Abstract

This symposium aims to share findings of a pilot “trainthe-trainer” intervention of the Trauma Center TraumaSensitive Yoga Community Leader (TCTSY-CL) certification held at United Nations refugee camps in Lebanon and Palestine. TCTSY is a trauma-informed, body-based approach to trauma care that has the potential to expand cultural inclusivity. The insidious effects of everyday traumas and fear present in refugee camps become somaticized, and then passed down in generational cycles. Such embodied healing approaches allow for connection to interoceptive (in-body) senses and expand cultural inclusivity by allowing for healing pathways outside of Western medicine talk therapy, which contains structures that lack relevance within refugee settings. Embodied healing approaches, versus stricter mental health licensing requirements, also allow for “train-the-trainer” approaches like the one we will describe in this symposium. Our proposed symposium would comprise three parts: (1) invitation to practice TCTSY; (2) review of mixed-method evidence for the program’s feasibility, acceptability, and usability; (3) panel discussion from community leaders and on-theground implementers.

Groundwork for the TCTSY-CL program began inperson in 2018 in Lebanon, followed by the Aida Refugee Camp, Palestine. The full 30-hour certification was then offered online in 2021–2023 and graduated seven women, four of whom are mothers and two of whom were pregnant during the training. The program was deemed feasible given the null attrition rate. Written and orally transcribed accounts pre-, peri-, and posttraining provide evidence for the program’s acceptability. Post-training data regarding the amount of in-community TCTSY offered provides evidence for the usability of TCTSY-CL. In sum, effects of the program were meaningful in vivo, notably introducing terms such as “trauma-sensitive yoga” and “interoception” into Arabic vernacular. Through the “train-the-trainer” TCTSY-CL model, participants are now able to teach, practice, and integrate trauma-sensitive yoga throughout their communities, keeping knowledge within communities even after providers from the outside leave.

Presented at the Vancouver Association for Survivors of Torture Symposium, “Community-Led Trauma Center Trauma-Sensitive Yoga: Interrupting Cycles of Trauma in the Refugee Experience” shared findings of a pilot “train-the-trainer” intervention of the Trauma Center Trauma-Sensitive Yoga Community Leader (TCTSYCL) certification held at United Nations refugee camps in Lebanon and Palestine. TCTSY (Emerson, 2015; Emerson et al., 2009; Emerson & Hopper, 2011) is an evidence-based (e.g., Zaccari et al., 2023), traumainformed, and body-based approach to trauma care that has the potential to expand cultural inclusivity. Incorporating a body-based approach into trauma care is critical, as the insidious effects of everyday traumas and fear present in refugee camps become somaticized and then passed down in generational cycles. Such embodied healing approaches allow for connection to interoceptive (in-body) senses and expand cultural inclusivity by allowing for healing pathways outside of Western medicine talk therapy, which contains structures that lack relevance within refugee settings. Embodied healing approaches, versus stricter mental health licensing requirements, also allow for “train-the-trainer” approaches like the one described in the present symposium. The present symposium comprised three parts: (1) invitation to practice TCTSY; (2) theoretical underpinnings and review of mixed-method evidence for the program’s feasibility, acceptability, and usability; (3) panel discussion from community leaders and on-theground implementers.

TCTSY is the first yoga-based empirically validated clinical intervention for complex trauma or treatmentresistant PTSD (Center for Trauma and Embodiment, 2024). Based on 20 years of research (e.g., Center for Trauma and Embodiment, 2024), this model has been utilized globally in many diverse settings by social workers, mental health clinicians, educators, community leaders, and additional healthcare providers. This collaboratively developed intervention for trauma treatment has not only been scientifically informed and rigorously tested over the past two decades, TCTSY has also been adapted across cultures and contexts with a commitment toward empowering survivors of trauma as the experts of their own healing journey. The theoretical underpinnings of trauma theory, attachment theory, and neuroscience were explored, with a focus on decolonizing approaches to healing that are centered in community and resilience.

Concepts surrounding transgenerational trauma and transgenerational resilience were then explored, with an emphasis on noting how prenatal trauma-sensitive yoga may intercept the passing of transgenerational trauma. The presentation then discussed the lifetime percentage of depression and anxiety disorders among individuals with at least one Holocaust survivor parent, with none, one, or two parent(s) diagnosed posttraumatic stress disorder (Yehuda et al., 2014). The presentation emphasized that trauma is stored in the body, and that to heal trauma, we cannot ignore the body and all the bodies that came before us, providing an experiential exercise from Vietnamese monk and author, Thích Nhất Hạnh (1990). Then, the presentation discussed yogic philosophy around human habitual tendencies in ways of perceiving, moving, thinking, and acting arising from three general sources: nature, nurture, and ancestors (Stone, 2018). Although these aspects of nurture are outside of one’s control and may not be readily changeable given how a maternal parent’s ovarian germ cells develop five months in utero (Sadler, 2012), there are aspects of “nurture” that are malleable and can facilitate transgenerational trauma as well as transgenerational resilience. Transgenerational trauma and resilience (Goodman, 2013) are derived from Western and ecosystemic components, both directly and across generations, and each area has its own possibility of resilience. The presentation then discussed potential strategies to promote adult neurogenesis (Sapolsky, 2017), particularly with the ideas of learning and moving.

Given this strong theoretical underpinning for TCTSY and its potential effects down generational lines, TCTSY seemed important to implement in the community. Groundwork for the TCTSY-CL program began in person in 2018 in Lebanon, followed by the Aida Refugee Camp, Occupied Palestinian Territory. The full 30-hour certification was offered online in 2021–2023, and seven women graduated, four of whom were mothers and two of whom were pregnant during the training. The program was deemed feasible given the null attrition rate. Written and orally transcribed accounts pre-, peri-, and post-training provide evidence for the program’s acceptability. Below is one such account by Khansa Hamoud, TCTSY-CL:  “In the Refugee Camp 013 where I live, there is a story —a healing journey of a refugee child. Gamila [pseudonym] joined my TCTSY sessions, which I have been facilitating in the Bekaa Valley region since last summer. Gamila had lost her father tragically while fleeing the conflict-ridden areas of Syria. However, despite the many reasons for staying in grief, the yoga sessions offered a positive change for Gamila.

When Gamila began to immerse herself in the world of meditation, interoceptive movement, and rhythm coordination she noticed she felt different. She felt an improvement in herself; a shift in her troubled mind, feeling more calm and a greater capacity to deal with her sense of loss and shock. She also noticed feeling more available to interact positively with her peers in the camp and participate in more social activities. Over time now, yoga has become an integral part of Gamila’s life. In addition to its positive impact on her mental health, her body strength and flexibility improved too.

Gamila feels a desire to support others and volunteers to help manage the yoga sessions for the children in the camp. She is compelled to support the same sense of safety and serenity she gained from yoga for others going through similar experiences. Gamila's story is an ongoing journey of healing: pain and loss and of positive transformation. We look at it as a source of inspiration for others in the camp.”

Post-training data regarding the amount of in-community TCTSY offered provides further evidence for the utility of TCTSY-CLs. In sum, the effects of the program were meaningful in vivo, notably introducing terms such as “trauma-sensitive yoga” and  “ interoception” into Arabic vernacular. Through the “train-the-trainer” TCTSY-CL model, participants are now able to teach, practice, and integrate trauma-sensitive yoga throughout their communities, keeping knowledge within communities even after providers from the outside leave.

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References

https://jamanetwork.com/journals/jamanetworkopen/full article/2812725

Center for Trauma and Embodiment. (2024). Our research. https://www.healwithcfte.org/research  

Emerson, D. (2015). Trauma-sensitive yoga in therapy: Bringing the body into treatment. W. W. Norton & Company.

Emerson, D, & Hopper, E. (2011). Overcoming trauma through yoga: Reclaiming your body. North Atlantic Books.

Emerson, D, Sharma, R, Chaudhry, S, & Turner, J. (2009). Trauma-sensitive yoga: Principles, practice, and research. International Journal of Yoga Therapy, 19(1),123-128. https://doi.org/10.17761/ijyt.19.1.h6476p8084l22160

Goodman, R. D. (2013) The transgenerational trauma and resilience genogram. Counselling Psychology Quarterly, 26(34), 386-405. https://doi.org/10.1080/09515070.2013.820172  

Hạnh, T. N. (1990). Present moment, wonderful moment: Mindfulness verses for daily living. Full Circle.  

Sadler, T. (2012). Langman's medical embryology (12th ed.). Lippincott Williams & Wilkins.

Sapolsky, R. M. (2017). Behave: The biology of humans at our best and worst. Penguin Random House.

Stone, M. (2018). The inner tradition of yoga: A guide to yoga philosophy for the contemporary practitioner. Shambhala.  

Yehuda, R., Daskalakis, N. P., Lehrner, A., Desarnaud, F., Bader, H. N., Makotkine, I., ... & Meaney, M. J. (2014). Influences of maternal and paternal PTSD on epigenetic regulation of the glucocorticoid receptor gene in Holocaust survivor offspring. American Journal of Psychiatry, 171(8), 872-880.

Zaccari, B., Higgins, M., Haywood, T. N., et al. (2023). Yoga vs. cognitive processing therapy for military sexual traumarelated posttraumatic stress disorder: a randomized clinical trial. JAMA Network Open, 6(12), Article e2344862. https://doi.org/10.1001/jamanetworkopen.2023.44862

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Gamila and a Journey of Healing

VAST Symposium  Torture, Refugee, Healing  February 27th., 2024 (9:00 am-5 pm) symposium@vastbc.ca

The proposed title of your paper:  Community-Led Trauma Center Trauma-Sensitive Yoga: Interrupting cycles of trauma in the refugee experience  

The name(s) and affiliation(s) of the author(s);  

1. Viann Nguyen-Feng, PhD MPH LP RYT-500 TCTSY-F Assistant Professor, Department of Psychology Director, Mind-Body Trauma Care Lab University of Minnesota Duluth Onigamiinsing, Mni Sota Makoche vnf@umn.edu | MindBodyTrauma.Care  Trauma Psychology News, A Publication of APA Division 56 TED Education: 4 Signs of Emotional Abuse

2. Emily Lapolice, LICSW, TCTSY-F Psychotherapist, Certified Trauma-Sensitive Yoga Facilitator Faculty Member at the Center for Trauma and Embodiment at JRI www.iwtherapies.com www.twocedars.com *Publications*

3. Farah Houssami, TCTSY-CL, Social Worker, Translator, Culture Consultant, Co-facilitator, Rebuilding Resilience: TCTSY & the Refugee Experience  Save the Children, Beirut, Lebanon  

4. Leila Johnson, TCTSY-F, Project Director & Co-facilitator, Rebuilding Resilience: TCTSY & the Refugee Experience, Canada, VAT Editorial Board Member  5. Khansa Hamoud, TCTSY-CL, Community Leader, Bekaa Valley, Lebanon 6. Fedaa Almudahi, TCTSY-CL, Regional Manager, Community Leader, Bekaa Valley, Lebanon 7. Aziza Makboul, We The Mindful (Design /Editor-in-Chief), Translator & Culture Consultant, Canada  

Corresponding Author:  Viann Nguyen-Feng                                                  

vnf@umn.edu

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