Trauma-Sensitive Yoga (TSY) / Trauma-Informed Yoga

Overview

Trauma-Sensitive Yoga (TSY) is an evidence-supported, body-based intervention adapted specifically for trauma survivors. Originating at the Trauma Center in Brookline, MA (Bessel van der Kolk, David Emerson, Jenn Turner), TSY is rooted in hatha yoga but modified to prioritize choice, safety, and interoceptive awareness over performance or achievement. It is now practiced globally in clinical, community, and correctional settings as part of trauma recovery programs.

Foundational Principles

• Choice and Agency: Trauma often robs survivors of agency; TSY prioritizes invitational language (“You might…”, “If you like…”) and permission to opt out.
• Interoception over Form: Focus on internal sensations rather than external appearance to rebuild body–mind connection.
• Present-Moment Orientation: Cultivates mindfulness and self-awareness without forcing traumatic recall.
• Predictability and Safety: Clear, consistent structure and non-coercive facilitation reduce the risk of triggering defensive responses.
• Non-Hierarchical Relationship: Facilitator shares practice rather than instructing from a position of authority, supporting relational repair.

Core Practices

• Grounding and Centering: Breath awareness, gentle seated poses to orient attention to the here-and-now.
• Gentle Asana (Postures): Accessible movements adaptable to all bodies; emphasis on comfort, stability, and personal pacing.
• Interoceptive Cues: Encouraging clients to notice physical sensations, tension, warmth, or breath changes without judgment.
• Mindfulness Integration: Linking movement with awareness to support self-regulation.
• Closing Rituals: Ending with relaxation or guided body scans to signal safety and completion.

Clinical Applications

TSY has been implemented successfully in:

• Complex PTSD and developmental trauma
• Survivors of sexual abuse, domestic violence, and combat trauma
• Correctional facilities and community programs for trauma recovery
• Group and individual therapy contexts

Empirical Evidence

• van der Kolk et al., 2014 (Randomized Controlled Trial):
  Compared TSY to women’s health education in chronic PTSD (predominantly interpersonal trauma). TSY participants showed significantly greater PTSD symptom reduction, with many no longer meeting diagnostic criteria.
• Emerson et al., multiple studies:
  Qualitative and quantitative research supports TSY’s role in enhancing interoception, body trust, and emotion regulation.
• Systematic Reviews (2020–2023):
  Moderate evidence supports yoga-based interventions for PTSD, with trauma-sensitive adaptations yielding the highest adherence and lowest dropout rates.

Neurobiological Mechanisms

• Autonomic Regulation: Yoga breathing and movement stimulate ventral vagal pathways, enhancing parasympathetic tone.
• Interoceptive Awareness: Activates insular cortex pathways associated with body awareness, helping survivors re-inhabit their bodies.
• Down-Regulation of Hyperarousal: Mindful movement decreases sympathetic overdrive and dampens amygdala activity.

Strengths and Limitations

Strengths:

• Gentle, accessible, adaptable for varied abilities.
• Strengthens body–mind connection without direct trauma narrative.
• Can be integrated into all three phases of trauma treatment.

Limitations:

• Not a stand-alone trauma therapy; best used as an adjunct.
• Requires facilitators trained specifically in trauma sensitivity.
• Group settings may need extra safety planning for highly dysregulated clients.

Clinical Tips for Implementation

• Always offer choice—no physical assists or touch unless explicitly consented to in advance.
• Use inclusive, non-triggering language; avoid commanding tone.
• Maintain predictable session structure; preview upcoming movements.
• Integrate post-session grounding, especially if clients become activated.
• Coordinate with primary therapist to align TSY with clinical goals.

References

• van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., & Spinazzola, J. (2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. Journal of Clinical Psychiatry, 75(6), e559–e565.
• Emerson, D., & Hopper, E. (2011). Overcoming trauma through yoga: Reclaiming your body. North Atlantic Books.
• Rhodes, A. M. (2015). Claiming peaceful embodiment through yoga in the aftermath of trauma. Complementary Therapies in Clinical Practice, 21(4), 247–256.
• Taylor, J., et al. (2020). Yoga for posttraumatic stress disorder: A systematic review and meta-analysis. Journal of Psychiatric Research, 123, 21–31.