The Influence of a Trauma Informed Yoga Intervention on Emotion Regulation and Skilled Awareness in Sexual Assault Survivors

Background: This study assessed the impact of trauma informed yoga (TIY) on symptoms of hyper-arousal, avoidance, and mindfulness in sexual assault survivors. Brain images demonstrate that language functions in the brain shut down in response to trauma. Testing interventions that allow survivors to heal in ways that reduce use of language is imperative. Evidence supporting the impact of TIY is growing, but limited. Van der Kolk conducted one of the few RCTs to test the efficacy of TIY for decreasing PTSD symptoms and found significant symptom reduction. Existing studies tend to focus solely on quantitative outcomes. Our study contributes to the literature by using mixed methods to examine 2 hypotheses: Participation in TIY will increase emotion regulation; Participation in TIY will increase mindful awareness.

Methods: This study utilized a convergent parallel design embedded in an intervention. Participants were recruited from those who registered for the TIY at The Blue Bench, an agency that provides treatment for sexual assault survivors.

The sample consisted of 35 women aged 18 -61 (average 31.5, SD=10.3). The majority of participants were White (58%), 13% were Latina,10.5% were African American/Black, 2.5% were Native American, 8% identified as “other” and 8% did not report ethnicity/race.  

Study procedures were approved by the IRB. Quantitative data were collected at the first and final group. Qualitative data were collected at each group session.

Quantitative items (n=30) were drawn from 2 validated measures (Five Facet Mindfulness Questionnaire, Baer et al., 2008; Difficulties in Emotion Regulation Scale, Gratz et al., 2004). Qualitative questions were administered before and after each session. Participants rated distress level (1 low to10 high); why they chose those ratings; one challenging and one enjoyable moment during group. 

The intervention (9 sessions) was delivered by licensed clinicians and based on Trauma-Sensitive Yoga (TSY) developed by the Trauma Center at Justice Research Institute. TSY is evidence-based and helps survivors reconnect to their bodies in safe, intentional ways (Emerson, 2015). 

Analysis of quantitative data involved paired-samples t-tests. The constant comparative method was used to analyze qualitative data. Limitations include the absence of a comparison group and small sample.

Results: Emotion regulation scores (α=.914;α=.932) were significantly different from pre-test (M=44.16, SD=13.14) to post-test (M=38.58, SD=11); [t (17)=2.396, p=.028]. Subscale analysis indicated significant changes in impulse control, strategies for emotion regulation, and emotional awareness, but no significant differences for non-acceptance, goals, and clarity.

Mindful awareness scores (α=.815;α=.852) were significantly different from pre-test (M=42.63, SD=5.7) to post-test (M=49.10, SD=8.27); [t (18)=-4.411, p=.00]. Subscale analysis indicated significant changes in describing experiences, not judging inner experiences, and perceiving inner experiences without reacting, but no significant differences for mindful observation and mindful action. Qualitative results suggest themes of awareness and regulation of inner experiences that support quantitative results.

Conclusions: While overall results suggest positive effects, subscale and qualitative results indicate areas for further exploration and changes to the intervention. Practitioners who use TIY may want to add elements that promote acceptance of emotional states, emotional clarity, and transferring mindful observation and action into daily life.