I was fortunate to be able to talk recently with Lili Graue, a registered yoga teacher, who has started an innovative program using yoga techniques to address mental health concerns including anxiety, depression, and trauma, to name a few. I asked Lili a few questions about how yoga is used in this way, its benefits, and about her program. Here’s our interview:
DS: Most people have heard of yoga, but what is yoga for trauma?
LG: Yoga for trauma is a therapeutic style of yoga designed to assist in healing the imprint of trauma in the body. The idea to use yoga in the treatment of trauma came from a collaboration between Bessel van der Kolk, a psychiatrist and leading trauma researcher, and David Emerson, a social worker and yoga teacher, both of whom worked with combat veterans suffering from PTSD (post-traumatic stress disorder). They teamed up in 2002 to conduct research looking at the effects of yoga on various physiological and psychological markers in trauma survivors. Their work led to the development of “trauma-sensitive” yoga and a growing body of research suggesting that this style of yoga reduces PTSD symptoms and promotes post-traumatic growth.
Trauma-sensitive yoga is different from the types of yoga taught in community classes in that modifications are made to minimize potential triggers that might create barriers to the healing process. Elements of the physical space are carefully considered to increase feelings of safety and predicability. These include room setup, class size, and lighting. Trauma-sensitive instructors use invitational language and offer choices to encourage participants to be in control of their experience at all times. This includes opting out of poses that feel physically or psychologically uncomfortable.The movement in and out of poses in trauma-sensitive classes is gentle and the pace is slow. This allows participants to mindfully observe thoughts, feelings, and sensations as they arise from moment to moment.
The relationship between the instructor and participants in trauma-sensitive classes is considered therapeutic in that rapport and trust are developed and maintained to facilitate healing. Trauma-sensitive instructors typically have a mental health background in addition to their yoga training. This enables them to recognize subtle signs of distress when it occurs and offer the proper assistance.
DS: How does yoga help?
LG: Yoga impacts every system in the body, including the nervous system. This makes it especially useful for healing trauma. Specifically, yoga teaches people how to use the breath and physical movement to manage fluctuations in the autonomic nervous system. This can lead to greater impulse control and distress tolerance, among other things.
Research demonstrates that yoga reduces symptoms related to trauma and PTSD, including depression, anxiety, and insomnia. But this is only part of the picture. What particularly excites me is the data showing how yoga is positively impacting trauma survivors’ quality of life. Several qualitative studies done by affiliates of The Trauma Center at Justice Resource Institute (JRI) have examined this in groups of women diagnosed with complex trauma. Study participants reported that yoga helped them cope more effectively with stress and triggers. They felt more capable of changing patterned behaviors. They made self-care a higher priority. Their relationships improved as their capacity for emotional and physical intimacy increased. They described feelings of empowerment, agency, and authenticity.
One study, by Alison Rhodes, PhD, used the phrase, “claiming peaceful embodiment” to describe the process of change being reported. I would like to share some quotes from her paper, “Claiming peaceful embodiment through yoga in the aftermath of trauma” (2015). Each of the following statements was made by a different person at the end of the study:
- “Just inhabiting my own skin is a major step forward. It allows me to be in my life now — like being attentive as I’m driving, to be present with my family, like in lots of different ways. I think the practice of being more in tune with my body and being able to develop some tools to control my inner energy and the calmness that can come is significant…Things feel more connected. I’m more real…I feel more authentic than I think I ever have.”
- “I started to feel a lot of physical stuff. I was having all the effects of a reaction, a triggered reaction so I breathed. I did some breathing and just trying to refocus and a little self-talk. But that’s a lot different than the way I used to have to deal with that stuff.”
- “It sometimes feels like my brain is using a map of my body from back when I was eight and not the one from now. Every time after I go to yoga class I feel better – more presence, more confidence, more secure in my body.”
- “My stance is different. I stand taller. I breathe, which I think I hadn’t done in a long time. I feel more connected with my body.”
- “When you are abused you feel small, even smaller than you are…That was my experience as a child. I wanted to be small and invisible if possible. I wanted not to be seen, and I constricted…I’d say the sense of being able to open up in this way physically [in yoga], as simple as it sounds, especially the upper part of my body — heart, lungs, diaphragm, shoulders — all the parts that I had scrunched down, that seemed to make a difference. It allowed an overall expansion…People are noticing it clearly. I have been invited to do more things. People seem interested in me in a different way. There is something that has changed because people are coming closer to me. I am able to tolerate that better. I am reaching out more in ways that I couldn’t have done.”
- “Practicing yoga has given me hope…It’s been a useful practice and tool to develop those things which led me to think I don’t have to be that person that I always thought I was just destined to be, that I could actually change some things, and become that person that I’ve wanted to be. The trauma doesn’t have to define me, although the trauma will always be part of me. I can change. I can change how I work, and how I want to be.”
These studies are worth reading if you work with trauma survivors or have an interest in this topic. They can be accessed on JRI’s website.
DS: Do you need a physical exam or medical approval before starting yoga? Any limitations on who can safely do yoga?
LG: While I don’t require medical approval up front, in my intake session I carefully consider each person’s medical and mental health history to determine whether they can safely participate and what support they may need. Persons with serious mental health conditions, such as major depression or bipolar disorder, should be relatively stable with no recent hospitalizations or active suicidal thoughts and behaviors. It is advisable, but not required, that participants be concurrently engaged in treatment with a mental health professional to ensure they have the necessary support to process things that may come up during yoga practice.
Trauma-sensitive yoga is generally safe. When necessary, modifications can be made to increase the safety and comfort of those with physical limitations and medical considerations.
However, checking with your doctor before beginning any form of exercise is a good idea. Women who are pregnant and persons with heart problems, vision/eye conditions, recent surgeries, fluid retention, and chronic respiratory problems should be cleared by their doctor before doing yoga.
DS: How are your yoga groups structured?
LG: I offer three different levels of 8-week trauma groups designed to work in succession. However, progression through the group levels is not the goal. Participants can choose to continue practicing at any level for as long as they like. Progression is based on a combination of participants’ body awareness and their personal goals for doing yoga. Special Topics groups will be offered periodically to address trauma-related symptoms, like depression and anxiety. Private sessions are an option for those who for any reason prefer individual instruction.
About Lili Graue
Lili is a therapeutically-oriented yoga instructor specializing in trauma-sensitive yoga. She earned a master’s degree in clinical psychology from University of Kentucky and worked at the VA Medical Center for 8 years. After completing her yoga certification, she began teaching yoga for veterans at the VA. Her experience teaching veterans, and seeing the positive effects of yoga in their lives, ultimately led to her decision to teach yoga full time. In her business, Lilipad Yoga, she combines her understanding of psychology and training in yoga to offer trauma-sensitive yoga groups and private instruction for adults and adolescents. You can learn more about her program by visiting her website.
Thanks so much to Lili for educating us about the many potential mental health benefits of yoga practice!
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