The Effects of Yoga on Symptoms of Posttraumatic Stress Disorder (PTSD) for Military Populations Who Have Sustained a Mild Traumatic Brain Injury (mTBI)

The Effects of Yoga on Symptoms of Posttraumatic Stress Disorder (PTSD) for Military Populations Who Have Sustained a Mild Traumatic Brain Injury (mTBI)

Prepared by: Amy Gwynn, SPT

Background:

I’ve been practicing yoga consistently for the past five years, and have noticed not only physical, but also mental/emotional benefits in my own life. I wondered about how much literature is actually available on this topic, and started with an evidence table about the effects of yoga on knee osteoarthritis back in EBP1. When trying to figure out a topic for my capstone, my advisor, Prue Plummer made me aware of a research project Karen McCulloch was working on establishing regarding the effects of yoga on PTSD symptoms, quality of sleep, and heart-rate variability in military personnel who have sustained a mTBI. I was very excited to have the opportunity to work on not only appraising the current literature on this topic, but also helping work on and learn about what it takes to write grants and start working on a research project.

Overview

PTSD, which typically involves physical, mental, and emotional symptoms including difficulty sleeping, nightmares, avoidance, exhaustion, and emotional numbing unfortunately often leads to personal, familial, and even societal disruptions.^2,3,5  Combat-related PTSD occurs frequently in the military, and unfortunately treatment is not always sought out due to fear of consequences and stigma.³  Yoga has been identified as an alternative treatment option for PTSD as talk therapies and pharmaceutical interventions are not always effective. Yoga has been shown to stimulate the parasympathetic nervous system, which reduces heart-rate variability, increase production of GABA, both which decrease allostatic load–an imbalance in the autonomic nervous system–and may trigger episodes of PTSD symptoms.⁶ 

While yoga has been shown to be helpful in significantly reducing PTSD symptoms in a few different populations, it is still not a well-established or reimbursed intervention. This is largely potentially due to the variability in yoga intervention in terms of type, elements, duration, frequency, population, and also the generally poor quality of studies available, with small sample sizes, often lack of control group, and non-blind investigators. Additionally, a lack of quantitative data from validated outcome measures, and for example, HRV devices further weakens this literature. There are still many questions as to the value of the use of yoga for this population. The good news is, this leaves plenty of room for projects such as this one.

Gathering the Evidence

So, in EBPII, my PICO question was: “In military personnel with mild traumatic brain injury and post-traumatic stress disorder, does yoga improve sleep quality and increase heart-rate variability?” I created an evidence table on this topic during EBPII, and updated it for this project to ensure I was using the most current literature available.  Critically appraising this topic (CAT) in EBP II helped me identify the best literature available, and understand more about how weak the current literature is. This made me all the more motivated to help contribute further and pursue working with Kmac on her project.

The Project

After Kmac worked to respond to different calls and on writing pre-proposals for this project all winter, we were sad to hear that no proposals had been requested, nor funding approved for this particular project. That said, we decided it would be best for me to go ahead and write the research background paper to be included in future proposals. Kmac is still collaborating with many other disciplines on this topic, and helped me recognize this slow, trial-and-error process is just the way the research world works.

The paper I wrote discusses the current state of the literature, which is weak and limited, on the effects of yoga on PTSD symptoms not only in military populations, both active-duty, and veteran, but also for women who were victims of interpersonal violence, and flood victims in India. There is no literature available on the effects of yoga on PTSD symptoms, HRV, and sleep quality for military populations who have sustained a mTBI. I also sought to highlight the frequency, duration, elements, and timeline of the strongest studies, identified in my CAT, as research design has been a limiting factor in the approval of project pre-proposals on this topic.

Evaluation

I sought evaluation from Kmac most directly through in-person meetings, phone calls, and e-mails. Kmac’s feedback has already been integrated into my final products.

I’m hopeful my work will be helpful in the future to further research on this topic, about which I’m very passionate. I intend on continuing to work with Kmac on this during clinical, and potentially even post-graduation, if she’ll have me.

Self-Assessment:

This process has taught me a lot about how much time and energy goes into seeking out and applying for grant funding for research projects. Understanding about what companies or the government is calling for, and how many different sources of funding are available has surprised and challenged me. I didn’t realize getting funding was such a long trial-and-error process, and that’s before you even start the research. I feel like I only played a very small part in what could become eventually a large project, and I can’t imagine trying to coordinate an entire study, writing a manuscript, and getting published–that seems so far off! I was fairly independent with the project, and would just check in with Kmac on the phone or in person about once a month on my progress. While I had a little bit of accountability, I also learned about what it means to be accountable to myself. I set deadlines for the evidence review, evidence table, paper, and integrating feedback, and stuck to them. I’m glad to know I have this skill, as I anticipate I’ll need to use it for the rest of my life as I become a more independent therapist. I’ve also learned I’d like to be involved in research in some way as a clinician, and want to be able to help contribute to our field in that way, whether it’s doing literature reviews, which seems unlikely, or implementing a particular intervention in the clinic for a researcher. I’d like to look into more ways that I could be active in research while in clinical practice.

Acknowledgements:

I would like to thank Prue for pointing me in this direction, and for her very thorough feedback on my EBPII materials. I’d also like to thank Kmac for providing helpful feedback and guidance throughout this process, which started in June 2014. I learned a lot about how much patience and research goes into research before the project even gets funded and started from you, Kmac. I’d also like to thank Ginger Garner, PT, MPT, ATC, PYT, CPI, Camp Lejeune, Jacksonville, NC, and Amy Cecchini, MS, PT, Fort Bragg, Fayetteville, NC, for their feedback as well.

References:

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