Decrease In Posttraumatic Stress Disorder Symptoms Research Articles

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Treating Veterans With PTSD and Borderline Personality Symptoms in a 12‐Week Intensive Outpatient Setting: Findings From a Pilot Program

Rates of comorbidity between borderline personality disorder and posttraumatic stress disorder (PTSD) are high in veteran populations, and clinicians are hesitant to treat PTSD given high rates of suicidality. Given promising early work integrating dialectical behavior therapy (DBT) and prolonged exposure (PE) therapy, we created a 12-week intensive outpatient program combining these two treatments. PE and DBT were provided concurrently to 33 veterans with PTSD symptoms and BPD symptoms at a large, midwestern Veteran Affairs medical center. Approximately half of the participants were male, with the majority identifying as Caucasian. Participants' ages ranged from 23 to 58 years, with a mean age of 43.21 years. The full-model of DBT was provided; PE was provided twice weekly for approximately 6 weeks of the program. Of participants, 22 veterans successfully completed the program with no dropout during PE. Large pre- to posttreatment effect sizes were found for decreases in PTSD symptoms (d = 1.61) and dysfunctional coping styles (d = 1.55), and an increase in the use of DBT skills (d = 1.02). A moderate effect size was found in the decrease of suicidal ideation (d = 0.64). The results of this pilot program suggest that PTSD can be safely and effectively treated among veterans with comorbid symptoms of borderline personality disorder through the combination of concurrent intensive DBT and PE.

The Effectiveness of Emotionally Focused Couples Therapy With Veterans With PTSD: A Pilot Study

ABSTRACTThe current study is a pilot project conducted at Baltimore VA Medical Center investigating the use of emotionally focused couples therapy (EFT) for couples in which one partner is a veteran who has been diagnosed with posttraumatic stress disorder (PTSD). Fifteen couples enrolled in the study and seven of these couples completed treatment (26 to 36 weekly sessions of EFT). Both partners were assessed on measures of relationship satisfaction, psychological distress, depression, and quality of life, and veterans were assessed on measures of PTSD symptoms at baseline and 2 weeks after the intervention. Paired t-tests were used to compare scores before and after EFT. In terms of results, the veterans' partners reported significant improvements in relationship and life satisfaction and in decreased depression and a decrease in psychological distress. Veterans demonstrated a significant decrease in self-reported symptoms of PTSD. These results provide preliminary evidence for the usefulness of EFT to help foster improved relationship satisfaction, and psychological well-being for veterans with PTSD and their partners who completed treatment.

Psychosocial interventions for post-traumatic stress disorder in refugees and asylum seekers resettled in high-income countries: Systematic review and meta-analysis.

Treatment of post-traumatic stress disorder (PTSD) in refugees and asylum seekers resettled in high-income countries presents specific challenges. This systematic review examined the effectiveness of psychosocial interventions for this group. We searched the Cochrane Central Register of randomised trials, CINAHL, EMBASE, PILOTS, PsycINFO, PubMed and Web of Science up to July 2016. Studies included randomised and controlled clinical trials comparing psychosocial interventions with waiting list or treatment as usual in adult refugees and asylum seekers with PTSD resettled in high-income countries. PTSD symptoms post-intervention was the primary outcome. We computed standardized mean differences (SMD) with 95% confidence intervals (CI). This study is registered with PROSPERO: CRD42015027843. Twelve studies were included in the meta-analysis. Psychosocial interventions were effective in decreasing PTSD symptoms relative to control groups (SMD -1·03, 95% CI -1·55 to -0·51; number needed to treat 4·4; I2 86%; 95% CI 77 to 91). Narrative exposure therapy, a manualized short-term variant of cognitive behavioural therapy with a trauma focus, was the best-supported intervention (5 RCTs, 187 participants, SMD -0·78, 95% CI -1·18 to -0·38, I2 37%; 95% CI 0 to 77). Methodological quality of the included studies was limited. Overall, psychosocial interventions for asylum seekers and refugees with PTSD resettled in high-income countries were found to provide significant benefits in reducing PTSD symptoms. Yet, the number of studies is small and their methodological quality limited, so that more rigorous trials should be conducted in the future.

Patient, Therapist, and System Factors Influencing the Effectiveness of Prolonged Exposure for Veterans With Comorbid Posttraumatic Stress Disorder and Traumatic Brain Injury

In contrast to concerns that cognitive limitations and neurobehavioral symptoms (NBS) associated with traumatic brain injury (TBI) may inhibit treatment effectiveness, a recent study found prolonged exposure (PE) led to large reductions in posttraumatic stress disorder (PTSD) symptoms among Iraq-Afghanistan veterans with a range of TBI severity (article by Wolf, Kretzmer, Crawford, Thors, Wagner, Strom, Eftekhari, Klenk, Hayward, and Vanderploeg [J Trauma Stress 28:339-347, 2015]). We further examined this sample of 69 veterans to determine whether system, veteran, and therapist factors predicted clinically significant responses. Results of hierarchical, logistic regressions revealed that therapist training in PE and lower service connection were associated with increased odds of large decreases in PTSD symptoms after adjusting for the robust effect of PE sessions completed. Other patient-level factors including age, time since injury, and baseline NBS were unrelated to significant improvements. Findings emphasized the impact of PE dosage, indicated greater mastery of the protocol was beneficial, and showed that service connection could impede self-reported, clinically significant change during PE in this important cohort.

After the Storm: Helping Children Cope with Trauma after Natural Disasters

The hurricane season for 2017 was plagued with catastrophic storms impacting millions of people in the US and its territories. Surviving a natural disaster can have a range of consequences including the development of post-traumatic stress disorder (PTSD). Those who are most susceptible to developing PTSD after a traumatic event are children. Hurricane Katrina was an event marked by severe deficits in the provision of care to residents in Louisiana and Mississippi causing increased PTSD symptoms that were preventable. No crisis intervention is perfect and lessons learned are applied to the next, similar event. Recommendations to plan for and recover from natural disasters to decrease PTSD symptoms based on studies conducted with children who survived Hurricane Katrina are discussed.

Journal Digest

Journal Digest

Evidence-based care for Iraqi, Kurdish, and Syrian asylum seekers and refugees of the Syrian civil war: A systematic review.

The start of the Syrian Civil War in 2011 displaced many from their homes. In the years since, Western countries have received an influx of Syrian asylum seekers and refugees. The United Nations High Commissioner for Refugees (UNHCR) defines an asylum seeker as someone who claims to be a refugee without those claims being verified (UNHCR, 1951). Thus, as these displaced people wait to qualify for international protection they are classed as asylum seekers. Consequently, a refugee is defined by the UNHCR as someone whoowing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country. (UNHCR, 1951, p. 3, para. 1)A recent poll by the UNHCR (2015) estimated there were 15.1 million refugees and 2.3 million asylum seekers worldwide by mid-2015, the highest rates recorded in 20 years, with Syrian refugees being the largest source by mid-2015 (4.2 million, apCisse proximately 24.1%). As part of the newly elected Canadian government's plan to resettle 25,000 refugees from Syria to Canada, it is crucial that such individuals are looked after for their humanitarian needs, including mental health.To determine whether an asylum seeker qualifies as a refugee they must demonstrate a well-found fear of persecution in their home country, and the legitimacy of this claim is determined by the host country. The refugee status determination is conducted by the state or the UNHCR-if the state is unable or unwilling. Once refugee status is awarded, refugees that are deemed low risk by the UNHCR or the state are contacted to determine whethere they are interested in being resettled to Canada. Canadian visa officers process refugees overseas in Beirut or Amman, interviewing interested refugees and conducting a full medical examination. As well, interested refugees undergo a security screening against immigration, law enforcement, and security databases using biometrics. Following that, refugee identification is verified before departure to the host country and once again upon arrival (Ministry of Justice Canada, 2001). As can be expected on the basis of the requirement of fear of persecution by one's home country in determining refugee status, elevated rates of posttraumatic stress disorder (PTSD) in refugees have been documented (Teodorescu et al., 2012). Moreover, interestingly, previous studies found that asylum seekers experienced more traumatic life events when compared to refugees and that PTSD symptom severity is predicted by a lack of refugee status (vs. asylum seeking status) and the number of traumatic life events experienced (Knipscheer et al., 2015; Nickerson et al., 2011; Stenmark et al., 2013). Although there are multiple factors that predict PTSD symptom severity, it is worthwhile to note that refugee status is potentially one that could be controlled for with faster processing of refugee applications without sacrificing the rigor of detailed security checks (Knipscheer et al., 2015). For example, Nickerson et al. (2011) found that refugees with temporary protection visa who were granted permanent residency demonstrated a decrease in PTSD symptoms and depression, along with an increase in quality of life, suggesting ease of transition into residency status can directly impact psychological symptoms and functioning. The most common fears identified in refugees indeed include being sent back to their country of origin, whereas on the other hand also include being unable to return home in case of emergencies. In other words, the cause of PTSD in asylum seekers and refugees may have begun with the conflict in their native country; however, stress experienced as a result of the process of becoming a refugee and seeking asylum in a foreign country has been shown to evoke further psychological disturbance. …

Cannabinoids and post-traumatic stress disorder: clinical and preclinical evidence for treatment and prevention.

There is substantial evidence from studies in humans and animal models for a role of the endocannabinoid system in the control of emotional states. Several studies have shown an association between exposure to trauma and substance use. Specifically, it has been shown that there is increased prevalence of cannabis use in post-traumatic stress disorder (PTSD) patients and vice versa. Clinical studies suggest that PTSD patients may cope with their symptoms by using cannabis. This treatment-seeking strategy may explain the high prevalence of cannabis use among individuals with PTSD. Preliminary studies in humans also suggest that treatment with cannabinoids may decrease PTSD symptoms including sleep quality, frequency of nightmares, and hyperarousal. However, there are no large-scale, randomized, controlled studies investigating this specifically. Studies in animal models have shown that cannabinoids can prevent the effects of stress on emotional function and memory processes, facilitate fear extinction, and have an anti-anxiety-like effect in a variety of tasks. Moreover, cannabinoids administered shortly after exposure to a traumatic event were found to prevent the development of PTSD-like phenotype. In this article, we review the existing literature on the use of cannabinoids for treating and preventing PTSD in humans and animal models. There is a need for large-scale clinical trials examining the potential decrease in PTSD symptomatology with the use of cannabis. In animal models, there is a need for a better understanding of the mechanism of action and efficacy of cannabis. Nevertheless, the end result of the current clinical and preclinical data is that cannabinoid agents may offer therapeutic benefits for PTSD.

Structured Approach Therapy for Combat-Related PTSD in Returning U.S. Veterans: Complementary Mediation by Changes in Emotion Functioning.

To address the impact of combat-related posttraumatic stress disorder (PTSD) on U.S. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans, the investigators developed a 12-session manualized PTSD treatment for couples called structured approach therapy (SAT). A randomized controlled trial had shown that 29 OEF/OIF veterans with combat-related PTSD who had participated in SAT showed significantly greater reductions in PTSD compared to 28 veterans receiving a 12-session PTSD family education intervention (Sautter, Glynn, Cretu, Senturk, & Vaught, 2015). We conducted supplemental follow-up and mediation analyses, which tested the hypothesis that changes in emotion functioning play a significant role in the decreases in PTSD symptoms primarily observed in veterans who had received SAT. Veterans assigned to the SAT condition showed significantly greater decreases than those assigned to PTSD family education in emotion regulation problems (p < .001, Cohen's f(2) = .18) and fear of intense emotions (p < .001, Cohen's f(2) = .152). Decreases in both emotion regulation problems (mediated effect:ab̂= .36), and fear of intense emotions (mediated effect:ab̂ = .24) were found to be complementary mediators of reductions in PTSD symptoms greater with SAT. These findings suggest that SAT may aid veterans in improving their ability to regulate trauma-related emotions.

Face to face but not in the same place: A pilot study of prolonged exposure therapy

ABSTRACTThis pilot study examined use of smartphone technology to deliver prolonged exposure (PE) therapy to patients with posttraumatic stress disorder (PTSD) with geographic limitations hindering in-person therapy. The primary goal was to examine the feasibility and acceptability of using video teleconferencing (i.e., computer-based and iPhone 4 streaming technology), with a secondary goal of examining clinical outcomes of PE delivered via teleconferencing compared with treatment as usual (TAU) on PTSD and depressive/anxious symptom reduction. Rural veterans (N = 27) were randomized to receive PE by computer teleconferencing at a Veterans Administration community clinic, PE by an iPhone issued for the duration of the study, or TAU provided by a referring clinician. To examine the research goals, we collected data on the number of referrals to the study, number of patients entering the study, and number completing psychotherapy and documented pragmatic and technical issues interfering with the ability to use teleconferencing to deliver PE; results are discussed. In addition, measures of symptom change examined clinical outcomes. Results indicated decreases in PTSD symptoms in veterans who completed PE therapy via teleconferencing; however, there was significantly more attrition in these groups than in the TAU group.

SLEEP AND TREATMENT OUTCOME IN POSTTRAUMATIC STRESS DISORDER: RESULTS FROM AN EFFECTIVENESS STUDY.

BackgroundMost patients with posttraumatic stress disorder (PTSD) suffer from sleep problems. Concerns have been raised about possible detrimental effects of sleep problems on the efficacy of psychological treatments for PTSD. In this study, we investigated the relation of session‐to‐session changes in PTSD symptoms and sleep, and tested whether sleep problems predicted poorer short‐ and long‐term treatment outcome.MethodsSelf‐reported sleep quality, sleep duration, and PTSD symptoms were assessed weekly in a consecutive sample of 246 patients who received cognitive therapy for PTSD (CT‐PTSD; Ehlers & Clark, 2000), and at follow‐up (mean = 247 days posttreatment). Additionally, moderating effects of medication use and comorbid depression were assessed.ResultsSleep and PTSD symptoms improved in parallel. The relation was moderated by depression: Sleep problems at the start of therapy did not predict improvement in PTSD symptoms during treatment for patients without comorbid depression. Patients with comorbid depression, however, showed less rapid decreases in PTSD symptoms, but comparable overall outcome, if their sleep quality was poor. Residual sleep problems at the end of treatment did not predict PTSD symptoms at follow‐up once residual PTSD symptoms were taken into account.ConclusionsCT‐PTSD leads to simultaneous improvement in sleep and PTSD symptoms. Sleep problems may reduce the speed of recovery in PTSD patients with comorbid depression. For these patients, additional treatment sessions are indicated to achieve comparable outcomes, and additional interventions targeting sleep may be beneficial. For those without comorbid depression, self‐reported sleep problems did not interfere with response to trauma‐focused psychological treatment.

Avoidance symptoms and delayed verbal memory are associated with post-traumatic stress symptoms in female victims of sexual violence

BackgroundVictimization by sexual violence is strongly associated with the development of posttraumatic stress disorder (PTSD). While several psychological and cognitive factors are known to be associated with PTSD prognosis, multivariable analysis is scarce. This study examined factors affecting the severity of PTSD symptoms in early stage of traumatic experience of sexual violence, including initial post-traumatic symptoms and cognitive characteristics. MethodsParticipants were recruited from the center for women and children victims of violence in a university hospital. Thirty-four sexual assault victims were assessed at the baseline and the second visit one to five months after the baseline. At the baseline, an array of posttraumatic symptoms and cognitive functions were measured: at follow-up, PTSD symptoms were determined by Clinician Administered PTSD Scale. ResultsStepwise multiple regression showed that avoidance symptoms (β=0.551, P<0.01) and delayed verbal memory (β=−0.331, P<0.05) at early stage of trauma predicted the severity of PTSD symptoms one to five month later. The regression model, factoring in avoidance and delayed verbal memory, showed a 34.9% explanatory power regarding the PTSD symptom severity. ConclusionThis study suggests that avoidance symptoms and verbal memory at the early stage of trauma are associated with later PTSD symptoms. It is also suggested that early intervention targeting avoidance symptoms may be beneficial in decreasing PTSD symptoms.

Effectiveness of Cognitive Processing Therapy for Male and Female U.S. Veterans With and Without Military Sexual Trauma.

Military sexual trauma (MST) affects approximately 2% and 36% of male and female veterans, respectively, (e.g., Allard, Gregory, Klest, & Platt, 2011). Although the deleterious consequences of MST have been clearly established, few studies have explored treatment effectiveness for this population. Using archival data from a residential treatment program, the current study explored the effectiveness of cognitive processing therapy (CPT) in treating full or subthreshold posttraumatic stress disorder (PTSD) to compare U.S. veterans reporting an MST index trauma (MST-IT) to those without MST-IT. Of the 481 participants, 40.7% endorsed MST-IT. Multiway frequency analyses were utilized to compare men and women with and without MST on baseline demographic variables. Hierarchical linear models were constructed to investigate treatment outcome by MST status and sex. Results showed that 44.8%, 23.8%, and 19.6% of the variation in clinician- and self-reported PTSD and depression symptoms were explained by three models. Scores on all outcome measures significantly decreased over time for both groups. Additionally, women demonstrated a sharper decrease in PTSD symptoms over time than men. Lastly, men who reported MST-IT had higher PTSD symptoms than men without MST-IT on average. With no control group or random assignment, preliminary findings suggest residential treatment including CPT may be effective for MST-IT regardless of sex.

The Use of Medicinal Marijuana for Posttraumatic Stress Disorder: A Review of the Current Literature.

Medicinal marijuana has already been legalized in over 23 states with more considering legalization. Despite the trend toward legalization, to date, there has been no systematic review of the existing literature for the efficacy of medicinal marijuana for many of the conditions for which it is proposed to treat. This study seeks to understand the current literature regarding the use of medicinal marijuana in the treatment of posttraumatic stress disorder (PTSD). PubMed and PsycINFO databases were searched until April 2014 for articles outlining outcomes of case files, control studies, and observational studies regarding the efficacy of medicinal marijuana in treating PTSD. Various combinations of the following search terms were used: marijuana, medicinal marijuana, cannabis, cannabinoid, PTSD, efficacy, trial, and neurobiology. Full text of each article was reviewed, and those directly addressing the question of efficacy of medicinal marijuana on PTSD symptomatology were included. Data were extracted from a total of 46 articles. Analysis revealed that most reports are correlational and observational in basis with a notable lack of randomized, controlled studies. Many of the published studies suggest a decrease in PTSD symptoms with marijuana use. Though the directionality of cannabis use and PTSD could not be fully differentiated at this time, there appears to also be a correlation between PTSD and problematic cannabis use. Despite this finding, there is a growing amount of neurobiological evidence and animal studies suggesting potential neurologically based reasons for the reported efficacy. Posttraumatic stress disorder is 1 of the approved conditions for medicinal marijuana in some states. While the literature to date is suggestive of a potential decrease in PTSD symptomatology with the use of medicinal marijuana, there is a notable lack of large-scale trials, making any final conclusions difficult to confirm at this time.

Delivery of self training and education for stressful situations (DESTRESS-PC): a randomized trial of nurse assisted online self-management for PTSD in primary care

ObjectiveThis randomized controlled trial examined the effectiveness of a nurse assisted online cognitive-behavioral self-management intervention for war-related posttraumatic stress disorder (PTSD), compared to optimized usual primary care PTSD Treatment (OUC) to reduce PTSD symptoms. MethodParticipants were 80 veterans of recent military conflicts with PTSD as assessed by the PTSD Checklist (PCL) seeking primary care treatment at one of three Veterans Affairs (VA) and four Army clinics. DESTRESS-PC consisted of logins to a secure website three times per week for 6 weeks with monitoring by a study nurse. All participants received nurse care management in the form of phone check-ins every two weeks and feedback to their primary care providers. Blinded raters assessed outcomes 6, 12, and 18 weeks post-randomization. ResultsDESTRESS-PC was associated with a significantly greater decrease in PTSD symptoms compared to OUC (F(3, 186)=3.72, p=.012). The effect was largest at the 12-week assessment (∆PCL=12.6±16.6 versus 5.7±12.5, p<0.05) with the treatment effect disappearing by the 18-week follow-up. Notably, there was a dose effect; number of logins correlated significantly with PTSD outcomes, with more logins associated with greater PTSD symptom improvement. None of the secondary outcomes (depression, anxiety, somatic symptoms, and functional status) showed statistically significant improvement; however, the treatment effect on depression approached significance (F(3, 186)=2.17, p=.093). ConclusionsDESTRESS-PC shows promise as a means of delivering effective, early PTSD treatment in primary care. Larger trials are needed.

Post-Traumatic Stress Disorder and Quality-of-Life Outcomes of Veterans Seeking Treatment in a Residential Rehabilitation Treatment Program

The purpose of this study was to determine the clinical utility of the Quality of Life Inventory (QOLI) in a sample of veterans with post-traumatic stress disorder (PTSD). Limited research has examined the quality of life of veterans with combat- and non-combat-related PTSD seeking treatment at a Veterans Affairs Medical Center (VAMC) residential rehabilitation treatment program (RRTP). This study investigated the difference in PTSD symptom severity and quality of life following successful completion of an RRTP using the PTSD Checklist (PCL) and the QOLI, and whether there is a differential treatment effect due to type of trauma exposure (i.e., combat-related and non-combat-related event). Findings suggest that veterans completing treatment at a VAMC RRTP demonstrate overall significant decreases in PTSD symptoms and improvement in their quality of life, with type of trauma exposure having no significant effect on treatment outcome.

Eye Movement Desensitization and Reprocessing (EMDR) Therapy for Handling Post Traumatic Stress Disorder (PTSD) Respondents

EMDR therapy is designed to reduce distress related traumatic event. PTSD prevalence is large enough in Indonesia. It was caused by many natural disasters that happened in several area of Indonesia. However, the application of EMDR for reducing PTSD symptoms was still rare. The objective of this study was to examine the intervention of EMDR therapy in handling PTSD respondents and using a one group pretest-posttest design. There were nine PTSD respondents involved during treatment. EMDR treatments were conducted in four repetitive sessions. Each session was completed in 60-90 minutes. Data was taken using PSS (PTSD Symptom Scale) and tested with Wilcoxon statistical analysis. The statistic test showed (Z = - 2.668; p = .05) with Asymp. Sig. =.008. Descriptive data showed that mean scores before and after therapy are 30.88 and 15.77 respectively. This research concluded that EMDR therapy can work to decrease PTSD symptoms.

A pilot examination of the use of narrative therapy with individuals diagnosed with PTSD.

Narrative therapy is a postmodern, collaborative therapy approach based on the elaboration of personal narratives for lived experiences. Many aspects of narrative therapy suggest it may have great potential for helping people who are negatively affected by traumatic experiences, including those diagnosed with posttraumatic stress disorder (PTSD). The potential notwithstanding, narrative therapy is relatively untested in any population, and has yet to receive empirical support for treatment among survivors of trauma. A pilot investigation of the use of narrative therapy with 14 veterans with a diagnosis of PTSD (11 treatment completers) is described. Participants completed structured diagnostic interviews and self-report assessments of symptoms prior to and following 11 to 12 sessions of narrative therapy. After treatment, 3 of 11 treatment completers no longer met criteria for PTSD and 7 of 11 had clinically significant decreases in PTSD symptoms as measured by the Clinician Administered PTSD Scale. Pre- to posttreatment effect sizes on outcomes ranged from 0.57 to 0.88. These preliminary results, in conjunction with low rates of treatment dropout (21.4%) and a high level of reported satisfaction with the treatment, suggest that further study of narrative therapy is warranted as a potential alternative to existing treatments for PTSD.

Yoga as an adjunctive treatment for posttraumatic stress disorder: a randomized controlled trial.

More than a third of the approximately 10 million women with histories of interpersonal violence in the United States develop posttraumatic stress disorder (PTSD). Currently available treatments for this population have a high rate of incomplete response, in part because problems in affect and impulse regulation are major obstacles to resolving PTSD. This study explored the efficacy of yoga to increase affect tolerance and to decrease PTSD symptomatology. Sixty-four women with chronic, treatment-resistant PTSD were randomly assigned to either trauma-informed yoga or supportive women's health education, each as a weekly 1-hour class for 10 weeks. Assessments were conducted at pretreatment, midtreatment, and posttreatment and included measures of DSM-IV PTSD, affect regulation, and depression. The study ran from 2008 through 2011. The primary outcome measure was the Clinician-Administered PTSD Scale (CAPS). At the end of the study, 16 of 31 participants (52%) in the yoga group no longer met criteria for PTSD compared to 6 of 29 (21%) in the control group (n = 60, χ²₁ = 6.17, P = .013). Both groups exhibited significant decreases on the CAPS, with the decrease falling in the large effect size range for the yoga group (d = 1.07) and the medium to large effect size decrease for the control group (d = 0.66). Both the yoga (b = -9.21, t = -2.34, P = .02, d = -0.37) and control (b = -22.12, t = -3.39, P = .001, d = -0.54) groups exhibited significant decreases from pretreatment to the midtreatment assessment. However, a significant group × quadratic trend interaction (d = -0.34) showed that the pattern of change in Davidson Trauma Scale significantly differed across groups. The yoga group exhibited a significant medium effect size linear (d = -0.52) trend. In contrast, the control group exhibited only a significant medium effect size quadratic trend (d = 0.46) but did not exhibit a significant linear trend (d = -0.29). Thus, both groups exhibited significant decreases in PTSD symptoms during the first half of treatment, but these improvements were maintained in the yoga group, while the control group relapsed after its initial improvement. Yoga significantly reduced PTSD symptomatology, with effect sizes comparable to well-researched psychotherapeutic and psychopharmacologic approaches. Yoga may improve the functioning of traumatized individuals by helping them to tolerate physical and sensory experiences associated with fear and helplessness and to increase emotional awareness and affect tolerance. ClinicalTrials.gov identifier: NCT00839813.