Exploring trauma-sensitive yoga (TCTSY) as an aid for women after birth trauma.

TCTSY is a structured, body-based intervention developed at the Trauma Centre at the Justice Resource Institute. It uses invitational language, choice-making, non-coercion, present-moment experience, and shared authentic experience to support participants in developing a sense of agency, self-efficacy, interoceptive awareness, and bodily ownership. No physical materials or equipment are required. Participants attend from a private space of their choosing. The intervention is delivered by the researcher, who holds a Trauma Centre Trauma-Sensitive Yoga Facilitator (TCTSY-F) credential and has several years of facilitation experience with trauma-affected populations. The researcher is also the principal investigator of the study. The intervention consists of 8 individual online sessions delivered once per week over 8 weeks via the University of Canterbury (UC) -licensed Zoom. Sessions are 45 minutes each, except for the first session, which is 60 minutes to allow time for questions. TCTSY core elements (choice-making, effective action, interoceptive awareness, present-moment experience and creating rhythm) are introduced gradually and built upon each week, following TCTSY protocol. The sequence prioritises effective action before interoceptive awareness, in line with clinical reasoning for a CB-PTSS population. The intervention is embedded within a 16-week single-case experimental design (SCED). It is preceded by a 4-week baseline phase and followed by a 4-week follow-up phase. There is no control group; each participant serves as her own control. Session attendance and questionnaire completion are supported by weekly reminder texts to participants. The researcher maintains a session log following each session. TCTSY Elements: Choice-making (CM) – Allowing space to make choices is fundamental to empowerment. The majority of trauma survivors had choice taken from them. A TCTSY session creates opportunities for participants to practice choice making within forms/shapes, titration of movement, positioning of their body, whether they engage or not etc. Interoception(IC) – For many trauma survivors, a sense of self or connection to self is removed. This includes connection to their bodies. TCTSY sessions aim to co-create, with participants, a sense of power-sharing and relational safety. They may experience enough safety to stop trying to manage the facilitator as an external threat and turn inward to notice what they and their body are feeling. Present-moment Experience – Many trauma survivors can struggle to experience the present moment, as trauma can cause an individual to become “stuck” in the past. They may also struggle with being in the moment, as that can be directly linked to being in the body, something survivors struggle with. Through interceptive awareness, choice-making, and effective action, TCTSY seeks to create a space where participants feel safe being present in the moment. Taking effective action (TEA) – A sense of control and power can be removed from someone who exepreinces trauma. TCTSY session encourages a sense of control and power in participants by suggesting possible aysin which a participants might take effective action. They might choose to change a form as it feels uncomfortable fort them or do a different form they realise their body wants in that moment. They are taking action to help themselves feel more comfortable. Creating Rhythms (CR) – Unpredictability can create a sense of high alert in trauma survivors. An example of creating rhythm in this study is that each TCTSY session is structured around a set of simple, core forms. Additional forms are offered over the following weeks while retaining the core structure. That core structure of forms creates a sense of known rhythm to each session. Repetitive movement within forms creates a sense of rhythm within the body, allowing the nervous system to slowly begin to understand that movement and the body are safe. Facilitation Principles: Non-coercion (NC)– Power imposed on others can be detrimental. Sharing of power is central in a TCTSY session. A facilitator suggests how a body can be moved and creates structure. Participants can enforce their power by choosing how to move within that structure, the may choose not to move. Compassion underpins this collective sharing, which directs the facilitator's guidance and structuring, while understanding that the goal is for the participants to learn to make choices. That includes choosing something different to the facilitator's guidance. Invitational Language (IL) – Unlike yoga classes that command poses, TCTSY uses specific trauma-sensitive invitational language to provide participants an opportunity to consider what they want and need to do in the moment. The language promotes as sense that they have control of what they choose to do with their body. Examples of guidance language: “feel free to begin your practice today in a way that is useful to you…”, “when you are ready…”, “perhaps you feel the size of your arm movement…”, “perhaps the sensation in your shoulder, might guide your choice in shape or movement…”. Examples of trigger words/phrases not used in TCTSY due to their connections to forms of abuse: pose, spread your legs apart, touch, sigh, …do…, get down, stay etc. Sanskrit names for forms are not used as this can cause a sense of separation and trigger those who have had negative experiences in traditional yoga settings. In one-on-one sessions, facilitators and participants identify if there are particular words that the participants find distressing. Shared authentic experience – Power is shared in a TCTSY session. No one person's experience is more valid than another's. Everyone in the session is involved in the yoga and it is ok for the participant and facilitator to be authentic in actions, relationship with self and others. An example of TCTSY sessions: A TCTSY session uses the facilitation principles to create the conditions in which the TCTSY elements are introduced and practised. Each TCTSY session is built on the previous one, introducing new forms and TCTSY elements slowly. Participants can choose to use a chair, a mat on the floor, stand, or lie down. Forms can be altered to accommodate any space they choose. The forms used week by week are also built upon, depending on the participants' needs and abilities. For example, a participant may not move to interoceptive cues until week 7, as it may be too uncomfortable for them in an earlier session. Another participant may move to interoceptive cues in week 4 as they are ready. TCTSY is adaptable for each participant's physical and mental situation. For Example: Week 1: Invitational Language (IL) only – e.g. “you are welcome to move in a way that suits you today. Forms: Seated mountain Head drop/Flexion/Rolls Shoulder Rolls or lifts Torso circle/forward/backward Rounding and extending spine Twist Ankle flexion/circles Leg raise/lower Lean back Forward Fold Rest Week 2: IL Only Forms: As week one with Standing mountain, Lean side to side, warrior 1 Week 3: IL & Choice making (CM) (One additional choice e.g. – “perhaps you choose to raise your arms or maybe you place them on your legs”.) Forms: As week 2 with seated cat/cow Week 4: IL, CM (Two additional Choices = “you might choose to twist your body to the right, perhaps twisting your body to the left feels better today or you might choose to lean forward”) & Taking Effective Action (TEA) = “…would raising your arms to your shoulders suit your body today or would a completely different movement suit more”, “…this is your practice for your body…” Forms: As week 3 with Lifting/lower arms Week 5: IL, CM & TEA Forms: As week 4 with half sun salutation x 2 Week 6: IL, CM, TEA & Interoception (IC) = “If you are interested you might notice how your side feels in the stretch…” Forms: As week 5 with half sun salutation x 4 Week 7: IL, CM, TEA & IC (if participant is comfortable to perhaps introduce breath work – “…if it's helpful for you, perhaps you notice if you breathe in or out as you raise your arms…” Forms: As week 6 with offer of Tree. Week 8: As Week 7. Follow-up Phase (no TCTSY sessions) = Weeks 13, 14, 15, 16; include the weekly questionnaire measured in the baseline and intervention phases. In week 16, the primary measures are taken for the last time. This structure allows monitoring of maintenance or changes in potential gains from the intervention. Week 16 will include a debrief with the researcher for the participants and a final questionnaire to assess if the intervention is acceptable.