diagnosed with PTSD are also diagnosed with
at least one other co-morbid psychiatric disorder (2
5). In addition to high attrition rates, as many as
half of patients do not respond to current standard
treatments for PTSD, which include a combination of
psychotherapy and medication (6), indicating a need
for alternative or adjunctive treatment approaches.
Mind-body practices (e.g., yoga, tai chi, qigong)
that facilitate interaction between the mind, body, and
behavior have demonstrated therapeutic efficacy in
treating effects of traumatic stress (7, 8). The benefits
of these practices have been proposed to work
by facilitating communication between the brain
and the rest of the body (9), in part by enhancing
interoception and proprioception (sensing internal
states of the body and the position of one’s
body relative to itself and the environment) (10).
Indeed, trauma sequelae often involve a loss of body
awareness, inability to describe emotions, and
decreased modulation of physiological arousal
symptoms which can be treated with mind-body
interventions that aim to increase interoception
and ability to tolerate discomfort, enhance arousal
modulation, and engage in taking action after
experiencing distress (11).
Yoga practitioners in particular have been
shown to be more effective at emotional regulation
and achieving restful states (12), indicating yoga
as a potential therapeutic intervention for mood
and anxiety disorders. Indeed, yoga has been shown
effective for depression reduction and stress manage-
ment (1315), and a growing body of evidence,
including several randomized controlled trials, has
indicated yoga as a clinically useful intervention
for PTSD (1619). However, many of the trauma-
related studies have focused primarily on the physical
exercise component of yoga and its effects on
symptoms of PTSD with little attention given
additional measures of health and well-being that are
relevant in trauma recovery. It has been suggested
that the most effective therapeutic yoga approaches
integrate practices of breathing techniques, physical
movement, meditation, and philosophical principles
and that future research should include outcome
measures on quality of life, relationships, pain,
anxiety, and depression (10). The current study does
just this, as it centers primarily on the traditional
philosophical roots of yoga that focus on the
understanding of self and alleviation of suffering and
employs a wide range of outcome measures to assess
the effects of trauma and yoga on an individual’s
whole being. Here, we report on the impact of an
8-week individual yoga therapy intervention on
symptoms related to cognition, emotion, relationships,
pain, and physical health in fifteen adults with various
traumatic stress histories.
Methods
Participants
Fifteen adults (4 males, 11 females) living within the
community were recruited through referrals received
from area mental health practitioners, word-of-mouth,
website and social media advertising for Kintla Yoga
Therapy (KYT) private sessions. No participants were
denied participation, and all participants completed
the program in its entirety. Demographic information
(i.e., age; race; symptomology; employment status;
marital status; veteran status; medications; family
history of psychiatric hospitalization, substance abuse
and suicidality; and whether participant was under
the care of a licensed mental health practitioner)
were collected. Study consent was obtained from
all participants. Facilitation occurred from January
2015 to November 2017. All participants were
Caucasian, and 39 was the median participant
age (range 21-68 years). Participants were exposed
to a range of self-reported traumas including child
physical abuse, child psychological abuse, child
sex trafficking, child sexual abuse, chronic illness,
chronic stress, combat-related trauma, domestic viol-
ence, gang rape, medical trauma, psychiatric insti-
tution abuse, rape, sexual assault, sexual exploitation,
and the unexpected death of a parent, all of which
Therapeutic efficacy of yoga in individuals with varied traumatic stress histories
269
fulfilled the DSM-5 PTSD diagnostic criterion-A
for a qualifying traumatic event. All suffered a
particular trauma on multiple occasions (except
one participant who had a single-event rape) and
some individuals suffered various kinds of trauma.
Three participants were medication-free and twelve
reported current prescription medications including
Adderall, Ativan, Buspar, Cymbalta, Gabapentin,
Klonopin, Lexapro, Medical Marijuana, Norco,
Nortrel, Protonix, Prozac, Remeron, Requip, Restoril,
Robaxin, Synthroid, Vicodin, Vistaril, Wellbutrin,
and Xanax.
Assessment questionnaire
Before the first yoga session, each participant comp-
leted a 72-item “symptom assessment” questionnaire
reporting the frequency (5-level Likert scaling) and
quality/intensity (e.g., 1-10 interval scale from poor-
excellent) of trauma-related symptoms and behaviors
(Table 1). The questionnaire was developed by the
yoga teacher/co-author for the purpose of identifying
the symptoms participants were experiencing, inform-
ing and refining protocol, and measuring efficacy.
Upon completion of the 8-week yoga therapy
program, participants completed the same questionn-
aire again.
Table 1
.
Questions presented on intake questionnaire. All questions were rated on a Likert scale with
0 = never, 1 = seldom, 2 = sometimes, 3 = often, and 4 = always (except where noted in questions 53, 64-68)
Number
Question
I AM EXPERIENCING
1
Frequent worry or tension
2
Fear of many things
3
Discomfort in social situations
4
Feelings of guilt
5
Phobias: unusual fears about specific things
6
Panic attacks: Sweating, trembling, shortness of breath, heart palpitations
7
Recurring, distressing thoughts about a trauma
8
“Flashbacks” as if reliving the traumatic event
9
Avoiding people/places associated with trauma
10
Nightmares about traumatic experience
11
General anxiety
I AM FEELING
12
Decreased interest in pleasurable activities
13
Social isolation, loneliness
14
Suicidal thoughts
15
Bereavement or feelings of loss
16
Changes in sleep (too much or not enough)
17
Normal, daily tasks require more effort
18
Sad, hopeless about future
19
Excessive feelings of guilt
20
Low self-esteem
I NOTICE
21
I am angry, irritable, hostile
22
I feel euphoric, energized and highly optimistic
23
I have racing thoughts
24
I need less sleep than usual
25
I am more talkative
26
My moods fluctuate: go up and down
(Table 1 continued on next page.)
Apryl E Pooley, Sam J Striker, and Kintla Striker
270
Question
I HAVE
Memory problems or trouble concentrating
Trouble explaining myself to others
Problems understanding what others tell me
Intrusive or strange thoughts
Obsessive thoughts
Been hearing voices when alone
Problems with my speech
I HAVE
Risk taking behaviors
Compulsive or repetitive behaviors
Been acting without concern for consequence
Been physically harming myself
Been violent toward other(s)
I USE THE FOLLOWING
Alcohol
Nicotine (Cigarettes)
Marijuana
Cocaine
Opiates
Sedatives
Hallucinogens
Stimulants
Methamphetamines
MY EATING INVOLVES
Restriction of food consumption
Bingeing and purging
Binge eating
A lot of weight loss or gain
IN MY BODY I FEEL
Pain
-Please rate pain level from 0-10 (0=no pain; 10=unbearable pain) ________
Severe tightness or stiffness in muscles
Numb
Joy
I HAVE
Concern about my sexual function
Discomfort engaging in sexual activity
EMPLOYMENT & SELF-CARE
I have problems getting/keeping a job
I have problems paying for basic expenses
I am afraid of becoming homeless
I have problems accessing healthcare
How well you are doing in your marital/significant other relationship (0=Cannot Function; 10= No
Problems): _____
How well you are doing in your family relationships (0=Cannot Function; 10=No Problems): _____
How well you are doing in relationships with people outside your family (0=Cannot Function;
10=No Problems): _____
Please rate your current physical health (1= Very Poor; 10=Excellent): _____
Please rate your general happiness and wellbeing (1=Very Poor; 10=Excellent):_____
Therapeutic efficacy of yoga in individuals with varied traumatic stress histories
271
Yoga therapy intervention
All participants completed eight 75-minute KYT
private yoga sessions led by the certified yoga
teacher/co-author with over nine years of teaching
experience in hatha yoga and KYT and a significant
background in the study of how traumatic events
impact individuals. KYT was designed and developed
out of the yoga teacher/co-author’s theory that traum-
atic stress arises out of an individual’s traumatic
experience creating a mind-body disconnect, and
that consequently, healing must begin with safe
experience incorporating interventions that offer the
subjective building of internal resources that foster
agencya mind-body reconnect. KYT is a trauma-
informed, comprehensive yoga style. It incorporates
the traditional elements of yoga practice including
breathing techniques, mindfulness, yoga postures,
meditation, and cultivation of mind-body awareness.
It merges those traditional elements with emphasis on
teacher qualities (i.e., empathy, compassion, presence,
a caring tone of voice, eye contact, gentle movement,
and a tranquil and warm demeanor), and encourage-
ment of curiosity, choice, imagination, and with
teacher and student practicing side-by-side. Proper
alignment in yoga postures is not a primary focus,
rather the focus is directed to the students’ attention to
their own experience of themselves and with another.
The chosen curriculum elements and the implem-
entation style are believed to help restore self-
regulation and build resilience after trauma and
address the underlying causes of PTSD through
effects on nervous and endocrine systems.
Statistical analyses
All data were analyzed by experimenters using
SPSS statistical analysis software (v. 24.0) who were
blinded to any individual identifying characteristics
and who were not present during any yoga sessions.
Likert-scale frequency items from the symptom
assessment questionnaire were sorted into five
categories based on the relevant domain of function-
ing (cognitive, psychological, emotive, relationship,
and physical) addressed by each question (Table 2).
Each of the five categories also consisted of sub-
categories. Effects of yoga therapy on sub-category
measures within each main category were determined
by averaging each individual’s baseline and post-
yoga responses across all items in a sub-category
and analyzing by one-way repeated measures
ANOVA with factors of time and sub-category. The
conservative Bonferroni test was used to correct for
multiple tests to hold the probability of a type I error
at 0.05. If no significant effects of sub-category were
found within a main category, all items in the main
category were collapsed and analyzed using paired
t-tests to compare baseline and post-yoga differences
for all participants (using each participant’s average
score across all questions in that main category). The
six quality/intensity interval questions were each
analyzed separately using paired t-tests to compare
baseline and post-yoga differences averaged for all
participants.
Table 2. Items from the intake questionnaire
(see Table 1) were sorted into categories based on
the relevant domain of functioning addressed
by each question
Category
Sub-Category
Questions
(n = 61)
Cognitive
Memory
27
Understanding
29
Psychological
Self-care/risky behavior
14, 34, 60-63
Fear
2, 5
Dissociation
56
Panic
6
Emotive
Anxiety
1, 7, 8, 11,
23, 30, 31, 35
Depression
12, 15, 17-19
Self-esteem
4, 20
Anger
21
Relationship
Avoidance
3, 9, 13
Communication
28, 33
Physical
Sleep
10, 16, 24
Self-harm
36-38, 48-51
Substance use
39-47
Pain frequency
52, 54
Pain intensity
53
Quality of
current health
Physical health
67
Happiness and
well-being
68
Quality of
relationships
Quality of significant
other relations
64
Quality of family
relations
65
Quality of other
relations
66
Apryl E Pooley, Sam J Striker, and Kintla Striker
272
Results
After eight weekly yoga sessions, participants (n =
15) reported significant decreases in the frequency of
problems (0-4 Likert scale) in all five domains of
functioning (Figure 1) when baseline and post-yoga
scores were compared with paired t-tests (Table 3).
This effect was not specific to any individual sub-
category element (non-significant effect of sub-
category in ANOVA analysis), as the frequency of all
items within a category decreased after yoga therapy.
Baseline vs. post-yoga scores in the cognitive
(mean = 2.1 ± 0.2 vs 1.3 ± 0.2), psychological
(mean = 1.3 ± 0.1 vs 0.7±0.1), emotive (mean
= 2.5 ± 0.2 vs 1.7 ± 0.1), and relationship (mean
= 2.2 ± 0.3 vs 1.2 ± 0.2) categories decreased by a
mean of 0.5-1.0 points, while the effects of yoga on
the frequency of physical problems (mean=0.9 ±0.1
vs 0.7±0.1) such as sleep problems, substance abuse,
and pain were less robust (mean decrease 0.2 points)
but nonetheless significant (Table 3).
Table 3. Individual paired
t
-tests comparing baseline and post-yoga scores from the intake questionnaire
(see Tables 1 and 2) in each domain of functioning category
Category
Mean
t value
DF
p
Cognitive
0.783
3.787
14
0.002*
Psychological
0.576
5.270
14
<0.0001*
Emotive
0.850
6.926
14
<0.0001*
Relationship
0.973
6.584
14
<0.0001*
Physical
0.237
2.842
14
0.013*
Intensity of pain
1.000
1.706
13
0.112
Physical health
-0.067
-0.165
14
0.872
General wellbeing
-1.733
-4.052
14
0.001*
Sig. other relations
-1.556
-2.081
8
0.071
Family relations
-1.067
-1.734
14
0.105
Other relations
-1.467
-2.564
14
0.023*
*Significant difference in baseline and post-yoga scores.
Figure 1. The frequency of current problems in five categories (total of 55 questions) were rated by each client (n = 15) at
intake (baseline) and after 8 yoga sessions (post-yoga). Yoga decreased the frequency of experiencing problems in all five
categories, indicating therapeutic efficacy of yoga for improving traumatic stress symptoms across several domains of
functioning. Data are presented as mean ± SEM. Significance set at P < .05 (indicated by asterisk) on a paired t-test for each
category. See Table 3 for full statistical results.
Therapeutic efficacy of yoga in individuals with varied traumatic stress histories
273
Figure 2. The intensity of current pain and quality of current health and relationships were rated by each client (n = 15) at
intake (baseline) and after 8 yoga sessions (post-yoga). (a) Yoga increased client rating of general well-being but not
physical health. (b) Yoga increased client rating of the quality of relationships other than family or significant other, but
significant other and family relationships did show a trend for improving (P =.071 and P =.105, respectively). (c) Yoga did
not affect intensity of current pain. These data indicate therapeutic efficacy of yoga for improving general well-being and the
quality of interpersonal relationships. Data are presented as mean±SEM. Significance set at P<.05 (indicated by asterisk) on
a paired t-test for each category. See Table 3 for full statistical results.
When asked to rate the quality of current
health on a 1-10 scale from very poor to excellent,
participants reported no change in baseline vs. post-
yoga scores on current physical health (mean = 7.0
± 0.5 vs 7.1 ± 0.4) but reported a significant increase
in current feelings of happiness and general well-
being (mean = 5.1 ± 0.6 vs 6.9 ± 0.4) (Figure 2a)
by a mean of over 1.5 points (Table 3). After yoga
therapy, participants reported a significant increase
in the quality of non-family/partner relationships
(mean = 6.1 ± 0.8 vs 7.5 ± 0.5), while significant
other (mean = 4.3 ± 1.1 vs 5.8 ± 0.8) and family
(mean = 5.8 ± 0.8 vs 6.9±0.6) relationships showed
a trend for improving (P = .071 and P = .105,
respectively) (Figure 2b) by at least one full point
(Table 3). Participants did not report a significant
change in pain intensity (mean = 4.8 ± 0.5 vs
3.8 ± 0.7) after yoga therapy (Figure 2c), but pain did
trend toward decreasing (P = 0.112, Table 3).
Subjective reports indicate positive reactions to
the yoga intervention. Participants made positive
comments to the teacher regarding the study, for
example, “When I think of the growth I’ve made in
(the) past couple years, it always comes back to my
work with you.” Other comments included, “You
have helped me so much. I am starting to feel present
again. What a great feeling!” and “I thank you from
the bottom of my heart for your love, support, and
gentle kindness in navigating trauma.”
Discussion
The results reported here indicate that 8 weekly yoga
sessions significantly improved the self-reported
quality of life, health, and relationships in participants
with various traumatic stress histories. The particip-
ants in the current study reported exposure to a wide
variety of trauma types, implicating the therapeutic
efficacy on yoga on many forms of trauma. Indeed,
yoga has been effective in treating trauma sequelae
after natural disaster, combat and terrorism, inter-
personal violence, and incarceration (20). Further-
more, the participants in this study reported trauma
doses and types that have been shown to lead to
significant functional impairments. All but one of the
participants in the current study experienced multiple,
prolonged, or repeated traumas. PTSD and other
adverse outcomes of trauma become more likely as
individuals experience more cumulative traumatic
events, and experiencing four or more traumatic
events is associated with significantly greater impair-
ment of functioning than experiencing any fewer
number of traumatic events (4, 21, 22). Additionally,
the majority of participants in the current study
(12 out of 15) experienced interpersonal trauma
(e.g., physical and sexual assault, emotional abuse,
domestic violence), which is unique from other
trauma types and is the class of events most likely to
Apryl E Pooley, Sam J Striker, and Kintla Striker
274
result in PTSD (2325). The significant improve-
ments reported after yoga in this participant sample
may reflect the robustness of the intervention in
treating even the most severely traumatized indiv-
iduals.
Trauma involving social betrayal, like inter-
personal traumas, “violates a fundamental ethic of
human relationships” (26), and the yoga therapy
protocol used here may be especially useful for
treating the effects of interpersonal trauma, as it is
highly focused on building a trusting relationship
between teacher and participant, with each practicing
together side-by-side, rather than in a group setting
with the teacher simply giving instructions. This
format breaks down the power dynamic that is often
present in a traditional teacher-student relationship,
which can feel threatening to survivors of inter-
personal violence if they feel that they do not have
control of their body but must do what the teacher
expects of them at all costs. The protocol used here
emphasizes choice, such that participants are never
required to do what the teacher instructs but are
informed that instructions are merely suggestions, and
participants are free to move out of any posture or
stop the practice at any time. This practice not only
provides a sense of empowerment to participants but
does so within the context of a trusting relationship,
both of which may counteract the loss of agency and
social betrayal that are present during interpersonal
trauma.
Interpersonal trauma also presents an especially
high risk for the dissociative subtype of PTSD
(27). Dissociative PTSD includes the standard
DSM-5 criteria plus prominent depersonalization and
derealization symptoms, which present as disruptions
in memory (including amnesia for all or part of the
trauma), identity, body awareness, and self-perception
and is associated with an attenuation of the intensity
of emotional experience (28). The high likelihood
that some participants in the current study exhibited
dissociative symptoms is worth noting because, while
an increase in pain or anxiety could be interpreted as a
negative effect of yoga intervention, this may actually
be a positive improvement in dissociative individuals
if increased pain perception or emotional awareness
is the result of decreased dissociation. This type of
response could also be present in individuals with
PTSD who begin to show a reduction in avoidance
symptoms, as some individuals with PTSD experience
previously avoided emotions as distressing when
initially practicing mindfulness (29). Nonetheless,
while decreased dissociation or avoidance may
indicate the resolution of some trauma symptoms,
experiencing new emotional and bodily states can be
distressing and participants may benefit by being
informed about dissociation and avoidance and how
to cope with new feelings. Distressful reactions to
yoga treatment can be addressed by appropriate
supervision and tailoring the techniques used to an
individual’s needs (e.g., using sitting meditations with
eyes open if lying meditations with eyes closed are
distressing). Focusing on mindfulness components of
yoga that increase an individual’s ability to tolerate
unpleasant feelings before moving into other more
body-focused components of the practice may reduce
distress that accompanies a reduction in trauma-
related avoidance behaviors (30). Even with
considering these potential reactions, the adverse
effects of mindfulness-based interventions have been
shown to be minimal (8).
With substantial evidence supporting the efficacy
of yoga as a therapeutic intervention for trauma-
related disorders, it will be important for future
studies to investigate the mechanisms by which these
effects are achieved, some of which we can speculate
here. First, it is entirely possible that some of the
symptom improvements reported by the participants
in this study were related to developing a trusting
relationship with the yoga teacher, and not entirely on
the yoga practice itself. Among 14 separate risk
factors for developing PTSD after trauma, social
support is the single greatest factor (31). More
specifically, lack of social support in the form
of negative responses from others after trauma
significantly predicts PTSD (32). The yoga therapy
protocol used here is highly focused on building a
trusting relationship between teacher and participant
and could be considered a form of social support.
This possibility does not minimize the importance
of the yoga therapy portion of the intervention,
but rather highlights the potential significance of
the participant’s relationship with the teacher in
maximizing the benefits of yoga. And indeed, the
physiological effects of yoga on the nervous system
have been demonstrated via measurement of para-
Therapeutic efficacy of yoga in individuals with varied traumatic stress histories
275
sympathetic and GABAergic activity (12) and neuro-
imaging studies (33).
These effects have been described to work
through bi-directional “top-down” and “bottom-up”
regulation of autonomic, neuroendocrine, emotional,
and behavioral responses to challenges (34, 35). The
techniques utilized in the yoga protocol reported here
employ both top-down (e.g., regulating attention,
setting intention) and bottom-up (e.g., breathing,
movement) processes of facilitating brain-body
communication, and restoring this connection may be
a key factor in resilience to and recovery from trauma.
Indeed, individuals with low resilience to stress show
reduced attention to bodily signals, and evidence
suggests that the ability to identify and attend to
internal distressand to link it with appropriate
actioncan restore homeostasis (36). The mindful-
ness and meditation aspects of yoga may facilitate
interoception (necessary for the ability to identify
and attend to internal distress), while the movement
and postures portion of yoga may facilitate the
action portion of this homeostatic restoration
process.
Finally, the yoga program used here emphasizes
teacher qualities (i.e., empathy, compassion, presence,
a caring tone of voice, eye contact, gentle movement,
and a tranquil and warm demeanor), with teacher
and student practicing side-by-side. This approach
capitalizes on the theory of “embodiment,” which
describes the ability of a person to experience
the emotions and bodily states of a person they
are observing. This process is thought to occur in an
individual via mirror neurons that, when observing
another person, activate the same neural network as if
that individual was executing the movement or
emotion themselves (37). The mirror neuron system
is thought to underlie the human capacity for
empathy and social cognition (38, 39). Others have
hypothesized that yoga activates the mirror neuron
system and improves social cognition and empathy in
patients with schizophrenia (40), and we suggest
the activation of mirror neurons may underlie the
improvements in relationships and communication
observed in traumatized individuals here. Further, that
the teacher and participant are practicing side-by-side,
literally mirroring each other’s movement, may
further reinforce the embodiment of the teacher’s
healing demeanor within the student.
While this study provides important framework
for future investigations, limitations should be con-
sidered. First, this study is an observational, non-
controlled, case study with a small sample size.
With no waitlist or active control group, we cannot
account for possible effects of seeking help, taking
the questionnaire, talking with a practitioner, or
spontaneous recovery. Additionally, the internally-
developed nature of the questionnaire may not reflect
clinically significant outcomes and may have been
influenced by self-report bias. That the participants
paid out-of-pocket to receive these services could
have influenced how they perceived its effectiveness.
The long-term impact of the intervention was not
evaluated, and the sample was all Caucasian adults.
Future studies should include diverse racial/ethnic/
gender/age groups, additional and long-term measures
beyond simple self-report psychometrics, and a
control group.
Conclusion
Together, these findings support the therapeutic
efficacy of yoga interventions for treating individuals
with varied traumatic stress histories. The beneficial
effects of yoga on cognition, emotion, relationships,
physical and psychological health, and overall well-
being are thought to result from a combination of
building a trusting, supportive relationship with the
yoga teacher and from the practice itself in facilitating
a mind-body connection that promotes trauma
resilience and recovery.
Acknowledgments
The authors want to thank all of the yoga participants
for doing the most difficult work of this study and for
their consent to communicate these findings.
Ethical compliance
The authors have stated all possible conflicts of
interest within this work. The authors have stated
all sources of funding for this work. If this work
involved human participants, informed consent was
Apryl E Pooley, Sam J Striker, and Kintla Striker
276
received from each individual. If this work involved
human participants, it was conducted in accordance
with the 1964 Declaration of Helsinki. If this work
involved experiments with humans or animals, it was
conducted in accordance with the related institutions’
research ethics guidelines.
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