YogaHOPE is a non-profit organization dedicated to bringing rehabilitative trauma-informed mind-body programming to women internationally. YogaHOPE strives to lead women toward empowerment and recovery by cultivating mindfulness through yoga, meditation, and non-judgmental self-inquiry. YogaHOPE’s focus is on the implementation of a Trauma Informed Mind Body (TIMBo) program. Developed by yogaHOPE founder Sue Jones, TIMBo represents a manual based curriculum rooted in trauma theory and an understanding of gender-responsive programming. The TIMBo program offers a deliverable, research-based curriculum addressing the ways in which mind-body practices allow for long-term traumatic stress recovery. TIMBo was developed specifically for women suffering from chronic trauma, addiction and/or abuse.
To understand how trauma can significantly interfere with everyday functioning, even long after the traumatic experience has passed, we must understand our body’s “fight or flight” response to threat. The amygdala, a small structure in the brain’s limbic system, prepares our bodies to flee, fight, or freeze in the presence of danger by activating brain areas responsible for releasing stress hormones. These stress hormones increase our heart rate, blood pressure, and breathing to provide us with enough energy to escape from or defend against threat. Sometimes we have this reaction even when we are not in the presence of danger, for instance when we react to a traumatic memory as if we are reliving the experience. This phenomenon in which one’s emotional reaction is disproportionate to or incongruent with threat is known as “amygdala hijack” (Goleman, 1996). Individuals who have experienced trauma can thus become “stuck” in their traumatic experience, emotionally and physiologically reliving their trauma through intrusive flashbacks, memories, and sensations (Van der Kolk, 2014). This “cycle of trauma” can significantly interfere with an individual’s psychological wellbeing, social functioning, and everyday life. The TIMBo program offers women the tools needed to address the psycho-social, emotional, and physiological root causes of traumatic stress, enabling them to seek healing and to improve emotion regulation.
TIMBo utilizes a strengths based approach, encouraging female survivors to take an active role in their own recovery. The TIMBo program provides facilitators with a structured curriculum of 16 sessions that leaves participants with tools to address their habituated patterns and symptoms that lead to relapse and entrapment in the cycle of trauma. The TIMBo program is psychoeducational based, but additionally allows women the space for self-discovery and personal empowerment and in time becomes an every day practice.
The TIMBo curriculum represents a closed group program integrating pyschoeducation and mindfulness practices. A growing body of research supports the use of yoga-based therapies with individuals who have experienced trauma. Yoga has been shown to be an effective adjunctive therapy for treatment resistant women with PTSD (Van der Kolk et al., 2014) and a promising treatment for anxiety in deployed U.S. military personnel (Stoller et al., 2012). YogaHOPE’s own work with incarcerated women, women in post-earthquake Haiti, and in trauma-recovery community groups, has shown significant increases in positive coping mechanisms such as breathing and meditation (YogaHOPE, 2013 and 2014). Based on the theory that trauma, informed treatment strategies provide safety, predictability, structure, and repetition, all groups follow a similar structure with each session building on the last. Each session includes 1. group discussion; 2. pranayama (breath work) and asana (physical yoga); and 3. meditation. Progressive psychoeducational discussions regarding the emotional and physical impact of trauma build hand in hand with mindfulness practices. The curriculum progresses with the goal of building group cohesion and self-inquiry. Additional components, including an arts based project, are included as part of the program.
Impact and Results
Evaluation is a critical component to determining the effectiveness in meeting the goals of the TIMBo program. Program activities are incorporated into a formal review process by the yogaHOPE evaluation team, which is independent of yogaHOPE and therefore conducts the evaluation with objectivity. The aim is to have the evaluation contribute to yogaHOPE’s efforts to help bring the healing power of mindfulness training to women in recovery. The formal process for evaluation includes mechanisms to measure the impact and the effectiveness of the overall program, and the eventual longer-term impact on the women that participate, and their surrounding communities. Ongoing process evaluation is collected and analyzed to ensure the quality and breadth of the program and highlight any needed modifications. Outcomes are based on pre and post-program assessment measures including a series of validated scales and qualitative feedback. Participants are always made aware of the voluntary nature of participation in both the programming as well as program evaluation and feedback. Outcomes could provide useful information towards fostering new and effective strategies for trauma-informed care.
Four validated self-report scales are typically administered assessing levels of depression, anxiety, post-traumatic stress disorder, and self-compassion. The Zung Self-Rating Depression Scale is administered to assess symptoms of depression (Gabrys, & Peters, 1985; Carrol Fielding, & Blashki, 1973) and the Zung Self-Rating Anxiety Scale (Olatunji, Deacon, Abramowitz, & Tolin, 2006) to assess symptoms of anxiety. The PTSD Checklist (PCL-C) is included to measure symptoms of post-traumatic stress disorder (Blanchard, Jones-Alexander, Buckley, & Forneris, 1996). The included Self-Compassion Scale—Short Form (SCS-SF) determines levels of self-compassion through assessment of how an individual acts or feels towards themselves during difficult times (Raes, Pommier, Neff, & Van Gucht, 2011). Gathering data on these measures allows for analysis of positive change, growth and healing in participants. Changes in mean scores for participant outcomes on standardized measures are compared using statistical analyses.
The outcomes from the data collected thus far, from all completed programs, consistently demonstrate that the program contributes to a statistically significant reduction in mental and behavioral health symptoms such as depression, anxiety and symptoms of PTSD, and an increase in self-compassion (Rousseau & Jackson 2015 and Rousseau & Jackson 2014). Please see yogaHOPE’s references for published literature, numerous presentations and research briefs included at the end of this document for more information. This has been extremely helpful in engaging the traditional mental health community to at least be curious about the model as a “treatment” option.
“The TIMBo program opened my eyes, my mind and my heart. Throughout the next eight weeks I discovered more about myself than I had in the last 20 years. Through the guidance of TIMBo I waded through all of the complex emotions I felt after the marathon and began to make sense of where they were coming from. Most of all the program showed me how to begin to give myself the gift of patience and self compassion…” ~ Participant from the Boston TIMBo program