Yoga for Post-Traumatic Stress Disorder (Extracts)

Swami Ahimsadhara, Australia

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur following an over­whelmingly traumatic, possibly life-threatening experi­ence or series of experiences. There are specific criteria for diagnosing PTSD.

It is most common in groups such as the military, police, emergency workers, fire­fighters, professionals working in war zones such as journalists, aid workers, and so forth, civilian survivors of war and refugees. PTSD also affects victims of crime, domestic violence, natural disasters and accidents. Sustained psychological abuse can lead to PTSD. Children of abusive parents are vulnerable.

Why does yoga help?

Yoga, correctly understood, is a perfected psychology system. By perfected I mean that it not only includes a complete understanding of the human condition, it also has the tools and techniques for managing and optimizing that condition in all its diverse forms.

More specifically, yoga is good for PTSD because:

  • Yoga benefits every system of the body, including the nervous system. Those with PTSD often have multiple physical ailments such as indigestion, pains in the muscles and joints, headaches and high blood pressure. Some of these problems may be due to an unhealthy breathing pattern, which yogic breathing practices immediately relieve. We'll look at this in more detail soon.
  • Yoga directly relieves problems that may commonly be regarded as psychological but also have a strong physiological influence and impact, for example insomnia and panic attacks. The relaxation techniques of yoga are key practices.
  • Yoga has a powerful, direct and positive influence on the nervous system – this is a key point that will be looked at in detail.
  • Yoga gives methods for management of the mind and emotions, which are supported by practices of hatha and raja yoga. These practices are based in an understanding that body and mind are interdependent and interactive. For example, the way you breathe affects the way you feel, think and act.
  • Yoga includes lifestyle adjustments, clearly stating that the way you live has a profound effect on the way you experience life.

Bearing the above points in mind, I feel that the most important and unique reason for the effectiveness of yoga in helping sufferers recover from PTSD is the direct effect of certain practices on the nervous system. Put simply, PTSD is a condition in which the nervous system becomes stuck in the stress response, known as the fight or flight mechanism. Yoga specifically activates the relaxation response, thus reducing the dominance of the stress response, which in PTSD sufferers has become overpowering. Psychologists describe this as a 'sensitized' nervous system. It is a massive problem because it cannot be controlled just by wanting to control it. Willpower is not enough. The nervous system needs healing, and for that it needs retraining. Yoga, to the best of my knowledge, is the most efficient method for retraining the nervous system. Hence it has immense benefits to those with this incredibly debilitating condition. Understanding and awareness of the breath is one of the most important tools for this aim.

Hyperventilation Syndrome (HVS)

Hyperventilation is also called over-breathing. It means you are breathing faster than your body can actually respire. That is, you aren't giving your body enough time to process the gases in the air you breathe. Respiration is a chemical process in which your body extracts what it needs to keep, for example, oxygen, and releases what it doesn't need to keep, for example, carbon dioxide. I have said 'needs to keep' because your body does need carbon dioxide, but it does not need to keep it.

Hyperventilation is part of the normal response to danger: the breathing and heart rates go up, adrenalin surges through the body and the muscles become tense as the nervous system prepares to cope with an emergency. This is the sympathetic nervous system swinging into action to help you save yourself from the threat. When the danger has passed, the body should return to normal.

Sometimes, however, hyperventilation becomes chronic, perhaps due to ongoing stress. It becomes a habit to over-breathe, carbon dioxide levels become too low and all the body's systems are compromised. The levels of carbon dioxide give important messages to many of the body's systems.

Symptoms of HVS include: breathlessness for no apparent reason, frequent deep sighs or yawning, chest-wall pains, palpitations, light-headedness and feeling 'spaced out', tingling or numbness at extremities, digestive problems including irritable bowel syndrome, aching muscles or joints, tremors, tiredness, weakness, sleep problems, nightmares, sexual problems, clammy hands, anxiety and phobias.

Counsellors or other health professionals may not recognize the connection of these problems with the way the person breathes. For example, medication is often given for stomach acidity. When such a person comes to me, I examine their way of breathing and ask questions that give me clues about their range of symptoms. If they seem to have a short, shallow breath, I explain some of the effects of short, shallow breathing in simple terms. My rave goes a bit like this:

"When the duration of your breathing is less than three seconds in and three seconds out, and the breathing action is mainly in your chest, your body doesn't actually have the time to respire fully. This causes your body to become too alkaline. This causes certain problems. For example, to compensate for the alkalinity, your stomach secretes too much acid, and you get symptoms of acidity. Elsewhere in the body, lactic acid is produced in an attempt to correct the pH, leading to aches and pains in the muscles. I just noticed you sighing deeply. Does that often happen? Yes. Okay. That's another sign that your breathing needs to change. The good news is that you breathe twenty-four hours a day, seven days a week, and all you need to do is retrain your breathing mechanism and there's a good chance these problems, and others, will just go away."

Another simple example is a war veteran who woke up multiple times in the night due to headache. Each time he woke he took paracetamol. After the session on HVS he realized that his breath became extra shallow at night. So instead of taking pills he used abdominal breathing. He did abdominal breathing before going to sleep and each time he woke with a headache. The headache would pass and he'd go back to sleep. After some time he stopped getting headaches, stopped waking and had a good night's sleep. After decades of feeling helpless, blaming the war and the PTSD, he solved the problem by retraining his breathing mechanism. It's so simple if you know how.

Many people with anxiety tell me that they often feel as if they are suffocating. They are! This is called 'air hunger'. Of course we feel anxious if we don't have enough air! Ultimately not enough air means death! The feelings are correct, but the diagnosis of why the feelings are there is often incorrect. In response to low carbon dioxide, oxygen clings to the red blood cells, and the tissues are starved of oxygen. The oxygen supply to the brain drastically reduces. This desperate shortage of oxygen makes us breathe faster, and hyperventilation becomes chronic.

The student needs to routinely practise about ten minutes of abdominal breathing upon waking and before sleep. It should also be incorporated into yoga sadhana and used at any time of the day when shortness of breath or shallow breathing is noticed, by simply taking ten abdominal breaths. In this way the message is repeatedly given to the breathing centre in the brainstem, and just as the man with the night-time headaches cured himself by repetition of the practice, your system will gradually learn and take over so that good breathing becomes automatic. When this happens, you will literally breathe easy. My final word on this point is: breathing is the most important thing you do, therefore it is good to get it right!

Pranayama

Yogic breathing and knowledge of the breath is more involved and refined than the aspect that was just covered, and has much to offer those with PTSD. Sorting out HVS and learning diaphragmatic breathing is first base. Then come the more classical yogic pranayamas. Those with particular relevance here are bhramari, ujjayi, nadi shodhana and breathing ratios. One important thing about all of these techniques is that they activate the parasympathetic nervous system, also known as the relaxation response. It is essential that people with PTSD do practices that strengthen the relaxation response, because this is the way to overcome their overactive sympathetic response. That principle applies to the whole of this topic, not just in relation to pranayama.

Bhramari and ujjayi are categorized as tranquillizing pranayamas. Their effect on the nervous system is direct, immediate and powerful. They should be used regularly during sadhana and used as needed at any other time.

Ujjayi normalizes blood pressure. That means it helps low as well as high blood pressure. One of the war veterans had serious problems with anger. For example, if he was watering the garden and the hose kinked, he would grab the axe and chop up the hose! If the lawnmower stalled, he might just throw it over the fence. He is famous for throwing a computer out of the window, something we have probably all felt like doing at times. The stories are amusing, but it's not a pleasant way to live and destroying property is an expensive habit. He also lost his job when he punched the boss, so something needed to be done. He learned ujjayi. He also learned witnessing. Once he had these two skills, he could witness the onset of anger and begin ujjayi before the destructive reaction took place. He thereby short-circuited the reaction, saving himself and those people and things around him from the consequences, and in the process contributed to the overall healing of his nervous system.

Nadi shodhana is unique to yoga and is a major technique in classical hatha yoga. We know today that the process of alternating the breathing in the left and right nostrils balances the functioning of the left and right brain hemispheres. Those with psychological disturbances benefit immensely from this effect, as often they have developed left or right dominance. Many people report feelings of calm and the absence of inner conflict after practising simple nadi shodhana. These are important feelings for those with PTSD to have access to and to make more accessible through regular experience of them.

Yoga nidra

Dr. Rishi Vivekananda is an Australian psychiatrist whose patients included many war veterans. I often asked his advice and invited him to spend time with the veteran's yoga group whenever the opportunity arose. Everyone who came to Rishi Vivekananda as a patient was given a yoga nidra cassette that he had made especially for war veterans. I had a copy of that cassette, which we made into a CD and distributed freely to the group. His soothing, kind voice has helped many with PTSD not only to relax, which is normally impossible for them, but to sleep peacefully without drugs, another experience they rarely have. He told me two things in relation to yoga nidra for PTSD that are imprinted on my mind: one, the first thing to do is fix the sleep; two, he never lost a patient to suicide. Statistically that was remarkable and he attributed it to yoga nidra.

The yogic concept of pratyahara is relevant here. Pratyahara is commonly translated as sense withdrawal. Yoga nidra is a technique of pratyahara. As mentioned already, relaxation is next to impossible for people with PTSD. One reason for this is their state of hyper-vigilance. That is, they are always on the alert and their nervous system overreacts to stimuli. The state of pratyahara is specifically intended to reduce responses to sensory stimuli and it achieves this systematically and scientifically. Pratyahara, therefore, is the perfect antidote for hyper-vigilance and yoga nidra is the easiest and most effective method for inducing such a state.

Anyone who has trouble sleeping is missing out on a basic need and their physical and mental wellbeing are affected. Insomnia and nightmares are major issues for those with PTSD. The same man who used ujjayi so effectively for his anger, used yoga nidra to retrain himself into a healthy sleep pattern. When his PTSD was at its worst he took multiple Valiums (a tranquillizer) through the night. He also used to have a cigarette and a coffee and pace the floor when he woke up. He had probably had a nightmare or a flashback and was trying to escape the horror.

Once he discovered yoga nidra, however, he changed his coping methods. Instead of the Valium, tobacco and coffee cocktail, he played the yoga nidra tape. Just as the man with headaches did abdominal breathing when he woke, this man did yoga nidra many times a night. After two or three months, he slept through the night, and he sleeps through to this day. Incidentally, hyperventilation results in nightmares and waking due to panic attack. This is experienced by hyperventilators who have no history of trauma, suggesting that the prevalence of sleep disorders in those with PTSD may be linked to hyperventilation.

Additionally, yoga nidra includes sankalpa, another useful tool for recovery. Sankalpa is a powerful part of bringing a positive way of thinking into life. It brings a beautiful hope into a life of despair. Sankalpa becomes a symbol of what is possible, focusing the mind in this way at a time when it is highly suggestible and open to an uplifting influence.

Witnessing

The practice of witnessing is the final tool I want to focus on in this presentation. It is a prerequisite for management of the mind and emotions. It is also a skill that is learned in any Satyananda Yoga class, simply due to the way the class is taught. Beginning with the teaching of asanas, the process of witnessing is integrated into every practice of Satyananda Yoga. The instructions are rich with lines such as: be aware of this, observe that, witness the feeling here, witness the feeling there, notice any sensations, observe thoughts that arise, and so forth. A good teacher never lets the students lose awareness unless they want to make a point about how easy it is to lose awareness!

This emphasis on witnessing and awareness fulfils various functions. It gives the brain a rest from its involvement in the usual monologue of self-talk and unconscious attraction to external goings on. This in itself is relaxing and internalizing. Witnessing enables the student to learn about their body, their breath and their mind in a new way, so that understanding develops at a deeper level. Of major importance, the witnessing that is practised during class time trains the student to be able to witness their mind and behaviour in daily life, meaning they can start the process of managing their mind and behaviour through conscious effort. For example, the man who used ujjayi to control his anger had to first be able to witness the onset of anger, then use the tool of ujjayi to short-circuit the sympathetic reaction.

Witnessing is therefore an important part of helping those with PTSD. In fact, without awareness, without witnessing, yoga is incomplete. Meditations such as antar mouna actively develop the concept of witnessing for mind management and should be taught to people with PTSD.

One more extremely important point on this before looking briefly at other practices: the state of being the witness implies a degree of detachment from that which is being observed. The witnessing position is one in which emotions and memories can be experienced without being totally identified with or overwhelmed by. This happened to the hose-chopping, computer-throwing, boss-punching guy when he practised trataka. Trataka on a candle flame caused him to have a type of flashback in which he saw the war scenes in front of him like a movie. Once he had the ability to witness, he could observe these frightful experiences with detachment. They lost their power over him, the memories were processed anew so that they didn't dominate his life, and he recovered from PTSD. That same man became a yoga teacher and poorna sannyasin. He owes his life to Satyananda Yoga.

Other practices

Asanas are always part of classes, and have an important role to play. They need only be simple. Pawanmuktasana part one is a favourite. All beginners' asanas can be used, taking into account contra-indications for high blood pressure and the many other health conditions that people with PTSD tend to have. Shashankasana is number one for settling a busy or anxious mind and reducing anger. Asanas that open the breathing area and take tension out of the abdomen and diaphragm are an effective preparation for breath training.

I have often used hasta mudra pranayama with the men as a meditation. Its effect on the breath is so strong and real that they respond very well to it. Trataka is also a favourite. Other forms of meditation such as chanting the mantra Om and ajapa japa are also useful. So much more can be said on these and other beautiful practices.

Yoga is holistic

Yoga is holistic, as it is about connection and creates connections by working with the body and the mind together. PTSD is a state of disconnection in which the person is stuck in past experience. This stuckness is not only mental; it is also physiological, as we have seen in relation to the unhealthy dominance of the sympathetic nervous system. Yoga generates movement at the physical, energetic and mental levels, lifting the practitioner out of stagnation and back into the dynamism of life's flow.

A combination of simple yoga postures, breathing techniques, relaxation and meditation retrains the nervous system, tones all the physical systems and gives skills for management of the mind and emotions.

—Workshop, 23 October 2013, Ganga Darshan