A pilot study of trauma-sensitive yoga and Breathe2Relax among service members in an intensive outpatient program.

Emerging research indicates that yoga is a promising adjunct to psychological trauma treatment. The current pilot study examined the associations between psychophysiological stress, diaphragmatic breathing (DB), and a trauma-sensitive yoga (TSY) regimen developed specifically for trauma-exposed service members in alignment with recent calls for precision in reporting therapeutic yoga protocols. Participants were 31 service members enrolled in a trauma-focused intensive outpatient program (IOP). Service members participated in a brief diaphragmatic breathing (DB) session using the Breathe2Relax (B2R) app followed by the TSY session. Heart rate (HR) and perceived stress were measured at baseline and after both the DB practice and the TSY session. We assessed Yoga and DB expectancies at baseline and post TSY. Participants also rated the acceptability and usability of the B2R app. Results of linear mixed effects regression models showed decreases in HR and perceived stress, compared to baseline, following DB (HR, b = -8.68, CI 95% = -13.34, -4.02; perceived stress, b = -1.77, CI 95% = -2.35, -1.18) and TSY (HR, b = -12.44, CI 95% = -17.15, -7.73; perceived stress b = -3.69, CI 95% = -4.29, -3.08). Higher levels of expectancies, compared to lower levels, related to stronger decreases in HR and perceived stress, particularly after TSY. Overall, participants rated the B2R usability as high; virtually all participants reported that "most would learn to use the app quickly," and 76.6% reported that they would use it frequently.

Trauma Center Trauma-Sensitive Yoga Versus Cognitive Processing Therapy for Women Veterans With PTSD Who Experienced Military Sexual Trauma: A Feasibility Study.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a common sequela to military sexual trauma (MST) among women veterans. Yoga has shown promise in research examining its benefit for symptoms and sequela of PTSD. AIMS: The objective of this study was to evaluate the feasibility of a randomized controlled trial (RCT) of Trauma Center Trauma-Sensitive Yoga (TCTSY) for women veterans with PTSD related to MST. METHOD: In this feasibility study, the final sample included women veterans (n = 41) with PTSD related to MST accessing health care in a Veterans Affairs Health Care System in the southeast United States; the majority were African American (n = 33; 80.5%). Interventions used established protocols of 10 weekly sessions of group TCTSY versus 12 weekly sessions of group Cognitive Processing Therapy (CPT). PTSD was assessed via clinical interview and participant report. Additional data collection included multiple participant-reported outcomes commonly associated with PTSD and psychophysiological measures. We also collected data regarding participant satisfaction and feasibility-related feedback from participants and providers. RESULTS: Feasibility and acceptability were evaluated via demand, practicality, fidelity, and acceptability. This was measured by expressed interest, attendance, program completion, barriers to care and satisfaction with treatment, and satisfaction with interventions and data collection. CONCLUSIONS: Results indicate the RCT design and TCTSY implementation were feasible; a full-scale RCT was subsequently conducted to determine efficacy of the experimental intervention. Recommendations for successful research strategies are provided.

Effects of One-to-One Trauma Center Trauma-Sensitive Yoga Sessions on Psychological Symptoms and Interoception over 6 Months.

Posttraumatic stress disorder (PTSD) is a serious health condition that adversely affects the mind and body. Current first-line treatment for PTSD tends to focus on the mind and overlook the impacts of trauma on the body. Trauma Center Trauma-Sensitive Yoga (TCTSY) is an evidence-based adjunctive therapy for complex trauma and PTSD that uses a body-based approach to trauma healing. Although designed to be used in group or individual contexts, previous studies have focused only on TCTSY facilitated in groups. The present study examined the effects of one-to-one TCTSY (i.e., one participant receiving TCTSY services, not in a group TCTSY context) on anxiety, depression, posttraumatic stress, interoception, substance use, and sleep over time. Using an observational approach, all certified TCTSY facilitators received the study invitation to share with clients who were enrolled in one-to-one TCTSY services. Ten clients participated in the study across four countries (women n = 8; mean age 44.80 ± 11.91; PTSD diagnosis n = 9). Clients completed Qualtrics surveys at TCTSY sessions in June-December 2022. Linear mixed-model analyses found that anxiety, depression, posttraumatic stress symptoms, attention regulation, self-regulation, and body listening significantly improved over time. There were no significant changes in sleep or substance use from pre- to post-study. TCTSY is a somatic approach for managing trauma symptoms and enhancing interoceptive awareness. Extensions of the present study are warranted to further understand the effects of one-to-one TCTSY for trauma care.

Findings from a pilot study of Trauma Center Trauma-Sensitive Yoga versus cognitive processing therapy for PTSD related to military sexual trauma among women Veterans.

OBJECTIVE: The study objective was to explore the preliminary efficacy of trauma-sensitive yoga compared to cognitive processing therapy (CPT) for women Veterans with posttraumatic stress disorder (PTSD) related to military sexual trauma (MST) in a pilot randomized control trial (RCT). We then compared these results to published interim results for the subsequent full-scale RCT. METHOD: The analytic sample included women Veterans (N = 41) with PTSD related to MST accessing healthcare in a southeastern Veterans Affairs Health Care System. The majority were African American, non-Hispanic (80.5 %). The protocol-driven group interventions, Trauma Center Trauma-Sensitive Yoga (TCTSY; n = 17) and the evidence-based control condition, CPT (n = 24), were delivered weekly for 10 and 12 sessions, respectively. Multilevel linear models (MLM) were used to compare changes over time between the two groups. RESULTS: The primary outcomes presented here are PTSD symptom severity and diagnosis, assessed using the Clinician Administered PTSD Scale (CAPS) and the PTSD Symptom Checklist (PCL) total scores. PTSD symptom severity on both clinician-administered (CAPS) and self-reported (PCL) measures, improved significantly (p < .005) over time, with large within group effect sizes (0.90-0.99) consistent with the subsequent RCT. Participants in the TCTSY group showed clinically meaningful improvements earlier than the CPT group participants from baseline on the CAPS and PCL Total scores. CONCLUSIONS: Results support published findings of the effectiveness of TCTSY in the treatment for PTSD related to MST among women Veterans, particularly African American women. TCTSY warrants consideration as an adjunctive, precursor, or concurrent treatment to evidence-based psychotherapies. Future research should include patient preference, men with sexual trauma, and civilian populations.

Tailoring Trauma-Sensitive Yoga for High-Risk Populations in Public-Sector Settings.

Low-income, racial-minority, high-risk populations have limited access to evidence-based treatments for posttraumatic stress disorder (PTSD), and their acceptance of complementary interventions is unknown. Trauma Center Trauma-Sensitive Yoga (TC-TSY), which has demonstrated efficacy in community samples, has not yet been widely used with ethnic minority low-income individuals. This article presents a culturally tailored version of a TC-TSY intervention delivered as a drop-in service in a public hospital-based clinic to patients with histories of interpersonal violence and suicide attempts. TC-TSY was iteratively tailored to meet the unique clinical needs of individuals within this setting. Group facilitator observations are summarized; they describe a successful initial implementation and culturally informed adaptation of the group intervention. The facilitators' observations illustrated that group members accepted the integration of this structured, gentle yoga practice into outpatient behavioral health programming and identified site-specific modifications to inform formal study. The process by which TC-TSY was adapted and implemented for Black individuals with a history of interpersonal trauma at risk for suicidal behavior can serve as a guide for tailoring other complementary, integrative interventions to meet the needs of unique clinical settings. This process is offered as a foundation for future systematic testing of this complementary, integrated, culturally adapted trauma therapy in high-risk clinical populations.

Trauma-Sensitive Yoga Interventions and Posttraumatic Stress and Depression Outcomes Among Women: A Systematic Review and Analysis of Randomized Control Trials.

Research shows that most people experience at least one traumatic event in their lifetimes, and between 6% and 8% of those with a history of trauma will develop posttraumatic stress disorder (PTSD) and/or related mental health conditions. Women face a greater threat of trauma exposure and have a higher risk of PTSD and depression than men. Trauma-Sensitive Yoga (TSY), a body-based adjunctive therapy, has shown potential in several studies as an effective method for reducing PTSD and depression symptoms. However, existing research and systematic reviews vary widely in their methodological rigor and comparison samples. Thus, in this systematic review we examined the effectiveness of TSY among women with a history of trauma and depression who had participated in randomized control trials with clear control and experimental groups. Findings in fixed- and mixed-effects meta-analysis models suggest marginally significant to no effects of TSY on PTSD and depression outcomes. Our systematic review highlights critical questions and significant gaps in the existing literature about the rationale and best practices of TSY intervention duration.

The experience of Trauma Center-Trauma Sensitive Yoga training on professional practice of mental health professionals and yoga instructors.

BACKGROUND AND PURPOSE: Traumatic psychological events are thought to alter brain physiology, notably regions such as the thalamus and the limbic system, affecting personal choice, autonomy, and behavior. Innovative therapies are needed to address the diverse, mental and physical consequences of these changes. Trauma Center-Trauma Sensitive Yoga (TC-TSY) has shown promising results in clinical trials among individuals experiencing posttraumatic symptomatology. MATERIALS AND METHODS: Using a qualitative, descriptive design, we examined the impact of TC-TSY training on the professional practice of seven practitioners who were certified yoga instructors and/or registered psychologists. RESULTS: The findings suggest TC-TSY training enriched their practices, chiefly through its choice-based, widely applicable approach; invitation- and mindfulness-based language; and building of therapeutic trust and attunement. Some participants questioned the accessibility and suitability of the training, as well as the rigidity of TC-TSY terminology. CONCLUSION: More research is needed to examine potential outcomes of TC-TSY practice related to self-efficacy, coping, quality of life, and stress reduction among traumatized individuals.

The Influence of Trauma-Informed Yoga (TIY) on Emotion Regulation and Skilled Awareness in Sexual Assault Survivors.

This study examined a Trauma-Informed Yoga (TIY) intervention created specifically for sexual assault survivors and delivered in a community-based group setting. Much of the existing research on this type of intervention has been conducted in clinical trials as opposed to community-based venues. As sexual assault is a common type of trauma and results more commonly in posttraumatic stress disorder (PTSD), the current study aimed to shed light on the potential benefits of a trauma-sensitive yoga and mindfulness intervention for survivors of sexual assault in the natural setting of a community-based organization. The intervention was developed and implemented by licensed mental health providers and registered yoga teachers and modeled on the evidence-based work of the Trauma Center at the Justice Research Institute. The study employed a traditional quantitative one-sample, pre- and posttest design. Survey items were drawn from two existing measures: (1) Five Facet Mindfulness Questionnaire and (2) Difficulties in Emotion Regulation Scale. The majority of the sample (n = 37) identified as White (67.6%), followed by Latina (13.5%), African American (8.1%), multiracial (5.4%), and other (2.7%). The mean age of participants was 29 years (standard deviation 8 years, range 18-56 years). All participants identified as female. Findings demonstrated statistically significant changes in participants' emotion regulation and skilled awareness, both of which have the potential to reduce PTSD symptomatology. The present discussion considers the results in light of previous research and presents study limitations.

Bending without breaking: A narrative review of trauma-sensitive yoga for women with PTSD.

OBJECTIVE: The purpose of this review is to evaluate the peer-reviewed empirical evidence on the use of Trauma-Sensitive Yoga (TSY) for the treatment of women with post-traumatic stress disorder (PTSD): specifically interpersonal trauma such as intimate partner violence. To date, no such review has been conducted. METHODS: Articles meeting study inclusionary criteria were identified through electronic database searches. A total of five studies (N = 5) were selected and reviewed. These studies included two randomized controlled trials (RCT), one follow-up of an RCT, one quasi-experimental study, and one qualitative study. RESULTS: There is tentative evidence to support the efficacy of TSY in reducing PTSD, depression, and anxiety symptomatology for women with PTSD; there is also tentative evidence confirming the feasibility of implementing TSY as an adjunctive mental health intervention, particularly for individuals who are non-responsive to cognitive-based psychotherapies. The qualitative findings speak to a number of benefits of yoga practice stimulated by TSY participation centering on the phenomenon of peaceful embodiment. CONCLUSIONS: Replication of these results using larger and more diverse samples and rigorous study designs by independent researchers would add credibility to these findings and contribute to the growing body of knowledge on TSY. Additionally, there is a dearth of studies on this nascent form of therapeutic yoga. Therefore, further research is needed to explore the potential efficacy of TSY with other types of trauma, populations, and settings.