Journal of Religion & Spirituality in Social Work:

Social Thought, 34:394–413, 2015

Copyright © Taylor & Francis Group, LLC
ISSN: 1542-6432 print/1542-6440 online
DOI: 10.1080/15426432.2015.1082455

A Journey to Embodied Healing: Yoga as a

Treatment for Post-Traumatic Stress Disorder

FARAH JINDANI, PhD

Centre for Addiction and Mental Health, Toronto, Ontario, Canada

GURU FATHA SINGH KHALSA, BA

Multi-Faith Centre for Spiritual Study and Practice, University of Toronto,
Toronto, Ontario, Canada

This article introduces the spiritual dimension of the experiences of

40 participants in an 8-week Kundalini yoga (KY) program to treat
the symptoms of post-traumatic stress disorder (PTSD). Trauma dis-
rupts the mind–body connection, while yoga is dedicated to holistic
reintegration by positively affecting the nervous system and improv-
ing self-regulation, mood, and feelings of self-worth. Treatment
involved yogic techniques of meditation, breath regulation, move-
ment, and relaxation, together with a routine of meeting once a
week. A phenomenological approach was used to derive the mean-
ing of participant experiences. Narratives of program participants
are presented and coincide with factors pertaining to spiritual or
personal beliefs defined by the World Health Organization Quality
of Life Group. Implications for holistic embodiment practice are
discussed.

KEYWORDS embodied healing, identity, Kundalini yoga, mind–

body–spirit, post-traumatic stress disorder, self-regulation, spiritu-
ality, well-being

INTRODUCTION

Post-traumatic stress disorder (PTSD) is a highly debilitating and preva-

lent condition resulting from exposure to traumatic events. Individuals

Received December 19, 2014; accepted August 20, 2015.

Address correspondence to Farah Jindani, PhD, Centre for Addiction and Mental Health,
33 Russell Street, Toronto, Ontario, Canada, M5S 2S1. E-mail: [email protected]

394
 Spirituality, Yoga, and PTSD 395

with PTSD experience disintegration between body and mind (Rothschild,

2000). This disconnect may manifest itself as any of a variety of symptoms
of dysregulation, including spontaneous re-experiencing of the traumatic
event, avoidance behaviors, mood disorders, and hyper-arousal. Observed
physiological changes include low parasympathetic nervous system (PNS)
activity, inhibited heart rate variability, and increased cortisol and decreased
gamma-aminobutyric-acid (GABA) levels in the brain (Porges, 2001; Streeter,
Gerbarg, Saper, Ciraulo, & Brown, 2012; van der Kolk, 2006).
Current PTSD treatments use cognitive and pharmacological models that
primarily address symptoms of PTSD. Van der Kolk and colleagues (2014)
conclude that PTSD treatments have a high rate of incomplete response and
do not address the deep physiological, psychological, and sociological dis-
integration and dysregulation characteristic of PTSD. Garber (2006) explains
that negative cognitive structure and worldview are connected to anxiety and
depression. Negative beliefs about self, the world, and the future contribute
to global attributions of negative stress creating a vicious cycle. Dalton (2009)
concludes that spirituality is related to positive identity development as well
as meaning and purpose in life. In light of these new understandings, there
is today an increased interest in holistic or embodied therapeutic modalities.
Kundalini yoga (KY) is a comprehensive contemplative system of prac-
tices incorporating physical postures, breath and mantra, meditation and
mental focus, self-observation and relaxation. The discipline of yoga is ded-
icated to the awakening of the potentialities of the self and ultimately to the
personal realization of oneness, known as samadhi. Thus, while yoga may
be applied as a therapy to treat the immediate bodily and mental distresses
of the individual, the ultimate aim is self-realization (Eliade, 1958; Mishra,
1972; Newberg, 2009).
The practice of yoga was introduced to North America in the late 1800s
(Syman, 2010). Yoga treatment interventions have demonstrated effective-
ness in various studies of chronic pain, insomnia, depression, anxiety, and
medical disorders involving stress reactions (Balasubramaniam, Telles, &
Doraiswamy, 2012; Büssing, Michalsen, Khalsa, Telles, & Sherman, 2012;
Kohn, Persson Lundholm, Bryngelsson, Anderzen-Carlsson, & Westerdahl,
2013). Yoga therapy affects psychophysiological changes that reduce activ-
ity of the body’s stress response systems and enhance self-regulation, mood,
well-being, quality of life, and resilience (Büssing et al., 2012). Recent neuro-
scientific studies of yoga and meditation have led to an increase in scholarly
focus on the therapeutic applications of yoga and meditation to issues of
mental health (Anderzen-Carlsson, Persson Lundholm, Kohn, & Westerdahl,
2014; Kissen & Kissen-Kohn, 2009; Wallace & Shapiro, 2006). To date, studies
focused on yoga as a treatment for PTSD symptoms have not investigated
participant perspectives in relation to the theme of spirituality.
While admitting any definition of spirituality to likely be deficient
and contestable, Crisp (2010) describes it as an awareness of the “other”
396 F. Jindani and G. F. S. Khalsa

which provides the basis for understanding our experiences of, and ask-
ing questions about, meaning, identity, connectedness, transformation, and
transcendence (p. 7). Significant relationships have been demonstrated
among spirituality, wholeness, and well-being (Miller & Thorensen, 2003;
Saxena & WHO-QOL Group, 2006). The scale devised by the World Health
Organization in this light is of particular interest because it is one of the
few that embraces both secular and religious interpretations of spirituality in
the context of quality of life and holistic embodiment (Saxena & WHO-QOL
Group, 2006).
This study presents participant perspectives in relation to the lens of
spiritual and integrative healing. The narratives of participants involved in
an 8-week KY intervention are examined for insights into embodied –
physiological, psychological, social, and spiritual – healing.

Reformation of Self and Identity Through Yoga

Embodied healing does not come easily or naturally in our culture, where
the mind and body have long been considered separate and distinct entities.
This accepted bifurcation dates back at least as far as Descartes’s state-
ment that the basis of his being resided in his thinking, “I think, hence
I am.” (Descartes, 1537/1986, p. 27) and still dominates our Western medical
paradigm. Greenwood and Delgado, in countering this mentalist tendency,
have designated the physical body “the locus of human agency” in this world
(Greenwood & Delgado, 2011 p. 948). Through the body, our consciousness
is localized. Through it, we see and are seen, act and are acted upon. Without
the body, we practically do not exist.
In yoga therapy, the body provides not only the foundation for the
integrative work to come, but also the keystone of yogic psychological
understanding: the system of chakras, vortexes of psychophysicality, aligned
with the spine and ascending to the top of the head. They correspond
roughly with Maslow’s hierarchy of needs, ranging from physiological needs
to security, to social needs, self-esteem, and self-actualization (Maslow,
1943). The chakras of KY philosophy, representing eight domains of apti-
tude and experience, competence or incompetence, differ most significantly
from Maslow’s needs hierarchy in that they are situated in alignment with
a series of distinct locations in the spine and brain. In succession, they are:
survival and self-destruction at the rectum; creativity and rejuvenation at the
sex organs; identity, power, and judgement at the navel; compassion and
forgiveness at the centre of the chest near the heart; knowledge, truth, and
willpower at the throat; discovery at the brow; connection with the infinite
at the top of the head; and lastly, well-being in the magnetic field. As the
chakras are awakened, their ontological faculties, individually and cumula-
tively, are considered to have an integrative and empowering effect on the
individual (Khalsa, 2001).
 Spirituality, Yoga, and PTSD 397

In 1932, when KY was first being considered as an adjunct to Western

psychotherapy, Carl Jung delivered a series of four lectures on the psychol-
ogy of Kundalini yoga, most of which was devoted to a detailed analysis
of the chakras (Jung, 1932/1996). In his essay “Yoga and the West” Jung
effused that yoga is “one of the greatest things the human mind has ever
created” (Jung, 1969, p. 537). His only concern was for the West’s capacity
to assimilate the yogic paradigm.
Breath control serves an important function in yogic integration and
self-regulation, as it is believed to focus and calm the mind and help
direct it away from emotional causality. Etymology points to cross-cultural
links between breath, wellness, and spirituality. Our word “health” derives
from “hale” meaning whole or sound in Middle English, and is directly
related to “inhale,” to breath in, even as our verb “inspire” derives from
the Latin “spirit,” which originally meant breath (Webster’s New Encyclopedic
Dictionary, 2002). Numerous contemporary studies have affirmed the capac-
ity of breath-based therapies to treat the symptoms of insomnia, stress,
anxiety, and depression (Brown & Gerbarg, 2005a; Brown & Gerbarg, 2005b;
Choliz, 1995; Descilo et al., 2010).
Meditation, the churning of the conscious and subconscious minds,
serves a most important role in the yogic discipline of personal integration,
self-regulation, and self-actualization. It is the yogic understanding that the
healing of the organism is a natural outcome of the practitioner’s adherence
through meditation to their intrinsic, spiritual nature and their shedding of
“the false sense of union with mental and physical disorders because they
are not inherent properties of body and mind” (Mishra, 1972, p. 97).
The yogic quest for Supreme Consciousness, or Brahman, considered
to be the inherent, disease-free state of being, shares some similarity with the
dynamic of Ryan and Deci’s (2000) Self-determination Theory (SDT). Both
theorize the superiority of an intrinsic locus of control over an extrinsic locus
developed over time. Although yogic philosophy focuses on knowledge and
perception of self, while SDT focuses instead on motivation, they coincide
in their understanding that deviation from what is intrinsic is stressful and
therefore unhealthy for the organism. Both offer remedies for unhealthy,
extrinsic influences (Ryan & Deci, 2000).
Ryan and Deci’s approach would nurture intrinsic motivation by encour-
aging behaviors and cultivating environments characterized by a sense of
security and relatedness, while yogic methodology would instead focus on
rediscovering that which is intrinsic through meditation (Ryan & Deci, 2000).
Moreover, the three human needs of competence, relatedness, and autonomy
identified in SDT also cohere with yogic philosophy. Herein, this study uses
the term self-realization to encompass Maslow’s concept of self-actualization
and Ryan and Deci’s (2000) notion of self-determination. The yogic path itself
may be termed a journey toward: (a) autonomy from extrinsic forces, (b) the
experience of relatedness to the Absolute Brahman, and (c) the realization of
398 F. Jindani and G. F. S. Khalsa

competence through continued practice of meditation and self-actualization

(Mishra, 1972; Ryan & Deci, 2000). From Greenwood’s perspective based
on biokinetics together with Delgado’s focus on theological anthropology
together with her personal journey through anorexia, they welcome yoga as
a possible way to “restore the body-spirit divide” (Greenwood & Delgado,
2011, p. 950)

Yoga Therapy for PTSD

Our societal dissociation of mind and body may be seen reflected in a num-
ber of significant morbidities endemic to modern cultures. The objectification
and commodification especially of the female body that can result in eat-
ing disorders and unhealthy self-image is widely recognized (Thompson,
Heinber, Altabe, & Tantleff-Dunn, 1999; Grabe, Ward, & Hyde, 2008). The
connection between our increasingly sedentary lifestyle, unhealthy dietary
choices, and our current pandemic of obesity are also known and studied
(Hu, Li, Colditz, Willett, & Manson, 2003; Ogden et al., 2006). Our general
dissociation of body and mind is further exacerbated by traumatic stress (van
der Kolk, 2006).
In their review of literature on trauma, PTSD, and resilience, Agaibi
and Wilson have suggested that self-regulatory deficits could be the most far
reaching effects of psychological trauma (Agaibi & Wilson, 2005). By focus-
ing on mastery experiences, an effective treatment intervention for PTSD
may develop self-efficacy and lift the mood of participants (Seligman, 1998).
Changes in patterns of bodily movement and posture, through an integrative
body–mind intervention, may bring about changes in emotional responses,
beliefs, and sense of self as postulated by van der Kolk (2006) and Odgen
and colleagues (2006).
Yogic exercise and meditation engages the entire organism in the pro-
cess of psychological healing. With practice, victories in self-regulation, small
at first, lead to predictable improvements in mood, self-confidence, and
resilience. These positive developments may then lead to a greater sense
of self-worth.
Psychological healing also implies social healing for individuals with
PTSD, who tend to isolate socially. In his study of the social history of addic-
tion, Bruce Alexander argues that, unlike some other mammals, humans are
not well adapted for survival in isolation (Alexander, 2008). As he points out,
the aggravated trauma of social isolation leads to a heightened susceptibility
to addiction among the PTSD population. According to the polyvagal theory
of Stephen Porges, the myelinated vagus nerve, which plays an important
role in human social engagement by governing vital functions such as vocal
and facial expression and heart rate variability, is functionally depressed by
trauma (Porges, 2001). The healing of the body through yoga may contribute
 Spirituality, Yoga, and PTSD 399

to the repair of the vagus nerve and subsequent restoration of psychosocial

integration (Streeter et al., 2012).
Improvements in self-regulation, self-confidence, and self-esteem are
integral to the reformation of dysfunctional constructs of self and identity.
The continued practice of yoga aims toward the realization of a higher
level of self-determination (Ryan & Deci, 2000), a greater degree of self-
actualization (according to Maslow’s pyramid of needs), and a convergence
of the individual being, defined by its limitations, with the infinite, spiritual
Self according to the yogic paradigm.
To our knowledge, few studies have investigated the qualitative experi-
ences of participants partaking in yoga treatment (Anderzen-Carlsson et al.,
2014; Cramer et al., 2013). No studies have examined participant perspectives
in relation to a KY treatment intervention to understand how individuals
with PTSD make meaning of their yoga treatment experiences in relation
to spirituality. The aim of the present study was to understand the holistic
dimensions of yoga through the narratives of individuals with PTSD.

METHOD
Design
Qualitative research provides an understanding of how participants make
meaning of a treatment intervention and its contextual impact (Verhoef,
Casebeer, & Hilsden, 2002). This study utilized a descriptive design with
phenomenological methodology. Phenomenological analysis is grounded in
the philosophy that reality is only an object of human consciousness and
language is vital to making meaning (Dahlberg, Drew, & Nystrom, 2001;
Husserl, 1999). An inductive phenomenological oriented approach was uti-
lized whereby participant interviews were examined for similarities and
patterns of response. In consideration of this approach, qualitative inter-
views were gathered and utilized to understand and describe the meaning
that individuals with PTSD attributed to their KY experience.

Study Sample and Setting

Participants of the present study were recruited from the KY and PTSD RCT.
Twenty-nine participants completed the KY PTSD intervention and 21 partic-
ipants were part of the wait-list control condition (Jindani, Turner, & Khalsa,
2015). The RCT took place in Toronto, Ontario, Canada in 2012, and par-
ticipant interviews were completed 1 week following completion of the
RCT. The University of Toronto office of research ethics granted approval
for the study. Informed consent was obtained from participants at study
onset. Confidentiality was ensured by assigning each participant a numeric
code which was used in the data analysis.
400 F. Jindani and G. F. S. Khalsa

All 50 participants who completed the 8-week KY treatment interven-

tion were invited to participate in a semistructured interview with the lead
researcher. Ten participants were unavailable for the interview a week after
study completion due to scheduling issues. The narratives of 40 participants
were analyzed for the purposes of this study.
Three certified KY yoga instructors in Toronto, Ontario, each with a per-
sonalized yoga practice and over 5-years mental health teaching experience,
taught the 8-week KY program. Inclusion criteria for study participation was
a score of 57+ on the PTSD Checklist (PCL-17), no current contemplative
practice, and being 18 years of age or older. In total, 31 females and 9 males
participated in the semistructured interview. Mean age of participants was
44.7 years (SD = 11.2) years. The majority of participants were not practition-
ers of yoga. In total, nine participants had practiced yoga and/or meditation
in the past. Participants were generally interested in partaking in the program
as it was specifically designed for PTSD.

Procedures and Measures

The team that designed the treatment protocol consisted of the lead
researcher, a trauma-certified psychologist, a clinical psychologist, a social
worker, a war veteran who used KY personally for PTSD healing, and a
KY teacher trainer. All program developers were certified KY teachers with
personal yoga and meditation practices. The 8-week KY PTSD treatment
program comprised a number of strengths-based elements dedicated to cul-
tivating resilience and self-efficacy, with a focus on reintegration and the
development of coping strategies.
The protocol was specifically designed according to KY yogic philoso-
phy to: (a) help participants learn to relax and manage trauma and related
stress; (b) engage them in mindful awareness of their body, mind, breath,
and surroundings; (c) help them improve their cognitions, behavior, and
emotions related to self-esteem and self-efficacy; (d) encourage participants
to develop greater physical flexibility and strength; and (e) help them to
reintegrate socially.
Empowering affirmations were used in the treatment program to sup-
port the healthy reformation of self and identity. Sat Nam (true identity),
the “seed mantra” of Kundalini yoga, is an affirmation to “be your Self”
(Shannahoff-Khalsa, 2010, p. 241). Similarly, chanting “I am, I am” was a
technique to center participants in their essential wholeness and to support
self-acceptance and empowerment (Fowlis, 1975, p. 32).
Rather than looking to the trauma narrative situated in the past, the
emphasis in the KY PTSD program is on accessing the powerful possibilities
inherent in the here and now using mindful breathing and movement. In this
way, individuals with PTSD can learn to become comfortable and attune to
their internal sensations. While KY provides physical exercises that allow
 Spirituality, Yoga, and PTSD 401

for deep relaxation and help participants feel at home in their bodies, it
simultaneously embraces the emotionally integrative and spiritual aspects of
their healing.
Study participants met for 8 weekly 90-min group yoga practice ses-
sions. Each week’s program built upon the work of the previous week.
Participants were introduced to exercises of increasing difficulty and dura-
tion. Relaxations which at first were short and led by the facilitator, gradually
were lengthened and unguided.
Overall, the program included: (a) a publicly expressed intention of
“getting better,” (b) a daily practice to help realize that intention, (c) exer-
cises believed in yogic theory to “correct underactivity of the PNS and GABA
system in part through stimulation of the vagus nerve and reduced allostatic
load” (Streeter et al., 2012, p. 571), (d) exercises designed to increase men-
tal focus and bodily awareness, (e) positive visualizations, (f) guided and
unguided relaxations, (g) group support, and (h) a supportive facilitator.

Data Collection
A semistructured interview was conducted by the lead researcher and took
place within a week of program completion. The yoga instructors were not
present. The interviews were audiotaped with the consent of participants
and transcribed verbatim. On average, each interview was approximately
30 min in length. The interviews between researcher and participant were
conversational in nature, and participants were encouraged to describe their
experiences of the yoga program, treatment outcomes, and suggestions for
future yoga treatment interventions. Further descriptions of findings are
presented in Jindani and Khalsa (2015) and Jindani, Turner and Khalsa
(2015).

Data Analysis
The research team separately read all transcripts several times to familiar-
ize themselves with the interview data. Participant experiences related to
self-observed changes, new awareness, and perceptions of the program are
described in more detail in Jindani and Khalsa (2015). Using a phenomeno-
logical approach, the researchers were open to perspectives that emerged
from the data and the meaning that individuals attributed to their experiences
(Dahlberg et al., 2001). Research meetings were held to discuss findings,
key issues, and to identify themes. The final step consisted of revisiting the
dataset to ensure the analytic process and to confirm that all data were
reflected in the coding and thematic analysis while retaining the voices of
participants.
402 F. Jindani and G. F. S. Khalsa

RESULTS

The majority of participants discussed how an embodied KY practice

impacted feelings of energy and renewal, self-esteem, spiritual strength,
centeredness, peace, and connection with spirit, self/wonder. While for the
purposes of analysis, the authors attempted to distinguish and delineate the
various facets of participants’ experiences, many participants presented sig-
nificant overlaps and synergies. Many of them identified yoga as a spiritual
or embodied practice supportive of healing for PTSD.

Heightened Energy/Renewal
Heightened energy was one of the most widely reported experiences of
embodied healing cited by program participants. Greater energy and feelings
of revitalization were particularly noted for individuals with acute depression,
low mood, and physical illness. Those with PTSD often feel low in mood,
and this impairs their ability to sleep adequately and relax and renew their
bodies and minds. A frequently mentioned experience of practicing yoga
was the ability to calm down physically and mentally.
Several interviewees shared that the practice of yoga brought their atten-
tion to breathing patterns and that they were learning to slow down, pay
attention to the body, and breathe slowly and from the abdomen, which
supported their feeling better about themselves. The majority of participants
noted that in achieving greater self-esteem, they were simultaneously feeling
more compassionate toward themselves and others:

It is a powerful thing when we are breathing and moving our body.

There is a lot of energy and there is a lot of compassion.

I’ve noticed that just doing it made me feel better physically, like I have
more energy after doing it, so I figured that I might as well keep this
up. And I’m having success with my physical health . . . and more self-
esteem, by far.

Some program participants stated that the enhanced feelings of inter-

nal energy and well-being were reflected in other areas of life. Interviewees
shared that because they felt more energy, they were able to participate
in other activities and lifestyle changes. Many believed that the physical
practices enabled them to achieve improved states of well-being. They
related how the combination of physical practice, breathing, and meditation
enhanced their mood, calmness, vitality, and compassion.
 Spirituality, Yoga, and PTSD 403

Self-esteem
Among numerous participants, self-esteem translated into renewed
confidence in self and making empowering choices and decisions for self.
Participants expressed that because they were feeling clearer in their think-
ing and emotions, they had greater confidence and were taking time to care
for themselves.
Searching for answers outside of self and relying on others are actions
characteristic of PTSD. The majority of program participants reported that
since feeling enhanced self-esteem and confidence, they were learning to
rely on themselves rather than seeking answers from outside, from oth-
ers. Trusting in themselves was a change that made participants feel greater
happiness and confidence:

I am going by my values. I am happy to follow my goals, not somebody

else’s goals. Who cares? I am learning this is not a problem. I am allowing
myself to do what is right for me. I am happy with that. I am very happy
with yoga, extremely happy.

I’m asking less for help and just trusting myself more to make my deci-
sions, yeah, like really taking responsibility for myself. I’m so grateful I
got to participate in this.

Centeredness
PTSD makes it difficult to recognize what is happening in the moment.
As participants learned to be more aware in the present moment, they were
learning to attune to and regulate the body rather than being overwhelmed
by thoughts as is characteristic of PTSD:

I said to myself, “My goodness, I am present to myself!” When I am in

the world, I am in the world. I am not either disassociated or thinking so
much that I don’t even realize the sun is on my body. That is the biggest
change.

As participants practiced living in the here and now and breathing

through challenging experiences, they were learning to control their thought
patterns. This, in turn, translated into better focus and awareness of emotions
and feelings inside of the body:

I just was so aware of the things that were going on in my body, even all
the pain, yeah of the sitting. I was way more present and I was surprised
since I have not done meditation.
404 F. Jindani and G. F. S. Khalsa

All interviewees conveyed that as they were learning to become more

attuned to the experiences, sensations, and feelings of the body, they
were feeling greater tranquility and peace. For many, this was a very new
experience.

Spiritual Strength
All participants described program experiences that occasioned new feelings
of inner strength and resilience. Several interviewees noted that because
they were feeling stronger internally, they were not feeling victimized by the
past and also not fearful about the future. They stated that with a stronger
confidence they could control themselves and their reactions to situations.

I am actually feeling a lot stronger, more powerful and in charge of my

destiny . . . There’s no doubt in my mind. This is really powerful for me.
It gave me the ability to be grounded.

Some participants described a faith in self and something higher than

self. For a few members of the program, this meant having an awareness
and confidence that even in difficult times, there will be good times, and for
many, this meant a connection to God or a greater power:

I feel stronger, like I have a whole lot of ability to stay upright in difficult
times and I don’t get knocked down . . . Spiritually, I feel more of the
connection with God and that helps so much

Regaining a sense of self, self-control and self-efficacy is critical for PTSD

recovery. Many participants shared that as they were feeling greater internal
strength and confidence, they felt that their mind and body was working in
harmony and this awareness was imperative to learning to live in the present.

Inner Peace
Several participants reported learning to cultivate a sense of inner calm when
feeling stressed in their lives. A related overarching theme was that of self-
confidence:

Some things in my life have actually gotten crazier, but I’m feeling really,
like a really deep peace and balanced and strong in it.

Inner peace, balance, and calm was discussed by participants and

related to feelings of self-esteem:
 Spirituality, Yoga, and PTSD 405

I feel an inch taller after a yoga session. I can stand taller and I feel
calmer, and just being in an environment like that always feels calmer
afterwards.

Experiencing an internal alignment and peace with self, participants

discussed feeling greater strength, balance, and focus in other areas of life.
While all participants mentioned that they benefited from the practice, the
majority expressed that the program was an introduction and they wanted to
continue to practice. Many participants expressed that they were feeling that
the peace that comes from a mind–body practice is not an external process,
but has to come from within.

Connection With Spirit/Self/Wonder

Renewed vitality, inner strength, calm, and peace led some participants to
embody these experiences in other areas of their life. In their interviews,
they spoke of this new awareness and connection as an interrelated connec-
tion between spirit, self, and wonder, or awe. Interviewees described this
awareness as a sense of alignment with their own spirit:

The first week here, when it was over, she said, ‘How was it?’ I said, ‘It
was unbelievable!’ And I said, ‘This is about love.’ I just knew it.

Love, peace, emotional integration, security, and centeredness were

found to coexist with feelings of spirituality and connection with self. Several
interviewees expressed that as they were feeling greater unity between mind,
body, and spirit, they were feeling enhanced states of strength and wellness
that they were grateful for and that they felt was related to spirituality or
something outside of themselves:

I’m spending more time with my spiritual self, doing my meditation and
my prayers in the morning, and stopping during the day and just giving
thanks. I’m more centered, I think.

The majority of program participants said they felt that by taking part in
the yoga program they were developing a new or renewed relationship with
spirituality. For some, this included formalized practices while for others, this
included a new relationship with external environments like nature or the
world in general. In whatever manner this embodied practice manifested,
participants expressed that they felt greater control over their healing and
thus, felt more empowered living in the world.
406 F. Jindani and G. F. S. Khalsa

DISCUSSION

The 8-week KY program for PTSD introduced a number of simultaneous

catalysts into the lives of participants for the duration of the study. The
response to this multifaceted treatment was similarly multidimensional. Many
participants spoke of experiencing heightened energy and both physical
and spiritual rejuvenation in the course of their recovery. Some participants
shared their experiences of seemingly contrary sensations. For example, par-
ticipants described feeling a really deep peace and gentleness and connected
these feelings with newfound feelings of strength, hope, confidence, balance,
less worry, and alertness. Inner peace was commonly intertwined with other
essential capacities such as strength, balance, and mental focus.
Participants discussed a relationship between heightened feelings of
energy and calmness, heightened energy and compassion toward self and
others, as well as energy being connected to feeling better about self. These
findings may be an affirmation of the calming effects of yoga on individuals
with generalized anxiety disorder documented by Katzman and colleagues
(2012) and possibly the theory of Streeter and colleagues (2012) that yoga
affects the overall well-being of the organism by balancing the nervous
system and reducing allostatic load.
Discussion of high energy, inner strength, and greater belief in self
seem to indicate an intrinsic, holistic healing from the inside out. These
findings align with Greenwood and Delgado’s (2011) suggestion that yoga
may restore the body–spirit divide. Participant narratives also focused on a
greater awareness and understanding of one’s experiences. The majority of
participants discussed feeling a renewed sense of meaning, identity, connect-
edness, transformation, and transcendence. These perspectives reflect Crisp’s
(2010) definition of spirituality.
Participant narratives suggest that an embodied KY practice can support
those with PTSD in focusing on interoceptive processes contributing to feel-
ings of empowerment. Participants were able to separate from the cognitive
trauma narrative and to discuss positive feelings toward self. Participants’
negative cognitive structure and worldview dominant at program onset was
shifting to include greater perceptions of positive identity (Dalton, 2009) at
treatment completion. The restoration of an intrinsic sense of being, resonat-
ing both with SDT and yogic philosophy, was deeply ingrained in many
of the interviews (Ryan & Deci, 2000). As participants were experiencing
enhanced feelings of rejuvenation and calmness, they noted that their per-
ceptions toward self were altering. It is worth noting here that Seligman
(1998) associated heightened self-esteem and reduced incidents of depres-
sion with increased self-efficacy. For Maslow (1943), self-esteem occupied
an important place in his hierarchy of needs, just below self-actualization.
PTSD widens the pre-existing schism between mind and body, making
it difficult to recognize what is happening in the moment (Krystal, 1988; van
 Spirituality, Yoga, and PTSD 407

der Kolk, 2006). As such, those with PTSD are prone to lack of motivation
or compulsions that are merely extrinsic. As the yoga practice helped partic-
ipants find their center, participants noted increased autonomy, relatedness,
and competence in line with Ryan and Deci’s SDT (2000). These findings
suggest that yogic treatment interventions offer an embodied mind–body–
spiritual practice whereby those with PTSD can positively grow from their
experiences and develop positive self-awareness, self-regulation, identity,
and resilience.
Individuals with PTSD are generally known to isolate socially, and
most of the participants lived alone (Alexander, 2008; Ferrada-Noli, Asberg,
Ormstad, Lundin, & Sundbom, 1998). Significantly, many of the participants
bonded together and continued their friendships out of class. This psychoso-
cial integration may have been symptomatic of the healing of the myelinated
vagus nerve, considered to be vital to human social engagement (Porges,
2001). It also reflects the self-actualization at the pinnacle of Maslow’s (1943)
needs hierarchy. This unity between self and others is linked to confidence
as well as gentleness toward self, hope, and a sense of social and spiri-
tual connection. This dynamic is familiar to the yogic concept of realizing
oneness between the limited individual, others and the unlimited, Supreme
Consciousness.
The World Health Organization’s Quality of Life Spirituality
Religiousness and Personal Beliefs (SRPB) Group’s template of eight expe-
riential nonsectarian factors (Saxema, & WHO-QOL Group, 2006) were well
represented in the testimonials of group participants, though some of them
required a degree of interpretation. In this analysis, the WHO-QOL fac-
tors “awe” and “connection to a spiritual being/force” were combined as
connection with spirit/self/wonder since in a number of cases the sense
of communion and the feeling of awe coincided. “Faith” and a sense of
“meaning in life” were combined as self-esteem and interpreted as an inter-
nal dynamic of belief in oneself and trust in the evolving purpose of one’s
life. “Wholeness and integration” was translated as centeredness with the
understanding that integration and wholeness are an outcome of cultivating
self-awareness in the present moment. While many of the interviews were
suffused with a spirit of “hope and optimism,” participants were more likely
to speak in terms of their heightened energy/renewal. “Spiritual strength”
and “inner peace” were not combined with other WHO-QOL factors.

Limitations
There are some limitations to this study. In terms of participant recruitment, it
is possible that those who chose to volunteer in the 8-week yoga intervention
were healthier, more self-aware or more optimistic at program outset than
those who chose not to participate. Weekly interaction and the development
of trust and safety with the teacher and other program participants who
408 F. Jindani and G. F. S. Khalsa

shared a common background may also have had a positive impact on par-
ticipants, aside from the yoga. Finally, some participants who had no prior
experience with a physical practice suggested that a greater focus on simple,
breath-focused meditations that are very easy to learn and practice may have
supported their experience in the program.

Implications for Practice

Some 80 years ago, Carl Jung opined that yoga presented a method of
psychological and physiological hygiene

far superior to ordinary gymnastics or breathing exercises in that it is not

merely mechanistic and scientific but, at the same time philosophical.
In its training of the parts of the body, it unites them with the whole
of the mind and spirit, as is quite clear, for instance, in the pranayama
exercises, where prana is both the breath and the universal dynamics of
the cosmos. When the doing of the individual is at the same time a cosmic
happening, the elation of the body (innervation) becomes one with the
elation of spirit (the universal idea), and from this there arises a living
whole which no technique, however scientific, can hope to produce.
(Jung, 1969, pp. 532–533)

Jung’s was a bold endorsement of a practice barely known in the West

at the time. While this KY program is a preliminary study, participants’ sub-
jective assessment of changes in self-perception, self-regulation, confidence,
and connection to self, others, and the world suggest the possibility of deep
physiological, psychological, and sociological reintegration and regulation.
The role of holistic and spiritual affects in the treatment of trauma was a key
finding of the KY PTSD treatment program suggesting intertwined physical,
mental, emotional, social, and spiritual dimensions to the journey to wellness
and recovery.
In consideration of micro level social work practice, the facilitator’s
contribution to the group healing dynamic cannot be underestimated. The
teacher likely played an invaluable role through encouragement and sup-
port of participants, while serving also as a role model. It is possible that the
empowerment and inspiration felt by participants was largely an outcome
of their personal interaction with the program’s facilitators who had been
selected for both their knowledge of yoga and their personal attributes.
Future studies may examine relational characteristics of teachers, such as
trust and empathy that participants might find empowering and significant
to their personal growth.
Social support and peer feedback is critical in the healing of PTSD (Price,
Gros, Strachan, Ruggiero, & Acierno, 2013). At program onset, numerous
participants discussed feelings of isolation and loneliness. The findings of
 Spirituality, Yoga, and PTSD 409

this research demonstrate that while the majority of participants entered the
program as isolated individuals, they completed the program feeling more
connected to themselves, their own spirituality, the facilitator, and to oth-
ers in the group. Mezzo level social work intervention focuses on bringing
communities of people together. The relationship developed by participants
with the group facilitator and group members likely accounts for a large
component of change noted by participants as the KY treatment intervention
provided social support for program participants. The KY treatment program
may have also offered a safe space for the reinforcement and practice of
coping strategies that could later be utilized in daily life. The group was
also an opportunity for those with PTSD to interact with others experiencing
similar issues.
Another important element of the program was accessibility for those
who wanted to participate. Macro level social work practice focuses on sys-
temic issues. Individuals with PTSD often experience numerous barriers to
treatment (van der Kolk et al., 2014). The KY treatment program was devel-
oped and implemented with the aim of offering an opportunity to address
several intersecting issues faced by individuals with PTSD. For instance, the
KY PTSD program was developed with specific short and medium term goals
and objectives. Efforts were taken by the researchers and teachers to estab-
lish a continuum of care between the KY program and involvement in other
clinical or health-related programs. The KY PTSD program was relatively
affordable, requiring a skilled and empathic teacher, a safe and supportive
environment and access to trauma-skilled clinicians. In any holistic treat-
ment program, care must be taken to ensure continuity between sessions,
and integrity with the informing vision throughout. Finally, all participants
who identified with PTSD were admitted into the program irrespective of
sex, gender, class, race, or ability. The accessibility of the program makes it
transferrable to other mental health settings.
Future research focused on the spiritual aspect of individuals’ quality
of life may seek to differentiate the key operative elements of a KY treat-
ment intervention—which exercises, how often, and for how long—that
yield the best results. There would be wisdom as well in assessing the
long-term compliance of participants with the protocols they had learned,
as well as the duration of their personal connections with fellow participants
and teachers with a view to assessing their significance in overall recov-
ery. The WHO-QOL questionnaire might prove a useful tool in this regard.
For a better understanding of physiological components of the program,
future participants might be studied using magnetic resonance imaging and
electroencephalography brain scan technology.
While the global prevalence of PTSD is rising, mind–body treatment
interventions like yoga offer the possibility of embodied healing: physio-
logical, psychological, social, and spiritual. Empowering PTSD interventions
present individuals the possibility of better recognizing their own needs,
410 F. Jindani and G. F. S. Khalsa

interpreting their experiences, and identifying positively with themselves and

their social environs. Yoga and similar methodologies offer the potential for
the development and implementation of broadly based, cost-effective strate-
gies directed toward individual self-regulation and enhanced self-realization.
With the growing acceptance of integrative therapies, social workers, policy
makers, and wellness administrators must take into consideration the increas-
ing demand for holistic treatment interventions to make such programs more
universally available. The KY program is a promising preliminary study of
one such embodied approach for the treatment of PTSD.

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