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Trauma Centre Trauma-Sensitive Yoga in Indigenous Communities: A Review and Experiences from the Field
Traumatic life events affect a significant percentage of the population. The effects of trauma and complex trauma can have lasting effects throughout one's lifespan. Mental health statistics show a grave disparity between Indigenous Peoples in Canada and non-Indigenous populations that mirror the impacts of intergenerational trauma. This report investigates some oppressive societal issues Indigenous Peoples face today, how yoga can be used as a tool to benefit one’s mental health and gives an overview of experiences teaching Trauma Centre Trauma-Sensitive Yoga (TCTSY) within Indigenous communities.
A Review and Experiences from the Field
Mental health has become a major public health issue. The global prevalence rate of posttraumatic stress disorder (PTSD) is 20% (Maschi et al., 2012). Research reveals that in the United States, 3.6% of men and 9.7% of women may experience PTSD at some point in their life (Gradus, 2020). Although mainstream talk therapy modalities can be useful, more options of therapeutic modalities are required. Modalities based on creating a mind and body connection can help to fill this gap in service and can provide a space for people to slowly regain control of their own lives (Follette & Vijay, 2008; Kempson, 2007; van der Kolk, 2006). Studies show that trauma-sensitive yoga can be an effective intervention for people who have experienced trauma. This report will investigate some oppressive societal issues Indigenous Peoples face today, how yoga can be used as a tool to benefit one’s mental health and give an overview of experiences teaching Trauma Centre Trauma-Sensitive Yoga (TCTSY) within Indigenous agencies and communities.
Societal Oppression and Indigenous Peoples
Many Canadians take pride in identifying as Canadian. They see Canada as a progressive country that adheres to the basic human rights of all of its citizens. Due to a continued colonialist history, Indigenous social issues must be taken into consideration to ensure a sustainable future for Indigenous communities.
Colonialist history and intergenerational trauma.
To have a broader understanding of the issue of the overrepresentation of Indigenous Peoples in government care, one has to acknowledge the history of Indigenous Peoples and the effects of colonization. Blackstock et al. (2004) explain that historically, Canada’s Indigenous child welfare and education policies have been intertwined with assimilation practices. One example of this is the residential school system, which lasted longer than a century. The last school closed in Saskatchewan in 1996. During the most active period of the residential school system, there were 80 schools in operation (Cargo et al., 2003). While Indigenous children were attending these schools, children were not permitted to speak their own languages or practice their spiritual and cultural traditions (Blackstock et al., 2004), resulting in cultural genocide. Students were routinely restricted from communication and visits with their families and communities.
This extreme maltreatment and oppression continue to have long-lasting negative impacts on Indigenous people’s mental health. This cycle of intergenerational trauma continues to exist today. In recent months, there have been findings in Canada of thousands of unmarked mass graves with student children’s remains at residential school sites (Austen & Bilefsky, 2021). The genocidal tactics of the residential school system continue to have negative impacts on the mental health of Indigenous Peoples today.
There were and continue to be many other detrimental colonization practices (e.g., Cargo et al., 2003), such as placing a large number of Indigenous children in foster care along with assimilationist welfare policies that sparked the “60s Scoop.” This initiative lasted about three decades, resulting in a large number of Indigenous children being placed in foster care (Cargo et al., 2003). The reasoning for these apprehensions appeared to be based upon Euro-centric values— based on unfounded beliefs that Indigenous parents could not provide a proper upbringing for their children (Cargo et al., 2003). Today, more Indigenous children are in foster care than there were in residential schools (Blackstock et al., 2004).
Creating links between Indigenous Peoples, oppression, mental health, and suicide. Suicide is considered one of the clearest indicators of oppression and social disruption among Indigenous communities in Canada (Kirmayer, 1994). Adelson (2005) explained that suicide in the Indigenous population directly results from a lethal mix of oppression, colonization, and intergenerational trauma. When considering Indigenous Peoples, it can be argued that “individuals suicide robs a people of their investment in the future and hope of passing on the culture to future generations” (Strickland et al., 2006, p. 5). When considering the reasons for suicide, evidence of mental health disorders occurred in 81-95% of the cases (Kirmayer, 1994). Suicide amongst Indigenous Peoples is an emergency situation, as there is evidence of growing suicide rates in many of the Indigenous communities. Suicide accounts for approximately 38% of all deaths amongst Indigenous youths between the ages of 10-19 (Adelson, 2005).
Various studies identified risk factors specific for Indigenous Peoples. Some of the risk factors included: normalized suicidality, communication barriers, family factors, economics, federal government influence, and alcohol/substance abuse (Walls et al., 2013). A common thread throughout various types of research in relation to Indigenous Peoples appears to highlight an overarching theme of historical trauma and colonization. Alternatively, research shows that protective conditions such as strong cultural beliefs, supportive adults, friends who do well in school, and a sense of community assist in lowering the rates of suicide in this population (Strickland, 2011). In order to effectively address the increasing rate of suicide amongst Indigenous Peoples, programs must adopt an Indigenous wellness model. The model must be holistic, sustainable, and homegrown- embody what the people who will utilize it want.
Another issue facing Indigenous Peoples is the lack of sovereignty communities should have over their destiny. A study conducted in an Indigenous community with high suicide rates found the community knew the protective factors needed to reduce suicides. The community wanted, e.g., stronger cultural values and activities, economic development, tribal unity, opportunity to make contributions to the tribe (Strickland, 2011).
Research clearly showed that people in communities who are engaged in cultural reclamation programs have lower to absent suicide rates (Walls et al., 2013). In order to lower the rate of suicide amongst Indigenous Peoples, professionals need suicide prevention, mental health, and empowerment programs that are developed in collaboration with Indigenous communities. It is pivotal that these programs are based on traditions and culture with the incorporation of decolonial and holistic strategies.
Trauma can be defined as an event that is “extremely upsetting and at least temporarily overwhelms the individual’s inner resources” (Telles et al., 2012, p.1). Although people experience trauma in different ways, it is generally characterized by the persistent re-experiencing of the traumatic event (intrusions), avoidance of stimuli associated with the trauma, and increased physiological arousal (American Psychiatric Association, 2013).
Although definitions vary for complex trauma (CT), the common theme of abusive interpersonal relationships runs through them. CT is defined as trauma that involves “repeated interpersonal trauma by caregivers in early life; and the emotional, behavioral, interpersonal, physiological, and cognitive functioning” (Greeson et al., 2001, p. 93). The interpersonal traumas experienced in CT could be classified as sexual, emotional, and physical abuse, neglect; loss; and witnessing domestic and community violence.
Complex trauma causes serious negative implications for human development across the lifespan. Studies showed that various developmental and cognitive aspects of human development are affected by trauma and can continue from childhood to adulthood (Williams, 2006; Gabowitz et al., 2008). Williams (2006) explained that CT could result in many mental health issues, including dissociation, arousal difficulties, anxiety, depression, and numbing. Gabowitz et al. (2008) explained that when considering adolescents in terms of behavior, trauma responses often involve acting-out, risk-taking, and self-destructive behaviors such as sexual promiscuity, substance abuse, dangerous re-enactment behavior delinquency, depression, withdrawn behaviors, and somatic complaints. From the literature, it is clear that trauma can impact all aspects of peoples’ lives.
Trauma and its effects. When exploring CT impacts, Nader (2011) revealed that traumatic events could interrupt brain development. Studies of neuroimages show that there is decreased functioning of the Broca’s area during exposure to trauma. This implies that verbal processing would be difficult for an individual who has experienced trauma, especially when aroused emotionally (Van der Kolk, 2000). In addition to the above, CT does not only have effects in younger age ranges, but it can also have lifelong effects such as PTSD, psychiatric disorders, chronic mental illness, and functional impairments (Gabowitz, 2008). Not only can the reactions to CT exposure last a lifetime, but its trauma symptoms can also be easily misdiagnosed.
Incorrect diagnosis and impacts of complex trauma. Mental health services are severely underfunded. My experience in working in this sector appears to be focused on crisis intervention instead of prevention. People who struggle with mental health issues and exhibit challenging behaviors often receive a misdiagnosis such as attention deficit hyperactivity disorder, oppositional defiant disorder, anxiety, mood disorders, and eating disorders, to name a few. A misdiagnosis of CT by labeling behaviors ignores the overarching causal mechanism of CT (Gabowitz, 2008). This may result in inappropriate mental health services, as it withholds the suitable treatment recommendations that one may need to embark on their healing journey.
PTSD directly affects the body as it can cause the impairment of the neuroendocrine systems by over activating the sympathetic nervous system and suppressing the parasympathetic nervous system; this causes an increased level of cortisol in the body and can directly result in feelings of stress and anxiety, both physically and mentally (Telles et al., 2012). If trauma and mental health issues are not taken seriously in childhood and adolescence, studies showed that the struggles people experienced may escalate and worsen during adulthood (Norton, 2011). When considering the literature and the effects CT has on the brain, it is clear that innovative therapeutic modalities are needed for people to access. Alternative therapies such as yoga are viable options.
A brief outline of the history of yoga. The practice of yoga has existed for thousands of years. It derives from Vedic philosophy. The principles of this philosophy are enshrined by Patañjali, the author of the Yoga Sutras (Iyengar, 2001). The yogic practice consists of eight limbs, which include universal ethical principles, self-restraint, physical forms, breathwork, quieting of the senses, concentration, meditation, and self-emancipation (Ross et al., 2013). Farhi (2005) explained that “yoga is a technology for arriving in this present moment. It is a means of waking up from our spiritual amnesia so that we can remember all that we already know” (p. 5). The practice of yoga has increased in the Western world across the past several decades (Wiener 2007). Yoga is an increasingly widely utilized therapeutic practice involving the breath, the body, and the mind.
Yoga as an alternative therapeutic intervention. Although creative and spiritual endeavors such as drama, music, art, and ritual have been used for centuries as healing methods, they have been highly disregarded in the professional realm of therapy until recently (Wiener, 2007). Alternative therapies such as dance, movement, art, and music therapy were adopted into Western therapy during the early 1900s (Degges-White & Davis, 2011). Therapists that utilize movement therapy attribute its benefits to the ultimate synchronization of the body and mind, which occurs when one moves their body with a particular consciousness.
Movement can be considered the primary language of the body (Halprin, 2003). When one moves the body, emotions and memories can surface. Therefore, how we move our bodies day to day tells a story about our lives and what emotions live inside of us, our habits and patterns that serve or disable us. Therefore, when we become aware of this movement as an expression of our life experiences, body movement can become a tool for insight and change. Margolin (2014), who studied dance in relation to adolescent high school girls, revealed that:
Inner-directed movement is a sacred practice that can heal emotional wounds lodged in the body. When the body is attended with the ever-present openness to arising sensations, feelings, and images, and draw on to move and be moved from an inner wholeness, emotional and spiritual transformation occurs (p. 143).
Various theories support the healing properties of yoga with regards to Peoples’ mental health. Alderian theory, for instance, states that individual psychology is an iterative theory that offers creative, socially focused, meaning-making, and growth-oriented strategies to heal (Degges-White & Davis, 2011). This theory offers a person-centered foundation as it ascertains that Peoples are unique and, therefore, have different needs. This perspective supports the practice of yoga.
Gestalt theory also supports alternative therapeutic interventions such as yoga. It outlines that “once the person in distress reconnects with his or her creativity through a deeper experiential awareness of the processes and stops resisting his or her connection to present awareness, the side effects (i.e., the client’s symptoms) will begin to go away” (Degges-White & Davis, 2011, p. 134). This approach aims to foster the emergence of one’s authentic being (Wiener, 2007). Yoga therapy focuses on increasing awareness and intentional interoceptive experiments to reconnect the spontaneity and interconnection of sensing, feeling, and movement.
Yoga and mindfulness as an intervention for trauma. The National Centre for Complementary and Alternative Medicine considers yoga a mind-body intervention (Frank et al., 2014). When utilized as a therapeutic intervention, the research illustrated that yoga could ultimately train the Peoples to increase perceived control and autonomy (Telles et al., 2012). Over the past few decades, many studies have shown that yoga has provided numerous benefits on physical, emotional, and mental health (e.g., Halsall et al., 2015; Kirkwood et al., 2005; Pilkington et al., 2005; Sherwood, 2008; Uebelacker et al., 2010). The above reigns true, especially with depression, anxiety, and PTSD (e.g., Ross et al., 2013).
Mindfulness-based practices can provide effective interventions for People experiencing a variety of mental and physical health issues (Allen et al., 2006). The origins of the practice of mindfulness are based within Eastern philosophies, which date back to Hinduism and have large foundations in Buddhism (Baer, 2003; Folette et al., 2006). Mindfulness involves paying attention to the present experience in a nonjudgmental way (Goldsmith et al., 2014; Kabat-Zinn, 1994). By paying attention in this way, we attune to the present moment instead of being caught in external factors outside of ourselves or in our thoughts and emotions of the past or future (Huppert & Johnson, 2010). By being present, we are able to have a choice over how we respond to our day-to-day life instead of remaining on autopilot. Mindfulness, therefore, fosters an awareness of the present moment and a sense of acceptance.
Mindfulness involves the three main components of intention, attention, and attitude (Zoogman et al., 2014; Shapiro et al., 2006). When one incorporates mindfulness and trains their body to learn how to observe emotions, thoughts, and sensations in the body, they learn to remain engaged rather than dissociate. This awareness allows practitioners to invite a sense of curiosity, openness, and acceptance into clients’ lives (Hofmann et al., 2010). The mechanisms of this practice (focusing one’s attention, decentering, and emotional regulation) can decrease depressive and anxious rumination and result in calming and grounding effects (Huppert & Johnson, 2010; Zoogman et al., 2014).
Yoga and mindfulness are inextricably linked as yoga integrates the concept of mindfulness. During yoga practice, the key concepts of mindfulness are the basis of movement. By observing thoughts and focusing on breath during the yoga poses, practitioners continuously bring their attention back to what is happening in the present moment (Zoogman et al., 2014).
Trauma sensitive yoga. Trauma-sensitive yoga, which involves gentle postures, breath work, and meditation, has been shown to decrease stress, anxiety, and depression while improving coping skills and well-being and increasing trauma survivors’ way of life (Butler & Waelde, 2008; Goldsmith et al., 2014). Furthermore, research (Goldsmith et al., 2014) has shown an increase in the sense of self-empowerment, self-acceptance, and self-care, as well as decreased reactivity and distress due to yoga and meditation. The physical postures of yoga poses may also allow people who experience symptomology from trauma to focus on the present moment, which develops a feeling of safety (Spinazzola et al., 2011).
There are specific styles of trauma-sensitive yoga. Trauma Centre Trauma-Sensitive Yoga (TCTSY) was researched and developed in response to trauma treatment studies conducted by the Centre for Trauma and Embodiment located in Boston, Massachusetts. One of its main underpinnings is creating a space where participants can perhaps begin to practice making choices for their own bodies. This is done through invitational language and the language of inquiry. Using a curiosity-based mindset, this style of non-judgmental language opens up spaces for people to make choices within their own bodies if they so choose (Emerson et al., 2009).
Neurobiological impact of yoga. When considering brain function, recent research shows that practicing yoga poses increased brain GABA levels, which are low among people with PTSD (Spinazzola et al., 2011). Other studies illustrate that yoga works by down-regulating the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system response to stress (Ross et al., 2013). The breathwork done in yoga has been shown to improve emotional regulation, modulate the sympathetic nervous system, and improve heart rate variability (Spinazzola et al., 2011). Due to the positive evidence yoga has provided in the realm of mental health, a growing number of interventions are being developed that integrate the body and the mind.
People exposed to trauma and the therapeutic benefits of yoga. Spinazzola et al. (2011) worked with people residing in residential treatment who experienced PTSD and showed that yoga positively impacts both the physical and mental well-being of trauma survivors. Yoga helps develop a more positive body image and helps ease the many overwhelming symptoms of PTSD. This study further revealed that yoga shows great potential. In fact, yoga,
Plays an important role in helping shift chronically traumatized adolescents’ relationship to their bodies from negligence, gross indulgence, numbing or self-harm toward the capacity to feel safe in and accepting of their bodies, to increase tolerance and regulation of painful affect states and behavior impulses, and to begin to identify, cultivate, and positively appraise physical competencies (Spinazzola et al., 2011, p. 432).
That is, yoga can be used effectively to treat many symptoms of PTSD that people experience, such as anxiety, depression, and insomnia. In addition, studies have revealed that yoga can improve coping skills, stress management, overall quality of life, and emotional well-being (Goldsmith et al., 2014).
The learnings outlined below came from my experiences counseling and facilitating TCTSY sessions during my clinical practicum at the Prince George Friendship Centre’s Native Healing Centre and working as a counselor within Indigenous communities in Western Canada.
In the lectures I attended for TCTSY yoga training, my main learning was that one of the main components of complex trauma is the withholding of choice from the survivor. I learned that the purpose of trauma-informed yoga is to provide a safe place for people to start practicing choices and practicing a connection to their body in the present moment. When teaching trauma-informed yoga, I realized I must remember never to tell the people in my classes what to do. I must always offer the yoga forms as options and give people optional choices within the forms.
Sometimes it is difficult in yoga class to gauge whether or not clients are benefitting from the classes. When teaching TCTSY yoga classes at the Native Healing Centre, feedback from clients offered me some reflection. During yoga with the adult group I co- facilitated, some of the group members did not feel comfortable participating. I learned that it is essential to give people the option to participate in yoga, as it may not be a fit for everyone.
One of the adults in the group that participated in a yoga session disclosed that it was the most relaxed she had felt in a very long time. During my practicum, I also led a yoga group for teens. Some of the peoples’ caregivers mentioned that the people started doing yoga at home and taught the caregivers how to do the forms. It became clear to me that some of the participants resonated with the practice of yoga and viewed it as a valuable intervention.
During my practicum and work with Indigenous communities in the field, I have learned that anti-oppressive practice is an imperative underpinning of ethical Social Work practice within Indigenous communities and Indigenous organizations. Dominelli explains that “oppression takes place in the social arena in the form of interactions between people. Consequently, oppression is socially constructed through people’s actions with and behaviors towards others” (2002, p.9). I learned that as the larger society’s model is oppressive, it is important to hold a space where people can have the freedom to define their own lives and make their own choices. I learned that it is important to carry this teaching in relationship with people from the micro to the macro level both nationally and internationally.
During my practicum, I did research on the strengths-based model and realized that historically, social work professionals saw their role as finding problems with their clients. At the basis of traditional models of social work is the belief that people need help because they have a problem to be fixed (Hammond, 2010). The problem-solving approach saw problems as part of the human condition; this approach argued that people’s inability to deal with problems was due to “the motivation to work on the problem in appropriate ways; the capacity to work on the problem in appropriate ways; the opportunity, whether of ways or means, to meet or mitigate the problem” (Early & Glen Maye, 2000, p. 121). This theory isolates and labels the client as having a problem (Hammond, 2010). The strengths-based practice model was developed to counteract the traditional model. This perspective argues that social workers must not view clients in terms of their deficits (Heinonen & Spearman, 2010).
During supervision with J. Mortenson, she questioned my use of the word “late.” We discussed the social construct of time and the barriers that clients may face in getting to NHC in order to uphold strengths-based practice models. In my supervision sessions with Erin Anderlini, the strengths-based practice was a common theme that was discussed. When working with children in individual sessions, E. Anderlini stressed the importance of including the client’s family as a way to reflect a strengths-based approach. She emphasized building on the family’s strengths of what they already have in place.
The NHC does a great job keeping strengths-based practice at the core of their interactions with clients. For example, in order to track sessions with clients, counselors use a tool called a “Resiliency Map”. This map is client-led and indicates the client’s strengths and supports in all aspects of their life, such as school, friends, and family. These conversations and teachings added to my knowledge of strengths-based practice and inevitably enriched my personal practice.
I learned that using decolonization practices in counseling and facilitating TCTSY is extremely important when practicing in Indigenous communities. In order for counselors to embody a decolonization practice, they must understand the historical and present-day traumas faced by Indigenous people (McKenna & Woods, 2012). Equipped with the knowledge of colonization, counselors must be cautious not to take a pan-Indigenous approach. They must remember that although colonization is a common experience, not everyone’s experience is identical (Cox, 2008).
In addition, decolonization practice means looking to culture to guide a counselor’s practice. My experience in this realm was interesting as I was a non-Indigenous person doing a practicum at an Indigenous agency. Although I have worked with and attended ceremonies in different Indigenous cultures, by no means do I hold traditional knowledge? In order to meet the needs of future clients, if they express a desire to bring culture into their counseling sessions, I must be guided by their knowledge and by the traditional knowledge of Elders at the particular agency or community where I work.
Dr. Yellow Bird explains that decolonization begins “from the assumption that Indigenous Peoples have the power, strength, and intelligence to develop culturally specific decolonization strategies to pursue our own strategies of liberation” (2005, p.1). It is essential to keep this teaching at the crux of practice when working in Indigenous communities. As a non-Indigenous counselor working within Indigenous communities, I must ensure that the power is kept in the hands of the community. Ideas for mental health and wellness must come from the community instead of coming from a colonial top-down approach.
When working within Indigenous communities, TCTSY sessions and workshops are often requested. When they are requested, I ensure to involve the community in all the planning stages to ensure that proper cultural protocol is followed. Of course, every community is different, so it is important to enquire what the specific community or individual would like for their session. For example, some communities may want an Elder or a cultural healer present; some may want mental health supports available; some may like a prayer or opening done before a session and a closing at the end. To ensure that power is shared, an anti-oppressive and decolonial model is followed. It is important to enquire, collaborate and follow community lead.
Throughout my experiences in the field, I learned that it is essential to understand the potential effects that colonization and genocide have had on the lives of the people I will be working with. It is imperative for me to remain cognizant of intergenerational trauma as a potential risk factor but to also remember the resiliency and strength of the people with whom I will work.
As I do not have Indigenous heritage, it is important for me to recognize this and ask questions as needed when working in this area. When appropriate, it is essential to consult with traditional knowledge holders. In order to uphold a decolonial mindset, I must learn about the unique cultures of the people I work with. I must always remain curious and uphold a strengths-based approach.
The literature review gave an overview of relevant information regarding continued societal oppression, Indigenous mental health, and trauma-informed yoga. Lastly, it outlined my major learnings facilitating TCTSY during my practicum and work within Indigenous communities. The literature review pointed out a grave disparity between the health determinant statistics of Indigenous and non-Indigenous Peoples. Through this disparity, it is clear that Indigenous Peoples face systemic oppression on a daily basis. When considering people who have experienced trauma, alternatives to talk therapy must be developed and offered as potential therapeutic options, as talk therapy isn’t a viable option for all. Through my experiences working with Indigenous communities, it is clear that TCTSY could potentially provide an effective alternative therapeutic option.