Stress Among Female Assault Survivors in Trauma-Sensitive Yoga

Traumatology | 2024, Vol. 30, No. 2, p. 153-163

A Qualitative Study Examining the Lived Experiences of Stress Among Female Sexual Assault Survivors in an 8-Week Trauma-Sensitive Yoga Intervention

Nicole Nicotera; University of Denver Graduate School of Social Work

Margaret Megan Connolly; University of Denver Graduate School of Social Work

Lenna Jawdat; Supportive Embodied Therapy, Washington, District of Columbia, United States

Laura Ostrow; University of Denver Graduate School of Social Work

Evidence supports trauma-sensitive yoga’s (TSY) efficacy, but little is known about participant processes in TSY. This qualitative study’s purpose was to examine the lived stress experiences of sexual assault survivors in an 8-week TSY intervention. Data were collected as part of an embedded mixed methods design testing the intervention. Licensed Clinical Social Workers-Registered Yoga Teachers facilitated the intervention which is grounded in evidence from the Trauma Center at the Justice Research Institute TSY and Herman’s model of trauma therapy. Participants (n = 23 women) provided a rationale for their level of stress via check-in/check-out sheets at the beginning and close of each group meeting. Analysis followed a constant comparative approach and was conducted in Atlas-ti over a series of five steps. Findings indicate three umbrella themes: stress with four subthemes, sense of well-being with eight subthemes, and group effects with three subthemes. Implications of the study suggest that survivors were processing stress experiences and emotions and integrating skills and concepts across the 8-week TSY group. Findings suggest different stressors experienced by sexual assault survivors in a TSY group, as well as experiences that connect them with their bodies and minds. Further study is required for generalizable and definitive statements to be made about sexual assault survivors’ experiences while participating in a TSY.

Trauma sensitive; sexual assault survivor, yoga; qualitative; trauma-sensitive yoga

“In the United States, nearly 44% of women experience sexual trauma in their lifetime, and people of all gender identities experience sexual assault (Breiding et al., 2011). During a sexual assault, one may feel threatened and automatically respond with fight, f light, or freeze responses. The sympathetic nervous system is activated, stress hormones such as adrenaline and noradrenaline are released, and the body gears up to respond to the threat with increased heart rate and blood pressure, accelerated breathing, and engagement of muscles. If we are unable to fight or flee, our parasympathetic response might kick in and we might freeze or collapse” (p. 153). 

“Because trauma can manifest physically in the body, literature suggests a need for alternative treatments and nonverbal interventions for trauma survivors, such as trauma-sensitive yoga (TSY) and other mind–body approaches. In fact, existing trauma treatments (e.g., eye movement desensitization and reprocessing, exposure-based therapies, and cognitive-behavior therapies) are ineffective for at least 33% to 44% of those with PTSD. Fortunately, an emerging evidence-base supports TSY’sefficacy for survivors of trauma. However, to truly garner how these interventions are experienced, it is also important to examine the lived experiences of participants” (p. 153).

“The current study aimed to examine the lived stress experiences of sexual assault survivors over the course of an 8-week TSY group called Being in Your Body: Yoga Therapy and Mindfulness Group (BIB)... Study participants were enrolled in the BIB yoga groups between January 2016 and July 2017, and a total of 28 individuals consented to be participants in the institutional review board-approved research associated with the intervention. The average age of participants was 29 years, and the majority of the 28 participants identified as White (78.6%), followed by multiracial (10.7%) and Latina (7.1%). A small percentage (3.6%) did not report ethnic-racial identities… The qualitative Measure for this study was the check-in/checkout worksheet that group members completed at the beginning and again at the close of each of the eight sessions” (p. 155). 

“The study’s findings respond to our research question: “How do sexual assault survivors describe their experiences of stress while participating in the BIB intervention?” The three umbrella themes, stress, sense of well-being, and group effects, suggest that while participants did indeed describe stresses, they also noted experiences of well-being and described the effects of the group itself. The stress umbrella theme includes four subthemes, extraordinary stress, common stress, and emotion stress which were associated with data from both pre- and postsession, and the subtheme stress pile-up which was associated only with presession data. The fact that the stress pile-up subtheme was not found in the post-session data suggests that the pile-up or cascade of stressors that participants noted at the beginning of BIB group meetings did not carry over to the close of group meetings” (p. 160). 

“The sense of well-being umbrella theme is composed of eight subthemes. Only one of them, coping, is associated with both pre- and post-session data. Recall that the coping subtheme is defined as acknowledging the existence of stressful experiences while simultaneously acknowledging satisfactory, calm or other positive experiences. This kind of coping, described at both the beginning and close of each BIB group meeting, suggests the resilience of the participants. In a similar vein, participant resilience is also suggested by the two subthemes, self-care and feeling good, which were associated with only presession data. This is noteworthy, since there will always be unavoidable stressors in life and having a capacity for coping, self-care, and feeling good, even in the aftermath of sexual assault is powerful” (p. 160).

“Our third umbrella theme, group effects and its related subthemes, processing, integration of skills and concepts, and triggers were found only in the post-session data. Recall that the processing subtheme reflected participant descriptions of how experiences during group allowed them to work through tough emotions, while the integration of skills and concepts subtheme accounted for how participants applied or used aspects of the group such as the yoga forms, mindfulness, breathing exercises to regulate or manage less than positive experiences. While we do not purport to draw statistical inferences from this qualitative study, these subthemes suggest that the BIB group may assist participants in learning to process emotions and apply mind–body skills for self-regulation” (p. 160).

“Our findings suggest that survivors are processing emotions and integrating skills and concepts across the eight sessions of the BIB group. While practitioners tend to worry about clients being triggered, our results of only six quotes related to triggers suggest that the frequency of triggers may be limited, and because triggering can happen anywhere and at any time, being triggered in group can provide an opportunity for participants to learn and use skills to manage difficult thoughts and feelings associated with triggers. Becoming triggered during the group also provides the opportunity for participants to have control of their own experience in a contained, safer space and to take effective action to shift away from movements that are triggering. On the other hand, we caution practitioners to be aware that in our study we did not specifically ask participants about triggers and therefore they should always proceed carefully and become well-acquainted with works on trauma-informed mindfulness such as that by Treleaven (2018). In addition, it is important for practitioners to collect written client feedback if not before and after each session, then at least after each one. Collecting written feedback is especially important when running a group without verbal check-ins as it allows facilitators to learn about participant experiences that would remain unknown, such as how they are feeling before and after each group, experiences of triggers or other negative experiences in group, and positive and empowering experiences resulting from group. Practitioners may also gain information gleaned from written feedback that participants would not have been comfortable sharing in front of other participants or face-to-face with facilitators” (p. 161).

“There is much more to learn about the stress experiences of those who participate in TSY groups. Specifically, it would be helpful for future research to assess if there are particular yoga forms, breathing activities, and topics used during TSY interventions that are more helpful than others for increasing well-being, and reducing posttraumatic stress symptoms and stress levels. In addition, our study had a minimal number of quotes related to triggers and the literature we reviewed did not mention triggers. Hence, it is important for future research to directly ask about and evaluate participant experiences of triggers and other posttraumatic stress symptoms during TSY interventions. This could be achieved through posing more direct, planned, closed-ended questions in follow-up interviews regarding triggers. As noted in the Discussion section, TSY tends to be delivered in group settings and this may provide additional support among members and be a strength of such interventions. This suggests that future studies examine elements of communal support in TSY groups as well as compare TSY as commonly delivered in group settings with one-on-one delivery of TSY interventions to explore any potential differences. Lastly, future studies could use mixed-methods to allow for analysis of statistical changes in posttraumatic symptoms and/or stress experiences as well as well-being in conjunction with qualitative findings. Such studies may contribute to a broader picture of how survivors of trauma experience TSY, as well as provide statistical Measures of the impact of TSY interventions” (p. 161).

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