Military-Tailored Yoga for Veterans with Post-traumatic Stress Disorder†

Abstract

Introduction: Among veterans of post-9/11 conflicts, estimates of post-traumatic stress disorder (PTSD) range from 9% shortly after returning from deployment to 31% a year after deployment. Clinical and pharmaceutically based treatments are underutilized. This could be due to concerns related to lost duty days, as well as PTSD patients’ fears of stigma of having a mental health condition. Yoga has been shown to reduce PTSD symptoms in the civilian population, but few studies have tested the impact of yoga on veterans of post-9/11 conflicts. The purpose of this study is to test the impact of yoga on post-9/11 veterans diagnosed with PTSD. Materials and Methods: Participants were 18 yr of age or older and veterans of post-9/11 conflicts. They had subthreshold or diagnostic-level PTSD related to their combat military service, as determined by a score of 30 or higher on the PTSD Checklist-Military version (PCL-M). Veterans participated in 60-min weekly yoga sessions for 6 wk taught by a Warriors at Ease-trained yoga instructor who is a, post-9/11 veteran. The yoga sessions incorporated Vinyasa-style yoga and a trauma-sensitive, military-culture informed approach advocated by two separate organizations: Warriors at Ease and Meghan’s Foundation. Data were collected at baseline and again after 7 wk. The primary outcome was PCL-M score. Participants also completed the Patient Health Questionnaire, the Beck Anxiety Inventory, the Pittsburgh Sleep Quality Index, and the Mindful Attention Awareness Scale at both time points. Results: Eighteen Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans completed the pre- and post-intervention self-report questionnaires. Age ranged from 26 to 62 yr (median = 43 yr), length of service ranged from 2 to 34 yr (median = 18.8 yr), and 13 (72.2%) had completed college. Decreased PTSD symptomatology was demonstrated in the three-symptom clusters represented in the PCL-M (i.e., hyperarousal, re-experiencing, and avoidance). In addition, the total score on the PCL-M decreased significantly, by both statistical and clinical measures. The participants also demonstrated improved mindfulness scores and reported decreased insomnia, depression, and anxiety symptoms. Conclusion: This study demonstrates that a trauma-sensitive yoga intervention may be effective for veterans with PTSD symptoms, whether as stand-alone or adjunctive therapy. The impressive decrease in PTSD symptomatology may be due to the tailored military-specific nature of this intervention and the fact that it was led by a veteran of post-9/11 conflicts. More research is needed with a larger sample and a more diverse veteran population.

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“…18 It may also be useful to offer yoga interventions taught by older veterans, such as in Veteranto-Veteran programs, and veteran-specific resources available through VHA Whole Health program. 24,26,27 Researchers should consider interventions that address investigator reluctance to include older adults in clinical trials, including comorbidities, ageism, and practical barriers. 39 These considerations may be especially applicable now that research on the efficacy of yoga has matured and effectiveness studies are now needed.…”

“…[21][22][23] Yoga has been increasingly studied within the Veterans Health Administration (VHA) for treatment of posttraumatic stress disorder (PTSD) and has been found effective in reducing symptoms through the use of traumainformed and military-relevant instruction as well as a military veteran yoga teacher. [24][25][26] This work has not targeted older veterans or cancer survivors who may be more difficult to recruit into such programs, but who would nevertheless benefit.…”

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“…One study reported that yoga intervention effectively suppressed PTSD symptoms in OEF, OIF, and OND veterans. 84…”

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“…These can include clinical treatments such as deep brain stimulation [ 25 ], noninvasive brain stimulation via repetitive transcranial magnetic stimulation, transcranial direct current stimulation [ 26 ], and neurofeedback [ 27 ]. Emerging therapies may also include cognitive-based conjoint therapy for PTSD [ 28 ], animal-assisted therapy [ 29 ], and yoga or mindfulness-based therapies [ 30 ]. In addition, given the high rates of comorbidities in individuals with PTSD, many approaches have incorporated the treatment of comorbidities to create new combination or adjunctive therapies for the treatment of PTSD [ 31 ].…”