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Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder: A Randomized Controlled Trial
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 DSM-IV 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, χ²₁ = 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. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00839813.
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“In one RCT, women with chronic, treatment-resistant PTS problems who completed a 10 week TSY program experienced a significant reduction in PTS symptoms that were sustained for a greater length of time compared to women who received only conventional talk therapy [60].”
In the citing paper
“Two randomized controlled trials of women with treatment-resistant PTSD showed reductions in symptoms and dissociation; the shorter-duration study (10-weeks) resulted in symptom decreases comparable to psychopharmaceutical and psychotherapeutic interventions ( van der Kolk et al., 2014 ) while extended yoga practice (20-weeks) drove even greater improvements ( Price et al., 2017 ).”
From The brain-body disconnect: A somatic sensory basis for trauma-related disorders (2022) · cites this paper as van der Kolk et al., 2014
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Potential self-regulatory mechanisms of yoga for psychological health
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“For example, a few studies have suggested how mindful yoga may be more suited for those with chronic illness or for patients with psychopathology and a history of trauma (van der Kolk et al., 2014).”
BackgroundMindfulness and Behavior Change
Schuman-Olivier, Z., Trombka, M., Lovas, D. A., Brewer, J. A., Vago, D. R., Gawande, R., Dunne, J. P., Lazar, S. W., Loucks, E. B., & Fulwiler, C. (2020) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000277 · Cited by 435
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Martín-Rodríguez, A., Gostian, L. A., Beltrán-Velasco, A. I., Belando‐Pedreño, N., Simón, J. A., López-Mora, C., Navarro-Jiménez, E., Tornero-Aguilera, J. F., & Clemente‐Suárez, V. J. (2024) · Sports · doi:10.3390/sports12010037 · Cited by 450
“A research study by van der Kolk et al. demonstrated that yoga can help in regulating the autonomic nervous system, which is often dysregulated in PTSD [111].”
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“…Maquet, Velez, & Lopez, 2015; Reddy, Dick, Gerber, & Mitchell, 2014; Rhodes, Spinazzola, & Van Der Kolk, 2016; Shannahoff-Khalsa et al., 1999; van der Kolk et al., 2014); one further article was published as a conference abstract only and did not provide enough information to be eligible…”
BackgroundFrom treatment to healing: The promise of trauma-informed primary care
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“Three studies reported remission rates where symptom severity scores returned to below the diagnostic threshold. van der Kolk et al 49 reported that 52% of participants no longer had clinically significant PTSD symptoms compared with 21% in the health education control group; Prathikanti, et al 44…”
ResultGallegos, A. M., Crean, H. F., Pigeon, W. R., & Heffner, K. L. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.10.004 · Cited by 181
“Yoga has been shown to reduce physiological arousal in PTSD patients and is believed to affect the pathology of PTSD by improving somatic regulation and body awareness, which are imperative to emotion regulation (van der Kolk et al., 2014).”
Hopwood, T. L., & Schutte, N. S. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.08.002 · Cited by 167
On the Run for Hippocampal PlasticityPreprint
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The brain-body disconnect: A somatic sensory basis for trauma-related disorders
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Yoga for posttraumatic stress disorder-a systematic review and meta-analysis
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“while four RCTs used clinician-assessed instruments [39, 41, 43, 45].”
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“In addition to substantiating previous findings suggesting TSY’s impact on symptom-reduction (van der Kolk et al., 2014), participants provided their own perceptions of TSY’s impact on their symptoms and personal development in and out of the class.”
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“Trauma survivors often report difficulty controlling their autonomic functions, with threat‐related psychological difficulties such as hyper‐vigilance for danger and overwhelming anxiety or anger (van der Kolk et al., 2014).”
A Yoga Intervention for Posttraumatic Stress: A Preliminary Randomized Control Trial
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“Research Article”
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“One trial, for example, used yoga as an intervention to treat post-traumatic stress disorder (37).”
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“…interactions that can promote symptom relief in PTSD (Corrigan, 2002; Gallegos, Crean, Pigeon, & Heffner, 2017; Gordon, Staples, He, & Atti, 2016; Polak, Witteveen, Denys, & Olff, 2015; van der Kolk et al., 2014; for a review, see Banks, Newman, & Saleem, 2015; Boyd, Lanius, & McKinnon, 2018).”
Yoga for adult women with chronic PTSD: a long-term follow-up study
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“18 Given the increased mindfulness, somatic awareness, and body acceptance thought to result from TCTSY, it was possible that women in the present study would also experience reductions in dissociative symptoms.”
InfluentialSelf-citationA systematic review of randomized trials of mind-body interventions for PTSD
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“Van der Kolk et al. (2014) utilized an active treatment control condition whereas the other five studies utilized a waitlist or assessment control condition.”
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Wynn, G. H. (2015) · Current Psychiatry Reports · doi:10.1007/s11920-015-0600-2 · Cited by 71
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“…2011; Emerson et al. 2009) is an example of a somatically-based, non-verbal approach to self-regulation that has been found in a recent randomized controlled trial to reduce PTSD and related symptoms in adults with chronic, treatment-resistant PTSD and related conditions (Van der Kolk et al. 2014).”
BackgroundYoga in Correctional Settings: A Randomized Controlled Study
Kerekes, N., Fielding, C., & Apelqvist, S. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00204 · Cited by 72
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BackgroundMaddux, R. E., Daukantaité, D., & Tellhed, U. (2017) · Anxiety Stress & Coping · doi:10.1080/10615806.2017.1405261 · Cited by 71
“Most investigations of yoga modify standard practices to adjust to clinical samples (Beltran et al., 2016; Bijlani et al., 2005; Janelsins et al., 2016; Mitchell et al., 2014; Van der Kolk et al., 2014).”
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Addressing Mental Health Concerns in Refugees and Displaced Populations: Is Enough Being Done?
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“This example builds upon the growing evidence of the benefits of wellness practices for healing from trauma (H€olzel et al., 2011; van der Kolk et al., 2014) and the emotional and psychological toil of engaging in social justice and activism (Bernal, 2006; Gorski, 2019).”
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“30 This 5-year study addresses the current gaps in knowledge of the effectiveness of yoga for PTSD and associated symptoms.”
Trauma-informed approaches to physical activity: A scoping study
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“Yoga has also been associated with decreased symptoms of anxiety, [17] depression, [18] and PTSD, [19] as well as improvements in management of chronic low back pain [20].”
BackgroundSafety learning during development: Implications for development of psychopathology
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Kripalu yoga for military veterans with PTSD: a randomized trial
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Claiming peaceful embodiment through yoga in the aftermath of trauma
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Bending without breaking: A narrative review of trauma-sensitive yoga for women with PTSD
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Evidence Map of Yoga for Depression, Anxiety, and Posttraumatic Stress Disorder
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“In only two studies (Rosenbaum et al., 2014; Van der Kolk et al., 2014), sufficient information was available to conclude that they were free of selective outcome reporting, whereas for the other studies, no pretest-specified study protocol was available.”
BackgroundMethodResultInfluentialComplexity Variability Assessment of Nonlinear Time-Varying Cardiovascular Control
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“Yoga for PTSD has been shown to target hyperarousal symptoms in particular (Staples, Hamilton, & Uddo, 2014) and has been efficacious in reducing overall symptoms (van der Kolk et al., 2014).”
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A five-day inpatient EMDR treatment programme for PTSD: pilot study
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“Especially trauma-sensitive yoga has shown promising results as stand-alone intervention (Van der Kolk et al., 2014) and various forms of physical activity, including yoga, show potential to contribute to effective multidisciplinary treatments for PTSD (Rosenbaum et al., 2015).”
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Yoga for PTSD and the role of interoceptive awareness: A preliminary mixed-methods case series study
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“Research on these interventions is emerging, such as research on yoga (Van der Kolk et al., 2014), somatic experiencing (Andersen et al., 2017; Brom et al., 2017), and sensorimotor psychotherapy (Gene-Cos et al., 2016; Langmuir et al., 2012).”
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“Other trauma interventions incorporate more body-centered approaches (Porges, 1995; van der Kolk et al., 2014).”
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“Indeed, treatments that include yoga, a practice that includes mindfulness meditation, have been shown to be effective at reducing PTSD symptoms (Van der Kolk et al., 2014).”
BackgroundDong, F., Liu, H.-L., Yang, M., Lu, C.-L., Dai, N., Zhang, Y., Robinson, N., & Liu, J. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.645460 · Cited by 44
“Previous studies have shown that during and after the outbreak of severe acute respiratory syndrome (SARS) in China, SARS survivors, as well as the general public, experienced symptoms of anxiety, depression, and PTSD (Cheng et al., 2004; Hong et al., 2009).”
BackgroundInfluentialBulaj, G. W., Ahern, M., Kuhn, A. K., Judkins, Z., Bowen, R. C., & Chen, Y. (2016) · Current Clinical Pharmacology · doi:10.2174/1574884711666160603012237 · Cited by 41
Equine Facilitated Therapy for Complex Trauma (EFT-CT)
Naste, T. M., Price, M. A., Karol, J., Martin, L., Murphy, K., Miguel, J. L., & Spinazzola, J. (2017) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-017-0187-3 · Cited by 47
“TCTSY has been found to significantly reduced PTSD symptom severity and achieve high rates of loss of PTSD diagnosis in civilian females with chronic treatment-resistant PTSD (van der Kolk et al. 2014).”
Twenty years and counting: The past, present, and future of ACEs research
Dube, S. R. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816065-7.00001-x · Cited by 38
Trauma-informed exercise for women survivors of sexual violence
Pebole, M. M., Gobin, R. L., & Hall, K. S. M. (2020) · Translational Behavioral Medicine · doi:10.1093/tbm/ibaa043 · Cited by 40
Steele, E., Wood, D. S., Usadi, E. J., & Applegarth, D. M. (2018) · Military Medicine · doi:10.1093/milmed/usx153 · Cited by 40
Ng, A., Reddy, M., Zalta, A. K., & Schueller, S. M. (2018) · JMIR Mental Health · doi:10.2196/10415 · Cited by 37
“More recently, evidence suggests that wellness interventions such as mindfulness and yoga may also have positive benefits in the treatment of PTSD [36,37].”
BackgroundDarroch, F., Varcoe, C., Montaner, G. G., Webb, J. M., & Paquette, M. (2022) · Violence Against Women · doi:10.1177/10778012221134821 · Cited by 38
“Existing trauma-informed approaches to physical activity programs point to positive physical and psychosocial outcomes for women (Emerson, 2015; Jindani & Khalsa, 2015; Rhodes, 2016; van der Kolk et al., 2014; West et al., 2017).”
BackgroundYoga for veterans with PTSD: Cognitive functioning, mental health, and salivary cortisol.
Zaccari, B., Callahan, M. L., Storzbach, D. M., McFarlane, N., Hudson, R., & Loftis, J. M. (2020) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000909 · Cited by 39
“…have been conducted to date, results for yoga are promising—in some cases with effect sizes comparable to psychotherapeutic and psychopharmacologic approaches (Cramer, Anheyer, Saha, & Dobos, 2018, Jindani et al., 2108, Mitchell et al., 2014; Reinhardt et al., 2018; van der Kolk et al., 2014).”
ResultJoss, D., & Teicher, M. H. (2021) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-021-00240-4 · Cited by 35
Military-tailored yoga for veterans with post-traumatic stress disorder
Cushing, R. E., Braun, K. L., Alden, C.-I., & Katz, A. R. (2018) · Military Medicine · doi:10.1093/milmed/usx071 · Cited by 36
Yoga for warriors: An intervention for veterans with comorbid chronic pain and PTSD.
Chopin, S. M., Sheerin, C. M., & Meyer, B. L. (2020) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000649 · Cited by 37
“To date, few studies have examined PTSD specifically, and were primarily conducted in female civilian samples (Jindani, Turner, & Khalsa, 2015; Mitchell et al., 2014; van der Kolk et al., 2014).”
BackgroundSporting Activities for Individuals Who Experienced Trauma During Their Youth: A Meta-Study
Massey, W. V., & Williams, T. L. (2019) · Qualitative Health Research · doi:10.1177/1049732319849563 · Cited by 34
“While the evidence base is still growing, preliminary findings have generally supported this hypothesis (Levin & Land, 2016; Mitchell et al., 2014; Streeter et al., 2012; van der Kolk et al., 2014).”
ResultRousseau, D., Long, N., Jackson, E., & Jurgensen, J. (2019) · The Prison Journal · doi:10.1177/0032885519860546 · Cited by 34
Exploring flow in sport and exercise therapy with war and torture survivors
Ley, C., Krammer, J., Lippert, D., & Barrio, M. R. (2017) · Mental health and physical activity · doi:10.1016/j.mhpa.2017.03.002 · Cited by 34
Smith‐Marek, E. N., Baptist, J. A., Lasley, C., & Cless, J. D. (2018) · Qualitative Health Research · doi:10.1177/1049732318786482 · Cited by 40
Yoga bei psychischen Störungen
Meister, K., & Becker, S. (2018) · Der Nervenarzt · doi:10.1007/s00115-018-0537-x · Cited by 32
Uebelacker, L. A., & Broughton, M. K. (2018) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.16104 · Cited by 32
Budde, H., Akko, D. P., Ainamani, H. E., Murillo-Rodríguez, E., & Weierstall, R. (2018) · Trials · doi:10.1186/s13063-018-2753-x · Cited by 31
“Two of these programs used combined aerobic exercises [12, 13], whereas the other two used yoga sessions [16, 17] in their program.”
Ley, C., & Barrio, M. R. (2018) · Springer eBooks · doi:10.1007/978-3-319-72914-5_13 · Cited by 32
Evidence Map of Yoga for High-Impact Conditions Affecting Veterans
Coeytaux, R. R., McDuffie, J. R., Goode, A. P., Cassel, S., Porter, W. D., Sharma, P., Meleth, S., Minnella, H., Nagi, A., & Williams, J. W. (2014) · Europe PMC (PubMed Central) · Cited by 30
Müller-Engelmann, M., Wünsch, S., Volk, M., & Steil, R. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.01407 · Cited by 30
“Support for the idea that the teaching style may be the problem comes from studies that demonstrated yoga to be applicable and helpful to PTSD sufferers (van der Kolk et al., 2014).”
BackgroundMethodBlaauwendraat, C., Berg, A. L., & Gyllensten, A. L. (2017) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2017.1325957 · Cited by 29
“Our main findings are in line with the results of a group with women diagnosed with PTSD after a 10-weeks yoga program, emphasizing breathing exercises, postures, and mindfulness meditation (Van Der Kolk et al., 2014).”
BackgroundResultInfluentialYang, H., Koh, E., & Kang, Y. (2021) · Biomolecules · doi:10.3390/biom11050708 · Cited by 33
Program evaluation of trauma-informed yoga for vulnerable populations
Tibbitts, D., Aicher, S. A., Sugg, J. G., Handloser, K., Eisman, L., Booth, L. D., & Bradley, R. D. (2021) · Evaluation and Program Planning · doi:10.1016/j.evalprogplan.2021.101946 · Cited by 29
“…posttraumatic stress disorder (PTSD) symptomology (Carter et al., 2013; Jindani et al., 2015; Quinoñes et al., 2015; Seppälä et al., 2014; van der Kolk et al., 2014), anxiety (Jindani et al., 2015; Seppälä et al., 2014; Stoller et al., 2012), and insomnia (Jindani et al., 2015), and may improve…”
BackgroundResultZaccari, B., Higgins, M. K., Haywood, T. N., Patel, M. N., Emerson, D. J., Hubbard, K., Loftis, J. M., & Kelly, U. A. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.44862 · Cited by 28
Assessment of yoga as an adjuvant treatment for combat-related posttraumatic stress disorder
McCarthy, L., Fuller, J. R., Davidson, G., Crump, A., Positano, S., & Alderman, C. (2017) · Australasian Psychiatry · doi:10.1177/1039856217695870 · Cited by 27
Metadata
- Authors
- van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., & Spinazzola, J.
- Affiliations
- Suffolk University (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2014-06-15
- Volume
- 75
- Issue
- 06
- Pages
- e559-e565
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2163976266
- Cited by
- 389
- References
- 57
- Citations by year
- 2026: 27 · 2025: 47 · 2024: 36 · 2023: 27 · 2022: 26 · 2021: 39 · 2020: 37 · 2019: 27 · 2018: 40 · 2017: 33 · 2016: 19 · 2015: 24 · 2014: 6
- FWCI
- 32.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1r21at003905-01a2)
- National Center for Complementary and Integrative Health (1R21AT003905)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- post-traumatic stress disorder, trauma-informed yoga, interpersonal violence, women, emotion regulation, affect tolerance, depression, treatment-resistant PTSD, adjunctive therapy, relapse, women's health education, medication adherence
- MeSH terms
- Adult, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Middle Aged, Personality Inventory, Psychometrics, Psychotherapy, Group, Stress Disorders, Post-Traumatic, Yoga
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