Yoga for posttraumatic stress disorder - a systematic review and meta-analysis

Holger Cramer, Dennis Anheyer, Felix J Saha, Gustav Dobos, Holger Cramer, Dennis Anheyer, Felix J Saha, Gustav Dobos

Abstract

Background: Yoga is increasingly used as a therapeutic treatment and seems to improve psychiatric conditions such as anxiety disorders and depression. The aim of this systematic review was to assess the evidence of yoga for reducing symptoms of posttraumatic stress disorder (PTSD).

Methods: The Cochrane Library, Medline/PubMed, PsycINFO, Scopus, and IndMED were searched through July 2017 for randomized controlled trials (RCTs) assessing the effects of yoga on symptoms of PTSD. Mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CI) were computed. The quality of evidence and the strength of recommendation were graded according to the GRADE recommendations.

Results: Seven RCTs (N = 284) were included. Meta-analysis revealed low quality evidence for clinically relevant effects of yoga on PTSD symptoms compared to no treatment (SMD = - 1.10, 95% CI [- 1.72, - 0.47], p < .001, I2 = 72%; MD = - 13.11, 95% CI [- 17.95, - 8.27]); and very low evidence for comparable effects of yoga and attention control interventions (SMD = - 0.31, 95%CI = [- 0.84, 0.22], p = .25; I2 = 43%). Very low evidence was found for comparable retention of patients in the trial for yoga and no treatment (OR = 0.68, 95%CI [0.06, 7.72]) or attention control interventions (OR = 0.66, 95%CI [0.10, 4.46]). No serious adverse events were reported.

Limitations: Few RCTs with only limited sample size were available.

Conclusions: Only a weak recommendation for yoga as an adjunctive intervention for PTSD can be made. More high quality research is needed to confirm or disconfirm these findings.

Keywords: Meta-analysis; PTSD; Posttraumatic stress disorder; Yoga.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Risk of bias assessment for each included study. +, low risk of bias; −, high risk of bias; ?, unclear risk of bias
Fig. 3
Fig. 3
Effects of yoga versus no treatment or attention control interventions on PTSD symptoms. CI, confidence interval; IV, inverse variance; SD; standard deviation
Fig. 4
Fig. 4
Retention of patients in the trial for yoga versus no treatment or attention control interventions. CI, confidence interval; IV, inverse variance; SD; standard deviation

References

    1. Kessler RC, Ustun TB. The WHO world mental health surveys: global perspectives on the epidemiology of mental disorders. New York: Cambridge University Press; 2008.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders, 5 edn. Washington, DC: American Psychiatric Association; 2013.
    1. NICE. Post-traumatic stress disorder: management []. Accessed 20 Aug 2017.
    1. Hoskins M, Pearce J, Bethell A, Dankova L, Barbui C, Tol WA, van Ommeren M, de Jong J, Seedat S, Chen H, et al. Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis. Br J Psychiatry. 2015;206(2):93–100. doi: 10.1192/bjp.bp.114.148551.
    1. Cipriani A, Williams T, Nikolakopoulou A, Salanti G, Chaimani A, Ipser J, Cowen PJ, Geddes JR, Stein DJ. Comparative efficacy and acceptability of pharmacological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychol Med. 2017:1–10.
    1. Lee DJ, Schnitzlein CW, Wolf JP, Vythilingam M, Rasmusson AM, Hoge CW. Psychotherapy versus pharmacotherapy for posttraumatic stress disorder: systematic review and meta-analysis to dtermine first-line treatment. Depress Anxiety. 2016;33(9):792–806. doi: 10.1002/da.22511.
    1. Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev. 2013;12:CD003388.
    1. Wynn GH. Complementary and alternative medicine approaches in the treatment of PTSD. Curr Psychiatry Rep. 2015;17(8):600. doi: 10.1007/s11920-015-0600-2.
    1. Kim SH, Schneider SM, Kravitz L, Mermier C, Burge MR. Mind-body practices for posttraumatic stress disorder. J Investig Med. 2013;61(5):827–834. doi: 10.2310/JIM.0b013e3182906862.
    1. Iyengar BKS. Light on yoga. New York: Schocken Books; 1966.
    1. Bussing A, Ostermann T, Ludtke R, Michalsen A. Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. J Pain. 2012;13(1):1–9. doi: 10.1016/j.jpain.2011.10.001.
    1. Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos GJ. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev. 2017;1:CD010802.
    1. Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for depression: a systematic review and meta-analysis. Depress Anxiety. 2013;30(11):1068–1083. doi: 10.1002/da.22166.
    1. Cramer H, Anheyer D, Lauche R, Dobos G. A systematic review of yoga for major depressive disorder. J Affect Disord. 2017;213:70–77. doi: 10.1016/j.jad.2017.02.006.
    1. Sharma A, Barrett MS, Cucchiara AJ, Gooneratne NS, Thase ME. A breathing-based meditation intervention for patients with major depressive disorder following inadequate response to antidepressants: a randomized pilot study. J Clin Psychiatry. 2017;78(1):e59–e63. doi: 10.4088/JCP.16m10819.
    1. Kirkwood G, Rampes H, Tuffrey V, Richardson J, Pilkington K. Yoga for anxiety: a systematic review of the research evidence. Br J Sports Med. 2005;39(12):884–891. doi: 10.1136/bjsm.2005.018069.
    1. Doria S, de Vuono A, Sanlorenzo R, Irtelli F, Mencacci C. Anti-anxiety efficacy of Sudarshan Kriya yoga in general anxiety disorder: a multicomponent, yoga based, breath intervention program for patients suffering from generalized anxiety disorder with or without comorbidities. J Affect Disord. 2015;184:310–317. doi: 10.1016/j.jad.2015.06.011.
    1. Vancampfort D, Vansteelandt K, Scheewe T, Probst M, Knapen J, De Herdt A, De Hert M. Yoga in schizophrenia: a systematic review of randomised controlled trials. Acta Psychiatr Scand. 2012;126(1):12–20. doi: 10.1111/j.1600-0447.2012.01865.x.
    1. Broderick J, Knowles A, Chadwick J, Vancampfort D. Yoga versus standard care for schizophrenia. Cochrane Database Syst Rev. 2015;10:CD010554.
    1. Cramer H, Lauche R, Klose P, Langhorst J, Dobos G. Yoga for schizophrenia: a systematic review and meta-analysis. BMC Psychiatry. 2013;13:32. doi: 10.1186/1471-244X-13-32.
    1. Cramer H, Ward L, Steel A, Lauche R, Dobos G, Zhang Y. Prevalence, patterns, and predictors of yoga use: results of a U.S. nationally representative survey. Am J Prev Med. 2016;50(2):230–235. doi: 10.1016/j.amepre.2015.07.037.
    1. Rosenbaum S, Vancampfort D, Steel Z, Newby J, Ward PB, Stubbs B. Physical activity in the treatment of post-traumatic stress disorder: a systematic review and meta-analysis. Psychiatry Res. 2015;230(2):130–136. doi: 10.1016/j.psychres.2015.10.017.
    1. Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses. 2012;78(5):571–579. doi: 10.1016/j.mehy.2012.01.021.
    1. Cramer H. The efficacy and safety of yoga in managing hypertension. Exp Clin Endocrinol Diabetes. 2016;124(2):65–70.
    1. Brewin CR, Holmes EA. Psychological theories of posttraumatic stress disorder. Clin Psychol Rev. 2003;23(3):339–376. doi: 10.1016/S0272-7358(03)00033-3.
    1. Bishop SR, Lau M, Shapiro S, Carlson L, Anderson ND, Carmody J, Segal ZV, Abbey S, Speca M, Velting D, et al. Mindfulness: a proposed Oerational definition. Clin Psychology. 2004;11:230–241.
    1. Descilo T, Vedamurtachar A, Gerbarg PL, Nagaraja D, Gangadhar BN, Damodaran B, Adelson B, Braslow LH, Marcus S, Brown RP. Effects of a yoga breath intervention alone and in combination with an exposure therapy for post-traumatic stress disorder and depression in survivors of the 2004 South-East Asia tsunami. Acta Psychiatr Scand. 2010;121(4):289–300. doi: 10.1111/j.1600-0447.2009.01466.x.
    1. Emerson D, Hopper E, Levine PA, Cope S, van der Kolk B. Overcoming trauma through yoga: reclaiming your body. Berkeley: North Atlantic Books; 2011.
    1. Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry. 2005;162(2):214–227. doi: 10.1176/appi.ajp.162.2.214.
    1. Daubenmier JJ. The relationship of yoga, body awareness, and body responsiveness to self-objectification and disordered eating. Psychol Women Q. 2005;29:207–219. doi: 10.1111/j.1471-6402.2005.00183.x.
    1. Hitchcock C, Ellis AA, Williamson P, Nixon RD. The prospective role of cognitive appraisals and social support in predicting Children's posttraumatic stress. J Abnorm Child Psychol. 2015;43(8):1485–1492. doi: 10.1007/s10802-015-0034-7.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–341. doi: 10.1016/j.ijsu.2010.02.007.
    1. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. West Sussex: Wiley; 2008.
    1. Cramer H, Lauche R, Dobos G. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement Altern Med. 2014;14:328. doi: 10.1186/1472-6882-14-328.
    1. Cohen J. Statistical power analysis for the behavioral sciences. New York, London: Lawrence Erlbaum Associates; 1988.
    1. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, DeBeer H, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–394. doi: 10.1016/j.jclinepi.2010.04.026.
    1. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–406. doi: 10.1016/j.jclinepi.2010.07.015.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–560. doi: 10.1136/bmj.327.7414.557.
    1. Carter JJ, Gebarg PL, Brown RP, Ware RS, D'Ambrosio C, Anand L, Dirlea M, Vermani M, Katzman MA. Multi-component yoga breath program for Vietnam veteran post traumatic stress disorder: randomized controlled trial. J Trauma Stress Disor Treat. 2013;2:3. doi: 10.4172/2324-8947.1000108.
    1. Jindani F, Turner N, Khalsa SB. A yoga intervention for posttraumatic stress: a preliminary randomized control trial. Evid Based Complement Alternat Med. 2015;2015:351746. doi: 10.1155/2015/351746.
    1. Mitchell KS, Dick AM, DiMartino DM, Smith BN, Niles B, Koenen KC, Street A. A pilot study of a randomized controlled trial of yoga as an intervention for PTSD symptoms in women. J Trauma Stress. 2014;27(2):121–128. doi: 10.1002/jts.21903.
    1. Quinones N, Maquet YG, Velez DM, Lopez MA. Efficacy of a Satyananda yoga intervention for reintegrating adults diagnosed with posttraumatic stress disorder. Int J Yoga Therap. 2015;25(1):89–99. doi: 10.17761/1531-2054-25.1.89.
    1. Reinhardt KM, Noggle Taylor JJ, Johnston J, Zameer A, Cheema S, Khalsa SBS. Kripalu yoga for military veterans with PTSD: a randomized trial. J Clin Psychol. 2017;74(1):93-108.
    1. Seppala EM, Nitschke JB, Tudorascu DL, Hayes A, Goldstein MR, Nguyen DT, Perlman D, Davidson RJ. Breathing-based meditation decreases posttraumatic stress disorder symptoms in U.S. military veterans: a randomized controlled longitudinal study. J Trauma Stress. 2014;27(4):397–405. doi: 10.1002/jts.21936.
    1. van der Kolk BA, Stone L, West J, Rhodes A, Emerson D, Suvak M, Spinazzola J. Yoga as an adjunctive treatment for posttraumatic stress disorder: a randomized controlled trial. J Clin Psychiatry. 2014;75(6):e559–e565. doi: 10.4088/JCP.13m08561.
    1. Reddy S, Dick AM, Gerber MR, Mitchell K. The effect of a yoga intervention on alcohol and drug abuse risk in veteran and civilian women with posttraumatic stress disorder. J Altern Complement Med. 2014;20(10):750–756. doi: 10.1089/acm.2014.0014.
    1. Rhodes A, Spinazzola J, van der Kolk B. Yoga for adult women with chronic PTSD: a long-term follow-up study. J Altern Complement Med. 2016;22(3):189–196. doi: 10.1089/acm.2014.0407.
    1. Monson CM, Gradus JL, Young-Xu Y, Schnurr PP, Price JL, Schumm JA. Change in posttraumatic stress disorder symptoms: do clinicians and patients agree? Psychol Assess. 2008;20(2):131–138. doi: 10.1037/1040-3590.20.2.131.
    1. Gallegos AM, Crean HF, Pigeon WR, Heffner KL. Meditation and yoga for posttraumatic stress disorder: a meta-analytic review of randomized controlled trials. Clin Psychol Rev. 2017;58:115–124. doi: 10.1016/j.cpr.2017.10.004.
    1. Kim SH, Schneider SM, Bevans M, Kravitz L, Mermier C, Qualls C, Burge MR. PTSD symptom reduction with mindfulness-based stretching and deep breathing exercise: randomized controlled clinical trial of efficacy. J Clin Endocrinol Metab. 2013;98(7):2984–2992. doi: 10.1210/jc.2012-3742.
    1. Hilton L, Maher AR, Colaiaco B, Apaydin E, Sorbero ME, Booth M, Shanman RM, Hempel S. Meditation for posttraumatic stress: systematic review and meta-analysis. Psychol Trauma. 2017;9(4):453–460. doi: 10.1037/tra0000180.
    1. Metcalf O, Varker T, Forbes D, Phelps A, Dell L, DiBattista A, Ralph N, O'Donnell M. Efficacy of fifteen emerging interventions for the treatment of posttraumatic stress disorder: a systematic review. J Trauma Stress. 2016;29(1):88–92. doi: 10.1002/jts.22070.
    1. Longacre M, Silver-Highfield E, Lama P, Grodin M. Complementary and alternative medicine in the treatment of refugees and survivors of torture: a review and proposal for action. Torture. 2012;22(1):38–57.
    1. Telles S, Singh N, Balkrishna A. Managing mental health disorders resulting from trauma through yoga: a review. Depress Res Treat. 2012;2012:401513.
    1. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010;63(8):834–840. doi: 10.1016/j.jclinepi.2010.02.005.
    1. Siddaway AP, Wood AM. Recommendations for conducting mindfulness based cognitive therapy trials. Psychiatry Res. 2013;207(3):229–231. doi: 10.1016/j.psychres.2012.12.030.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する