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

A 10-week, yoga-based mindfulness program reduced symptoms of PTSD among women with chronic, treatment-resistant PTSD.

FindingsMethodology

In the United States, about one in ten women have experienced a violent assault. Over one-third of these women develop posttraumatic stress disorder (PTSD), characterized by unwanted memories or re-experiences of the trauma, avoidance of reminders of the trauma, negative thoughts and feelings, and hyperarousal. PTSD is typically treated with medication and counseling, yet the majority of patients continue to experience at least some symptoms, in part because counseling approaches such as prolonged exposure therapy require engaging with previous traumatic memories. However, guided mindfulness meditation—which draws attention to bodily sensations and breathing—can help PTSD patients to manage the negative emotions provoked by cognitive therapies.

Yoga offers a widely available, structured mindfulness practice combining physical postures, breathing exercises, and meditation techniques. Past research has tied yoga to a range of health benefits including reduced stress, depression, and anxiety. This study tests the potential for yoga to improve emotional regulation and reduce symptoms of PTSD among women who have not responded to other types of treatments. The authors compared the effect on PTSD symptoms of a 10-week yoga-based mindfulness program compared to a control

Findings

For women diagnosed with chronic, treatment-resistant PTSD, both the yoga and control treatments decreased the number of individuals meeting diagnostic criteria, but the 10 weeks of trauma-specific yoga classes reduced PTSD symptoms significantly more than the 10 weeks of non-trauma-related health education.

  • The yoga treatment significantly reduced the number of women who met diagnostic criteria for PTSD.
    • Both treatments decreased the number of women who met diagnostic criteria for PTSD, but the decrease was significantly greater in the yoga treatment (52% of women) than the control treatment (21% of women).
  • The yoga treatment significantly reduced the severity of PTSD symptoms:
    • On the clinician-administered measure, both treatments reduced PTSD symptom severity, but the effect size was significantly larger in the yoga treatment (1.07) than the control treatment (0.66).
    • On the self-reported measure, both treatments reduced PTSD symptom severity at the mid-point, but only the yoga treatment maintained those reductions by the end of the treatment (average score in yoga group: 65.17 at start, 56.01 at 5 weeks, 51.49 at 10 weeks; average score in control group: 73.06 at start, 50.96 at 5 weeks, 63.75 at 10 weeks).
  • Both the yoga treatment and the control treatment significantly reduced the severity of depressive symptoms among women who have experienced trauma, with no statistically significant difference between the two groups
    • Both treatments reduced depressive symptom severity (average score in yoga group: 20.98 at start, 19.23 at 5 weeks, 13.92 at 10 weeks; average score in control group: 24.06 at start, 19.51 at 5 weeks, 19.47 at 10 weeks).
    • Although the effect size was larger in the yoga treatment (0.60) than the control treatment (0.39), this difference was not statistically significantly difference.

In short, yoga may provide an effective complementary approach to reducing PTSD by improving physical and emotional awareness and regulation, with the effectiveness of this treatment being comparable to current psychotherapeutic and pharmacologic treatments.

Methodology

The study enrolled 64 women (age 18-58 years) with chronic, treatment-resistant PTSD (currently met diagnostic criteria, trauma at least 12 years prior, at least 3 years of prior treatment); 60 completed treatment. Participants were randomized to receive 10 weeks of either yoga or control treatment. The yoga treatment consisted of weekly 1-hour classes designed to treat trauma. Yoga classes incorporated postures, breathing, and meditation from hatha yoga. The control treatment consisted of weekly 1-hour women’s health education classes, using an interactive, supportive model to build women’s self-efficacy around a range of health issues not related to trauma. Participants in the control group were encouraged to share food and maintain personal contact outside of the program, while participants in the yoga group were not permitted to do so.

All participants completed the same assessments, administered by evaluators blinded to condition. Before and after treatment, participants were assessed for PTSD symptoms (Clinician-Administered PTSD Scale, CAPS) and self-reported issues with affect regulation (Inventory of Altered Self-Capacities). PTSD was diagnosed from a CAPS score ≥65 using DSM-IV criteria. Participants no longer met PTSD criteria when their CAPS score fell below 45, a conservative benchmark ruling out false negatives. Before treatment, at the 5-week midpoint, and after treatment, participants were additionally assessed using self-report measures for trauma symptoms (Davidson Trauma Scale) and depressive symptoms (Beck Depression Inventory-II).

For further information on the methodology:


MLA: van der Kolk, Bessel A., et al. “Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder: A Randomized Controlled Trial.” Journal of Clinical Psychiatry, vol. 75, no. 6, 2014, pp. e559-e565.
APA: van der Kolk, B.A., 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(6), e559-e565.
Chicago: van der Kolk, Bessel A., Laura Stone, Jennifer West, Alison Rhodes, David Emerson, Michael Suvak, and Joseph Spinazzola. “Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder: A Randomized Controlled Trial.” Journal of Clinical Psychiatry 75, no. 6 (2014): e559-e565.