How yoga can help people with PTSD

PTSD or Post-Traumatic Stress Disorder is a psychiatric disorder that can occur in people after a traumatic event. It was once known as “shell shock” after World War I. Then later called “combat fatigue” after World War II. But PTSD is not only experienced by soldiers.

PTSD can occur after any terrible or life-threatening event, whether the event happened to you directly, you witnessed it, it happened to someone very close to you, or you were a first responder at the event. These events could include war, a natural disaster, an act of violence, sexual assault, child abuse, a serious accident, isolation, or any other violent assault.

Symptoms of PTSD (as described by the Mayo Clinic)

Intrusive memories

Symptoms of intrusive memories may include:

• Intrusive, recurrent, involuntary, and distressing memories of the event
• Reliving the trauma as if it were happening again (flashbacks)
• Nightmares about the event
• Severe distress or physical reactions to a trigger that reminds you of the event

Avoidance

Symptoms of avoidance may include:

• Avoiding thinking or talking about the traumatic event
• Avoiding people, places, and activities that remind you of the event

Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

• Pervasive negative thoughts about yourself, people, or the world
• Hopelessness
• Memory problems, including inability to remember important aspects of the event
• Difficulty maintaining relationships
• Feeling alienated from family and friends
• Lack of interest in things you used to enjoy
• Difficulty experiencing positive emotions
• Emotional numbness

Changes in physical and emotional reactions

Symptoms of changes in physical and emotional reactions (also called arousal symptoms) may include:

• An active stress response that leaves you easily startled or frightened
• Hyper-vigilance
• Self-destructive or reckless behavior, such as drinking too much or driving too fast
• Difficulty sleeping
• Lack of focus or problems with concentration
• Irritability, angry outbursts or aggressive behavior
• Overwhelming guilt or shame. Blaming oneself

Traumatic memories are not stored the same way as regular memories.

During a traumatic experience, the brain’s alarm system called the amygdala is activated which in turn “shuts down” the rest of the brain. The hippocampus, which is responsible for categorizing memories in an organized way, goes offline. This causes traumatic memories to come up scattered, disorganized, incomplete, and not timestamped.

People often cannot remember key parts of their trauma, the timeline of events can become confusing, and memories of the traumatic experience can often show up in intrusive, fragmented, and unwanted ways.

When these memories show up, it can cause both emotional and physical distress. They can also feel as if they are happening in the moment rather than in the past because of their lack of a timestamp or cohesive timeline.

Who is affected by PTSD?

While we tend to think of PTSD as primarily a disorder affecting veterans, this disorder can affect a wide variety of people. It is not limited to those who have seen combat. PTSD occurs in all people – regardless of ethnicity, nationality, gender, or age. The disorder is estimated to affect approximately 3.5% of U.S. adults. An estimated one in 11

people will be diagnosed with PTSD at some point in their lifetime. Interestingly, women are twice as likely as men to be diagnosed with PTSD.

Polyvagal Theory

How we process trauma is affected by our relationships and whether we receive isolation or support.

Our basic understanding of the autonomic nervous system or ANS is that it includes two parts: the sympathetic, and parasympathetic nervous systems. The sympathetic is often called the “fight or flight” or “fight, flight, freeze” response. While the parasympathetic is considered the “feed and breed” or “rest, digest, and heal” response.

Polyvagal theory explains that the ANS is regulated by the vagus nerve. This nerve is associated with the parasympathetic, or healing side of the ANS. The theory however further explains that the parasympathetic nervous system actually has two sides to it: one side is the healing side we are already familiar with, while the other side has its own defense mechanism.

To summarize the way this works, when a threat is perceived:

1. First, we rely on the social part of the nervous system to resolve the conflict.
2. Then, if that doesn’t work or if the threat is too great, the fight or flight response is activated.
3. If we cannot fight or escape our way out of danger, then the vagus nerve’s oldest defense mechanism turns on. This may cause us to faint, or disassociate.

“It turns out that the parasympathetic nervous system is not only associated with relaxation but is also implicated with symptoms of PTSD. Stephen Porges introduced the polyvagal theory as a means to help us understand this dual function of the parasympathetic nervous system. His work reveals an evolutionary older survival mechanism in which the parasympathetic nervous system leads us to immobilize or “faint” in the face of a life-threatening event. Most importantly, the polyvagal theory teaches you to engage your social nervous system to consciously inhibit your defensive system. This allows you to finally find freedom from trauma symptoms and experience a deeply nourishing sense of safety here and now.”

Dr. Arielle Schwartz

How can yoga help?

“Yoga became a major cornerstone in our understanding that it is imperative to befriend one`s bodily sensations in order to overcome the imprint of trauma.”

Bessel Van der Kolk

PTSD symptoms are based in biology and experienced somatically. When traumatic memories come up, PTSD sufferers are re-experiencing the traumatic event. Their fear and pain are very real. When they experience a trigger, or their brain senses danger, it can be challenging to differentiate between the past and present. Polyvagal theory indicates that engaging with and strengthening the social nervous system can pave the way for healing.

Mindful awareness of bodily sensations such as breath, heart rate, or engaging muscles can help build a healthy social nervous system. Yoga’s emphasis on breath and awareness does just this. Breathing with Ujjayi breath is also said to stimulate the vagus nerve.

Both yoga and mindfulness meditation give people tools to self regulate so that they can build resiliency.

Yoga specifically teaches self regulation through:

• Orientation – Orientation refers to awareness of our surroundings. In yoga, this is taught through use of a drishti or gazing point. During a yoga flow, students also orient themselves on their mat by stepping to the top of the mat, or stepping one foot to the top left corner of the mat, etc.
• Grounding – Yoga also teaches proprioception, the sense of where your body is in space and what it’s physically doing. Yoga also emphasizes grounding through the feet, sit bones, or whatever body part is being used as a support. Link to Grounding Yoga Flow
• Centering – Core engagement and subtle engagement, such as the use of bandhas and understanding of the subtle energies of the body like the chakras can promote centering. Feeling what’s going on inside the body takes you into the present moment.
• Breath – Breath is the single most important piece of the yoga practice. Many pranayama techniques stimulate the parasympathetic nervous system (the part of the nervous system nicknamed Rest, Digest & Heal, or Feed & Breed), which calms you down. If nothing else, noticing the breath and consciously deepening it will promote a sense of relaxation.