Yoga, a practice that involves breath control, meditation, and adopting a series of specific body postures, is widely practiced to improve psychological and physical health as well as for relaxation. For some, this practice is also part of a spiritual tradition, and for others the practice is completely secular. While there are different ways to practice yoga, research suggests that its benefits are equal to or better than more traditional forms of exercise for a variety of health conditions1-2.
Physical Effects of Yoga
Yoga is considered beneficial through its downregulation (that is, the process of reducing or suppressing a response to a stimulus) of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. These are two physiological systems that respond to and recover from stressors in our environment3.
Yoga may also be effective through its effect on emotion-regulation skills, such as the ability to identify, label, and respond effectively to fear, sadness, and other emotions4. Many researchers are interested in how yoga can be used as an adjunctive treatment for posttraumatic stress disorder (PTSD) and other psychological disorders characterized by high levels of stress.
Treating PTSD
Initial research studies with small samples have found that time-limited yoga (fewer than 10 sessions) may be effective as adjunctive treatments to reduce symptoms of PTSD among survivors of trauma,5 but not as effective as stand-alone exposure-based treatments6,7. However, less is known about how the length and duration of yoga treatment could affect the potential benefits on PTSD symptoms and possibly add to the clinical benefits.
Psychiatrist Bessel van der Kolk and colleagues examined these questions in collaboration with The Trauma Center at the Justice Resource Institute, Boston University School of Medicine, Boston College, and Suffolk University. They wanted to learn if the benefit in a trauma-focused yoga treatment would be greater if practice time was extended to 20 weeks and included more closely monitored out-of-session yoga practices. In addition, they wanted to understand the effect of this treatment among people experiencing PTSD symptoms who had not responded well to other types of interventions or treatments for at least three years7.
Nine women diagnosed with chronic PTSD began a 20-week trauma-informed hatha yoga treatment (and six completed it). The program consisted of weekly hour-long, instructor-led yoga classes, and they included cultivating safety, being in the present moment, making choices to take effective action, and moving in rhythm with others.
Each class employed a combination of chair, mat, and breath exercises. Participants were also asked to complete 30-minute yoga practices at home three times a week while using a DVD or CD as a guide. The women were assessed for PTSD symptoms prior to treatment, twice in the middle, and twice at follow-up sessions. Importantly, all the women in the study were required to be enrolled concurrently in ongoing supportive psychotherapy and be stable on medications.
Promising Results
The results suggested some promising outcomes. The six women who completed treatment exhibited clinically significant reductions in PTSD symptoms, defined as a 30 to 45 percent reduction before treatment and at post-treatment points. By mid-treatment, treatment they showed a 25 percent reduction in symptoms, which suggests that most of change occurred during the first half of this treatment. By the follow-up assessments, 83 percent no longer met criteria for a PTSD diagnosis.
These results highlight that a trauma-focused hatha yoga program may be a helpful adjunctive treatment for chronic PTSD when it is extended to 20 sessions. However, this study has notable limitations: The sample size was very small so it is unclear if these findings could be replicated in a different sample with a greater number of participants. And it remains unclear if the effect of trauma-focused yoga interventions are equivalent or superior to exposure therapy and other effective interventions for PTSD.
This study provides initial evidence that yoga-focused treatments may be effective in reducing chronic PTSD symptoms and that it is important to expand the options for treatments to trauma survivors. Hopefully, future studies will examine this treatment with larger samples, as well as strategies to make trauma-informed yoga class more accessible to survivors of trauma so they have the most evidence-based options available as they seek help and support and find the most effective treatments in their recovery process.
Sources
1. Ross, A., Thomas, S. (2010) The health benefits of yoga and exercise: A review of comparison studies. Journal of Alternative and Complementary Medicine,16:3–12.
2. Govindaraj, R., Karmani, S., Varambally, S., & Gangadhar, B. N. (2016). Yoga and physical exercise—A review and comparison. International Review of Psychiatry, 28(3), 242-253. doi:10.3109/09540261.2016.1160878.
3. Gothe, N. P., Keswani, R. K., & McAuley, E. (2016). Yoga practice improves executive function by attenuating stress levels. Biological Psychology, 121(Part A), 109-116. doi:10.1016/j.biopsycho.2016.10.010.
4. Emerson, D., Sharma, R., Chaudhry, S., Turner, J. (2009). Trauma-sensitive yoga: Principles, Practice, and Research. International Journal of Yoga Therapy, 19:123–128.
5. Carter, J. J., Gerbarg, P. L., Brown R.P., … & Katzman, M. A. (2013). Multi-Component Yoga Breath Program for Vietnam Veteran Post Traumatic Stress Disorder: Randomized Controlled Trial. Journal of Traumatic Stress Disorders & Treatment, 2:1–10. doi.org/10.4172/2324-8947.1000108.
6. Johnston, J. M., Minami, T., Greenwald, D., … & Khalsa, S. (2015). Yoga for military service personnel with PTSD: A single arm study. Psychological Trauma: Theory, Research, Practice, and Policy, 7:555–562.
7. 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. The Journal of Clinical Psychiatry, 75(6), e559-e565. doi:10.4088/JCP.13m08561.
Sarah Krill Williston is a PhD Candidate in the Roemer lab at the University of Massachusetts Boston. Sarah’s research primarily focuses on developing strategies to increase mental health literacy and reduce mental health stigma, to empower individuals to more effectively seek evidence-based mental health care for anxiety and trauma-related disorders. In addition, Sarah’s clinical interests include providing evidenced-based treatments (primarily CBT, ABBT) to individuals with mood, anxiety and trauma-related disorders, with a particular interest in working with military families, active duty service members, and veterans.
