In our May/June issue, Part 1 of this article discussed trauma and the roots and practice of yoga. In this issue, Part 2 explores the impacts of therapeutic yoga and its impact on the nervous system.
Therapeutic Yoga and TCTSY
Western cultures often associate yoga with Asana, the physical practice. Therapeutic yoga may be defined as the use of physical yoga practices, such as breath and movement, which are aimed to help improve one’s physical, psychological, or spiritual well-being. According to Singh, the therapeutic principles of a yoga practice include one’s holistic nature, individuality, self-empowerment, and the importance of the mind in creating a healing state.
These principles identified by Singh are similar to the philosophical foundation of TCTSY. The therapeutic alliance between the TCTSY facilitator and the participant is a key component of a TCTSY practice. The therapeutic alliance is promoted by the use of the five core elements of TCTSY, which include invitational language, non-coercion, choice-making, interoception, and shared authentic experience:
- Invitational language: Nondirective use of language, such as “if you’d like,” “perhaps,” or “you may/might/could.”
- Noncoercion: The TCTSY practice is based on the participant’s choice and preferences for movement and intentional breath. Cues are verbal, and hands-on assists or adjustments are avoided.
- Choice-making: Offering non-hierarchical options for movement, such as an “either/or” choice or an “A, B, or C” choice for participants to engage in the TCTSY practice.
- Interoception: Present moment awareness of somatic sensations.
- Shared authentic experience: The TCTSY facilitator engages in the practice along with the participants.
The TCTSY practice was originally developed to treat women diagnosed with complex PTSD related to childhood sexual abuse. TCTSY has been found to reduce the symptoms of PTSD at a similar rate as cognitive processing therapy (CPT), a form of treatment that directly addresses the memories, thoughts, and feelings surrounding the traumatic event. TCTSY is considered a form of Hatha yoga made accessible to individuals with diverse levels of physical ability. The use of physical postures, called shapes or forms in TCTSY, is a movement-based modality and may be considered a bottom-up approach to trauma treatment. Bottom-up practices, such as a movement practice like yoga, have been found to help regulate the nervous system by reducing SNS activity.
Yoga and the Nervous System
Improvements in trauma-related symptoms have resulted from interventions such as yoga that are based in present-moment awareness. The practice of yoga has the potential to increase parasympathetic activity and vagal tone, as well as promote resilience. Resilience may be conceptualized as an individual’s capacity to adapt to difficult or stressful life events without expending excessive time or energy to return to homeostasis. A lack of resilience may result in dysregulation of the ANS.
The vagus nerve is involved in the regulation of the ANS and is a major link between the brain and the body. Homeostasis in the human body is maintained by the ANS, which is comprised of the SNS and the parasympathetic nervous system (PNS). The physiological response to a stressor activates the SNS, causing increased catecholamine and cortisol levels while decreasing gamma-aminobutyric acid (GABA), which may lead to symptoms of anxiety. SNS activation may also result in an increase in heart rate, respiration, and muscle activation, preparing the body for a fight-or-flight response.
When SNS activation is reduced, this physiological response is reversed, which helps to improve attentiveness, mindfulness, and interoception. One way a body-based therapy such as TCTSY may help to improve physical distress tolerance is to improve interoception in individuals with complex PTSD. Interoception may be defined as the processing of the body’s internal stimuli transmitted by the nervous system. Misinterpretation of interoceptive cues is posited to contribute to mental health
conditions, including somatoform, anxiety, and mood disorders.
Polyvagal Theory
The vagus nerve is the longest cranial nerve in the human body. The functions of the vagus nerve include parasympathetic innervation, which regulates the respiratory, cardiovascular, endocrine, and immune systems. The vagus nerve contains 80% afferent (leading from the body to the brain) and 20% efferent (leading from the brain to the body) nerve fibers. Polyvagal theory (PVT) theorizes that the PNS has two distinct vagal pathways, the dorsal vagal complex (DVC) and the ventral vagal complex (VVC). When activated, the DVC may result in physical immobilization or collapse, while the VVC, which, as part of the social engagement system, may result in a freeze or fawn response.
The DVC is the oldest part of the vagus nerve and is responsible for the body’s response to psychological trauma and the return of the nervous system to homeostasis after the resolution of the trauma. In response to a threat, DVC activation automatically results in decreased muscle tone and reduced cardiac output. Because the DVC innervates the viscera below the diaphragm, digestion slows, and bowel and bladder control is reduced often resulting in a reflexive loss of control. Outwardly, DVC activation may result in a freeze response, fainting, dissociation, or loss of consciousness.
Homeostasis, the body’s ability to grow and repair, is supported by feelings of safety which in turn allows individuals to co-regulate their nervous system as part of the social engagement system. Both eye contact and vocal tone may help to socially engage another while reducing SNS activation. When the DVC is activated, SNS response is reduced resulting in lower heart rate, decreased cortisol levels and lower levels of inflammation.
The VVC is integral to the social engagement system, feelings of safety and connection in relationship to others, and is often expressed through facial expression and tone of voice. Increased social engagement occurs when an individual perceives safety from both the internal and external environment. When a real or imagined threat is detected, the SNS becomes activated. SNS activation results in physiological changes, including increased heart and respiratory rate, bronchial dilation, decreased gastrointestinal motility, and the release of stress hormones to prepare the body for mobilization.
Typically, the nervous system adequately senses risk in the environment. However, some individuals experience disruption of neuroception, thus perceiving a safe environment as unsafe. When this occurs, the SNS becomes activated, social behaviors are inhibited, and an individual may experience symptoms of withdrawal or aggression. Conversely, activation of the social engagement system decreases the SNS response and inhibits the hypothalamic-pituitary axis.
When there is an overwhelming or significantly threatening traumatic event, an individual may initially respond with SNS activation. If exposure to a threatening situation persists or the response to the situation is restrained, the PNS, or dorsal vagal system, may co-activate with the SNS, resulting in a freeze, collapse, or dissociative response. In time, this may result in a dysfunctional and paradoxical activation between the SNS and PNS. Symptoms of co-activation of the SNS and PNS may range from extreme states of anger and rage to a depressive collapse. TCTSY is an intervention that may help to target the co-activation of the SNS and PNS and help return the nervous system to normal functioning.
TCTSY is a specific yoga practice that utilizes the five core elements of invitational language, noncoercion, choice-making, interoception, and shared authentic experience to assist individuals who have experienced complex trauma. TCTSY decreases the effects of complex trauma by improving the body’s response to stress and increasing interoception through vagal pathways. The use of physical movement in the TCTSY practice offers a bottom-up strategy to help regulate the vagus nerve and promote homeostasis, which is an essential component of both physiological and psychological well-being.
Nanci Kaczegowicz, MSN, APRN, FNP-C, PMHNP-BC, ERYT 200, RYT 500, is an advanced practice registered nurse with over twenty-seven years of experience. She is nationally certified as both a family and psychiatric mental health nurse practitioner. Her additional training in holistic nursing and yoga helps her to promote spiritual, mental, emotional, and physical well-being. She is passionate about helping teens and adults experiencing depression, anxiety, insomnia, and chronic stress understand the root cause of psychological distress impacting their lives. Services may include medication, psychotherapy, therapeutic yoga, mindfulness, stress reduction, and relaxation techniques.
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