You are being pro­vid­ed with a book chap­ter by chap­ter. I will request you to read the book for me after each chap­ter. After read­ing the chap­ter, 1. short­en the chap­ter to no less than 300 words and no more than 400 words. 2. Do not change the name, address, or any impor­tant nouns in the chap­ter. 3. Do not trans­late the orig­i­nal lan­guage. 4. Keep the same style as the orig­i­nal chap­ter, keep it con­sis­tent through­out the chap­ter. Your reply must com­ply with all four require­ments, or it’s invalid.
I will pro­vide the chap­ter now.

T
CHAPTER 16
LEARNING TO INHABIT YOUR BODY:
YOGA
As we begin to re-expe­ri­ence a vis­cer­al recon­nec­tion with the
needs of our bod­ies, there is a brand new capac­i­ty to warm­ly love
the self. We expe­ri­ence a new qual­i­ty of authen­tic­i­ty in our car­ing,
which redi­rects our atten­tion to our health, our diets, our ener­gy,
our time man­age­ment. This enhanced care for the self aris­es
spon­ta­neous­ly and nat­u­ral­ly, not as a response to a “should.” We
are able to expe­ri­ence an imme­di­ate and intrin­sic plea­sure in self-
care.
—Stephen Cope, Yoga and the Quest for the True Self
he first time I saw Annie she was slumped over in a chair in my
wait­ing room, wear­ing fad­ed jeans and a pur­ple Jim­my Cliff T‑shirt.
Her legs were vis­i­bly shak­ing, and she kept star­ing at the floor even after I
invit­ed her in. I had very lit­tle infor­ma­tion about her, oth­er than that she
was forty-sev­en years old and taught spe­cial-needs chil­dren. Her body
com­mu­ni­cat­ed clear­ly that she was too ter­ri­fied to engage in con­ver­sa­tion—
or even to pro­vide rou­tine infor­ma­tion about her address or insur­ance plan.
Peo­ple who are this scared can’t think straight, and any demand to per­form
will only make them shut down fur­ther. If you insist, they’ll run away and
you’ll nev­er see them again.
Annie shuf­fled into my office and remained stand­ing, bare­ly breath­ing,
look­ing like a frozen bird. I knew we couldn’t do any­thing until I could help
her qui­et down. Mov­ing to with­in six feet of her and mak­ing sure she had
unob­struct­ed access to the door, I encour­aged her to take slight­ly deep­er
breaths. I breathed with her and asked her to fol­low my exam­ple, gen­tly
rais­ing my arms from my sides as she inhaled and low­er­ing them as I
exhaled, a qigong tech­nique that one of my Chi­nese stu­dents had taught me.
She stealth­ily fol­lowed my move­ments, her eyes still fixed on the floor. We
spent about half an hour this way. From time to time I qui­et­ly asked her to
notice how her feet felt against the floor and how her chest expand­ed and
con­tract­ed with each breath. Her breath grad­u­al­ly became slow­er and
deep­er, her face soft­ened, her spine straight­ened a bit, and her eyes lift­ed to
about the lev­el of my Adam’s apple. I began to sense the per­son behind that
over­whelm­ing ter­ror. Final­ly she looked more relaxed and showed me the
glim­mer of a smile, a recog­ni­tion that we both were in the room. I
sug­gest­ed that we stop there for now—I’d made enough demands on her—
and asked whether she would like to come back a week lat­er. She nod­ded
and mut­tered, “You sure are weird.”
As I got to know Annie, I inferred from the notes she wrote and the
draw­ings she gave me that she had been dread­ful­ly abused by both her
father and her moth­er as a very young child. The full sto­ry was only
grad­u­al­ly revealed, as she slow­ly learned to call up some of the things that
had hap­pened to her with­out her body being hijacked into uncon­trol­lable
anx­i­ety.
I learned that Annie was extra­or­di­nar­i­ly skilled and car­ing in her work
with spe­cial-needs kids. (I tried out quite a few of the tech­niques she told
me about with the chil­dren in our own clin­ic and found them extreme­ly
help­ful). She would talk freely about the chil­dren she taught but would clam
up imme­di­ate­ly if we verged on her rela­tion­ships with adults. I knew she
was mar­ried, but she bare­ly men­tioned her hus­band. She often coped with
dis­agree­ments and con­fronta­tions by mak­ing her mind dis­ap­pear. When she
felt over­whelmed she’d cut her arms and breasts with a razor blade. She had
spent years in var­i­ous forms of ther­a­py and had tried many dif­fer­ent
med­ica­tions, which had done lit­tle to help her deal with the imprints of her
hor­ren­dous past. She had also been admit­ted to sev­er­al psy­chi­atric hos­pi­tals
to man­age her self-destruc­tive behav­iors, again with­out much appar­ent
ben­e­fit.
In our ear­ly ther­a­py ses­sions, because Annie could only hint at what
she was feel­ing and think­ing before she would shut down and freeze, we
focused on calm­ing the phys­i­o­log­i­cal chaos with­in. We used every
tech­nique that I had learned over the years, like breath­ing with a focus on
the out breath, which acti­vates the relax­ing parasym­pa­thet­ic ner­vous
sys­tem. I also taught her to use her fin­gers to tap a sequence of acu­pres­sure
points on var­i­ous parts of her body, a prac­tice often taught under the name
EFT (Emo­tion­al Free­dom Tech­nique), which has been shown to help
patients stay with­in the win­dow of tol­er­ance and often has pos­i­tive effects
on PTSD symptoms.1
THE LEGACY OF INESCAPABLE SHOCK
Because we can now iden­ti­fy the brain cir­cuits involved in the alarm
sys­tem, we know, more or less, what was hap­pen­ing in Annie’s brain as she
sat that first day in my wait­ing room: Her smoke detec­tor, her amyg­dala,
had been rewired to inter­pret cer­tain sit­u­a­tions as har­bin­gers of life-
threat­en­ing dan­ger, and it was send­ing urgent sig­nals to her sur­vival brain to
fight, freeze, or flee. Annie had all these reac­tions simultaneously—she was
vis­i­bly agi­tat­ed and men­tal­ly shut down.
As we’ve seen, bro­ken alarm sys­tems can man­i­fest in var­i­ous ways,
and if your smoke detec­tor mal­func­tions, you can­not trust the accu­ra­cy of
your per­cep­tions. For exam­ple, when Annie start­ed to like me she began to
look for­ward to our meet­ings, but she would arrive at my office in an
intense pan­ic. One day she had a flash­back of feel­ing excit­ed that her father
was com­ing home soon—but lat­er that evening he molest­ed her. For the
first time, she real­ized that her mind auto­mat­i­cal­ly asso­ci­at­ed excite­ment
about see­ing some­one she loved with the ter­ror of being molest­ed.
Small chil­dren are par­tic­u­lar­ly adept at com­part­men­tal­iz­ing expe­ri­ence,
so that Annie’s nat­ur­al love for her father and her dread of his assaults were
held in sep­a­rate states of con­scious­ness. As an adult Annie blamed her­self
for her abuse, because she believed that the lov­ing, excit­ed lit­tle girl she
once was had led her father on—that she had brought the molesta­tion upon
her­self. Her ratio­nal mind told her this was non­sense, but this belief
emanat­ed from deep with­in her emo­tion­al, sur­vival brain, from the basic
wiring of her lim­bic sys­tem. It would not change until she felt safe enough
with­in her body to mind­ful­ly go back into that expe­ri­ence and tru­ly know
how that lit­tle girl had felt and act­ed dur­ing the abuse.
THE NUMBING WITHIN
One of the ways the mem­o­ry of help­less­ness is stored is as mus­cle ten­sion
or feel­ings of dis­in­te­gra­tion in the affect­ed body areas: head, back, and
limbs in acci­dent vic­tims, vagi­na and rec­tum in vic­tims of sex­u­al abuse.
The lives of many trau­ma sur­vivors come to revolve around brac­ing against
and neu­tral­iz­ing unwant­ed sen­so­ry expe­ri­ences, and most peo­ple I see in
my prac­tice have become experts in such self-numb­ing. They may become
seri­al­ly obese or anorex­ic or addict­ed to exer­cise or work. At least half of
all trau­ma­tized peo­ple try to dull their intol­er­a­ble inner world with drugs or
alco­hol. The flip side of numb­ing is sen­sa­tion seek­ing. Many peo­ple cut
them­selves to make the numb­ing go away, while oth­ers try bungee jump­ing
or high-risk activ­i­ties like pros­ti­tu­tion and gam­bling. Any of these meth­ods
can give them a false and para­dox­i­cal feel­ing of con­trol.
When peo­ple are chron­i­cal­ly angry or scared, con­stant mus­cle ten­sion
ulti­mate­ly leads to spasms, back pain, migraine headaches, fibromyal­gia,
and oth­er forms of chron­ic pain. They may vis­it mul­ti­ple spe­cial­ists,
under­go exten­sive diag­nos­tic tests, and be pre­scribed mul­ti­ple med­ica­tions,
some of which may pro­vide tem­po­rary relief but all of which fail to address
the under­ly­ing issues. Their diag­no­sis will come to define their real­i­ty
with­out ever being iden­ti­fied as a symp­tom of their attempt to cope with
trau­ma.
The first two years of my ther­a­py with Annie focused on help­ing her
learn to tol­er­ate her phys­i­cal sen­sa­tions for what they were—just sen­sa­tions
in the present, with a begin­ning, a mid­dle, and an end. We worked on
help­ing her stay calm enough to notice what she felt with­out judg­ment, so
she could observe these unbid­den images and feel­ings as residues of a
ter­ri­ble past and not as unend­ing threats to her life today.
Patients like Annie con­tin­u­ous­ly chal­lenge us to find new ways of
help­ing peo­ple reg­u­late their arousal and con­trol their own phys­i­ol­o­gy. That
is how my Trau­ma Cen­ter col­leagues and I stum­bled upon yoga.
FINDING OUR WAY TO YOGA: BOTTOM-UP
REGULATION
Our involve­ment with yoga start­ed in 1998 when Jim Hop­per and I first
heard about a new bio­log­i­cal mark­er, heart rate vari­abil­i­ty (HRV), that had
recent­ly been dis­cov­ered to be a good mea­sure of how well the auto­nom­ic
ner­vous sys­tem is work­ing. As you’ll recall from chap­ter 5, the auto­nom­ic
ner­vous sys­tem is our brain’s most ele­men­tary sur­vival sys­tem, its two
branch­es reg­u­lat­ing arousal through­out the body. Rough­ly speak­ing, the
sym­pa­thet­ic ner­vous sys­tem (SNS) uses chem­i­cals like adren­a­line to fuel
the body and brain to take action, while the parasym­pa­thet­ic ner­vous
sys­tem (PNS) uses acetyl­choline to help reg­u­late basic body func­tions like
diges­tion, wound heal­ing, and sleep and dream cycles. When we’re at our
best, these two sys­tems work close­ly togeth­er to keep us in an opti­mal state
of engage­ment with our envi­ron­ment and with our­selves.
Heart rate vari­abil­i­ty mea­sures the rel­a­tive bal­ance between the
sym­pa­thet­ic and the parasym­pa­thet­ic sys­tems. When we inhale, we
stim­u­late the SNS, which results in an increase in heart rate. Exha­la­tions
stim­u­late the PNS, which decreas­es how fast the heart beats. In healthy
indi­vid­u­als inhala­tions and exha­la­tions pro­duce steady, rhyth­mi­cal
fluc­tu­a­tions in heart rate: Good heart rate vari­abil­i­ty is a mea­sure of basic
well-being.
Why is HRV impor­tant? When our auto­nom­ic ner­vous sys­tem is well
bal­anced, we have a rea­son­able degree of con­trol over our response to
minor frus­tra­tions and dis­ap­point­ments, enabling us to calm­ly assess what
is going on when we feel insult­ed or left out. Effec­tive arousal mod­u­la­tion
gives us con­trol over our impuls­es and emo­tions: As long as we man­age to
stay calm, we can choose how we want to respond. Indi­vid­u­als with poor­ly
mod­u­lat­ed auto­nom­ic ner­vous sys­tems are eas­i­ly thrown off bal­ance, both
men­tal­ly and phys­i­cal­ly. Since the auto­nom­ic ner­vous sys­tem orga­nizes
arousal in both body and brain, poor HRV—that is, a lack of fluc­tu­a­tion in
heart rate in response to breathing—not only has neg­a­tive effects on
think­ing and feel­ing but also on how the body responds to stress. Lack of
coher­ence between breath­ing and heart rate makes peo­ple vul­ner­a­ble to a
vari­ety of phys­i­cal ill­ness­es, such as heart dis­ease and can­cer, in addi­tion to
men­tal prob­lems such as depres­sion and PTSD.2
In order to study this issue fur­ther, we acquired a machine to mea­sure
HRV and start­ed to put bands around the chests of research sub­jects with
and with­out PTSD to record the depth and rhythm of their breath­ing while
lit­tle mon­i­tors attached to their ear­lobes picked up their pulse. After we’d
test­ed about six­ty sub­jects, it became clear that peo­ple with PTSD have
unusu­al­ly low HRV. In oth­er words, in PTSD the sym­pa­thet­ic and
parasym­pa­thet­ic ner­vous sys­tems are out of sync.3 This added a new twist
to the com­pli­cat­ed trau­ma sto­ry: We con­firmed that yet anoth­er brain
reg­u­la­to­ry sys­tem was not func­tion­ing as it should.4 Fail­ure to keep this
sys­tem in bal­ance is one expla­na­tion why trau­ma­tized peo­ple like Annie are
so vul­ner­a­ble to over­re­spond to rel­a­tive­ly minor stress­es: The bio­log­i­cal
sys­tems that are meant to help us cope with the vagaries of life fail to meet
the chal­lenge.
Our next sci­en­tif­ic ques­tion was: Is there a way for peo­ple to improve
their HRV? I had a per­son­al incen­tive to explore this ques­tion, as I had
dis­cov­ered that my own HRV was not near­ly robust enough to guar­an­tee
long-term phys­i­cal health. An Inter­net search turned up stud­ies show­ing
that marathon run­ning marked­ly increased HRV. Sad­ly, that was of lit­tle
use, since nei­ther I nor our patients were good can­di­dates for the Boston
Marathon. Google also list­ed sev­en­teen thou­sand yoga sites claim­ing that
that yoga improved HRV, but we were unable to find any sup­port­ing
stud­ies. Yogis may have devel­oped a won­der­ful method to help peo­ple find
inter­nal bal­ance and health, but back in 1998 not much work had been done
on eval­u­at­ing their claims with the tools of the West­ern med­ical tra­di­tion.
Heart rate vari­abil­i­ty (HRV) in a well-reg­u­lat­ed per­son. The ris­ing and falling black lines
rep­re­sent breath­ing, in this case slow and reg­u­lar inhala­tions and exha­la­tions. The gray area
shows fluc­tu­a­tions in heart rate. When­ev­er this indi­vid­ual inhales, his heart rate goes up;
dur­ing exha­la­tions the heart slows down. This pat­tern of heart rate vari­abil­i­ty reflects excel­lent
phys­i­o­log­i­cal health.
Respond­ing to upset. When some­one remem­bers an upset­ting expe­ri­ence, breath­ing speeds up
and becomes irreg­u­lar, as does heart rate. Heart and breath no longer stay per­fect­ly in sync.
This is a nor­mal response.
HRV in PTSD. Breath­ing is rapid and shal­low. Heart rate is slow and out of synch with the
breath. This is a typ­i­cal pat­tern of a shut-down per­son with chron­ic PTSD.
A per­son with chron­ic PTSD reliv­ing a trau­ma mem­o­ry. Breath­ing ini­tial­ly is labored and
deep, typ­i­cal of a pan­ic reac­tion. The heart races out of synch with the breath. This is fol­lowed
by rapid, shal­low breath­ing and slow heart rate, signs that the per­son is shut­ting down.
Since then, how­ev­er, sci­en­tif­ic meth­ods have con­firmed that chang­ing
the way one breathes can improve prob­lems with anger, depres­sion, and
anxiety5 and that yoga can pos­i­tive­ly affect such wide-rang­ing med­ical
prob­lems as high blood pres­sure, ele­vat­ed stress hor­mone secretion,6
asth­ma, and low-back pain.7 How­ev­er, no psy­chi­atric jour­nal had pub­lished
a sci­en­tif­ic study of yoga for PTSD until our own work appeared in 2014.8
As it hap­pened, a few days after our Inter­net search a lanky yoga
teacher named David Emer­son walked through the front door of the Trau­ma
Cen­ter. He told us that he’d devel­oped a mod­i­fied form of hatha yoga to
deal with PTSD and that he’d been hold­ing class­es for vet­er­ans at a local
vet cen­ter and for women in the Boston Area Rape Cri­sis Cen­ter. Would we
be inter­est­ed in work­ing with him? Dave’s vis­it even­tu­al­ly grew into a very
active yoga pro­gram, and in due course we received the first grant from the
Nation­al Insti­tutes of Health to study the effects of yoga on PTSD. Dave’s
work also con­tributed to my devel­op­ing my own reg­u­lar yoga prac­tice and
becom­ing a fre­quent teacher at Kri­palu, a yoga cen­ter in the Berk­shire
Moun­tains in west­ern Mass­a­chu­setts. (Along the way, my own HRV pat­tern
improved as well.)
In choos­ing to explore yoga to improve HRV we were tak­ing an
expan­sive approach to the prob­lem. We could sim­ply have used any of a
num­ber of rea­son­ably priced hand­held devices that train peo­ple to slow
their breath­ing and syn­chro­nize it with their heart rate, result­ing in a state of
“car­diac coher­ence” like the pat­tern shown in the first illus­tra­tion above.9
Today there are a vari­ety of apps that can help improve HRV with the aid of
a smartphone.10 In our clin­ic we have work­sta­tions where patients can train
their HRV, and I urge all my patients who, for one rea­son or anoth­er, can­not
prac­tice yoga, mar­tial arts, or qigong to train them­selves at home. (See
Resources for more infor­ma­tion.)
EXPLORING YOGA
Our deci­sion to study yoga led us deep­er into trauma’s impact on the body.
Our first exper­i­men­tal yoga class­es met in a room gen­er­ous­ly donat­ed by a
near­by stu­dio. David Emer­son and his col­leagues Dana Moore and Jodi
Carey vol­un­teered as instruc­tors, and my research team fig­ured out how we
could best mea­sure yoga’s effects on psy­cho­log­i­cal func­tion­ing. We put
fly­ers in neigh­bor­hood super­mar­kets and laun­dro­mats to adver­tise our
class­es and inter­viewed dozens of peo­ple who called in response.
Ulti­mate­ly we select­ed thir­ty-sev­en women who had severe trau­ma his­to­ries
and who had already received many years of ther­a­py with­out much ben­e­fit.
Half the vol­un­teers were select­ed at ran­dom for the yoga group, while the
oth­ers would receive a well-estab­lished men­tal health treat­ment, dialec­ti­cal
behav­ior ther­a­py (DBT), which teach­es peo­ple how to apply mind­ful­ness to
stay calm and in con­trol. Final­ly, we com­mis­sioned an engi­neer at MIT to
build us a com­pli­cat­ed com­put­er that could mea­sure HRV simul­ta­ne­ous­ly in
eight dif­fer­ent peo­ple. (In each study group there were mul­ti­ple class­es,
each with no more than eight par­tic­i­pants.) While yoga sig­nif­i­cant­ly
improved arousal prob­lems in PTSD and dra­mat­i­cal­ly improved our
sub­jects’ rela­tion­ships to their bod­ies (“I now take care of my body”; “I
lis­ten to what my body needs”), eight weeks of DBT did not affect their
arousal lev­els or PTSD symp­toms. Thus, our inter­est in yoga grad­u­al­ly
evolved from a focus on learn­ing whether yoga can change HRV (which it
can)11 to help­ing trau­ma­tized peo­ple learn to com­fort­ably inhab­it their
tor­tured bod­ies.
Over time we also start­ed a yoga pro­gram for marines at Camp Leje­une
and have worked suc­cess­ful­ly with var­i­ous oth­er pro­grams to imple­ment
yoga pro­grams for vet­er­ans with PTSD. Even though we have no for­mal
research data on the vet­er­ans, it looks as if yoga is at least as effec­tive for
them as it has been for the women in our stud­ies.
All yoga pro­grams con­sist of a com­bi­na­tion of breath prac­tices
(pranaya­ma), stretch­es or pos­tures (asanas), and med­i­ta­tion. Dif­fer­ent
schools of yoga empha­size vari­a­tions in inten­si­ty and focus with­in these
core com­po­nents. For exam­ple, vari­a­tions in the speed and depth of
breath­ing and use of the mouth, nos­trils, and throat all pro­duce dif­fer­ent
results, and some tech­niques have pow­er­ful effects on energy.12 In our
class­es we keep the approach sim­ple. Many of our patients are bare­ly aware
of their breath, so learn­ing to focus on the in and out breath, to notice
whether the breath was fast or slow, and to count breaths in some pos­es can
be a sig­nif­i­cant accomplishment.13
We grad­u­al­ly intro­duce a lim­it­ed num­ber of clas­sic pos­tures. The
empha­sis is not on get­ting the pos­es “right” but on help­ing the par­tic­i­pants
notice which mus­cles are active at dif­fer­ent times. The sequences are
designed to cre­ate a rhythm between ten­sion and relaxation—something we
hope they will begin to per­ceive in their day-to-day lives.
We do not teach med­i­ta­tion as such, but we do fos­ter mind­ful­ness by
encour­ag­ing stu­dents to observe what is hap­pen­ing in dif­fer­ent parts of the
body from pose to pose. In our stud­ies we keep see­ing how dif­fi­cult it is for
trau­ma­tized peo­ple to feel com­plete­ly relaxed and phys­i­cal­ly safe in their
bod­ies. We mea­sure our sub­jects’ HRV by plac­ing tiny mon­i­tors on their
arms dur­ing shavasana, the pose at the end of most class­es dur­ing which
prac­ti­tion­ers lie face up, palms up, arms and legs relaxed. Instead of
relax­ation we picked up too much mus­cle activ­i­ty to get a clear sig­nal.
Rather than going into a state of qui­et repose, our stu­dents’ mus­cles often
con­tin­ue to pre­pare them to fight unseen ene­mies. A major chal­lenge in
recov­er­ing from trau­ma remains being able to achieve a state of total
relax­ation and safe sur­ren­der.
LEARNING SELF-REGULATION
After see­ing the suc­cess of our pilot stud­ies, we estab­lished a ther­a­peu­tic
yoga pro­gram at the Trau­ma Cen­ter. I thought that this might be an
oppor­tu­ni­ty for Annie to devel­op a more car­ing rela­tion­ship with her body,
and I urged her to try it. The first class was dif­fi­cult. Mere­ly being giv­en an
adjust­ment by the instruc­tor was so ter­ri­fy­ing that she went home and
slashed herself—her mal­func­tion­ing alarm sys­tem inter­pret­ed even a gen­tle
touch on her back as an assault. At the same time Annie real­ized that yoga
might offer her a way to lib­er­ate her­self from the con­stant sense of dan­ger
that she felt in her body. With my encour­age­ment she returned the fol­low­ing
week.
Annie had always found it eas­i­er to write about her expe­ri­ences than to
talk about them. After her sec­ond yoga class she wrote to me: “I don’t know
all of the rea­sons that yoga ter­ri­fies me so much, but I do know that it will
be an incred­i­ble source of heal­ing for me and that is why I am work­ing on
myself to try it. Yoga is about look­ing inward instead of out­ward and
lis­ten­ing to my body, and a lot of my sur­vival has been geared around nev­er
doing those things. Going to the class today my heart was rac­ing and part of
me real­ly want­ed to turn around, but then I just kept putting one foot in
front of the oth­er until I got to the door and went in. After the class I came
home and slept for four hours. This week I tried doing yoga at home and the
words came to me ‘Your body has things to say.’ I said back to myself, ‘I
will try and lis­ten.’”
A few days lat­er Annie wrote: “Some thoughts dur­ing and after yoga
today. It occurred to me how dis­con­nect­ed I must be from my body when I
cut it. When I was doing the pos­es I noticed that my jaw and the whole area
from where my legs end to my belly­but­ton is where I am tight, tense and
hold­ing the pain and mem­o­ries. Some­times you have asked me where I feel
things and I can’t even begin to locate them, but today I felt those places
very clear­ly and it made me want to cry in a gen­tle kind of way.”
The fol­low­ing month both of us went on vaca­tion and, invit­ed to stay in
touch, Annie wrote to me again: “I’ve been doing yoga on my own in a
room that over­looks the lake. I’m con­tin­u­ing to read the book you lent me
[Stephen Cope’s won­der­ful Yoga and the Quest for the True Self]. It’s real­ly
inter­est­ing to think about how much I have been refus­ing to lis­ten to my
body, which is such an impor­tant part of who I am. Yes­ter­day when I did
yoga I thought about let­ting my body tell me the sto­ry it wants to tell and in
the hip open­ing pos­es there was a lot of pain and sad­ness. I don’t think my
mind is going to let real­ly vivid images come up as long as I am away from
home, which is good. I think now about how unbal­anced I have been and
about how hard I have tried to deny the past, which is a part of my true self.
There is so much I can learn if I am open to it and then I won’t have to fight
myself every minute of every day.”
One of the hard­est yoga posi­tions for Annie to tol­er­ate was one that’s
often called Hap­py Baby, in which you lie on your back with your knees
deeply bent and the soles of your feet point­ing to the ceil­ing, while hold­ing
your toes with your hands. This rotates the pelvis into a wide-open posi­tion.
It’s easy to under­stand why this would make a rape vic­tim feel extreme­ly
vul­ner­a­ble. Yet, as long as Hap­py Baby (or any pos­ture that resem­bles it)
pre­cip­i­tates intense pan­ic, it is dif­fi­cult to be inti­mate. Learn­ing how to
com­fort­ably assume Hap­py Baby is a chal­lenge for many patients in our
yoga class­es.
GETTING TO KNOW ME: CULTIVATING
INTEROCEPTION
One of the clear­est lessons from con­tem­po­rary neu­ro­science is that our
sense of our­selves is anchored in a vital con­nec­tion with our bodies.14 We
do not tru­ly know our­selves unless we can feel and inter­pret our phys­i­cal
sen­sa­tions; we need to reg­is­ter and act on these sen­sa­tions to nav­i­gate
safe­ly through life.15 While numb­ing (or com­pen­sato­ry sen­sa­tion seek­ing)
may make life tol­er­a­ble, the price you pay is that you lose aware­ness of
what is going on inside your body and, with that, the sense of being ful­ly,
sen­su­al­ly alive.
In chap­ter 6 I dis­cussed alex­ithymia, the tech­ni­cal term for not being
able to iden­ti­fy what is going on inside oneself.16 Peo­ple who suf­fer from
alex­ithymia tend to feel phys­i­cal­ly uncom­fort­able but can­not describe
exact­ly what the prob­lem is. As a result they often have mul­ti­ple vague and
dis­tress­ing phys­i­cal com­plaints that doc­tors can’t diag­nose. In addi­tion,
they can’t fig­ure out for them­selves what they’re real­ly feel­ing about any
giv­en sit­u­a­tion or what makes them feel bet­ter or worse. This is the result of
numb­ing, which keeps them from antic­i­pat­ing and respond­ing to the
ordi­nary demands of their bod­ies in qui­et, mind­ful ways. At the same time,
it muf­fles the every­day sen­so­ry delights of expe­ri­ences like music, touch,
and light, which imbue life with val­ue. Yoga turned out to be a ter­rif­ic way
to (re)gain a rela­tion­ship with the inte­ri­or world and with it a car­ing, lov­ing,
sen­su­al rela­tion­ship to the self.
If you are not aware of what your body needs, you can’t take care of it.
If you don’t feel hunger, you can’t nour­ish your­self. If you mis­take anx­i­ety
for hunger, you may eat too much. And if you can’t feel when you’re
sati­at­ed, you’ll keep eat­ing. This is why cul­ti­vat­ing sen­so­ry aware­ness is
such a crit­i­cal aspect of trau­ma recov­ery. Most tra­di­tion­al ther­a­pies
down­play or ignore the moment-to-moment shifts in our inner sen­so­ry
world. But these shifts car­ry the essence of the organism’s respons­es: the
emo­tion­al states that are imprint­ed in the body’s chem­i­cal pro­file, in the
vis­cera, in the con­trac­tion of the stri­at­ed mus­cles of the face, throat, trunk,
and limbs.17 Trau­ma­tized peo­ple need to learn that they can tol­er­ate their
sen­sa­tions, befriend their inner expe­ri­ences, and cul­ti­vate new action
pat­terns.
In yoga you focus your atten­tion on your breath­ing and on your
sen­sa­tions moment to moment. You begin to notice the con­nec­tion between
your emo­tions and your body—perhaps how anx­i­ety about doing a pose
actu­al­ly throws you off bal­ance. You begin to exper­i­ment with chang­ing the
way you feel. Will tak­ing a deep breath relieve that ten­sion in your
shoul­der? Will focus­ing on your exha­la­tions pro­duce a sense of calm?18
Sim­ply notic­ing what you feel fos­ters emo­tion­al reg­u­la­tion, and it helps
you to stop try­ing to ignore what is going on inside you. As I often tell my
stu­dents, the two most impor­tant phras­es in ther­a­py, as in yoga, are “Notice
that” and “What hap­pens next?” Once you start approach­ing your body with
curios­i­ty rather than with fear, every­thing shifts.
Body aware­ness also changes your sense of time. Trau­ma makes you
feel as if you are stuck for­ev­er in a help­less state of hor­ror. In yoga you
learn that sen­sa­tions rise to a peak and then fall. For exam­ple, if an
instruc­tor invites you to enter a par­tic­u­lar­ly chal­leng­ing posi­tion, you may
at first feel a sense of defeat or resis­tance, antic­i­pat­ing that you won’t be
able to tol­er­ate the feel­ings brought up by this par­tic­u­lar posi­tion. A good
yoga teacher will encour­age you to just notice any ten­sion while tim­ing
what you feel with the flow of your breath: “We’ll be hold­ing this posi­tion
for ten breaths.” This helps you antic­i­pate the end of dis­com­fort and
strength­ens your capac­i­ty to deal with phys­i­cal and emo­tion­al dis­tress.
Aware­ness that all expe­ri­ence is tran­si­to­ry changes your per­spec­tive on
your­self.
This is not to say that regain­ing inte­ro­cep­tion isn’t poten­tial­ly
upset­ting. What hap­pens when a new­ly accessed feel­ing in your chest is
expe­ri­enced as rage, or fear, or anx­i­ety? In our first yoga study we had a 50
per­cent dropout rate, the high­est of any study we’d ever done. When we
inter­viewed the patients who’d left, we learned that they had found the
pro­gram too intense: Any pos­ture that involved the pelvis could pre­cip­i­tate
intense pan­ic or even flash­backs to sex­u­al assaults. Intense phys­i­cal
sen­sa­tions unleashed the demons from the past that had been so care­ful­ly
kept in check by numb­ing and inat­ten­tion. This taught us to go slow, often
at a snail’s pace. That approach paid off: In our most recent study only one
out of thir­ty-four par­tic­i­pants did not fin­ish.
Effects of a week­ly yoga class. After twen­ty weeks, chron­i­cal­ly trau­ma­tized women
devel­oped increased acti­va­tion of crit­i­cal brain struc­tures involved in self-reg­u­la­tion: the insu­la
and the medi­al pre­frontal cor­tex.
YOGA AND THE NEUROSCIENCE OF SELF-AWARENESS
Dur­ing the past few years brain researchers such as my col­leagues Sara
Lazar and Brit­ta Hölzel at Har­vard have shown that inten­sive med­i­ta­tion
has a pos­i­tive effect on exact­ly those brain areas that are crit­i­cal for
phys­i­o­log­i­cal self-regulation.19 In our lat­est yoga study, with six women
with his­to­ries of pro­found ear­ly trau­ma, we also found the first indi­ca­tions
that twen­ty weeks of yoga prac­tice increased acti­va­tion of the basic self-
sys­tem, the insu­la and the medi­al pre­frontal cor­tex (see chap­ter 6). This
research needs much more work, but it opens up new per­spec­tives on how
actions that involve notic­ing and befriend­ing the sen­sa­tions in our bod­ies
can pro­duce pro­found changes in both mind and brain that can lead to
heal­ing from trau­ma.
After each of our yoga stud­ies, we asked the par­tic­i­pants what effect
the class­es had had on them. We nev­er men­tioned the insu­la or
inte­ro­cep­tion; in fact, we kept the dis­cus­sion and expla­na­tion to a min­i­mum
so that they could focus inward.
Here is a sam­ple of their respons­es:
“My emo­tions feel more pow­er­ful. Maybe it’s just that I can
rec­og­nize them now.”
“I can express my feel­ings more because I can rec­og­nize them
more. I feel them in my body, rec­og­nize them, and address
them.”
“I now see choic­es, mul­ti­ple paths. I can decide and I can
choose my life, it doesn’t have to be repeat­ed or be expe­ri­enced
like a child.”
“I was able to move my body and be in my body in a safe place
and with­out hurt­ing myself/getting hurt.”
LEARNING TO COMMUNICATE
Peo­ple who feel safe in their bod­ies can begin to trans­late the mem­o­ries that
pre­vi­ous­ly over­whelmed them into lan­guage. After Annie had been
prac­tic­ing yoga three times a week for about a year, she noticed that she
was able to talk much more freely to me about what had hap­pened to her.
She thought this almost mirac­u­lous. One day, when she knocked over a
glass of water, I got up from my chair and approached her with a Kleenex
box, say­ing, “Let me clean that up.” This pre­cip­i­tat­ed a brief, intense pan­ic
reac­tion. She was quick­ly able to con­tain her­self, though, and explained
why those par­tic­u­lar words were so upset­ting to her—they were what her
father would say after he’d raped her. Annie wrote to me after that ses­sion:
“Did you notice that I have been able to say the words out loud? I didn’t
have to write them down to tell you what was hap­pen­ing. I didn’t lose trust
in you because you said words that trig­gered me. I under­stood that the
words were a trig­ger and not ter­ri­ble words that no one should say.”
Annie con­tin­ues to prac­tice yoga and to write to me about her
expe­ri­ences: “Today I went to a morn­ing yoga class at my new yoga stu­dio.