June 2019
“You should try meditation.” Chances are you’ve heard this suggestion at some point – either from yourself or someone else. Meditation, mindfulness meditation, in particular, has become a mainstream recommendation for everything from chronic pain to anxiety to cancer. Viewed as safe, relatively harmless and accessible, many health care providers are practising, teaching and recommending mindfulness meditation to their patients. Meditations are easily found online and public classes in yoga and meditation abound.
Most of us want people to be empowered to take charge of their health and well-being and it is great that there is such an effective tool that is free, readily available and simple to use. However, since reading Dr. David Treleaven’s (2018) book: “Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing,” I have realized that meditation practices should come with a caution: “May cause distress in people with a history of trauma.” Treleaven was motivated to research this topic and write a book based on his personal experience. A seasoned meditator, he had traumatic symptoms arise during mindfulness meditation as a result of vicarious trauma from working as a therapist with sex offenders. As a result of finding many people who had similar experiences in meditation, he described the tendency to regard mindfulness as a cure-all for all difficulties as the ‘panacea problem’ (Treleaven, 2018).
As a mental health professional and yoga teacher, it concerns me that I am only learning this now and have come to realize that most people are not aware that meditation can have adverse effects. My intention with this article is to help spread awareness about the need to make meditation safe and accessible for everyone, including trauma survivors.
Trauma is defined as “Any experience that is stressful enough to leave us feeling helpless, frightened, overwhelmed or profoundly unsafe” (Ogden, 2015, p.66). An estimated 90% of the population has experienced a traumatic event (Elliott, 1997; Kilpatrick et al., 2013). Not everyone who is exposed to trauma develops post-traumatic stress disorder (PTSD). PTSD can occur vicariously through exposure to details of a traumatic event (e.g. therapists, first responders, journalists). Canada has one of the highest reported rates of post-traumatic stress disorder (PTSD), at 9.2% of the population. Symptoms can include flashbacks, nightmares, anxiety and uncontrollable thoughts about the event. Dr. Pat Ogden (2015) referred to trauma survivors’ “diminished sense of security with others and in the world, and a sense of feeling unsafe inside our own skin” (p.66).
Treleaven highlights the critical role that systematic oppression plays in trauma. Socioeconomic status, skin colour, disability, and gender identity can subject a person to ‘microaggressions’; subtle and pervasive acts of discrimination that compound and result in traumatic symptoms (Carter, 2007). Awareness of targeted systemic discrimination towards certain groups and one’s own lens and life experience is essential to practising in a trauma-sensitive manner.
Safety and choice are central to teaching trauma-sensitive yoga. Typically, mindfulness meditation utilizes the breath as an anchor. People with trauma tend to track internal and external stimuli associated with their trauma. For example, a person who was attacked or with someone when they died, may have a traumatic association with the sound and sensation of breathing, even if it is not their own. Treleaven explains: “When we ask someone with trauma to pay close, sustained, attention to their internal world, we invite them into contact with traumatic stimulus – thoughts, images, memories and physical sensations that may relate to a traumatic event … this can aggravate and intensify symptoms of traumatic stress, in some cases even lead to retraumatization” (p. 6). For example, certain pranayama (breathing) techniques in yoga that involve making sounds or speeding up the breath, could be triggering, as could inviting someone to approach the fear that is manifesting in a bodily symptom. I now understand the possible reason why some people will leave a yoga class before Savasana at the end of the practice.
Trauma symptoms can manifest as hyperarousal (‘fight or flight’ response, e.g. jaw clenched, repetitive thinking, hypervigilance, intrusive images) or hypoarousal (‘freeze’ response, e.g. numbness, apathy, immobility). The ‘window of tolerance’ provides a middle ground where a person is able to self-regulate by monitoring their internal state and make adjustments to avoid a trauma response. Offering choices of a stable and neutral anchor, such as the sensation of hands or feet on the ground or external sounds, can help a person stay within their window of tolerance. Other techniques include inviting a person to focus on one part of their body that is comfortable or concentrate on something in their surroundings that is pleasing to one of their senses. Another helpful strategy to respond to upsetting stimuli is to open the eyes and shift attention to something that is neutral or positive, such as looking out the window, naming objects in the room, or recollecting a positive memory and noticing the bodily sensations associated with it. Treleaven recommends tangible or tactile anchors as most effective for sustaining focus. With education and practice, a person with trauma can learn to track their responses to internal and external stimuli with mindfulness of an internal anchor of their choice, such as bodily sensations, emotions, thoughts or breath.
Mindfulness meditation is an effective and useful tool for stress reduction. However, for it to be trauma-sensitive, modifications are required that give the practitioner a sense of safety and choice. David Treleaven has written an accessible and informative book. He has also established a Trauma-Sensitive Mindfulness Community to provide mindfulness teachers with free resources to support evidence-based practice that avoids retraumatization. These tools have transformed my personal understanding and practice and helped me feel better equipped to recognize and respond to a trauma response in my clients and students.
Access a free webinar "The Truth About Mindfulness and Trauma: How to Mitigate Risks and Promote Healing for Trauma Survivors", at www.davidtreleaven.com.
This article was published in Social Work Now Journal of the Ontario Association of Social Workers, October 2019
© Kathleen Pratt, 2019, Kingston, Ontario
