Mechanisms of Change in Yoga and Physical Activity for Veterans

创伤后应激障碍（PTSD）是一种慢性的，使人衰弱的疾病，具有广泛的负面影响 身体和心理健康的功能。创伤后应激障碍的优秀的、有医疗支持的干预措施很容易 但大多数接受最佳治疗的患者仍然有一个 治疗后可诊断的疾病。这表明，补充性干预措施可能有助于充分 恢复功能。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PTSD患者转向其他方法。目前， 然而，我们缺乏一个良好的证据基础来提出关于使用 补充和替代办法。 瑜伽是非常受欢迎的练习，被吹捧为增强身体，心理和精神健康。许多 患有创伤后应激障碍的退伍军人已经转向瑜伽作为他们恢复计划的一部分，通常寻求精神以外的护理。 卫生系统。初步证据表明，这种做法会导致临床症状发生显着变化，但 结果还不确定，特别是在退伍军人中。因此，本项目将提供关于疗效的额外数据 瑜伽与体力活动相比，对于患有创伤后应激障碍的退伍军人来说。 瑜伽文献尚无定论的一个原因可能是， 瑜伽是如何实施的。通过了解瑜伽影响创伤后应激障碍症状的机制， 可以识别普遍的变革过程。因此，本项目将研究两种不同的理论 瑜伽的临床效果的模型。随着3000万美国人练习瑜伽， 制定一项具体的议定书是不切实际的。尽管如此，创伤敏感瑜伽的指导方针， 主要是对创伤个人的做法的可接受性，似乎与更好地 对PTSD患者的影响这项工作将有助于扩大这些准则的范围， 优化积极的变化机制，以最大限度地发挥瑜伽对创伤后应激障碍的影响 症状 这项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状况。这两种干预措施都将由受过培训的教员以 在12周的时间里进行小组设置。临床结局和方法学变量的评估将 在干预前、干预期间、干预后立即和干预后3个月进行。分析将侧重于以下方面的变化： 随着时间的推移，干预组以及与候选人相关的变化程度 机制等 这项研究的结果也有可能为退伍军人提供瑜伽的方式 以增加关于PTSD可以改善的潜在过程的知识。因为 正在评估的机制是transdiagnosis，这项工作可能会扩展到情绪和焦虑的治疗 紊乱也是。鉴于创伤后应激障碍患者对瑜伽的需求很高， 实践已经在许多临床环境中提供，这项研究的结果将立即 相关的研究结果还可以指导未来的补充和替代方法的研究， 展示了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.