Valued living among veterans in breath-based meditation treatment or cognitive processing therapy for posttraumatic stress disorder: Exploratory outcome of a randomized controlled trial

Promoting Adherence to a Yoga Intervention for Veterans With Chronic Low Back Pain

Background

Research demonstrates that yoga can be effective for improving chronic low back pain (cLBP) among military veterans and non-veterans. Attendance of yoga interventions is necessary to obtain benefits, yet yoga class attendance can be a challenge both within and outside of research, especially for persons who lack resources.

Objective

Our objective was to describe efforts to boost attendance within a randomized trial of yoga for cLBP, and to examine factors related to attendance.

Methods

A previous trial of yoga for cLBP among military veterans randomly assigned participants to 2x weekly yoga for 12 weeks, or delayed treatment. After the second of 6 intervention cohorts, efforts were made to improve participant attendance. Attendance and reasons for missing yoga sessions were tracked using sign-in logs and phone calls. Regression analysis was used to examine factors related to attendance.

Results

After efforts to boost attendance, mean attendance increased from 10.2/24 sessions, (42% attending at least half of sessions), to 13.3/24 sessions, (df (1,74), t = -1.44; P = 0.15) (59% attending half of the sessions). The most common reasons for non-attendance were transportation, financial problems, other health issues, and work or school conflicts. Living status and back pain-related disability at baseline were significantly associated with attendance (P= < .001 and P = .038 respectively). When including all participants, yoga session attendance was significantly associated with reduced pain severity (P = 0.01).

Conclusions

Efforts to boost attendance appeared meaningful but the changes were not statistically significant. Attendance rate in later cohorts were comparable to those in other studies. Reasons provided for non-attendance by participants, and the regression results suggest that resources such as transportation, a stable living situation, and disability levels at baseline were related to attendance rates for this in-person intervention. Remotely delivered yoga may address some of these barriers but hybrid interventions that bring in-person yoga closer to participants may be the best option.

Efficacy of yoga for posttraumatic stress disorder: A systematic review and meta-analysis of randomized controlled trials

Yoga is an increasingly popular complementary intervention to reduce posttraumatic stress disorder (PTSD) symptoms and related comorbidities, but its safety and treatment efficacy are not firmly established. We conducted a systematic review and meta-analysis of existing randomized control trials (RCTs) of yoga interventions for PTSD and related secondary outcomes (e.g., depression). Initial search results found over 668 potential papers. Twenty met inclusion criteria (e.g., RCTs on adult participants with PTSD that evaluated safety or efficacy outcomes). Meta-analysis indicated that, compared to control interventions, participation in yoga interventions significantly improved self-report PTSD (standardized mean difference [SMD]: -0.51; 95 % confidence interval [CI]: -0.68, -0.35) and immediate (SMD: -0.39; 95 % CI: -0.56, -0.22) and long-term (SMD: -0.44; 95 % CI: -0.74, -0.13) depression symptoms. However, using clinician-reported assessments, yoga interventions were not associated with improved PTSD symptoms. Type of yoga differentially predicted outcomes. Sensitivity analysis showed consistent effect sizes when omitting each study from main analyses. Six studies reported whether any serious adverse events occurred. None were indicated. No publication bias was found, although individual intervention studies tended to be high in bias. Results suggest yoga is likely a safe and effective complementary intervention for reducing PTSD and depressive symptoms in individuals with PTSD. More rigorous RCTs are warranted.

School-Based Services May Eliminate Substance Treatment Disparities: Results From a Nonrandomized Program Evaluation

BACKGROUND

There are known health disparities in adolescent substance treatment access and engagement. The purpose of this project is to compare outcomes from school- and clinic-based substance treatment and to evaluate if providing school-based substance treatment reduces disparities in treatment access and engagement.

METHOD

This quality improvement retrospective chart review compares baseline and outcome data for adolescents accessing school-based (n = 531) and clinic-based (n = 523) substance treatment in a natural quasi-experimental study with nonequivalent control group design. Baseline demographic and clinical measures include age, sex, ethnicity, race, and clinical diagnoses. Outcome measures include the number of sessions completed, proportion reaching a week of self-reported abstinence, and proportion providing a negative urine drug screen.

RESULTS

Compared to the clinic-based sample, the school-based sample includes more female (47.65% vs 26.77%) and Hispanic/Latinx (59.89% vs 46.46%) adolescents. The school-based group has a similar proportion reaching a negative urine drug screen (31.84% vs 28.83%, p = .5259) or a week of abstinence (43.15% vs 41.03%, p = .6718) as the clinic-based sample. There are significant differences in total session completion over a period of 16 weeks between school-based and clinic-based adolescents. In multivariable analyses, there was a significant interaction effect of race/ethnicity by location on the number of sessions completed.

CONCLUSION

Providing school-based substance treatment increases access to care and treatment engagement for female, African American, and Hispanic/Latinx adolescents without diminishing outcomes.

Combined effect of transcutaneous auricular vagus nerve stimulation and 0.1 Hz slow-paced breathing on working memory

Background

Previous research has found that transcutaneous auricular vagus nerve stimulation (taVNS) can improve working memory (WM) performance. It has also been shown that 0.1 Hz slow-paced breathing (SPB, i.e., breathing at a rate of approximately 6 breaths/min) can significantly influence physical state and cognitive function via changes in autonomic afferent activity. In the present study, we investigated the synergistic effects of taVNS and SPB on WM performance.

Methods

A total of 96 healthy people participated in this within-subjects experiment involving four conditions, namely taVNS, SPB, combined taVNS with SPB (taVNS + SPB), and sham. Each participant underwent each intervention for 30 min and WM was compared pre- and post-intervention using the spatial and digit n-back tasks in a random order four times. Permutation-based analysis of variance was used to assess the interaction between time and intervention.

Results

For the spatial 3-back task, a significant interaction between time and intervention was found for the accuracy rate of matching trials (mACC, p = 0.03). Post hoc analysis suggested that both taVNS and taVNS + SPB improved WM performance, however, no significant difference was found in the SPB or sham groups.

Conclusion

This study has replicated the effects of taVNS on WM performance reported in previous studies. However, the synergistic effects of combined taVNS and SPB warrant further research.