Addressing Workplace Vicarious Trauma:  A New Way with Trauma Sensitive Yoga

Understanding Trauma

Trauma is an experience of not being able to live in the present moment.  The central and peripheral nervous systems trigger either fight or flight or dissociative responses, as a means of escaping threatening experiences that are unbearable in the present tense.  As a result of traumatic experiences, the mind becomes hypervigilant toward the future, informed by fearful memories from the past, in order to cope with any potential next threat. In the case of complex, recurrent trauma, such survival tactics, over time, become biologically hardwired and keep one out of the here-and-now.  The trauma victim becomes cut off from their present moment experience in the body.  With repeated inflicted trauma or chronic unmet human needs, power is taken away from the trauma victim, as they lack control over their own sensory bodily experience. This disembodiment and disempowerment become the hallmark of the trauma experience and targets for therapeutic intervention. 

Bearing witness to traumatic experiences is a vivid part of the day-to-day work in the field of child welfare as well as in many medical settings.  Identifying, seeing, treating, interviewing, and supporting a child who has been neglected or abused, or a suffering patient, can be traumatic to the care provider.  Trauma in the workplace may be experienced as primary, when a medical provider, child welfare clinician, social worker, interviewer, detective, or attorney experiences a direct threat during a client interaction or neighborhood experience.  More commonly, traumatic experiences in such settings are secondary or vicarious, defined as heightened distress due to exposure to another’s traumatic suffering.   Vicarious trauma (VT) may occur from direct care of others or hearing about traumas through professional venues, such as peer review, debriefs, record review, or clinical rounds.   Factors such as exposure severity, high trauma caseload, unpredictability, lack of supervisory support, personal stressors, or having one’s own trauma history can exacerbate VT.

The symptoms of VT vary widely.  Without self-awareness they may go unnoticed, yet significantly impact one’s own health and even quality of work.  VT may manifest as irritability or mood changes such as depression or anxiety.  However, a range of emotional responses are possible, including anger, sadness, fear, guilt, or even apathy.  The distress of VT, like other traumatic stress, can challenge staying in the present moment.  VT is a guttural response and somatic complaints are common.  Gastrointestinal or musculoskeletal complaints, including nausea or back or neck pain for example, can persist and become chronic health problems.  Other possible symptoms of VT include hypervigilance, avoidance, cynicism, sleep difficulties, and concentration problems.  Overall, VT is a sort of “gut reaction” to bearing witness to another’s trauma, and in this way is fundamentally held in the body, often as physical ailments.  Many traumatic experiences shared in child welfare or medical settings are so egregious they are unthinkable, and words cannot do justice.  These experiences become memories, stored in the body, not unlike intrinsic memories of the survivor of early life trauma.  

VT stems from compassion for another’s suffering and should be honored as such.  VT becomes exacerbated when the care provider feels helplessness –again, not unlike the primary trauma victim experience.   Both survivors of primary trauma as well as providers affected by VT may experience altered expectations of the world as unsafe and unjust.   Oppression that perpetuates trauma also intensifies VT and can limit seeking care despite impaired functioning and health. 

Trauma Sensitive Yoga

Trauma Center Trauma Sensitive Yoga (TCTSY) is a body-based healing modality for complex trauma that offers a re-experiencing of presence in the body that is safe and empowering.  The theoretical underpinnings include trauma theory, neuroscience, and attachment theory.  Complex trauma is a relational attachment-based experience, often involving a coercive power dynamic between a child and caregiver.  As such, TCTSY theory supports that healing as well must happen through relationships that are non-coercive and instead, empowering for the trauma survivor.  The delivery of TCTSY by a certified Facilitator serves to do just that.

The neuroscience that supports TCTSY for complex trauma is based on our understanding of interoception, internal sensory awareness that becomes blocked in the survivor of complex trauma.  Interoception involves autonomic neural pathways from the skin, joints, muscles, gut, and lungs that get processed in a different part of the brain than external stimuli.  Whereby sensations inputting from the external environment travel to the somatosensory cortex, interoceptive visceral sensations are processed through vagal afferent neurons to the insula cortex of the brain.  In short, interoception is a basic survival system to inform the brain about the body’s internal state.  In a trauma-exposed individual, interoceptive capacity becomes altered, due to the need to focus on threat from the external environment in order to prioritize survival.  These neural pathways which signal basic needs such as hunger or pain, may be ignored and underdeveloped in the experience of abuse or neglect.  This also alters one’s sense of worthiness and personal identity, when interceptive needs are repeatedly ignored in the case of the maltreated child. The practice of TCTSY aims to re-establish interceptive pathways through opportunity for present moment sensory awareness in the body.

The five core elements of TCTSY practice include empowerment, choice making, present moment experience, shared authentic experience, and non-coercion.  The practice aims to allow the participant to reclaim their body, through their own choice-making and interoceptive awareness.  Agency and empowerment are gained by honoring that each individual knows best how to calibrate their own healing through the practice.  The process is supported by a relational shared experience between the facilitator and participant, that is non-coercive and predictable to maintain safety.  The practice aims to restore power and control to the individual as much as possible, empowered through neutral choices offered throughout the practice, to enable formation of new connections in a safe context.

 In a landmark randomized controlled trial in 2014, TCTSY was shown to be effective at reducing PTSD symptoms in adults also receiving verbal therapy. ¹ Sixty-four women with chronic PTSD were enrolled in the study, assigned randomly to either trauma sensitive yoga for one hour weekly for 10 weeks, or an equivalently timed health education class as control.  The study showed that the yoga intervention significantly reduced PTSD symptomatology, with effect sizes comparable to other psychiatric approaches. 

 Another qualitative study adds to our understanding of the value of TCTSY for the individual who has experienced trauma.²  This study 31 adult females with PTSD due to childhood trauma after trauma sensitive yoga weekly for 10 weeks, Themes identified included compassion and gratitude, acceptance, centeredness, and empowerment.  Although more research is needed, these studies support that TCTSY can be greatly beneficial for individuals who have experienced relational trauma.

Theoretical support for TCTSY for VT

TCTSY for VT is theoretically grounded based on several principles.  Firstly, TCTSY is beneficial for healing trauma that occurred in the context of caregiver or partner relationships.  Similarly, VT occurs in the context of relationships–that is, the relationship between the professional offering care and the patient or client.  According to trauma theory, healing of relational trauma needs to occur in the context of relationship as well.  In TCTSY the facilitator and participant engage in a shared authentic experience that supports a shift toward relational safety.  A shared practice may be beneficial for VT as well, not only because it offers a safe space for healing but challenges the culture of silence around addressing emotions that come up in the workplace, countering feelings of isolation. 

 A second point it that TCTSY is a mindfulness practice, which has been proven beneficial for workplace stress and VT.  During exposure to a traumatic experience, the natural tendency is to leave the present moment to gear up for the next moment’s threat.  It is human nature to shift away from feelings of distress from VT as well. Yet healing and integration happen in the present moment. Similar to the benefits of TCTSY for complex trauma, offering an opportunity to re-experience the present moment as safe, professionals experiencing VT may benefit from processing stuck emotions that are accessed for healing through present moment awareness.

 The third reason TCTSY may benefit those with VT symptoms is the fact it is a body-based modality.  Like primary trauma experiences, VT often presents as a guttural response after exposure to an unthinkable tragedy.  Physical ailments are common with VT, and a body-based therapy may be targeted to such symptoms.  

 The fourth point is that, like the disempowerment experienced by survivors of complex trauma, VT often arises from feelings of helplessness and lack of agency in the workplace.  TCTSY may help by grounding the participant in their own decision-making and self-efficacy.

 The fifth point why VT symptoms may be addressed well with TCTSY practice is that talk venues, such as debriefing or peer review, may not be helpful, and at times can be re-traumatizing.  TCTSY may be complementary to low-impact debriefing approaches.

Confronting and accepting the rewards and challenges in our work in child welfare and medicine, is not an easy task, but a necessary part of trauma stewardship.  Addressing symptoms of VT that will inevitably come up in our careers, is necessary for well-being and longevity in the field. Identifying, seeing, treating, and supporting suffering of others in our work can inform a crossroads toward vicarious suffering or vicarious transformation, depending on how it is processed and integrated into the whole Self.  Similar in some ways to primary trauma, secondary trauma may lead to feelings of distress that impair one’s ability to stay in the present moment, feelings of helplessness and disempowerment, and physical bodily manifestations of stress.  Thus, TCTSY is a well-suited modality for not only primary complex trauma but for VT as well.  Future studies may be beneficial to assess TCTSY for VT.  But for now, consider trying TCTSY for VT–to honor showing up for the challenges of your work–and allow TCTSY to bring increasing presence, agency, and groundedness to move you forward.  

References:

1. Van der Kolk B, 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.  J Clin Psychiatry 75: 6, 559-565.
2. West J, Liang B, & Spinazzola J.  2017.  Trauma sensitive yoga as a complementary treatment for posttraumatic stress disorder:  A qualitative descriptive analysis.  International J of Stress Management 24,2, 173-195.