A 2024 systematic review and meta-analysis of randomized controlled trials of the efficacy of yoga for posttraumatic stress disorder was completed by Seyed Aria Nejadghaderi and colleagues, The research published in the journal Psychiatry Research examined the idea of yoga for PTSD.
The Study
Nejadghaderi and team initially found over 668 potential papers. Twenty of these met inclusion criteria for the meta-analysis. The criteria were: randomized control trials (RCTs) on adult participants with PTSD that evaluated safety or efficacy outcomes. It also included related secondary outcomes (e.g., depression).
The twenty studies represented 954 participants. The average age was 51.26; the majority identified as female (59.6 %). All included trials were published between 2013 and 2022. Follow-up duration across the trials was between one month and 1.5 years.
Key Findings: Efficacy
The meta-analysis revealed that yoga interventions reduced PTSD symptoms when measured through self-reported assessments. The standardized mean difference (SMD) of -0.51 (95% confidence interval [CI]: -0.68, -0.35) indicated a moderate effect size compared to control interventions for PTSD. However, these differences were not sustained when measured at a secondary follow-up assessment (SMD: -0.17; 95 % CI: -0.34, 0.01).
In addition, yoga showed promising results immediate post-intervention (SMD: -0.39; 95 % CI: -0.56, -0.22) and at secondary follow-up (SMD: -0.44; 95 % CI: -0.74, -0.13) for symptoms of depression.
However, significant reductions in anxiety symptoms were not evident at immediate post-intervention (SMD: -0.28; 95 % CI: -0.71, 0.15) or at secondary follow-up (SMD: -0.28; 95 % CI: -0.59, 0.02)
Is Yoga Safe for PTSD?
A critical concern for any intervention is its safety, particularly for individuals with PTSD, who may be vulnerable to stress triggers. The review examined six studies that reported on adverse events and found no evidence of serious adverse events across the included studies.
Participant vs.Clinician Ratings
All twenty included studies used self-report questionnaires for PTSD. Nine also included clinician-administered assessments. Interestingly, Nejadghaderi and team found discrepancies between participant self-reports and clinician-reported assessments. While individuals reported improvements in PTSD symptoms after participating in yoga, when clinician evaluations were examined, they did not consistently meet with these findings. They suggested that one reason for this divergence may be that clinician-administered assessments may focus more on objectively observed aspects of PTSD, while self-report questionnaires may draw more from subjective symptom perceptions, leading to these differences.
Recommendations: More Research Needed
Nejadghaderi et. al (2024) review also highlighted gaps in the existing research. Many of the individual studies included in the meta-analysis were high in bias. The researchers used the Cochrane risk-of-bias instrument for randomized trials (RoB 2) which assesses for five potential areas of bias to classify studies as having high, low, or some concerns: randomization method, variations from the intended interventions, missing outcome data, measurement of the outcome, and selection of the reported outcomes.
They suggested more rigorous RCTs are needed to firmly establish yoga’s efficacy. Future studies should explore the specific types of yoga that yield the best outcomes and include diverse populations to ensure generalizability.
Final Thoughts
When considering recommending yoga it appears to offer a safe and potentially effective way to reduce PTSD and depressive symptoms, in the immediate term. One would anticipate that the effects of Yoga occur in the context of ongoing practice. Just as the effects of physical movement, such as going to the gym and building muscle mass occur while maintaining the practice of the movement. In contrast to this, the effects appear to still be present at follow up for depressive symptoms (although follow up periods varied across studies, from 1 month to 1.5 years). It would also be important to keep in mind that a recommendation would include that yoga doesn’t seem to make a difference to anxiety symptoms.
The authors recommended the following forms of yoga as showing the most promise:
TCTSY: Trauma Center Trauma-Sensitive Yoga
HYP: Holistic Yoga Program
Satyananda Yoga
Kundalini yoga
As with many recommendations, experimentation or trial and error might help with discovering if this is for your individual client. While it could be an addition to traditional treatment options yoga doesn’t present as a substitute for trauma focussed therapy.
References
Nejadghaderi, S. A., Mousavi, S. E., Fazlollahi, A., Motlagh Asghari, K., & Garfin, D. R. (2024). Efficacy of yoga for posttraumatic stress disorder: A systematic review and meta-analysis of randomized controlled trials. Psychiatry Research, 340, 116098. https://doi.org/10.1016/j.psychres.2024.116098
