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

Zaccari, Belle; Sherman, Athena D F; Febres‐Cordero, Sarah; Higgins, Melinda; Kelly, Ursula A.

doi:10.1016/j.ctim.2022.102850

Cited by 7 publications

(10 citation statements)

References 53 publications

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“…Studies have shown that yoga can increase psychological resilience in older adults [ 49 – 51 ], in trauma healing [ 52 , 53 •] for women’s health [ 54 ] and Veterans [ 55 , 56 ], and in individuals with opioid use disorder [ 57 ]. For example, Trauma Center Trauma-Sensitive Yoga (TCTSY) has shown to be a viable posttraumatic stress disorder (PTSD) treatment option with earlier symptom improvement, higher retention, and sustained effect over cognitively based psychotherapy (CPT) in Women Veterans with PTSD related to military sexual trauma (MST) [ 58 ].…”

Section: Asynchronous Technologies In Clinical Carementioning

confidence: 99%

Asynchronous Technologies in Mental Health Care and Education

Lagera

Chan

Yellowlees

2023

Curr Treat Options Psych

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Purpose of review Patients, providers, and trainees should understand the current types of asynchronous technologies that can be used to enhance the delivery and accessibility of mental health care. Asynchronous telepsychiatry (ATP) removes the need for real time communication between the clinician and patient, which improves efficiency and enables quality specialty care. ATP can be applied as distinct consultative and supervisory models in clinician-to-clinician , clinician-to-patient , and patient-to-mobile health settings. Recent findings This review is based on research literature and the authors’ clinical and medical training, using experiences with asynchronous telepsychiatry from before, during, and after the COVID-19 pandemic. Our studies demonstrate that ATP provides positive outcomes in the clinician-to-patient model with demonstrated feasibility, outcomes and patient satisfaction. One author’s medical education experience in the Philippines during COVID-19 highlights the potential to utilize asynchronous technology in areas with limitations to online learning. We emphasize the need to teach media skills literacy around mental health to students, coaches, therapists, and clinicians when advocating for mental well-being. Several studies have demonstrated the feasibility of incorporating asynchronous e-tools such as self-guided multimedia and artificial intelligence for data collection at the clinician-to-clinician and patient-to-mobile health level. In addition, we offer fresh perspectives on recent trends in asynchronous telehealth in wellness, applying concepts such as “tele-exercise” and “tele-yoga.” Summary Asynchronous technologies continue to be integrated into mental health care services and research. Future research must ensure that the design and the usability of this technology puts the patient and provider first.

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Section: Asynchronous Technologies In Clinical Carementioning

confidence: 99%

Asynchronous Technologies in Mental Health Care and Education

Lagera

Chan

Yellowlees

2023

Curr Treat Options Psych

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“…(2019), and Zaccari et al. (2022) had a significant baseline imbalance, which might reflect a problem with the randomization process. Risk of bias resulting from deviations in the intended interventions was deemed low in three studies (Kahn et al., 2016; Thorp et al., 2019; Vera et al., 2022), we noted some concerns in 18 studies and categorized eight studies as high risk.…”

Section: Resultsmentioning

confidence: 99%

“…Risk of bias resulting from deviations in the intended interventions was deemed low in three studies (Kahn et al, 2016;Thorp et al, 2019;Vera et al, 2022), we noted some concerns in 18 studies and categorized eight studies as high risk. Risk of bias resulting from missing outcome data was rated low for all studies except Brom et al (2017), Kelly et al (2021), Reinhardt et al (2018), and Zaccari et al (2022); these studies had an imbalance in dropout rates between intervention groups. All studies except the study by Descilo et al (2009) had blinded outcome assessors or outcomes based on self-report, which are considered unlikely to be influenced by knowledge of the intervention.…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

“…In 11 studies, the presented data were in accordance with a prespecified analysis plan, and we had no reason to assume they were selectively reported (Hall et al, 2020;Kahn et al, 2016;Kelly et al, 2021;Lang et al, 2019;Nakamura et al, 2017;Nordbrandt et al, 2020;Reinhardt et al, 2018;Rosenbaum et al, 2015;Thorp et al, 2019;van der Kolk et al, 2014). The studies by Gibert et al (2022), Vera et al (2022), and Zaccari et al (2022) reported different secondary outcome measures than what was listed in the preregistered protocol. For the other studies, we did not find a prespecified analysis plan, leading to a categorization of "some concerns," but we had no reason to assume selective reporting.…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

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Body‐and movement‐oriented interventions for posttraumatic stress disorder: An updated systematic review and meta‐analysis

van de Kamp,

Scheffers,

Emck

et al. 2023

Journal of Traumatic Stress

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This study is an update of the meta‐analysis we published in 2019 on the effectiveness of body‐ and movement‐oriented interventions (BMOIs) for adults with posttraumatic stress disorder (PTSD) in decreasing PTSD symptoms and secondary outcomes of depressive symptoms, sleep disturbance, and interoceptive awareness. Search terms for BMOIs and PTSD were combined to identify eligible studies in four bibliographical databases. Articles were selected if they included adult participants with a primary diagnosis of PTSD, included BMOI as one of the investigated therapies, were designed as a comparative outcome trial with any control condition, and involved a standardized outcome measure for PTSD symptom severity. This resulted in the addition of 14 new studies compared to the 2019 study. The meta‐analysis, which included 29 studies in total, resulted in a mean Hedges’ g effect size of 0.50, 95% CI [0.22, 0.79], in decreasing PTSD symptoms, with very high heterogeneity, I2 = 89%. Meta‐analyses of secondary outcomes resulted in Hedges’ g effect sizes of 0.37, 95% CI [0.08, 0.66] for depressive symptoms; 0.62, 95% CI [0.42, 0.81] for sleep quality; and −0.10, 95% CI [−0.23, 0.43] for interoceptive awareness. The risk of bias analysis resulted in some concerns or high risk of bias in almost all included studies; only one study had a low risk of bias. We conclude that BMOIs may be valuable for patients with PTSD. There is, however, still a lack of high‐quality studies with proper control conditions and long‐term follow‐up periods from which to draw conclusions.

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“…17 Evidence of the effectiveness of yoga to treat PTSD is growing. [18][19][20][21][22] In this multisite, randomized clinical trial (RCT), we examined the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY), a Hatha-style yoga intervention designed for women who experienced childhood sexual trauma. In contrast to cognitively based EBTs, TCTSY is a body-based intervention that focuses on reducing stress reactions of the body by cultivating interoception.…”

Section: Introductionmentioning

confidence: 99%

Yoga vs Cognitive Processing Therapy for Military Sexual Trauma–Related Posttraumatic Stress Disorder

Zaccari,

Higgins,

Haywood

et al. 2023

JAMA Netw Open

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ImportanceFirst-line treatment for posttraumatic stress disorder (PTSD) in the US Department of Veterans Affairs (VA), ie, trauma-focused therapy, while effective, is limited by low treatment initiation, high dropout, and high treatment refraction.ObjectiveTo evaluate the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY) vs first-line cognitive processing therapy (CPT) in women veterans with PTSD related to military sexual trauma (MST) and the hypothesis that PTSD outcomes would differ between the interventions.Design, Setting, and ParticipantsThis multisite randomized clinical trial was conducted from December 1, 2015, to April 30, 2022, within 2 VA health care systems located in the southeast and northwest. Women veterans aged 22 to 71 years with MST-related PTSD were enrolled and randomized to TCTSY or CPT.InterventionsThe TCTSY intervention (Hatha-style yoga focusing on interoception and empowerment) consisted of 10 weekly, 60-minute group sessions, and the CPT intervention (cognitive-based therapy targeting modification of negative posttraumatic thoughts) consisted of 12 weekly, 90-minute group sessions.Main Outcome and MeasuresSociodemographic data were collected via self-report survey. The primary outcome, PTSD symptom severity, was assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Checklist for DSM-5 (PCL-5). Assessments were conducted at baseline, midintervention, 2 weeks post intervention, and 3 months post intervention.ResultsOf 200 women veterans who consented to participate, the intent-to-treat sample comprised 131 participants (mean [SD] age, 48.2 [11.2] years), with 72 randomized to TCTSY and 59 randomized to CPT. Treatment was completed by 47 participants (65.3%) in the TCTSY group and 27 (45.8%) in the CPT group, a 42.6% higher treatment completion rate in the TCTSY group (P = .03). Both treatment groups improved over time on the CAPS-5 (mean [SD] scores at baseline: 36.73 [8.79] for TCTSY and 35.52 [7.49] for CPT; mean [SD] scores at 3 months: 24.03 [11.55] for TCTSY and 22.15 [13.56]) and the PCL-5 (mean [SD] scores at baseline: 49.62 [12.19] for TCTSY and 48.69 [13.62] for CPT; mean [SD] scores at 3 months: 36.97 [17.74] for TCTSY and 31.76 [12.47]) (P &lt; .001 for time effects). None of the group effects or group-by-time effects were significant. Equivalence analyses of change scores were not significantly different between the TCTSY and CPT groups, and the two one-sided test intervals fell within the equivalence bounds of plus or minus 10 for CAPS-5 for all follow-up time points.Conclusions and RelevanceIn this comparative effectiveness randomized clinical trial, TCTSY was equivalent to CPT in reducing PTSD symptom severity, with both groups improving significantly. The higher treatment completion rate for TCTSY indicates its higher acceptability as an effective and acceptable PTSD treatment for women veterans with PTSD related to MST that could address current VA PTSD treatment limitations.Trial RegistrationClinicalTrials.gov Identifier: NCT02640690

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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

Cited by 7 publications

References 53 publications

Asynchronous Technologies in Mental Health Care and Education

Asynchronous Technologies in Mental Health Care and Education

Body‐and movement‐oriented interventions for posttraumatic stress disorder: An updated systematic review and meta‐analysis

Yoga vs Cognitive Processing Therapy for Military Sexual Trauma–Related Posttraumatic Stress Disorder

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