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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
Gard, T., Noggle, J. J., Park, C. L., Vago, D. R., & Wilson, A. (2014) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2014.00770 · Cited by 472
“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
Sporting Mind: The Interplay of Physical Activity and Psychological Health
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].”
Rosenbaum, S., Vancampfort, D., Steel, Z., Newby, J., Ward, P. B., & Stubbs, B. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.10.017 · Cited by 333
Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials
Cramer, H., Lauche, R., Anheyer, D., Pilkington, K., de Manincor, M., Dobos, G., & Ward, L. (2018) · Depression and Anxiety · doi:10.1002/da.22762 · Cited by 329
“…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…”
Background
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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