Trauma Center Trauma-Sensitive Yoga (TCTSY) and cognitive processing therapy (CPT) are similarly effective in treating military sexual-trauma related posttraumatic stress disorder (PTSD) in women veterans, according to a recent study published in JAMA Network Open.
Takeaways
- The study suggests that Trauma Center Trauma-Sensitive Yoga (TCTSY) and cognitive processing therapy (CPT) are similarly effective in treating military sexual-trauma related posttraumatic stress disorder (PTSD) in women veterans.
- PTSD has a significant impact on the physical and mental health of veterans. Military sexual trauma (MST) is a leading cause of PTSD in women veterans, with associated outcomes including suicide and deficits in social determinants of health.
- While evidence-based treatments such as CPT are commonly used for managing MST-related PTSD, they often have high dropout rates. This highlights a potential barrier to effective treatment in this population.
- The study notes a growing preference for yoga among veterans as a means to manage PTSD. This preference could be associated with lower dropout rates and increased acceptability compared to traditional evidence-based treatments.
- The results indicate that TCTSY is an acceptable and potentially cost-effective treatment method for PTSD symptoms in women veterans. The higher completion rate for TCTSY compared to CPT suggests its potential as a viable alternative or complementary approach for PTSD treatment in this specific population.
PTSD leads to significant adverse effects on veterans’ physical and mental health, and an exponential increase has been observed in the harmful effects of PTSD for women veterans and associated medical costs. In 2015, PTSD was reported in 1 in 5 women patients in the Veterans Health Administration, 300% more than in 2000.
Thirty-eight percent of women veterans experience military sexual trauma (MST), which is the leading cause of PTSD related to military service. This includes threatened sexual harassment or sexual assault during military service. Associated outcomes include suicide and deficits in social determinants of health.
While evidence-based treatments such as CPT are often used to manage MST, these treatments have high dropout rates. However, preference for yoga to manage PTSD has increased among veterans.
To evaluate the efficacy of TCTSY compared to CPT for PTSD treatment among women veterans, investigators conducted a multisite, randomized clinical trial. Participants were recruited between December 5, 2015, and June 22, 2020, from US Department of Veterans Affairs (VA) PTSD and other clinics.
Patients were randomized to receive TCTSY or CPT, with assessments occurring at baseline, midintervention, 2 weeks post intervention, and 3 months post intervention. Veterans aged 22 to 71 years who were enrolled in VA, had experienced MST, had a PTSD diagnosis with MST as the index trauma, and had insomnia were included in the analysis.
Primary outcomes included PTSD symptom severity, chronic pain, and insomnia. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Checklist for DSM-5 (PCL-5) were used to measure PTSD symptom severity.
The CAPS-5 and PCL-5 both measure symptom severity using a Likert scale from 0 to 4, with the CAPS-5 measuring severity and the PCL-5 measuring how greatly the patient is bothered by symptoms.
TCTSY and CPT were the evaluated interventions, delivered by 2 interventionalists. Patients in the TCTSY group received 1 60-minute group session per week for 10 weeks. These sessions included interception, invitational language, choice making, noncoercion, and shared authentic experience, with a focus on shared power between the facilitator and participant.
Patients in the CPT group received 1 90-minute group session per week for 12 weeks. These sessions included Socratic dialogue and progressive worksheets to help patients challenge trauma-related stuck points.
Participants were aged a mean 38.2 years, with 72.6% being Black and 19.1% White. Participant dropout before the first intervention session was observed in 9.7% of the TCTSY group vs 18.6% of the CPT group.
There were more participants in the CPT group with attrition through the final intervention session than the TCTSY group, at 45.8% and 31.9%, respectively. However, completed treatment was reported in 65.3% of the TCTYS group vs 45.8% of the CPT group, indicating a 42.6% higher treatment completion rate from TCTSY compared to CPT.
Improvements in CAPS-5 scores overtime were observed in both groups. At baseline, the TCTSY group had a mean CAPS-5 score of 36.73 and the CPT group a mean score of 35.52. At 3 months, these scores were 24.03 and 22.15, respectively.
PCL-5 scores also improved over time in both groups, with scores of 49.62 and 48.69 at baseline in the TCTSY and CPT groups, respectively. At 3 months, these scores were 36.97 and 31.76, respectively.
These results indicated TCTSY is an acceptable treatment method for PTSD symptoms in women veterans. Investigators concluded TCTSY could be a cost-effective method of expanding PTSD treatment.
Reference
Zaccari B, Higgins M, Haywood TN, et al. Yoga vs cognitive processing therapy for military sexual trauma–related posttraumatic stress disorder: A randomized clinical trial. JAMA Netw Open. 2023;6(12):e2344862. doi:10.1001/jamanetworkopen.2023.44862
