Qualitative vs. Quantitative Data on the Benefits of Yoga, Ayurveda & Mindfulness for Inmates with Complex Trauma
I presented this research poster at the National Ayurvedic Medical Association’s yearly conference April 26-28 near Santa Cruz, California and was encouraged to write about it.
This very informal, ongoing study includes findings from a three year time period with low-security women at Wayne Brown Correctional Facility in Nevada City, California. This study elucidates the difference between quantitative values for self- reflective questions about inmates’ experience, and qualitative statements, or testimonials, by inmates through an eight week series. I have taught Mindfulness and Trauma Informed Yoga Asana classes to over a hundred men and women. Though I have dozens of initial surveys, for the purpose of this study, I included only those who had completed both an initial and final questionnaire, which, so far, are only from seven women. While I know this is not enough to draw any kind of definitive conclusions on, say, how yoga reduces recidivism, I believe there is enough to illustrate some difference between qualitative and quantitative data, and demonstrate the need for both, even though Western medicine relies so heavily on “more objective” quantitative data.
Inspiration to make life changes cannot be quantified, and as such, qualitative data is necessary. While Ayurveda and Yoga Therapy seek a seat at the table with Western Medicine, we should honor the art of listening, intuition, and more feminine wisdom that qualitative data reveals.
Benefits of Conducting this Study in this Location
Inmates can be perfect subjects because they are all exposed to relatively the same stimulus in their daily lives. This is also an ideal time for inmates to learn about and start new self care habits while many are in a mental emotional space that is open to change because 1) many are sober for the first time in years, 2) most are humbled by the experience of imprisonment, and 3) they are a captive audience, on a required personal “retreat” of sorts, away from daily worries about putting food on the table and typical distractions, like a TV on all day or their drug dealer coming over.
It is generally understood that inmates have experienced a higher rate of trauma, and of longer duration or greater complexity than a typical civilian. For a study not interested in capturing data about trauma, this might be a less than ideal location. But with my interest, this was a perfect place in some ways.
Challenges in Collecting Data in this Setting
With no ability to choose my students, I couldn’t select only people who hadn’t done yoga before, or interview a control group of people that were not in my program, or require perfect attendance or fill out a questionnaire.
Another big unforeseen challenge ensued after a story came out in the local newspaper about my work at the jail. It was a very positive story, even though there was some criticism of the program vented by people on Facebook groups who believed that inmates are in jail to be punished, saying things like, “most people have to pay for yoga.” But the most surprising twist came when a higher security inmate who was not offered yoga sued the jail for discrimination, insisting yoga was his religion. (Yes, really.). So instead of offering him yoga, the jail discontinued the yoga program for everyone. We all thought it would be a temporary hiatus, but it is still discontinued. I was able to return to teach as part of the Mindfulness program.
The initial third of the questions were designed to capture Ayurvedic laksana variability, for example, one question seeks to identify Vata, Pitta, or Kapha appetite, digestion, and elimination. Another identifies VPK Skin, Sleep, and so on. The other two-thirds of the questions were more positively framed questions directly from the MAAS, or Mindfulness Awareness Assessment Survey. Questions evolved over the three years to best capture benefits through an Ayurvedic lens, to make it more appropriate for a traumatized jail population, and as I appreciated new information to capture.
There is not agreement among researchers as to whether to use only previously validated and standardized assessment tools, such as MAAS, or be willing to pioneer new ones. I see benefits to both, but I decided to forge a new path.
In the classes that were predominantly Mindfulness, the first twenty to thirty minutes were always devoted to movement- usually chair and standing postures because we couldn’t lie on the floor. Because the third of the Eight Limbs is Asana, and concentration/ meditation wasn’t until much later, it has been part of my mission to integrate asana before every Mindfulness class. And boosting effectiveness of formal recovery programs with asana & self-care contributed greatly to my motivation to develop trainings.
In the classes that were predominantly asana, we also started in chairs, since that is where most people feel comfortable, slowly warming up. For people who have been dissociated much of their lives, it is important to keep it simple, and go slowly so as to not injure/ reinjure them. The asana was presented in a Trauma Informed manner. Everyone’s back was to the wall, able to see the doorway. English was used to reduce overwhelm. Focus was gently invited inward to awareness of the body’s sensations, as well as to their points of contact with the ground to be present with a sense of stability.
After circling joints, and opening the body more or less in the five directions as much as possible from a chair, we stood to do a couple half Sun Salutations, and a couple balancing poses on two legs, then on one. Standing and balancing poses helps shake up energy and build strength in people who are stuck in Tamas, depression, and/ or Parasympathetic freeze, with the classic folded arms, slouched posture and breath. Adjusting the pace and difficulty of the class to the newest or most challenged person is important because too often people don’t want anything to do with yoga because they tried it once and were injured or left behind. Too many hurt themselves with a new tool before they learn how to use it. Sadly, this tool could likely be the best resource they’ll ever have- themselves!
The last third of class, we sat for core strengthening, then relaxation poses. While some TI teachers consider restorative postures to be dissociative, I think it is the best medicine for people stuck in Sympathetic nervous system activation because they so rarely get a chance to press their nervous system’s reset button and truly relax.
At the end of every class, during savasana, or in meditation afterward, I would integrate some sensory awareness tool, like aromatherapy, an envisioned journey in nature, a mindful eating meditation, or a sung mantra.
Sometimes the energy of the class was scattered, or excitable, but by the end of class, most everyone was more focused and present. Sometimes, in the final resting poses, a quiet sob could be heard, usually from the women who had just arrived, had a court date, or just received bad news from family or their lawyer.
Of the 172 answered questions, 49% reflected cumulative improvement, 40% had no change, and 10% worsened symptoms. While an inquiry was never done into the cause of worsened symptoms, I believe some could be due to misunderstanding the question, or an exceptionally bad day, drug use (yes, even inside jail), and state of mind. Factors could include the status of their case, how long they had been inside, how well they have accepted their fate, as well as relational factors among inmates and guards.
Questions asked were intended to reveal information about inmates physical experience as well as the functioning of their brains, especially the medial prefrontal cortex, which usually has decreased function due to trauma. These results indicate the medial prefrontal cortex functions improve with practice:
Compare the feeling in your body after reading the above information and reading these statements:
In comparing the results of quantitative and qualitative questions, the qualitative benefits more clearly demonstrate the nuances of inspiration, which may make them less likely to recidivate. Inspiration is not quantifiable, especially given the individual nature of each person’s trauma or story. Qualitative findings honor the nonlinear story, our intuitive nature and our common humanity.
Vata (air/ etheric qualities such as dryness, lightness, cold) related symptoms like light sleep, pain, mental distraction, and emotional fluctuation were balanced by regular somatic self-care. Quantitative findings appeal to the linear, rational, masculine mind and are important to seeing the big picture.
Recommendations for Further Study
Better cooperation with the jail, perhaps an agreement for the sake of the study, that the same group of people would begin and end the eight weeks in part to create more safety in the space. Also it might benefit the study’s credibility to only use people with no prior yoga experience. Since the long term inmates (3) had a longer exposure to yoga, the findings might have some imbalance due to this.
Obviously, it would be better to have many more questionnaires completed at both beginning and end. Even better would be if we could have individual meetings with each inmate before and after, and be able to have a control group that only had individual meetings, where Ayurvedic principles and practices could be applied more throughly.
Better yet would be to have three perspectives on each client, for example, an MD or therapist, other inmates who see each client regularly, in addition to their own perspective, to increase a wider view, perhaps more objectivity among the three.
Brain scans, Heart Rate Variability, blood pressure, and other tests could be given to offer even more information.
Finally, follow up with inmates at intervals, and post-release would be ideal, even two to five years down the road, to observe retention of practices, and correlation to recidivism.
Trauma Informed Care accepts that post traumatic stress looks like bad behavior, invites caregivers and teachers to inquire what happened to make a child want to act out, as well as take measures to help the child feel safer, or better protected. This way of seeing bad behavior is slower to extend to adults. More inmates would benefit from treatment than punishment. If Correctional Facilities will ever be more than places to further dehumanize traumatized people who mainly grew up with violence, addiction and poverty, then more practices offering compassionate resources and individual attention, like yoga therapy with Ayurveda should find their way inside.
I still feel lucky to be able to offer mindfulness and yoga at all, especially because I was once an inmate in this facility for a weekend following a DUI, at the end of a 20 year drinking career following my own traumas. I vowed to come back and teach what I knew one day, once I was living more aligned in my integrity. After three years of sobriety and diligently working my steps, especially the steps to retain a firm foundation of self-care, the door opened to work with these inmates. My seva there is the highlight of my week. I’m sure my life isn’t the only one that’s improved because of our time together.
P.S. We are now in development of a re-entry program integrating yoga and trauma informed self-care for inmates, in addition to other job skills, etc.
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