Evaluation of Effectiveness of a Group Yoga Intervention as Trauma Therapy for Adolescent Girls
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 11 - 18 |
| Updated: | 4/21/2016 |
| Start Date: | May 2015 |
| End Date: | September 2015 |
A Mixed Methods Evaluation of Effectiveness of a Group Yoga Intervention as an Adjunctive Trauma Therapy for Adolescent Girls
Neuroscience evidence indicates that trauma is stored in the body, that trauma impairs the
language centers found in the brain, and that emotion centers in the brain tend to override
cognitive centers in the brain following trauma. Most evidence-based models to date to treat
trauma using cognitive therapy, which does not fully resolve symptoms, particularly in the
case of complex trauma. This evidence has led to researchers to call for alternative,
body-oriented treatments that target trauma from the lowest levels of regulation up to
higher levels of regulation in the brain. Yoga has been proposed as one such intervention.
Recent research has investigated the benefits of yoga to treatment adult females who have
experienced PTSD, but only anecdotal, descriptive, and qualitative data is available for
studies of yoga with adolescents. This mixed methods study seeks to generate quantitative
data demonstrating whether or not the 6-week group yoga intervention leads to decreases in
general mental health and trauma-specific symptoms and qualitative data regarding the
components of the intervention the participants found both helpful and unhelpful.
language centers found in the brain, and that emotion centers in the brain tend to override
cognitive centers in the brain following trauma. Most evidence-based models to date to treat
trauma using cognitive therapy, which does not fully resolve symptoms, particularly in the
case of complex trauma. This evidence has led to researchers to call for alternative,
body-oriented treatments that target trauma from the lowest levels of regulation up to
higher levels of regulation in the brain. Yoga has been proposed as one such intervention.
Recent research has investigated the benefits of yoga to treatment adult females who have
experienced PTSD, but only anecdotal, descriptive, and qualitative data is available for
studies of yoga with adolescents. This mixed methods study seeks to generate quantitative
data demonstrating whether or not the 6-week group yoga intervention leads to decreases in
general mental health and trauma-specific symptoms and qualitative data regarding the
components of the intervention the participants found both helpful and unhelpful.
A mixed methods design was chosen for this study due to the study representing a new stream
of literature, and a desire to capture the fullest picture possible regarding the
participants' response to the intervention. The purpose of this mixed methods study is to
generate quantitative data that demonstrates a decrease in trauma and general mental health
symptoms following a yoga psychotherapy intervention for trauma, and to collect qualitative
data during the group process and following the group that provides a picture of the
mechanisms that allow the intervention to be effective. Broad Hypotheses: Quantitatively,
there will be significant differences in total number of mental health symptoms and
trauma-related symptoms experienced from pretest to posttest. Qualitative data will
demonstrate the benefits from the yoga postures and experiences of relaxing breath work the
youth experienced during the yoga group.
Trauma is a prevalent experience in our society, with between 50-76% of individuals
experiencing a traumatic event with the potential to cause Posttraumatic Stress Disorder.
The current standard of care in trauma treatment largely involves cognitive interventions,
but neuroscience evidence demonstrates reasons for their limited effectiveness and a need to
help traumatized individuals regulate the brain from the lowest levels up. Neuroscience
research indicates the brains of individuals who have experienced trauma are less able to
use cognitive centers to suppress emotional fear responses, and language centers in the
brain experience deactivation during traumatic events. Indeed, 33% of individuals who
develop PTSD fail to recover fully, which leads to ongoing mental health difficulties,
impaired interpersonal relationships, substance abuse, physical health problems, and sexual
problems.
Yoga has been proposed as a somatic, bottom-up intervention that allows the individual to
regulate from the lowest level of the brain to higher levels of the brain by working with
the body and mindful experience in the present moment. Existing investigation of yoga as a
psychotherapeutic intervention is preliminary, but promising. van der Kolk and colleagues
conducted a preliminary randomized controlled study and found that over 50% of individuals
who participated in the yoga group no longer met criteria for Posttraumatic Stress Disorder
following the group. Carmody and Baer found that yoga-based interventions in
Mindfulness-Based Stress Reduction impacted the widest range of symptoms (compared to body
scans and seated meditation). No quantitative investigations of trauma-related yoga
treatment for adolescents have been conducted, other than one dissertation with juvenile sex
offenders. Existing yoga psychotherapy research on youth who have experienced trauma has
been qualitative in nature with case studies and limited samples.
Additional study of yoga as an intervention for traumatized adolescents is needed both
quantitatively and qualitatively. One model of group yoga as adjunctive treatment for trauma
has been identified in the literature, but it has only been described anecdotally and with
limited qualitative data. Thus, the aim of the current study is to use the model created for
the Healing Childhood Sexual Abuse with Yoga curriculum with a wider sample of adolescents
across types of trauma (emotional, physical, & sexual abuse & neglect) in the United States
and Canada to generalize the curriculum and generate qualitative and quantitative data
regarding its effectiveness and the perceived mechanisms that contribute to success.
Additional qualitative research would be beneficial to describe the themes and cases across
a full sample of participants in such a group. Current research has been observational, case
studies, or limited qualitative questionnaires at the end of the group, but this study
proposes to collect qualitative data at each group yoga session regarding the experience. In
addition, follow-up interviews are also proposed to ask more detailed questions about the
participants' experiences.
Participants will be referred from within the agencies providing the groups, and therapists
will complete an internal referral form providing minimal demographic data with the
referral. Participants will be contacted by the respective group leaders at the phone
numbers listed on the referrals forms. Prior to the beginning of the initial group, the
group leaders will meet with prospective clients to interview them for appropriateness for
the group, obtain informed consent and assent, and allow them to complete the pretest
measures. In addition to obtaining informed consent for the research process, the group
leader will explain the physical nature of the yoga group, and the group leader will obtain
waivers from parents for the youth to participate in the physical activity involved in the
group. Copies of consent and assent forms will be provided to participants and parents.
During each group, participants will complete the Yoga Experience Form at each session.
Posttests will be completed at the end of the sixth group meeting. They will include all the
pretest questionnaires, as well as the Therapeutic Factors Inventory- Cohesiveness Scale and
the Working Alliance Inventory-Short Form- Bond Scale. After the final group, pretest,
within, and posttest data will be coded and analyzed to determine the questions to be
utilized for the follow-up interviews. Two participants from each group at McMaster
Children's Hospital will be asked to complete a follow-up interview with the investigator
that will be approximately 30 minutes in length. Participants will be selected with well
defined symptom improvement and poor response to the intervention. The follow-up interviews
will be audio recorded. Willingness to be audio recorded is necessary for participation in
the follow-up interviews, but not for participation in the larger group. The time commitment
for the treatment group is 540 minutes. This study does not involve additional
post-treatment follow-up, aside from clients who volunteer to participate in the follow-up
interviews.
of literature, and a desire to capture the fullest picture possible regarding the
participants' response to the intervention. The purpose of this mixed methods study is to
generate quantitative data that demonstrates a decrease in trauma and general mental health
symptoms following a yoga psychotherapy intervention for trauma, and to collect qualitative
data during the group process and following the group that provides a picture of the
mechanisms that allow the intervention to be effective. Broad Hypotheses: Quantitatively,
there will be significant differences in total number of mental health symptoms and
trauma-related symptoms experienced from pretest to posttest. Qualitative data will
demonstrate the benefits from the yoga postures and experiences of relaxing breath work the
youth experienced during the yoga group.
Trauma is a prevalent experience in our society, with between 50-76% of individuals
experiencing a traumatic event with the potential to cause Posttraumatic Stress Disorder.
The current standard of care in trauma treatment largely involves cognitive interventions,
but neuroscience evidence demonstrates reasons for their limited effectiveness and a need to
help traumatized individuals regulate the brain from the lowest levels up. Neuroscience
research indicates the brains of individuals who have experienced trauma are less able to
use cognitive centers to suppress emotional fear responses, and language centers in the
brain experience deactivation during traumatic events. Indeed, 33% of individuals who
develop PTSD fail to recover fully, which leads to ongoing mental health difficulties,
impaired interpersonal relationships, substance abuse, physical health problems, and sexual
problems.
Yoga has been proposed as a somatic, bottom-up intervention that allows the individual to
regulate from the lowest level of the brain to higher levels of the brain by working with
the body and mindful experience in the present moment. Existing investigation of yoga as a
psychotherapeutic intervention is preliminary, but promising. van der Kolk and colleagues
conducted a preliminary randomized controlled study and found that over 50% of individuals
who participated in the yoga group no longer met criteria for Posttraumatic Stress Disorder
following the group. Carmody and Baer found that yoga-based interventions in
Mindfulness-Based Stress Reduction impacted the widest range of symptoms (compared to body
scans and seated meditation). No quantitative investigations of trauma-related yoga
treatment for adolescents have been conducted, other than one dissertation with juvenile sex
offenders. Existing yoga psychotherapy research on youth who have experienced trauma has
been qualitative in nature with case studies and limited samples.
Additional study of yoga as an intervention for traumatized adolescents is needed both
quantitatively and qualitatively. One model of group yoga as adjunctive treatment for trauma
has been identified in the literature, but it has only been described anecdotally and with
limited qualitative data. Thus, the aim of the current study is to use the model created for
the Healing Childhood Sexual Abuse with Yoga curriculum with a wider sample of adolescents
across types of trauma (emotional, physical, & sexual abuse & neglect) in the United States
and Canada to generalize the curriculum and generate qualitative and quantitative data
regarding its effectiveness and the perceived mechanisms that contribute to success.
Additional qualitative research would be beneficial to describe the themes and cases across
a full sample of participants in such a group. Current research has been observational, case
studies, or limited qualitative questionnaires at the end of the group, but this study
proposes to collect qualitative data at each group yoga session regarding the experience. In
addition, follow-up interviews are also proposed to ask more detailed questions about the
participants' experiences.
Participants will be referred from within the agencies providing the groups, and therapists
will complete an internal referral form providing minimal demographic data with the
referral. Participants will be contacted by the respective group leaders at the phone
numbers listed on the referrals forms. Prior to the beginning of the initial group, the
group leaders will meet with prospective clients to interview them for appropriateness for
the group, obtain informed consent and assent, and allow them to complete the pretest
measures. In addition to obtaining informed consent for the research process, the group
leader will explain the physical nature of the yoga group, and the group leader will obtain
waivers from parents for the youth to participate in the physical activity involved in the
group. Copies of consent and assent forms will be provided to participants and parents.
During each group, participants will complete the Yoga Experience Form at each session.
Posttests will be completed at the end of the sixth group meeting. They will include all the
pretest questionnaires, as well as the Therapeutic Factors Inventory- Cohesiveness Scale and
the Working Alliance Inventory-Short Form- Bond Scale. After the final group, pretest,
within, and posttest data will be coded and analyzed to determine the questions to be
utilized for the follow-up interviews. Two participants from each group at McMaster
Children's Hospital will be asked to complete a follow-up interview with the investigator
that will be approximately 30 minutes in length. Participants will be selected with well
defined symptom improvement and poor response to the intervention. The follow-up interviews
will be audio recorded. Willingness to be audio recorded is necessary for participation in
the follow-up interviews, but not for participation in the larger group. The time commitment
for the treatment group is 540 minutes. This study does not involve additional
post-treatment follow-up, aside from clients who volunteer to participate in the follow-up
interviews.
Inclusion Criteria:
- Adolescents between the ages of 11 and 18
- Current participation in outpatient treatment at the Denver Children's Advocacy
Center or McMaster Children's Hospital (Regional and Outpatient Services).
- History of complex trauma with clinical or subclinical PTSD symptoms
Exclusion Criteria:
- Non-English-speaking individuals.
- Currently suicidal, homicidal, or psychotic
- Significant substance use (daily or greater use of marijuana or weekly or greater use
of other non-prescription/illegal drugs)
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