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«By Farah Jindani A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Department of Applied Psychology and ...»

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EXPLORATIONS OF WELLNESS AND RESILIENCE: A YOGA INTERVENTION

FOR POST-TRAUMATIC STRESS

By

Farah Jindani

A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy

Department of Applied Psychology and Human Development

Ontario Institute for Studies in Education of the

University of Toronto

© Copyright by Farah Jindani, 2014

EXPLORATIONS OF WELLNESS AND RESILIENCE: A YOGA INTERVENTION

FOR POST-TRAUMATIC STRESS

Doctor of Philosophy, 2014 Farah Jindani Department of Applied Psychology and Human Development University of Toronto Abstract Post-traumatic stress is a highly prevalent mental health condition. Mind-body interventions like yoga are increasingly being utilized in the treatment of PTS, but further research is needed to assess its effectiveness. This present randomized control study was designed to supplement the current field of inquiry with a relatively large group of participants and mixed method analysis of the data. The PTS symptoms and overall well-being of 50 participants enrolled in an eight-week trauma-specific Kundalini yoga (KY) program were examined. The findings demonstrate that KY may impact PTS symptomology, sleep, positive affect, perceived stress, and feelings of resilience. Eight month follow-up data are presented. Participant narratives are discussed corroborating quantitative findings and suggest that participants learnt tools to modulate emotions leading to self-mastery. Study limitations are presented with recommendations for future trauma-related research and practice.

ii

ACKNOWLEDGEMENTS

I am grateful for the assistance and support of a number of people without which this research would not have been possible. Each individual whom I have encountered during this journey has

played a critical role in the completion of this project. Particular appreciation is expressed to:

Dr. Rick Volpe. Your enthusiasm and encouragement to think and research critically and innovatively added considerably to my graduate experience and will be remembered. I would like to thank the other members of my committee, Dr. Carl Corter, Dr. Roy Moodley and Dr.

Lana Stermac for the assistance they provided at all levels of this dissertation. Your feedback and guidance always gave much to consider. The valuable insight, support and humour of Dr.

Eunice Jang was intellectually and personally rewarding. Finally, I would like to thank Dr.

Richard Brown for serving as my external reader.

The classes would not have been possible without the dedication and teaching of Sandi Loytomaki, Inna Bondarchuk, Nancy West and Salimah Kassim-Lakha. Your love of the teachings and commitment to serving others is manifest. Your classes were a catalyst for change in the lives of participants. This research would not have been possible without you. Thank you to Pat Currie, Marika Csotar, Paramjit Kaur, and Tenille Chen. Your administration skills and presence in the yoga classes was uplifting. I express sincere gratitude to the participants of this research study. Your motivation to heal is manifest to countless others.

A very special thanks to Guru Fatha Singh Khalsa, whose inspiration motivated me to conduct this research. He personifies the teachings of Yogi Bhajan daily and it was under his tutelage that I developed the focus and passion to teach and research yogic practices for mental health.

He provided me with direction, technical support and became more of a mentor and friend, than a teacher. I doubt that I will ever be able to convey my appreciation fully, but I owe him my eternal gratitude.

I would like to thank Family Services Toronto and the Multi-faith Centre, University of Toronto for dedicating space for this research. Thank you to Siri Kirpal for offering feedback on the first draft of this work.

The unconditional love, belief and encouragement of my partner, Nizar Moosa. Your formatting and technical assistance at the final stages were an added bonus.

I am appreciative of my sisters for their critiques and unwavering support. To my parents who taught me that anything can be accomplished through hard work and commitment. I thank you for your unwavering love, support and all that sacrifices you have made for my success.

–  –  –

List of Tables……………………………………………………………………………………..vi List of Figures……………………………………………………………………………………vii List of Appendices………………………………………………………………………………viii INTRODUCTION………………………………………………………………………………...1

1. LITERATURE REVIEW

1.01 Post-Traumatic Stress: Definition, Causes and Symptomology

1.02 Post-Traumatic Stress: Mind and Body Evidence

1.03 Behavioural and Emotional Post-Traumatic Stress

1.04 Conventional Therapeutic Interventions for Post-Traumatic Stress

1.05 Limitations of Conventional Trauma Interventions





1.06 Health and Mental Health: Recent Mind-Body Understandings and Therapies.............25

1.07 Meditation as Therapy

1.08 Prevalence of Yoga as Recreation and Therapy

1.09 Yoga: A Comprehensive Behavioural Mind-Body Practice

1.10 Reconsidering the Relationship Between the Body and Mind

1.11 Lack of Quality Research on the Therapeutic Effects of Yoga and Meditation..............47

2. METHODOLOGY

2.01 Chapter Overview

2.02 Overview of Yoga Treatment

2.03 Design and Development of 8-week Kundalini Yoga Post-Traumatic Stress Protocol....53

2.04 Recruitment

2.05 Study Procedures

2.06 Participants

2.07 Outcome Indicators

2.08 Study Follow-Up

3. RESULTS

3.01 Chapter Overview

3.02 Quantitative data collection

3.03 Follow-up Responses

3.04 Analysis of Qualitative Data Strand

3.05 Participants’ Experiences of Self-Observed Changes

3.05.01 Overview.

3.05.02 Physical Exercise.

3.05.03 Clarity/Cleansing.

3.05.04 Breath

3.05.05 Relaxation.

3.05.06 Body Awareness.

3.05.07 Diet.

3.05.08 Sleep.

3.05.09 Energy.

3.06 Other Key Study Themes

3.06.01 Overview.

3.06.02 Emotional changes.

3.06.03 Psychosocial changes.

iv 3.06.04 Action/Behavioural changes.

3.06.05 Changes in awareness.

3.06.06 Cognitive changes

3.07 Yoga Program

3.08 New Awareness

3.09 Participant Journals

3.10 Program Compliance

3.11 Summary

4. DISCUSSION, FINDINGS, LIMITATIONS, AND FUTURE RESEARCH

4.01 Chapter Overview

4.02 Findings

4.03 Practice Implications

4.04 Limitations

4.05 Future Research

4.06 Summary

REFERENCES

APPENDICES

v LIST OF TABLES

Table 1. Characteristics of Study Participants at Baseline

Table 2. Means and Standard Deviation of Questionnaire Data for Wait-list Control and Yoga Treatment at Pre-, Mid-, and Post-treatment

Table 3. KY Follow-up Practice

Table 4. KY Follow-up Frequency of Practice

Table 5. KY Follow-up Length of Practice

vi LIST OF FIGURES

Figure 1. Mean Change Across All Scales for Intervention and Control Group

Figure 2. Mean Change for PCL (Post-traumatic Stress Checklist)

Figure 3. Mean Change for Insomnia Scale

Figure 4. Mean Change for PANAS (Positive Affect Scale)

Figure 5. Mean Change for Perceived Stress Scale

Figure 6. Mean Change for Resilience Scale

Figure 7. Coding Frequency of Dataset

Figure 8. Self-observed Changes Diagram

Figure 9. New Awareness Diagram

Figure 10. Yoga Program Diagram

vii LIST OF APPENDICES

Appendix A: Kundalini Yoga

Appendix B: Information and Recruitment Forms

Appendix C: Participant Screening Tools

Appendix D: Consent form

Appendix E: Quantitative Questionnaires

Appendix F: Homework Log

Appendix G: Semi-structured Interview Guide

Appendix H: Code Scheme/Themes

Appendix I: Journal Responses…

–  –  –

The purpose of this study is to evaluate the efficacy of a vigorous mind-body protocol in effecting the behaviours of people affected by post-traumatic stress disorder (PTSD). This research is founded on the premise that mind-body interventions may effectively empower and cultivate resilience in those affected by trauma. This study expands the framework of current treatments for PTSD by implementing both the social learning theory of Bandura (1971; Bandura and McClelland, 1977) to explain social behavioural outcomes and the unitive theory of Streeter, Gerbarg, Saper, Ciraulo and Brown (2012) to conceptualize the physiological transformations affected in the brains of participants. Bottom-up methodologies that engage the body directly to generate deep psychophysiological changes and increased self-regulation, as advocated by Van der Kolk (2000; 2003; 2006; Van der Kolk, Roth, Pelcovitz, Sunday & Spinazzola, 2005) and Ogden, Pain and Fischer (2006) are utilized. Participants will engage and practice empowering skills that may enhance quality of life.

Emotional trauma directly affects large segments of the population. A single distressing experience or multiple experiences can overwhelm an individual’s ability to cope and integrate ideas and emotions related to the stressful experience (Van der Kolk, 2006). Trauma symptoms can manifest after exposure to any traumatic stressor. Causes include accidents, physical assault, emotional loss, and anything that violates a person’s familiar ideas of the world or their human rights, thereby causing great confusion and insecurity. When a person whom an individual is dependent on for survival betrays or violates the individual, symptoms of extreme stress can result (Deprince & Freyd, 2002). While the causes of trauma are numerous, so are the responses.

Some people adapt to the distressing experience(s) while others may develop symptoms of posttraumatic stress (PTS).

Epidemiologic studies indicate that approximately 8% of Americans have had or will have post-traumatic stress during their lifetime, and that about 5% have post-traumatic stress at any given time. Women are twice as likely than men to develop post-traumatic stress (Howard & Crandall, 2007). Estimates suggest that trauma-related disorders cost over $45 billion U.S.

dollars a year in medical and related costs (Howard & Crandall, 2007; Tanielian, 2009).

Canadians typically associate post-traumatic stress with war veterans, but Van Ameringen, Mancini, Patterson and Bennett (2007) suggest that in actuality, almost one in 10 civilians meets the criteria for post-traumatic stress in his or her lifetime. Post-traumatic stress disorder (PTSD) has become a global health issue (Tanielian, 2009). Van Ameringen et al. (2007) suggest that at any given time, 2.4% of the population is experiencing symptoms of post-traumatic stress.

A vast research literature documents the physiological and somatic effects of posttraumatic stress (Levine & Frederick, 1997; Rothschild, 2000; Ogden et al., 2006; Van der Kolk, 2006). Experiences of extreme stress may impact the entire body, involving physical changes of the brain and brain chemistry that influence future stress responses (Van der Kolk et al. 2005).

Trauma causes a disruption of brain functioning as the amygdala and autonomic nervous system are continually in highly alert states of arousal. Experiences of traumatic stress inhibit the natural regulating flow between the parasympathetic and sympathetic bodily systems. This imbalance may cause physiological responses in the body after the traumatic situation has ceased including, but not limited to, rapid heart beat, difficulty breathing, muscle tightness, hyper-arousal, inability to relax, chronic pain, mood issues, racing thoughts, and substance abuse (Briere & Spinazzola, 2005).

Imbalances of the nervous system may create feelings of depression, anger, anxiety, extreme fear, racing thoughts, low mood, low energy, difficulty with sleep, dissociation, body numbness, digestive and immune system difficulties (Briere & Spinazzola, 2005). PTS symptoms are common in survivors of trauma, often embedded in a complex trauma spectrum that includes anxiety, substance abuse, mood issues, self-efficacy, sleep issues, and somatic complaints (Breslau, 2002; Breslau, Davis, Peterson, & Schultz, 2000; Van der Kolk et al., 2005). Individuals with a trauma history have a four to twelve times greater risk for attempting suicide, a four to twelve times greater risk of mood disorders and all forms of substance abuse, a two to four times greater risk for smoking, a 1.4 to 1.6 times greater risk for physical inactivity and obesity, and a 1.6 to 2.9 times greater risk for developing heart conditions, cancer, lung disease, skeletal fractures, hepatitis, stroke, diabetes, and liver disease than a person without a history of trauma (Felitti et al., 1998; Saxe et al., 1994). As the issues of trauma are complex and can impact individuals over the lifespan, effective treatment interventions are required.

Individuals with PTS typically re-experience the stressful situations of the past in the present, avoid trauma-related stimuli, have increased symptoms of physiological arousal, and often exhibit a constellation of physical and mental health issues (Van der Kolk et al., 2005).

Symptoms of trauma may not manifest immediately after the event has occurred and in fact may emerge weeks or years later. Inability to cope can result in mood difficulties, feelings of low self worth and helplessness. Treatment interventions should focus on alleviating these symptoms and providing feelings of comfort and security in the present by allowing individuals to feel comfortable in their own body.



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