Posttraumatic Stress Disorder (or PTSD) affects around 3.5% of the US population, approximately 8 million Americans, in a given year. Those living with PTSD are often supported by a programme of pharmaceutical intervention and talking therapies, but treating PTSD isn’t always straightforward, with a high co-occurrence of addiction suggesting that people may turn to self-medication to cope with their symptoms.
It is in this context that researchers have looked for alternative ways to help people living with PTSD, and evidence is growing to suggest that not only are yoga and mindfulness potentially soothing self-help techniques, they could actually form an important part of symptom management and recovery.
What is the cause of PTSD?
PTSD is the result of trauma, and while it is most often associated with soldiers and veterans, anyone who is frequently exposed to traumatic or life-threatening situations – such as emergency medical technicians, firefighters or social workers – can be at risk of developing the illness.
It can also affect those who have lived through traumatic events, such as sexual assault, a natural disaster or a difficult birth experience. Those who are subject to sustained trauma (for example, in cases of childhood abuse) may go on to develop complex post-traumatic stress disorder, known as c-PTSD.
According to research, 70% of adults will experience at least one traumatic event in their lifetime, and 20% of those will go on to develop PTSD. It is unknown why some people have the echoes of trauma reverberate so distressingly throughout their lives while others can recover and move on, but it appears that not receiving comprehensive support in the aftermath of trauma may elevate their risk.
It is likely that a person’s vulnerability to PTSD is linked to a variety of intersecting factors, but for those already living with this mental health issue, the most pertinent question is not ‘why does this happen?’ but ‘how do we treat it?’. PTSD can be debilitating and profoundly impact a person’s ability both to function within and enjoy their life. Its major symptoms include flashbacks, nightmares, high anxiety, and feelings of helplessness.
How yoga can help
People with PTSD live with hyperarousal of the body’s survival mode, which can go on to impact their brain structure through the function of neuroplasticity, further embedding unconscious patterns of extreme reactivity to stress and fear. The impact of trauma can be felt in every aspect of a person’s life – affecting them on a physical, mental, and emotional level – and by using yoga therapy alongside traditional treatment, we can support recovery in all these domains.
Using evidence-based techniques from yoga and mindfulness can be an extremely helpful treatment pathway, with evidence pointing towards a variety of mechanisms through which yoga can reduce the symptoms of PTSD. As described by Dan Nervins, a yoga ambassador and US Army veteran: ‘All of us are living with the invisible wounds of some kind of war. Yoga helps you to let go of the things that don’t serve you anymore.’
Perhaps the most important feature of PTSD is that sufferers are no longer able to regulate their ‘fight or flight’ response, which is an instinctive reaction governed by the autonomic nervous system (ANS). Research suggests that regularly practising yoga trains the ANS to be more dynamically adaptive, so those living with PTSD can return to a state of physiological calm more quickly after experiencing a triggering episode.
Mindfulness (which is a defining aspect of yoga) has also been demonstrated to result in helpful neurological changes, including reduced density in the ‘stress centre’ of the brain and greater hippocampal volume – potentially counteracting some of the changes researchers observe in the brains of those with PTSD.
People living with PTSD can sometimes feel alienated from and mistrustful of their own bodies. Our survival response in the face of traumatic situations is extremely powerful, and the unconscious and seemingly uncontrollable way our bodies react in these scenarios can be very disturbing. Through flashbacks and panic attacks, posttraumatic stress disorder makes people revisit this frightening state, so they may start trying to avoid or ignore certain triggering sensations, or begin to view their body as an unconnected and unpredictable entity.
With the guidance of a trained yoga therapist, people affected by trauma can begin to rebuild their body awareness in a safe environment, developing skills in tolerance and modulating physiologic and affective states that have become dysregulated by trauma exposure. Combined with mindfulness, which develops people’s capacity to observe their thoughts at a non-judgemental distance, they can start to recognise and manage triggers in a healthy and sustainable way.
One study, looking at 23 male veterans, discovered that mindfulness-based exposure therapy changed activity in areas of the brain associated with mind-wandering and purposeful shifting of attention, hinting that the therapy helped veterans redirect their thoughts and attention. Another, involving mild electric shocks, suggested that mindfulness could help people ‘unlearn’ fear.
While this is only a snapshot of the promising research into the efficacy of using yoga for PTSD, it demonstrates the highly promising and growing evidence base for the use of yoga in the treatment of trauma. By giving medical professionals another treatment option (and one that can be used seamlessly alongside others) yoga and mindfulness could improve quality of life and help pave the way to recovery for their patients.
Heather Mason is a yoga therapist and founder of The Minded Institute, which offers yoga therapy training to yoga and health professionals.