Evaluation of a Tai Chi Resilience Training Program on Objective and Subjective Measures of Post Traumatic Stress Disorder Severity
Condition: Post Traumatic Stress Disorder; Tai Chi; Aerobic Exercise
MeSH terms: Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      The standard of care for PTSD involves both psychotherapy and pharmacotherapy, but treatment
      resistance is common. The discovery of effective complementary treatment approaches would
      have major implications for patients with PTSD. Mindfulness meditation and related practices
      have been studied intensively in recent years for a variety of psychiatric illnesses,
      including depression, generalized anxiety disorder, and PTSD. Studies in PTSD suggest that
      mindful meditation holds promise. For example, mindfulness-based stress reduction (MBSR) has
      shown effectiveness for reducing symptom severity and improving mental-health related quality
      of life in combat-exposed veterans and child survivors of sexual abuse. Mechanistically,
      mindfulness meditation appears to counteract the types of functional changes that have been
      identified in the brains of patients with PTSD. In particular, while PTSD symptoms are
      associated with decreased activation of the prefrontal cortex (PFC) and increased amygdala
      activity, mindfulness meditation is associated with increased PFC activation and decreased
      amygdala activation. Other physiological effects of mindfulness meditation in patients with
      PTSD are not fully defined. However, available data suggest that it leads to a normalization
      of vagal tone and plasma cortisol levels, which are known to be abnormal in patients with
      chronic PTSD. Research utilizing validated and standardized pre- and post- PTSD outcome
      measures, in addition to pre- and post- physiologic variables such a vagal tone, plasma
      cortisol and catecholamine levels, may better the understandings of physiological effects of
      mindfulness medication.
    

Detailed description: 
      Post-traumatic stress disorder (PTSD) affects an estimated 4.7% of the United States
      population every year, leading to increased rates of disability, suicide, substance use, and
      interpersonal difficulties. Mindfulness interventions for PTSD offer a low-cost, repeatable
      method that has the potential to induce fear extinction, and that has no known side effects.
      While several studies have reported the efficacy of mindfulness meditation and related
      mind-body exercises to reduce self-reported PTSD symptoms, little is known about the
      physiologic changes associated with mindfulness interventions. The present study seeks to
      evaluate the effects of a mind-body mindfulness intervention (tai chi) on subjective reports
      of PTSD symptoms, as well as physiologic correlates of PTSD in a population of law
      enforcement officers. Tai chi was chosen because its focus on awareness of physical movements
      is expected to provide an easier mindfulness target, as compared to traditional seated
      meditation. It is well documented that patients with PTSD, who frequently struggle with
      intrusive trauma-related memories, are often unable to attend to current circumstances, a
      problem that leads to exacerbation of symptoms. While there are promising preliminary data
      suggesting that tai chi leads to improvements in self-reported symptoms of PTSD, there are no
      data regarding the effects of tai chi on objective endocrine, physiological, and behavioral
      measures of PTSD.

      The investigators hypothesize that the use of the mind-body practice of tai chi will lead to
      reductions in subjective self-report measures of PTSD as well a normalization of objective
      physiological correlates of PTSD. In particular, it is hypothesized that the efficacy of tai
      chi in the treatment of PTSD is hypothesized to be achieved by facilitating fear extinction
      and augmenting stress resilience through improved integration of mindfulness practices with
      daily physical activities. To test this hypothesis, the investigators propose the following
      specific aims:

      • Specific Aim 1: To determine the self-reported symptom changes, behavioral changes, and
      physiological effects that take place during an 8-week intervention of simplified Tai Chi
      Moving Mindfulness Meditation and Resilience Training (TCMMMRT) in a population of police
      officers with and without self-reported PTSD. Results from these two groups will also be
      compared to a control group engaging in aerobic exercise.

        -  Self-reported outcome measures: Brief Pain Inventory (BPI) short form, Beck Depression
           Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), PTSD Checklist for Diagnostic
           and Statistical Manual of Mental Disorders (DSM-V) (PCL-5), and Canadian Occupational
           Performance Measure (COPM).

        -  Physiological outcome measures: Mobile Acoustic startle Reflex-monitoring System (MARS)
           measures, heart rate variability (HRV), cortisol measurements, and actigraphy to monitor
           sleep patterns and activity levels.
    

Intervention name(s): Tai Chi Moving Mindfulness Meditation and Resilience Training; Aerobic Exercise
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Low-impact mind-body exercise adapted from traditional tai chi.; Low-impact aerobic exercise, led by instructor
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment