By Christine Saari, MA, C-IAYT
For many trauma clients with anxiety, insight is not the issue. They’ve spent years in therapy, built a strong understanding of their thought patterns, and developed language for their emotional experience. Yet the body tells a different story. Clients complain of shallow breathing, digestive unrest, racing heartbeats, and muscle tension. And these troubling experiences often persist beyond what cognitive or emotional tools alone can resolve.
These are not just symptoms. They’re signs of an autonomic nervous system that has not yet felt safe enough to downshift.
Understanding the Limits of Top-Down Treatment Models
Top-down approaches like CBT, psychodynamic therapy, or insight-oriented modalities are foundational to trauma recovery. They help clients make meaning, recognize triggers, and reframe unhelpful beliefs. But they don’t always reach the body.
Even when a client is cognitively aware of their anxiety, their physiology may remain stuck in patterns of hyperarousal. Breath becomes shallow, muscles remain braced, and the autonomic nervous system stays on high alert. These clients are not resisting change. They simply need a different access point.
Bottom-Up Approaches To Anxiety: Regulating First, Then Processing
Yoga therapy offers a bottom-up complement to traditional talk therapy. In yoga therapy, we start with the body—not the story. We work one-on-one to introduce simple, targeted practices that help regulate autonomic function. This includes tailored breathwork, rhythmic movement, and somatic techniques designed to restore nervous system flexibility.
Rather than asking clients to revisit trauma or modulate anxious behaviors before they feel safe, we help the body experience safety first.
A Yoga Practice Example: 4:0:6:2 Ratio Breathing
One of the foundational therapeutic breathwork practices we often introduce is 4:0:6:2 Ratio Breathing. This practice uses a breath pattern that includes an inhale for 4 counts, an exhale for 6, and a 2-count pause after the exhale. Notably, it does not involve holding the breath in at fullness, which is contraindicated for anxiety. Instead, the 4:0:6:2 Ratio Breathing technique emphasizes holding the breath out. This breathing technique supports vagal activation, lengthens exhalation, and helps recalibrate the stress response.
A 2023 study by Balban et al. compared several brief breath-based interventions and found that cyclic sighing, which emphasizes extended exhalation, was more effective than mindfulness meditation in reducing anxiety symptoms. Participants experienced improved mood, reduced respiratory rate, and greater physiological calming1.
Yoga therapists often teach this technique as a short daily practice for clients who report persistent anxiety symptoms like tight chest, insomnia, or “always being on.” For many, it’s the first time they feel their system settle in real time.
For Clients Who Struggle with Stillness: Movement-Based Alternatives
Not all clients respond well to stillness or breath awareness, especially those with unresolved trauma or high interoceptive sensitivity. Interoceptive sensitivity refers to heightened awareness of internal bodily sensations, such as heartbeat, breath, or muscle tension. In clients with trauma histories, this sensitivity can be distressing because internal cues are often associated with past threat or dysregulation, making it difficult to engage in practices that require focused attention on the body.
In these cases, we use slow, rhythmic movement, such as cat-cow variations, seated sways, or repetitive standing sequences, to regulate the nervous system without evoking overwhelm. These movements are paced to match the client’s current arousal state and are often paired with grounding cues and rhythm rather than breath-focused instruction. For example, a client who experiences anxious GI symptoms might benefit from gentle pelvic tilts with exhale emphasis, helping reestablish parasympathetic dominance through synchronized movement and breath.
In cases of high interoceptive sensitivity, it can be helpful to avoid mentioning breathing altogether. Instead, we might guide the client through a simple movement flow, such as bending and straightening the front leg in and out of Warrior II while raising and lowering the arms with the motion. This repetitive, externally-focused movement can regulate the system through rhythm and proprioception, offering a non-triggering path to nervous system balance.
Sound-Based Interventions: Humming and Chanting for Vagal Stimulation
For clients with breath sensitivity or difficulty accessing stillness through movement, sound can be a powerful gateway. We often incorporate Bhramari (humming breath) or brief chanting techniques like Kirtan Kriya to support nervous system regulation.
Research supports these approaches. Bhramari Pranayama has been shown to increase parasympathetic activity and stimulate the vagus nerve2,3. Chanting-based practices have also been linked to enhanced emotional well-being and stress reduction. In particular, Kirtan Kriya, which includes extended exhalation and rhythmic repetition, has been shown to reduce anxiety and support cognitive resilience4.
A client who struggles with anxiety-related throat tightness or difficulty vocalizing emotions may find that gentle humming allows for both physical release and emotional regulation without requiring verbal processing.
Why Yoga Therapy Practices Matter in Clinical Treatment Plans
For trauma-informed clinicians, the question is not whether to use somatic tools. It’s how to integrate them in a way that supports rather than overwhelms the client.
Yoga therapy offers structured, individualized tools that clients can safely practice at home or between therapy sessions. Most of our clients work with us for 6 to 8 sessions, and many report major shifts in anxiety symptoms, sleep, digestion, and emotional reactivity. These changes are not just psychological. They reflect real shifts in autonomic regulation.
Yoga Therapy As A Bridge, Not a Replacement
Yoga therapy does not replace psychotherapy. It enhances it. By helping clients stabilize their physiological baseline, these practices often make cognitive and emotional work more accessible. For clients who have plateaued in therapy or for whom exposure work feels intolerable, yoga therapy can be a gateway to deeper engagement.
This was echoed in findings from Wells et al. (2022), where many veterans dropped out of prolonged exposure therapy due to heightened distress. Alternative bottom-up approaches like yoga therapy may offer a preparatory step or even a primary path for certain clients.
What a Yoga Therapy Session Looks Like
Yoga therapy sessions are one-on-one and tailored to the client’s symptoms, history, and preferences. Practices are short, simple, and designed to be repeated independently in daily life.
Some clients begin with breathing or movement. Others start with sound, grounding, or sensory-based tools that bypass the need for internal focus altogether. Everything is adjustable based on how the nervous system responds.
For Clinicians Seeking Collaborative Support
If you have clients with anxiety symptoms that persist despite strong insight and therapeutic engagement, yoga therapy may be a meaningful addition to their care plan.
Yoga Therapy Associates offers direct one-on-one care to clients, as well as collaborative support for therapists, physicians, and treatment teams. We also offer CE trainings through our accredited clinician education courses and yoga teacher training programs at ClinicAlly Trained.
We would love to talk with you about how these yoga therapy might support your clients. Explore more at our Clinician resource hub or schedule a clinician consultation here.
References
- Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., & Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895. https://doi.org/10.1016/j.xcrm.2022.100895
- Patil, K. H., Wasnik (Thatere), V., & Jain, S. S. (2021). Role of Bhramari Pranayama in Generalised Anxiety Disorder. Ayurline: International Journal of Research in Indian Medicine, 5(4), 1–6. https://doi.org/10.52482/ayurline.v5i03.575
- Shrivastava, S., Goyal, P., Tiwari, S. K., & Patel, A. K. (2017). Interventional effect of Bhramari Pranayama on mental health among college students. International Journal of Indian Psychology, 4(2), 29–33. https://doi.org/10.25215/0402.044
- Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., … & Zucker, N. (2018). Interoception and mental health: A roadmap. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(6), 501–513. https://doi.org/10.1016/j.bpsc.2017.12.004
- Wells, S. Y., Morland, L. A., Hurst, S., Jackson, G. L., Kehle-Forbes, S. M., Jaime, K., & Aarons, G. A. (2022). Veterans’ reasons for dropping out of prolonged exposure therapy across three delivery modalities: A qualitative examination. Psychological Services, 20(3), 483–495. https://doi.org/10.1037/ser0000714
