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Easing the Pain: Exploring the Effects of Yoga on PTSD Symptoms
The overwhelming majority of American men and women have experienced at least one traumatic event in their lifetime. Of those, nearly 10% of women and 4% of men will develop Post Traumatic Stress Disorder (PTSD). People with PTSD often experience avoidance, emotional reactivity, psychological rigidity and other debilitating effects. New research suggests that yoga may help to alleviate some of these symptoms.
A study just published on line in the Journal of Clinical Psychology, finds that women with either clinical or sub-threshold levels of PTSD symptoms may experience less expressive suppression, an important indicator of emotion regulation, following participation in a yoga program.
Expressive suppression is a form of emotion regulation that involves the repressing the expression of emotion, and controlling positive and negative feelings. Even though the outward communication of emotions is masked, the intense emotional arousal associated with those feelings is still present but remains unexpressed. Consequently, the ability to cope with or experience distressing emotions is impaired. This strategy can have negative emotional and psychological effects, and is often linked to clinical depression or dysthymia.
In the study, thirty-eight adult women with full or sub-threshold PTSD were randomly assigned to either a 12-session, Kripalu-based, “trauma sensitive” yoga intervention or a weekly assessment control group. Yoga classes were 75-minutes in duration either once per week for 12-weeks (9 participants), or twice per week for 6-weeks (11 participants) based on participants’ preference.
The average age of all participants in this ethnically diverse sample (52.6% Caucasian, 36.8% African American, 5.3% Asian and 5.3% other ethnic/racial group) was approximately 44 years of age. Most participants reported multiple traumatic experiences spanning from childhood through adulthood. At the time of this study, 70.7% met full criteria for PTSD, and over 24% met criteria for major depression.
The sample was well educated, with 94.7% of women having some form of college education. Nearly 50% of participants had prior experience with yoga, however most had not practiced regularly, and none had practiced in the past 6 months. There were no significant differences between the yoga and control groups on any of the key variables at the beginning of the study.
Trauma-sensitive yoga and Dialectical Behavior Therapy combined
The trauma-sensitive yoga approach consisted of “Hatha yoga that emphasizes connections between mind and body, compassionate self-observation, and focus on the present moment”. Four primary themes - examining choices and decision-making, engaging in effective action, synchronizing breath and movement, and present moment awareness, were used.
The yoga curriculum also included principles from Dialectical Behavior Therapy (DBT), a well known and scientifically validated psychological intervention initially developed for individuals with borderline personality disorder and chronic suicidal thoughts and behaviors (see Linehan, 1993). Principles of DBT including “mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness” were emphasized in this yoga program.
Control group activities included weekly meetings in small groups of 5 in which participants completed the identical questionnaires as the yoga group. Both the yoga group and controls were assessed before the start of the yoga program, at program completion, and 1-month later.
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 (see Mitchell et al, 2014 for details).
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 or unsuitable, and the extent to which this approach is appropriate for women reporting a higher degree of trauma symptoms.
Results are mixed
Results of the study revealed that women with high levels of PTSD symptoms might experience less expressive suppression after participating in a yoga program compared to the no-yoga control group.
The authors suggested that lower levels of suppression might be linked to the development of a non-judgmental attitude as a function of practicing yoga.
Contrary to expectation, only the control group demonstrated significant increases in psychological flexibility and significant reductions in PTSD symptoms. There was, however, a non-significant trend toward a relationship between increased psychological flexibility and a decrease of PTSD symptoms in the yoga group.
More research is needed
Yoga research for individuals with PTSD is in the early stages, and more empirically rigorous studies are needed to understand the specific mechanisms (cognitive, emotional, behavioral, physiological, etc.) that might be affected by regular yoga practice, as well as yoga’s direct effects on PTSD symptoms.
This study is one of the first randomized, controlled trials to look at the specific mechanisms related to change in PTSD symptoms that might be positively impacted by yoga practices. While the findings are mixed, this is consistent with many studies of new interventions in yoga and elsewhere in which researchers are eager to test the effects of their newly developed protocols.
Greater attention and research need to be focused on the nature and content of these programs and their delivery systems before directly assessing their effects as we run the risk of confusing mixed findings with ineffective programs. In the interim, yoga teachers and others are encouraged to remain cautiously optimistic as well as realistic about the use of yoga as an adjunctive approach to relieve PTSD symptoms.
Grace Bullock, PhD, E-RYT 500 is a psychologist, research scientist, educator, author, yoga and mindfulness expert and creator of BREATHE: 7 Skills for Mindful Relationships. Her mission is to reduce stress, increase health and wellbeing and improve the quality of relationships. She offers classes, workshops, writing and research that combine the wisdom of applied neuroscience, psychophysiology, psychology and contemplative science and practice. Her goal is to empower individuals, groups, leaders and organizations to reduce chronic stress and increase awareness, attention, compassion, mindfulness and effective communication to strengthen relationships, release dysfunctional patterns and unlock new and healthy ways of being. Dr. Bullock is a Certified Viniyoga Therapist and Faculty at the Integrated Health Yoga Therapy (IHYT) Training program. She is the former Senior Research Scientist at the Mind & Life Institute and former Editor-in-Chief of the International Journal of Yoga Therapy. For more information see www.bgracebullock.com