Yoga’s Place in the Treatment of PTSD (Posttraumatic Stress Disorder)

» Posted by on Aug 15, 2014 in Alpha Blog | 0 comments

by Steven Bengis, David S. Prescott, and Joan Tabachnick

The Question
Can Participation in a Trauma-Sensitive Yoga Program Significantly Reduce PTSD Symptoms?

The Research
Bessel van der Kolk and his colleagues conducted a randomized clinical trial involving 64 women with chronic, treatment-resistant PTSD. Half was assigned to a 10-week treatment trauma-informed yoga program and the other half was given a 10-week supportive women’s health education program. The researchers found that the women who participated in yoga (a combination of breathing, postures, and mindfulness meditation) reported a significant reduction in PTSD symptoms. Specifically, 52% of the woman who did yoga and only 21% of the talk therapy control group showed a significant reduction in PTSD symptoms. Even more importantly, over time, those involved with Yoga maintained the impact while the control group lost that initial improvement.

The researchers point out what many studies have found: 12.7% of women experience rape and 10% of adult women report having histories of violent physical assaults. The authors further observe that one-third of these women develop PTSD alongside other disorders such as anxiety, depression, heart disease, and chronic pain. Although research for PTSD treatment demonstrates overall effectiveness, most clients experience substantial residual PTSD symptoms. The authors further cite one large study finding that less than half of clients receiving cognitive-behavioral therapy made clinically meaningful improvements (Bradley, Greene, Russ, et al. 2005).

Observing, accepting, and managing one’s trauma-based response to one’s environment is critical to the resolution of PTSD. Such responses enable one to regulate intense emotions, either in reaction to the environment or internal changes. Clearly, before one can manage one’s responses to the world, first it is necessary to observe and identify those responses; that’s where yoga and meditation come in. In addition to the therapeutic impact that yoga and meditation generate, successfully reducing the impact of PTSD has the added benefit of decreasing the use and cost of mental health and general health care utilization.

BOTTOM LINE:
Yoga significantly reduced PTSD symptomatology, helping individuals tolerate both physical and sensory experiences associated with fear and helplessness and increase their emotional awareness, key to successful PTSD treatment.

Implications for Professionals
Although this article focuses on adult women, the overall benefits of yoga and meditation for people of all ages and genders have received considerable research attention. Therefore, the results of this study can help professionals develop a more effective approach to reducing PTSD symptoms and thereby increase a client’s ability to respond to treatment and other interventions.

Self-regulation is an essential element of treatment for any client, but it is an especially important skill for those who have sexually abused, including those who have also experienced trauma. Cognitive-behavioral treatments, while important, risk focusing on thought patterns to the detriment of physical experience. Brain-based research has found that trauma impacts the brain at more fundamental levels. While talk therapy and medications may enable professionals to have a dialog with a client’s frontal lobe, it does not allow them to impact on their entire being. The current research shows – once again – that the recovery process from trauma is much more complex than simply talking about it.

Practitioners working with traumatized youth – whether they were harmed by or perpetrated sexual abuse – should now consider incorporating techniques that impact these deeper neurological levels. This study and many others demonstrate that yoga, meditation, neuro-feedback, biofeedback, and sensory integration can help clients enter a safe, calm state that allows them to make use of new cognitive framing and to ultimately make healthier choices. This study also encourages the use of these techniques at self-observation and calming because their impact remains, often long after the effects of educational programs have worn off.

Implications for the Field
For many years, Cognitive Behavior Therapy (CBT) has been the most advanced frontier of treatment for people of all ages who have sexually abused. This research reminds us that there are other means of increasing clients’ abilities to respond to interventions and manage their lives effectively. As our understanding of abuse and trauma has deepened, so too has the need to address PTSD and other neurologically generated feelings and behaviors that impact a client’s ability to self-regulate. While this study focuses on one technique (yoga), this study calls all of us into a different treatment world. It urges us to expand our more traditional “toolkits” and to embrace the mind-body integration that should help lead to better treatment outcomes and safer communities.

Citation
Van der Kolk, BA, Stone, L, West, J, Rhodes, A, Emerson, D, Suvak, M & Spinazzola, J. (2014). Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder: A Randomized Controlled Trial. Journal of Clinical Psychiatry, 75, e1-e7.

Abstract
Background: More than one 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 Clinician-Administered 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 these 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.