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Zaccari B, Sherman ADF, Higgins M, Ann Kelly U. Trauma Center Trauma-Sensitive Yoga Versus Cognitive Processing Therapy for Women Veterans With PTSD Who Experienced Military Sexual Trauma: A Feasibility Study. J Am Psychiatr Nurses Assoc 2024; 30:343-354. [PMID: 35833676 PMCID: PMC9839891 DOI: 10.1177/10783903221108765] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a common sequela to military sexual trauma (MST) among women veterans. Yoga has shown promise in research examining its benefit for symptoms and sequela of PTSD. AIMS The objective of this study was to evaluate the feasibility of a randomized controlled trial (RCT) of Trauma Center Trauma-Sensitive Yoga (TCTSY) for women veterans with PTSD related to MST. METHOD In this feasibility study, the final sample included women veterans (n = 41) with PTSD related to MST accessing health care in a Veterans Affairs Health Care System in the southeast United States; the majority were African American (n = 33; 80.5%). Interventions used established protocols of 10 weekly sessions of group TCTSY versus 12 weekly sessions of group Cognitive Processing Therapy (CPT). PTSD was assessed via clinical interview and participant report. Additional data collection included multiple participant-reported outcomes commonly associated with PTSD and psychophysiological measures. We also collected data regarding participant satisfaction and feasibility-related feedback from participants and providers. RESULTS Feasibility and acceptability were evaluated via demand, practicality, fidelity, and acceptability. This was measured by expressed interest, attendance, program completion, barriers to care and satisfaction with treatment, and satisfaction with interventions and data collection. CONCLUSIONS Results indicate the RCT design and TCTSY implementation were feasible; a full-scale RCT was subsequently conducted to determine efficacy of the experimental intervention. Recommendations for successful research strategies are provided.
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Affiliation(s)
- Belle Zaccari
- Belle Zaccari, PsyD, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Belle Zaccari, PsyD, Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Athena D F Sherman
- Athena D. F. Sherman, PhD, PHN, RN, CNE, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Melinda Higgins
- Melinda Higgins, PhD, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Ursula Ann Kelly
- Ursula Ann Kelly, PhD, APRN, ANP-BC, PMHNP-BC, FAANP, FAAN, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
- Ursula Ann Kelly, PhD, APRN, ANP-BC, PMHNP-BC, FAANP, FAAN, Atlanta VA Health Care System, Atlanta, GA, USA
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Miles LW, Valentine JL, Mabey LJ, Hopkins ES, Stodtmeister PJ, Rockwood RB, Moxley ANH. A Systematic Review of Evidence-Based Treatments for Adolescent and Adult Sexual Assault Victims. J Am Psychiatr Nurses Assoc 2023:10783903231216138. [PMID: 38148646 DOI: 10.1177/10783903231216138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND Sexual assault (SA) is a serious crime that is a prevalent mental and public health problem. AIMS Addressing the needs of SA victims and providing appropriate treatment are essential to reduce potential adverse short- and long-term outcomes. METHODS Our team undertook an extensive systematic literature review (published between January 2006 and July 2021) to provide evidence-based mental health intervention recommendations for adolescent and adult victims of SA. Where SA-specific research was limited, the literature and clinical practice guidelines on treatments for trauma-induced post-traumatic stress disorder (PTSD) were reviewed to provide additional information to formulate recommendations. RESULTS Findings strongly support several primary psychotherapy treatments: cognitive behavioral therapy, cognitive processing therapy, eye movement desensitization and reprocessing, narrative exposure therapy, and prolonged exposure therapy. Complementary (aerobic exercise, art, drama, and music therapy) and pharmacological treatments were explored. CONCLUSIONS Mental health nurses who provide services for victims of SA can utilize this overview to guide recommendations for treatment of SA trauma and related PTSD symptoms to mitigate the short- and long-term negative impacts after a traumatic event. When victims of SA receive optimal mental health treatments, our communities benefit as victims heal and recover.
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Affiliation(s)
- Leslie W Miles
- Leslie W. Miles, DNP, PMHNP-BC, Brigham Young University College of Nursing, Provo, UT, USA
| | - Julie L Valentine
- Julie L. Valentine, PhD, RN, SANE-A, FAAN, University of Utah, Salt Lake City, UT, USA
| | - Linda J Mabey
- Linda J. Mabey, DNP, PMHCNS-BC, Brigham Young University College of Nursing, Provo, UT, USA
| | | | - Paige J Stodtmeister
- Paige J. Stodtmeister, DNP, PMHNP-BC Brigham Young University College of Nursing, Provo, UT, USA
| | - Reilly B Rockwood
- Reilly B. Rockwood, DNP, PMHNP-BC, Brigham Young University College of Nursing, Provo, UT, USA
| | - Alyssa N H Moxley
- Alyssa N. H. Moxley, DNP, CNM, WHNP-BC, Brigham Young University College of Nursing, Provo, UT, USA
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Zaccari B, Higgins M, Haywood TN, Patel M, Emerson D, Hubbard K, Loftis JM, Kelly UA. Yoga vs Cognitive Processing Therapy for Military Sexual Trauma-Related Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2344862. [PMID: 38064219 PMCID: PMC10709771 DOI: 10.1001/jamanetworkopen.2023.44862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/14/2023] [Indexed: 12/18/2023] Open
Abstract
Importance First-line treatment for posttraumatic stress disorder (PTSD) in the US Department of Veterans Affairs (VA), ie, trauma-focused therapy, while effective, is limited by low treatment initiation, high dropout, and high treatment refraction. Objective To evaluate the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY) vs first-line cognitive processing therapy (CPT) in women veterans with PTSD related to military sexual trauma (MST) and the hypothesis that PTSD outcomes would differ between the interventions. Design, Setting, and Participants This multisite randomized clinical trial was conducted from December 1, 2015, to April 30, 2022, within 2 VA health care systems located in the southeast and northwest. Women veterans aged 22 to 71 years with MST-related PTSD were enrolled and randomized to TCTSY or CPT. Interventions The TCTSY intervention (Hatha-style yoga focusing on interoception and empowerment) consisted of 10 weekly, 60-minute group sessions, and the CPT intervention (cognitive-based therapy targeting modification of negative posttraumatic thoughts) consisted of 12 weekly, 90-minute group sessions. Main Outcome and Measures Sociodemographic data were collected via self-report survey. The primary outcome, PTSD symptom severity, was assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Checklist for DSM-5 (PCL-5). Assessments were conducted at baseline, midintervention, 2 weeks post intervention, and 3 months post intervention. Results Of 200 women veterans who consented to participate, the intent-to-treat sample comprised 131 participants (mean [SD] age, 48.2 [11.2] years), with 72 randomized to TCTSY and 59 randomized to CPT. Treatment was completed by 47 participants (65.3%) in the TCTSY group and 27 (45.8%) in the CPT group, a 42.6% higher treatment completion rate in the TCTSY group (P = .03). Both treatment groups improved over time on the CAPS-5 (mean [SD] scores at baseline: 36.73 [8.79] for TCTSY and 35.52 [7.49] for CPT; mean [SD] scores at 3 months: 24.03 [11.55] for TCTSY and 22.15 [13.56]) and the PCL-5 (mean [SD] scores at baseline: 49.62 [12.19] for TCTSY and 48.69 [13.62] for CPT; mean [SD] scores at 3 months: 36.97 [17.74] for TCTSY and 31.76 [12.47]) (P < .001 for time effects). None of the group effects or group-by-time effects were significant. Equivalence analyses of change scores were not significantly different between the TCTSY and CPT groups, and the two one-sided test intervals fell within the equivalence bounds of plus or minus 10 for CAPS-5 for all follow-up time points. Conclusions and Relevance In this comparative effectiveness randomized clinical trial, TCTSY was equivalent to CPT in reducing PTSD symptom severity, with both groups improving significantly. The higher treatment completion rate for TCTSY indicates its higher acceptability as an effective and acceptable PTSD treatment for women veterans with PTSD related to MST that could address current VA PTSD treatment limitations. Trial Registration ClinicalTrials.gov Identifier: NCT02640690.
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Affiliation(s)
- Belle Zaccari
- Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Mental Health and Clinical Neurosciences, Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Psychiatry, Oregon Health & Science University, Portland
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | | | - Meghna Patel
- Mental Health Service Line, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David Emerson
- The Center for Trauma and Embodiment at Justice Resource Institute, Needham, Massachusetts
| | - Kimberly Hubbard
- Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Jennifer M. Loftis
- Research and Development Service, Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Psychiatry, Oregon Health & Science University, Portland
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland
| | - Ursula A. Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Nursing and Patient Care Services, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia
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Davis LW, Schmid AA, Daggy JK, Yang Z. Mediators of improved PTSD symptoms in veterans and civilians following a yoga program. Acta Neuropsychiatr 2023; 35:232-240. [PMID: 36710002 DOI: 10.1017/neu.2023.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Although yoga shows some promise as an intervention for post-traumatic stress disorder (PTSD), little is known about how yoga reduces PTSD symptoms. The current study hypothesised that aspects of interoceptive awareness would mediate the effect of a yoga intervention on PTSD symptoms. METHODS We used data from our recently completed randomised controlled trial of a 16-week holistic yoga programme for veterans and civilians diagnosed with PTSD (n = 141) that offered weekly 90-minute sessions. We conducted a mediation analysis using interoceptive awareness and other variables that were associated with PTSD symptom reduction at mid-treatment and treatment end. RESULTS Although measures of anxiety, interoceptive awareness, and spirituality were identified in individual mediator models, they were no longer found to be significant mediators when examined jointly in multiple mediator models. When examining the multiple mediator models, the strongest mediator of the yoga intervention on PTSD symptoms was mental well-being at mid-treatment and stigma at the treatment end. The total effect of yoga on CAPS and PCL at the treatment end mediated by stigma was 37.1% (-1.81/-4.88) and 33.6% (-1.91/-5.68), respectively. CONCLUSION Investigation of mental well-being and mental illness stigma as potential mediators is warranted in future studies of yoga as a treatment for PTSD as they may prove to be important foci for yoga interventions.
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Affiliation(s)
- Louanne W Davis
- Research Department, Roudebush VA Medical Center, Indianapolis, Indiana, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Arlene A Schmid
- Department of Occupational Therapy, Colorado State University System, Denver, Colorado, USA
| | - Joanne K Daggy
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ziyi Yang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Zaccari B, Sherman ADF, Febres-Cordero S, Higgins M, Kelly U. Findings from a pilot study of Trauma Center Trauma-Sensitive Yoga versus cognitive processing therapy for PTSD related to military sexual trauma among women Veterans. Complement Ther Med 2022; 70:102850. [PMID: 35820575 PMCID: PMC9704511 DOI: 10.1016/j.ctim.2022.102850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The study objective was to explore the preliminary efficacy of trauma-sensitive yoga compared to cognitive processing therapy (CPT) for women Veterans with posttraumatic stress disorder (PTSD) related to military sexual trauma (MST) in a pilot randomized control trial (RCT). We then compared these results to published interim results for the subsequent full-scale RCT. METHOD The analytic sample included women Veterans (N = 41) with PTSD related to MST accessing healthcare in a southeastern Veterans Affairs Health Care System. The majority were African American, non-Hispanic (80.5 %). The protocol-driven group interventions, Trauma Center Trauma-Sensitive Yoga (TCTSY; n = 17) and the evidence-based control condition, CPT (n = 24), were delivered weekly for 10 and 12 sessions, respectively. Multilevel linear models (MLM) were used to compare changes over time between the two groups. RESULTS The primary outcomes presented here are PTSD symptom severity and diagnosis, assessed using the Clinician Administered PTSD Scale (CAPS) and the PTSD Symptom Checklist (PCL) total scores. PTSD symptom severity on both clinician-administered (CAPS) and self-reported (PCL) measures, improved significantly (p < .005) over time, with large within group effect sizes (0.90-0.99) consistent with the subsequent RCT. Participants in the TCTSY group showed clinically meaningful improvements earlier than the CPT group participants from baseline on the CAPS and PCL Total scores. CONCLUSIONS Results support published findings of the effectiveness of TCTSY in the treatment for PTSD related to MST among women Veterans, particularly African American women. TCTSY warrants consideration as an adjunctive, precursor, or concurrent treatment to evidence-based psychotherapies. Future research should include patient preference, men with sexual trauma, and civilian populations.
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Affiliation(s)
- Belle Zaccari
- Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Athena D F Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA.
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA.
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA.
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, USA; Atlanta VA Health Care System, Decatur, GA, USA.
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Tibbitts DC, Aicher SA, Sugg J, Handloser K, Eisman L, Booth LD, Bradley RD. Program evaluation of trauma-informed yoga for vulnerable populations. EVALUATION AND PROGRAM PLANNING 2021; 88:101946. [PMID: 33901773 PMCID: PMC8325936 DOI: 10.1016/j.evalprogplan.2021.101946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND Trauma is highly prevalent among vulnerable populations, including those who are incarcerated, in treatment for substance use, or seeking mental health services. Trauma-informed yoga seeks to create a safer yoga practice for individuals with a trauma history and may improve emotional and physical wellbeing. Thus, we conducted an evaluation of a trauma-informed yoga program to gain insight into participant experiences. METHODS Trauma-informed yoga classes were led by trained volunteers and held in three sectors that work with vulnerable populations: corrections and reentry, substance use treatment and recovery, and community and mental health. Data were collected via anonymous survey using a retrospective pre-post design. The survey instrument captured reasons for student participation and perceived effects of yoga on emotional and physical wellbeing. RESULTS Students were motivated to participate in yoga classes by expectations of physical, mental, and spiritual benefit. Students reported perceived improvements in emotional and physical wellbeing and greater use of self-regulation skills after starting yoga. CONCLUSION Our findings suggest trauma-informed yoga is perceived as beneficial by vulnerable individuals, especially those in the correctional system or recovering from substance use. Our results support the value of offering trauma-informed yoga in institutionalized and community settings. Improvements in emotional and physical wellbeing warrant formal study.
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Affiliation(s)
- Deanne C Tibbitts
- Helfgott Research Institute, National University of Natural Medicine, 049 SW Porter Street, Portland, OR, 97201, USA.
| | - Sue A Aicher
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA; Living Yoga (Board of Directors: SAA, JS, Staff: LE, LDB, Volunteer: KH), 5100 SW Macadam Ave., Suite 360, Portland, OR, 97239, USA.
| | - Judith Sugg
- Living Yoga (Board of Directors: SAA, JS, Staff: LE, LDB, Volunteer: KH), 5100 SW Macadam Ave., Suite 360, Portland, OR, 97239, USA.
| | - Kimberlee Handloser
- Living Yoga (Board of Directors: SAA, JS, Staff: LE, LDB, Volunteer: KH), 5100 SW Macadam Ave., Suite 360, Portland, OR, 97239, USA.
| | - Liz Eisman
- Living Yoga (Board of Directors: SAA, JS, Staff: LE, LDB, Volunteer: KH), 5100 SW Macadam Ave., Suite 360, Portland, OR, 97239, USA.
| | - Lauren D Booth
- Living Yoga (Board of Directors: SAA, JS, Staff: LE, LDB, Volunteer: KH), 5100 SW Macadam Ave., Suite 360, Portland, OR, 97239, USA.
| | - Ryan D Bradley
- Helfgott Research Institute, National University of Natural Medicine, 049 SW Porter Street, Portland, OR, 97201, USA.
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Schmid AA, Sternke EA, Do ANL, Conner NS, Starnino VR, Davis LW. The Eight Limbs of Yoga can be Maintained in a Veteran Friendly Yoga Program. Int J Yoga 2021; 14:127-132. [PMID: 34188384 PMCID: PMC8191223 DOI: 10.4103/ijoy.ijoy_106_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/13/2021] [Accepted: 03/27/2021] [Indexed: 11/04/2022] Open
Abstract
Background Posttraumatic stress disorder (PTSD) may occur after a traumatic event and has deleterious effects on individuals, including decreased quality of life and function. Yoga is an intervention that may help with the management of PTSD symptoms, however yoga interventions in research studies frequently only include postures and breathwork, not all eight limbs of yoga. Aims and Objectives The aims of this qualitative study was to examine whether participants with PTSD in a group yoga program discussed the benefits of yoga in a way that represented the eight limbs of yoga, when answering questions about their experience of the yoga program. Methods Qualitative data were collected after participants completed a 16-week yoga intervention. Qualitative data were collected via survey, reviewed, coded, and categorized into themes representing each of the eight limbs of yoga. Results Overall, 108 people were randomized to the yoga intervention and 67 individuals completed the intervention and follow up questions used in these analyses. The mean age of the 67 participants in this study was 52.4 years (±12.0), the majority were male (70.2%), and most had combat-related trauma (62.7%). All eight limbs of yoga were represented in the data, including each of the five yamas and niyamas, even though the yoga intervention did not explicitly include Sanskrit terms, definitions, or education about yoga philosophy or the eight limbs of yoga. Conclusion Results may indicate that yoga, even when only including postures, breathwork, intentions, and relaxation/meditation, may still address all of the yamas, niyamas, and the other eight limbs of yoga.
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Affiliation(s)
- Arlene A Schmid
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado
| | | | - Ai-Nghia L Do
- Roudebush VA Medical Center, VA HSR&D Center for Health Information and Communication, Indianapolis, Indiana
| | | | | | - Louanne W Davis
- Roudebush VA Medical Center, VA HSR&D Center for Health Information and Communication, Indianapolis, Indiana.,Department of Psychiatry, Indiana University, School of Medicine, Indianapolis, Indiana
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Kelly U, Haywood T, Segell E, Higgins M. Trauma-Sensitive Yoga for Post-Traumatic Stress Disorder in Women Veterans who Experienced Military Sexual Trauma: Interim Results from a Randomized Controlled Trial. J Altern Complement Med 2021; 27:S45-S59. [PMID: 33788599 DOI: 10.1089/acm.2020.0417] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To conduct an interim analysis of data collected from an ongoing multisite randomized clinical trial (RCT) assessing the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY) for post-traumatic stress disorder (PTSD) among women veterans with PTSD related to military sexual trauma (MST). The purpose of the interim analysis was to assess outcomes from the primary site, which is geographically, demographically, culturally, and procedurally distinct from the second site. Design: RCT was conducted within a Veterans Administration Health Care System. Data collection included preintervention through 3 months postintervention. Participants: Enrollment for the main site was 152 women. The sample size for the intent-to-treat analysis was 104. The majority were African American (91.3%) with a mean age of 48.46 years. Intervention: The TCTSY intervention (n = 58) was conducted by TCTSY-certified yoga facilitators and consisted of 10 weekly 60-min group sessions. The control intervention, cognitive processing therapy (CPT; n = 46), consisted of 12 90-min weekly group sessions conducted per Veterans Administration protocol by clinicians in the PTSD Clinic. Outcome measures: The Clinician Administered PTSD Scale for DSM-5 (CAPS-5) was used to assess current PTSD diagnosis and symptom severity, including overall PTSD and four symptom clusters. The PTSD checklist for DSM-5 (PCL-5) was used to obtain self-report of PTSD symptom severity, including total score and four symptom clusters. Results: The findings reported here are interim results from one clinical site. For both the CAPS-5 and PCL-5, total scores and all four criterion scores decreased significantly (p < 0.01) over time in all five multilevel linear models within both TCTSY and CPT groups, without significant differences between groups. There were clinically meaningful improvements seen for both TCTSY and CPT with 51.1%-64.3% of TCTSY subjects and 43.5%-73.7% of CPT decreasing their CAPS-5 scores by 10 points or more. Effect sizes for total symptom severity were large for TCTSY (Cohen's d = 1.10-1.18) and CPT (Cohen's d = 0.90-1.40). Intervention completion was higher in TCTSY (60.3%) than in CPT (34.8%). Symptom improvement occurred earlier for TCTSY (midintervention) than for CPT (2 weeks postintervention). Safety: There were no unanticipated adverse events in this study. Conclusion: The results of this study demonstrate that TCTSY may be an effective treatment for PTSD that yields symptom improvement more quickly, has higher retention than CPT, and has a sustained effect. TCTSY may be an effective alternative to trauma-focused therapy for women veterans with PTSD related to MST. The study is registered in ClinicalTrials.gov (CTR no.: NCT02640690).
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Affiliation(s)
- Ursula Kelly
- Atlanta VA Health Care System, Decatur, GA, USA.,Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Eliza Segell
- Atlanta VA Health Care System, Decatur, GA, USA.,Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Zaccari B, Callahan ML, Storzbach D, McFarlane N, Hudson R, Loftis JM. Yoga for veterans with PTSD: Cognitive functioning, mental health, and salivary cortisol. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2020; 12:913-917. [PMID: 32772534 PMCID: PMC7880235 DOI: 10.1037/tra0000909] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Research indicates that cognitive functioning is negatively impacted by exposure to chronic stress due to overactivation of the stress response. Yoga has demonstrated benefits when practiced by individuals diagnosed with posttraumatic stress disorder (PTSD). This quasi-experimental pilot study examined the impact of a yoga intervention on cognitive functioning, symptoms of PTSD, and the biological stress response in Veterans diagnosed with PTSD. Method: Cognitive functioning, self-report measures of mental health symptoms, and salivary cortisol were measured within two weeks prior to beginning and following completion of a 10-week yoga protocol. Veterans with PTSD participated in gender-specific groups of the yoga intervention. Paired t tests and correlational analyses were used to analyze quantitative data. Results: Statistically significant improvements were observed between baseline and postintervention scores on measures of response inhibition, PTSD, depression, sleep, quality of life, and subjective neurocognitive complaints. Positive correlations were found between baseline and postintervention changes in sleep and depression, and between change in cortisol output and a measure of life satisfaction. Statistically significant differences (baseline to postintervention) for other objective measures of cognitive performance and cortisol were not detected. Conclusions: Results provide preliminary support for the practice of yoga to improve cognitive functioning (response inhibition) related to symptoms of PTSD while also improving mental health symptoms, sleep, and quality of life. Positive correlations affirm the role of sleep in mood symptoms and indicate the need for further examination of the role of cortisol in life satisfaction. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Rebekah Hudson
- Department of Psychiatry, Oregon Health & Science University
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