Evaluation of Effectiveness of a Group Yoga Intervention as Trauma Therapy for Adolescent Girls
Condition: PTSD
Study type: Interventional

Summary: 
      Neuroscience evidence indicates that trauma is stored in the body, that trauma impairs the
      language centers found in the brain, and that emotion centers in the brain tend to override
      cognitive centers in the brain following trauma. Most evidence-based models to date to treat
      trauma using cognitive therapy, which does not fully resolve symptoms, particularly in the
      case of complex trauma. This evidence has led to researchers to call for alternative,
      body-oriented treatments that target trauma from the lowest levels of regulation up to higher
      levels of regulation in the brain. Yoga has been proposed as one such intervention. Recent
      research has investigated the benefits of yoga to treatment adult females who have
      experienced PTSD, but only anecdotal, descriptive, and qualitative data is available for
      studies of yoga with adolescents. This mixed methods study seeks to generate quantitative
      data demonstrating whether or not the 6-week group yoga intervention leads to decreases in
      general mental health and trauma-specific symptoms and qualitative data regarding the
      components of the intervention the participants found both helpful and unhelpful.
    

Detailed description: 
      A mixed methods design was chosen for this study due to the study representing a new stream
      of literature, and a desire to capture the fullest picture possible regarding the
      participants' response to the intervention. The purpose of this mixed methods study is to
      generate quantitative data that demonstrates a decrease in trauma and general mental health
      symptoms following a yoga psychotherapy intervention for trauma, and to collect qualitative
      data during the group process and following the group that provides a picture of the
      mechanisms that allow the intervention to be effective. Broad Hypotheses: Quantitatively,
      there will be significant differences in total number of mental health symptoms and
      trauma-related symptoms experienced from pretest to posttest. Qualitative data will
      demonstrate the benefits from the yoga postures and experiences of relaxing breath work the
      youth experienced during the yoga group.

      Trauma is a prevalent experience in our society, with between 50-76% of individuals
      experiencing a traumatic event with the potential to cause Posttraumatic Stress Disorder. The
      current standard of care in trauma treatment largely involves cognitive interventions, but
      neuroscience evidence demonstrates reasons for their limited effectiveness and a need to help
      traumatized individuals regulate the brain from the lowest levels up. Neuroscience research
      indicates the brains of individuals who have experienced trauma are less able to use
      cognitive centers to suppress emotional fear responses, and language centers in the brain
      experience deactivation during traumatic events. Indeed, 33% of individuals who develop PTSD
      fail to recover fully, which leads to ongoing mental health difficulties, impaired
      interpersonal relationships, substance abuse, physical health problems, and sexual problems.

      Yoga has been proposed as a somatic, bottom-up intervention that allows the individual to
      regulate from the lowest level of the brain to higher levels of the brain by working with the
      body and mindful experience in the present moment. Existing investigation of yoga as a
      psychotherapeutic intervention is preliminary, but promising. van der Kolk and colleagues
      conducted a preliminary randomized controlled study and found that over 50% of individuals
      who participated in the yoga group no longer met criteria for Posttraumatic Stress Disorder
      following the group. Carmody and Baer found that yoga-based interventions in
      Mindfulness-Based Stress Reduction impacted the widest range of symptoms (compared to body
      scans and seated meditation). No quantitative investigations of trauma-related yoga treatment
      for adolescents have been conducted, other than one dissertation with juvenile sex offenders.
      Existing yoga psychotherapy research on youth who have experienced trauma has been
      qualitative in nature with case studies and limited samples.

      Additional study of yoga as an intervention for traumatized adolescents is needed both
      quantitatively and qualitatively. One model of group yoga as adjunctive treatment for trauma
      has been identified in the literature, but it has only been described anecdotally and with
      limited qualitative data. Thus, the aim of the current study is to use the model created for
      the Healing Childhood Sexual Abuse with Yoga curriculum with a wider sample of adolescents
      across types of trauma (emotional, physical, & sexual abuse & neglect) in the United States
      and Canada to generalize the curriculum and generate qualitative and quantitative data
      regarding its effectiveness and the perceived mechanisms that contribute to success.
      Additional qualitative research would be beneficial to describe the themes and cases across a
      full sample of participants in such a group. Current research has been observational, case
      studies, or limited qualitative questionnaires at the end of the group, but this study
      proposes to collect qualitative data at each group yoga session regarding the experience. In
      addition, follow-up interviews are also proposed to ask more detailed questions about the
      participants' experiences.

      Participants will be referred from within the agencies providing the groups, and therapists
      will complete an internal referral form providing minimal demographic data with the referral.
      Participants will be contacted by the respective group leaders at the phone numbers listed on
      the referrals forms. Prior to the beginning of the initial group, the group leaders will meet
      with prospective clients to interview them for appropriateness for the group, obtain informed
      consent and assent, and allow them to complete the pretest measures. In addition to obtaining
      informed consent for the research process, the group leader will explain the physical nature
      of the yoga group, and the group leader will obtain waivers from parents for the youth to
      participate in the physical activity involved in the group. Copies of consent and assent
      forms will be provided to participants and parents.

      During each group, participants will complete the Yoga Experience Form at each session.
      Posttests will be completed at the end of the sixth group meeting. They will include all the
      pretest questionnaires, as well as the Therapeutic Factors Inventory- Cohesiveness Scale and
      the Working Alliance Inventory-Short Form- Bond Scale. After the final group, pretest,
      within, and posttest data will be coded and analyzed to determine the questions to be
      utilized for the follow-up interviews. Two participants from each group at McMaster
      Children's Hospital will be asked to complete a follow-up interview with the investigator
      that will be approximately 30 minutes in length. Participants will be selected with well
      defined symptom improvement and poor response to the intervention. The follow-up interviews
      will be audio recorded. Willingness to be audio recorded is necessary for participation in
      the follow-up interviews, but not for participation in the larger group. The time commitment
      for the treatment group is 540 minutes. This study does not involve additional post-treatment
      follow-up, aside from clients who volunteer to participate in the follow-up interviews.
    

Intervention name(s): Group yoga intervention
Intervention type(s): Behavioral
Intervention description(s): Participants will participate in 6 90-minute yoga groups designed to promote themes related to trauma recovery (safety & boundaries, strength & power, assertiveness, intuition, trust, & community) using mindfulness, breath work, and physical yoga poses.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Complex trauma; Yoga