Trauma-Informed Yoga Is Trending, But Therapists Must Take Caution

What’s happening – Trauma-informed care, which assumes that a person has experienced trauma and provides a supportive environment for healing, has garnered attention in recent weeks with announcements of several new initiatives. City officials in Baltimore will be required to undergo trauma-informed care training, and the city has enabled a task force to address trauma among residents. A new coalition in Kentucky has called on schools and communities to use trauma-informed care and education for children across the state. The Children’s Hospital of Philadelphia, or CHOP, created a new program for patients and families based on trauma-informed care principles that helps to manage pain and stress using mindfulness, nutrition training, and, you guessed it, yoga.

The therapeutic value of yoga is at the heart of trauma-informed and trauma-sensitive yoga programs. Woodland describes the trauma-sensitive yoga program (TCTSY) developed by the Trauma Center in Brookline, Massachusetts, as “an empirically validated, adjunctive clinical treatment for complex trauma or chronic, treatment-resistant PTSD.” The practice been featured in a recent consumer magazine and has been the study of scholarly articles as well. In fact, this spring’s World Congress of Psychiatry meeting has Yoga as psychotherapy on this program.

The research

  • An RCT by Davis et al found that yoga helped to better improve PTSD symptoms in veterans and civilians when compared to a wellness program. The authors concluded that for people with PTSD, yoga could be a good adjunct to standard treatment.
  • A pilot study explored the implementation of a trauma-informed yoga and mindfulness program in Kenya – concluding that the program showed potential for acceptability and feasibility. Participants reported that they intended to use and share the curriculum’s tools.
  • Participants in a peer-facilitated, trauma-informed yoga and mindfulness program in a women’s prison showed improvements in healthy coping skills, emotional awareness, self-regulation, and symptoms of PTSD, anxiety, and depression, according to a case study by Rousseau et al.

Why it’s complicated – As the trend picks up, your clients may be asking about yoga –but it’s important to understand the full scope. For instance, while trauma-informed and trauma-sensitive yoga have well-established benefits, care must be taken for survivors of sexual assault or domestic violence who are considering such a program to ensure that their unique needs are met (more on this in our Psy-Q trivia challenge). TCTSY classes focus less on getting poses exactly right, and do not include hands-on adjustments by the instructor, but instead focus on how the class participants are feeling.

  • A study that used TCTSY for sexual assault survivors in a community-based group setting found that emotional regulation and skilled awareness increased as a result of the intervention. The authors noted that increased emotional regulation and skilled awareness may reduce PTSD symptomology.
  • Researchers offered guidance to clinicians on how to refer patients who have survived sexual trauma to yoga classes in an informed way.

The conversation

  • @exhale2inhale, the nonprofit group Exhale to Inhale that supports survivors of domestic and sexual violence, tweeted a quote from one of their instructors: “I taught at Exhale to Inhale because survivors deserve yoga that meets them where they are, helps rather than risks harm, and fully respects their needs.”
  • @_jasmineyallen, a yoga instructor whose Twitter handle is Black Owned Yoga Mats & Trauma-Informed Yoga, tweets, “I ask my students can they take a deep breath and notice what happens next when they feel discomfort. As a trauma-informed yoga instructor and sexual assault survivor, I always remind students they can stop at any time. I never want them to feel like they have to take pain.”
  • In a reply to the question of how to get started with yoga, Twitter user @EmmaBunnie shared, “Gently and patiently. For me this was helpful. Also having a trauma-informed instructor was a great help and changed so much for me. As a victim herself, she understands how triggering it is just to even exist in my body, as well as yoga, and or any physical activity is painful.”
  • @RootToRiseYogis tweeted “Prediction: It’s going to be more important than ever for yoga teachers to teach in a trauma-informed way.”

In practice – For polytrauma cases, such as those including PTSD and depression, a multimodal approach may be best.

Psy-Q: This Week's Challenge

Can yoga be an effective therapeutic tool for survivors of trauma?

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OCD Sufferers May Soon Have a New Treatment Option, Including for Residual Symptoms

What’s happening – It has been 20 years since a mechanistically novel treatment for obsessive-compulsive disorder (OCD) has been approved – but that may soon change.  A Phase 3 trial of the drug candidate troriluzole studying its role as a treatment to help people with OCD was announced by Biohaven Pharmaceuticals. Troriluzole is a new chemical entity that works by normalizing the neurotransmitter glutamate; its novel mechanism of action could benefit those who do not respond or continue to experience residual symptoms with currently available medications, according to the company. If troriluzole is eventually approved by the FDA, it would also mean another treatment option for the 2.3% of US adults who live with OCD.

Troriluzole is also being investigated by Biohaven as a treatment for spinocerebellar ataxia and Alzheimer’s disease (AD). Just this week, the company announced that a Phase 2/3 trial for mild to moderate AD missed its co-primary endpoints but results for early-onset AD may continue to be pursued.

The details – See Biohaven’s announcement of the Phase 3 OCD trial.

Why it’s complicated – People with OCD have had an especially difficult time during the pandemic, as reported in numerous news articles and academic studies. Heightened anxiety around COVID-19 transmission makes it difficult for adults and children with OCD to cope.

Guidance & Background for Mental Health Professionals

  • The American Psychiatric Association offers guidance for providers on how to help patients manage concerns about COVID-19.
  • An article from Yale School of Medicine offers tips for coping.
  • NPR profiled a man with OCD and discussed the special concerns faced by people with the disorder.
  • The difficulties faced by children with OCD were the focus of articles in The New York Times and The Washington Post.
  • OCD symptoms worsened in April–May 2020 in adults with OCD, particularly those with contamination fears and a remission state before the pandemic began, in this Psychiatry Research
  • In a study of children and adolescents, Nissen et al found that symptoms of OCD, anxiety, and depressive symptoms worsened in the early days of the pandemic in 2020.
  • An article in Psychological Trauma asks if the pandemic is a trigger for OCD and illness anxiety disorder.

The conversation

  • @NAMICommunicate asked “Has the pandemic affected your OCD? If so, what are some of your coping mechanisms?” and linked to this article about how the pandemic has “upended” therapy for those with OCD
  • @CentreforMH, the UK’s Centre for Mental Health, quoted a recent article, “Could you imagine living with my brain in 2020 in a global pandemic? I started using hand gel excessively, wearing a face mask long before anyone else, not letting people in my home… My life is now as wide as the four walls of my house.”
  • @womensrepublic_ tweeted “Being in a pandemic is already tough, but add OCD into it and it becomes even harder,” and linked to an essay written by a woman living with OCD.

In practice – Recognizing COVID-related trauma and mental health impact. Case data on the use of Deep TMS for Refractory OCD.

Social Media Continues to Impact Young People, This Time with Depression Risk

What’s happening – A study uncovered a 10% increase in depression among young adults based on just 6 months of increased social media usage. Researchers assessed 990 18- to 30-year-olds for depression before the study began (baseline) and at 6-month follow-up. During those 6 months, participants who used social media for more than 300 minutes per day were found to be 2.8 times more likely to develop depression than those who used social media for fewer than 120 minutes a day.

The results showed no association between depression at baseline and increased social media use during the 6-month period. The authors noted that although their findings cannot determine causality, the results highlight the importance of understanding temporal and directional associations in this area of research.

The details – Read the full study by Primack et al in the American Journal of Preventive Medicine.

In an interview published by The University of Arkansas, lead author Dr. Brian Primack said that these findings are especially important to consider during the COVID-19 pandemic, noting, “Now that it’s harder to connect socially in person, we’re all using more technology like social media. While I think those technologies certainly can be valuable, I’d also encourage people to reflect on which tech experiences are truly useful for them and which ones leave them feeling empty.”

Why it’s complicated – The pandemic is causing increased social isolation in children as well – they are experiencing increased screen time due to online learning, connecting with friends and family, or simply finding ways to pass the time when sports and other in-person activities are canceled. Along with extra doses of screen time, increased social media use is of concern to parents, caregivers, and mental health experts.

  • NAMI has provided ways for parents to help their children manage pandemic-related depression, including strategies to limit social media use with a schedule.
  • The New York Times reported on skyrocketing screen time use during the pandemic by children, and an addiction specialist warned about the “epic withdrawal” from it once in-person school and life resume.
  • For a deep dive on the addictiveness-by-design of social media platforms, watch The Social Dilemma An NPR interview with director Jeff Orlowski reveals more insight into the manipulative practices of social media companies.

The conversation

  • @PsychiatricNews, the news service of American Psychiatric Association, sounded the alarm on the long-term effects of the pandemic on the mental health of children and adolescents, tweeting, “Despite the availability of remote peer communication through technology and social media, the isolating circumstances of the pandemic appear to be impacting children through increased levels of anxiety, depression, and suicidal ideation.”
  • @EENet_news, an Ontario-based branch of Canada’s largest mental health and addiction teaching hospital, tweeted, “For teens, more time spent on social media during #COVID19 is associated with higher levels of depression and loneliness, but there may be a solution: family time,” and links to their research snapshot on the topic.
  • “Overuse of social media” topped the list of the Top 10 Child Health Concerns Among Parents, according to an article posted by @FuturityNews, the Twitter account for the nonprofit Futurity.

In practice – A look at anxiety, speech patterns, and later-life mental illness in children. When young adults discontinue therapy.

 

Last Updated: Jun 16, 2021