Mechanisms of Change in Yoga and Physical Activity for Veterans

创伤后应激障碍(PTSD)是一种慢性、衰弱的疾病，具有广泛的负面影响 对身心健康功能的影响。优秀的、有经验支持的创伤后应激障碍干预措施是容易的 可供退伍军人使用，但接受最好治疗的大多数患者仍有 治疗后可诊断的障碍。这表明，补充性干预可能对充分 恢复运行。此外，许多患者寻求心理治疗或药物治疗的替代方案。这是 越来越多的创伤后应激障碍患者正在转向替代方法，这是显而易见的。目前， 然而，我们缺乏良好的证据基础来提出关于使用 互补性和替代性办法。 瑜伽是非常受欢迎的练习，被吹捧为增强身体、精神和精神的健康。许多 患有创伤后应激障碍的退伍军人将瑜伽作为康复计划的一部分，经常寻求精神以外的治疗 卫生系统。初步证据表明，这种做法导致了临床上显著的症状变化，但 结果还不确定，特别是在退伍军人中。因此，该项目将提供更多关于功效的数据。 对于患有创伤后应激障碍的退伍军人来说，瑜伽比体力活动更重要。 瑜伽文献尚无定论的一个原因可能是瑜伽方式的巨大异质性 瑜伽就是在其中实施的。通过了解瑜伽影响创伤后应激障碍症状的机制， 可以确定普遍的变化过程。因此，这个项目将检验两种不同的理论 可能解释瑜伽临床效果的模型。随着3000万美国人练习瑜伽，传播 一项具体的协议将是不可行的。尽管如此，对创伤敏感的瑜伽指南，重点是 主要是关于受创伤的个人对这种做法的可接受性，似乎与更好的 创伤后应激障碍患者的结果。这项工作将有助于将这类准则扩大到包括实践 优化主动改变机制的功能，以最大限度地提高瑜伽对创伤后应激障碍的影响 症状。 建议的研究是一项随机对照试验，涉及192名来自旧金山的患有创伤后应激障碍的退伍军人。 迭戈地区。这些退伍军人将随机接受手动哈他瑜伽干预或 支持性体力活动控制条件。这两种干预措施都将由训练有素的讲师在 在12周的时间内进行小组设置。临床结果和方法学变量的评估将需要 放置在干预前、干预期间、干预后立即和干预后3个月。分析将重点放在以下方面的变化 随时间变化的干预组以及与候选人相关的变化程度 机械装置。 这项研究的结果也有可能为退伍军人传授瑜伽的方式提供参考 以增加关于可改善创伤后应激障碍的潜在过程的知识。因为 正在评估的机制是跨诊断的，这项工作可能会延伸到情绪和焦虑的治疗 疾病也是如此。鉴于创伤后应激障碍患者对瑜伽的高需求以及 这种做法已经在许多临床环境中提供，这项研究的结果将立即 切合实际。研究结果还可能通过以下方式指导未来在补充和替代方法方面的研究 展示针对不同变化过程的原则，以创建综合护理计划。

Posttraumatic stress disorder (PTSD) is a chronic, debilitating condition with a broad negative impact on physical and mental health functioning. Excellent, empirically-supported interventions for PTSD are readily available to Veterans, but the majority of patients who receive the best available treatments continue to have a diagnosable disorder after treatment. This suggests that complementary interventions may be useful to fully restore functioning. In addition, many patients seek alternatives to psychotherapy or pharmacotherapy. This is evident in the increasing numbers of individuals with PTSD are turning to alternative approaches. At present, however, we lack a good evidence base from which to make recommendations about the use of complementary and alternative approaches. Yoga is very popular practice, touted to enhance physical, mental and spiritual well-being. Many veterans with PTSD have turned to yoga as a part of their recovery plan, often seeking care outside the mental health system. Initial evidence suggests that the practice leads to clinically significant change in symptoms, but results are yet inconclusive, particularly in Veterans. Thus, this project will provide additional data as to efficacy of yoga as compared to physical activity for Veterans with PTSD. One reason that the yoga literature is yet inconclusive may be the tremendous heterogeneity in the way in which the yoga is implemented. By understanding the mechanisms by which yoga affects PTSD symptoms, universal change processes can be identified. This project, therefore, will examine two different theoretical models that may account for yoga’s clinical effect. With 30 million Americans practicing yoga, dissemination of a specific protocol would not be practicable. Nonetheless, guidelines for trauma-sensitive yoga, which focus primarily on acceptability of the practice for traumatized individuals, appear to be associated with better outcomes for those with PTSD. This work would facilitate the extension of such guidelines to include practice features that optimize active mechanisms of change in order to that maximize the impact of yoga on PTSD symptoms. The proposed study is a randomized controlled trial involving 192 Veterans with PTSD from the San Diego area. These Veterans will be randomized to receive a manualized hatha yoga intervention or a supportive physical activity control condition. Both interventions will be delivered by trained instructors in a group setting over a 12-week period. Assessment of clinical outcomes and methodological variables will take place before, during, immediately after, and 3-months after the intervention. Analyses will focus on change in the intervention groups over time and the degree to which change is associated with the candidate mechanisms. Results of this study have the potential to inform the way in which yoga is delivered to Veterans as well as to increase knowledge about the underlying processes by which PTSD can be ameliorated. Because the mechanisms being evaluated are transdiagnostic, the work may extend to the treatment of mood and anxiety disorders as well. Given the high demand for yoga demand by individuals with PTSD and the degree to which the practice is already being provided in many clinical settings, findings from this study will be immediately relevant. Findings may also guide future research in complementary and alternative approaches by demonstrating the principle of targeting different processes of change to create an integrative care plan.