Breathing Meditation Intervention for Post Traumatic Stress Disorder
Study Details
Study Description
Brief Summary
Post traumatic stress disorder (PTSD) is a condition that develops as a result of exposure to a traumatic event. The purpose of this study is to determine whether a breathing meditation technique (Sudarshan Kriya Yoga; SKY) provides a treatment benefit that is as effective as the standard intervention. Patients' PTSD symptoms will be monitored before treatment, at the end of treatment, one month after treatment and 12 months after treatment.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
N/A |
Detailed Description
Post traumatic stress disorder (PTSD) is a condition that develops as a result of exposure to a traumatic event and is characterized by intense physiological and psychological reactivity to stimuli associated with that trauma. PTSD represents a substantial proportion of the burden of illness among Veterans. A recent study found that PTSD was diagnosed in 13% of Veterans returning from Iraq and Afghanistan. Recent reports have also highlighted that PTSD is associated with suicidality - a fact that may explain the alarming rise of suicidal behavior amongst returning Veterans. Several studies suggest that meditation-based treatments may be helpful in treating PTSD. Sudarshan Kriya Yoga (SKY) is a meditation technique that involves a sequence of breathing exercises and has shown promise in treating PTSD. There are several lines of evidence to suggest that such meditation techniques provide a solid foundation for treating PTSD. First, breathing meditation techniques offer a powerful method for balancing autonomic nervous system activity that is often heightened in PTSD. Second, they promote the relaxation response that counters hyperarousal and results in a calmer approach to difficulties and challenges. Third, they may improve sleep quality. This may be important in treating PTSD because memories are encoded into long-term storage during sleep via a process known as consolidation. It is possible that the disturbed sleep which is common in PTSD (nightmares and insomnia) lead to disrupted memory consolidation. Therefore improvement in sleep may lead to improvement in PTSD.
Despite promising findings, meditation has not been sufficiently studied in Veterans to recommend its widespread use in treating PTSD. The goal of this proposal is to examine the effects of SKY meditation therapy on Veterans with clinically significant PTSD symptoms. SKY intervention will be compared to cognitive processing therapy (CPT) that is commonly used to treat Veterans with PTSD. CPT will be given as a "cognitive only" version (CPT-C) which is efficacious in treating PTSD. Veterans will be randomly assigned to one of the two groups (SKY, CPT-C; n=38 per group) and treatment will be delivered over a six-week period. A "noninferiority" experimental design will be used as is appropriate for trials in which the primary objective is to show that a novel intervention (SKY) is as effective as the standard intervention. Patients' PTSD symptoms will be monitored across time; before treatment (i.e., baseline), at the end of treatment, one month after treatment and 12 months after treatment. Other measures will be taken at baseline and at the end of treatment, and will include autonomic arousal (heart rate) and cognitive functioning including memory consolidation. The investigators will also monitor dropout rates as these can be high in conventional PTSD treatment programs. Based on preliminary studies using SKY in Veterans with PTSD and the existing literature, the investigators expect that PTSD symptom severity will be reduced following treatment with SKY, that this effect will not be clinically inferior to CPT-C and that the dropout rates will be no higher than CPT-C. Such findings would provide strong evidence for the efficacy of SKY in treating Veterans with PTSD. The investigators also expect that improvements in clinical measures of PTSD will correlate with improvements in memory consolidation, reflecting improvements in sleep following treatment. It is also likely that the individual's response to treatment will be influenced by their baseline characteristics. The SKY and CBT-C interventions focus on different aspects of PTSD; the SKY intervention focuses on breathing and relaxation techniques whereas CPT-C focuses on modifying the understanding of trauma through cognitive restructuring. For this reason the SKY intervention may be more effective for Veterans who have exaggerated arousal (e.g. heightened heart rate). In contrast the CPT-C intervention may be more effective for Veterans who have more cognitive symptoms (e.g., flashbacks, attentional difficulties) since CPT-C addresses cognitive processes. The long term goal of this project is to conduct a fully-powered multi-center randomized controlled clinical trial of SKY meditation in Veterans.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: SKY a standardized meditation program |
Behavioral: SKY meditation
SKY (Sudarshan Kriya Yoga) meditation is a standardized, manual-based and replicable program that includes relaxation techniques as well as periods of discussion. The format is a 7-day intensive group class (2 1/2 hours/day intensive format) followed by five weeks of sessions twice per week (1hr/session). SKY meditation incorporates several types of breathing exercises involving arousal and attentional control. Initial breathing exercises are calming and focusing. Subsequent breathing exercises are more fully engaging energizing, allowing the practitioner to focus more fully in each moment.
|
Active Comparator: CPT-C CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. |
Behavioral: CPT-C
CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Change in PTSD Checklist (PCL) [baseline, after treatment (six weeks), one month after treatment, and one year after treatment]
Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C) (Blanchard et al., 1996) is a 17-item self- report scale that assesses PTSD symptom severity in the past month corresponding to DSM-IV criteria for PTSD. Scores range from 17-85 with higher scores reflecting greater severity. We used the civilian version to assess symptoms from both military and non-military trauma.
Secondary Outcome Measures
- Change in Beck Depression Inventory II (BDI-II) [baseline, after treatment (six weeks), one month after treatment, and one year after treatment]
The BDI-II scale is a 21-item self-report measure that assesses depression symptom severity. Items are rated on a 4-point scale according to how much the symptom bothered the respondent over the prior two weeks. Scores range from 0-63 with higher scores reflecting greater severity.
- Change in Positive and Negative Affect Schedule (PANAS) [baseline, after treatment (six weeks), one month after treatment, and one year after treatment]
A 20-item self-report measure assessing positive and negative mood states over "the past few weeks" on a 5-point scale. Scores for positive and negative affect range from 10-50 with higher scores reflecting stronger affect.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Veteran from any conflict era
-
Symptoms of Posttraumatic Stress Disorder measured during study screening (scoring ≥38 on the PCL-5)
Exclusion Criteria:
-
planning on starting a new course of behavioral therapy during the trial
-
started new medication for PTSD within 8 weeks of the study screening
-
participation in another study
-
mania or psychosis within the past 6 months
-
suicidal or homicidal intent within the past 60 days
-
substance dependence (other than nicotine) within the past 30 days,
-
seizure disorder
-
severe traumatic brain injury
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | VA Palo Alto Health Care System, Palo Alto, CA | Palo Alto | California | United States | 94304-1290 |
Sponsors and Collaborators
- VA Office of Research and Development
Investigators
- Principal Investigator: Peter J Bayley, PhD, VA Palo Alto Health Care System, Palo Alto, CA
Study Documents (Full-Text)
More Information
Publications
None provided.- D1485-R
- IRX001485A
Study Results
Participant Flow
Recruitment Details | |
---|---|
Pre-assignment Detail |
Arm/Group Title | Sudarshan Kriya Yoga | CPT-C |
---|---|---|
Arm/Group Description | a standardized meditation program SKY meditation: SKY (Sudarshan Kriya Yoga) meditation is a standardized, manual-based and replicable program that includes relaxation techniques as well as periods of discussion. The format is a 7-day intensive group class (2 1/2 hours/day intensive format) followed by five weeks of sessions twice per week (1hr/session). SKY meditation incorporates several types of breathing exercises involving arousal and attentional control. Initial breathing exercises are calming and focusing. Subsequent breathing exercises are more fully engaging energizing, allowing the practitioner to focus more fully in each moment. | CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. CPT-C: CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. |
Period Title: Overall Study | ||
STARTED | 41 | 44 |
COMPLETED | 30 | 29 |
NOT COMPLETED | 11 | 15 |
Baseline Characteristics
Arm/Group Title | Sudarshan Kriya Yoga | CPT-C | Total |
---|---|---|---|
Arm/Group Description | a standardized meditation program SKY meditation: SKY (Sudarshan Kriya Yoga) meditation is a standardized, manual-based and replicable program that includes relaxation techniques as well as periods of discussion. The format is a 7-day intensive group class (2 1/2 hours/day intensive format) followed by five weeks of sessions twice per week (1hr/session). SKY meditation incorporates several types of breathing exercises involving arousal and attentional control. Initial breathing exercises are calming and focusing. Subsequent breathing exercises are more fully engaging energizing, allowing the practitioner to focus more fully in each moment. | CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. CPT-C: CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. | Total of all reporting groups |
Overall Participants | 41 | 44 | 85 |
Age (years) [Mean (Standard Deviation) ] | |||
Mean (Standard Deviation) [years] |
56.9
(13.6)
|
56.2
(11.7)
|
56.6
(12.7)
|
Sex: Female, Male (Count of Participants) | |||
Female |
7
17.1%
|
3
6.8%
|
10
11.8%
|
Male |
34
82.9%
|
41
93.2%
|
75
88.2%
|
Ethnicity (NIH/OMB) (Count of Participants) | |||
Hispanic or Latino |
26
63.4%
|
31
70.5%
|
57
67.1%
|
Not Hispanic or Latino |
11
26.8%
|
9
20.5%
|
20
23.5%
|
Unknown or Not Reported |
4
9.8%
|
4
9.1%
|
8
9.4%
|
Race (NIH/OMB) (Count of Participants) | |||
American Indian or Alaska Native |
0
0%
|
0
0%
|
0
0%
|
Asian |
1
2.4%
|
4
9.1%
|
5
5.9%
|
Native Hawaiian or Other Pacific Islander |
0
0%
|
0
0%
|
0
0%
|
Black or African American |
8
19.5%
|
5
11.4%
|
13
15.3%
|
White |
23
56.1%
|
29
65.9%
|
52
61.2%
|
More than one race |
0
0%
|
0
0%
|
0
0%
|
Unknown or Not Reported |
9
22%
|
6
13.6%
|
15
17.6%
|
Region of Enrollment (participants) [Number] | |||
United States |
41
100%
|
44
100%
|
85
100%
|
Outcome Measures
Title | Change in PTSD Checklist (PCL) |
---|---|
Description | Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C) (Blanchard et al., 1996) is a 17-item self- report scale that assesses PTSD symptom severity in the past month corresponding to DSM-IV criteria for PTSD. Scores range from 17-85 with higher scores reflecting greater severity. We used the civilian version to assess symptoms from both military and non-military trauma. |
Time Frame | baseline, after treatment (six weeks), one month after treatment, and one year after treatment |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Sudarshan Kriya Yoga | CPT-C |
---|---|---|
Arm/Group Description | a standardized meditation program SKY meditation: SKY (Sudarshan Kriya Yoga) meditation is a standardized, manual-based and replicable program that includes relaxation techniques as well as periods of discussion. The format is a 7-day intensive group class (2 1/2 hours/day intensive format) followed by five weeks of sessions twice per week (1hr/session). SKY meditation incorporates several types of breathing exercises involving arousal and attentional control. Initial breathing exercises are calming and focusing. Subsequent breathing exercises are more fully engaging energizing, allowing the practitioner to focus more fully in each moment. | CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. CPT-C: CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. |
Measure Participants | 41 | 44 |
change from baseline to end of treatment |
-5.6
(9.5)
|
-6.8
(11.4)
|
change from baseline to one month after treatment |
-4.8
(10.5)
|
-6.8
(11.9)
|
change from baseline to one year after treatment |
-4.4
(11.4)
|
-6.2
(10.7)
|
Title | Change in Beck Depression Inventory II (BDI-II) |
---|---|
Description | The BDI-II scale is a 21-item self-report measure that assesses depression symptom severity. Items are rated on a 4-point scale according to how much the symptom bothered the respondent over the prior two weeks. Scores range from 0-63 with higher scores reflecting greater severity. |
Time Frame | baseline, after treatment (six weeks), one month after treatment, and one year after treatment |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Sudarshan Kriya Yoga | CPT-C |
---|---|---|
Arm/Group Description | a standardized meditation program SKY meditation: SKY (Sudarshan Kriya Yoga) meditation is a standardized, manual-based and replicable program that includes relaxation techniques as well as periods of discussion. The format is a 7-day intensive group class (2 1/2 hours/day intensive format) followed by five weeks of sessions twice per week (1hr/session). SKY meditation incorporates several types of breathing exercises involving arousal and attentional control. Initial breathing exercises are calming and focusing. Subsequent breathing exercises are more fully engaging energizing, allowing the practitioner to focus more fully in each moment. | CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. CPT-C: CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. |
Measure Participants | 41 | 44 |
Change from baseline to end of treatment |
-6.1
(6.8)
|
-3.6
(10.9)
|
Change from baseline to one month after treatment |
-4.7
(8.7)
|
-2.8
(11.7)
|
Change from baseline to one year after treatment |
-5.6
(9.6)
|
-4.5
(10.0)
|
Title | Change in Positive and Negative Affect Schedule (PANAS) |
---|---|
Description | A 20-item self-report measure assessing positive and negative mood states over "the past few weeks" on a 5-point scale. Scores for positive and negative affect range from 10-50 with higher scores reflecting stronger affect. |
Time Frame | baseline, after treatment (six weeks), one month after treatment, and one year after treatment |
Outcome Measure Data
Analysis Population Description |
---|
[Not Specified] |
Arm/Group Title | Sudarshan Kriya Yoga | CPT-C |
---|---|---|
Arm/Group Description | a standardized meditation program SKY meditation: SKY (Sudarshan Kriya Yoga) meditation is a standardized, manual-based and replicable program that includes relaxation techniques as well as periods of discussion. The format is a 7-day intensive group class (2 1/2 hours/day intensive format) followed by five weeks of sessions twice per week (1hr/session). SKY meditation incorporates several types of breathing exercises involving arousal and attentional control. Initial breathing exercises are calming and focusing. Subsequent breathing exercises are more fully engaging energizing, allowing the practitioner to focus more fully in each moment. | CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. CPT-C: CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. |
Measure Participants | 41 | 44 |
PANAS positive: change from baseline to end of treatment |
2.5
(5.8)
|
0.3
(5.9)
|
PANAS positive: change from baseline to one month after treatment |
1.3
(8.6)
|
-1.3
(7.1)
|
PANAS positive: change from baseline to one year after treatment |
-0.1
(10.5)
|
0.4
(7.0)
|
PANAS negative: change from baseline to end of treatment |
-3.2
(4.6)
|
-0.9
(8.8)
|
PANAS negative: change from baseline to one month after treatment |
-2.9
(6.7)
|
-1.2
(8.4)
|
PANAS negative: change from baseline to one year after treatment |
-1.8
(8.2)
|
-1.7
(8.0)
|
Adverse Events
Time Frame | baseline to one year posttreatment (i.e. 58 weeks) | |||
---|---|---|---|---|
Adverse Event Reporting Description | Study staff conducted safety evaluations and followed safety protocols whenever a participant endorsed any suicidal or homicidal ideation, including via self report measures. | |||
Arm/Group Title | Sudarshan Kriya Yoga | CPT-C | ||
Arm/Group Description | a standardized meditation program SKY meditation: SKY (Sudarshan Kriya Yoga) meditation is a standardized, manual-based and replicable program that includes relaxation techniques as well as periods of discussion. The format is a 7-day intensive group class (2 1/2 hours/day intensive format) followed by five weeks of sessions twice per week (1hr/session). SKY meditation incorporates several types of breathing exercises involving arousal and attentional control. Initial breathing exercises are calming and focusing. Subsequent breathing exercises are more fully engaging energizing, allowing the practitioner to focus more fully in each moment. | CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. CPT-C: CPT-C (Cognitive Processing Therapy-cognitive only) is a standardized, manual-based treatment consisting of 12, 60-minute sessions which will be given twice per week. Sessions will focusing on specific issues, learning new therapeutic techniques and setting up homework for the following session including real-life application of learned CPT techniques. | ||
All Cause Mortality |
||||
Sudarshan Kriya Yoga | CPT-C | |||
Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
Total | 0/41 (0%) | 0/44 (0%) | ||
Serious Adverse Events |
||||
Sudarshan Kriya Yoga | CPT-C | |||
Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
Total | 0/41 (0%) | 1/44 (2.3%) | ||
Psychiatric disorders | ||||
Admission to inpatient psychiatry | 0/41 (0%) | 0 | 1/44 (2.3%) | 1 |
Other (Not Including Serious) Adverse Events |
||||
Sudarshan Kriya Yoga | CPT-C | |||
Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
Total | 0/41 (0%) | 1/44 (2.3%) | ||
Psychiatric disorders | ||||
Distressed and lost to follow up | 0/41 (0%) | 0 | 1/44 (2.3%) | 1 |
Limitations/Caveats
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
Name/Title | Peter Bayley, PhD |
---|---|
Organization | War Related Illness and Injury Study Center, VA Palo Alto Healthcare System |
Phone | 650 493-5000 ext 68653 |
peter.bayley@va.gov |
- D1485-R
- IRX001485A