Brigham & Women’s Hospital Harvard Medical School Scientific Research on Yoga for Trauma Yoga Alliance Webinar July 6, 2020 Sat Bir S. Khalsa, Ph.D. Assistant Professor of Medicine, Harvard Medical School Director of Yoga Research, Yoga Alliance Director of Research, Kundalini Research Institute Editor in Chief, International Journal of Yoga Therapy Research Associate, Benson Henry Institute for Mind Body Medicine Research Affiliate, Osher Center for Integrative Medicine
https://www.ptsd.va.gov/understa nd/common/common_adults.asp
Diagnostic Criteria for PTSD Requires exposure to an event that involved or held the threat of death, violence or serious injury. • Experiencing the traumatic event • Witnessing, in person, the traumatic event • Learning that someone close to you experienced or was threatened by the traumatic event • Repeatedly exposed to graphic details of traumatic events (e.g. first responders)
Diagnostic Criteria for PTSD One or more of the following signs or symptoms: • You relive experiences of the event, e.g. images and memories. • You have upsetting dreams about the event. • You experience flashbacks as if you were experiencing the event. • Ongoing or severe emotional distress or physical symptoms if something reminds you of the event.
Diagnostic Criteria for PTSD For > 1 month after the traumatic event you may: • Avoid situations or things that remind you of the event • Not remember important parts of the traumatic event • View yourself, others and the world in a negative way • Lost interest in activities and feel detached from family and friends • Emotional numbness, irritability or angry outbursts • Dangerous or self-destructive behavior • Constant vigilance for danger and startling easily • Trouble sleeping • Trouble concentrating Your symptoms cause significant distress in your life or interfere with your ability to go about your normal daily tasks.
https://www.ptsd.va.gov/apps/decisionaid/compare.aspx
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747539/pdf/43-1-7.pdf
From: Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence. Boyd JE, Lanius RA, McKinnon MC, Journal of Psychiatry and Neuroscience 43:7-25, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747539/pdf/43-1-7.pdf
Mantra Meditation for PTSD From: A spiritually based group intervention for combat veterans with posttraumatic stress disorder: feasibility study. Bormann JE, Thorp S, Wetherell JL, Golshan S. Journal of Holistic Nursing 26:109-16, 2008.
Physical PTSD Symptoms • Angry or violent outbursts • Dangerous or self-destructive behavior • Hyperarousal, constantly on guard or alert and startle easily • Panic attacks: shortness of breath, dizziness, sweating, nausea, and a racing heart • Have trouble sleeping • Dissociation from the body, lowered physical activity • Physical symptoms: muscle tension, chronic pain, headaches, stomach pain, diarrhea, tightness or burning in the chest, muscle cramps, or low back pain • Higher rates of neurological, respiratory, musculoskeletal and cardiovascular symptoms
“Interoceptive, body -oriented therapies can directly confront a core clinical issue in PTSD: traumatized individuals are prone to experience the present with physical sensations and emotions associated with the past.” “If past experience is embodied in current physiological states and action tendencies and the trauma is reenacted in breath, gestures, sensory perceptions, movement, emotion and thought, therapy may be most effective if it facilitates self-awareness and self- regulation.”
https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00133/full
Breath Regulation for PTSD From: The effects of respiratory sinus arrhythmia biofeedback on heart rate variability and posttraumatic stress disorder symptoms: a pilot study. Zucker TL, Samuelson KW, Muench F, Greenberg MA, Gevirtz RN. Applied Psychophysiology and Biofeedback, 34:135-43, 2009
Yogic Breathing for Tsunami Survivors with PTSD From: Effects of a yoga breath intervention alone and in combination with an exposure therapy for post-traumatic stress disorder and depression in survivors of the 2004 South- East Asia tsunami, Descilo T, Vedamurtachar A, Gerbarg PL, Mean Scores PTSD Checklist PCL-17 Nagaraja D, Gangadhar BN, Damodaran B, Adelson B, Braslow LH, Marcus S, Brown RP, Acta Psychiatrica Scandinavia, 121:289- 300, 2010.
Yoga Practices Postures, Breathing, Relaxation, Meditation Self-Regulation Awareness Spirituality Fitness ↑Flexibility ↑Attention ↑Unitive State ↑Stress Regulation ↑Strength ↑Emotion Regulation ↑Mindfulness ↑Transcendence ↑Coordination/Balance ↑Resilience ↑Concentration ↑Flow ↑Respiratory Function ↑Equanimity ↑Cognition ↑Transformation ↑Self -Efficacy ↑Self -Efficacy ↑Meta -cognition ↑Life Meaning/Purpose Global Human Functionality ↑Physical & Mental Health, ↑Physical Performance ↑Stress & Emotion Regulation, ↑Awareness/Mindfulness, ↑Meta -cognition ↑ Positive Behavior, ↑Wellbeing, ↑Values, ↑Life Purpose & Meaning, ↑Spirituality
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6508087/pdf/nihms-1010761.pdf
Yoga for PTSD From: Yoga as an adjunctive treatment for posttraumatic stress disorder: a randomized controlled trial, van der Kolk BA, Stone L, West J, Rhodes A, Emerson D, Suvak M, Spinazzola J, Journal of Clinical Psychiatry, 75:e559-65, 2014.
Yoga for PTSD in Veterans From: A yoga program for the symptoms of post-traumatic stress disorder in veterans, Staples JK, Hamilton MF, Uddo M, Military Medicine 178:854-60, 2013.
Yoga for PTSD in Veterans Clinician Administered PTSD Scale (CAPS) 22 75 Re-experiencing Total 20 70 Symptoms Score Clinician Administered PTSD Scale Score Score 18 65 120 60 p=0.009 16 p=0.030 100 Total CAPS Score 55 14 80 50 12 60 Baseline End Treatment Baseline End Treatment 25 40 24 35 Avoidance 23 Hyperarousal 22 20 Symptoms Symptoms 21 30 Score Score 20 0 19 Baseline End Treatment 18 p=0.006 p=0.038 25 17 16 15 20 14 13 Baseline End Treatment Baseline End Treatment From: Yoga for military service personnel with PTSD: A single arm study. Johnston JM, Minami T, Greenwald D, Li C, Reinhardt K, Khalsa SB, Psychological Trauma: Theory, Research, Practice, and Policy 7:555-62, 2015.
Yoga for PTSD in Veterans RCT CAPS Total CAPS Reexperiencing 80 22 Average Score Average Score 75 20 70 18 65 16 60 14 Pre-TX Mid-TX Pre-TX Mid-TX CAPS Avoidance CAPS Hyperarousal 30 32 Average Score Average Score 28 30 26 28 24 22 26 20 24 Pre-TX Mid-TX Pre-TX Mid-TX From: Kripalu Yoga for Military Veterans With PTSD: A Randomized Trial. Reinhardt KM, Noggle Taylor JJ, Johnston J, Zameer A, Cheema S, Khalsa SBS, Journal of Clinical Psychology 74:93-108, 2018.
Yoga for PTSD in Veterans RCT PCL 70 Average Score 60 50 40 Pre-TX Mid-TX Post-TX From: Kripalu Yoga for Military Veterans With PTSD: A Randomized Trial. Reinhardt KM, Noggle Taylor JJ, Johnston J, Zameer A, Cheema S, Khalsa SBS, Journal of Clinical Psychology 74:93-108, 2018.
Yoga for PTSD in Veterans RCT IES Total IES Intrusion 3.0 4 Average Score Average Score 2.5 3 2.0 2 1.5 1 Pre-TX Mid-TX Post-TX Pre-TX Mid-TX Post-TX IES Avoidance IES Hyperarousal 3.5 3.0 3.0 Average Score Average Score 2.5 2.5 2.0 2.0 1.5 1.5 1.0 Pre-TX Mid-TX Post-TX Pre-TX Mid-TX Post-TX From: Kripalu Yoga for Military Veterans With PTSD: A Randomized Trial. Reinhardt KM, Noggle Taylor JJ, Johnston J, Zameer A, Cheema S, Khalsa SBS, Journal of Clinical Psychology 74:93-108, 2018.
Yoga for PTSD PANAS +ve Affect PANAS -ve Affect 28 32 26 Average Score Average Score 30 24 28 22 26 20 24 18 22 16 Pre-TX Mid-TX Post-TX Pre-TX Mid-TX Post-TX DASS Anxiety Insomnia Severity Index 11 18 10 Average Score Average Score 16 9 8 14 7 12 6 10 5 Pre-TX Mid-TX Post-TX Pre-TX Mid-TX Post-TX From: A Yoga Intervention for Posttraumatic Stress: A Preliminary Randomized Control Trial, Evidence-Based Complementary and Alternative Medicine, Jindani F, Turner N, Khalsa SBS, 351746, 2015.
PTSD Checklist Yoga 60 Average Score 55 for 50 PTSD 45 40 35 Pre-TX Mid-TX Post-TX Resilience Scale Perceived Stress Scale DASS Stress 130 28 26 14 125 24 Average Score Average Score Average Score 22 12 120 20 18 115 10 16 14 110 8 12 105 10 Pre-TX Mid-TX Post-TX Pre-TX Mid-TX Post-TX Pre-TX Mid-TX Post-TX From: A Yoga Intervention for Posttraumatic Stress: A Preliminary Randomized Control Trial, Evidence-Based Complementary and Alternative Medicine, Jindani F, Turner N, Khalsa SBS, 351746, 2015.
Yoga and CBT for PTSD From: Evaluation of a Combined Yoga and Cognitive Behavioral Therapy Program for Posttraumatic Stress Disorder, Staples JK, Mintie D, Khalsa SBS, Journal of Alternative and Complementary Medicine 22, No. 6, Abstracts 2016. https://www.liebertpub.com/doi/full/10.1089/acm.2016.29003.abstracts
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