Comparing Effects of a Holistic Yoga Program and a Wellness Program on PTSD Symptoms

Posttraumatic Stress Disorder constitutes a substantial proportion of the burden of illness
among Veterans. However, current PTSD treatments are not effective for all, and a significant
number remain symptomatic despite pharmacotherapy and psychotherapy. As a result, there has
been increased interest within the military and VA in Complementary and Alternative Medicine
approaches, such as yoga, to improve symptoms without requiring direct verbal processing of
the trauma. Yoga provides an innovative approach to calming hyperarousal, reducing
numbness/avoidance, and improving self-regulation of emotions, while cultivating physical and
emotional well-being. Because of this unique approach to the biological, psychological, and
social dimensions of PTSD, we believe that yoga interventions are poised to meet the demand
for more effective PTSD treatment options for Veterans. Recent research indicates that yoga
interventions can be delivered successfully to individuals who have PTSD and have the
potential to reduce clinician rated and self-reported overall PTSD symptoms, depression and
anxiety. However, few studies exist that have evaluated yoga for PTSD and they have involved
small sample sizes and are either uncontrolled or waitlist/usual care controlled. Also, there
is much variation among studies in the style and components of yoga interventions. Thus, a
randomized controlled trial of a standardized, traditional, holistic yoga intervention is
urgently needed to inform VA policy makers and clinicians of the potential benefits of yoga
as an adjunct to currently available PTSD treatments.

OBJECTIVE: The overall goal of this project is to compare the effects of a 16-week Holistic
Yoga Program (HYP) with a 16-week Wellness Lifestyle Program (WLP) on PTSD and related
symptoms and outcomes. This project has three specific aims: 1) to compare the effects of the
interventions (HYP vs. WLP) on overall PTSD symptom severity; 2) compare the interventions'
effects on PTSD-specific symptoms (anger, sleep), PTSD-related symptoms (depression, anxiety,
pain) and related outcomes (well-being/quality of life); 3) to manualize the Holistic Yoga
Program and training process for experienced yoga teachers to deliver HYP to individuals who
have PTSD in order to facilitate future study and dissemination efforts.

METHODS: This study sample will include 232 outpatients with a clinician-confirmed diagnosis
of PTSD, recruited from the Roudebush VA Medical Center as well as metropolitan area mental
health clinicians and military/Veterans' organizations, who will be randomly assigned to
receive the Holistic Yoga Program (HYP) or the Wellness Lifestyle Program (WLP). The HYP will
involve a standardized 16-week intervention consisting of: 1) in-person group yoga class
taught by a yoga instructor registered through the Yoga Alliance at least at the 200 hour
level; 2) classes will include yoga postures, breathing practices, deep muscle contraction
practices, relaxation practices, and teacher-led discussions to exchange "lessons learned,"
and introduce relevant aspects of yoga philosophy; 3) guided yoga postures, breath and
relaxation practice audio recordings for home-use; and 4) a Participant Handbook to reinforce
concepts taught during in-person sessions. The WLP is an attention control comprised of low
intensity physical activity and didactics about wellness topics that will also encourage home
practice and provide a Participant Handbook to reinforce concepts taught during in-person
sessions.

Inclusion Criteria:

Veterans and civilians will be eligible for inclusion if

- they are age 18 or older,

- have a CAPS-confirmed PTSD diagnosis,

- and access to a working telephone for ease of contact during the course of the study.

Exclusion Criteria:

Exclusion criteria will include:

- severe medical conditions in which yoga is contraindicated;

- active psychosis;

- active suicidal intent;

- moderate to severe cognitive impairment as determined by the short Mini-Mental State
Examination, a six-item screener (MMSE);

- involvement in ongoing yoga classes and/or regular home practice of yoga in the
previous 3 months;

- and receiving ongoing medical or psychological treatment that includes more than one
hour weekly of relaxation and mind-body based stress reduction strategies (related
directly to meditation and yoga).