Overcoming Trauma Through Yoga: An Interview with David Emerson.

 

Interview with David Emerson, March 13th, 2012

{This is part two in the ongoing series, “At Attention, At Peace,”which shares interviews with veterans, yoga teachers and military officials as they discuss the uses of yoga and meditation in recovery from post traumatic stress disorder. Part One of the series can be found here.}
David Emerson is the Director of Yoga Services at the Trauma Center in Brookline Massachusetts, and founder of the Black Lotus Yoga Project, Inc., a nonprofit organization dedicated to the teaching of yoga to individuals with PTSD.
Mr. Emerson has extensive experience in the instruction of yoga with PTSD in various populations, and has developed and conducted yoga groups for several rape crisis centers, domestic violence programs, residential programs for youth, military bases, and Veterans Administration centers and clinics throughout the east coast of the United States. Mr. Emerson is the co-author of “Overcoming Trauma through Yoga”released in 2011 by North Atlantic Books.

In this interview, he discusses the rehabilitative role of physical movement, current research on the effects of yoga in recovery from trauma, the difficulties of placing blame in the context of inter-connection and how healing from past trauma begins in the present.

Full Interview:

Lilly: Could you tell me a little bit about the work that you’re doing right now? I know you’re at the Trauma Center, and that you’ve been working with veterans for a while, and that your work with veterans has been kind of a parallel track to the trauma center, is that correct?

David:  Yeah, I started the Black Lotus Yoga Project about 11 or so years ago. The U.S. was starting to ramp up for the Iraq war, and right near my yoga studio there’s a shelter for people who are active drug and alcohol users and a lot of the people there are Vietnam vets. So, I would see them every morning when I would go to clean the studio, they would be there, you know, coming out and heading off for their day.

And just thinking about the next generation of veterans that would be headed for this shelter, once we started these wars… What could I do as a yoga teacher, what made sense?

I was a social worker too, by trade and then by training, I was going to become a clinician. I had done about a year of school, to become a therapist, but really decided that the talking wasn’t for me. I did get to read some of Bessel’s book, Traumatic Stress. He talked about engaging the body as an important thing for trauma healing and it felt like yoga would be the perfect fit, the perfect way to integrate the body holistically into the process of healing.

Lilly: And what is the Black Lotus Yoga Project? What is the mission statement, and how has that mission changed over time?

David: To teach yoga to people with PTSD. That was it. Early on I partnered with Bessel van der Kolk and with the Trauma Center. So I started that little non-profit and then partnered with the Trauma Center, and then as we started to look, do studies, and get things moving, I was hired by the Trauma Center a few years later. And so most of the work I do with trauma is there now.

But we had Black Lotus and luckily we kept it because there’s a program called There and Back Again, which you may know about, that grew out of it and which serves younger veterans who are experiencing trauma symptoms specifically. We’ve also been donating the studio to Kripalu for a study they’ve been doing with veterans. I also have my veterans group that meets at the studio; we’ve been together for about eight years or so now.

Lilly: And how long overall have you been working with veterans and how long have you been working with PTSD? Is that the same amount of time?

David: It’s about 10 years.

Lilly: Do you have a class that you meet with regularly now?

David: Yeah. The first class that I did was at a VA in Bedford, Massachusetts. Some of the VA’s in the country have places where you can stay at this place for a certain number of months in your lifetime, so it’s kind of like a respite place. So then, on the campus of the VA, they have a shelter. I did yoga classes there.

It was there I met this group that I’m with now. For the past six years they’ve come down to the studio. Every other week, they come down. They make a drive, it’s about a 45 minute drive down, every other Friday. We do Chair yoga. Pretty much the same thing we’ve been doing together for eight years. It’s great. We like each other quite a bit. It’s quite fun.

Lilly: Who’s your longest standing student?

David: That group is the longest group. The core group of guys there have been the whole eight years. They are Vietnam veterans, all of them. Every now and then I’ve met a younger guy, but this particular group is kind of specialized.

It’s Vietnam veterans. They’ve also been diagnosed with major mental illness. There’s a lot of psychosis and schizophrenia in the group, and there are a lot of medications. I would say that medications are the biggest sort of impediment to actually practicing yoga; even more so than physical challenges. There are some heavy duty drugs that have significant physiological side effects.

These guys are incredibly devoted to themselves, to the practice, to me and me to them… I think we all kind of lift each other. They want to do more! Usually we meet every other week, but the past couple of months they’ve been coming every week. And they’ve been wanting a little more, like a little more physicality to it, staying in the chair but with a little more muscular energy.

So it’s been kind of cool. It’s evolved. It’s been kind of a slow evolution, like we will be doing the same thing for a while and then they will really want to do a little more.

Also, in terms of long-term students, I’ve known and had some students over at the trauma center now since our second pilot study in 2005. We’ve done three studies to this point, two pilot studies and one big study we just finished, that was funded by the National Institute of Health. Those are the longest term relationships I’ve had, six to eight years.

Lilly: As it’s been directly shared with you or as you sense it, what keeps your students coming back?

David: The veteran’s group especially, I think they feel better after every class or session.

I always kind of check in as much as I can, “What do you notice?” “What does it feel like,” “Did anything change for these 25, 30 minutes?” It’s very consistent that they feel a little better every time and they notice it … I haven’t tracked it long term, if there’s an arc of feeling better over the course of months or years, but from when they come in, to when they leave, there’s a better feeling. I’m sure that’s one reason why they want to keep coming back. It feels good.

One guy said that he’ll be walking around in the city where he lives, and he says “I get a yoga feeling sometimes”, which he describes by holding his head high and expanding his chest a little.

So it’s kind of like developed in his body, some sense of what that is. I think it would be a sense of well-being of some kind. You get to practice a sense of well-being for half an hour there every week, and, over time, they’ve developed a way to be well, to be with themselves. I think that’s why they keep coming back.

And that’s that specific group. I get really specific answers with other Trauma Center students because we’ve done so many studies, we’ve got a lot of archived feedback. So we get to hear some very specific things from people there, about why they do yoga, and why they come back.

Lilly: What are some of the things that have struck you?

David: Many people have said, “Feeling strong is helpful”, or, “I Like to feel my muscles.” People have talked a lot about the emphasis on choice and that is a very intentional approach on our part – turning over as many choices as possible to yoga students. All of the studies we’ve done have been women. Most of our students over the years at the trauma center have been women but I work with a lot of teenagers too, both boys and girls, in residential settings. Feeling strong and feeling likes one’s body can be effective along with the ability to make real choices about what one does with one’s body at any given moment are all themes that we have heard over the years.

Also, there’s something about yoga that has helped people feel more fulfilled in their relationships and this is a thing we’ve noted that’s really interesting to us. People feel like their intimate relationships are more satisfying and safer. And there’s something about the yoga that’s doing that. And we kind of speculate on that: if I feel safer in my own body, more confident and safe in my own body, then I can be more available to someone else.

So people say things like “I can’t let my family touch me, I can’t let my kids touch me, it’s too much of a trigger, it just brings up too much. But after doing yoga for a while, I noticed I could be touched more by my family, by appropriate people.” So that, to me, is huge.

With kids, with the teens, another thing I hear a lot is that yoga helps them feel more calm. It could be different things in yoga for different people, though that creates this sense of calm, so I am not prescribing anything particular here. It is more about working with each individual as they discover for themselves what helps them feel calm or strong or safe in their body.

Lilly: How do you teach a class differently to someone who has post-traumatic stress?

With the yoga there’s a lot of emphasis on choices. We want to make it clear to people that they have choices, and give them ways to make those choices. Invitational language is important, so we really try to pay attention to not ordering people.

Many students tell me that being able to make real choices right in their bodies is critically important. So, everything we do, we’re like, “here’s something you can experiment with, if you’d like to. Here is a choice for you -whether you do a neck roll in one way or another for example.”

It’s not wishy-washy, but it really is an invitation. Other important stuff with trauma sensitive yoga is we recognize, clinically, what’s happening, because everything we do is in conjunction with clinicians. So we know what the clinical goals are for trauma treatment, and we know the neuro-physiological impact of trauma. We have recently done some brain scans that are beginning to shine a light on what might be happening with yoga. We try to teach yoga with both the clinical and the neuro-physiological impacts in mind.

To me, therefore, if you’re just a pure neuroscientist, the value of trauma-sensitive yoga is just that you’ll start to reignite, reinvigorate those parts of the brain that are shut down by severe trauma, which causes a lot of the suffering. As a humanist, from a humanistic perspective, you’re also reclaiming your body, y’know, ‘this is my body, I’m in charge of it, I have control. To a reasonable, human degree, I have control.’”

We really try to help people get oriented physically, in every form, to what’s happening.

The other part there that’s kind of new, based on the implications of our recent brain scans, is locating yourself spatially. So, something like triangle, we’ll give a cue, like, “see if you can keep track of your top hand, when you move your fingers you can look at your hand if you want, but just experiment with moving your fingers. Feel where your hand is, and then you’ll know that you’re maybe moving your arm a little bit, but you’re practicing tracking yourself, in the space.” We know those parts of the brain that help us feel ourselves, feel our bodies, our muscles, and feel ourselves in space, those parts of the brain are really damaged by trauma.

A lot of the suffering of trauma is not being able to feel yourself. Bessel talks about it as, “you just aren’t”. At this moment in time, you just aren’t anymore. You may be able to trace that experience, that feeling that sometimes people actually articulate (“I can’t feel myself” etc.) to these areas of the brain. So we work on feeling ourselves, to sensing ourselves. There are parts of the body that are more safe, for some people, than others, and we just try to find where we can start with this process of sensing ourselves. Maybe it’s feet on the ground. Maybe it’s one hand in the space, moving your hand, moving your arm, maybe it’s core strength etc. Different for everybody.

Lilly: What parts of the brain are associated with that lack of spatial awareness?

David: One is the medial prefrontal cortex. It’s in the space, actually, amazingly, around the third eye. Bessel describes it as a Mohawk from between your eyebrows up toward the crown of your head. And there is the insular cortex, which is on either side, right and left hemispheres. The Insular Cortex has been pretty well identified as having a lot to do with feeling ourselves, and sensing ourselves dynamically and spatially. There have been some really good studies that show how it’s almost completely off, with PTSD and trauma (see Ruth Lanuius, for example). It’s almost totally shut down.

Lilly: Why?

David:  I don’t know. If you think about it philosophically, or if you just speculate, when we’re hurt so badly, maybe over time the best thing we can do is withdraw from being, so we’re not seeing, or we don’t have to feel what’s happening. So it makes sense to me that that part of the brain would be impacted, but that’s just speculation.

Lilly: It’s interesting to think about that defense coming involuntarily…

David: Yeah!

Lilly: …how it does provide a kind of protection or shelter, but how long-term, it’s not a functional way to exist. So there’s a disconnect for me there, when I think about how sometimes the long-term ways that we stay safe are different from the short-term. What are your thoughts on that?

David: That’s a great point. I think that’s what trauma is. The trauma response is unconscious. The “fight, flight, freeze, submit” response, we’re going to respond to life-threatening, or integrity-threatening situations with something that’s unconscious, really. Still, it’s adaptive. It’s what our organism is set up to do, to protect us.

But then what happens is, like you said, it becomes chronic. And then, after a while, especially if we’re not in that circumstance anymore, it’s still happening. That’s suffering. How do we turn that off? How do we live in the present? Bessel talks about the primary treatment goal for severe trauma as helping people be present. Trauma is like a disease of not being present. What can we do to be able to live right now without being trapped by the past?

Lilly: What is the process like, of trying to offer somebody a present moment, if the present moment is painful?

David: So for us the present moment is a physical thing, it’s not a cognitive thing, or an idea. It’s feeling your feet on the ground, it’s feeling your muscles working in Warrior II. So you’re trying to help people get oriented to the present moment through their body, body mechanics, body dynamics, inter-spatial attention.

In my limited experience, the suffering of not being present is much worse than the suffering of being present. It’s much more painful to try and be a parent, a lover, have a job, partner, anything, if you are constantly hijacked by the past. That pain is almost unbearable for people.

We can’t really think ourselves into the present. But it seems like we can “do” ourselves into the present. When we do things, and notice/feel that they’re happening, that’s being present.

Lilly: Would it be fair to say that emotional pain usually has some relevance to the past?

David: I think so. That’s how I would think about it.

Lilly: Would it be fair to say that emotional pain always has some relevance to the past? Or, is that too far of a stretch?

David: In the context of trauma, I would say yes, that’s fair.

In the context of PTSD, when we’re talking about the limbic system (the emotional brain) hijacking us at any given moment… That would be emotional material that’s not related to the present. To me, the physical stuff is a much more reliable source of the present moment than what we think. So it’s kind of an opportunity to realign what being in the present is.

There are studies with meditation, and how meditation can get some of those parts of the brain going too, but it never quite worked for me personally. And we found, especially with the really severe trauma, asking people to just sit still and breathe was like torture. All the demons would come up and they’d have nothing to do with them. Luckily it looks like yoga also can get those parts of the brain going as well.

Lilly: What is the relationship between the present moment and long-term recovery from trauma?

David: Bessel says straight up that the goal of trauma treatment is to help people be present. If you’re limited to just talking about being present… your body is the most reliable source of that presence. Instead of talking about being present, with yoga, you are practicing it right in your body.

I think that somebody like Judith Herman, who’s a great writer and trauma therapist, who is also a contemporary of Bessel’s, also talks about an aspect of being present, which is the process of becoming empowered. We’ve got the present moment practice, and it’s reverberating, it’s got this deeper quality to it also of an immediate inhabiting of self, of a “claiming” of my body as my own. That’s empowerment.

Trauma is this process of our selves being taken away, our body, our sense of self, everything is just stripped away. And then we have to take it back.

I’ve found that in the work that we do with people with really severe trauma it’s not a fight to take it back, it’s not like we’re going into it as a fight; that doesn’t help.

People that we know, veterans, the folks that we work with every day, kids, they’ve been through so much violence, that bringing any more violence to the process makes it worse. Fighting trauma makes it worse. So we have to bring in a very committed, strong, gentleness to the whole thing.

Lilly: I have this image of a haunted house, and the present moment being this one room in the house with nothing in it. And it’s empty to give us the opportunity to redefine it, to say that in this room, we can be this way, and then slowly that room expands to the other rooms. That’s a roundabout way of responding to the idea of how, over time, the relationship of one’s self to the moment during to yoga practice affects the ability to reclaim and redefine the story of the past. Is that what you’re getting at?

David: I hear what you’re saying, and that’s what I would say. I think Bessel would say, and I’m getting convinced about, and my students over the years would agree.

If you have an experience in a yoga class where you are present, that resonates. You start to stake out that little corner, like that room in your house. And from that little corner you stake out more space. And that doesn’t go away! That corner doesn’t go when practice ends. You just build on it. That’s what seems to happen.

The next thing we’re going to do is a longer study very much focused on the fMRIs, so that we can really see over time what happens to the brain as a result of these physical yoga practices. I picture that part of the brain getting brighter and brighter.

Lilly: This may be an assumption, but to work with veterans, as opposed to people who are not… Veterans being people who have fought, who have been involved in inflicting violence, and the people who you are working with at the trauma center are victims, more predominantly… Is that true?

David: That’s a really interesting question. I think trauma, in my experience… “Victim” is a tricky word. I know what you mean, I totally know what you mean there, but I think the experience of severe trauma is very similar for all who experience it. PTSD is the only diagnosis we have and frankly, a great many of our students don’t have the diagnosis though they have been through hell. Maybe, they were children in an abusive home and their capacity to fight was limited; the adults were bigger and stronger than them, but they were fighters, you know. They were fighting.

When we’re threatened, we fight. We fight; we run; we try to protect ourselves. So, I think the experience of trauma is that you’re fighting, you’re trying to run.. I mean anything can happen in the course of a battle. There’s gonna be fighting and there’s gonna be running. People freeze, and submit. We do it all. So I think it’s the experience we were talking about earlier, which is that those adaptive mechanisms become chronic. And that’s trauma.

I really see more similarities than anything, between veterans, the kids I work with, the adults. Trauma is a vicious thing that cuts across all the lines. I mean think about the soldiers who have been victimized in some way apart from the actual war fighting (sexual assault by peers for example). It’s part of war.

War is so unclean. It’s combating and fighting and victimizing, it’s everything, y’know? So it’s just like what it’s like to grow up in a chronic, dangerous environment. Sometimes you fight, and sometimes you are harmed.

I think that people like you, or myself, or any of us involved in the process of helping trauma, if we can’t understand that kind of complexity, I think we’re doing people a disservice. It’s not clean cut, and that’s exactly what trauma is, it’s not clear.

Bessel was talking about our study the other day, y’know, publicly, and he was saying that he thinks yoga is pretty much the centerpiece of the trauma center’s work at this point, because you have to feel safe and regulated before you can do anything, before talking, or anything. So having your body again is where it’s at.

Lilly: Thinking about yoga as a philosophy of oneness and connection, and how on the one hand that idea has this sort of magic and excitement to it, but for someone who has experienced trauma, that idea of connection could not be exciting at all. So much of what the trauma-sensitive practice is seeking to do is to give somebody a sense of themselves… but how does that not carry over into one’s sense of being safe in themselves only? Where and how does a sense of empathy or connection come back?

David: This is interesting. I’ll go back to that stuff I was telling you about earlier, where people were saying, as a result of maybe 10 weeks or so of yoga, “ I feel like my relationships are better.” From what I’ve seen, if people are feeling safer, stronger, and more confident in their own bodies, then they can start to have relationships again. They can start to connect with the world again in a way that feels safe.

Trauma is absolutely isolating: me from myself; me from other people; and me from the larger, more universal experience of being alive. Being around other people in a trauma-sensitive yoga class and practicing reconnecting with oneself but with other people who are in the same boat has been very meaningful to some of our students.

People have said to me, “I like that I’m in this class because I know we’re all in the same boat.” Or, “this is the only social thing I do during the week. This yoga class is the only thing I do with other people.” So there’s that. That sense, like Judith Herman would talk about, of reconnecting with the larger society, the larger group.

In my work with kids, which is usually one on one, the focus there is always on your relationship to yourself which is where real empathy starts.

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