Saturday, February 4, 2017

Trauma sensitive yoga


ARTICLES ABOUT RESEARCH INTO SOMATIC THERAPY & TRAUMA

http://www.janinafisher.com/resources.php

http://www.janinafisher.com/pdfs/addictions.pdf

http://www.janinafisher.com/pdfs/trauma.pdf

The benefits of yoga practice in helping people affected by trauma 
1. Being trauma-informed is a best practice for everyone working with the public, not just “mental health” or “recovery yoga” teachers.
2. If even one new person comes to the class, review protocol for a safe practice.
3. Avoid making hands-on adjustments without asking permission, or review a protocol for declining.
Don’t assume—give people a chance to decline whether you have some sort of system (e.g., cards near the front of the mat, asking quietly or making eye contact when you approach). Avoid approaches from behind.
4. Consider that some people believe that they can’t say no, especially with adjustments.
Many emotionally vulnerable folks believe that they have to say “yes” to you in order for you to like them. Thus, people may say it’s okay for you to touch them, yet if the body language suggests they are uncomfortable, remember that the body doesn’t lie.
5. Offer a protocol for opting out of uses of essential oils or creams.
6. Make yourself available after class.
7. Closing the eyes is not always optimal.
8. Be mindful of the guided imagery that you may use.
9. Just because a pose makes you feel a certain way, don’t assume it’s that way for others..
10. Avoid telling the class how a pose “should” feel.
>>> This pose may alleviate depression.
>>> This pose has been known to alleviate depression.
>>> Many people say this pose creates great space in the spine.
>>> This pose is known to create great space in the spine.
>>> This breath can be very balancing.
>>> This breath may take some practice for you to experience its intended balancing effect.
11. Make a few statements about non-competitiveness during the class.
12. Avoid public or overt praise of your “favorite” or “best” students—consider the message it might send to others.

From "Decolonizing Yoga":

Yoga for Trauma Survivors

The resource below was contributed by Lauren Rubenstein, a clinical psychologist and yoga teacher with experience teaching yoga to outreach populations and consulting to non-profits. Lauren has a private practice in Bethesda, where she offers integrative psychotherapy and stress management.  She can be reached at DrLaurenRubenstein@gmail.com .
What is Trauma? Psychological trauma occurs when an actual or perceived threat of danger overwhelms a person’s usual coping ability.  The danger can come from a single stressful event, such as a car accident, or a series of events such as war or repeated sexual, physical or emotional abuse.
All traumas are stressful, but not all stress is traumatic. For many reasons, individuals differ in their response to threat or acute stress. As a general rule, however, intentional human causes seem to be the most difficult to recover from, while acts of nature tend to resolve more quickly.
Neurophysiology of Stress Most people have heard stories about superhuman strength in the face of stress — e.g., a mother lifting a car off of her trapped child.  This is due to the body’s fight or flight response to life-threatening situations.  The surge of stress hormones enables us to mobilize enormous energy in preparation to fight or escape.  Once the body has discharged energy and the danger has passed, the stress hormones subside.
When we are unable to discharge this excess energy by running or fighting, the brain continues to release stress hormones, and the body remains on high alert.
Freezing, or immobility, is the third, lesser-known survival tool in response to threat.  Peter Levine uses the example of a cheetah stalking an impala.  When the cheetah catches its prey, the impala falls to the ground and plays dead, which reduces its chances of being devoured. Even if it is killed, numbness will attenuate the pain or terror that normally would ensue.
Fighting, escaping and freezing are all normal responses to extreme threat.  What becomes problematic is when these responses persist in the body after the danger has passed.  Bessel van der Kolk, an expert on traumatic stress, describes trauma as “hijacking the body.”  Brain, mind and body remain in a state of high alert (fight or flight) or under-arousal (freeze).  This scheme is helpful in understanding the complex symptoms of Post-Traumatic Stress Disorder, or PTSD.
Post Traumatic Stress Disorder (PTSD) Defined
The Diagnostic & Statistical Manual of Mental Disorders (“DSM-IV”) outlines six criteria for a diagnosis of PTSD:
  1. 1. Exposure to Stressor. Intense fear, helplessness or horror experienced in the face of event(s) involving actual or threatened death, serious injury, or bodily violation.
  2. 2. Event Re-experienced through intrusive memories, distressing dreams, feeling as if the trauma were recurring, intense distress when exposed to cues symbolizing an aspect of the trauma, or physiological reactivity when exposed to cues.
  3. 3. Persistent Avoidance and Numbing. At least three symptoms are required from a list including avoidance of internal or external stimuli that arouse memories of the trauma; inability to remember an important aspect of the trauma; diminished interest in formerly pleasurable activities; feelings of detachment; and restricted range of affect.
  4. 4. Persistent Symptoms of Increased Arousal. At least two of the following: difficulty falling or staying asleep; angry outbursts or irritability; difficulty concentrating; hyper vigilance; and exaggerated startle response.
  5. 5. Symptoms persist for more than one month
  6. 6. Life Disrupted / Functioning Impaired
As yoga teachers, our intention is to make our classes as warm, inviting and non-threatening as possible.  We are likely to succeed more often than not for the average student.  For the traumatized student, however, even our most heartfelt efforts can easily go awry.  By hijacking the nervous system, trauma robs its victims of a sense of basic safety and security. On the other hand, trauma-sensitive yoga practice can help people “befriend their bodies,” which van der Kolk says is such a crucial aspect of trauma recovery.
Trauma Aftermath On the Mat
There are unlimited possibilities as to how the aftermath of trauma might show up on the yoga mat.  Some common pitfalls that may trigger reactions include:
Turning out lights for savasana
Bending over in front of others
Sexually provocative poses, e.g. happy baby, cat/cow
Lack of structure or too much quiet time in a restorative pose might prompt dissociation
Use of language with potentially sexual or aggressive meaning (see below)
Physical assists can startle or trigger flashbacks of unwanted touch
“The healing of trauma is a natural process that can be accessed through awareness in the body.”
–Peter Levine
Creating Safety in a Yoga Class
1st stage of trauma recovery is safety – in the body and with people.  Need a supported, structured, consistent environment.
Universal triggers of stress (produce feelings of helplessness): Uncertainty; Lack of information; Lack of control
Breath:     “Let’s breathe together.”  Tell how many breaths, either counting down, or “two more”
Space
Presence
Pace
Accessibility (poses everyone can do)
Unity
During the course of practice, most yoga practitioners naturally come to know their most comfortable poses, which they can use as a touchpoint or resting pose when they need a time out during class. Trauma survivors can be quite disconnected from their bodies and sensations. Teach some common resting poses, with the instruction that they are welcome to come into these poses any time they need to during class. Depressed or dissociative students might find comfort in child’s pose, while hyper-aroused students might prefer an upright seated pose with their back against a wall, so they can continue to monitor what is happening in the room.
Inviting students to “take some time and follow your own flow,” or “do any postures that your body needs” runs the risk of losing students who are prone to dissociation. It is probably better to err on the side of more specific instruction, repeated often.
Trauma-Sensitive Language
Language commonly used in yoga class can be unwittingly provocative.  Here are some instructions to avoid, and suggested alternatives.
“I want you to….”  →      “If it’s comfortable/available to you…”
“Claw the mat like you’re trying to rip it in half”    →  “Plant/root your fingers into the ground”
“Stick your butt out” →  “move your hip creases back”
“Close your eyes” → “Gaze softly down at the floor in front of you, or close your eyes if you’d like”
“Nail your fingers/toes into the mat,” → “knit/root your fingers/toes into the fabric of the earth”
Tone of voice and clarity of instruction are also important.  Avoid the “yoga teacher whisper.”  Use simple, minimal wording and direct verbs:  “Bending your right knee…”  → “Bend your right knee…”
Trauma can result in a wide range of vulnerabilities and behaviors that might seem odd — to the survivor as well as the observer.  Understanding trauma as a mind-body reaction to extreme stress provides a framework within which these behaviors make sense.  For a more in-depth understanding, consult the resource list.  Emerson’s guide is particularly helpful for yoga teachers, and Peter Levine’s work is refreshingly jargon-free.
© Dr. Lauren Rubenstein, Calm Heart Integrative Wellness
Physical Expressions of POSSIBLE Dissociation and Emotional Triggers in Children
(from Gillen & Gillen, Yoga Calm)
Extreme resistance to particular poses (without a physical injury)
Holding a specific part of the body in an overly stiff or unnatural way
A military or rigid approach to poses
Holding the breath
A glazed or distant look in the eyes
An upward gaze
Extreme agitation
Inability to follow directions in a particular pose
An unwillingness to participate in relaxation poses
Extreme silliness or a flippant attitude about particular poses
Mindfulness: paying attention to inner and outer experience on purpose without judgment.
Stress response: a response to a real or perceived threat. The brainstem / reptilian brain triggers the survival response.  The experience creates new neural circuitry. Results in inability to self-regulate emotions.
4 kinds of resilience / strengths that can lead to post-traumatic growth
  1. Physical resilience:  don’t sit still.  Asana
  2. Mental resilience: will power works like a muscle. Take on a challenge, e.g. count backwards by 7 from 100.
  3. Emotional resilience: experience 3 positive emotions for every 1 negative.  Connection among class/group members
  4. Social resilience: derive strength from others. Gratitude; reaching out to others.  Touch: shaking hands for 60 seconds increases oxytocin.  Partner poses (if appropriate)
People who regularly boost these 4 types of resilience live 10 years longer.
I came across this free online dialogue series; have not yet listened to it: Dialogue Series, produced by Diana Justl realspirituality.com Psychological Integration Through Yoga. Listen to dialogues with leaders in the field of trauma research, yoga, somatic psychology and neuroscience.
Brief (weekend) kids’ yoga trainings:  Budding Yogis and YoKid
Brief trauma yoga training: YogaActivist. They place volunteer teachers in outreach settings.
You do not need to be a yoga teacher to attend these trainings!
Interview on Haiti work with Rob Schware of Give Back Yoga:
http://www.huffingtonpost.com/rob-schware/yoga-how-we-serve-haitian_b_1930905.html
Introductory steps for Yoga Nidra for children:
  1. Create an atmosphere that is quiet with dim lighting, but not dark. Shut off all electronics – even the low hum of a desktop computer can be distracting.
  2. Have the child lie flat on his or her back, arms away from body at the sides, palms facing up.
  3. Gently cover the eyes with a dry, warm washcloth.
  4. Start the relaxation process by asking the child to focus on his or her breath. On the inhale, ask the child to fill his or her body with a favorite color. On the exhale, release the color and the breath. Do this three times.
  5. Next, have the child tighten all his or her muscles at once, even making a fist, then release all at once. Do this three times.
  6. Ask the child to imagine something such as the sun, the moon, a star, sand, bubbles, or warm bath water.
  7. Starting with the toes, ask the child to imagine that whatever he or she chose above is touching that body part.
  8. Slowly move up the body: toes, ankle, foot, calf, knee, and so on for all the parts of the body. When the image touches the body part, it fills it with the light of the child’s favorite color.
  9. Move up the entire body to the head, which also fills with color.
  10. Give the child a minute or two (depending on age) to feel that his or her body is filled with color.
  11. Then, ask the child to roll to one side, remove the washcloth but leaving the eyes closed, and wait a moment before sitting in a cross-legged position. Then, open the eyes.
Sydney Solis:  SIMPLIFIED VERSION OF YOGA NIDRA FOR CHILDREN
Basic method of Beginning Yoga Nidra adapted for children
  • Preparation: find a quiet place with dimmed lights, but not total darkness. There should be no interruptions. Children should lie on their backs with arms slightly away from the body, palms facing up. I encourage children to cover their eyes with a beanie baby or a washcloth or even a sock – anything to cover the eyes and cut down distractions.
  • I use a small glockenspiel during relaxation, which really helps children focus and relax. I just play random notes to my liking. Children have told me how much they enjoy it, how much it helps them focus, even having the feeling of leaving their body.
  • Have children focus on their breath. Begin with three deep breaths. Inhale say “yes” to life, exhale, let go, and drop into the earth.
  • Tighten all body muscles, let go, and repeat 3 times.
  • Imagine a sun, the moon, being on the beach, something that they can visualize. Allow light from that sun or moon or their imagination to touch each body part as it is called out. Imagine it filled with golden, or silver light. Beginning with toes, proceed to name each body part, such as heel, ankle, entire foot, calf, knee, thigh, hips, stomach, chest, back, neck, shoulders, arms, elbows, hands, fingers, neck, chin, jaw, lips, cheeks, eyes, whole head, whole body.
FOR PRESCHOOL
    • Entire yoga nidra should not take longer than 2-5 minutes.
    • 1) Imagine the sun touching general body parts, feet, legs, hips, chest, arms, hands, neck, jaw, cheeks, lips, eyes, nose, ears. Whole head. Whole body. Relax.
    • Call out images, such as a rose, a candle, a tall mountain.
    • Make a suggestion such as “I am peaceful, I am relaxed, I feel safe.”
    • Return to silence.
    • Return awareness to the outside world, let them stretch, rock, roll over to their right side and rest before using their arms to get up.
    • Let children talk about their experiences and what they “saw and felt” within.
    • Have them draw pictures; make up stories around the images. Transcribe their words onto paper.
FOR K-2
a. Expand on Yoga Nidra by taking longer, such as 5-10 minutes total. Adding more body parts, such as back of knee, armpit. Imagining space between lips, space between eyelids. Space where body touches the floor.
b. Drop in imagery, such as a rose, a candle, a rushing river, and then tell a short story, such as the Cracked Pot or from the list below.
c. Drop in a suggestion, such as “I love myself,” I am whole and complete, I have value. My ideas matter.
d. Afterwards, allow silence.
e. Ringing a bell, bring children’s awareness back to room. Return awareness to the outside world, let them stretch, rock, roll over to their right side and rest before using their arms to get up.
f. Ask the children what they saw and felt. Ask children to journal, draw about feelings. Children can make up new stories, or relate their lives to the story.
FOR CHILDREN 8-12 YEARS OLD
10-15 minutes you go through more body parts. I also introduce left and right sides of the body at this age. Such as right toes, right ankle, right foot, right calf, and so on up the right side of the body, then to the left, then both arms or legs together and so on. On the face, take more time with the left eye, right eye, right eyebrow, left eyebrow, etc.
1) Visualization,
a. You can use a longer story or a fairy tale. The story and imagery, told in a soft tone, will keep them focused on the body through the imagination.
b. Or you can use longer guided imagery. For instance, have them imaging a treasure chest at the heart level. Ask them to decorate that chest with their imagination. Then they open it a crack, see the golden light peeping out. Feel the golden light. It touches the toes, body, etc. Open it more; see inside, what is there? What gifts do you have? Perhaps it’s helping your mother, or you are good at art and math, or you can make people laugh. Smile at those treasures. Make a wish for yourself, your family, your school, and the world. Imagine it coming true. Create your own visualization.
c. Cracked Pot. Ask children to see themselves cracked, something that they don’t like about themselves or. think has no value. Ask them to smile at themselves. I accept all of myself. I have value. All my gifts are special. I do not judge.
2) Allow for silence
3) Ringing a bell, bring awareness back to room. Return awareness to the outside world, let them stretch, rock, roll over to their right side and rest before using their arms to get up.
4) Ask them to share with the class
5) Ask the children what they saw and felt. Ask children to journal, draw about feelings. Children can make up new stories, or relate their lives to the story. Children can create their own visualizations.

The Cutting Edge of Trauma Treatment: Healing Through the Body by Nora Isaacs
The muscles elongate. The heart opens. The breath deepens. A yoga practice can help us feel more vibrant, agile, and connected. But for anyone who has experienced trauma, a body-based practice like yoga can also be a lifesaving healing technique. By releasing held tension, paying attention to the present, and regulating the nervous system, a somatic approach helps ease the feelings of helplessness, fear, arousal, and disconnection that can arise for trauma patients.
Traumatic experiences can take many forms—a car accident, a mugging, or abuse, to name a few. In the past, conventional wisdom led people to talk therapy for healing. But some experts say this isn’t enough.
“Trauma causes the body to be frozen in a state of fear, terror, and hypervigilance,” says Dr. Bessel A. van der Kolk, a clinical psychiatrist and founder of the Trauma Center in Brookline, Massachusetts and a leader in the field of posttraumatic stress. “So fundamentally, the effect of trauma is in relationship to one’s body. One’s body gives the signal that it’s not safe, and your body keeps fighting an existing enemy.”
Because trauma is so linked with the body, a growing number of people—led by van der Kolk—have been vocal advocates for incorporating body-based techniques into trauma recovery. And although yogis have understood the mind-body link for thousands of years, modern science is now catching up: cutting-edge brain scans have recently given neuroscientists the chance to more accurately understand the physiological effects of trauma on the body. With this knowledge, it’s clear that practices like yoga, Eye Movement Desensitization and Reprocessing (EMDR), and Somatic Experiencing can help unlock the body’s pattern of fear by allowing trauma survivors to become masters—rather than victims—of their own physiology.
Trauma 101
Some of us toss around the word “trauma”” lightly: “That meeting was so traumatic!” But for those who’ve experienced it, there is nothing lighthearted about it. “Trauma is a condition under which your body continues to get triggered into living an old situation as if you were back there again,”” explains van der Kolk, who has worked with many types of trauma patients.
According to Kripalu-trained yoga teacher Dana Moore, trauma runs on a continuum. Dana is a founding member of the Trauma Center Yoga Program and a faculty member of the Trauma Center Professional Training Institute who uses yoga, mindfulness, and counseling to help people overcome stress and trauma. On one end lies “Big T” trauma. Big T traumas, such as child abuse, physical or sexual assault, or a life-threatening medical procedure or car accident, pose “a threat to life or bodily integrity,” Moore explains. They can be single events, or things that happen over and over, such as chronic abuse. These experiences overwhelm a person’s capacity to tolerate the experience as it’s happening, and it’s common to get numb or disassociate during a traumatic incident. “The psyche shuts down, which is the body’s natural way of dealing with overwhelming stress,” explains Moore. “Often the result of a Big T trauma is that a person lives in a hyperaware, hyper-sensitive state to ensure that an intense life-threatening experience doesn’t happen again.”
People who’ve experienced Big T trauma include the combat soldier returned from war who builds a bunker in the basement or a 9/11 survivor who sleeps with a gun on the night table.
On the other end of the spectrum lie “little T” traumas, which include the universal stresses in life such as a breakup, job loss, big move, or minor traffic accident. While most of us experience these at one time or another, in some people they can trigger a significant stress response in the body. Moore uses the example of a significant breakup: although it’s hard on everyone, one person might grieve and then move on, while for another person it might trigger intense feelings of abandonment left over from early childhood.
Van der Kolk doesn’t focus on the cause of trauma in his patients. Instead, he is concerned with the effects of trauma—feelings of numbness and disassociation or a hyperaroused state, among others. In his decades of working with posttraumatic stress, he’s observed that many people turn to medication, drugs, food, and alcohol to deal with these states of being. But, of course, these external substances don’t address the root cause. To do this, he says, he aims to “get people’s bodies to function again.”
The Effects of Trauma on the Body
In order to get the body functioning normally, it’s helpful to understand exactly what happens physically when we are under stress. When the body feels threatened, it shifts into the “fight or flight” response, the evolutionary reaction that gets us ready to fight the proverbial tiger at our backs. As the body goes on red alert for danger, the heart rate increases, blood pressure rises, and stress hormones like cortisol and adrenaline flood the body.
During a traumatic experience, the body goes through even more profound changes. These changes have become clearer over the past five to seven years because of breakthroughs in brain scans like functional magnetic resonance imaging (fMRI), which enables scientists to look at how the brain functions in real time, rather than just taking a still photograph. “Only now are we getting a really deep understanding of how trauma impacts the body,” says Moore.
A key finding from these brain scans is that during traumatic stress, the speech center shuts down—one reason why many people cannot completely put what happened to them in words. ”This is why talk therapy is limited in helping someone recover from or heal from overwhelming stress,” says Moore.
Scans also show that the part of the brain responsible for experiencing what happens in the present moment—the medial prefrontal cortex—shuts down during stress. (On the other hand, Moore cites research conducted at Harvard on mindfulness meditation, where the medial prefrontal cortex lights up.) Yet another enlightening finding from scans shows that people who’ve experienced trauma have more difficulty processing information than those who haven’t. All of this information is helping the trauma community better understand—and help—those in need.
How Yoga Can Help
Because trauma has so many physical effects, it’s clear to van der Kolk why it’s important to move beyond simply talking: “It’s great to be able to put your feelings into words,” says van der Kolk, “and feeling that somebody understands your suffering is enormously comforting. But it doesn’t make your body know that you are safe. The real method is resetting your physiology.”
Van der Kolk says that yoga is an ideal method to do this. “Yoga really attends to the body and the breath, attends to stillness. It allows you to feel everything you feel, to tolerate every sensation, and to live and move with it.”
To this end, he recommends yoga in conjunction with working with a person who has special training in trauma therapy. “None of my patients have been able to tolerate a yoga program if they weren’t in therapy at the same time. Too much painful stuff comes up.”
Because a common outcome of trauma is hyperarousal—the gun by the bed, the bunker in the basement or, in less extreme cases, an intense reaction to a loud noise like a car backfiring—a gentle, trauma-sensitive yoga practice offers the opportunity to experience a change in mental states. “They can shift from hyperaroused to feeling relaxed, and that is very profound for them, even more so than the average population,” says Moore, who teaches yoga to trauma patients. “They can feel what it’s like to be ‘normal’ again.” He adds: “Then after yoga practice, they are able to say, ‘This is how I want to feel all of the time.’” Because yoga is nonverbal, it can help those people who experience the shutting down of their speech center. Even though they don’t talk about it, they can use their body as a means of self-expression.
And the simple act of moving the body can create a major sense of accomplishment for people whose bodies have been frozen or numbed by their experiences. Many people who’ve been through an overwhelming experience like a car wreck feel like victims of circumstances. “When they can move the body in a purposeful way, they cultivate an internal locus of power,” says Moore. “They can say, ‘I can act in my own best interest,’ or ‘I can determine the kind of experiences I have.’”
Overall, van der Kolk says that a somatic approach can radically alter the body’s physiology: “It can rewire your brain stem, and change the fear system in your brain. It can regulate the balance between the sympathetic and the parasympathetic nervous systems and activate the cranial nerves so your body doesn’t respond to everything as if it’s getting hurt.”
A New Frontier
Of course, yoga isn’t the only body-based therapy for releasing past trauma. “Overcoming trauma is learning how to regulate your own psychological system, and there are many ways to do that,” says van der Kolk. Other somatic techniques helpful for trauma include Somatic Experiencing, Sensory Motor Therapy, Hakomi Method, EMDR, and Internal Family Systems (IFS) Therapy. As more research is done on trauma, somatic therapies like these just might move to the forefront of trauma recovery.
Whether a person chooses yoga or another method, it’s important to find a skilled practitioner to work with, to move slowly, and to stick with it. What we know now that we didn’t know 40 or 50 years ago is that healing from trauma is possible. And for many the secret lies in accessing that healing through the body. “To feel what you feel and know what you know in your body, can go a long way toward healing,” says van der Kolk.
Nora Isaacs, a former senior editor at Yoga Journal, is a San Francisco-based journalist who writes about health and spirituality and is the author of Women in Overdrive: Find Balance and Overcome Burnout at Any Age.
© Kripalu Center for Yoga & Health. All rights reserved. Originally published in the Summer 2009 issue of the Kripalu catalog. To request permission to reprint, please e-mail editor@kripalu.org.

Reading List:  Psychological trauma
Cope, Stephen (1999).  Yoga and the Quest for the True Self. NY:  Bantam Books.
Emerson, David (2011). Overcoming Trauma through Yoga
Emerson, David (2009).  Toward Becoming a Trauma-Sensitive Yoga Teacher: A best practices guide from the trauma center.  Order from www.traumacenter.org.
Fisher, Janina, “The Work of Stabilization in Trauma Treatment”; “Addictions and Trauma Recovery.”  www.janinafisher.com/resources.php
International Society for Traumatic Stress www.istss.org
Levine, Peter A.  In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness.
Healing Trauma (includes CD). Boulder: Sounds True
Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences.
Ogden, Pat (2006).  Trauma and the Body New York: WW Norton
Rothschild, B. (2010).  8 Keys to Safe Trauma Recovery.  New York: WW Norton (2000).
The Body Remembers: The psychophysiology of trauma and trauma treatment. New York: WW Norton. (2003).
“Applying the Brakes.”  Family Therapy Networker.  Available at Home.webuniverse.net/babette/brakes.html . Website with newsletter at http://www.8keys.webs.com/
Scaer, Robert (2001). The Body Bears the Burden: Trauma, Dissociation and Disease. Binghamton: Haworth Press.
Schiraldi, Glenn R. (2000).  The Post-Traumatic Stress Disorder Sourcebook.  Los Angeles: Lowell House.
Talbot, Margaret (2009).  A Reporter at Large, “Nightmare Scenario,” The New Yorker, November 16, p. 43.  http://www.newyorker.com/reporting/2009/11/16/091116fa_fact_talbot#ixzz187d4DC8E
Trauma Center at Justice Resource Institute.  “Developing Trauma-Informed Services for Families Experiencing Homelessness: An Interactive DVD and Guide.”  Order at http://www.traumacenter.org/products/homelessness_video.php
van der Kolk, Bessel, “The Body Keeps the Score: Memory and the Evolving Psychobiology of Post-Traumatic Stress Disorder.” www.trauma-pages.com
van der Kolk, Bessel et al. (2006).  “Clinical Implications of Neuroscience Research in PTSD.” [Includes results of study using yoga to change heart rate variability.]  Annals of N.Y. Academy of Science 1071:277-293.
(2007).  Traumatic Stress:  The effects of overwhelming experience on mind, body, and society.  Guilford Press
Wills, Denise Kersten .  “Healing Life’s Traumas.”  Yoga Journal, June 2007.  www.yogajournal.com/health/2532 .
Working with Children
Gillen, L., & Gillen, J. (2007). Yoga Calm for Children: Educating heart, mind and body. Portland, Oregon: Book Printers Network. This book, written by a school psychologist and a yoga teacher, positions yoga as an ideal tool to help students understand and work with socio-emotional learning.  The substantial curriculum makes it ideal for the K-8 teacher.
Murdock, M. (1987). Spinning Inward: Using guided imagery with children for learning, creativity and relaxation. Boston: Shambhala. Basic meditations and visualizations to enhance learning. One of the first books to ground learning in the five senses.
Viegas, Marneta (2004). Relax Kids: The Wishing Star: 52 Magical Meditations for Children, Ages 5+. Out of print but still available.
Please don’t hesitate to contact me if I can answer any questions. DrLaurenRubenstein@gmail.com 301.928.9606

Yoga and adhd

https://m.youtube.com/watch?v=TjuXMPHtPkA

http://m.additudemag.com/?url=http%3A%2F%2Fwww.additudemag.com%2Fadhd%2Farticle%2F6564.html&utm_referrer=#2729




ADD’s core symptoms include inattention, difficulty following directions, poor control over impulses, excessive motor activity in many but not all cases, and difficulty conforming to social norms. But low intelligence is not among these, despite the fact that ADD can hamper learning. On the contrary, a great majority of those diagnosed enjoy above-average intelligence. 

The Yoga Connection
It’s important to realize, though, that while yoga may help those with ADD, it is not a miracle worker. It requires time and discipline--—concepts that can be difficult for those with ADD to master. In many cases, it takes a year or more for the effects of yoga to make any difference, while medication works in minutes.

But the benefits of medication wear off along with the prescription. The effects of yoga, —which include suppleness, poise, and better concentration—are much longer lasting: They develop gradually through a type of learning that transforms the entire person. There is no learning or transformation involved in taking a pill.
The asanas helped reduce her pain and yielded a surprising side effect: Her symptoms of ADD improved too. “I noticed that standing postures put me into the perfect mental state for listening and learning,” she says. So Askew began standing in Tadasana (Mountain Pose) at the back of the classroom. “It gave me something to do with my energy, besides fidgeting,” says Askew. “It helped me stay in the academic moment.”
 yoga provides several benefits for those with ADD:
  • SELF-AWARENESS. People with ADD lack it, notoriously underreporting their own symptoms. The ADD brain, struggling with an overload of sensory stimuli, lacks the mental space for introspection. By emphasizing physiological self-perception, yoga strengthens self-awareness, which can represent the first step in self-healing. “I used to feel hyper-aware of everything but myself,” says Askew. “But yoga helped me get comfortable within my own skin.”
  • STRUCTURE. Many with ADD leave considerable creative potential unfulfilled because they can’t seem to organize their creative energies. Therefore, positive, life-enhancing routines that establish order can be a very important part of ADD management. Systematic patterns of movement help organize the brain. A highly systematized approach, like Ashtanga Vinyasa Yoga, for example, provides consistent, reliable patterning along with the progressive challenges that ADD people require to sustain long-term interest in an activity.
  • COORDINATION & PHYSICAL FITNESS. Children with ADD frequently miss out on physical education—not because of physiological limitations but because their inability to “play by the rules” makes them anathema to coaches and unpopular with their peers. Consequently, ADD kids don’t develop the same level of physical coordination as other children. Therapists often recommend martial arts for their ADD patients because it offers a disciplined, athletic outlet without the pressures of a team sport. 
    Yoga, though, goes one step further, providing physical fitness without competition. The relative safety of yoga allowed Askew to explore her body and gain a sense of physical self-confidence, thus shedding the feeling of awkwardness she’d suffered most of her life. “Having my posture in alignment makes it easier to move in a fluid way, shifting attention without stress,” she says.

One Child’s Class
It takes a special yoga teacher to work with ADD kids. “The teacher must have access to a variety of specialized techniques for dealing with anger, distractibility, and impulsivity, as well as a solid foundation in yoga,” says Sonia Sumar, author of Yoga for the Special Child (Special Yoga Publications, 1998). Sumar trains and certifies yoga teachers, like Randolph, to work with developmentally challenged children. Randolph combines Sumar’s special education approach with 30 years of hatha yoga practice in her classes with Clayton.
She works patiently, often one-on-one for several months, before integrating a child with ADD into a group setting, which includes two or three kids at the most. “These kids can be very intense,” says Randolph. “A yoga teacher who works with children with ADD must develop patience, boundless energy, and a keen focus herself. These children need someone who can think faster and more creatively than they do; otherwise, they soon get bored.”
Every Thursday, Clayton steps into Randolph’s studio at The Yoga Center in Reno, Nevada. “Sometimes it’s a struggle to get him there,” says his mother, Nancy Petersen, “but in the end, he’s always glad he went.” Children with ADD struggle with transitions, so Randolph enlists a brief ritual, including candles and incense, to help Clayton shift into yoga mode. The structure of Clayton’s classes generally follows the same basic pattern every week, with a few alternating poses chosen for variety.
ADD children do best in a well-organized environment, as their internal sense of structure lacks coherence. The Yoga Center has a sunny room with large windows and mirrored walls, but Clayton’s classes take place in Randolph’s basement studio, where the ivory-yellow paint and sienna carpet keep distractions to a minimum. Since the ADD brain functions too slowly while processing sensory information, concentration comes more easily when the stimulation level remains low.
To encourage body awareness, Randolph begins by asking Clayton how tight his body feels and how much warm-up he needs. Depending on the answer, Randolph begins with Suryanamaskar (Sun Salutation) in either a 12- or 28-posture sequence. This cycle challenges Clayton’s ability to focus and helps increase his attention span. Learning a complex series like Sun Salutation “recruits a lot of nerve cells in the prefrontal cortex,” says Ratey. “The brain is like a muscle: When you strain it, you strengthen it.” But purely intellectual endeavors, like learning multiplication tables, don’t promote what Ratey jokingly calls “neurological Miracle-Gro” to the extent that complex movement patterns do.
Following Sun Salutation, Randolph leads Clayton through a succession of forward bends, lateral bends, triangle poses, and backbends. In addition to their psychological benefits, these yoga poses help children with ADD learn to coordinate their bodies in space, which is important since they tend to have higher injury rates than their peers. Similar to the work of a physical therapist, carefully performed asanas engage alignment, balance, and coordination to train a child’s sensory-motor system.
Balancing poses like Vrksasana (Tree Pose) are Clayton’s favorites, and he frequently practices them outside of class. Says Randolph, “Kids gravitate toward play that involves balance,” such as skateboards, pogo sticks, swings, merry-go-rounds, and tumbling, because it excites what physiologists call the vestibular system. The inner ear’s vestibular system allows you to judge your position in space and informs the brain to keep you upright.

But beyond its role in physiological equilibrium, researchers are discovering that the vestibular system plays a vital role in behavioral and cognitive stability. “There’s
a fundamental kind of coordination that patterns behavior so it makes sense and flows together, which is believed to be deficient in those with ADD,” says Eugene Arnold, M.Ed., M.D., an ADHD specialist at Ohio State University and formerly with the National Institute of Mental Health.
To this end, Randolph employs asanas like Tolasana (Scales Pose) and an exercise she’s dubbed Roll Asana, in which the student rocks back and forth on the floor like a teeter-totter. Each new position in yoga provides a different plane of stimulation for the neurological circuits of the vestibular system. Inverted positions, such as Sirsasana (Headstand) and Salamba Sarvangasana (Supported Shoulderstand) are especially beneficial because they also calm the nervous system and help curb hyperactivity while training the attention system. Near the end of class, Randolph guides Clayton through a series of relaxation poses to calm his breath, quiet his mind, and prepare for meditation. Meditation lasts approximately one minute—which can seem like a lifetime for ADD children.
After four months of yoga, Clayton can finally complete a half-hour yoga session, flowing from one posture to the next with minimum interruption. Though Clayton’s significant progress in yoga has not yet translated into better concentration at school, it’s difficult to imagine that the focus he has developed in yoga would
be confined to the sticky mat. On at least one occasion, Clayton says he used techniques learned in meditation to train his attention during a mathematics exam. On another, his mother spotted him practicing Bakasana (Crane Pose) in the outfield during Little League—although, unfortunately, he wasn’t paying much attention to the game.
His yoga teacher accepts this gradual pace as a fact of life. “Quieting the mind is a long haul for any of us,” says Randolph. “It can be an epic journey for those with ADD, but they need it most.” Talking with Clayton about his yoga practice, one gets the sense that he’s found something important and personal at which he can excel—a refuge for his spirit and a tool for establishing harmony between his body and mind.

After several years of yoga, Askew knows it takes that kind of full-time commitment to manage the symptoms of ADD. Maintaining a healthy lifestyle that includes yoga has helped Askew cope with her condition. It gives her confidence to know she can gain mental clarity on her own—without a pill. “Yoga,” says Askew, “involves learning how to manage attention and learning how to move fluidly from focusing on the details to the big picture.”


Managing ADHD symptoms with "Breathing"? ---Pranayama

Studies suggest that rhythmic, deep breathing can balance the autonomic nervous system, which helps individuals with ADHD become more attentive and relaxed.


1. Several studies show that rhythmic, paced breathing balances the autonomic nervous system
-- Controlling your breathing can help you become more attentive and more relaxed at the same time.
Many of Brown’s ADD patients have benefited from coherent breathing -- a term coined by author and yoga specialist Stephen Elliott because the technique synchronizes heart, lung, and brain rhythms.

2. Your autonomic nervous system (ANS) has two components: a stress response and a recharge response. Attention deficit adults and ADHD children have nervous systems that are out of whack: Most of the time the stress and recharge responses are under-active. But when an ADDer’s stress response kicks in, it goes into high gear, compared to those who don’t have the condition. 
--For your brain to work better -- and for you to be less impulsive and hyperactive -- both components of the ANS need to work optimally and in the right balance. Coherent breathing can help accomplish these goals.
--The heart, lungs, and blood vessels work more efficiently, delivering more oxygen to the body’s tissues and the brain. Parts of the brain that deal with complex problems begin to function better. Typically, you see a big change in brain-wave patterns -- meaning more healthy alpha waves and fewer sleepy delta waves.(with metered breathing)

Deep Breathing


Train Your Child's Brain to Focus
Interactive Metronome Technology 
meditation and working-memory training can improve attention and focus across the board.

Neurofeedback

What it is:Neurofeedback is an alternative ADHD treatment that uses brain exercises to reduce impulsivity and increase attentiveness.
How it works:Neurofeedback is based on a simple principle: training the brain to emit brain-wave patterns associated with focus (as opposed to those waves associated with day dreaming. The result: Some ADHD symptoms — impulsivity, distractibility, and acting out — are less detectable.
Treatment:First, a practitioner takes a detailed history of the patient and then maps the patient's brain by having him wear an electrode-lined cap while performing a complex cognitive task, such as reading aloud. The brain activity is fed to a computer, which then maps the areas of the brain where there is too much or too little brain-wave activity — the sources, theoretically, of the patient's ADHD symptoms .
The patient then trains those areas of the brain that are under-aroused by controlling a computer or video game by producing short bursts of sustained brain-wave activity in the target areas. The games only run when the patient exercises that portion of the brain that is deficient in focus .
Cost:While sessions are brief (approximately 30 minutes) and painless, they are expensive. The average course of treatment can range from $2,000 to $5,000.

Working Memory Training

What it is:Training that aims to build up those areas of the brain that hold onto information long enough to accomplish a specific goal. For example, you hold a phone number in your mind as you dial it, or you hold the task at hand in your mind —organizing your room, say—as you work on it.
How it works:When you improve working memory, you improve fluid IQ—the ability to solve problems or adapt to situations as they occur.
Treatment:The patient logs on to the working-memory program, such as the software developed by Cogmed , which is downloaded on his home computer. He completes eight exercises that vary from shooting down floating asteroids to recalling numbers in the reverse order in which they are given. The program stays a step ahead of the patient's ability, making exercises increasingly harder. A trainer calls once a week to talk with the parents, troubleshoot, and encourage the patient.
Cost:The training runs five weeks, five days a week, an hour a day. It ranges in price from $1,500 to $2,000, and it is not covered by most medical insurance plans.

Considerations and Benefits of Working Memory Training

Things to keep in mind:
-- The training is rigorous, so few children under seven can stick with it. Children recently diagnosed with ADHD should have their medication adjusted before beginning training.
-- The program does not claim to replace medication. While many kids get good results on meds, drugs don't usually manage all ADHD symptoms . Improving working memory can address those problems.
Benefits:
-- About 75 to 80 percent of kids show improvement in inattention and hyperactivity. Kids also become more alert to their surroundings. They are also more aware of social cues. Learn about the age-by-age working-memory 'milestones' here. 
-- Parents often report that their kids become more "mature." They take charge of their hygiene and do chores without being nagged. They remember to bring books and materials to and from school.
-- Studies have found that at six-month and one-year follow-ups, about 80 percent of subjects maintained their working-memory gains or improved on them.

Meditation

What it is: Mindful awareness , or mindfulness involves paying close attention to your thoughts, feelings, and bodily sensations; in other words, developing a greater awareness of what’s going on with you from moment to moment. It can be used as a tool to foster wellness, especially psychological well-being. Similar techniques have been used to lower blood pressure and to manage chronic pain, anxiety, and depression .
How it works:Meditation improves your ability to control your attention . In other words, it teaches you to pay attention to paying attention. Mindful awareness can also make people more aware of their emotional state, so people with ADHD won't react impulsively as often.
Treatment:The basic practice is very simple: sit in a comfortable place and spend five minutes focusing on the sensation of breathing in and breathing out—pay attention to how it feels when your stomach rises and falls. If your mind wanders to something else—your job or some noise you just heard, label these thoughts as "thinking," and refocus your attention on your breath.
This practice should be done daily, and every couple of weeks patients should increase the length of time spent on the exercise—up to 20 or more if they feel they can.
Apply the same thinking throughout each day, focusing on your breath for a few minutes as you walk from place to place, or when you're stopped at a red light or sitting at the computer. The meditation sessions are important practice, but the key is to use mindfulness throughout your daily life, always being aware of where your attention is focused while you are engaged in routine activities. For example, you might notice while you drive that your attention wanders to an errand you must run later that day. Lots of people practice mindfulness while eating. Once you get used to checking in with yourself and your body, you can apply the technique anytime you start to feel overwhelmed .
Training centers can also help explain these basic concepts, and keep you on track.
Cost:$0 if you do it on your own, but training programs and books are available for purchase.

Benefits and Considerations of Meditation

Things to keep in mind:
-- It's the nature of the mind to be distracted . Mindful awareness isn’t about staying with the breath, but about returning to the breath. That's what enhances your ability to focus. And this emphasis on re-shifting your attention, of outwitting the mind's natural tendency to wander, is what makes experts think this technique could be especially helpful to ADHD children and adults.
-- With a long history but little scientific data on its effects, more research is still needed to confirm these early findings.
Benefits:
-- Some studies show promising results with significant improvements in both inattention and hyperactivity for ADD and ADHD adults.-- In cognitive tests, the participants got better atstaying focused , even when different things were competing for their attention. Many of them also felt less anxious and depressed by the end of study.

Attention Training in School and Beyond

If focus skills can be groomed, as research has begun to hint, the important next question is whether, and how, attention should be integrated into education. Will attention become a 21st-century 'discipline', a skill taught by parents, educators, even employers? Already some educators are showing interest in attention training, mostly through the practice of meditation.
But with the field of attention training still in its infancy, scientists don't know whether any current teaching brings long-lasting gains—or, for that matter, which practices work best. Nonetheless, with global use of ADHD medications tripling since the early 1990s, and evidence mounting that attention can be strengthened, researchers are permitting themselves cautious excitement at the prospect that attention training could work.
Portions of this article were adapted from an article that originally appeared in The Boston Globe .

Forget the Lotus Position: How to Meditate — ADHD Style

ADHD brains love adrenaline. For some, this means trying sky diving and roller derby. For others, it means seeking out stress and drama, which are even tougher on the body. Meditation can counteract these stresses; here's how to do it right.

ADHD girl in the woods, looking up at the sunlight
If you have spent a lifetime with a pinball machine in your brain, it is hard to imagine yourself peacefully sitting in the lotus position.
 — Kate Kelly and Peggy Ramundo, ADHD coaches
If you come to us as a coaching client, we will mention the "M" word to you.
Meditation, that is. Most ADDers we encounter seem to be allergic to the word. So were we, until we had calmed down, with the aid of medication and other self-care techniques . If you have spent a lifetime with a pinball machine in your brain, it is hard to imagine yourself peacefully sitting in the lotus position.
The big secret, which nobody seems to clue ADDers in on, is that you don't have to sit in the lotus position at all...you don't even have to sit down to meditate or (thank God!) stop moving. You don't need a mantra, a guru, or notes from your trek to India to do the meditation thing correctly.
It's not possible to fail at meditation. It is astonishing how many of our clients have told us that they tried meditation and found it frustrating . These clients thought that if there was a lot of activity going on in their brains, they were not doing it right. In fact, everybody has a lot of stuff going on in their brain most of the time. Buddhists refer to it as "monkey chatter."
We believe that meditation is critical for ADDers. We pick up some habits in compensating for ADD that serve us poorly in the long run. One of the worst is the habit of running on adrenaline. This is how it begins: Early on, we discover that excitement wakes up our sleepy brains. We then, without conscious thought or choice, arrange our lives in such a way as to keep some crisis happening on a regular basis. We scare ourselves (by waiting until the last minute to do something), we create excitement. We are hooked on drama and having lots of things to do — and we beat ourselves up over nothing. Why? Because it is stimulating.

Why We Must Slow Down

ADDers can become addicted to adrenaline. But waking up our sluggish frontal lobes with an injection of stress has consequences for the body. When we are stressed, adrenal hormones raise our heart rate, blood pressure, and blood sugar. They also dampen the immune system. The adrenaline junkie is, in effect, paying for focus at high interest rates. Yes, you get a few hours of higher performance, but you pay for those hours in stress on your brain and body.


It is possible for ADDers to have a peaceful, still mind . We have been in that pleasant place called peaceful, and we like spending as much of our time there as we can. We promise that you can go there, too. Here is your road map and tools for the journey.

Breathe In, Breathe Out

1) Repeat to yourself a thousand times(or as often as necessary): "Meditation is a practice. I intend to enjoy and learn from the experience. There are no wrong ways to do it, and I will refrain from grading myself."
2) Get comfortable.Many meditation books and teachers warn you to avoid getting too comfortable, because you might fall asleep. Our thought is that if you fall asleep, you probably need to sleep. If you got relaxed enough to fall asleep...terrific! If you are concerned that you will sleep the day away and miss work, set an alarm.
3) Find your own comfort zone.Getting comfortable for you might involve standing on your head or lying in your bed — you are the best judge of what works for you. No meditator needs the additional distraction of physical discomfort.
4) Take slow, even breaths .Don't worry if you begin in out-of-breath mode. As you relax, your breathing will slow naturally.
5) If you are in full, high-speed adrenaline mode,you won't be able to stop on a dime, change gears, and get into meditation mode. When you have calmed your system through meditation and a meditative approach to life, going to a deep state of relaxation will not be such a major transition. In the meantime, take time to settle down before you meditate. A hot bath might do the trick, or listening to soothing music. Set a timer for a wind-down ritual. Put your planner and your "to do" list away; get into comfortable clothing.
6) Use sensory cues to move from one mental state to another.You might wear a special hat, sit in a special chair, or play certain kinds of music to make your transition to meditation.
7) Choose a focus for yourself,something to listen to or watch while you meditate. Some people pay attention to their breathing, while others repeat a word or phrase in their minds. You can make it up. One of our favorites is "let go." You can also use a visual focus, such as a candle flame.
With ADD, some of us are more visually distractible, others are more distracted by sounds. Find out what works best for you.
8) You can also use music as your focus.Steven Halpern's music is especially good for meditation. We recommend that any music you choose be instrumental — it is too easy for you to get caught up in lyrics.
9) Don't "should" yourself.Some ADDers do fine sitting or lying down, but many of us get unbearably restless when we are required to be still for any length of time. Don't "should" all over yourself if you have a higher need for activity than someone else. Instead, work with it.
10) Moving meditation is as good as the sitting variety.It is a better choice for the active ADDer. You don't need the additional distraction of an antsy body when your goal is to calm the mind. We recommend that the activity you choose for meditation be something simple and repetitive, like walking.
11) It's time to meditate.The thoughts in your head may still be clamoring for your attention. What do you do? When you notice your attention drifting toward that thought salad, gently disengage your attention and bring your mind back to your focus. At first, and especially on those bad brain days, you will repeat this process a lot.


12) Stick with it.Meditation will get easier as you go along. The key to success is to take it in small bites. Meditate for five minutes a few times a day. As you become more comfortable doing it, you will want to increase the length of your sessions because they have become so enjoyable. And soon you will begin to see meditation's benefits.
13) When you have gotten into the meditation groove,you can attain a state of deep relaxation more quickly. Sometimes a few deep breaths will do the trick. When the workplace or a social situation is getting you into a tizzy, you can retire to an empty conference room or the men's or women's room and "take five" to get centered.
14) Remind yourself why you are meditating.It is not to clear your mind, but to step back from the noise , to put your attention on your chosen focus. 15) You may need to medicate before you meditate.The right dose of stimulant medicine can turn the brain noise down to acceptable levels.
16) Make it a routine.Yes, but don't ADDers have trouble sticking with a routine? There are ways around it. Get an ADD coach to keep you on track. A good coach will help you achieve your goals without blaming you if you fall short.
Accountability is not about guilt or failure. It is about not letting the goal drop, working to accomplish it, and celebrating little victories as well as big ones. If you forget to practice meditation for days, or even weeks, you can get back on the horse at a better time. That's what we did.