Trauma-Informed Yoga and Distress Tolerance: The STOP Skill

I began my yoga practice about 23 years ago.  I was 39 years old and pregnant with my third child. My first intention for my yoga practice was to stay physically healthy. But I soon discovered it provided emotional rewards as well. It was the one thing I did per week which got me out of the house, gave me something to look forward to, and eventually out of my head and into my body. 

It was my reset. 

As a highly verbal person with extreme expectations of myself, my words, my thoughts, always pushed me from one thing to the next. And I piled on. Over time my yoga practice became a way to tolerate quiet, to explore and play; it was my way to develop nonverbal expressions and to move my body.

Even though I generally looked forward to it, when the time came, I sometimes didn’t want to be there. I would fight my practice. 

Fight the reality that I would be in class with 16 other people. 

I would take my same spot in the back row with both the desire to not be noticed and to be noticed for my “efforting” — “See I am doing my practice; pushing myself to be here rather than staying safe at home.” 

Unexpectedly, I don't know when and don’t know why, I stopped fighting my practice. I seemed to settle into my practice. For a little while, I didn’t notice my judgmental mind shaming me that I should be doing something from my list of tasks, or being the best yoga practitioner. Then almost like taking an inhale, these thoughts would flow back into me.

“Am I holding the pose as well as the lady in the front row?”

“Why hasn’t the teacher said good job to me?”

“Do I belong in this space?” 

I am usually the only person of color in a yoga class. Add that to the list of obstacles — the feeling of not belonging when you truly want to belong, that sometimes imperceptible nudge that you are not welcomed into the group because of your appearance. I wanted to be in the class. I wanted to belong.

Over time, I noticed I was making subtle changes. Yoga helped me regulate my emotions by promoting interoception, my being able to sense my body from the inside out.

I have been a therapist since 1985, a DBT therapist since 2016 and a DBT/PE (Prolonged Exposure) therapist since 2019. Prolonged exposure is a modality for trauma reprocessing. It encourages clients to confront the trauma event in two ways. Imaginal exposure – confronting memories they have been avoiding. In-Vivo exposure – confronting events or situations which bring up negative beliefs and strong emotions like depression and shame.  In the training for Prolonged Exposure, I learned the importance of teaching a breath retraining exercise to reduce feelings of anxiety, anger or irritability.

Recently, a client was telling me about a particular traumatic memory, the more sensory information they shared, the more upset, tearful and fearful they became. She shared she could no longer continue to speak about the trauma event. I suggested we stop speaking and focus instead on gentle yoga movements. I could see by her level of agitation, she needed to move her body.  I invited her to sit at the edge of the chair, to make space to move her arms. I let my client know I am not going to look at her, so she can focus on how she wants to move her body. I moved with her. We started by taking a slow inhale and as she inhaled I asked her to raise her arms above her head and, when her body signaled it was time to exhale, she slowly floated her arms down by her sides. We let the breath lead the movement. As she became more comfortable with this pose, we added the feet. We pressed our feet actively into the floor as if we were stomping on the ground. As we pressed down onto the floor, we inhaled and  raised our arms up and on exhales we dropped our arms down. Five to ten times we used breath to cue the movement. It may have been for five to seven minutes.

In general doing something with their bodies increases a sense of control and calm. During difficult moments in a session I have observed clients’  moods getting a little lighter when we add gentle yoga. They have reported how moving their bodies helps them feel less afraid of the sensations they were experiencing.  They have also acknowledged their relationship with their bodies was changing. Over time, they felt more capable and resilient.  

This tool, learning to control breath and move slowly and mindfully, is something many people who struggle with trauma lack. This exercise, breathing and body movement, helps them relax and reduces undirected, distracting thoughts. The result is they can focus better, feel better and feel more control. The goal is to gain a sense of ease. The clients have gone from agitation and everything being too much in both head and body to a sense of control; to a sense of ease.  

Through my own yoga practice and teaching yoga as a Certified Yoga Instructor, these methods help me teach a range of tools to increase the window of tolerance — tightening a muscle as a person inhales and releasing the muscle as a person exhales, relaxing the body experience and body sensations without having or at least reducing the threat response.

Yoga is an ancient spiritual tradition to harmonize the mind and body. 

Trauma-informed yoga (TIY) is a supportive approach which starts with a concern for safety — starting with people as they are, and by using movement, awareness and breath to empower individuals to be in control of their own practice to create balance in their minds and bodies.

Talk therapy is based on being verbal. Being verbal means being able to shape and focus your thoughts via concepts expressed in words. And by thinking and expressing yourself, grow your awareness to affect change. Movement is another way to speak, another way to shape and focus your thoughts. Movement, and being sensitive to how your body feels while moving, gives another path to identify and work through pain.

TIY creates a safe space for those struggling with chronic pain who may not feel their bodies belong on the mat or making complex movements and poses. 

I once read a quote something like “if you can’t make it through one door, make your own door.” TIY may be your door.

Trauma informed yoga offers several benefits:

• Top-down regulation – observing the fluctuations, sensations, thoughts, and emotions of the mind-body system from the perspective of a compassionate witness

• Bottom-up regulation using breathwork, movement and touch

When we take a new posture, that sends a signal to the brain – fear may be very present

• The trauma response may go into fight, flight activation of the sympathetic nervous system

• The trauma response may be affecting the parasympathetic nervous system, shutting-down, checking out, dissociating, or losing awareness

We may find it helpful to work with both the body and the mind to help create the changes we are seeking. My favorite practice is a slow flow and repeated sequence to give the mind and body a chance to be present to as much of the experience as possible, a way to be alert and aware of sensations so that over time it may reduce the sense of alarm.

 To create a sense of Safety, I bring in the DBT distress tolerance tool – The STOP skill:

Stop: Stop all movements

Take a step back: This pause can be in the mind or in the body. I like taking an actual step back with the body. It is my way of signaling I am consciously changing directions.

Observe: I am observing what is happening inside the body — Interoception. I am also observing with my five senses what is happening outside the body.

 I describe the pose, demonstrate the movements and invite the client to join when they are ready.

Proceed mindfully: If movement is too much, we might practice the pose with our minds, I offer cues as if we are moving. 

The nervous system is engaged. Afterwards, I ask people what they noticed. If I gave the cue to imagine raising their arms above their heads as they inhale, they report an urge to move. Then proceed mindfully.

Some people find proceeding mindfully is a chance to slow down and to notice how they move in space or how they move today. It is still movement. Still yoga.

We end the class with five minutes of mindfulness. We spend 40 minutes on movement. 

We learn to be able to sit, stand or lie down quietly. 

I prompt every 30 seconds. In the 30 seconds, the person may have become distracted by a thought, a sensation or an emotion. The prompts are my way of being like a metronome. I am not only offering to keep the beat. It is also my way of saying I am here, you are not alone.

TIY offers a first step approach toward tolerating more sensations. The Essential Guide to Trauma Sensitive Yoga by Lara Land suggests that yoga does not demand that one confronts thoughts, images, or memories of the trauma. The modality adding yoga to DBT gives the means to regulate emotions.

TIY has been helpful when paired with talk therapy for trauma treatment.  I use it to manage anticipatory fear and anxiety at the beginning of the session, during moments of high arousal or shutdown or dissociation.  

Avoidance, not tolerating sensations leaves us blocked and disconnected from what we are experiencing internally and externally. When we are more present, aware and awake to sensations, we are Mindful. One client described her reasons for giving up on avoidance as a coping tool because it prevented her from  "Living fully.”