Complementary and Alternative Interventions for Veterans With Posttraumatic Stress Disorder

The overarching purpose of this study is to assess the impact of CA interventions on
posttraumatic stress symptoms in veterans with PTSD. Twenty percent of the approximately 2
million veterans returning from Iraq and Afghanistan ("Operation Iraqi Freedom" or OIF and
"Operation Enduring Freedom" or OEF) suffer from the symptoms of Post-traumatic Stress
Disorder. PTSD may be the reason behind alarming increases in suicidal behavior among
returning veterans in Wisconsin and nation-wide. In addition to traditional treatments,
Veterans Administration (VA) Hospitals and other community institutions for veterans now
offer CA programs to their patients. Past research from our laboratory and others suggests
that CA programs may provide effective relief from anxiety while increasing psychological
well-being. However, little research exists on the effects of CA programs for combat veterans
with PTSD. The proposed study aims to address this important gap by assessing CA programs
such as Sudarshan Kriya Yoga (SKY) and Mindfulness-Based Stress Reduction (MBSR). 150
veterans with PTSD will be randomly assigned to either SKY, MBSR, or the wait-list control
(WLC) group. We will assess participants' PTSD symptoms pre-intervention, post-intervention
(approximately 10-14 days after initial visit), and 1 month post-treatment (approximately 6
weeks after initial visit). In order to evaluate the programs' effects as comprehensively as
possible, we propose a multi-method approach: baseline psychophysiology, autonomic reactivity
and recovery, neuropsychological (cognitive) assessments, self-report questionnaires, and
functional brain imaging (fMRI). Baseline measures will be collected from a group of 50
combat-exposed veterans without PTSD to assess group differences on these measures prior to
treatment.

Inclusion Criteria:

- In the age range of 18-50.

- Capable of giving informed consent

- Fluent in English

- Exposure to one or more life-threatening war zone trauma events in Iraq or Afghanistan
within the last 8 years.

- Pharmacological or psychotherapeutic treatment stable for at least 8 weeks prior to
beginning of study

- Good general medical health (see Medical Exclusion Criteria)

- DSM-IV criteria for current PTSD as determined by CAPS (PTSD groups only)

- Combat-exposed, non-PTSD control veterans must be free of any current DSM-IV Axis I
disorder

- Participants must agree to not begin a new course of treatment for the duration of the
study

Exclusion Criteria:

- Weight of 352 pounds or over (due to constraints of MRI scanner)

- Women who are pregnant, planning to conceive during the research timeline, or
breastfeeding will be excluded.

- Metallic implants such as prostheses or aneurysm clip, or electronic implants such as
cardiac pacemakers

- Neurological or serious medical condition that may contraindicate MRI or that may
overlap with physiological substrates of psychiatric conditions (see below for
descriptions)

- History of seizures or seizure disorder

- Moderate or severe traumatic brain injury (over 30 minutes unconscious)

- Current active substance dependence or dependence within 3 months (other than
nicotine)

- Meets DSM-IV criteria for bipolar disorder, schizophrenia, schizoaffective disorder,
psychotic disorder NOS, delirium, or any DSM-IV cognitive disorder.

- Substance dependence disorder within 3 months or any current substance dependence

- Severe psychiatric instability or severe situational life crises, including evidence
of being actively suicidal or homicidal, or any behavior that poses an immediate
danger to patient or others.

- Current use of benzodiazepines or beta-blockers

- Nonsuicidal depression comorbid with PTSD will NOT be exclusionary

- Extensive experience in yoga and meditation or have learned MBSR or SKY previously