RESEARCH INTO THE EFFICACY OF TRAUMA SENSITIVE YOGA
Research into the Efficacy of Trauma-Sensitive Yoga
A note about the research
Throughout the scientific literature, you'll often see the term yoga used when describing these studies. In many of the key papers, however, the intervention being investigated is specifically Trauma Center Trauma-Sensitive Yoga (TCTSY), developed at the Trauma Center in Boston (now the Center for Trauma and Embodiment).
Likewise, because PTSD is currently the only trauma diagnosis recognised within the DSM, many studies necessarily refer to PTSD, even though participants often meet criteria consistent with complex and developmental trauma.
What does the research tell us?
Trauma Center Trauma-Sensitive Yoga (TCTSY) is now one of the most extensively researched body-based approaches for trauma recovery.
Over the past two decades, studies have explored its impact on chronic PTSD, complex trauma, military sexual trauma, emotional regulation, interoception and quality of life.
Taken together, the evidence consistently suggests that TCTSY can help many people:
reduce symptoms of PTSD
improve emotional regulation
develop greater interoceptive awareness (the ability to notice internal bodily sensations)
increase feelings of agency and empowerment
reconnect with their bodies in ways that many participants describe as life-changing.
Dr Bessel van der Kolk, a leading expert in the treatment of PTSD, and the team at what was previously called the Trauma Center, Boston, now called the Justice Resource Institute, have been pioneers in the development, application and academic study of trauma sensitive Yoga (TSY).
“What strikes me, and why I gave my book the title ‘The Body Keeps the Score,' is that if it's in the body, the treatment should be in the body. Body treatment is somewhere, like, way on the periphery of the world. Instead, we sit in a chair and we talk to people, somehow trying to magically make people safe in their body.
I did the first National Institutes of Health-funded study on Yoga. It is more effective for chronic PTSD than any drug with people I've ever studied. I didn't see a single drug-selling firm turn into a Yoga studio after we published this data. But this data was serious. If you learn how to really inhabit your body and learn to feel comfortable moving your body and being in your body, something starts shifting.”
Dr Bessel Van Der Kolk
Ground-breaking Study: Yoga as an Adjunctive Treatment for PTSD (2014)
This study that Van Der Kolk mentions is this one, published in the Journal of Clinical Psychiatry in 2014: Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder: A Randomized Controlled Trial. Over 10 weeks, 64 women with chronic, treatment-resistant PTSD were randomly assigned to either a TSY group or a group that received a supportive weekly class on women’s health education.
Yoga significantly reduced their PTSD symptoms - to the same degree observed in drug- and psychotherapeutic approaches. They hypothesised that TSY may help traumatised individuals to tolerate physical and sensory experiences associated with fear and helplessness and to improve ‘affect regulation’. This is the ability of an individual to modulate their emotional state in order to adaptively meet the demands of their environment, or in other words to function effectively and not lose control or shut down despite the presence of difficult emotions and sensations.
Long-Term Benefits of Trauma-Sensitive Yoga (2016 Follow-Up Studies)
The same research team followed up these findings with more studies. Published in the Journal of Alternative and Complementary Medicine in 2016, this study: Yoga for Adult Women with Chronic PTSD: A Long-term Follow-up Study found that the longer Yoga is practiced, the greater the benefits in terms of symptom reduction. And given Yoga’s low cost and the relative ease of access to community-based classes, suggested it should be considered as a long-term complement to therapeutic intervention for those struggling with the legacy of prolonged interpersonal trauma (caused by abusive person-to-person relationships rather than an accident or natural disaster).
This study - Trauma Sensitive Yoga as a Complementary Treatment for PTSD - published in the Journal of Stress Management, also in 2016, is a qualitative descriptive analysis of the experiences of some of those who took part in the team’s other studies, and provides some really interesting (and moving) comments and reflections that reflect the day-to-day human impact of the Yoga practice behind all the clinical observations. Beyond symptom scores, researchers were interested in how participants described the changes in their everyday lives. For example:
“If something is hurting, I think ‘hmm, why is that hurting’...instead of being like, ‘that doesn’t hurt, I’m just being weak.”
“…starting to think that I ought to give myself a little credit for all I’ve survived...I ought to like myself…”
“…appreciate how huge it is that I was able to survive…made me appreciate the level of trauma.”
“Being able to sit with myself [in yoga] allowed me to stay in myself when people tried to be affectionate... there’s more closeness in relationships, especially physical comfort.”
Trauma-Sensitive Yoga for Survivors of Sexual Trauma
TSY was very recently explored as an intervention with a group of 152 women who had experienced military sexual trauma (MST). The Journal of Alternative & Complementary Medicine published Trauma-Sensitive Yoga for Post-Traumatic Stress Disorder in Women Veterans who Experienced Military Sexual Trauma: Interim Results from a Randomized Controlled Trial in 2021.
Research has shown that women veterans MST are particularly vulnerable to developing PTSD and other mental health conditions, and this study looked at how effective an intervention Trauma Sensitive Yoga may be. It split the owmen into two groups, one receiving a 60 minute weekly TSY session, and the other weekly 60-minute cognitive processing therapy administered by clinicians in the veterans clinic. The paper outlines several key components of TSY that make it effective for women veterans who have experienced MST.
In addition to reducing symptoms of PTSD, TSY helped to develop a sense of empowerment and agency. Many women veterans who have experienced MST report a sense of powerlessness and vulnerability. Yoga facilitated a deeper connection to body and an opportunity to tap into a sense of inner strength, which helps to counteract these feelings.
Moreover, the TSY was found to facilitate symptom improvement more quickly, have a higher retention rate and a more sustained effect than cognitive processing therapy.
Trauma-Sensitive Yoga for Traumatised Youth in the Justice System
Many youth who are involved in the justice system have experienced significant trauma, including physical and emotional abuse, neglect, and exposure to violence. These experiences can lead to a range of mental health issues, including anxiety, depression, and post-traumatic stress disorder (PTSD). They may also have difficulty trusting adults or authority figures, and may have difficulty regulating their emotions and behaviour. Traditional forms of therapy may not be as effective for this population, as they may have difficulty connecting with traditional forms of talk therapy.
Yoga, on the other hand, can provide a non-verbal and non-threatening way for youth to explore and process their experiences. The physical aspect of yoga can also help release tension and stress in the body, which can be beneficial for individuals with PTSD, and the mindfulness component can help develop greater self-awareness and interoception or inner sensing of physiological states, which is so vital for self-regulation, a sense of embodiment and overall feelings of wellbeing.
However, traditional yoga interventions may not be appropriate for youth in the justice system, as they have differing needs and face different challenges compared to adults. Therefore, studies – particularly the work of the Yoga Services team at the Trauma Center at Justice Resource Institute in Brookline, MA, who in 2021 published a pilot study in the International Journal of Yoga Therapy - have shown that it is important to adapt a yoga intervention specifically for this population. I summarise key points from their paper below.
Key Adaptations for Young People with Complex Trauma:
Above all it is important to establish a safe and non-judgmental environment. This can be done by providing clear boundaries and expectations, explaining the benefits of the practice, incorporating trauma-sensitive language and by creating a sense of community and belonging among the participants. It is also important to be aware of the potential triggers that may arise during the yoga practice and to have a plan in place for addressing these triggers in a supportive and non-judgmental way.
The practice itself may include a combination of physical postures, breathing exercises, and mindfulness practices and should be tailored to the needs and abilities of the youth. This may include incorporating elements of play and creativity, as well as providing plenty of options for both seated or standing postures. Postures such as ‘child's pose’ (a kneeling forward fold, with the head resting on the ground) and ‘mountain pose’ (steady, standing pose with both feet on the ground) can be used to support feelings of groundedness and stability, while breathing exercises like alternate nostril breathing can be taught as a means to help them regulate their emotions. Mindfulness practices such as body scanning and loving-kindness meditation can be used to develop self-awareness and compassion.
In addition to the practice, it is important to provide support and resources to the participants outside of the sessions. This may include connecting them with counselling services, mentoring programs and educational opportunities. It is also important to involve families and caregivers in the process, as they can provide support and continuity.
TCTSY VS COGNITIVE PROCESSING THERAPY FOR MILITARY SEXUAL TRAUMA
One of the most significant randomised trials to date - a collaboration between numerous VA centres across Georgia and Oregon in the US, Oregon Health & Science University, Portland, and Emory University, Atlanta, Georgia, and the Center for Trauma & Embodiment - compared Trauma Center Trauma-Sensitive Yoga (TCTSY) with Cognitive Processing Therapy (CPT), a first-line treatment for PTSD, in women veterans experiencing PTSD related to military sexual trauma.
The study , published in the Journal of the American Medical Association in December 2023, found that TCTSY produced improvements equivalent to CPT, with a substantially higher treatment completion rate, suggesting it may be a particularly acceptable option for some veterans.
The findings were encouraging. The study highlighted that:
TCTSY produced clinically meaningful reductions in PTSD symptoms that were statistically equivalent to CPT, suggesting that body-led approaches can offer an effective alternative pathway for some people.
Improvements in emotional regulation, body awareness and overall wellbeing
Evidence that some participants experienced meaningful improvements earlier in TCTSY treatment than CPT treatment
Higher treatment completion and retention rates than CPT, suggesting that body-led approaches may feel more accessible or acceptable for some veterans
An effective complement or alternative for people who find trauma-focused talking therapies difficult or who are not yet ready to revisit traumatic memories verbally
Importantly, these findings do not suggest that TCTSY should replace established psychological therapies such as CPT. Rather, they reinforce a growing understanding that recovery from PTSD is not one-size-fits-all. Some people benefit enormously from trauma-focused psychotherapy. Others may find that beginning with the body with body-led therapy helps create enough safety and stability for deeper psychological work later on. For many, the most effective approach combines elements of both.
TCTSY vs trauma-focused psychological therapies for military sexual trauma (MST): A systematic review
Building on the last study, a 2024 systematic review by researchers from Combat Stress and King's College London Centre for Military Health Research, published in the Journal of Military, Veteran and Family Health in 2024, examined the evidence for treating PTSD resulting from military sexual trauma (MST) in women veterans. The review analysed 998 published papers, ultimately identifying 12 studies that met the criteria for inclusion. Together, these studies investigated seven different treatment approaches for PTSD.
The review concluded that trauma-focused psychological therapies, particularly Cognitive Processing Therapy (CPT), currently have the strongest evidence base for reducing PTSD symptoms over the longer term. However, the review also identified emerging evidence for Trauma Center Trauma-Sensitive Yoga (TCTSY) as an effective non-trauma-focused intervention. Participants receiving TCTSY demonstrated meaningful reductions in PTSD symptoms that continued beyond the end of treatment.
One of the most interesting findings wasn't simply whether treatments worked, but how people engaged with them. Across the studies reviewed, trauma-focused therapies generally reported higher dropout rates, whereas non-trauma-focused approaches such as TCTSY tended to have better treatment retention, suggesting that body-led interventions may feel more accessible or acceptable for some veterans—particularly those who find talking directly about traumatic memories overwhelming.
They concluded that it represents a promising complementary or alternative approach, while calling for more high-quality research, longer-term follow-up studies and greater consistency in how military sexual trauma is defined and studied internationally.
Summary: The Role of Trauma-Sensitive Yoga in supporting people in need
Yoga has never been a one-size-fits-all practice, and it is especially important to be mindful that things many of us may not even notice in a yoga class – a particular posture that could be construed as sexual or suggestive, revealing clothing, the type of music chosen, a scent, for example perfume or room scent, stern and directive teaching or feeling that leaving the room is not allowed - can be very upsetting for someone living with the imprints of trauma in their nervous system. Trauma Center, Sensitive Yoga should be practiced in a safe and supportive environment, led by a trained and accredited facillitator who understands the unique needs of individuals who have experienced trauma.
Further reading on WHAT IS TRAUMA SENSITIVE YOGA?
Further reading on IMPACTS OF YOGA, BREATHWORK & MINDFULNESS PRACTICES ON BRAIN CHEMISTRY AND FEELINGS OF WELLBEING
