Scientific Research on Yoga for Trauma Yoga Alliance Webinar July - - PowerPoint PPT Presentation

Brigham & Women’s Hospital

Harvard Medical School

Scientific Research on Yoga for Trauma

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

Yoga Alliance Webinar July 6, 2020

https://www.ptsd.va.gov/understa nd/common/common_adults.asp

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.

Diagnostic Criteria for PTSD

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.

• 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

Physical PTSD 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

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, Nagaraja D, Gangadhar BN, Damodaran B, Adelson B, Braslow LH, Marcus S, Brown RP, Acta Psychiatrica Scandinavia, 121:289- 300, 2010.

Mean Scores PTSD Checklist PCL-17

Yogic Breathing for Tsunami Survivors with PTSD

Yoga Practices

Postures, Breathing, Relaxation, Meditation

Fitness

↑Flexibility ↑Strength ↑Coordination/Balance ↑Respiratory Function ↑Self-Efficacy

Global Human Functionality

↑Physical & Mental Health, ↑Physical Performance ↑Stress & Emotion Regulation, ↑Awareness/Mindfulness, ↑Meta-cognition ↑Positive Behavior, ↑Wellbeing, ↑Values, ↑Life Purpose & Meaning, ↑Spirituality

Self-Regulation

↑Stress Regulation ↑Emotion Regulation ↑Resilience ↑Equanimity ↑Self-Efficacy

Awareness

↑Attention ↑Mindfulness ↑Concentration ↑Cognition ↑Meta-cognition

Spirituality

↑Unitive State ↑Transcendence ↑Flow ↑Transformation ↑Life Meaning/Purpose

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.

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

Yoga for PTSD in Veterans

Clinician Administered PTSD Scale

Total CAPS Score

20 40 60 80 100 120

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.

Total Score

Baseline End Treatment Score

50 55 60 65 70 75

Re-experiencing Symptoms

Baseline End Treatment Score

12 14 16 18 20 22

Avoidance Symptoms

Baseline End Treatment Score

20 25 30 35

Hyperarousal Symptoms

Baseline End Treatment Score

13 14 15 16 17 18 19 20 21 22 23 24 25

Clinician Administered PTSD Scale (CAPS)

p=0.009 p=0.030 p=0.038 p=0.006

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.

CAPS Total

Pre-TX Mid-TX Average Score

60 65 70 75 80

CAPS Reexperiencing

Pre-TX Mid-TX Average Score

14 16 18 20 22

CAPS Avoidance

Pre-TX Mid-TX Average Score

24 26 28 30 32

CAPS Hyperarousal

Pre-TX Mid-TX Average Score

20 22 24 26 28 30

Yoga for PTSD in Veterans RCT

PCL

Pre-TX Mid-TX Post-TX Average Score

40 50 60 70

Yoga for PTSD in Veterans RCT

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.

IES Total

Pre-TX Mid-TX Post-TX Average Score

1 2 3 4

IES Intrusion

Pre-TX Mid-TX Post-TX Average Score

1.5 2.0 2.5 3.0

IES Avoidance

Pre-TX Mid-TX Post-TX Average Score

1.5 2.0 2.5 3.0

IES Hyperarousal

Pre-TX Mid-TX Post-TX Average Score

1.0 1.5 2.0 2.5 3.0 3.5

Yoga for PTSD in Veterans RCT

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

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.

DASS Anxiety

Pre-TX Mid-TX Post-TX Average Score

5 6 7 8 9 10 11

Insomnia Severity Index

Pre-TX Mid-TX Post-TX Average Score

10 12 14 16 18

PANAS +ve Affect

Pre-TX Mid-TX Post-TX Average Score

22 24 26 28 30 32

PANAS -ve Affect

Pre-TX Mid-TX Post-TX Average Score

16 18 20 22 24 26 28

Yoga for PTSD

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

Pre-TX Mid-TX Post-TX Average Score

35 40 45 50 55 60

Resilience Scale

Pre-TX Mid-TX Post-TX Average Score

105 110 115 120 125 130

Perceived Stress Scale

Pre-TX Mid-TX Post-TX Average Score

10 12 14 16 18 20 22 24 26 28

DASS Stress

Pre-TX Mid-TX Post-TX Average Score

8 10 12 14

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

“I was nervous…I didn’t know what it was going to be about…” “I thought this was going to be nothing…I was going in for the money because it was a paid thing, but it was something beautiful. It was very useful.” “It was beautiful… I loved it. I felt full

• f energy and didn’t feel stressed out.

I felt very motivated. Not right from the get-go, but after the first good week, I was really into it. My blood was flowing, my heart rate was better, I was doing it at home … It brought down my stress level a lot. I was more focused and more understanding. My temper came down a lot.” “I got flexible. I lost weight. My belly went down…I lost 10 pounds.” From: Yoga’s Impact on Post- traumatic Stress Disorder, Newbound C, Kripalu Puranam Magazine 2011

From: A Yoga Intervention Program for Patients Suffering from Symptoms of Posttraumatic Stress Disorder: A Qualitative Descriptive Study. Jindani FA, Khalsa GF, Journal of Alternative and Complementary Medicine 21:401-8, 2015.

Yoga for PTSD Qualitative Study

Fitness: ‘‘In the past, I was consumed by emotions. With yoga, I could breathe and link my body and mind. I could feel my legs shaking at times, my arms aching. For the first time, I could sense my breath. I noticed that with this yoga, overall, I felt better afterwards. Everywhere in me...my mind and body.’’ Self-regulation: ‘‘I would say my biggest benefit has been that I am more emotionally

• balanced. Often after class, I would feel really strong and balanced and really, really alert,

but like deep calm. I would be able to return to that feeling the days I wasn’t in class.’’ Awareness: “I would be more aware and could then think more clearly how best to

• respond. When I would do that I’d feel really peaceful after and just be able to work with my

emotions and experiences in a healthier way.” Spirituality: ‘‘With yoga, I had a connection of mind, body, and spirit. During the practice and when you become aware of those three things, or be aware of them, it seems like things are more possible. I had more peace, the idea of finding increased peace of mind. I mean what could be richer than a sense of you know a spirit; my spiritual self.’’

From: A Yoga Intervention Program for Patients Suffering from Symptoms of Posttraumatic Stress Disorder: A Qualitative Descriptive Study. Jindani FA, Khalsa GF, Journal of Alternative and Complementary Medicine 21:401-8, 2015.

Yoga for PTSD Qualitative Study

‘‘Psychotherapy is very emotionally taxing because you have to rehash and rehash and bring it up again, the trauma. I stopped going to a psychotherapist because I did not want to talk about things anymore, and that’s what I liked about this because I did not have to talk about those things ’cause that can get exhausting! And it re-traumatizes. In this, you didn’t have to rehash the story.’’