Yoga and Post Traumatic Stress Disorder
Yoga for PTSD: New Research Points to Potential Benefits
By B Grace Bullock, PhD, E RYT-500
Roughly 10% of American women suffer from posttraumatic stress disorder (PTSD). Alternative approaches like yoga and meditation are now being used to alleviate PTSD symptoms, yet little is known about their effectiveness. A new study suggests that yoga may help, but more research is needed to understand its benefits.
PTSD can cause considerable distress and disruption to the mind, body and brain. It is characterized by hyperarousal and hypervigilance, emotional numbing, flash backs, insomnia and nightmares, anger and irritability, and social isolation. Depression, anxiety, substance use and abuse, and disrupted personal relationships often co-occur.
Brain changes include hyperactivation of regions associated with emotional processing including the amygdala, hippocampus, dorsal anterior cingulate cortex (dACC), and insula. Individuals with PTSD also consistently demonstrate elevated heart rate and lowered heart rate variability, as well as elevated cortisol and ACTH (adrenocorticotropic hormone) – all are indicators of elevated physiological and psychological stress.
Many years of research suggest that yoga can benefit the body and mind. A new study published in the Journal of Traumatic Stress investigated whether yoga practices might also improve the lives of women with PTSD.
Thirty-eight adult women with full or sub-threshold PTSD were randomly assigned to either a 12-session, Kripalu-based, “trauma sensitive” yoga intervention (either once per week for 12-weeks or twice per week for 6-weeks), or a weekly assessment control group. While little information is provided regarding the yoga program, the authors indicated that classes included both movement (asana) and breath exercises.
The multi-ethnic sample included 9 veterans and 29 civilians whose average age was 44.37 years (range approximately 32-56 years of age). Many were overweight and most had little to no prior experience with yoga.
Most participants reported multiple traumatic experiences spanning from childhood through adulthood. At the time of this study, 70.7% of these women met full criteria for PTSD, and over 24% percent met criteria for major depression. There were no major differences between yoga and control group participants on any of these factors.
All participants were evaluated for changes in PTSD symptoms, depression and anxiety at baseline, then weekly and at 1-mont follow-up. Members of both groups received a yoga mat and water bottle, and were compensated $30 each for the baseline and 1-month follow-up assessments and $20 for each yoga class or weekly assessment.
Seventy percent of yoga and 67% of control group participants completed the study. Those who dropped out had slightly higher scores on the PTSD checklist, but did not differ in any other way from those who completed.
Social effects linked to reduced symptoms
Contrary to their hypotheses, participants in both groups demonstrated improvement. Women in both the yoga and control groups reported clinically significant decreases in PTSD-related experiences including avoidance, hyperarousal and re-experiencing from baseline through 1-month follow-up. Both groups also reported reductions in depression and anxiety.
The authors suggested that both groups of women likely benefitted from factors such as weekly social engagement, self-monitoring and behavioral activation. They also suggest that the experience of interacting with other women with PTSD in a supportive, empathic, non-judgmental atmosphere may have helped to normalize their experience. All of these questions bear further study.
No adverse experiences were reported for either group. Participants were informed at the onset of the study that yoga might trigger negative emotions. One women required referral to a therapist.
The rate of attrition in the yoga (30%) and control (33%) groups was very high. The researchers noted that those who dropped out had slightly higher trauma symptom checklist scores than those who completed the study. This leaves the question as to whether some participants found the practices to be unsafe and unsuitable, and the extent to which this approach is appropriate for women reporting a higher degree of trauma symptoms.
Reducing the stress response
While yoga may not be feasible for some, there is evidence that it can reduce stress-related symptoms by regulating the nervous and endocrine systems, which are typically overactive and imbalanced in individuals with PTSD. This study provides some hope as well as a cautionary tale that more research is needed to understand which types of practices are appropriate, for whom, and under what conditions.
B Grace Bullock, PhD, E RYT-500, is Senior Research Scientist at the Mind & Life Institute, and Faculty at Integrated Health Yoga Therapy's, yoga therapist training programme. She is a psychologist, author, intervention and implementation scientist who has worked extensively in inpatient and outpatient behavioral health settings. Her research and clinical work explore the effects of integrating empirically supported psychotherapy with yoga therapy to relieve stress, anxiety, depression and other psychological illnesses, and to promote health and wellbeing for children, teens, adults, couples and families. She is the former Editor-in-Chief of the International Journal of Yoga Therapy, and the recipient of a Francisco J. Varela Research Award from the Mind & Life Institute in 2010. For more information contact Grace at firstname.lastname@example.org or see http://www.mind-bodytherapy.com.