Cited by 389Posttraumatic Stress Disorder ResearchMindfulness and Compassion InterventionsPsychotherapy Techniques and Applications

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Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder: A Randomized Controlled Trial

van der Kolk, Bessel A., Stone, Laura, West, Jennifer, Rhodes, Alison, Emerson, David, Suvak, Michael, Spinazzola, Joseph·2014·The Journal of Clinical Psychiatry

DOI 10.4088/jcp.13m08561

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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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The Experience of Yoga for Persons with Complex Interpersonal Trauma: A Phenomenological Approach
Bennett, L. M., & Starnino, V. R. (2022) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2022.101674 · Cited by 6
Trauma-Informed Yoga: A Capacity Building and Wellness Strengthening Intervention for Female Survivors of Intimate Partner Violence and Affiliative Staff
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“…al., 2021), depression (Pilkington et al., 2005), anxiety (Smith et al., 2007), acute stress reactions (Telles et al., 2010), and post-traumatic stress symptoms (Staples et al., 2013), including dissociation (Price et al., 2017), even among treatment-resistant patients (Van der Kolk et al., 2014).”
Background
The experience of Trauma Center-Trauma Sensitive Yoga training on professional practice of mental health professionals and yoga instructors
Oosterbroek, T. A., & Dirk, B. (2021) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2021.101365 · Cited by 6
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“9 Additionally, existing psychophar-macological treatments do not entirely prevent the progression of the disease but rather alleviate speci ﬁ c symptoms.”
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“However, there are a number of little-known somatic intervention approaches that can mitigate PTSD symptoms (Barnes, Rigg, & Williams, 2013; Corrigan & Grand, 2013; Dahm, et al., 2015; Fuzikawa, 2015; Payne, Levine, & Crane-Godreau, 2015; Polusny et al., 2015; van der Kolk et al., 2014).”
Background
Intergenerational Transmission of Inequality in Psychological Health
Sharma, S., & Prakash, A. (2021) · Science Insights · doi:10.15354/si.21.re251 · Cited by 5
“(103), Eye Movement Desensitization and Reprocessing (EMDR) (104), Art therapy techniques (105), Yoga practices (106) are some of the techniques that can be used during individual psychotherapy with the affected parents.”
Background
Trauma-Informed Yoga: A Scoping Review
Klukan, K., & Lunsford, D. (2023) · Occupational Therapy in Mental Health · doi:10.1080/0164212x.2023.2276148 · Cited by 6
“…bodily autonomy, verbal cues versus physical assist, refraining from triggering postures, and promoting interoception (Heinz et al., 2022; Justice & Brems, 2019; Nicotera & Viggiano, 2021; Smoyer, 2016; Steele et al., 2021; Taylor et al., 2020; Tibbitts et al., 2021; van der Kolk et al., 2014).”
Influential
PHYSICAL ACTIVITY OF UKRAINIAN AND POLISH MEDICAL STUDENTS IN THE BEGINNING OF THE WAR IN UKRAINE
Adamczak, B. B., Kuźnik, Z., Makles, S., & Kosendiak, A. A. (2023) · Health Problems of Civilization · doi:10.5114/hpc.2023.131867 · Cited by 5
‘Please, see me’; Informal and professional support of students with relatives with addiction problems: a three-year longitudinal qualitative study
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“Although body-oriented psychotherapy interventions are effective in different populations and settings [44, 45], treatments are neither standardized nor systematically evaluated [44, 46].”
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Rosenbaum, S., Stubbs, B., Schuch, F. B., & Vancampfort, D. (2017) · Springer eBooks · doi:10.1007/978-3-662-49322-9_16 · Cited by 5
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Moss, D. (2017) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207144.2017.1314744 · Cited by 6
“Van der Kolk advocates for a variety of mind–body-based therapies as first-level interventions for trauma, including yoga, physical exercise, and eye movement desensitization and reprocessing (EMDR; this therapy will be discussed later) (Van Der Kolk, 2014; Van Der Kolk et al., 2014).”
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Integrating Mindfulness and Biofeedback in the Treatment of Posttraumatic Stress Disorder
Oded, Y. (2018) · Biofeedback · doi:10.5298/1081-5937-46.02.03 · Cited by 5
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“The most common diagnosis for both young males and females is Attention-Deﬁcit Hyperactivity Disorder (ADHD), followed by Substance Use Disorder and Post-Traumatic Stress Disorder (PTSD).”
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Exploring the Impact of a Trauma-informed Yoga and Mindfulness Curriculum for Multiple Populations: A Pilot Study
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“Additionally, movement and stretching through yoga have been associated with reduced post-traumatic stress symptoms in veterans (Staples, Hamilton, & Uddo, 2013) and adult women with trauma histories (van der Kolk et al., 2014).”
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Strategies for Managing Chronic Pain, Chronic PTSD, and Comorbidities: Reflections on a Case Study Documented over Ten Years
Weisfeld, C. C., & Dunleavy, K. (2020) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-020-09741-5 · Cited by 5
“This case demonstrates the potential for integrating exercise approaches as an opportunity to practice self-management and somatic control, especially programs with a mind–body focus such as pilates and yoga (Rothschild, 2011; van der Kolk, 2014a) for combinations of conditions.”
Background
Post-traumatic Stress Disorder and Other Trauma-Related Disorders
Aron, C. M., & LeFay, S. M. (2022) · Springer eBooks · doi:10.1007/978-3-031-08364-8_8 · Cited by 4
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“26 Yoga has been hypothesized to ameliorate symptoms of CP/PTSD by providing space to focus on sensations rather than avoid them 27 while teaching how to differentiate between appropriate sensation associated with gentle movement and pain sent as a message from the body.”
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Kim, J., Im, S., Lee, R. S., & Heo, J. (2024) · Leisure Sciences · doi:10.1080/01490400.2024.2419057 · Cited by 3
“…poses, contributed to increased confidence, self-efficacy, and perseverance (Brown et al., 2017) which aligns with existing literature that suggests yoga can be an effective complementary therapy for trauma recovery by promoting emotional regulation and resilience (Van der Kolk et al., 2014).”
Mindfulness and Sexual Violence
Szoke, D. R., & Hazlett‐Stevens, H. (2019) · Springer eBooks · doi:10.1007/978-3-030-23645-8_28 · Cited by 3
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Toof, J., Mann, J., & Ouzts Moore, R. (2022) · Journal of Creativity in Mental Health · doi:10.1080/15401383.2021.1921648 · Cited by 3
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Cultivating Resilience in LGBTQ+ Youth
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Berbel, T., & Praetorius, R. T. (2023) · Social Work in Mental Health · doi:10.1080/15332985.2023.2299882 · Cited by 3
“In a study of 64 women with chronic, treatment-resistant PTSD, half were assigned to a yoga intervention and half received supportive health education.”
BackgroundInfluential
Exploring women's experiences of healing from sexual trauma through engagement in mind–body practices: A systematic review
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A Mixed Methods Evaluation of the Effectiveness of a Group Yoga Intervention as an Adjunctive Trauma Therapy for Adolescent Girls
Houser, M. E. (2015) · Digital Commons - DU (University of Denver) · Cited by 3
Eating Disorders: A Treatment Apart. The Unique Use of the Therapist's Self in the Treatment of Eating Disorders
Natenshon, A. H. (2017) · InTech eBooks · doi:10.5772/65697 · Cited by 3
“For ED patients suffering from co‐occurring substance abuse or addictions, yoga‐breathing practices may be useful in counteracting all types of urges brought on by environmental triggers that could result in relapse [31].”
Background
Approche sensorielle du psychotraumatisme auprès de jeunes enfants victimes de l’attentat de Nice du 14 juillet 2016 : de la réactivité à la régulation
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Posttraumatische Belastungsstörungen
Michael, T., Sopp, R., & Maercker, A. R. A. (2018) · Springer eBooks · doi:10.1007/978-3-662-54909-4_6 · Cited by 3
Complex Trauma Care Pathway: Results of a 12-Month Pilot
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“Phase II also offered members the option to participate in a weekly 60-minute mindful movement group based on traumasensitive yoga.(16) Phase III was envisioned as ongoing support for members who had either met Phase I or II treatment goals or were otherwise taking a break from treatment.”
Background
Child Maltreatment and Physical Health in Emerging Adulthood: Relationships with Physical Activity and Health Risk Behaviors
Moore, S. M. (2019) · Scholarship & Creative Works - Digital UNC a service of University Libraries (University of Northern Colorado) · Cited by 3
Exercise and PTSD
Kinsman, L. M., Norrie, H. J., Rachor, G. S., & Asmundson, G. J. G. (2024) · Current Topics in Behavioral Neurosciences · doi:10.1007/7854_2024_500 · Cited by 2
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“…present, modulate emotions, cultivate awareness, acclimate to environmental changes (Braun et al., 2021; Davis et al., 2020; Emerson & Hopper, 2011; Jindani & Khalsa, 2015), and for teaching stress tolerance (Braun et al., 2021; Rhodes, Spinazzola, & van der Kolk, 2016; Van der Kolk et al., 2014).”
BackgroundInfluential
How adult patients with complex trauma experiences (CTE) experience yoga as treatment
Lorentzen, K. E. A., Nordanger, D. Ø., Weimand, B. M., Hammersbøen, Å. M., Telles, S., & Halvorsen, M. S. (2025) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2025.100529 · Cited by 3
Adjunct psychomotor trauma exposure in the treatment of post-traumatic stress disorder: a case series
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“Research on this topic have been growing in interest this last years (including yoga, somatic experiencing, and sensorimotor therapy) (Brom et al., 2017; Classen et al., 2021; van der Kolk et al., 2014).”
Body- and movement-oriented interventions for prevention of post-traumatic stress disorder among first responders: A scoping review
Silva, L. D. D., Roubille, L., & Coq, J.-M. (2025) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2025.100538 · Cited by 2
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Background
Yoga als Add-on Therapie zu Dialektisch Behavioraler Therapie Sucht – Effekte auf die innere Anspannung von Patient:innen mit Substanzgebrauchsstörung und komorbider Borderline-Persönlichkeitsstörung
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“The results of several randomized controlled studies (RCTs) found that yoga (Davis et al., 2020; Jindani et al., 2015; van der Kolk et al., 2014) and yogic breathing (Carter et al., 2013; Seppala et al., 2014) signi ﬁ cantly reduced PTSD symptoms compared to a wait-list (Carter et al., 2013;…”
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“…that has been increasingly used in therapeutic settings to address the somatic impacts of trauma, with growing evidence demonstrating its effectiveness for improved self-regulation, capacity for self-care, and relationships with others (Rhodes, 2015; Rhodes et al., 2016; van der Kolk et al., 2014).”
THE IMPACT OF YOGA ON MENTAL HEALTH: A SYSTEMATIC REVIEW
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“12”
Toward a definition of treatment-resistant posttraumatic stress disorder: A systematic review
Al-Shamali, H. F., Meshkat, S., Janssen‐Aguilar, R., Uthayakumar, H., Burback, L., Winkler, O., Zhang, Y., Greenshaw, A. J., Enns, M. W., Nicholson, A. A., et al. (2025) · Journal of Military Veteran and Family Health · doi:10.3138/jmvfh-2025-0015 · Cited by 1
Trauma Center Trauma-Sensitive Yoga: Conceptual Components, Facilitation Guides, and Reflections
Emerson, D. J., Pringle, K., Jude, M., Bodine, E., Kempe, E., & Nguyen‐Feng, V. N. (2025) · Springer eBooks · doi:10.1007/978-3-032-00353-9_34 · Cited by 1
New Guidelines for Social Workers Who Treat Complex Posttraumatic Stress Disorder
Ball, T. B., Shtompel, N., & Harrison, J. (2026) · Clinical Social Work Journal · doi:10.1007/s10615-026-01026-y · Cited by 1
Non-specialist delivered psychosocial care after war and interpersonal violence: a systematic review and meta-analysis
Patel, A., Ramirez, G., Fernandes, L., Bariya-Sousa, A., McGuinness, E., Taha, S., Biswal, B., Awasthi, A., Wilson, D., Dixon, K. E., et al. (2026) · The Lancet Psychiatry · doi:10.1016/s2215-0366(26)00123-9 · Cited by 1
The 12 Steps of Alcoholics Anonymous as an Adjunctive Treatment for Trauma Survivors: An Experimental Approach
Edery, R. A. (2014) · International Journal of Emergency Mental Health and Human Resilience · doi:10.4172/1522-4821.1000120 · Cited by 1
Helping to Health Through Yoga: Exploring Yoga as an Adjunctive Therapy Tool for Adult Survivors of Childhood Sexual Abuse
Richeson, S. (2015) · Cited by 1
Beginning with the Clients: Mindfully Reconciling Opposites with Survivors of Trauma/Complex Traumatic Stress Disorders
Carnes, R., & Northcut, T. B. (2017) · Essential clinical social work series · doi:10.1007/978-3-319-43842-9_7 · Cited by 1
Traumatisierung findet im Körper statt – Traumaheilung auch!
Schulten, A., & Summhammer, M. T. (2017) · Psychosomatik im Zentrum · doi:10.1007/978-3-662-54146-3_19 · Cited by 1
Anxiety Disorders and Exercise: The Role for Health and Fitness Professionals
Brown, J., Pozzi, A. T. D., & Hicks-Little, C. A. (2019) · Strength and conditioning journal · doi:10.1519/ssc.0000000000000465 · Cited by 1
“Individuals who are dealing with an anxiety disorder who participated in yoga have reported reduced anxiety, mental stress, and depression while experiencing positive swings in moods, memory, and overall quality of life (16,24,27,36,40,41,52,53).”
Background
Social-emotional Problems of Children with Developmental Language Disorder
Richtrová, B. (2021) · Listy klinické logopedie · doi:10.36833/lkl.2021.029 · Cited by 1
Psychisches Trauma ohne Psyche?
Bruns, G. J. (2023) · PSYCHE · doi:10.21706/ps-77-11-1002 · Cited by 1
The Future of Behavioral Health Services for Youth With Foster Care Experience
Young, E. B., Day, A., Lewis, C. E., & YAO, R. L. (2023) · Families in Society The Journal of Contemporary Social Services · doi:10.1177/10443894231198550 · Cited by 1
“Other trauma-informed yoga classes have been reported to reduce PTSD symptoms, aid substance use recovery, and improve emotional well-being (Smoyer, 2016; Tibbitts et al., 2021; van der Kolk et al., 2014).”
Yoga in der jugendpsychiatrischen Behandlung von Essstörungen
Taferner, C., Sevecke, K., Schickl, M., Juen, B. H., & Exenberger, S. (2024) · Kindheit und Entwicklung · doi:10.1026/0942-5403/a000448 · Cited by 1
The Body as a Vessel for Trauma: The Clinical Case Study of Aisha
Visco‐Comandini, F., Barbieri, A., Mancini, F., & Ciolfi, A. (2025) · Brain Sciences · doi:10.3390/brainsci15010094 · Cited by 1
Lifestyle Psychiatry
Chawla, V., Burgess, J. D., Lagera, P. G. D., & Noordsy, D. L. (2025) · Springer eBooks · doi:10.1007/978-3-031-82888-1_15 · Cited by 1
The Integrative PTSD Healing Center: A Novel Three-Tier Treatment Model Bridging Neuroscience, Spirituality, and Alternative Medicine
(2025) · Journal of Psychology and Neuroscience · doi:10.47485/2693-2490.1113 · Cited by 1
Exercise and Posttraumatic Stress Disorder
Rosenbaum, S., Stubbs, B., Schuch, F. B., & Vancampfort, D. (2017) · Springer eBooks · doi:10.1007/978-3-662-49411-0_16-1 · Cited by 3
Child Massage Integrated Therapy: A Preliminary Intervention Manual for Psychological Trauma Treatment
Demers, S. P. (2016) · ScholarlyCommons (University of Pennsylvania) · Cited by 1
A Comparative Effectiveness Study of the Trauma Recovery Empowerment Model (TREM) and an Attachment-Informed Variation of TREM
Masin-Moyer, M. (2017) · ScholarlyCommons (University of Pennsylvania) · Cited by 1
Management of posttraumatic stress disorder
Patel, B., & Youssef, N. A. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-823039-8.00005-8 · Cited by 1
An Alternative Approach in the Treatment of Anxiety Disorders: Current DirectionsPreprint
Antos, Z., Zackiewicz, K., Tomaszek, N., Modzelewski, S., & Waszkiewicz, N. (2024) · Preprints.org · doi:10.20944/preprints202406.1166.v1 · Cited by 1
The experience of exercise: Women survivors of sexual violence
Smith‐Marek, E. N. (2015) · K-State Research Exchange (Kansas State University)
Yoga for Post Traumatic Stress Disorder in Women
Burns, J. (2016) · CommonKnowledge Research Repository (Pacific University Oregon)
Yoga in the Treatment of Trauma-Related Disorders
Olsen, E.-K. H. (2017) · Advances in medical diagnosis, treatment, and care (AMDTC) book series · doi:10.4018/978-1-5225-2788-6.ch013
Yoga for mental health : evaluation of yoga interventions for reducing depression and anxiety, and improving well-being
de Manincor, & Michael, J. (2017)
Recommendations and Moving Beyond the System
Hunter, N. (2018) · Springer eBooks · doi:10.1007/978-3-319-91752-8_9
Pathways Approaches for Post-traumatic Stress Disorders
McGrady, A. V., & Moss, D. (2018) · Springer eBooks · doi:10.1007/978-3-319-89313-6_8
Internal Body Awareness Among Sexual Trauma Survivors: A Multi-Method Study
Reinhardt, K. M. (2018) · Scholars' Bank (University of Oregon)
Butterfly, Emerging
Lucchesi, M. (2018) · Advances in medical technologies and clinical practice book series · doi:10.4018/978-1-5225-5981-8.ch004
Establishing the “area of need” through optimal responsiveness: Yoga/Psychotherapy for childhood sexual abuse survivors
Havron, E., & Edan, Y. I. (2019) · Cogent Psychology · doi:10.1080/23311908.2019.1580917 · Cited by 1
“These, combined with case studies of assisted yoga group therapy (Emerson, Sharma, Chaudhry, & Turner, 2009; Van der Kolk et al., 2014), have helped us hone our practical work and form the unique Yoga/Psychotherapy groups protocol.”
Background
Yogic Breathing for Post-Traumatic Stress Disorder: Designing an Application to Supplement Learning and Overcome a Stress State
Creighton, J. R. (2014) · UA Campus Repository (The University of Arizona)
The Relationship Between Frequency of Yoga and Meditation on PTSD Symptoms in Individuals Who Have Experienced Intimate Partner Violence
Polignani, K. (2019) · Digital Commons at National Lewis University (National Lewis University)
Psychoterapia Gestalt w Zarządzaniu zasobami ludzkimi
Paruzel‐Czachura, M., & Konieczniak, B. (2019) · Zarządzanie Zasobami Ludzkimi

Authors: van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., & Spinazzola, J.
Affiliations: Suffolk University (US)
ORCID: West, Jennifer
Emerson, David
Suvak, Michael
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)
DOI: 10.4088/jcp.13m08561
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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Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder: A Randomized Controlled Trial

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