1. Striking Poses: Yoga as an Intervention for PTSD in Military Populations

2. DSM V Criteria
A: Traumatic event: threatened death, serious injury or sexual violence; experienced, witnessed, or indirect to close friend or family. B: (beginning with event): Re-experiencing symptoms: intrusive thoughts, nightmares, flashbacks, psychological and physiological reactivity to reminders. C: (beginning with event): Avoidance (can be thoughts, feelings, or people connected to the event, or reminders) D: (worsen after event): Negative alteration in mood or cognition (e.g. negative thoughts about the self and the world; loss of interest in previously enjoyed activities; isolation, negative affect, and difficulty experiencing positive affect; exaggerated sense of blame or responsibility for the event.) E: (worsen after event): Arousal symptoms (difficulties with concentration, startle, anger, hypervigilance, and startle). F: Chronicity (at least one month duration) Specifiers: Dissociation and/or depersonalization (“this isn’t happening to me”), de-realization (“this isn’t real”).

3. Clinical Vignette
The Case of “Joe”

4. The 8 Limbs of yoga Yama: Ethics and Morals Niyama: Virtuous behavior
Asana: Physical postures
Pranayama: The regulation of the breath
Pratyahara: The discovery of one’s true self through introspection
Dharana: One-pointed concentration
Dhyana: Non-judgmental attitude toward to object of concentration
Samadhi: Absorption and unity with the object of concentration

5. Research BENEFITS CAVEATS Hyperarousal Few Studies Re-experiencing
Small ‘N’
Sleep
Few “dual arm” RCTs
Resting heart rate
High drop out rate
Confronting avoidance
Different styles of yoga used
Improved relatedness
Different elements of yoga emphasized
Improved self-compassion
Brevity of intervention
Connection with a sense of wonder
No control on quality of instruction

6. Ideal Benefits of a Yoga Program
1) I am safe in my body and in the world.
2) I am not my thoughts, and not every thought needs immediate response.
3) I have a body that works, and I can and should be a responsible shepherd of its cultivation.
4) Feelings come and go, and I can observe them rather than respond to them.
5) I have a safe physical outlet when I am feeling sluggish or hyper.
6) Through my feeling of enhanced safety, I can know a truer me, and cultivate that true self. I begin to see PTSD as separate from me. I shed PTSD as an identity.
7) Through greater distance from PTSD and connection to myself, I can sustain abiding, trusting connections to others.
8) Through this greater sense of connection to myself and others, I begin to connect to a sense of awe and wonder about our place in the cosmos. I have glimpses of transcendence and joy.

7. Positive Effects of Yoga on PTSD in military populations by Study
Authors (date)
Benefits recorded, if any
Size of study, type of study
Staples (2013)
Hyperarousal, sleep quality. No improvements in anger or ‘quality of life’.
N=12, single arm
Sepala, et al. (2014)
Re-experiencing, hyperarousal, reduction in resting heart rate.
N=11, single arm
Johnston, et al. (2015)
Re-experiencing, hyperarousal, avoidance, “resilience”.
N=10, single arm
Reinhardt, et al. (2017)
Did not show hypothesized benefits; high drop-out rate.
N(yoga)=9; N(non-yoga)=6; RCT

8. Positive Effects of yoga on PTSD in non-military populations
Authors (year)
Benefits
Number of participants; type of study.
Jindani & Khalsa (2015).
Improved feelings of energy and renewal, self-esteem, centeredness, and a connection with a feeling of wonder.
N=50; (yoga=29, non yoga=21); RCT.
West, Liang, & Spinazzola (2017)
Improvements in levels of relatedness, acceptance, centeredness, empowerment, and self-compassion.
N=31, all female, single arm.

9. References
Jindani, F., Khalsa, B.A A yoga intervention program for patients suffering from symptoms of posttraumatic stress disorder: A qualitative descriptive study. The Journal of Alternative and Complementary Medicine, 21, 7:  
Johnston, J Yoga for military service with PTSD: A single arm study. Psychological Trauma: Research, Practice, & Policy, vol. 7, no. 6,  
Reinhardt, et al Kripalu yoga for military veterans with PTSD: A randomized trial. Journal of Cliical Psychology, 00: 1-16. 
Sepala, et al Breathing-Based Meditation Decreases Posttraumatic Stress Disorder Symptoms in U.S. Military Veterans: A Randomized Controlled Longitudinal Study. Journal of Traumatic Stress, 27, ).
Staples, J., Hamilton, M., Uddo, M A yoga program for the symptoms of post-traumatic stress Disorder in Veterans. Military Medicine, 178,8,
West, Liang, & Spinazzola Trauma Sensitive Yoga as a Complementary Treatment for Posttraumatic Stress Disorder: A Qualitative Descriptive Analysis. International Journal of Stress Management
VA Press Release, September 15, 2017:
van der Kolk, Bessel The body keeps the score: brain mind, and body in the healing of trauma. Penguin Books.