Mechanisms of Change in Yoga and Physical Activity for Veterans

退伍军人瑜伽和身体活动的变化机制

• 批准号: 10439606
• 负责人: Ariel J Lang
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10439606
• 关键词: Address; Affect; Aftercare; American; Anger; Anxiety; Anxiety Disorders; Area; Attention; Caring; Chronic; Clinical; Conflict (Psychology); Coping Skills; Data; Development; Disease; Elements; Exercise; Fostering; Future; Goals; Guidelines; Health; Health system; Heterogeneity; Individual; Interruption; Intervention; Knowledge; Lead; Literature; Measures; Mediating; Mediation; Mental Depression; Mental Health; Methodology; Modeling; Mood Disorders; Morbidity - disease rate; Movement; Outcome; Patients; Personal Satisfaction; Pharmacotherapy; Physical activity; Post-Traumatic Stress Disorders; Practice Guidelines; Process; Protocols documentation; Psyche structure; Psychotherapy; Publishing; Randomized; Randomized Controlled Trials; Recommendation; Recovery; Research; Sleep; Standardization; Symptoms; Teacher Professional Development; Theoretical model; Time; Trauma; Veterans; Work; Yoga; associated symptom; attentional control; base; care seeking; clinical effect; clinical outcome assessment; clinical practice; clinically significant; coping; efficacy evaluation; evidence base; functional outcomes; functional restoration; group intervention; meetings; military veteran; mindfulness; mortality; physical conditioning; psychologic; reduce symptoms; symptomatology; treatment planning; treatment strategy

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.

创伤后应激障碍 (PTSD) 是一种慢性、令人衰弱的疾病，具有广泛的负面影响 创伤后应激障碍 (PTSD) 的优秀、有经验支持的干预措施很容易实现。 退伍军人可以使用，但大多数接受最佳可用治疗的患者仍然有 这表明补充干预措施可能有助于充分治疗后诊断出疾病。 此外，许多患者寻求心理治疗或药物治疗的替代方法。 越来越多的创伤后应激障碍患者正在转向其他方法，这一点显而易见。 然而，我们缺乏良好的证据基础来提出关于使用 补充和替代方法。 瑜伽是一种非常流行的练习，被誉为可以增强身体、心理和精神健康。 患有创伤后应激障碍 (PTSD) 的退伍军人已将瑜伽作为康复计划的一部分，他们经常寻求精神以外的护理 初步证据表明，这种做法会导致临床症状发生显着变化，但是 结果尚无定论，特别是在退伍军人中，因此，该项目将提供有关功效的额外数据。 与患有创伤后应激障碍 (PTSD) 的退伍军人相比，瑜伽与体力活动的比较。 瑜伽文献尚无定论的原因之一可能是瑜伽方式的巨大异质性 通过了解瑜伽影响创伤后应激障碍症状的机制， 因此，这个项目将研究两种不同的理论。 可能解释瑜伽临床效果的模型随着 3000 万美国人练习瑜伽，传播了瑜伽。 然而，针对创伤敏感瑜伽的指导方针并不可行。 主要取决于受创伤个体的做法的可接受性，似乎与更好的 这项工作将有助于扩展此类指南以包括实践。 优化主动变化机制的功能，以最大限度地发挥瑜伽对 PTSD 的影响 症状。 拟议的研究是一项随机对照试验，涉及 192 名来自旧金山、患有 PTSD 的退伍军人。 这些退伍军人将被随机接受手动哈他瑜伽干预或瑜伽治疗。 两种干预措施都将由经过培训的教练在支持性身体活动控制条件下进行。 将在 12 周内对临床结果和方法学变量进行评估。 干预前、干预期间、干预后立即和干预后 3 个月的分析将重点关注干预的变化。 随着时间的推移干预组以及变化与候选人相关的程度 机制。 这项研究的结果也有可能为退伍军人提供瑜伽的方式提供信息 增加对改善 PTSD 的基本过程的了解。 正在评估的机制是跨诊断的，工作可能会扩展到情绪和焦虑的治疗 考虑到患有创伤后应激障碍 (PTSD) 的人对瑜伽的需求量很大，而且需求的程度也很高。 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公布 研究结果还可以指导未来的补充和替代方法的研究。 展示针对不同变革过程来创建综合护理计划的原则。