Yoga Rehabilitation Theory: An Exploration into the Power to Heal Trauma

Abstract

History documents the health benefits of yoga for self-healing and self-realisation. Yet how does yoga benefit individuals who have endured significant physiological, psychological and mental trauma? It can be argued that trauma frequently requires a re-adjustment to one’s identity and their meaning of life, often connected to a self-healing and self-realisation framework. Yet, what role can yoga play? Accordingly, this chapter sets out to raise consciousness about yoga therapy principles in order to highlight, promote and inform such benefits. This chapter will draw on empirical discussions surrounding medical and social models of disability, as a way to highlight an increase need for awareness and acceptance of physiological, psychological and mental traumas through yoga. In conjunction, significant theoretical models underpin this narrative as a means of informing this emerging topic, specifically, Social Identity Theory (SIT), Self-Determination Theory (SDT) and Post-Traumatic Growth (PTG). The in-depth findings herein suggest that the novel concept of Yoga Rehabilitation Theory (YRT) understands the restorative power of yoga through identity adaptation, self-determination and positive transformations relating to meaning in life. It is suggested that the power of yoga resonates beyond a mind-body connection, to a deepening sense of purpose and transcendence for those that need it most.

1. Introduction

As a means of interpretation to strengthen the discussion in this chapter, key theories will be considered when assessing trauma initially and the ways in which yoga may aid an individual’s rehabilitation. Namely, Social Identity Theory (SIT), Self-Determination Theory (SDT) and Post-Traumatic Growth (PTG). This chapter suggests that by connecting mind, body and spirit through mindful movement, individuals can experience an acceptance and understanding of the change that has taken place externally, to their body, and internally, to their sense of purpose. This is extremely significant in a rehabilitation framework set in a social context, where the focus is to accept and adapt, rather than fix and cure. There are therefore wider social implications to yoga as rehabilitation that encompass union of community for all individuals, irrespective of their ability—mental and physical.

Underpinning this discussion, is the recognition that in many societies throughout the globe, physiological, psychological and mental trauma are feared due to the wealth of stigma surrounding disability, as well as ‘poor’ mental and emotional health [1]. It can be suggested that such stigma may be increased by the medical model of disability. Such a model of disability is largely incorporated into the medical profession who work predominantly from a biological perspective. This means that, in this professional domain, disability is believed to be a biological outcome. Hence, there is mindset that the problems encountered by individuals with disabilities are relating to their physicality, in addition to individuals who have mental impairments. As a result, a vast majority of the medical profession do not consider the broader environments for such individuals. For example, the social, cultural, environmental and political landscapes that may challenge them ([2], p. 430). It is also claimed that the medical profession present an influential opinion in relation to the ideals of the human body, what it ought to look like and how it should perform.

In this manner, Gronvik [3] concurs that throughout history, disability has largely been seated in the possession of the medical professionals. The focus has been to see disability as a negative perception relating to lack of bodily ability and functions, rather than seeing the individual living with such an impairment. This rhetoric has therefore induced an entire medical vocabulary that focus on a body that is ‘normal’ and fully functioning, rather than a body that is different and can still function in an adaptive way. This has therefore created a powerful supremacy relating to disabled individuals and the idea that they are less able members of our society.

This is relevant to this discussion as a strong medical model discourse may in fact impinge an individual’s ability to achieve self-healing and self-realisation through yoga. This is because when reflecting on the medical model of disability and its quest for a ‘normal’ body, there is little space for individuals who do not meet this criteria. Such individuals may be considered so different that they may not have access to yoga. In this way, the influence of the medical model of disability can influence the wider population’s view of disability. For this reason, campaigners and scholars in disability rights strive to challenge heavily medical models that solely seek to treat, repair and normalise individuals who are living with physical and/or mental impairments [2, 4, 5, 6]. Campaigners and scholars have confronted such negative viewpoints by promoting the social model of disability, stating that societal attitudes and the built environment, rather than biological impairments, disable.

When considering yoga as therapy, it is therefore important to assert that yoga should be made accessible to all individuals, disabled and non-disabled. It is therefore relevant in this discussion to see, in what ways, yoga may be able to challenge the medical model of disability, to highlight what individuals can achieve post-physiological, psychological and mental trauma—creating an acceptance of disability through yoga, which will be more in line with a social constructionist view; one of union, acceptance and healing.

It could be said that it is a ‘fact of life’ and somewhat natural process of life course and world order that physiological, psychological and mental traumas occur, for whatever reason. It is therefore even more relevant to challenge such stigmatisation and fear through yoga as therapy as a means of creating acceptance of a disabled body, showing the rest of society that individuals can still achieve and may not need to be ‘cured’ or ‘fixed’, rather just accepted. In this way, it may be that yoga can also heal society’s negative perception of physiological, psychological and mental trauma by acting as a tool to highlight and promote a greater sense of community and unity. After all, a main facet of yoga is union—whether that be to unite oneself, to others, or to the wider world. Thus, it is applicable to see yoga as a tool to unite disabled and non-disabled communities.

It is in this way that in-depth discussions will herein take place, set within a social constructionist framework, to highlight yoga as therapy for individuals who have endured trauma, as well as challenging the negative conceptions of the need to ‘fix’, ‘cure’ or ‘overcome’ trauma. Underpinning this chapter therefore is the realisation that the understanding of yoga as union can challenge the negative perception of trauma (grounded in the medical model of disability) as a ‘tragic’ circumstance, into a positive perception of trauma (grounded in the social model of disability) as a ‘transformative’ circumstance.

2. Theoretical framework

As a means of interpretation to add to this discussion, key theories ought to be considered when assessing the impact of trauma initially and the ways in which yoga may aid an individual’s rehabilitation. Namely, Social Identity Theory (SIT), Self-Determination Theory (SDT) and Post-traumatic Growth (PTG). As a way to develop this analytical framework and show the connections between such theoretical underpinnings, it is important to first consider each theory in its entirety before a wider discussion can begin on the emerging importance of their interactions in a yoga rehabilitation theory framework.

2.1 Social Identity Theory (SIT)

As a concept, the understanding of ‘identity’ is unique to each individual ([7], p. 1). In line with this, the expression ‘social identity’ highlights the parts of an individual associated with their group membership in society. As a result, it is recognised in extant literature that people as a whole have plural identities that is transient in nature and dependent on the environment or situation at that present time [8]. When an individual experiences physiological, psychological and/or mental trauma, their sense of social identity is affected [9]. This is especially the case as an individual’s self-concept comes from his or her membership of a social group, as well as the ways in which the individual values and places emotional importance on such membership which is drastically challenged through significant trauma. Trauma to any level, as is mentioned, therefore dramatically effects an individual’s identity, yet it is significant to see how yoga aids such challenges as a means of recovery in a “yoga therapy” context.

The main purpose here should be to analyse identity adaptation through participation in yoga. In this instance, it may be the individual’s response to “who am I” after a traumatic injury that is benefitted from a therapeutic yoga rehabilitation pathway as a means of gaining acceptance after a significant injury. It may be the ways in which yoga acts as a tool to encourage a strong sense of social identity in the context of answering the question “Who am I?” that proports a notion that yoga, post physiological, psychological and mental trauma, instils an identity adaptation process and acts as a medium to aid an individual’s rehabilitation, as well as an acceptance of physical changes that may have arisen during such trauma. In this manner, Yoga, as a movement process, can promote mind-body awareness and connection, encouraging individuals to appreciate what they still can do by the means of self-realisation ([10], p. 3). One of the most incredible benefits of practicing yoga is to be able to tune into subtle sensations and become attentive, which is unique for each individual. It is apparent therefore that individuals who are, in some form of recovery, develop such skills to enable them to realise their potential physically, mentally and emotionally.

Should yoga instil identity adaptation, individuals may be able to develop a strong sense of identity and a firm response to “who am I′. This is a significant facet in a therapy framework and a crucial turning point for an individual. This is because when an individual feels a sense of belonging, this transcends into their everyday life and their place within society and the wider world. A strong sense of identity may be developed through yoga participation as an individual can identify as someone that participates in yoga with others. They may meet other people in a similar situation to themselves, which would depreciate a sense of loneliness and overwhelm of the trauma into one of love and unity. This may sound very simple, but the subtle sensations that this may create aids empowerment, development and confidence—all of which are tools that can benefit individuals outside of a yoga practice and provide them with such a strong sense of identity and a voice within society. This is even more powerful as the individual may not consciously realise the power of a yoga practice overtly, rather just a sense of benefit to their emotional, psychological and physical health. It can be said that a depended sense of identity can promote a holistic sense of wellbeing as an individual may feel ‘whole’, complete and at peace with themselves, their trauma and world order.

2.2 Self-Determination Theory (SDT)

Self-Determination Theory (SDT) seeks to explore and shine light on an individual’s stimulus and enthusiasm for certain situations that arise, recognising their unique driving factors that may be contextually, socially and inter-personally influenced ([11], p. 79). A deeper understanding indicates the individual’s autonomy of choice to inform their behaviour [12]. That is to say, the extent a person has freedom to be self-motivated, which, in turn, influences their behaviour. It can be highlighted that the concepts that give rise to the notion of self-determination are autonomy, competence and relatedness ([13]: p. 311). SDT is extremely applicable when considering yoga as a rehabilitation tool because it considers the multiple constructs that, in this case, can be part of motivational experience to participate in yoga. Individuals may feel a determination to normalise their trauma through mind-body awareness, helping them to realise their potential and what their life can now be like [14].

The best way to achieve mind-body awareness is by active doing. Yoga therefore ought to be considered one of the most important tools in this context as not only is it manageable, affordable (as it does not rely on expensive equipment), but natural, innate and inherent to an individual deepening their understanding of themselves. In a recovery setting this is dramatic, and individuals may show a strong sense of determination to participate, should the environment and yoga practice be accessible. Determination is a strong characteristic to develop and aid a recovery process, helping people feel in more control of their situation and a stronger sense of choice in how to better their future. People often feel a strong sense to be able to return to some form of their previous life, whether that be their hobbies or physical pursuits. By developing a strong mind and body in yoga, individuals will have a greater chance of prospering in their rehabilitation and learn a skill that they can take further into life as a tool for their future.

2.3 Post-Traumatic Growth (PTG)

Post-Traumatic Growth (PTG) initiates a reflection on the ways in which an individual may experience mental and emotional transformations that are deemed positive after having experienced a traumatic life event. This can often lead to the individual’s unique resolve being challenged, which can influence people to think differently about their sense of belonging and purpose in society and the wider world [9]. In other words, an individual’s life course has changed, and they may need to adapt their identity as a means to find a place within their society, post-trauma. PTG therefore can occur as a deeply meaningful experience due to an improvement in one’s outlook on life [15]. It is appropriate to consider how yoga therefore may indeed aid this process, enabling individuals to undergo a transformational process, which is deeply meaningful and shines light on a longstanding history of the way in which suffering can yield positive change.

Yoga as a mind-body-breath-connection tool ought to be considered the best tool to achieve PTG as the growth within oneself by participating naturally aligns to this theoretical framework. In other words, yoga helps people grow—physically, mentally and emotionally. In a rehabilitation setting, growth is significant as a way to develop pathways for each individual and promote longitudinal goals. From a linear perspective, this creates a trajectory to development and goal attainment that heightens identity and belonging, as well as acceptance.

The three theoretical concepts, detailed above, underpin this discussion on yoga therapy principles. This chapter suggests that when these three theoretical constructs interact and combine through the experience of yoga, new theoretical understandings can be uncovered. This chapter indicates that individuals adapt their identity to incorporate their trauma, become self-determined to regain a sense of normality and experience positive adaptations and PTG. The above connections are all influenced by participation in and the experience of yoga. This is because, individuals may appreciate that yoga helps them to re-establish their meaning of life. Analytically speaking, this relates to the ways in which participation in yoga connects intrinsically motivated factors.

It is important to continue these suggestions and move on to deeper explore the notion that the experience of yoga, in a rehabilitation framework, may be able to help individuals re-establish their meaning of life. It is recognised that traumatic injury or disability affects an individual’s meaning of life and sense of purpose ([16]: p. 84). In connection, existing research and findings indicate that participation in physical activity creates changes in mental and emotional wellness, as well as quality of life that leads to a sense of empowerment [17, 18]. In addition to this, previous research also identifies that, after a significant injury, a person’s sense of meaning, purpose and spiritual beliefs may change [19, 20, 21, 22, 23]. These suggestions are relevant in this context and can be used to establish a discussion on the perceived relationship between the experience of yoga and meaning of life as a means of appreciating the way yoga may create positive psychological states and self-growth.

The importance of this suggestion is to bring together previous research on trauma and spirituality with the emerging field of spirituality and adaptive yoga—a field that is underdeveloped and under-explored. Set in this context, it is important to examine this concept through the social constructionist lens as a backdrop to analyse an individual’s dramatic change in their loss of physical, mental or emotional ability and how this impacts their self-esteem, confidence and meaning of life. It is in this way, as a yoga therapy framework, that individuals may gain positive experiences that “touch them in deep, mysterious and difficult-to-explain ways” ([24], p. xi). This could be because the experience of yoga helps individuals find purpose and meaning in their life through goal striving and goal attainment, both of which are unique to each individual. In greater detail, goal striving, and goal attainment is essential in a rehabilitation setting, to aid individuals. A goal, no matter how small, is significant and it is essential that should individuals need assistance mentally, physically or emotionally, to identify and achieve their goals, that it is provided holistically. Such opportunities should not be taken away from individuals, especially in societies that are steeped heavily in the medical model, where opportunities are not provided.

No matter what the individual’s level of trauma or impairment may be, each person may develop a quest to re-establish their meaning of life, their spirituality. It is an intrinsic and natural reaction to such a change in one’s life. Due to this, there has been an increased interest in spirituality in twenty-first-century and it has been recognised as an important facet of healthcare [25]. It is important to however recognise the unique and exclusive nature of its experience, which can be herein argued to be heightened by a yoga practice as a universal aspect of a human’s psychosocial life ([16], p. 84). This may also be because there has been a greater sense of self established ([22], p. 817; [23], p. 1283; [16]). The power of yoga must therefore be recognised as an important way to help people feel at ease and find an inner peace and acceptance of their new situation. It may be that bodily changes have occurred, which instil a dramatic sense of loss of a former self and a grief process. Yoga has to be recognised to be able to fill this void and promote a sense of healing to find a new meaning to life for each individual.

3. Yoga Rehabilitation Theory

In very simple terms, yoga unites mind, body and spirit. To this end, physiological, psychological and mental trauma directly impacts an individual’s mind, body and spirit; as their sense of meaning and purpose in life may change [9]. Yoga rehabilitation theory therefore seeks to recognise and understand the restorative power of yoga through identity adaptation, self-determination and positive adaptations. This is because, as this chapter suggests, it identifies the social implications of trauma, why they might be feared and explores how people may use yoga to overcome them. By connecting mind, body and spirit through mindful movement, individuals can experience an acceptance and understanding of the change that has taken place externally, to their body, and internally, to their sense of purpose. This is extremely significant in a rehabilitation framework set in a social context, where the focus is to accept and adapt, rather than fix and cure. There are therefore wider social implications to yoga as rehabilitation that encompass union of community for all individuals, irrespective of their ability—mental and physical.

4. Yoga as a prescription

If we are going to truly see yoga as therapy, we must now ensure that it is accessible to all individuals, irrespective of mental and physical impairments. This model of inclusive and adaptive yoga ought to be commissioned throughout the globe to ensure true unity. It may therefore entail a shift in perception from teachers, guides and followers in order to promote “yoga for all”. Teachers may need to challenge their mindset and no longer focus on alignment and correct posture, but the configuration of each individual, for which feeling, and movement, is the most important. There may therefore need to be a shift in perception in this manner, where a yoga pose is a transient journey to reach inner and outer development, rather than a postural gain.

Teachers and guides must also be open to adapting their approach and style of teaching, this must be carried out in an emotional and caring manner, where pre-existing experience of working with vulnerable individuals may be beneficial. In this manner, prospective courses should be offered worldwide in order for teachers to specialise and learn how to deliver effective and inclusive yoga. Lessons should be delivered in a clear and concise manner, where individuals are free to express themselves, should they wish. Each class should be tailored in a person-centred approach, where feelings matter most and movement flows to connect mind and body, aiding the individual to explore their inner and outer strengths as well as enabling them to achieve true self actualisation.

To continue in this manner, it is understood that an unmistakeable facet of yoga is the development of breath, body and mind. The challenge here, when considering yoga as therapy, is to be able to guide yoga for individuals who may have some form of physical, emotional and/or mental impairment—to help them achieve the development of breath, body and mind. The teacher has to therefore be aware of themselves throughout the delivery of the yoga class, adapting their style and drawing on teaching methods such as mirroring, visualisation, story-telling, repetition and prompting. Not only this, but the built environment ought to be considered. Are classes physically accessible for individuals who use a wheelchair, for instance? The built environment is essential for accessibility and inclusivity, where all impairments ought to be catered for. Within this wider discussion, it is the way in which society ought to be required to change their built environment in order to cater for all individuals, to make sure that people do not miss out on the benefits of yoga. It can be celebrated that chair yoga and some forms of adaptive yoga are in place, however, the wider global perspective needs to be championed as a necessity to mankind, rather than individuals sitting on the edge of society.

5. Conclusion

This chapter explores a range of topics from disability rights and activism, to social identity, determination and purpose, as well as many other theoretical constructs. The greatest message is that yoga can be seen as unity, to unite mind-body for individuals who have sustained physiological, psychological and mental trauma and to unite disabled and non-disabled members of society, challenging stigmatisation and negative misconceptions of tragedy into transformation.

When considering yoga as therapy, this discussion strongly asserts that it is important for yoga to be made accessible to all individuals, disabled and non-disabled. It is therefore relevant that this discussion has explored in what ways yoga may be able to challenge the medical model of disability, to highlight what individuals can achieve post-physiological, psychological and mental trauma—creating an acceptance of disability through yoga, which will be more in line with a social constructionist view; one of union, acceptance and healing. Should this be achieved, the power of yoga can be seen to transcend beyond the individual, a transcendence that can only be described to reach the cellular level of mankind.