Trauma-Sensitive Yoga for Female Veterans With PTSD Who Experienced Military Sexual Trauma (PSL II)
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ClinicalTrials.gov Identifier: NCT02640690 |
Recruitment Status :
Completed
First Posted : December 29, 2015
Last Update Posted : October 14, 2022
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Condition or disease | Intervention/treatment | Phase |
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Stress Disorders, Post-traumatic | Behavioral: Trauma Center Trauma Sensitive Yoga Intervention (TCTSY) Behavioral: Cognitive Processing Therapy | Not Applicable |
Objectives: The overall goal of this project is to maximize the health, social functioning, and quality of life of women Veterans with posttraumatic stress disorder (PTSD) who have experienced military sexual trauma (MST). The specific aims of this randomized controlled trial (RCT) are to evaluate the effectiveness of a trauma-sensitive yoga intervention designed specifically for women who experienced sexual trauma as compared to a gold-standard PTSD treatment, Cognitive Processing Therapy, to 1) treat PTSD and its co-morbid symptoms of chronic pain and insomnia, 2) improve social functioning and quality of life, and 3) reduce the biological and psychophysiologic responses associated with PTSD in women Veterans who experienced MST.
Research Plan: This five year RCT is the next step following the NRI Pilot Study (NRI 12-417) in which the investigators demonstrated the feasibility of recruitment, retention, randomization, intervention implementation, and data collection, including biological and psychophysiological data. Women Veterans seeking treatment for PTSD were recruited from a primary site (southeast US) and second site (northwest US) and were randomized to Trauma Center Trauma-Sensitive Yoga (TCTSY) (10 weekly sessions) or Cognitive Processing Therapy (CPT) (12 weekly sessions); both intervention protocols are data-driven. The target enrollment sample size is 210, with a target final sample of 100 or more. The investigators are conservatively allowing for 50%-60% retention, based on pilot study results.
Methods: Data Collection: Data are collected at four points, baseline through 3-months post-intervention. Outcome measures include self-report, clinical assessments and biologic and psychophysiologic markers. Specific outcomes include PTSD symptom severity, chronic pain, insomnia, social functioning, quality of life, cytokines (IL-6, IL-10), C-reactive protein, heart rate variability, and dark-enhanced startle. Data Analysis: Comparisons between the groups at baseline will be run using t-tests, Mann Whitney non-parametric tests, and chi-square tests as appropriate. Multilevel mixed models (MLM) will be used to analyze the differences between the groups over time. MLM adjusts for attrition (missing data) over time and applies appropriate correlation structure between the time points.
Clinical Relevance: Women Veterans experience MST and PTSD at alarming rates; consistently reported prevalence rates for both among VHA patient samples are 20% or more. MST and PTSD put this population at risk for significant physical and mental health symptoms, including chronic pain, suicide, and negative health behaviors. This RCT may provide sufficient evidence to support an innovative, complementary and alternative PTSD treatment for women Veterans who experienced MST. The positive effects of reducing distressing symptoms and PTSD-related psychophysiological stress would likely improve social functioning and quality of life and minimize the significant medical consequences of PTSD in this population. This new, evidence-based PTSD treatment could supplement existing evidence-based PTSD treatment modalities. Clinical guidelines for this innovative intervention based on evidence from this clinical trial could be disseminated to and implemented in VA Medical Centers nationwide.
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 200 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | Trauma-sensitive Yoga for Female Veterans With PTSD Who Experienced Military Sexual Trauma |
Actual Study Start Date : | January 1, 2016 |
Actual Primary Completion Date : | February 26, 2021 |
Actual Study Completion Date : | September 30, 2021 |

Arm | Intervention/treatment |
---|---|
Experimental: Trauma Center Trauma-Sensitive Yoga (TCTSY)
10-weekly 1-hour TCTSY Sessions
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Behavioral: Trauma Center Trauma Sensitive Yoga Intervention (TCTSY)
(10) 1-hour sessions of trauma sensitive yoga |
Active Comparator: Cognitive Processing Therapy (CPT)
12-weekly 1.5 hour CPT Sessions
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Behavioral: Cognitive Processing Therapy
(12) 1.5 hour sessions of cognitive processing therapy
Other Name: Cognitive Processing Therapy-Cognitive |
- Determine the effectiveness of TSY compared to CPT over time in reducing PTSD symptoms, chronic pain, and insomnia [ Time Frame: Baseline; Mid-Treatment (TSY, 5 weeks: CPT, 6 weeks); 2-Weeks Post-Treatment; 3-Months Post-Treatment ]Participants in the TSY group will show statistically and clinically meaningful reductions in PTSD symptoms, chronic pain and insomnia, Clinician Administered PTSD Scale (CAPS) scores, PTSD Checklist-5 (PCL-5) scores, Brief Pain Inventory (BPI) scores, Pittsburgh Sleep Quality Index (PSQI) scores) compared to CPT group results following treatment.
- To evaluate the effectiveness of TSY as compared to CPT over time in improving quality of life and social functioning in women Veterans with PTSD related to MST. [ Time Frame: Baseline; Mid-Treatment (TSY, 5 weeks: CPT, 6 weeks); 2-Weeks Post-Treatment; 3-Months Post-Treatment ]
Participants in the TSY group will show statistically and clinically meaningful improvements in quality of life and social functioning (PROMIS measures) compared to CPT group results.
- PROMIS v2.0 (Short Forms 4a) Ability to Participate in Social Roles and Activities, Social Isolation, Satisfaction with Social Roles and Activities, and Emotional Support; VR12/SF12.
- To evaluate the effectiveness of TSY as compared to CPT over time in alterations in C-reactive proteins. [ Time Frame: Baseline; 2-Weeks Post-Treatment; 3-Months Post-Treatment ]
Participants in the TSY group will show statistically and clinically meaningful changes in biological stress response (C-reactive protein).
Alterations in C-reactive protein is associated with symptoms that commonly co-occur with PTSD, including depressive symptoms, fatigue, chronic tissue inflammation, and enhanced sensitivity to pain.
-Blood samples will collected and analyzed by a laboratory.
- To evaluate the effectiveness of TSY as compared to CPT over time in elevations in pro-inflammatory cytokines. [ Time Frame: Baseline; 2-Weeks Post-Treatment; 3-Months Post-Treatment ]
Participants in the TSY group will show statistically and clinically meaningful changes in biological stress response (inflammatory cytokines).
Elevations in pro-inflammatory cytokines, including IL-6 and IL-10, have been shown to correlate with increasing pain intensity in patients with chronic pain, psychological stress, and PTSD. IL-6 has been shown to act as a messenger relaying chemotactic peripheral immune signals to the central nervous system. In addition, IL-6 has been established as part of the biochemical sleep regulatory process.
-Blood samples will collected and analyzed by a laboratory.
- To evaluate the effectiveness of TSY as compared to CPT over time in parasympathetic and sympathetic nervous systems [ Time Frame: Baseline; 2-Weeks Post-Treatment; 3-Months Post-Treatment ]
Participants in the TSY group will show statistically and clinically meaningful changes in biological stress response (nervous system).
Heart rate variability reflects the central nervous system's ability to respond immediately to fluctuations in blood pressure occurring with each beat. Decreased heart rate variability has been correlated with morbidity and mortality from diverse diseases, including anxiety and depression and cardiovascular disease.
- Electrocardiographic monitoring of the R-R interval using portable recording device.
- To evaluate the effectiveness of TSY as compared to CPT over time in autonomic electrocardiogram markers (QT interval). [ Time Frame: Baseline; 2-Weeks Post-Treatment; 3-Months Post-Treatment ]
Participants in the TSY group will show statistically and clinically meaningful changes in biological stress response (autonomic ECG markers).
- 12-lead electrocardiogram
- To evaluate the effectiveness of TSY as compared to CPT over time in levels of fear and anxiety. [ Time Frame: Baseline; 2-Weeks Post-Treatment; 3-Months Post-Treatment ]
Participants in the TSY group will show statistically and clinically meaningful changes in biological stress response (acoustic startle response).
- BIOPAC MP150 Psychophysiological Recording System
Dark-enhanced startle is an ecologically valid psychophysiological paradigm for assessing contextual levels of fear and anxiety. Dark-enhanced startle is a laboratory analogue of sustained anxiety and represents a clinically useful tool for assessing anxiety-like behaviors and hyperarousal as they relate to symptom severity.

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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | Female |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Women Veterans who experienced MST
- Diagnosed with PTSD related to MST
- Insomnia
- Willing to participate in either TCTSY or CPT study intervention
Exclusion Criteria:
- Schizophrenia with significant psychotic symptoms
- Current, active suicidal intent or plan
- Current substance abuse or dependence
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Certain medical conditions that can contribute significantly to psychiatric symptoms, including:
- poorly controlled hypo/hyperthyroidism
- kidney or liver failure
- Dementia
- Moderate or severe traumatic brain injury (TBI) or other cognitive impairment sufficient to interfere with ability to give informed consent
- Pain due to acute injury (<3 months), post-surgical pain (<3 months) or pain due to malignancy; pain related to injury and surgery are excluded to reduce risk of exacerbating underlying injury
- Receiving mental health treatment outside of the VA
- Ongoing participation in mental health treatment at odds with study intervention (For Example: yoga, trauma-focused treatment)

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02640690
United States, Georgia | |
Atlanta VA Medical and Rehab Center, Decatur, GA | |
Decatur, Georgia, United States, 30033 | |
United States, Oregon | |
VA Portland Health Care System, Portland, OR | |
Portland, Oregon, United States, 97239 |
Principal Investigator: | Ursula Ann Kelly, PhD MSN BA | Atlanta VA Medical and Rehab Center, Decatur, GA |
Responsible Party: | VA Office of Research and Development |
ClinicalTrials.gov Identifier: | NCT02640690 |
Other Study ID Numbers: |
NRI 15-151 |
First Posted: | December 29, 2015 Key Record Dates |
Last Update Posted: | October 14, 2022 |
Last Verified: | October 2022 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Product Manufactured in and Exported from the U.S.: | No |
Stress Disorders, Post-traumatic Yoga Cognitive Therapy Chronic Pain Veterans |
cytokines acoustic startle reflex women heart rate variability sexual trauma |
Stress Disorders, Traumatic Stress Disorders, Post-Traumatic Sexual Trauma Trauma and Stressor Related Disorders Mental Disorders |