PTSD Image by CJ Keller


About

PTSD is an anxiety disorder caused by a traumatic event. While its relationship with the battlefield is well established, anything from an accident to being the victim of a crime to sexual abuse can trigger it, causing nightmares and flashbacks, isolation and irritation, which further elevate stress levels. The brain’s preoccupation with fear and self-preservation means staying in the present feels like an impossible challenge. The sufferer gets stuck in the past, unable to feel respond to current circumstances, or move forwards.

By focusing on the breath and slow movements, yoga can give the sufferer a safe space in which to feel comfortable and grow strong in the body. Working on the fight or flight sympathetic nervous system, the practice can enable the parasympathetic nervous system to activate – helping to calm and restore, lowering the heart rate and blood pressure, and enabling the possibility of relaxation.

Once this practice of breath, postures and relaxation have laid stable physiological foundations the practice of meditation or mindfulness may be introduced. Observation of the internal experience without getting too involved in it can help modulate the fear centre and help us become more focused.

Clinical studies have suggested these practices, with their emphasis on staying in the present moment, to be a useful treatment for PTSD; helping reduce symptoms including anxiety and depression, and diminishing related substance and alcohol dependency.


What the clinical studies say

Yoga
  • Alleviates depression
  • Improves quality of life
  • Reduces anxiety
  • Reduces psychological distress
  • Reduces PTSD symptoms
  • Reduces risk of alcohol and drug use
Meditation
  • Reduces substance abuse
Mindfulness
  • Alleviates depression
  • Reduces drug and alcohol abuse
  • Reduces PTSD symptoms

The clinical studies

Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

A theory is proposed to explain the benefits of yoga practices in diverse, frequently comorbid medical conditions based on the concept that yoga practices reduce allostatic load in stress response systems such that optimal homeostasis is restored.

It is hypothesized that stress induces (1) imbalance of the autonomic nervous system (ANS) with decreased parasympathetic nervous system (PNS) and increased sympathetic nervous system (SNS) activity, (2) underactivity of the gamma amino-butyric acid (GABA) system, the primary inhibitory neurotransmitter system, and (3) increased allostatic load. It is further hypothesized that yoga-based practices (4) correct underactivity of the PNS and GABA systems in part through stimulation of the vagus nerves, the main peripheral pathway of the PNS, and (5) reduce allostatic load. Depression, epilepsy, post traumatic stress disorder (PTSD), and chronic pain exemplify medical conditions that are exacerbated by stress, have low heart rate variability (HRV) and low GABAergic activity, respond to pharmacologic agents that increase activity of the GABA system, and show symptom improvement in response to yoga-based interventions.

The observation that treatment resistant cases of epilepsy and depression respond to vagal nerve stimulation corroborates the need to correct PNS underactivity as part of a successful treatment plan in some cases. According to the proposed theory, the decreased PNS and GABAergic activity that underlies stress-related disorders can be corrected by yoga practices resulting in amelioration of disease symptoms. This has far-reaching implications for the integration of yoga-based practices in the treatment of a broad array of disorders exacerbated by stress.
Citations

84
Authors

C. C. Streeter | P.L. Gerbarg
Published

2012
Journal

Medical Hypotheses
Volume / Issue

78:5
Author's primary institution

Department of Psychiatry, Boston University School of Medicine, Boston, MA, US
Effects of a yoga breath intervention alone and in combination with an exposure therapy for post-traumatic stress disorder and depression in survivors of the 2004 South-East Asia tsunami
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective:

This study evaluated the effect of a yoga breath program alone and followed by a trauma reduction exposure technique on post-traumatic stress disorder and depression in survivors of the 2004 Asian tsunami.

Method:

In this non-randomized study, 183 tsunami survivors who scored 50 or above on the Post-traumatic Checklist-17 (PCL-17) were assigned by camps to one of three groups: yoga breath intervention, yoga breath intervention followed by 3–8 h of trauma reduction exposure technique or 6-week wait list. Measures for post-traumatic stress disorder (PCL-17) and depression (BDI-21) were performed at baseline and at 6, 12 and 24 weeks. Data were analyzed using anova and mixed effects regression.

Results:

The effect of treatment vs. control was significant at 6 weeks (F2,178 = 279.616, P < 0.001): mean PCL-17 declined by 42.5 ± 10.0 SD with yoga breath, 39.2 ± 17.2 with Yoga breath + exposure and 4.6 ± 13.2 in the control.

Conclusion:

Yoga breath-based interventions may help relieve psychological distress following mass disasters.
Citations

58
Authors

T. Descilo | A. Vedamurtachar | P.L. Gerbarg | D. Nagaraja | B. N. Gangadhar | B. Damodaran | B. Adelson | L.H. Braslow | S. Marcus | R.P Brown
Published

2010
Journal

Acta Psychiatrica Scandinavia
Volume / Issue

121:4
Author's primary institution

National Institute of Mental Health and Neurosciences of India, Bangalore, India
Post traumatic stress symptoms and heart rate variability in Bihar flood survivors following yoga: a randomized controlled study
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background:

An earlier study showed that a week of yoga practice was useful in stress management after a natural calamity. Due to heavy rain and a rift on the banks of the Kosi river, in the state of Bihar in north India, there were floods with loss of life and property. A week of yoga practice was given to the survivors a month after the event and the effect was assessed.

Methods:

Twenty-two volunteers (group average age ± S.D, 31.5 ± 7.5 years; all of them were males) were randomly assigned to two groups, yoga and a non-yoga wait-list control group. The yoga group practiced yoga for an hour daily while the control group continued with their routine activities. Both groups' heart rate variability, breath rate, and four symptoms of emotional distress using visual analog scales, were assessed on the first and eighth day of the program.

Results:

There was a significant decrease in sadness in the yoga group (p < 0.05, paired t-test, post data compared to pre) and an increase in anxiety in the control group (p < 0.05, paired t-test, post data compared to pre).

Conclusions:

A week of yoga can reduce feelings of sadness and possibly prevent an increase in anxiety in flood survivors a month after the calamity.
Citations

53
Authors

Shirley Telles | Nilkamal Singh | Meesha Joshi | Acharya Balkrishna
Published

2010
Journal

BMC Psychiatry
Volume / Issue

10:18
Author's primary institution

Department of Yoga Research, Patanjali Yogpeeth, Delhi-Haridwar Highway Haridwar, India
PTSD symptoms, substance use, and vipassana meditation among incarcerated individuals
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

The present study evaluated whether Posttraumatic Stress Disorder (PTSD) symptom severity was associated with participation and treatment outcomes comparing a Vipassana meditation course to treatment as usual in an incarcerated sample.

This study utilizes secondary data. The original study demonstrated that Vipassana meditation is associated with reductions in substance use. The present study found that PTSD symptom severity did not differ significantly between those who did and did not volunteer to take the course.

Participation in the Vipassana course was associated with significantly greater reductions in substance use than treatment as usual, regardless of PTSD symptom severity levels. These results suggest that Vipassana meditation is worthy of further study for those with comorbid PTSD and substance use problems.
Citations

68
Authors

T. L. Simpson | D. Kaysen | S. Bowen | L. M. MacPherson | N. Chawla | A. Blume | G.A. Marlatt | M. Larimer
Published

2007
Journal

Journal of Traumatic Stress
Volume / Issue

20:3
Author's primary institution

Department of Psychology, University of Washington, Seattke, WA
Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a veteran sample
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objectives:

To assess outcomes of veterans who participated in mindfulness-based stress reduction (MBSR).

Design:

Posttraumatic stress disorder (PTSD) symptoms, depression, functional status, behavioral activation, experiential avoidance, and mindfulness were assessed at baseline, and 2 and 6 months after enrollment.

Results:

At 6 months, there were significant improvements in PTSD symptoms (standardized effect size, d = -0.64, p< 0.001); depression (d = -0.70, p<0.001); behavioral activation (d = 0.62, p<0.001); mental component summary score of the Short Form-8 (d = 0.72, p<0.001); acceptance (d = 0.67, p<0.001); and mindfulness (d = 0.78, p<0.001), and 47.7% of veterans had clinically significant improvements in PTSD symptoms.

Conclusions:

MBSR shows promise as an intervention for PTSD and warrants further study in randomized controlled trials.
Citations

56
Authors

David J. Kearney | Kelly McDermott | Carol Malte | Michelle Martinez | Tracy L. Simpson
Published

2011
Journal

Journal of Clinical Psychology
Volume / Issue

68:1
Author's primary institution

VA Puget Sound Health Care System, Seattle, WA
Changes in mindfulness skills and treatment response among veterans in residential PTSD treatment.
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Recent research has explored the use of mindfulness principles as a component in treatments for various mental health difficulties, although limited research has explored the relationships between mindfulness and PTSD. Therefore, the current study assessed the relationships between mindfulness skills and PTSD and depression severity for a veteran sample (N = 149) in a residential PTSD treatment program.

Although overall mindfulness skills did not change significantly over the course of treatment, specific subscales of the Kentucky Inventory of Mindfulness Skills (KIMS) were negatively associated with clinician-rated measures of PTSD and depression. Veterans who reported greater improvement on Acting with Awareness skills over the course of treatment had lower levels of clinician-rated PTSD and depression at post treatment.
Citations

24
Authors

Gina P Owens | Kristen H Chard | Kathleen Chard | Paul A. Davis
Published

2012
Journal

Psychological Trauma: Theory, Research, Practice and Policy
Volume / Issue

42:2
Author's primary institution

Department of Psychology, University of Tennessee
The effect of a yoga intervention on alcohol and drug abuse risk in veteran and civilian women with post traumatic stress disorder.
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

BACKGROUND:

Individuals with posttraumatic stress disorder (PTSD) often exhibit high-risk substance use behaviors. Complementary and alternative therapies are increasingly used for mental health disorders, although evidence is sparse.

OBJECTIVES:

Investigate the effect of a yoga intervention on alcohol and drug abuse behaviors in women with PTSD. Secondary outcomes include changes in PTSD symptom perception and management and initiation of evidence-based therapies.

MATERIALS AND METHODS:

The current investigation analyzed data from a pilot randomized controlled trial comparing a 12-session yoga intervention with an assessment control for women age 18 to 65 years with PTSD. The Alcohol Use Disorder Identification Test (AUDIT) and Drug Use Disorder Identification Test (DUDIT) were administered at baseline, after the intervention, and a 1-month follow-up. Linear mixed models were used to test the significance of the change in AUDIT and DUDIT scores over time. Treatment-seeking questions were compared by using Fisher exact tests.

RESULTS:

The mean AUDIT and DUDIT scores decreased in the yoga group; in the control group, mean AUDIT score increased while mean DUDIT score remained stable. In the linear mixed models, the change in AUDIT and DUDIT scores over time did not differ significantly by group. Most yoga group participants reported a reduction in symptoms and improved symptom management. All participants expressed interest in psychotherapy for PTSD, although only two participants, both in the yoga group, initiated therapy.

CONCLUSIONS:

Results from this pilot study suggest that a specialized yoga therapy may play a role in attenuating the symptoms of PTSD, reducing risk of alcohol and drug use, and promoting interest in evidence-based psychotherapy. Further research is needed to confirm and evaluate the strength of these effects.
Citations

1
Authors

Reddy S |  Dick AM |  Gerber MR |  Mitchell K
Published

2014
Journal

Journal of Alternative and Complementary Medicine
Volume / Issue

20:10
Author's primary institution

Department of General Internal Medicine, Boston University School of Medicine , Boston, MA.
Original Research Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder: A Randomized Controlled Trial
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Background:

More than a third of the approximately 10 million women with histories of interpersonal violence in the United States develop posttraumatic stress disorder (PTSD). Currently available treatments for this population have a high rate of incomplete response, in part because problems in affect and impulse regulation are major obstacles to resolving PTSD. This study explored the efficacy of yoga to increase affect tolerance and to decrease PTSD symptomatology.

Method:

Sixty-four women with chronic, treatment-resistant PTSD were randomly assigned to either trauma-informed yoga or supportive women’s health education, each as a weekly 1-hour class for 10 weeks. Assessments were conducted at pretreatment, midtreatment, and posttreatment and included measures of DSMIV PTSD, affect regulation, and depression. The study ran from 2008 through 2011.

Results:

The primary outcome measure was the ClinicianAdministered PTSD Scale (CAPS). At the end of the study, 16 of 31 participants (52%) in the yoga group no longer met criteria for PTSD compared to 6 of 29 (21%) in the control group (n=60, χ2 1=6.17, P=.013). Both groups exhibited significant decreases on the CAPS, with the decrease falling in the large effect size range for the yoga group (d=1.07) and the medium to large effect size decrease for the control group (d=0.66). Both the yoga (b=−9.21, t=−2.34, P=.02, d=−0.37) and control (b=−22.12, t=−3.39, P=.001, d=−0.54) groups exhibited significant decreases from pretreatment to the midtreatment assessment. However, a significant group×quadratic trend interaction (d=−0.34) showed that the pattern of change in Davidson Trauma Scale significantly differed across groups. The yoga group exhibited a significant medium effect size linear (d=−0.52) trend. In contrast, the control group exhibited only a significant medium effect size quadratic trend (d=0.46) but did not exhibit a significant linear trend (d=−0.29). Thus, both groups exhibited significant decreases in PTSD symptoms during the first half of treatment, but thse improvements were maintained in the yoga group, while the control group relapsed after its initial improvement.

Discussion:

Yoga significantly reduced PTSD symptomatology, with effect sizes comparable to well-researched psychotherapeutic and psychopharmacologic approaches. Yoga may improve the functioning of traumatized individuals by helping them to tolerate physical and sensory experiences associated with fear and helplessness and to increase emotional awareness and affect tolerance.
Citations

4
Authors

Bessel A. Van der Kolk | Laura Stone | Jennifer West | Alison Rhodes | David Emerson | Michael Sucak | Joseph Spinazzola
Published

2014
Journal

Journal of Clinical Psychiatry
Volume / Issue

75:0
Author's primary institution

Boston University Medical School
Effects of sensory-enhanced yoga on symptoms of combat stress in deployed military personnel
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective

We examined the effects of sensory-enhanced hatha yoga on symptoms of combat stress in deployed military personnel, compared their anxiety and sensory processing with that of stateside civilians, and identified any correlations between the State–Trait Anxiety Inventory scales and the Adolescent/Adult Sensory Profile quadrants.

Method

Seventy military personnel who were deployed to Iraq participated in a randomized controlled trial. Thirty-five received 3 wk (=9 sessions) of sensory-enhanced hatha yoga, and 35 did not receive any form of yoga.

Results

Sensory-enhanced hatha yoga was effective in reducing state and trait anxiety, despite normal pretest scores. Treatment participants showed significantly greater improvement than control participants on 16 of 18 mental health and quality-of-life factors. We found positive correlations between all test measures except sensory seeking. Sensory seeking was negatively correlated with all measures except low registration, which was insignificant.

Conclusion

The results support using sensory-enhanced hatha yoga for proactive combat stress management.
Citations

22
Authors

Carolyn C. Stoller, Jon H. Greuel, Lucy S. Cimini, Mary S. Fowler, Jane A. Koomar
Published

2012
Journal

The American Journal of Occupational Therapy
Volume / Issue

66
Author's primary institution

Cotting School, 453 Concord Avenue, Lexington, Massachusetts
Effectiveness of yoga therapy as a complementary treatment for major psychiatric disorders: a meta-analysis
Practice
  • Yoga
  • Meditation
  • Mindfulness
Abstract

Objective:

To examine the efficacy of yoga therapy as a complementary treatment for psychiatric disorders such as schizophrenia, depression, anxiety, and posttraumatic stress disorder (PTSD).

Data Sources:

Eligible trials were identified by a literature search of PubMed/MEDLINE, Cochrane Control Trials Register, Google Scholar, and EBSCO on the basis of criteria of acceptable quality and relevance. The search was performed using the following terms: yoga for schizophrenia, yoga for depression, yoga for anxiety, yoga for PTSD, yoga therapy, yoga for psychiatric disorders, complementary treatment, and efficacy of yoga therapy. Trials both unpublished and published with no limitation placed on year of publication were included; however, the oldest article included in the final meta-analysis was published in 2000.

Study Selection:

All available randomized, controlled trials of yoga for the treatment of mental illness were reviewed, and 10 studies were eligible for inclusion. As very few randomized, controlled studies have examined yoga for mental illness, this meta-analysis includes studies with participants who were diagnosed with mental illness, as well as studies with participants who were not diagnosed with mental illness but reported symptoms of mental illness. Trials were excluded due to the following: (1) insufficient information, (2) inadequate statistical analysis, (3) yoga was not the central component of the intervention, (4) subjects were not diagnosed with or did not report experiencing symptoms of one of the psychiatric disorders of interest (ie, schizophrenia, depression, anxiety, and PTSD), (5) study was not reported in English, and (6) study did not include a control group.

Data Extraction:

Data were extracted on participant diagnosis, inclusion criteria, treatment and control groups, duration of intervention, and results (pre-post mean and standard deviations, t values, and f values). Number, age, and sex ratio of participants were also obtained when available.

Data Synthesis:

The combined analysis of all 10 studies provided a pooled effect size of −3.25 (95% CI, −5.36 to −1.14; P = .002), indicating that yoga-based interventions have a statistically significant effect as an adjunct treatment for major psychiatric disorders. Findings in support of alternative and complementary interventions may especially be an aid in the treatment of disorders for which current treatments are found to be inadequate or to carry severe liabilities.

Conclusions:

As current psychopharmacologic interventions for severe mental illness are associated with increased risk of weight gain as well as other metabolic side effects that increase patients’ risk for cardiovascular disease, yoga may be an effective, far less toxic adjunct treatment option for severe mental illness.
Citations

29
Authors

Patricia Cabral, Hilary B. Meyer, Donna Ames
Published

2011
Journal

The Primary Care Companion for CNS Disorders
Volume / Issue

13 : 4
Author's primary institution

Department of Psychology, California State University, Nothridge

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