Trauma Informed yoga training

In September of 2018 I volunteered at the Westchester Correctional Facility in Valhalla, New York, co-guiding yoga for men living in the mental health ward. It was apparent to 

me

me that I would benefit from a training focused specifically on leading yoga in jails and prisons, and that led me to this past weekend’s Liberation Prison Yoga (LPY) training.

In New York a jail is where a person is sent if they cannot afford bail and have not yet been sentenced. Prison is where a person winds up once they have been sentenced. Interestingly, we were told that people in prison, particularly maximum security prisons, know the duration of their sentences and therefore are often more accepting of yoga, participation in which is a choice for them.

That’s me on the first day, almost ready to head out the door and meet my friend Stephanie to attend the training together. Usually I attend trainings on my own and it was especially nice to have a friend and colleague with whom to share the experience and debrief.

Understanding Trauma
LPY is a trauma informed yoga training. According to the American Psychological Association “trauma is an emotional response to a terrible event like an accident, rape or natural disaster.” I was disappointed that the training did not include a more comprehensive discussion of trauma (the focus was on sexual trauma), and what happens neurologically as a result of trauma. (The National Institutes of Health provides an in-depth look at traumatic stress: effects on the brain.)

Anneke Lucas, our workshop leader and founder of LPY, shared Internal Family Systems Therapy (IFS) as a framework for understanding the nature of people and how a person’s system might devolve. Anneke noted that “self-esteem acts as a moral compass” and “in the moment of trauma there is a pause in emotional growth and development.”

Power Dynamics
While there was not as much as I would have like regarding the physiology and neurology of trauma, Anneke did spend time demystifying power dynamics, which I found quite interesting. She explained that abuse is a trauma-based system where the abuser has the power and the abused comes to love the abuser as a matter of survival. The abused feels a lack of self worth and therefore begins to think the abuser must be okay. For those of us wanting to share a trauma-informed yoga practice, the question becomes how do we share healing?

These are the stages of power dynamics:

  • Authority – student projects authority on the teacher, perceiving them as an authority figure in the healing role
  • Placating – student tends to placate the teacher
  • Humility – teacher needs humility to not accept the praise/placating of the student
  • Testing – student moves beyond placating to testing the teacher in their healing role
  • No Judgement – as long as the teacher is physically safe then s/he can be non-judgmental of themselves and of the student by not playing the role of the authority figure
  • Affirmation – the teacher says something positive and real about the student, thereby flipping the power dynamics around

Ultimately, as Anneke said, this work is all about personal empowerment. Thus, those of us interested in being of use should view this work as serving rather than helping or fixing. The distinction being that serving implies a connection and a sense of being equal, whereas helping suggests a relationship of inequality, and fixing focuses on a part that is broken rather than looking at the whole person. These distinctions called to mind a similar conversation regarding healing versus curing that took place in a recent yoga therapy training I took this past November and December.

Trauma-informed Yoga Practice
The training did provide much practical information about guiding a trauma-informed yoga practice. The second day of the training was especially informative as we broke up into small groups and practiced what a LPY yoga session might be like. We also heard from a LPY teacher who, with grace, heart and humor, shared stories and lessons from her experiences.

The highlights of a trauma-informed yoga practice include:

  • bringing conscious awareness in the form of body awareness, fostering of emotional intelligence, and journaling
  • inviting language with no commands – “I invite you to…,” providing choice, speaking in first person (I am lifting my arms…) or first person plural (we can bend the front knee…), no Sanskrit
  • connecting with the student – mats are in a circle, teacher practices with students and does not walk around, beginning with group discussion, teacher does not present as authority, no sustained silences, teacher checks in often with students, have fun, simple and direct communication
  • creating a safe space
  • self-acceptance via body-positive language and cueing that the student cannot do anything wrong
  • self-care via non-competitiveness, students respect their own limits and choose what to do
  • relaxation via meditation
  • respect for student by teacher being part of the class rather than the authority
  • trust resulting from teacher arriving on time and keeps students informed if s/he will be absent
  • mindfulness of one’s inner experience without judgement
  • meditation that highlights one’s inner light
  • living yoga philosophy by following these guidelines

Privilege
Our first day concluded with an extensive and passionate discussion about privilege. Privilege comes in many forms, among them age, money, race, sex, religion, citizenship, class, ability, sexual orientation, gender, physical attractiveness and where you live. While these were listed on a handout, the bulk of our group discussion revolved around race, sexual orientation and gender, and a relatively few people dominated the conversation.

Perhaps the best summation of the exploration is the quote that concluded the handout.

Recognizing Privilege simply means being aware that some people have to work much harder just to experience the things you take for granted (if they ever can experience them at all.)

This quote works two ways, in that those of us in positions of privilege need to work much harder to understand those of us not in positions of privilege.

Resources

Below is our group photo as posted on Instagram.

instagram

 

Okay, I’m stressed. Now what?

We can change the way we cope, both
physiologically and psychologically.

Acute stress and the body’s response to it is typically a one-two-three quick and it’s over situation, with the body soon returning to its healthy wellness balance. Chronic stress, on the other hand, is ongoing, providing precious little opportunity for the body to return to its healthy wellness balance. It is the chronic stress that causes the damage, and the damage can be physical, emotional or psychological, or any combination of these. From Robert Sapolsky, page 245 of Why Zebras Don’t Get Ulcers:

…the hormones of the stress-response should be nice and quiet when nothing bad is happening, secreted in tiny amounts. When a stressful emergency hits, your body needs a huge and fast stress-response. At the end of the stressor, everything should shut off immediately.”

To understand what happens when the stress-response doesn’t shut off immediately I suggest you read Sapolsky’s book, as he goes in-depth into how undue stress impacts us, with focus on multiple stress-related diseases. Thankfully, he also provides some insight into how to ameliorate the impact of ongoing stress, citing four factors the management of which can make a positive difference.

  • Having an outlet, “especially a healthy outlet, especially physical activity” is primary because the stress response primes the body for physical action so what better approach than to provide an outlet for that physical need! In any case, the frustration generated by the stress needs to have a positive outlet.
  • Being part of a social network or having a close friend to provide support to you but also, equally important, for you to provide support to them. Social support is a two-way process of receiving and of giving.
  • The importance of predictability, the ability to have a sense of what will happen by having “accurate information and in manageable quantities,” though Sapolsky noted that too much predicability can lead to boredom and too little can lead to stimulation, some of which might be exciting and too much of which can be stressful.
  • The importance of control, the ability to have an impact on the direction of events. “Hope for the best, prepare for the worst” and “control what can be controlled.”

Sapolsky says that the loss of predictability and control are closely related. The sense of being able to predict and control something provides the perception of things improving, which can have a positive impact on managing the response to the stress.

He further suggests that meditation can be a balm when done regularly and sustained over a period of time. Finally, it is important to pick the right strategy at the right time.

Repetition of certain activities can change the connection
between your behavior and activation of your stress-response.

The Physiology of Stress

Robert Sapolsky’s Why Zebras Don’t Get Ulcers hooked me from the title. At first read the title may sound irreverent but it actually is a true statement. I took copious notes based on his explanation of the science of stress and his suggestions, at the end, for managing stress. I’ve written about the nervous system in prior blog posts, but this is the first time the physiology has made its way front and center in my blogging and understanding.

As Sapolsky notes, our sympathetic and parasympathetic nervous systems work in opposition to one another. The sympathetic system turns on with excitement or alarm, causing the release of epinephrine (adrenaline) from the adrenal glands and norepinephrine (noradrenaline) from all other glands. This, in turn, speeds up the heart and sends blood to the muscles, allowing for a fast and efficient response to whatever caused the initial response. When the mellow parasympathetic system is activated via the vagus nerve, it slows down the heart and diverts blood from the muscles, making it possible to calm, slow down, or sleep. Each of these nervous system responses causes different, opposing reactions within the body. What intrigued me, and to the best of my recollection I have not written about, is the actual science of what happens in the body when it undergoes a stress response.

The Physiologic Details, in other words, the chemical flow
Within 15 seconds of being triggered by a stressor, the Hypothalamus releases CRH (corticotropin releasing hormone) which turns on the sympathetic nervous system and also suppresses appetite. CRH signals the Pituitary to release ACTH (adrenocorticotropic hormone or, simply, corticotropin). The pituitary regulates peripheral glands, and within a few minutes ACTH reaches the adrenal gland. The adrenal gland, in turn, releases glucocorticoid, which also stimulates appetite for starch, sugar and fat, those being energy sources which would be necessary if you needed to move your muscles and get out of a situation quickly! The adrenal glands also release the epinephrine and norepinephrine noted in the paragraph above.

The adrenals hand off to the pancreas, which releases glucagon, causing increases in the levels of glucose (glucose being sugar). The pituitary and brain release endorphins and enkephalins to blunt pain perception. The pituitary also releases vasopressin, which impacts cardiovascular response.

You might begin to see a cascading chemical soup that, depending upon the magnitude of the stressor, can begin to saturate the body. You might also wonder why the body might both suppress or stimulate appetite from the same series of signals. Turns out that the type of stressor, its duration and the time it takes to recover from the stressor all determine if appetite is suppressed or stimulated.  According to Sapolsky, two-thirds of people eat more when under stress (hyperphagic) and one-third eat less (hypophagic). (I am of the first type and my husband is of the second. The good news is, once you know your tendencies you can work to adjust accordingly.)

Stress and the Heart
The heart’s sole job is to pump blood thru the “hoses” – the veins and arteries snaking thru the body. Blood pressure is the force with which the blood flows thru these “hoses.” If you’ve had your blood pressure measured in a doctor’s office, you likely know there are two numbers generated. Systolic pressure is the upper number and is the force with which blood leaves the heart thru the arteries. Diastolic pressure is the lower number and is the force with which blood returns to the heart thru the veins.

Ideally, to keep a healthy heart, the hoses need to be free of obstructions and the blood pressure needs to be able to return to a healthy level after engaging in a stress response. What makes the difference is whether the body is undergoing an acute response to stress (quick and over soon) or a chronic response (ongoing, which provides insufficient opportunity to recalibrate at healthy levels).

Our breathing has an effect on our heart. Generally, inhaling turns on the sympathetic nervous system, allowing it to energize, and exhaling turns on the parasympathetic, sending the signal to calm. The interplay of the inhales and exhales is what can stimulate the relaxation response (more about the response here and here).

The length of time between heartbeats is HRV (heart rate variability). A higher HRV signifies short interbeat intervals during inhale and long interbeat intervals during exhale. A minimal HRV means it is difficult to turn on the parasympathetic and turn off the sympathetic. To quote what I wrote about HRV in a prior post:

Typically, during an INhale the message is to speed up the heart rate, which in turn activates the sympathetic nervous system. This automatically kicks in when we feel stress. During an EXhale the heart rate slows and that, in turn, activates the parasympathetic nervous system. The other piece of this process is HRV (heart rate variability). Whereas heart rate refers to the number of beats per minute, and can be measured by taking a pulse, heart rate variability is the time between each heart beat and requires an EKG machine for measurement. The higher HRV, the more parasympathetic activity there is, which bodes well for long-term health. Curiously, this is a measurement that is rarely provided during an annual physical!

A Visual Summary
I have taken numerous yoga trainings with Jillian Pransky and in just about every training she has shared imagery that distills what happens in the body when the stress response is activated. From Jillian’s imagery I created the graphic below, which also includes the Relaxation Response. 

Imagine a house with six rooms: reproduction, immunity, growth and repair, elimination, digestion, and a safe room. As a result of the FIGHT or FLIGHT response being activated, resources are channeled via a hormonal response to the safe room and shut off to the other rooms. In the safe room the brain is primed to isolate, build a wall, and separate and protect.

With activation of the REST and DIGEST response, resources are channeled via a hormonal response to the five main rooms and shut off to the safe room. When these other rooms are functioning the brain is primed to “tend and befriend.” The LARLAR at the upper left is Jillian’s acronym for how to manage the body’s response to stress and return to homeostasis: Land (the body internally and on the ground), Arrive (with your breath, guiding it deeper), Relax (arriving with a deeper breath will stimulate relaxation), Listen to yourself, Allow space for what you hear, Repeat because “the LARLAR is never done.”

imagery

Book Review – Why Zebras Don’t Get Ulcers

from my Goodreads Review:

In the recent yoga therapy training I took with Jillian Pransky she referenced this book multiple times. Before sitting down to read Robert Sapolsky’s book I watched this 90 minute talk he gave at The Beckman Institute for Advanced Science at the University of Illinois in June 2017. Sapolsky is an entertaining speaker and makes his points with a wonderful blend of humor, anecdotes and science.

zebrasHis book is written in that same voice, making it immensely easy to read, absorb and digest. Sapolsky starts off by explaining what stress is and how the body responds to stress. With the physiology as a foundation, he then tackles a multitude of diseases, each receiving their own chapter. Some of these I skimmed, some I skipped and others I devoured. He concludes by culling from previous chapters some of the strategies that can be useful for managing stress, along the way reminding us that even the strategies require a balance between too much and not enough.

Science has found many connections between stress and illness, both biological and psychological, and perhaps the most daunting are the causes related to what Sapolsky calls in the apt named chapter 17: “The View from the Bottom.” The place a person has in society, the education of a person’s parents, the level of wealth or poverty, socioeconomic status…these all impact the role that stress can have on a child as the child grows and develops, and on the ensuing adult that child becomes.

There is much in this book that could be construed as daunting, yet Sapolsky presents a balance in almost all of his teaching (for that’s what this book is, a teaching.) I was intrigued by the biology of stress and now understand what is happening in my body when it produces a cold sore. It was interesting to learn why some people eat when stressed and others have a loss of appetite.

Ultimately, everything boils down to understanding our autonomic nervous system, which is composed of the sympathetic nervous system – those parts of our system over which we have little to no control – and our parasympathetic nervous system – those parts over which we do have some control. The biggie here is that the sympathetic nervous system is what activates our stress response, what is commonly referred to as fight, flight or feint, while our parasympathetic nervous system, when activated via the vagus nerve, is known for rest and digest.

For more on any of this, however, read Sapolsky’s book! Take in the early chapters to create a base line of understanding about stress and the body, then read those chapters that have a connection to you, and finish up with the final chapter.

Book Review – The Vital Psoas Muscle

from my Goodreads Review:

psoas coverI quite enjoyed reading this book but have to giggle because upon falling asleep last night I mentally began composing this review and thought the title was “The Little Psoas Book” – not because the muscle is little, but because the book is smaller-sized, short and sweet.

Staugaard-Jones has compiled a concise book that highlights the psoas muscle. I especially liked the diagrams, which made it quite easy to understand the location not only of this important muscle but of other muscles and systems, and their interrelationships and interdependencies. The book’s physical size and paper, as well as colors and font helped make it a handy, legible guide that is comfortable to consult as well as mark-up with my additional notes.

As a fairly new yoga teacher of a little over two years, I appreciated the way Staugaard-Jones organized poses and stretches (some yogic and some pilates) complete with explanations of how the movement impacts the psoas and related muscles. I am considering purchasing The Concise Book of Yoga Anatomy, by this same author, as her style of writing and book design appeals to my sense of organization. While I have multiple books on yoga anatomy, many of them either have diagrams that are overly complex or explanations that are more technical than my needs or interest warrants.

You can learn more about Jo Ann Staugaard-Jones at Move To Live.

A Reflection

A few weeks ago I cut a quote out from the December 2, 2018 Letters to the Editor section of the Sunday NY Times magazine. I did not recall, and perhaps never even read the article to which it referred, but the quote resonated:

Aging is not the issue. The issue is decline, and it is different for everyone.

This evening I finished Frank Ostaseski’s book The Five Invitations: Discovering What Death Can Teach Us About Living Fully. In reading the book, which took me close to three weeks, I was touched by how profound the ideas were and by the anecdotes Frank lovingly shared of individuals he accompanied on their path to dying. You can learn more about The Five Invitations here and read my book review here.

During this afternoon’s walk I was telling Fred, my husband, about my response to the book, and he asked me what it was I found profound. In replying I described the many touching anecdotes and the explanations of Buddhism (which I sometimes had to reread to follow the full meaning). But mostly my mind lingered on the five invitations and the understanding that what can serve us in approaching our mortality can serve us as well in approaching our living.

Fred took in my words and then mentioned the science writer Robert Wright, who has written books about God, Buddhism, religion, as well as numerous articles for various magazines. It turns out Wright also teaches the coursera course Buddhism and Modern Psychology for which I signed up and started as of this evening.

These paragraphs may seem a bit disparate but that is not the case. Frank Ostaseski co-founded the Zen Hospice Project. While not everyone who turns to hospice is old in the sense of years, as the opening quote notes: it is not aging that is the issue, it is the decline, and decline can happen at any time along the aging continuum. Zen Buddhism is but one way to approach dying as well as living. It is this blend of looking at the aging continuum  thru a Zen lens that appeals to me.

Perhaps my interest stems from having witnessed my parents end-of-life, particularly my Mom’s and her decision to follow VSED. Or perhaps it is my own aging, having last month celebrated my 64th birthday, launching me full of wonder into my 65th year. Or maybe it is because I have become immersed in my yoga practice and yoga teaching, and wanting to try meditating – maybe for a spiritual reason but definitely because of the positive health benefits for the brain. Between the teachings of the book and what I may wind up learning from the course, I feel as if there are multiple strands of light waiting for me to braid them together into understanding.

Therapeutic Yoga Teacher Training, Module Two

Overview of Jillian Pransky’s Therapeutic Yoga Teacher Training, Module Two

Knowing full well what to expect in terms of format and my energy levels, this second second weekweek of training was in many ways less intense than the first week. DK, another yoga teacher participating in the training, coined our floor space as “apartments” and this is my apartment, which looked the same day-to-day and week-to-week.

There were close to 40 participants the first week, so imagine my “apartment” with others just like it nestled some 10 inches near by on each side. For this second week our numbers were pared down to 26, permitting a more spacious configuration.

On the first day of Module Two we revisited an overview of our relationship to wellness, stress, pain, and what it is we are trying to accomplish with therapeutic yoga. There was much in this discussion that resonated with me on a personal level. Ultimately, we are teaching out students how to create a safe space inside and to do that we create conditions outside so they can create conditions inside.

To paraphrase Jillian multiple times:

We aim to seek and find the barriers that inhibit energy and love, and when we find them, to love them. We change our perception of and relationship to our conditions (both the physical diagnosis and the emotions around it) which then sets up conditions for self-healing.

Dis-ease happens when the breakdown process happens faster than the healing process. Chronic pain IS chronic stress.

Wellness is an ongoing changing state of balance – the constant ability to adapt to the ever new now. This is the Ayurveda approach.

We also discussed the difference between tightness (muscle fibers contracting based on a load or force, i.e. an activity, that one voluntarily does) and tension (the sympathetic nervous system’s response as part of a self-protective mechanism.) Tension holds pain and limits the chemistry of healing. Both tightness and tension happen together.

This was followed by an in-depth look at fascia, which you can think of as similar to the white portion – the pith – of an orange. Fascia is the “stocking” or the “pith” around our muscles, as well as a communication system and “force transmission system” between muscles.

The remainder of the day included talk about hyper mobility versus flexibility, acute and chronic pain, and kinesthetic awareness.

Our second morning began with an almost two hour self-care session that was also a yoga tune-up ball experiential workshop. Small world – I walked into the room and immediately recognized the teacher as Darcy Bowman, a teacher whose restorative classes I have taken several times at my local yoga studio!

The rest of the morning included lecture on the history of yoga in the United States, and detailed information on how to design a therapeutic yoga session including the interview session that normally precedes any partnership. Before heading to lunch we partnered up for a structural alignment master class, switching partners at the end of the day so each of us had the opportunity to observe and be observed.

In the afternoon Heather Seagraves was our guest lecturer, speaking specifically about spine curvesspinal anatomy, pathology and injury management. I was reminded of the anatomy I already knew, and finally nailed anatomy about the spine that I was somewhat foggy on.

Day three began with extensive discussion about the psoas muscle, which is such a big deal in the body that it has a book dedicated to just it. This was followed by getting information about who each group of twos’ client would be the next day, with time to research and prepare for our session. The day concluded with another guest speaker, Dinneen Viggiano, whose focus for this talk was on shoulder injury and knee injury management.

Our final day of training began with a moving talk by Jenny, a friend of Jillian’s who lived with MS from her early twenties thru her thirties before having it go into full remission for the past 20 years. Jillian concluded the morning with lectures about high blood pressure, heart disease, stroke, diabetes, MS, fibromyalgia, and chronic fatigue, followed by a lovely and nourishing experiential session on applying touch. If we feel emotionally and physically present and available when providing a therapeutic yoga session, or indeed when leading a yoga class, we can warm up our hands and

  • move the body into alignment by moving structure (bone) with the entire palm and thumb pad,
  • massage to provide a “feel good” sensation using as much surface of the hand as possible,
  • place a solid yet light hands-on touch to promote stillness via cupping any of the joints,
  • simply leave our hands off and just sit with silence.

Our afternoon began as it had the prior week, meeting our clients and working with them, followed by small-group debriefing and then a full group debrief. As our clients headed home, we positioned ourselves in an oval and began an emotionally positive sharing about our eight day journey together with Jillian.

The bulk of additional resources were provided during the first week, in addition to manuals from each week. This week’s additional resources, besides links noted above, were: