MHM Magazine

30 | MENTALHEALTHMATTERS | Issue 6 | 2021 MHM Events (ACEs) study, found that adults who had experienced four or more adverse childhood experiences were also more likely to be diagnosed with a chronic medical condition as adults. A questionnaire can be found at: https://acestoohigh.com/got- your-ace-score/ . ACEs include: • Abuse (emotional, physical, sexual) • Neglect (physical and/or emotional) • Domestic violence • Household substance abuse • Household mental illness • Parental separation or divorce • Household member convicted of crime Survivors of complex trauma (and therefore ACEs), may have experienced a lack of power within relationships, had their basic needs consistently unmet and lost their sense of trust in caregivers/ others. This relational component of complex trauma, may leave survivors feeling disempowered and disconnected from others. TREATMENT The disruption which occurs in the mind-body system as a result of complex trauma, requires a holistic approach to treatment. Most health professionals first line of treatment, includes medication and psychotherapy. Medication may be helpful in decreasing the overwhelming emotional and physical symptoms that trauma survivors experience, while psychotherapy, which usually takes a top-down, or cognitive approach (like talk therapy), allows survivors to process their experience of the trauma. However, because trauma also has a body component, a bottom up (body-based) approach is also necessary, as it allows survivors to learn techniques to regulate their nervous system as well as increase their ability to self-regulate by experiencing and tolerating difficult emotions within a safe space. Trauma Centre Trauma Sensitive Yoga is one such body-based therapy, which can be used in combination with other treatments. WHAT IS TRAUMA CENTER SENSITIVE YOGA? " The mind needs to be re-educated to feel physical sensations and the body needs to be helped to tolerate and enjoy the comforts of touch. Individuals who lack emotional awareness are able, with practice, to connect their physical sensations to psychological events. Then they can slowly reconnect with themselves ". - Bessel van der Kolk - Trauma Center Trauma Sensitive Yoga (TCTSY) was developed at the Trauma Center in Brookline, Massachusetts, in the USA. It’s an evidence-based adjunctive clinical intervention for complex trauma or chronic, treatment resistant post- traumatic stress disorder (PTSD). TCTSY has foundations in trauma theory, attachment theory and neuroscience as well has hatha yoga (which focuses on physical forms and movements). The goal of TCTSY is for participants to experience their bodies in the present moment, in a safe way (within the context of a safe relationship and space). WHAT MAKES TCTSY DIFFERENT TO YOGA? In TCTSY, the focus is on the internal experience of the participant and empowering them, not on the physical forms. The ways in TCTSY is different to yoga can be further understood by looking at its five core elements: 1. It makes use of invitational language , that is, participants are given cues as invitations (rather than instructions/ commands) and this gives participants an opportunity to be mindful of their own inner experience. Also, facilitators do not subjectively describe experiences, as these are unique to each participant. 2. There is a focus on choice- making which refers to offering participants choices so they can experience making a choice regarding their own body. Trauma is about an extreme lack of choice and the offering of choices develops agency as participants learn to make embodied choices for themselves. 3. Interoception is gained through the present moment experience and can be described as the awareness of what is occurring within the boundaries of our own skin. Interoception can become distorted when an individual experiences trauma and is often seen in the loss of sensation or being unable to understand the sensations they experience in their bodies. The context of safe, empowering relationships, allows participants to explore their present moment experience in an embodied way (by feeling, not thinking) discover things about themselves from their own experiences and learn to trust their “gut feelings”. This leads to empowerment. 4. A shared authentic experience refers to the participant and facilitator practicing together. Facilitators create a safe space by practicing with participants, being authentic in their voice and behaviour, remaining in one place (rather than walking around the room), are consistent and predictable, limit eye contact and do not give praise to individuals. This further supports the development of agency. 5. Non-coercion refers to not using force, or threat, and allowing participants to feel safe within the therapy space. There is also no physical, hands-on approach (as seen in other yoga classes) as there is no right way to do a form or movement. Facilitators also practice cultural sensitivity, are aware of the language they use and remind participants that there is no wrong or right way to practice. Non- coercion is vital as facilitators want to avoid triggering and retraumatising participants. TCTSY SESSION TCTSY is usually offered as individual sessions or in small groups, ranging from 15 – 60 minutes long. Facilitators focus on basic movements, or forms, and offer participants choices. Forms can also be done on the floor, in a chair or standing, which allows participants to make choices based on the needs of their bodies in the present moment. HOW TO BECOME A FACILITATOR To become a TCTSY facilitator requires completion of the 300- hour certification programme. It’s not currently available in South Africa, but can be accessed online and is open to mental health professionals and yoga teachers. For more information: https://www. traumasensitiveyoga.com/ References available upon request