Mind-body exercise interventions for prevention of post-traumatic stress disorder in trauma-exposed populations: a systematic review and meta-analysis

Abstract

ObjectiveMind-body exercise (MBE) interventions, such as yoga, are increasingly recognised as an adjunct treatment for trauma-related mental disorders but less is known about their efficacy as a preventative intervention. We aimed to systematically review if, and what type of, MBE interventions are effective at preventing the development of post-traumatic stress disorder (PTSD) or acute stress disorder (ASD) in trauma-exposed populations.DesignSystematic review and meta-analysis.MethodsA systematic search of MEDLINE, PsycINFO, EMBASE and CENTRAL databases was conducted to identify controlled trials of MBE interventions aimed at preventing the development of PTSD or ASD in high-risk populations. Risk of bias was assessed using the revised Cochrane risk-of-bias and ROBINS-I tools. Pooled effect sizes using Hedges’gand 95% CIs were calculated using random effects modelling for the main meta-analysis and planned subgroup and sensitivity analyses.ResultsSix studies (N analysed=399) were included in the final meta-analysis. Overall, there was a small effect for MBE interventions in preventing the development of PTSD (g=−0.25, 95% CI −0.56 to 0.06) among those with previous or ongoing exposure to trauma. Although a prespecified subgroup analyses comparing the different types of MBE intervention were conducted, meaningful conclusions could not be drawn due to the small number of studies. None of the included studies assessed ASD symptoms.ConclusionLimited evidence was found for MBE interventions in reducing PTSD symptomology in the short term. Findings must be interpreted with caution due to the small number of studies and possible publication bias.PROSPERO registration numberCRD42020180375

Yoga resilience training to prevent the development of posttraumatic stress disorder in active-duty first responders: A cluster randomized controlled trial.

“…Our findings support previous trials on MBE interventions for trauma-exposed populations on posttraumatic stress symptoms (Kelly & Garland, 2016; Saban et al, 2022) and the small effect size at postintervention is consistent with a previous review on MBE for preventing the development of PTSD (Tan et al, 2023). While we did not find any differential effects on individuals with full PTSD, our significant findings for individuals with subthreshold PTSD have important implications around early interventions and possible selective prevention of PTSD (Fink et al, 2018).…”

“…Moderate effects have been found for yoga and meditation in improving PTSD symptoms among Veterans (Gallegos et al, 2017), another high-risk cohort with similar occupational characteristics to first responders. Furthermore, a meta-analysis found potential evidence for MBE interventions in preventing the development of PTSD in the short term (Tan et al, 2023). Despite these promising findings, evidence on MBE interventions is limited by the small number of high-quality studies (Cramer et al, 2018; Gallegos et al, 2017; Tan et al, 2023).…”

“…Furthermore, a meta-analysis found potential evidence for MBE interventions in preventing the development of PTSD in the short term (Tan et al, 2023). Despite these promising findings, evidence on MBE interventions is limited by the small number of high-quality studies (Cramer et al, 2018; Gallegos et al, 2017; Tan et al, 2023). Nonetheless, current guidelines consider these interventions a potential priority candidate for further research on the prevention and treatment of PTSD (Bisson et al, 2019).…”

A clinician's guide to the 2023 VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder

“…Existing interventions, such as psychological first aid (Brymer et al, 2006), could not be evaluated for inclusion because no randomized controlled trials of these approaches were identified in the review for the CPG; however, other researchers have concluded that the evidence that this approach is effective in preventing PTSD is weak (Hermosilla et al, 2023). In the interim, clinicians should strive to address basic needs (e.g., shelter, food), identify individuals at high risk of adverse outcomes, and support wellness (e.g., community support, exercise; Magruder et al, 2017;Tan et al, 2023). Module A (p. 26) of the clinical algorithm outlines strategies for identifying and managing ASR and ASD.…”