Trauma-Sensitive Yoga as a Therapy: Is there an Evidence-Base?

When looking at treatment options of PTSD and complex trauma its important to look for those that have an evidence-base. This means that practice has been rigorously tested experimentally. Following this, experts in the field critique and evaluate the work and give it a tick of approval before it is published for use in the wider scientific and public sphere.

So is trauma-informed yoga evidence based? Yes, there are a number of research articles that show that trauma-sensitive yoga has an evidence-base. Below is an overview of one of these that was published in 2021.

Researchers in Atlanta compared Trauma Center Trauma Sensitive Yoga (TC-TSY) to cognitive processing therapy (CPT) for treatment of post traumatic stress disorder (PTSD). The 104 participants involved were women veterans aged between 22-71 who had PTSD associated with military sexual trauma.

This study is the first to compare TCTSY therapy to one of the most beneficial first-line treatments for PTSD.

The results showed that trauma-sensitive yoga is just as effective at reducing symptoms of PTSD as CPT. However, midpoint through the study there was a greater reduction in PTSD symptoms in the trauma-sensitive yoga group, and a larger proportion of people finished the trauma-sensitive yoga treatment program.

It is important to mention, this study concerns TCTSY- this is a specific form of trauma-sensitive yoga. Researchers, psychologists, and yoga teachers at the Trauma Center (located within the Justice Resource Institute in Brookline, Massachusetts) spent years designing and experimentally validating their methodology. There are other forms of trauma-sensitive yoga, and I am not saying that they are not successful, but they often used different methods.

Typically, when a US veteran seeks treatment for military associated PTSD the current first-line treatments used by the Veterans Health Administration (VHA) are trauma focused psychotherapies- 1) prolonged exposure and 2) cognitive processing therapy.

However, the drop-out rates for treatment using these psychotherapies are high, between 60-90% reported in both military and civilian populations. Furthermore, more than half of people that complete the treatment continue to meet criteria for PTSD.

Why are the drop-out rates so high for psychotherapies? It can be difficult to talk about a trauma history and its effects or tolerate prolonged exposure to trauma triggers. In addition, symptom severity often gets worse before it gets better with these treatment modalities.

Because of the drop-out rates and the persistence in PTSD symptoms, a large number of people seeking treatment for PTSD do not receive effective therapy. Currently, there is need for other therapeutic options. This study shows that trauma-sensitive yoga is a viable alternative.

The 58 participants in the trauma-sensitive yoga group received 10 weekly 60-min group sessions. Trauma-sensitive yoga focuses on interoception- the sense of the physical condition of the body, and includes themes such as choice making, being in the present moment, and taking effective action.

The 46 participants in the CPT control group received 12 weekly 90-min group sessions. These sessions focused on identifying how thoughts change because of trauma exposure, and ways to evaluate maladaptive thoughts and create alternative thoughts.

PTSD symptom severity was measured at 4 timepoints using CAPS-5 and PCL-5 PTSD scales:

1. Baseline- before the intervention

2. Mid-treatment

3. 2-weeks post treatment

4. 3-months post treatment

At 2 weeks into the intervention the trauma-sensitive yoga group showed a greater reduction on the re-experiencing sub-cluster of PTSD symptoms. PTSD is currently divided into 4 clusters of symptoms. Re-experiencing includes intrusive memories, flashbacks, intrusive distressing thoughts, and distressing dreams. A faster symptom reduction within re-experiencing makes a lot of sense when considering that trauma-sensitive yoga does not require reprocessing of trauma-history.

But, importantly, over time both treatments reduced PTSD symptoms significantly and equally (i.e., reduction in total and across symptom sub-clusters on the CAPS-5 and PCL-5). In addition, both groups had equal reduction in PTSD diagnoses 3 months after treatment with less than 20% of people in each still reaching criteria. These results show that over the long-term both treatments are as effective as each other.

However, the retention rate across the treatment programs was significantly different. The trauma-sensitive yoga group stabilised at around 60% attendance after the second treatment. While the CPT group stabilised at around 40% mid-way through treatment. This means a larger proportion of people finished the trauma-sensitive yoga treatment program.

Overall, this study shows that TCTSY is just as effective as treating PTSD as CPT. However, because the drop-out rates are lower for TCTSY therapy a larger proportion of people found benefit.

This is an interim study, there is more data to collect from other sites. So, we will likely hear more as the data comes in. For example, they mentioned that they are collecting immunological data- assessing immune functioning. I'm really interested to see what they find. Additionally, this study concentrated on a very specific population- women veterans who had experienced military sexual trauma. Future research is required to determine whether the results hold for other forms of trauma and populations.

This really is a landmark finding. Historically, it was suggested that trauma-sensitive yoga should be an adjunctive treatment or complementary therapy- something that should be done along side psychotherapy. But as research concerning trauma-sensitive yoga continues, studies like this demonstrate that it is a viable treatment option in its own right.

Overall, it is great to see research demonstrating other effective treatment options for PTSD. I think its important that individuals have a choice when choosing their therapeutic strategy so they can find a treatment modality that works for them. So when looking for evidence-based treatments for trauma. You might consider trauma-sensitive yoga as an option.

If you would like to explore trauma-sensitive yoga for your clients or in your treatment plan, please feel free to get in touch.

About the author:

Dr Kathie Overeem (PhD Psychology) runs group and private TCTSY sessions. She has worked with adults and youth that have experienced stress, anxiety, complex trauma, developmental trauma, PTSD, eating disorders, complex mental illness, and individuals in alcohol and other drug rehabilitation. She also works with Queensland Health and a number of community support organisations in Brisbane.

To book a private trauma-sensitive yoga session with Kathie please use the contact tab above, if you are interested in group classes please follow this link.

Reference:

Kelly, U., Haywood, T., Segal, E., Higgans, M. (2021) Trauma-Sensitive Yoga for Post-Traumatic Stress Disorder in Women Veterans who Experienced Military Sexual Trauma: Interim Results from a Randamized Control Study. The Journal of Alternative and Complementary Medicine, 27, pp. S45-S59