Trauma-Sensitive Yoga

Yoga is a combination of physical forms, focused breathing, and purposeful attention or mindfulness. (Emerson, 2015) (xiv)

History of TSY

“The Trauma Center Yoga program began in 2002. Between 2003-2006, combining clinical insights and a dedication to yoga teaching for people who were suffering from psychological trauma, the first pilot studies were undertaken by the Trauma Center in Brookline, Massachusetts”

“We began offering sessions for groups and individuals in 2003 along side the pilot studies and immediately began learning from our students.”

In 2009, we received the first grant given by the National Institutes of Health (NIH) to study yoga for trauma.
In 2014 our original study was published in the Journal of Clinical Psychiatry. Since then, several organizations have replicated our study either verbatim or with modifications.
In 2017, TCTSY became the first dedicated yoga program listed as an evidence-based program/practice for the treatment of psychological trauma.
In 2018, the United States government removed the federal listing of evidence based practices and replaced it with a general reference to yoga as a "complementary therapy" for PTSD.”

(Trauma Sensitive Yoga, 2022)

“Trauma Center Trauma Sensitive Yoga is the first yoga-based empirically validated, clinical intervention for complex trauma or chronic, treatment-resistant post-traumatic stress disorder (PTSD).” (About — TCTSY • Trauma Center Trauma Sensitive Yoga, 2022)

Video: https://youtu.be/Mhz25kalsJ4 (Center for Trauma and Embodiment, 2021)

Trauma-Sensitive Yoga targets the very symptoms that other approaches struggle to address by using the body (bottom-up approach). TSY strengthens the mind-body connection by cultivating awareness of it. It also builds self-regulation skills that help address the way that trauma is held in the body. (Emerson, 2015, p. xiv)

The first way it differs is that in TSY the teacher will use the term “forms” instead of “poses”. The term pose can be triggering for those that have suffered abuse because victims could have been made to pose in sexual or exploitative ways. Also, the term pose implies externalization of the process by putting more emphasis on how the yoga looks instead of, more importantly, how the yoga invites the practitioner to feel the internal experience. 

The second way that TSY differs is that breath is not prescribed. TSY informs its practitioners that one type of breath is not better than another. The subjective experience is more important than any external idea of how the practice should be. 

Language is an important way that TSY differs from yoga in general. TSY teachers never speak in commands and instead use invitatory language. Everything is an invitation to the client, even whether or not they want to do yoga at all. To make everything into an invitation, TSY teachers will use the phrases “if you like” or “when you are ready.” 

Mindfulness is another way that TSY differs from other types of yoga. “Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p.4). In other types of yoga, mindfulness can be brought to a variety of things. In TSY, mindfulness is solely directed to what is felt in the body. There is another word for mindfulness directed to felt sensations in the body, interoception. (Emerson, 2015, p. 3-9)

Trauma Sensitive Yoga teaching principles:

• Choice-making : 

• Offering A-B or A-B-C options for ways to engage in the practice (e.g., “You could choose to start your practice sitting on a chair or on the floor”) 

• No hierarchy of choices/degree of engagement

• Shared authentic experience 

• The facilitator is also engaging in the practice with the participants for the entire session 

• Reduces power differential between facilitator and participants 

• Taking effective action :

• Offering invitations for ways to practice based on whatever is motivating the participant (e.g., interoceptive feedback, preference) rather than expectations of the facilitator or society 

• Experiencing the present moment 

• Offering cues that provide options to notice the present moment externally (e.g., “You may look around your space and notice where you are practicing”) or internally (e.g., “There’s a possibility you might notice some sensation in your torso as you lean to the side”) 

• Noncoercion 

• The entire practice is choice-based and empowers the participant to engage in the practice based on their preferences, not the facilitator’s, through invitational language (e.g., “If you’d like,” “Perhaps,” “You may/might/could”)

• No use of hands-on assists or adjustments (Move Through Trauma, 2019)

Coming soon.

https://www.ted.com/talks/krishna_sudhir_what_yoga_does_to_your_body_and_brain?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare.

•       Actions involving noticing and befriending the sensations in our bodies can produce profound changes in mind and brain that can lead to healing from trauma.

•       People who feel safe in their bodies can begin to translate the memories that previously overwhelmed them into language. (Emerson, 2015).

Yoga uses top-down and bottom-up processing that facilitates bi-directional communication between the brain and body. (Chawla, 2023)

• • Traumatic memory is primarily encoded as an emotion and these emotions are mediated by the body (not the mind, cognition). 

  • TSY uses the movement of the body and mindfulness as therapy. It is a body (somatic) movement therapy. 

    • • There is no attempt to make meaning out of bodily experience, however combined treatment is also beneficial.

      • The mission is to have an experience in the body.

      • The suggestion is that there is therapeutic value in not turning what is felt in the body into a story or emotion.

      • TSY strengthens the parasympathetic nervous system by repeating regulation of the nervous system via yoga. 

      • It works long term and short term, however there is a delayed effect in the beginning. (Emerson, 2015, p. 10-14)

Hakomi, sensorimotor therapy, and somatic experience are some of the most well known somatic/body therapies. However, Hakomi, sensorimotor therapy, and somatic experiencing are utilizing (cognitive processing, top down) to make meaning of bodily experiences. They are all meaning making paradigms.

• If I recognize my emotional state, I can have control over my emotional state.

• “These treatments access the body, not as an end in and of itself but rather as a doorway to a cognitive understanding of the emotional valence associated with trauma” (Emerson, 2015, p. 13)

Note: Somatic Experiencing does not require that people talk about their trauma and relies heavily on the body to facilitate healing, so it is in both groups. SE is not strictly a movement therapy because it also makes meaning out of bodily experience. 

• • • Both TSY and SE help clients gain access to the healing potential inherent in their bodies. (Emerson, 2015, p. 10-14)

EMDR is a targeted memory processing technique that specifically targets traumatic memories by using eye movements to help individuals reprocess and desensitize them, often requiring direct discussion and access to the traumatic experience itself. Trauma-sensitive yoga is a more body-centered approach to healing from trauma, while EMDR is a targeted memory processing technique that uses eye movements. (Bay Area CBT Center, 2024)

Neurofeedback is a top-down approach because the aim is to exert control over its own activity by providing real-time feedback. The feedback is given on brainwave states through EEG sensors (which is considered a higher level function compared to bodily sensations) and then addresses the specific symptoms by getting the client to consciously regulate their brain activity through targeted interventions. It can be considered a meaning making paradigm as it uses the awareness of brain activity to actively change brain activity. (Koush et al., 2015)

(may add brief descriptions of the other therapies here: Hakomi, sensorimotor therapy, and somatic experience)

 https://www.traumasensitiveyoga.com/facilitators

It is not required to be in the mental health field to be a TSY practitioner. If you are seeking to have a mental health provider that also does TSY, you may use this site and look for the mental health providers credentials by clicking on the specific bios. 

(Trauma Center Trauma Sensitive Yoga, n.d.)

Bay Area CBT Center. (2024, July 22). Combining EMDR Therapy and Yoga for Trauma Recovery. Bay Area CBT Center. https://bayareacbtcenter.com/emdr-therapy-and-yoga/

Center for Trauma and Embodiment. (2021, March 3). What is Trauma Sensitive Yoga (TCTSY)? Explained by its co-founders, Jenn Turner and Dave Emerson. YouTube. https://www.youtube.com/watch?v=Mhz25kalsJ4

Cleveland Clinic. (2022, March 29). EMDR therapy: What it is, procedure & effectiveness. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/22641-emdr-therapy

Emerson, D. (2015). Trauma-Sensitive Yoga in Therapy: Bringing the Body into Treatment. W. W. Norton & Company.

Emerson, D. (2022). About — TCTSY • Trauma Center Trauma Sensitive Yoga. TCTSY • Trauma Center Trauma Sensitive Yoga. https://www.traumasensitiveyoga.com/about

English, A., McKibben, E., Sivaramakrishnan, D., Hart, N., Richards, J., & Kelly, P. (2022). A Rapid Review Exploring the Role of Yoga in Healing Psychological Trauma. International Journal of Environmental Research and Public Health, 19(23), 16180. https://doi.org/10.3390/ijerph192316180

Kabat-Zinn, J. (1994). Mindfulness meditation for everyday life. Piatkus.

Kelly, U., Haywood, T., Segell, E., & Higgins, M. (2021). Trauma-Sensitive Yoga for Post-Traumatic Stress Disorder in Women Veterans who Experienced Military Sexual Trauma: Interim Results from a Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine, 27(S1), S-45-S-59. https://doi.org/10.1089/acm.2020.0417

Koush, Y., Meskaldji, Djalel-E., Pichon, S., Rey, G., Rieger, S. W., Linden, D. E. J., Van De Ville, D., Vuilleumier, P., & Scharnowski, F. (2015). Learning Control Over Emotion Networks Through Connectivity-Based Neurofeedback. Cerebral Cortex, bhv311. https://doi.org/10.1093/cercor/bhv311

Move Through Trauma. (2019, August 2). The 5 Core Elements of TCTSY. Movethroughtrauma.co.uk; Publisher named Move Through Trauma. https://www.movethroughtrauma.co.uk/blog/trauma-informed-emails/

Taylor, J., McLean, L., Korner, A., Stratton, E., & Glozier, N. (2020). Mindfulness and Yoga for Psychological trauma: Systematic Review and meta-analysis. Journal of Trauma & Dissociation, 21(5), 1–38. https://doi.org/10.1080/15299732.2020.1760167

Trauma Center Trauma Sensitive Yoga. (n.d.). Facilitators. TCTSY - Trauma Center Trauma-Sensitive Yoga. https://www.traumasensitiveyoga.com/facilitators

van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., & Spinazzola, J. (2014). Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder. The Journal of Clinical Psychiatry, 75(06), e559–e565. https://doi.org/10.4088/jcp.13m08561

West, J., Liang, B., & Spinazzola, J. (2017). Trauma sensitive yoga as a complementary treatment for posttraumatic stress disorder: A qualitative descriptive analysis. International Journal of Stress Management, 24(2), 173–195. https://doi.org/10.1037/str0000040

Yoga Therapy Associates. (2023, October 8). The Science Supporting Yoga Therapy for Trauma Recovery. Yoga Therapy Associates. https://yogatherapyassociates.com/trauma-research/

Zaccari, B., Higgins, M., Haywood, T. N., Patel, M., Emerson, D., Hubbard, K., Loftis, J. M., & Kelly, U. A. (2023). Yoga vs Cognitive Processing Therapy for Military Sexual Trauma–Related Posttraumatic Stress Disorder. JAMA Network Open, 6(12), e2344862–e2344862. https://doi.org/10.1001/jamanetworkopen.2023.44862