integrative yoga therapy

Scientific News by Irina are back: after a break of almost a year, I return to my small but beloved project — scientific news for Network Yoga Therapy. I will write about the latest research on yoga, yoga therapy meditation, and other mind–body practices. Every week I scan through 50–100 new articles on these topics, and try to filter out the most interesting and high quality ones.

STUDENT MENTAL HEALTH

So, today we look at student mental health in a Norwegian yoga study. Why students? Young people often experience mental difficulties, but rarely seek help. To prevent them from slipping into depression and other severe conditions, it is essential to find effective preventive interventions that reduce stress and maintain mental health.

Students who did yoga showed significant reductions in stress levels and statistically significant improvements in quality of life and mindfulness. The number of students in the yoga group with high-stress scores decreased by a third. Moreover, the effect was noticeable even three months after the end of the intervention.

The Norwegian study involved 202 university students (87% women). The students were randomly divided into two equal groups. One group did yoga twice a week for three months; the other/control group was on a waiting list. The effect of the exercises was measured three and six months after the start, using standard psychological questionnaires.

Yoga study

I like this article because it has a reasonably large sample for a yoga study. The more participants there are in a study, the better you can trust the statistical results. Like in many other psychological studies, the effect of yoga was moderate — which means that yoga did not necessarily help all students in the group. But those who did yoga were more likely to improve their condition. 

I also like that the students in the control group were invited to start the same yoga course once the study ended. It's a fair (and a very yogic) way to organise such a study.

A systematic review published in January 2020 analyzed a dozen studies of mind–body interventions in infertility. The outcomes are compelling: yoga and mindfulness practices reduce anxiety and depression in women during infertility treatment.

There is also an indication that mind–body interventions increase pregnancy rates, though not many studies followed the participants for a sufficiently long time to make reliable conclusions about pregnancy outcomes.

Grief, depression, and anxiety

Most women included in the reviewed studies had signs of mild anxiety and depression. It is not surprising — women undergoing infertility treatments have possibly lived through years of despair, guilt, and grief. 

Infertility problems and pregnancy losses are prevalent: one in ten pregnancies results in miscarriage. Yet, we do not talk about it openly, and women often receive little support during the time of treatment. 

Western protocols offer technical solutions to infertility but do not give us the tools to cope with difficult emotions. Holistic treatments and mind–body practices can fill this gap. I had a first-trimester miscarriage myself and felt incredibly sad and lonely, especially since I had to decide if I wanted to terminate the pregnancy when the heartbeat was no longer detectable. Yoga helped me to find compassion towards my body, rather than feeling angry with its failure. Yoga also helped me to navigate through waves of anxiety during the following pregnancy.

Is there “yoga for hormones”?

Research data now confirms what many other women and myself have discovered before: mind–body practices can support us on the path to motherhood. We do not know if it is particular yoga asanas that are helping, or perhaps it is simply the general de-stress quality of yoga. 

If we want to build a balanced practice, it's better to let go of the idea that one asana targets one specific hormone problem. 

Physical exercises affect many hormones and body parameters, such as heart output, blood biochemistry, and nutrient supply to organs. Slow breathing and focused attention reduce physiological stress reactions. As a combination of meditation and physical exercise, yoga could be an efficient protective strategy against hormonal imbalances. A shift in the physiological state towards calm and resilience makes miracles happen.

Healthcare professionals under stress

According to a report by the Dutch National Register of occupational disorders, healthcare providers in the Netherlands experience more mental distress than professionals from any other sector. At the same time, British Medical Association talks about a mental health crisis in healthcare professionals. Chronic stress, mood fluctuations and sleep disturbances put doctors at risk for health problems. A survey of thousands of doctors and medical students shows worrying levels of burnout, a high prevalence of psychological and emotional conditions, and a concerning number turning to alcohol, drugs, or medication (British Medical Association 2019).

“While there is no denying that being a doctor is a challenging and demanding role, too often the line of what can be considered routine pressures of the job has most definitely been crossed and the consequence is a workforce that has been pushed to literal breaking point.” – BMA

Good care starts with yourself

At Network Yoga Therapy we believe that yoga-based practices should be included in the healthcare sector, as a lifestyle management tool both for doctors and patients. Yoga is a tool for transforming mind and body patterns and working to improve health and wellbeing. In a world where most diseases come from poor lifestyle choices, yoga can be seen as a “lifestyle therapy”.  

A study that came out last week (January 2020) in the Journal of Alternative and Complementary Medicine showed that yoga improves psychological and occupational health in frontline professionals. The study participants took part in a 5-day course, including yoga, meditation, mindfulness, and breathing exercises. A series of psychological tests showed an improvement in stress levels, mindfulness, empowerment, and self-compassion immediately after the course. Practicing yoga brought sustained improvements in the long-run: the study shows that the positive changes lasted for at least 6 months.

In what way can yoga or yoga-based lifestyle interventions be integrated in healthcare? Do you know of any ongoing projects anywhere in the world?

Personal empowerment and holistic lifestyle management

This year we started Svastha 200 hours yoga teacher training and professional development for healthcare professionals, in collaboration with the Amsterdam School for Integrative Medicine & Health. During this training, we work towards personal optimal balance through an intensive yoga and meditation program. We investigate the original holistic wisdom from the yogic tradition and the basic principles of Ayurveda for optimal health balance. We show how to develop yoga and meditation classes for groups and in a 1-on-1 setting, for example in the consultation room. 

Does meditation change the brain? Or do an individual brain's qualities make some people more attracted to meditation than others?

You might expect someone who meditates regularly to show up as calm and thoughtful. Yes, research shows that meditation practitioners tend to have low impulsivity. But what comes first? Does meditation make someone less impulsive? Or do naturally calm people choose to spend time meditating?

Impulsivity is a personal trait, a tendency to act on a sudden urge. Extreme impulsivity is linked to psychological disorders (ADHD, personality disorders, and even brain injuries). Studies show that impulsive behavior correlates with brain structures responsible for planning and motor control.

A 2019 study compared these brain structures in long-term meditators (people with thousands of hours of lifetime meditation practice) with people who have never meditated. Researchers found differences in the neural measures of impulsivity between the groups. However,  the brain measures were not dependent on the extent of meditation practice. Instead, differences between meditators and non-meditators may be pre-existing. People with a particular neurological make-up may be more attracted to extensive meditation practice than others. 

Another study from 2013 showed that people engaging in compassion meditation might have a neurological predisposition in the way they respond to suffering. The study participants received painful electrical stimulation, and watched others receiving same stimulation. Neuroscientists put people through this unpleasant process to measure their empathy and brain responses. Participants then took up compassion and mindfulness meditation training. The brain activity in response to pain predicted how much time they would spend practicing mindfulness and compassion.

Does meditation change the brain and personality? Or do baseline differences in impulsivity, compassion, and other characteristics make some people more attracted to meditation?

I think that, likely, both are true.  

Anything that we do over and over again shapes our brain.  At the same time, our brain determines if we stick to the practice.

Ahimsa, the ethic of non harming can take on a number of meanings in the yoga classroom, including ensuring safety, being trustworthy, maximising choice, collaboration, and prioritising empowerment. These principles are important in a broad range of settings but especially vital in yoga contexts where many practitioners expose their bodies, minds, and vulnerabilities.

Whether through replicating inherited behaviours and practices from past generations or adopting business practices meant for commercial contexts, or not understanding the ways in which violence, victimization, and other traumatic experiences may exclude victims/survivors of trauma, many common practices in modern yoga fall short of these principles. 

Part 1 of this paper discussed empowerment, maximising choice and the need for collaboration with students.  This second part highlights some ways in which our practices can erode trust and compromise safety in the classroom.

While I draw from some of the standard practices learned from the Trauma Centre Trauma Sensitive Yoga framework [1] in offering possible ways forward, the possibilities are by no means finite. It is hoped that by highlighting these areas that we can focus our efforts to collectively imagine and shape paths ahead, so we may evolve as a profession and be better able to serve our communities. 

Exaggeration is a standard technique in the world of advertising, and the norms in the political, cultural and media realm in general are heading towards seemingly ever increasing exaggeration and hyperbole. Increasingly, so too are the claims in yoga related advertising. It is now commonplace to see yoga advertising touting claims that are hyper-inflated, over generalised, or are baseless in science. This is commonly seen in claims about the health benefits of yoga - for example, that certain postures "wring out toxins in internal organs" [2], or “rinse the spine” [3] or “purifies the body” [4]. Another common area for mistruths appear in advertising for retreats and yoga teacher trainings.  In these areas, concrete outcomes are promised.  Just about any Google search for yoga retreat or yoga teacher training will bring up advertisements for experiences that guarantee healing, life transformations, spiritual awakenings, removal of emotional blockages and so on [5].

Many yoga practitioners turn to teaching because our lives have been touched by yoga in profound ways. But our own experiences are not an accurate  predictor  of another's experience, however strong our own convictions.  Through exposure to increasingly inflated claims and exaggerated truths and imprecision in language, consumers have learned to be skeptical about both advertising, and the advertisers behind them.  As English Professor Marilyn Chandler McEntyre says:

“We need to reclaim words that have been colonised and held hostage by commercial and political agencies that have riddled them with distorted meanings" [6].

Our hyperbole, imprecision and inaccuracy with our words leads to a mistrust that calls into question our trustworthiness and our integrity as people. If yoga is to be a healing, positive experience for our communities, the relationship between a teacher and the community needs to be built on trust.  Without honesty and reliability in the information we share and the claims we make, there can not be trust - we need to mean what we say.   

TRUSTWORTHINESS IN DESCRIPTIONS OF CLASSES AND TEACHERS 

Related to trustworthiness and safety, is how accurately our classes match the class descriptions. Quite often, classes are advertised as being as welcoming ‘all abilities’ by those without the means to cater to those in wheelchairs, or those who can not sit on the floor, or can not kneel, or bear weight on their hands or those who can not follow the flow of a fast paced vinyasa flow class - such scenarios are common in the general public.

Facilitating chair yoga, offering variations to a genuinely broader range of the public requires skills often not covered in basic 200hr and 500hr yoga teacher training programs. Without the requisite training or experience to cater to the general public, it could be harmful to those attending those classes to hold ourselves as being able do so.

TRUSTWORTHINESS: SURPRISE CLASSES

Well-meaning teachers may at some point want to incorporate new modalities to keep classes fresh for example, trauma release, dance, or group sharing, sound bathing, tea ceremonies, wine tasting, yoga selfie events and so on. While some students may enjoy the new activity, this comes at the cost of others.  One of the key defining experiences of many trauma survivors is the feeling of being unsafe [7] - it stands to reason then that the first imperative of working with those with traumatised histories is to create conditions of safety.  And for many, this means predictability.  Surprise classes and unpredictable contexts that students did not consent to threatens to undermine the feeling of safety and leave some feeling exposed.  

TRUSTWORTHINESS: SCOPE OF PRACTICE

Scope of practice describes the procedures, action and processes that professionals are permitted to undertake in keeping with the their training and education. Scope of practice issues often emerge in dealings with students who have injuries or other health conditions, require counselling, or advice in relation to physical therapy, diet and nutrition. Given the power relations between a teacher and student, even a passing comment can be taken as actual advice when it is given by a teacher in a classroom.

For those with a history of eating disorders, or struggle with negative body image, hearing recommendations to fast, diet, cleanse etc in the context of a yoga class can have disastrous effects.

Advice beyond your scope of professional competence can compromise a student’s wellbeing - causing or prolonging confusion, fear and doubt, misdiagnosis and mistreatment or worryingly, delay seeking attention from someone qualified or worse, discourage seeking advice from qualified professionals all together.

Even if a facilitator is qualified in another area, if their role at in the classroom is to teach yoga, then arguably they should perform the role they were engaged to perform.

SAFE ENVIRONMENTS: YOGA BODIES

How we represent yoga has implications for who feels welcomed, who feels able to access yoga services, and who feels welcomed, who feels ‘at home.’  When our representation of yoga prompts otherwise interested people to self- exclude, we can do yoga and the public a disservice.

The world of advertising, which has largely normalized unrealistically thin bodies to create an unattainable desire that sells has long been criticised for perpetuating problems of poor self esteem, body negativity and anxiety amongst women.

“the media perpetuates a market for frustration and disappointment ensuring customers will never disappear” [8].

Worryingly, the yoga industry has borrowed the same tactics. Yoga related advertising often conflates yoga practice with stunning displays of hyper- flexibility and athleticism, and ’yoga bodies’ as belonging to thin, young, flexible, able bodied women who are often also white [9]. Yoga Journal models are less diverse today in age and race than they were 40 years ago and female ad model body sizes have changed in line with society body ideals [10].

Berger discusses experiences of black women and yoga who affirm the ‘skinny white girl yoga culture’.  The effect of this culture can be triggering and trauma-inducing for many Black women who have to navigate in spaces where they feel they don’t belong.

“I’m a black woman who’s been doing yoga regularly since 1989. I don’t enjoy the skinny white girl yoga culture that is prevalent where I live .. so it’s rare that I'll go to a class. Instead I practice at home, usually late at night. Light a candle, burn some incense, put on some mellow music and practice on my Mexican blanket for about 30 minutes. Yoga is for everybody” [11]

SAFE ENVIRONMENTS: PHYSICAL INJURY

While yoga is generally safe, the rates of yoga related injury is rising [12]. How we structure our businesses or classes have a bearing on safety levels for students.   Running large classes where odds are stacked against our ability to spot when someone might need assistance is a factor for injury risk.  Employing business models that allow people with no yoga experience to become yoga teachers after a month or two of training, employing or ‘certifying’ minimally experienced teachers who then go on to teach is another factor leading to increased injuries [13].  When we consider the combination of large classes, minimally trained teachers, who use physical adjustments the risks are compounded.

SAFE ENVIRONMENTS: ENCOURAGEMENT TO INJURY

Another way we can expose students to physical injuries is through how we encourage students in class. It is common in classes to see teachers praise demonstrations of athleticism in class, or moments of ‘achieving’ postures. The short term effect of praise may be boosting for a student - but the subtle implication could be that external achievement is praiseworthy. How we praise communicates what we value.  If we encourage students to explore the edge of their physical limits without equally reminding students of the value of easing off, we may send messages that amount to ‘more and further is better’.

Encouraging external achievement can be problematic in a number of ways.  First, it deprives a student from  exploring  subtler sensations.  Second, chasing accomplishments in asana fosters a mentality that will inevitably lead to injuries.  Finally - if we aim to  facilitate students towards embodiment and connection with their own mental, emotional and physical experiences, then this mentality works in the opposite direction of steering students towards using yoga as another way to dissociate, to push forward despite, not because of, feedback from their senses.

Praising external achievement may at times subtly reinforce the impression that the most athletic asana equates to the most ‘advanced’ yoga which exposes students to the risk of physical harm and closes them to the benefits of non-asana practice.

Whether this perception attracts people expecting yoga to teach them impressive feats of flexibility or repels people who can not see themselves in such depictions of yoga practice, the effect is equally misleading and harmful in the same way that widespread advertising of unattainable beauty standards has been shown to negatively affect the self-esteem and health of young women.

SAFE ENVIRONMENTS: EXPOSURE TO EMOTIONAL INJURY

Many yoga teachers intend to help their students to create a positive attitude or mindset particularly during times of grief, stress, or other difficulties. But we can emotionally injure students by suggesting to them how they should feel. There are many variations on themes of ’be positive’, ‘stay happy’, ‘be grateful for what you have rather than focusing on what you don’t’  etc in the yoga landscape. Such can minimise a student’s emotional state or negate their actual experiences.

Suggestions that: "everything happens for a reason"[14] or that our own thoughts cause everything that happens to us can be especially cruel to those who have suffer violence, abuse, neglect, poverty and/or tragedy.  Yoga and teacher teachers should not amplify or magnify trauma through well meaning, but ill-considered commentary or logic. 

SAFE ENVIRONMENTS: CONSENT

In many schools of yoga, touching the physical body has been an established teaching tool.  Many teachers assume their touch will be welcomed by students. Touch can be soothing, healing and helpful for some.  Sometimes touch will invoke  fear, inadequacy, intimidation, violation, confusion, pain, and disorientation -  it is impossible for a yoga teacher to know how touch will be experienced by the recipient, or to imagine what sensations, memories, or associations will be triggered by that touch - especially in trauma contexts.

“Sensory messages from muscle and connective tissue that remember a specific position, action or intention can be the source of the trigger”. [13]

If we simply assume that our well intentioned touch will be well received - it is a matter of time before that physical contact will intrude on someone’s feelings of safety. This is just as true for what we feel is skilfully applied touch done with valid reason as it is for aggressive adjustments: the impact is  not caused by our intention, but by the recipient’s response to our act. 

Holding classes where participation in class involves students touching each other, for example, group massage or partner yoga when there is no pre-warning of such touching prior to class can also feel intrusive or unsafe to some participants.

Many teachers now consider best practice is not to touch students at all, using verbal cues and demonstrations to guide students instead. For teachers who continue to use physical adjustments, securing timely and meaningful consent to physical touching is essential to avoid harming students.  Consent should be sought ahead of time before class, and allow the space for people to change their minds during class. Asking for consent while students are in the middle of a posture, or asking for verbal consent in front of others can make someone feel put on the spot and pressured to consent.

THANK YOU FOR READING THIS!

Yoga classrooms can be safe, healing, respectful spaces. However, inherited behaviours and practices from past generations, adopting mainstream advertising techniques, and failing to understand ways in which violence, victimisation, and other traumatic experiences may exclude victims/survivors of trauma has eroded student empowerment and compromised safety in yoga classrooms. It is hoped that by highlighting these areas we can apply that understanding to how we design yoga spaces so as to be consonant with healing and recovery. 

Feel free to share your story, question or feedback below this post, we love to hear your voice too!

- Yonnie Fung

References 

1. Emerson, David Overcoming Trauma through Yoga: Reclaiming Your Body , 2011
2. https://www.organicauthority.com/energetic-health/yoga-twist-to-detox-cleanse-body
3. https://www.theguardian.com/science/sifting-the-evidence/2014/jan/13/demystifying-detox-can-yoga-really-cleanse-the-liver
4. https://www.active.com/health/articles/yoga-detox-poses-to-cleanse-your-body
5. https://www.yogajournal.com/lifestyle/9-india-yoga-retreats-that-will-change-your-life
6. McEntyre, Marilyn Chandler, Caring for Words in a Culture of Lies, Wm. B. Eerdmans Publishing, 2009, p 7
7. Greenwald, Ricky Childhood Trauma, A handbook, Haworth, 2005
8. Hamburg, P. (1998). "The media and eating disorders: who is most vulnerable?" Public Forum: Culture, Media and Eating Disorders, Harvard Medical School.
9. Webb, J, Vinoski E, Warren-Findlow, J., Padro, M., Burris, E., Suddreth, E., Is the “Yoga Bod” the new skinny?: A comparative content analysis of mainstream yoga lifestyle magazine covers, Body Image, Volume 20, 2017, Pages 87-98
10. Erin Vinoski, Jennifer B. Webb, Jan Warren-Findlow, Kirstyn A. Brewer, Katheryn A. Kiffmeyer, Got yoga?: A longitudinal analysis of thematic content and models’ appearance-related attributes in advertisements spanning four decades of Yoga Journal, Body Image, Volume 21, 2017, Pages 1-5
11. Berger, M. T. (2018). I Do Practice Yoga! Controlling Images and Recovering the Black Female Body in ‘Skinny White Girl’ Yoga Culture. Race and Yoga, 3(1). Retrieved from https://escholarship.org/uc/item/3w04347q
12. Swain TA, McGwin G. Yoga-Related Injuries in the United States From 2001 to 2014. Orthop J Sports Med. 2016;4(11):2325967116671703. Published 2016 Nov 16. doi:10.1177/2325967116671703
13. Rothschild, B. The Body Remembers,. New York: Norton, 2000, page 45
14. https://www.doyou.com/everything-happens-for-a-reason/; https://thelifester.com/everything-happens-for-a-reason/

Ahimsa, the ethic of non harming can take on a number of meanings in the yoga classroom, including ensuring safety, being trustworthy, maximising choice, collaboration, and prioritising empowerment [1]. These principles are important in a broad range of settings but especially vital in yoga contexts where many practitioners expose their bodies, minds, and vulnerabilities.

While yoga promises tools for self empowerment and healing, yoga classrooms have not always been empowering, safe nor inclusive spaces for all, nor have our practices always been consonant with empowering our communities. 

Whether through replicating inherited behaviours and practices from past generations or adopting business practices meant for commercial contexts, or not understanding the ways in which violence, victimisation, and other traumatic experiences may exclude victims/survivors of trauma, many common practices in modern yoga fall short of these principles. 

This 2-part essay Written by Yonnie Fung considers the ways in which our practices in yoga may erode empowerment, take away from agency, and undermine safety.  It is hoped that by highlighting these areas that we can focus our efforts to evolve as a profession and be better able to serve our communities.

EMPOWERMENT AND TRAUMA

Trauma is universal. Global statistics consistently reveal that domestic and sexual violence, physical abuse and sexual abuse affect between 35 per cent to 70 per cent of women [2]. The landmark Adverse Childhood Experiences Study of 17,000 people found that  28% of study participants reported physical abuse and 21% reported sexual abuse [3]. The World Health Organisation reports child abuse as having affected 1 in 4 adults, and child sex abuse as affecting one in 5 women and 1 in 13 men [4], Trauma affects returning veterans [5], people of colour[6], members of the LGBT population [7],  users of the public mental health system, substance abuse and social services [8].

For any yoga teacher, it can be safely assumed that our classes will be attended by at least some whose lives have been impacted by traumatic experiences - even if such people, choose not to identify as such.

EMPOWERMENT AND AGENCY 

Empowerment refers to measures designed to increase a person’s autonomy. Approaches may vary according to context but they share the common theme of increasing one’s capacity to help themselves, not viewing people as passive or helpless victims to be rescued.

Yoga, at its best, can empower practitioners to reclaim their bodies, to take control of their own emotions and to establish tools for emotional resilience.   Facilitators can guide participants towards making choices about their own bodies, to develop confidence, to listen to and trust their sensations; and ultimately to develop independence. Trauma expert Judith Herman underscores the importance of empowerment in the trauma context:

"Many benevolent and well-intentioned attempts to assist the survivor founder because this basic principle of empowerment is not observed. No intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it appears to be in her immediate best interest" [8].

EMPOWERMENT: ACKNOWLEDGING POWER DIFFERENTIALS AND SHARING POWER

Classroom settings involve uneven power dynamics where the teacher inherently has more power [10]. They have the right to speak, their words carry weight and they are assumed to be experts in the room. The student, by contrast, has less of a voice.  They are tacitly expected to listen and follow the teacher’s instructions.  They are not experts.

The authoritarian styles of many yoga lineages exemplify power differentials between teacher and student starkly.

Within them, teachers are granted the right to decide which postures a student is allowed to practice, in which way, in which order, at what time, whether or not to use props, which ones, and in which way.   Over time, students may become habituated to viewing the right to place their bodies into a particular posture as a reward which needs to be earned, foregoing personal autonomy over their physical bodies and sense of self. Ashtanga teacher Zoe Ward describes how postures are viewed as hers to be given and taken as a teacher:

“If someone is collecting poses, I will stop giving them, even if the body is working fine. If someone is interested and humble in their work, I may let them play with things that haven’t physically ‘earned’ yet. Some people don’t like me for requiring this work" [11].

Authoritarian structures can disturb a person’s sense of autonomy and diminish the value of their own lived experience and expertise of their own bodies. 

“After 6 years of deferring to the authority of a severe Teacher, I found myself incapable of trusting my own judgement. Everything I learned, from my own work and my own body, required the approval and validation of my teachers before I could trust it” [12].

The all knowing teacher is believed to know the practitioner’s body better than the practitioner knows themselves. Far from empowering a student to trust their own bodies, students are required to ‘submit’ or ‘surrender’ to the teacher’s physical manipulations(13), a process which makes following one’s own limits and being guided by one’s own sensations impossible. In the words of Sharath Jois, the current head of the Ashtanga lineage:

“Knowledge can be transferred only after the student has spent many years with an experienced guru, a teacher to whom he has completely surrendered in body, mind, speech and inner being. Only then is he fit to receive knowledge" [14].

EMPOWERMENT: ADJUSTING LANGUAGE

The simplest and perhaps most overlooked way yoga teachers undermine their participants’ empowerment in the classroom is through language choice.

Cueing students to move their bodies in language that might sound like an instruction, direction or command can be disempowering.   Common examples are:  “I want you to do X” or “you’re going to raise your arm” or “step your right foot forward for me”.

These phrases subtly imply that the movement is in service of the teacher. This may conjure up triggering dynamics for sexual abuse survivors, those that have experienced rape, or were molested as children where their bodies were manipulated in the service of others. 

Another problem with prescriptive language is it’s implied choice-less-ness.  One of the key experiences of trauma is having no choice.  Children in abusive or neglectful homes, women in abusive relationships, being held hostage - in all these scenarios, victims feel they have no choice.

Prescriptive cuing reenacts choice-less-ness.  Furthermore, in cases where survivors can not  avert the abuse, they become habituated to choice-less-ness and can lose the neural ability to make choices [15]. While invitational language will help to re-establish this neural ability, prescriptive language potentially entrenches it.

EMPOWERMENT: INTEROCEPTION

Thirdly, prescriptive cueing interferes with a student’s interoception which is critical for our sense of embodiment and wellbeing. Broadly defined, it is the sense of signals originating within the body [16]. It emerged as a basic survival system that allows one to monitor what they need to preserve life.

Interoception allows us to detect afferent/visceral sensations including when we feel hungry or thirsty, feelings of pain, stress, sadness or anxiety.  It has much broader applications extending to our ability to make decisions, regulate our emotions, empathy and addiction [17]. Practising yoga asana is an opportunity to re-establish interoceptive capabilities if participants are guided to listen to their own internal cues.

Many trauma survivors can have experiences of both hyperactive and compromised interoceptive capacity.  Children, in abusive environments for example, develop extraordinary abilities to scan for warnings of attack, becoming very attuned to recognise subtle changes to their external environment [18].  However, this comes at the cost of their ability to feel what is going on internally. 

Interoception may also switch off in situations where people learn that their needs will not be met, or their needs anger their caregivers.  Children raised in neglectful homes  become habituated to having their needs ignored so over time, their ability to perceive their needs become weakened [19].   While this helps victims survive, in the long term, being unable to identify and fulfil one’s own needs can make life very challenging.  

Yoga can help to reestablish interoceptive capabilities if participants are guided in such ways that encourage them to listen to their own bodies [20]. Prescriptive language further entrenches the pattern of not listening to the internal cues - in other words, they encourage disembodiment when the situation calls for the opposite course of action.

As yoga teachers, we should be striving to facilitate in ways that do not reenact trauma dynamics of neglect and abuse, rather, to work against these dynamics to create safe spaces to practice and develop safe and respectful relationships to practice [21].

Empowering and enabling students means creating conditions of safety should be one of our highest priorities. However upholding this obligation to physical safety can at times paradoxically disempower students contributing to anxiety and dependency.

Verbal suggestions can cause hyperalgesia which is an increased sensitivity to pain.    Common classroom examples might be cautions on how it is “dangerous to hypertextend” or to the need to ‘protect the knee by doing x’, or the suggestion that certain alignments as ‘unsafe’ or ‘destabilising.’

Such alignment cues are intended to help people avoid injuries, but the negative language of pain and harm can have a noticeable effect [22] which induces anxiety about impending pain increase [23] and  creates fear or anxiety of movement.  Such language encourages a mentality of helplessness and dependence on the teacher without whom one won’t know how to move safely. They may plant the seeds for the belief one can’t trust their own bodies, or that they can not move safely.   

EMPOWERMENT AND TRANSPARENCY 

The yoga world has seen every major yoga lineage mired in scandal and its leaders exposed as perpetrators of different kinds of abuse to their community members [24]. While the lineages were different, the responses played out in similar ways. Leaders in the various lineages were not transparent or accountable.  When survivors spoke out, many in the community denied their experiences, discredited the survivor’s credibility and isolated the survivors. 

Others have attempted the moral impossibility of placing a foot in each camp - on the one hand, stating their support for the victims while on the other, expressing their loyalty to perpetrators and the power structures that allowed the abuses to happen [25].

As Herman observes, “it is very tempting to take the side of the perpetrator.  All the perpetrator asks is that the bystander do nothing…The victim, on the contrary, asks the bystander to share the burden of the pain. The victim demands action, engagement and remembering” [26].

In the aftermath of truth being exposed, we can experience a range of mixed feelings which being in this conflict entails. This can manifest itself in sympathy for those abused, without the costs of supportive action - carrying on our daily lives as though nothing has happened. 

We can compound the harm to survivors and betray the trust of our communities  by continuing to display images of perpetrators in yoga centres and in our public communications, or by continuing to capitalise off our proximity to perpetrators, referencing perpetrators in honorific terms or in ways that don’t reflect the truth of their actions.[27]

Such actions isolate survivors and send a clear messages that their painful experience is meaningless and does not matter to us.  They also signal to our community that we do not support the needs of victims of sexual abuse.

“… remembering, truth telling, and support for survivors is the prerequisite for recovery and healing [28]”.

For yoga teachers to be a part of the recovery process, we need to share our histories and be transparent and accountable about that history with our communities. Not doing harm in this context can not be a passive choice, it necessitates activity on our part - reflecting on the behaviours that enabled the perpetrator’s behaviour, examining whether or how our own attitudes and behaviours contribute to the survivor’s trauma and isolation.  Passive inaction compounds the damage suffered by survivors.

EMPOWERMENT AND CRITICAL THINKING 

Any environment that supports the empowerment of its members needs to adhere to the value of transparency and accountability.  For this to happen, the freedom to question and engage in critical dialogue is essential. The inability to question, choose or challenge is inherently oppressive.  It’s presence is a breeding ground for dogma.

Creating environments that discourages questioning and open discussion undermines a student’s agency and empowerment.  Common examples include levelling the claim one is ‘over-intellectualising’, ‘over-analysing”, brushing questioning aside by prioritising ‘practice over theory’, conflating critical thinking with ‘spreading negativity’ or ‘being judgemental’ or adopting a mantra of ‘live and let live’ - on the face of it a harmless ethos, but works to terminate further inquiry and absolves one of the need to engage or respond in discussion.

Thank you for reading this.

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REFERENCES

1. Fallot, R. D., & Harris, M. (2009). Creating Cultures of Trauma-Informed Care (CCTIC): A self-assessment and planning protocol. Washington, DC: Community Connections. Retrieved from http://www.healthcare.uiowa.edu/icmh/documents/CCTICSelf-AssessmentandPlanningProtocol0709.pdf
2. UN Women, http://www.unwomen.org/en/what-we-do/ending-violence-against-women/facts-and-figures
3. Substance Abuse and Mental Health Services, https://www.samhsa.gov/capt/practicing-effective-prevention/prevention-behavioral-health/adverse-childhood-experiences
4. 30 September 2016, https://www.who.int/en/news-room/fact-sheets/detail/child-maltreatment
5. RAND Corporation. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, April 2008. http://veterans.rand.org/
6. Bryant-Davis, T., & Ocampo, C. (2005). Racist-incident based trauma. The Counseling Psychologist, 33, 479–500. 
7. A. L. Roberts, S. Bryn Austin, Heather L. Corliss, Ashley K. Vandermorris, Karestan C. Koenen,  April 15, 2010, “Pervasive Trauma Exposure Among US Sexual Orientation Minority Adults and Risk of Posttraumatic Stress Disorder,” American Journal of Public Health, online: URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2978167/
8. ^[Jennings, A. (2004). The damaging consequences of violence and trauma: Facts, discussion points, and recommendations for the behavioral health system. Retrieved from http://www.theannainstitute.org/Damaging%20Consequences.pdf  
9. Herman J., Recovery from psychological trauma, 04 January 2002, Psychiatry and Clinical Neurosciences, https://doi.org/10.1046/j.1440-1819.1998.0520s5S145.x
10. Fahad Alsobaie, M, 2015, Power and Authority in Adult Education, Journal of Education and Practice,Vol.6, No.15, URL:https://www.iiste.org/Journals/index.php/JEP/article/view/22709
11. https://www.ashtangadispatch.com/the-role-of-a-mysore-teacher-by-zoe-ward/
12. URL: https://www.ashtangadispatch.com/the-role-of-a-mysore-teacher-by-zoe-ward/
13. URL: http://matthewremski.com/wordpress/tag/yoga-adjustments/
14. URL: https://sharathjois.com/the-practice/parampara/
15. J Herman, 1997 p 98
16. Farb N., Daubenmier J, Price C. J., Gard T, Kerr C., Dunn B. D., Klein A., Paulus M. P., Mehling W E., 2015, Interoception, contemplative practice, and health, Frontiers in Psychology, vol.6, p 763 URL: https://www.frontiersin.org/article/10.3389/fpsyg.2015.00763
17. J Herman, 1997 p 99
18. J Herman, 1997,  p 99
19. Ainsworth M, Attachments Beyond Infancy, https://pdfs.semanticscholar.org/5431/41e657bda74736ff87ac10d70643cd639892.pdf
20. Neukirch, N., Reid, S., Shires, A. 2019, Yoga for PTSD and the role of interoceptive awareness: A preliminary mixed-methods case series study,European Journal of Trauma & Dissociation,Volume 3, Issue 1, pp 7-15, https://doi.org/10.1016/j.ejtd.2018.10.003.
21. Van der Kolk, B, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking, 2014.
22. URL: https://www.smithsonianmag.com/science-nature/what-is-the-nocebo-effect-5451823/
23. F. Benedetti, M. Lanotte, L. Lopiano, L. Colloca, When words are painful: Unraveling the mechanisms of the nocebo effect, Neuroscience, Volume 147, Issue 2, 2007, pp 260-271.
24. Remski M, 2019, Practice and All Is Coming Abuse, Cult Dynamics, and Healing in Yoga and Beyond, Embodied Wisdom Publishing
25. Yoga Talks Podcast “Synthesizer of Contemplative Traditions”, Feb 05 2018 interview https://www.jbrownyoga.com/yoga-talks-podcast/2018/2/richard-freeman and “Conflicts and Confluences”, April 23, 2018, Interview https://www.jbrownyoga.com/yoga-talks-podcast/2018/4/kino-macgregor
26. Herman, J., 1997, p 8
27. Rain, K., 2019: URL: http://www.decolonizingyoga.com/responding-to-kino-macgregors-statements-on-pattabhi-jois-by-karen-rain/
28. Herman, J., 1997, p 8