Yoga and Physical Activity for Veterans

Posttraumatic stress disorder (PTSD) is a chronic, debilitating condition with a broad
negative impact on physical and mental health functioning. Excellent, empirically-supported
interventions for PTSD are readily available to Veterans, but the majority of patients who
receive the best available treatments continue to have a diagnosable disorder after
treatment. This suggests that complementary interventions may be useful to fully restore
functioning. In addition, many patients seek alternatives to psychotherapy or
pharmacotherapy. This is evident in the increasing numbers of individuals with PTSD are
turning to alternative approaches. At present, however, the investigators lack a good
evidence base from which to make recommendations about the use of complementary and
alternative approaches.

Yoga is very popular practice, touted to enhance physical, mental and spiritual well-being.
Many Veterans with PTSD have turned to yoga as a part of their recovery plan, often seeking
care outside the specialty mental health system. Initial evidence suggests that the practice
leads to clinically significant change in symptoms, but results are yet inconclusive,
particularly in Veterans. Thus, this project will provide additional data as to efficacy of
yoga for Veterans PTSD.

One reason that the yoga literature is yet inconclusive may be the tremendous heterogeneity
in the way in which the yoga is implemented. By understanding the mechanisms by which yoga
affects PTSD symptoms, universal change processes can be identified. This project, therefore,
will examine a set of candidate processes, which are known important determinants of PTSD
symptomatology and potentially modifiable by yoga practice, in order to understand which are
contributing to symptom change. With 30 million Americans practicing yoga, dissemination of a
specific protocol would not be practicable. Nonetheless, guidelines for trauma-sensitive
yoga, which focus primarily on acceptability of the practice for traumatized individuals,
appear to be associated with better outcomes for those with PTSD. This work would facilitate
the extension of such guidelines to include practice features that maximize the impact of
yoga on PTSD symptoms.

The proposed study is a randomized controlled trial involving 192 Veterans with PTSD from the
San Diego area. These Veterans will be randomized to receive a manualized hatha yoga
intervention or a supportive physical activity control condition. Both interventions will be
delivered by trained instructors in a group setting over a 12-week period. Assessment of
clinical outcomes and methodological variables will take place before, during, immediately
after, and 3-months after the intervention. Analyses will focus on change in the intervention
groups over time and the degree to which change is associated with the candidate mechanisms.

Results of this study have the potential to inform the way in which yoga is delivered to
Veterans as well as to increase knowledge about the underlying processes by which PTSD can be
ameliorated. Given the high demand for yoga demand by individuals with PTSD and the degree to
which the practice is already being provided in many clinical settings, findings from this
study will be immediately relevant. Findings may also guide future research in complementary
and alternative approaches by demonstrating the principle of targeting different processes of
change to create an integrative care plan.

Inclusion Criteria:

- Veterans who have clinically meaningful PTSD symptoms

Exclusion Criteria:

- serious suicidality or homicidality that has required urgent or emergent evaluation or
treatment within the past three months

- a known, untreated substance abuse or dependence problem

- inclusion is possible if there is evidence that the individual has been afforded
and is complying with treatment for the substance problem

- serious mental disorders, such as psychotic disorders or bipolar type I, or serious
dissociative symptoms

- cognitive impairment that would interfere with treatment

- circumstances that lead to recurrent traumatization

- e.g., engaged in a violent relationship

- any medical condition for which exercise is contraindicated, including pregnancy

- concurrent enrollment in any other treatment specifically targeting PTSD symptoms or
in any meditative or mind-body intervention

- including yoga practice >1 class/month in the preceding 6 months