Omega: How do you define “trauma?”

David: The definition that I use comes from Pat Ogden, who says, “It's any experience that is stressful enough to leave us feeling helpless, frightened, overwhelmed, or profoundly unsafe.”

There is also the Diagnostic and Statistical Manual of Mental Disorders definition of trauma: “directly experiencing or exposure to death, serious injury, or sexual violation, and that can happen through either directly experiencing the event, witnessing the event, worrying it happened to a close friend or relative, or through repeated exposure, which is more tertiary trauma or secondary trauma.”

There's an interesting tension between these two—the clinical definition of post-traumatic stress disorder (PTSD), which is important and necessary, and the broader understanding that at some point in our life a majority of us will experience something overwhelming that we might consider traumatic. I tend to work with the latter definition, which I think encompasses PTSD.

Omega: What inspired your curiosity for trauma-sensitive mindfulness?

David: As a therapist, I had studied trauma. I also practiced meditation. I had a difficult personal experience on a meditation retreat at one point and when I began to talk to others about it, I realized I wasn't alone. I ended up focusing a dissertation on the topic of mindfulness and trauma. My defense got recorded and went somewhat viral—as much as a dissertation on meditation and trauma can go viral!

As it got out there, I started receiving a lot of correspondence from people who were struggling inside of their contemplative community or inside their own practice. They were curious about whether their trauma background or history might be playing a role in their struggle. This left me with a concern. I felt that while meditation teachers may know about trauma, I wasn’t sure whether they could recognize symptoms and work with them skillfully. A number of colleagues said, "Look, we want to know what to do. Help us with best practices."

So that's how I came to write my book, Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing, a collection of best practices that could be utilized, debated, and basically brought into different meditation and contemplative communities.

Meditation is a powerful practice, but it can sometimes be a negative experience for those who have experienced trauma. It's helpful for practitioners and teachers to know that there is a way to practice that can mitigate that.

Omega: How can mindfulness meditation exacerbate symptoms of trauma and/or post-traumatic stress?

David: There can be a tendency for people to over-attend to traumatic stimuli, focusing on sensations connected to a trauma, like gut-wrenching sensations in the stomach or a sense of constriction in the chest or legs, or flashbacks or thoughts. When we over-attend to these things, it may feel threatening, internally or externally.

If you're asking someone who is struggling with trauma to pay close attention to their experience, they’ll eventually bump into elements of their trauma. Unless they have a map of how to handle that, or they have the right support in place, they will keep attending to those stimuli, which can end up triggering and dysregulating someone.

Trauma-sensitive yoga is a little bit ahead of the meditation and contemplative community. They've been talking about this a bit longer and there is more research. 

An example of a trauma-sensitive yoga technique would be when you walk into class and there are two chips or signs at the front of your mat. One says, “Yes, please, adjustments,” and the other one says, “No, thank you.” You get to choose. It’s simple but powerful practices like these that can leave people feeling a sense of autonomy and choice, and ideally not become re-traumatized.

The meditation community I think is getting there, but we’re still assessing what this might look like inside a contemplative setting.

Omega: What makes traumatic stress symptoms easy to miss in meditation?

David: The particular difficulty with meditation and contemplative practice is that we don't have the same cues we might if we were having a one-to-one conversation.

If you are a meditation teacher, even in a small group, most of the people you’re working with will have their eyes closed. They're inside their practice, and some of the cues that you might pick up on in conversation are not available.

One of the main recommendations I make is to look for nonverbal signs of what’s known as dysregulated arousal, which is a common symptom of traumatic stress. When someone is feeling incredibly anxious, it's called hyperarousal and they might have disturbing intrusive thoughts. At the other end, they might have too little arousal and feel disassociated, spacey, and deeply disorganized.

As meditators or people who are teaching meditation, we can start to look for the signs that someone might be outside of their window of tolerance, or a more regulated arousal.

Other signs of dysregulation include extremely slack or extremely rigid muscle tone, hyperventilation, excessive sweating, an exaggerated startle response, emotional volatility, or noticeably pale skin tone.

These are all signs of dysregulated arousal, but they don’t necessarily mean that someone has trauma. They can, however, be a flag that you might want to engage in a conversation. How you do that is important—you don’t go up to someone and say, “Hey, you have trauma.”

There's a nuance in being able to get curious with someone and approach them in a respectful way that communicates curiosity as opposed to judgment.

The issue of shame is really huge in this work, where people often end up feeling broken or flawed. They may bring the best of intentions to their practice, but it somehow end up making things worse, and they feel badly about that.

There's an art to being able to approach someone if you notice that they’re having what might seem like symptoms of traumatic stress and opening a conversation about how practice is going for them and what they're noticing, as opposed to asking them to reveal their entire trauma history. If they come to you, let them know that their effort and their practice is important, and that there may be some modifications to practice that will support them to be more regulated.

Omega: How can we practice mindfulness safely ourselves even if we are unsure or know little about trauma?

David: Just because someone has experienced trauma doesn't mean they'll have a negative experience with meditation. I want to make that clear. Many people who have experienced trauma have an incredible experience with meditation and mindfulness.

There are two ways to keep an eye on it. One is to be very practical about continually assessing how your meditation practice is actually affecting you. How is it affecting your mood? How is it affecting your well-being or regulation or dysregulation? Do you feel more regulated after practice or really spun out? It’s important to be honest conversation with yourself or your teacher about how it's going.

There's also a model called the Window of Tolerance by Dan Siegel that was adapted for trauma work by Pat Ogden, who wrote Sensorimotor Therapy. It's a very helpful framework and model to self-assess whether mediation is actually supporting one’s nervous system or dysregulating it.

Omega: How common is trauma? 

David: The research tells us that about 90 percent of us will experience a traumatic experience in our lifetime and 6 to 8 percent of us will end up experiencing PTSD. There's a whole range inside of that of people having different experiences around trauma. As teachers, it's up to us to keep being curious about how someone is doing or how our group is doing and know that in all likelihood, trauma is there and present in the room. It will be experienced in different ways for different people, depending on the person and the practice, but it's there and we can learn how to work with it.