Some rules for Teaching Students to Students with PTSD

Some Rules for Teaching Yoga to Students with PTSD. ~ Mark-Francis Mullen Sorry, there are no rules. 1. There are no rules. Ultimately, the teaching and practice of yoga, as well as the therapeutic applications of yoga, are so dependent on individual circumstances and needs that any rules are moot. The ultimate inspiration for teaching and practice comes not from a rule book, but from within. However, there are some general guidelines to teaching and practicing yoga that can help us as ‘signposts’ along the way. With people experiencing Post-Traumatic Stress Disorder, some of these guidelines become more important, in order to allow the student to be open to and receive the life-transforming benefits of yoga. Still, there are no hard and fast rules: just to be present, and to observe the breath with gratitude and gentleness. 2. Stay with the comfort zone. While we often think of yoga as helping us gently push the limits of our physical, mental, and spiritual existences, we can do this only from a firm, safe, and secure base. Before we can expand or fly, we must first find and root ourselves at a calm, peaceful center. This helps calm the stress response, which is so easily ‘triggered’ in students with PTSD. Sometimes the comfort zone can be acknowledging the physical, and sometimes it means acknowledging (or not directly acknowledging) the spiritual. For example: >>The high temperatures experienced in power Vinyasa or Bikram/hot yoga classes may remind the military veteran of less-than-positive experiences in the area they served, which may be hot, like Iraq, Afghanistan, Vietnam or Somalia. This could trigger the veteran, bringing up imagery or memories from the past, and occurrence of PTSD symptoms. >>Mantras in foreign languages may trigger memories of past experiences. Similarly, spiritual concepts and rituals that appear foreign may distract the student from the breath and the present moment, and take them out of their personal comfort zone. >>Seemingly innocent comments on recent events, political or religious themes can also distract or trigger the student experiencing PTSD. Likewise, certain music (however seemingly innocent) may also bring up memories or re-occurrences, or otherwise “trigger” the PTSD sufferers. >>Certain asanas (postures) can elicit a sensation of constriction, which can be interpreted as confinement or another highly unpleasant experience. Reactions to these sensations or perceptions can result in panic attacks, or at best increased arousal. Note that just because triggers exist, we do not necessarily need to avoid them. However, we do need to be aware of their possible existence, acknowledge them and offer some strategies for dealing with these distractions when they come up. In some cases, especially at the start of a yoga practice, or in a clinical setting with patients suffering from severe PTSD, certain triggers may need to be temporarily avoided, until the student is ready to deal with them. Offering the safety of child’s pose provides a safe place and temporary respite, as does simply observing and being present with the sensations. The techniques for dealing with PTSD-related responses do not vary greatly from those of dealing with physical discomfort or mental wandering experienced by all students of yoga, but must be more subtly diagnosed and applied. 3. It is critical to “join” with the student. There is a poster on my hallway wall that reminds me that “no one cares how much you know until they know how much you care.” Until the student has developed a basic sense of trust (or at least openness/receptivity) for both the instructor and the healing potential of yoga, gains are likely to be slow and sporadic. It cannot be stressed enough that the practice of yoga is ultimately an individual and inward one, not dependent on social relationships or interactions. Still, one must be comfortable (and motivated) enough to go to yoga practice, stay present, and to be open to the benefits. This requires some degree of comfort and safety in the social situation, one that can often only be achieved if the student is comfortable with the instructor, the environment, and the group. 4. You do not need to be a veteran or PTSD sufferer to teach yoga to students with PTSD. Just like you do not need to have been addicted to help those who are addicted, you do not need military experience to have compassion for and successfully teach yoga to students with PTSD. If we focus on the common experience we all share, that will develop enough rapport to begin to develop the interpersonal and student-teacher relationships required for success. While I believe we need more veteran instructors to help bridge the experiential/paradigm gap between the average yoga instructor and average veteran, any and all can help, simply by being present, giving good care and instruction and understanding some of the basics of PTSD’s manifestations and issues. 5. We are not here to teach yoga, but to guide students into the practice of yoga. The beauty of yoga is that is requires no faith or beliefs, no adherence to a particular tradition or set of rituals, and no prerequisites. Ultimately, only we can perform the experiment of our own lives. Only we can interpret our experiences and learn lessons from them. Only we can bear our personal burdens, and liberate ourselves from them. None of us are experts on yoga (no such animal exists), and the most and best we can hope for is to gently guide the student into developing a safe personal and sustainable practice, one which fits their own unique needs and lifestyles. My business card identifies me as a guide, not a yoga instructor, for I believe that we can only hope to guide the student, to show them the mystery and magic of yoga, and perhaps align ourselves and our “teaching” with those of the countless sages and wise people who also help guide the student with their experiences and insights. We let the Divine teach them, the higher self within. This self is not guided by or constrained by any particular rules or religions—it is not containable at all. We can only hope to help the student still their minds and calm their breaths long enough to come into contact with this power, to develop and relationship with this higher self within us all. That is enough. 6. Students with PTSD are individuals too. While the guidelines for diagnosing and caring for patients and students with PTSD may be applicable to most, it is critical to remember that we are dealing with individuals. What works for one (or most) may not work for others. Only by being careful observers can we sense where we may need to stick with established treatment modalities (or fundamentals of yoga instruction), and where to adapt for individual needs. Only through developing personal experience, sharing the experience of other instructors and caregivers, and listening carefully to feedback can we fine-tune this sense. We can only teach yoga to one person at a time, on an individual basis—no matter how large the class is. 7. It takes time. Just like relieving back pain is a game of millimeters, of making space, so is the transformation that comes through yoga a game of slow and steady gains. The progress may not be apparent at first. The practice may not resonate with some students, or meet their needs of the moment. In some cases, the practice may seem to be counter-productive, “stirring up” some issues that may seem to be better left alone. Birth is always painful (or so I’m told), and the birth of a new life is also painful at times. Just as the student may become discouraged, so may the instructor, if they expect too many gains too soon. We need to remind ourselves that ultimately we are not here to cure PTSD, or to teach or learn yoga, just simply be here and observe the breath. Everything else follows that…in time. 8. It needs to be accessible. Yoga needs to be accessible to the student. It cannot seem too scary or foreign, or (at first) challenging beyond what the student believes their limitations are. Yoga is available (and helpful) to all, regardless of age, physical shape, personal experience or beliefs. We need to remind the student (and ourselves) or that reassuring fact—often. For best results, we need to approach the student with relatively familiar language and concepts, relate the process to familiar things, then build from that firm and familiar base. We need to speak to them in their own language…the language of love and common human experience. 9. Don’t bulls**t them—these people are smart. Amputees get bullsh**ted a lot. Their doctors and families and religious leaders tell them that they have lost a limb—yet the veteran feels the limb daily (the “phantom limb” syndrome) and somehow knows it is not totally gone. They feel the existence of their subtle body. If we ignore the need to move energy in the subtle body (even supposedly missing parts), we do the student a disservice. If we try to “adapt” our asana for the student too much, we miss the chance to exercise and help heal and integrate the “missing” limb. We need to deal with the whole person—the hurt parts, the missing parts, all of it. Once we begin to tell the veteran things like his limb is missing (he can feel that it is not) or that the entire world supports her (someone in it obviously did not support her), we are risking losing the trust that is so necessary. We can acknowledge the bad things, the seemingly missing limbs, all of it—without reducing the healing effects or potential of yoga. Yoga teaches is not to seek a world of “woo-woo” where everything is fine, but to exist peacefully in the often chaotic and confusing world we do live in. We must acknowledge where we are before we can hope to go somewhere else, or change our world into something else. We must remember that these people are smart, unique individuals, and treat them accordingly. They are not helpless victims or unwitting dupes, but people. 10. Love cures all. I cannot say it enough. Love is the answer. The more we feel an act out love, the more valuable and authentic our teachings and practices become. All people have an inherent bullsh*t detector—they can sense if the instructor truly believes and lives the path of yoga. They can see if it has helped them, and if they enjoy doing it and teaching it. Our love shines from us, and sparks love in others. This may be more helpful in the end than any particular yogic technique. Through our yoga practices, we help the student calm their minds and spirits enough to connect with that love. That is true love—love as action, manifesting in the actual material world in which we live right now.. Aum, Shanti, Shanti (Light, Peace, Peace) Mark-Francis Mullen is a Nowist monk, the only one in the world who claims this distinction. He is lucky enough to live in Boulder, Colorado amongst a vibrant yoga community. He is called to be a guide to those who think they are ‘too something’ for yoga (too old, too sick, too fat, etc.). He loves to live, laugh, practice/teach yoga, and write. He prays that all beings experience peace and serenity.