Brain imaging studies in yoga practitioners have shown a consistent positive relationship with measures of brain structure (gray matter volume, density, and cortical thickness) in the frontal cortex, hippocampus, anterior cingulate cortex, and insula (Gothe, Hayes, Temali, & Damoiseaux, 2018). The amygdala was found to have reduced in size, which may explain why the yoga practitioner experiences reduced perceived stress, as it is shown to be on overdrive in trauma survivors. Brain scans showed improved connectivity between neural networks in the brain, specifically the Default Mode Network, and areas involved in self-monitoring, and cognitive control (Aalast et al., 2020).
Research has shown that yoga can reduce perceived stress as well as levels of stress hormones, such as cortisol and adrenocorticotropic hormone (Vedamurthachar et al., 2006, Saoji, 2016). Stress reduction is important, given that many substance users report stress being the reason that they feel they cannot quit, or the reason why they end up relapsing. Even a few weeks of yoga practice can result in significant stress reduction and negative mood (Bock et al., 2012).
Yoga has also been shown to reduce anxiety, increase general health and wellbeing (physiologically and psychologically), and reduce negative affect (Bir S. et al., 2008, Bock et al., 2012). It has been shown to improve cognition and cultivate positive emotions, such as empathy, compassion, and self-regulation (Saoji, 2016). Changing the way one breathes (as is practiced in many types of yoga) can improve problems with anger, depression, anxiety, and high blood pressure (van der Kolk, 2014).
Yoga stimulates the parasympathetic nervous system. With the parasympathetic system restored, the practitioner is able to enter a state of rest and relaxation, a state of being that may have been inaccessible for a trauma survivor, and, by proxy, a substance user. A trauma survivor may be living in flight-or-fight mode, meaning they may be hypervigilant, hypersensitive to sights, sounds, or touch; agitated, excitable, and restless. Van der Kolk (2014) found that trauma survivors were unable to reach a point of relaxation, as their muscles continued to prepare them to fight or flee. In other words, the survivor is living in a constant state of terror.
As Judith Herman mentions in her book Trauma and Recovery (2015), the first step in recovery is establishing safety. The latter stages of recovery cannot occur until the survivor has first restored a sense of security. This is one reason why a bottom-up approach to recovery is essential for healing to take place. In a 2014 study at the Trauma Center by van der Kolk, the practice of yoga significantly improved arousal problems in participants with PTSD and dramatically improved their relationships to their bodies.
The brain is physiologically incapable of processing information in a healthy, appropriate manner until homeostasis, or a sense of balance, has been restored. The use of physical forms, breathing, and meditation/mindfulness practiced synchronously allows the body to slow down, lower heart rate and blood pressure, slow respiration, and begin processes of restoration that can only happen while the body is in a state of rest. Since the body and the brain are linked together, the feedback loop between the conscious awareness of bodily processes and the brain is one that is continuously reinforced. Through this process, the restoration of normal functioning is able to be restored at a subconscious, cellular level. This is imperative, because talk therapy or education cannot be as useful until the survivor has first established this basic sense of safety on an intrinsic, fundamental level.
Some psychological approaches discuss suppression, distraction, or reappraisal. However, yoga allows one to notice, process, and respond to stimuli. This is significant for people living with substance abuse disorder, PTSD, and/or anxiety, because it involves systematically attending to bodily sensations and emotional states, instead of automatically reacting in unhealthy ways (Farb et al., 2015).
This process of watching and sitting with what is happening with the body is neurologically rewiring the process that the person may have experienced before. The process of interpreting information in the brain is damaged in trauma survivors and substance users. The amygdala (the brain’s alarm system) is overactive, signaling the alarm when it isn’t necessary. This causes the survivor or the user to respond in ways that are disruptive. With the practice of trauma sensitive yoga, the systems in the brain that interpret incoming information are restored. This practice allows time for the brain to process what information it is receiving, to evaluate it, and then to formulate a response. Before, the information went straight from receiving to reacting, a process that happened in nanoseconds, beyond the survivor’s control.
With trauma sensitive yoga, the survivor is able to first, establish safety, and second, notice the bodily sensations that arise in the present moment. With time and practice, the brain can be reconditioned. It can learn to interpret stimuli for what it is instead of reacting with a behavior that is dysregulating to the survivor.
Where a survivor may have been conditioned to live in a state of arousal, establishing a regular trauma sensitive yoga practice can condition the brain to live in a state of balance. The more a person spends time in such a restorative practice, the more natural it becomes for the brain to adapt to this restful state. Over time, a person can become habituated, or reconditioned, learning to live in a way that is possibly calmer, more peaceful, and centered. Just as a person has learned to live in survival mode, they too can learn to live in a way that is more easeful.
This process is also useful when it comes to cognitive-behavioral phenomena as well. Memory is involved in both trauma and substance use disorder. The memory of the trauma, either explicit or implicit, could cause an automatic reaction from the survivor, a response that the survivor does not want to have, nor is able to control. It is a similar process with drug use. The brain may have been conditioned to have a certain response to a certain experience. Through sustained substance use, the brain is conditioned to associate the substance with a pleasurable feeling through memory and the brain’s reward system. The hippocampus (involved in memory formation, learning, and emotions) is shown to be damaged in trauma survivors and substance users, whereas yoga practitioners are shown to have increased grey matter in the area of the hippocampus. Yoga practitioners also perform better on cognitive and memory tasks. These findings would suggest that it’s possible that practicing yoga can repair some of the damage that was done to the hippocampus and restore functioning.
Once a survivor has established that they are now safe, in control of their bodies, they may begin to re-evaluate cognitive-behavioral processes, thought patterns, and biases. Once a person feels safe in their body, and parts of their brain have been restored, they are able to translate experience and memory into language, something that may not have been possible before (van der Kolk, 2014). This is the type of top-level processing that one can work through with a licensed counselor, but this process cannot effectively take place if one is stuck in a state of survival, if they do not feel safe, do not trust other people, or if they are unwilling to feel their emotions. The continued practice of yoga allows the participant to experience being in their body in the present moment. It lets them practice techniques wherein a foundation of safety can be established. Normal functioning of the parasympathetic nervous system can be restored, allowing a person to enter into a state of relaxation and contemplation that may have been inaccessible before.
Yoga has the ability to induce dopamine homeostasis, meaning that the brain can create a balance in its dopamine production (Miller et al. 2015). This is crucial given that most drugs hijack the reward system, in which dopamine is a key player in. The user experiences a surge of dopamine and other neurotransmitters after substance use. After continued use, the brain’s ability to secrete the chemicals on its own is severely diminished. Through the reward system and the production of dopamine, the brain “learns” that drug use is pleasurable and reinforces the user to repeat this activity. Since the addicted person stops being able to produce these neurotransmitters effectively on their own, and the threshold for reward has been significantly increased (meaning that they are unable to find pleasure through normal activities), they will use drugs to experience relief from the stressful, anxious, uneasy, and uncontrollable feelings associated with withdrawal, rather than to get high (NIDA, 2020).
Most of the current methods of treatment involve Medication Assisted Therapy (MAT), which utilize drugs that block the neurotransmitter dopamine; involvement with one-size-fits-all 12-step programs, and counseling (Miller et al. 2015). These methods have merit and offer a considerable amount of support for the person living with substance use disorder, however, conventional therapies have not been able to alter the outcome of these disorders, and as many as 90% of participants end up returning to treatment, indicating a veritable need for adjunctive, alternate evidence-based treatment modalities (Behere, Muralidharan, Benegal, 2009, Miller et al., 2015).
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