Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2018

Open Access 01-12-2018 | Research article

Yoga for posttraumatic stress disorder – a systematic review and meta-analysis

Authors: Holger Cramer, Dennis Anheyer, Felix J. Saha, Gustav Dobos

Published in: BMC Psychiatry | Issue 1/2018

Login to get access

Abstract

Background

Yoga is increasingly used as a therapeutic treatment and seems to improve psychiatric conditions such as anxiety disorders and depression. The aim of this systematic review was to assess the evidence of yoga for reducing symptoms of posttraumatic stress disorder (PTSD).

Methods

The Cochrane Library, Medline/PubMed, PsycINFO, Scopus, and IndMED were searched through July 2017 for randomized controlled trials (RCTs) assessing the effects of yoga on symptoms of PTSD. Mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CI) were computed. The quality of evidence and the strength of recommendation were graded according to the GRADE recommendations.

Results

Seven RCTs (N = 284) were included. Meta-analysis revealed low quality evidence for clinically relevant effects of yoga on PTSD symptoms compared to no treatment (SMD = − 1.10, 95% CI [− 1.72, − 0.47], p < .001, I2 = 72%; MD = − 13.11, 95% CI [− 17.95, − 8.27]); and very low evidence for comparable effects of yoga and attention control interventions (SMD = − 0.31, 95%CI = [− 0.84, 0.22], p = .25; I2 = 43%). Very low evidence was found for comparable retention of patients in the trial for yoga and no treatment (OR = 0.68, 95%CI [0.06, 7.72]) or attention control interventions (OR = 0.66, 95%CI [0.10, 4.46]). No serious adverse events were reported.

Limitations

Few RCTs with only limited sample size were available.

Conclusions

Only a weak recommendation for yoga as an adjunctive intervention for PTSD can be made. More high quality research is needed to confirm or disconfirm these findings.
Appendix
Available only for authorised users
Literature
1.
Kessler RC, Ustun TB. The WHO world mental health surveys: global perspectives on the epidemiology of mental disorders. New York: Cambridge University Press; 2008.
2.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5 edn. Washington, DC: American Psychiatric Association; 2013.CrossRef
3.
4.
Hoskins M, Pearce J, Bethell A, Dankova L, Barbui C, Tol WA, van Ommeren M, de Jong J, Seedat S, Chen H, et al. Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis. Br J Psychiatry. 2015;206(2):93–100.CrossRefPubMed
5.
Cipriani A, Williams T, Nikolakopoulou A, Salanti G, Chaimani A, Ipser J, Cowen PJ, Geddes JR, Stein DJ. Comparative efficacy and acceptability of pharmacological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychol Med. 2017:1–10.
6.
Lee DJ, Schnitzlein CW, Wolf JP, Vythilingam M, Rasmusson AM, Hoge CW. Psychotherapy versus pharmacotherapy for posttraumatic stress disorder: systematic review and meta-analysis to dtermine first-line treatment. Depress Anxiety. 2016;33(9):792–806.CrossRefPubMed
7.
Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev. 2013;12:CD003388.
8.
Wynn GH. Complementary and alternative medicine approaches in the treatment of PTSD. Curr Psychiatry Rep. 2015;17(8):600.CrossRefPubMed
9.
10.
Iyengar BKS. Light on yoga. New York: Schocken Books; 1966.
11.
Bussing A, Ostermann T, Ludtke R, Michalsen A. Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. J Pain. 2012;13(1):1–9.CrossRefPubMed
12.
Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos GJ. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev. 2017;1:CD010802.PubMed
13.
Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for depression: a systematic review and meta-analysis. Depress Anxiety. 2013;30(11):1068–83.CrossRefPubMed
14.
Cramer H, Anheyer D, Lauche R, Dobos G. A systematic review of yoga for major depressive disorder. J Affect Disord. 2017;213:70–7.CrossRefPubMed
15.
Sharma A, Barrett MS, Cucchiara AJ, Gooneratne NS, Thase ME. A breathing-based meditation intervention for patients with major depressive disorder following inadequate response to antidepressants: a randomized pilot study. J Clin Psychiatry. 2017;78(1):e59–63.CrossRefPubMedPubMedCentral
16.
Kirkwood G, Rampes H, Tuffrey V, Richardson J, Pilkington K. Yoga for anxiety: a systematic review of the research evidence. Br J Sports Med. 2005;39(12):884–91.CrossRefPubMedPubMedCentral
17.
Doria S, de Vuono A, Sanlorenzo R, Irtelli F, Mencacci C. Anti-anxiety efficacy of Sudarshan Kriya yoga in general anxiety disorder: a multicomponent, yoga based, breath intervention program for patients suffering from generalized anxiety disorder with or without comorbidities. J Affect Disord. 2015;184:310–7.CrossRefPubMed
18.
Vancampfort D, Vansteelandt K, Scheewe T, Probst M, Knapen J, De Herdt A, De Hert M. Yoga in schizophrenia: a systematic review of randomised controlled trials. Acta Psychiatr Scand. 2012;126(1):12–20.CrossRefPubMed
19.
Broderick J, Knowles A, Chadwick J, Vancampfort D. Yoga versus standard care for schizophrenia. Cochrane Database Syst Rev. 2015;10:CD010554.
20.
21.
Cramer H, Ward L, Steel A, Lauche R, Dobos G, Zhang Y. Prevalence, patterns, and predictors of yoga use: results of a U.S. nationally representative survey. Am J Prev Med. 2016;50(2):230–5.CrossRefPubMed
22.
Rosenbaum S, Vancampfort D, Steel Z, Newby J, Ward PB, Stubbs B. Physical activity in the treatment of post-traumatic stress disorder: a systematic review and meta-analysis. Psychiatry Res. 2015;230(2):130–6.CrossRefPubMed
23.
Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses. 2012;78(5):571–9.CrossRefPubMed
24.
Cramer H. The efficacy and safety of yoga in managing hypertension. Exp Clin Endocrinol Diabetes. 2016;124(2):65–70.PubMed
25.
Brewin CR, Holmes EA. Psychological theories of posttraumatic stress disorder. Clin Psychol Rev. 2003;23(3):339–76.CrossRefPubMed
26.
Bishop SR, Lau M, Shapiro S, Carlson L, Anderson ND, Carmody J, Segal ZV, Abbey S, Speca M, Velting D, et al. Mindfulness: a proposed Oerational definition. Clin Psychology. 2004;11:230–41.
27.
Descilo T, Vedamurtachar A, Gerbarg PL, Nagaraja D, Gangadhar BN, Damodaran B, Adelson B, Braslow LH, Marcus S, Brown RP. Effects of a yoga breath intervention alone and in combination with an exposure therapy for post-traumatic stress disorder and depression in survivors of the 2004 South-East Asia tsunami. Acta Psychiatr Scand. 2010;121(4):289–300.CrossRefPubMed
28.
Emerson D, Hopper E, Levine PA, Cope S, van der Kolk B. Overcoming trauma through yoga: reclaiming your body. Berkeley: North Atlantic Books; 2011.
29.
Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry. 2005;162(2):214–27.CrossRefPubMed
30.
Daubenmier JJ. The relationship of yoga, body awareness, and body responsiveness to self-objectification and disordered eating. Psychol Women Q. 2005;29:207–19.CrossRef
31.
Hitchcock C, Ellis AA, Williamson P, Nixon RD. The prospective role of cognitive appraisals and social support in predicting Children's posttraumatic stress. J Abnorm Child Psychol. 2015;43(8):1485–92.CrossRefPubMedPubMedCentral
32.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41.CrossRefPubMed
33.
Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. West Sussex: Wiley; 2008.CrossRef
34.
35.
Cohen J. Statistical power analysis for the behavioral sciences. New York, London: Lawrence Erlbaum Associates; 1988.
36.
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, DeBeer H, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94.CrossRefPubMed
37.
Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–6.CrossRefPubMed
38.
39.
Carter JJ, Gebarg PL, Brown RP, Ware RS, D'Ambrosio C, Anand L, Dirlea M, Vermani M, Katzman MA. Multi-component yoga breath program for Vietnam veteran post traumatic stress disorder: randomized controlled trial. J Trauma Stress Disor Treat. 2013;2:3.CrossRef
40.
Jindani F, Turner N, Khalsa SB. A yoga intervention for posttraumatic stress: a preliminary randomized control trial. Evid Based Complement Alternat Med. 2015;2015:351746.CrossRefPubMedPubMedCentral
41.
Mitchell KS, Dick AM, DiMartino DM, Smith BN, Niles B, Koenen KC, Street A. A pilot study of a randomized controlled trial of yoga as an intervention for PTSD symptoms in women. J Trauma Stress. 2014;27(2):121–8.CrossRefPubMed
42.
Quinones N, Maquet YG, Velez DM, Lopez MA. Efficacy of a Satyananda yoga intervention for reintegrating adults diagnosed with posttraumatic stress disorder. Int J Yoga Therap. 2015;25(1):89–99.CrossRefPubMed
43.
Reinhardt KM, Noggle Taylor JJ, Johnston J, Zameer A, Cheema S, Khalsa SBS. Kripalu yoga for military veterans with PTSD: a randomized trial. J Clin Psychol. 2017;74(1):93-108.
44.
Seppala EM, Nitschke JB, Tudorascu DL, Hayes A, Goldstein MR, Nguyen DT, Perlman D, Davidson RJ. Breathing-based meditation decreases posttraumatic stress disorder symptoms in U.S. military veterans: a randomized controlled longitudinal study. J Trauma Stress. 2014;27(4):397–405.CrossRefPubMed
45.
van der Kolk BA, Stone L, West J, Rhodes A, Emerson D, Suvak M, Spinazzola J. Yoga as an adjunctive treatment for posttraumatic stress disorder: a randomized controlled trial. J Clin Psychiatry. 2014;75(6):e559–65.CrossRefPubMed
46.
Reddy S, Dick AM, Gerber MR, Mitchell K. The effect of a yoga intervention on alcohol and drug abuse risk in veteran and civilian women with posttraumatic stress disorder. J Altern Complement Med. 2014;20(10):750–6.CrossRefPubMedPubMedCentral
47.
Rhodes A, Spinazzola J, van der Kolk B. Yoga for adult women with chronic PTSD: a long-term follow-up study. J Altern Complement Med. 2016;22(3):189–96.CrossRefPubMed
48.
Monson CM, Gradus JL, Young-Xu Y, Schnurr PP, Price JL, Schumm JA. Change in posttraumatic stress disorder symptoms: do clinicians and patients agree? Psychol Assess. 2008;20(2):131–8.CrossRefPubMed
49.
Gallegos AM, Crean HF, Pigeon WR, Heffner KL. Meditation and yoga for posttraumatic stress disorder: a meta-analytic review of randomized controlled trials. Clin Psychol Rev. 2017;58:115–24.CrossRefPubMed
50.
Kim SH, Schneider SM, Bevans M, Kravitz L, Mermier C, Qualls C, Burge MR. PTSD symptom reduction with mindfulness-based stretching and deep breathing exercise: randomized controlled clinical trial of efficacy. J Clin Endocrinol Metab. 2013;98(7):2984–92.CrossRefPubMedPubMedCentral
51.
Hilton L, Maher AR, Colaiaco B, Apaydin E, Sorbero ME, Booth M, Shanman RM, Hempel S. Meditation for posttraumatic stress: systematic review and meta-analysis. Psychol Trauma. 2017;9(4):453–60.CrossRefPubMed
52.
Metcalf O, Varker T, Forbes D, Phelps A, Dell L, DiBattista A, Ralph N, O'Donnell M. Efficacy of fifteen emerging interventions for the treatment of posttraumatic stress disorder: a systematic review. J Trauma Stress. 2016;29(1):88–92.CrossRefPubMed
53.
Longacre M, Silver-Highfield E, Lama P, Grodin M. Complementary and alternative medicine in the treatment of refugees and survivors of torture: a review and proposal for action. Torture. 2012;22(1):38–57.PubMed
54.
Telles S, Singh N, Balkrishna A. Managing mental health disorders resulting from trauma through yoga: a review. Depress Res Treat. 2012;2012:401513.PubMedPubMedCentral
55.
Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010;63(8):834–40.CrossRefPubMed
56.
Siddaway AP, Wood AM. Recommendations for conducting mindfulness based cognitive therapy trials. Psychiatry Res. 2013;207(3):229–31.CrossRefPubMed
Metadata
Title
Yoga for posttraumatic stress disorder – a systematic review and meta-analysis
Authors
Holger Cramer
Dennis Anheyer
Felix J. Saha
Gustav Dobos
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2018
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-018-1650-x

Other articles of this Issue 1/2018

BMC Psychiatry 1/2018 Go to the issue

Study protocol

The effectiveness of 6 versus 12-months of dialectical behaviour therapy for borderline personality disorder: the feasibility of a shorter treatment and evaluating responses (FASTER) trial protocol

Research article

Self-perceived level of competitiveness, tension and dependency and depression risk in the SUN cohort

Research article

Sequential treatment of ADHD in mother and child (AIMAC study): importance of the treatment phases for intervention success in a randomized trial

Research article

Improving risk prediction accuracy for new soldiers in the U.S. Army by adding self-report survey data to administrative data

Study protocol

Effectiveness of iconic therapy for the reduction of borderline personality disorder symptoms among suicidal youth: study protocol for a randomised controlled trial

Research article

A research study review of effectiveness of treatments for psychiatric conditions common to end-stage cancer patients: needs assessment for future research and an impassioned plea