In 2014, we were fortunate to be able to participate in a wonderful study written by Erin Fisher, Professor of Psychology at Rock Valley College in Rockford, Illinois. Below are the results of the study. We are both proud and honored to be a part of this incredibly important research that has the ability to help many people.
“The Reduction of Hyperarousal as a Mechanism for Reducing the Overall Severity of Posttraumatic Stress Disorder”
Summary Results
Erin Fisher
A total of 35 women from three different counseling agencies participated in a study on the reduction of hyperarousal as a mechanism for reducing the overall severity of PTSD. Hyperarousal is defined as feeling jumpy, having difficulty concentrating, frequent outbursts of anger, insomnia and/or non-restful sleep, and a general feeling of being on edge all of the time. The neuropsychological model of PTSD posits that these symptoms are the result of a hyperactive autonomic nervous system (the system responsible for our fight-or-flight syndrome) and that the resulting symptoms of hyperarousal are the “guiding force” in PTSD. In other words, all of the other symptoms of PTSD (for example, nightmares, feelings of detachment, not being able to experience joy, etc.) are the result of this hyperarousal going on for too long. According to this model, focusing on the reduction of hyperarousal will, by default, also result in the reduction of these other symptoms.
Participants agreed to attend a yoga class that also incorporated meditation, with the option of attending up to 6 yoga classes. All 35 participants completed pre- and post-measures, but only 27 went to at least one yoga class. Data for the 27 participants who went to yoga were analyzed for pre and post differences in skin conductance (as a measure of autonomic reactivity), hyperarousal symptoms, avoidance symptoms, and intrusion symptoms.
The multiple analysis of variance test (MANOVA) indicated that there was a significant reduction in skin conductance, and also a reduction in the mean scores in all three symptom categories among those who participated in yoga, with the more yoga classes attended resulting in greater decreases in symptom severity and frequency.
Mean differences pre-yoga to post-yoga:
Pre-Yoga skin conductance: 1.24
Post-Yoga skin conductance: .81
Pre-Yoga hyperarousal: 27.93
Post-Yoga hyperarousal: 16.07
Pre-Yoga intrusion: 24.00
Post-Yoga intrusion: 13.52
Pre-Yoga Avoidance: 34.82
Post-Yoga Avoidance: 18.81
Pre-Yoga symptom
severity/frequency: 85.52
Post-Yoga symptom
severity/frequency: 49.00
An additional test called hierarchical multiple linear regression (HMLR) was conducted in order to determine if a reduction in hyperarousal could predict a reduction in the other symptoms. Results of the HMLR indicated that post hyperarousal scores accounted for 74% of variance in post intrusion scores, while post hyperarousal scores accounted for 77% of the variance in avoidance scores. What this means is that when hyperarousal is reduced, intrusion and avoidance are also reduced, even if the intervention is not specifically addressing intrusion and avoidance. The results of this test support the neuropsychological model of PTSD.
An ad-hoc analysis was conducted on the data collected from the 8 women who did not attend yoga but did complete both pre- and post-measures. Paired samples t-test results indicated no significant change in skin conductance. Hyperarousal scores increased slightly, while intrusion, avoidance, and skin conductance showed almost no change. While 8 participants cannot be considered a viable control group, at the very least it can be tentatively concluded that the addition of yoga and meditation to a traditional therapy regimen can be beneficial.
Conclusion
Well known trauma clinician and yoga specialist Bessel van der Kolk has said, “I have been surprised that something that is so obvious to me is not central in our pursuit of effective treatments: learning to regulate your autonomic arousal system may be the single most important prerequisite to dealing with PTSD.” The results of this study indicate that targeted reduction of autonomic arousal not only decreases the severity and frequency of the symptoms of hyperarousal, but also decreases the severity and frequency of the remaining symptom clusters of re-experiencing/intrusion and avoidance/numbing. Furthermore, decreases in hyperarousal predict decreases in re-experiencing/intrusion and avoidance/numbing. These results suggest that PTSD treatments that heighten arousal, such as those that require the trauma victim to recount the trauma during therapy, may be challenging for those trauma victims who are already experiencing heightened sympathetic nervous system arousal.
Because it is not feasible to measure physiological indicators of heightened nervous system arousal (such as measuring skin conductance or taking blood tests or measuring heart rate) in a therapy office, it is recommended that PTSD symptom questionnaires that identify hyperarousal symptoms be used to identify those clients who may benefit from arousal reduction. The use of such mindfulness-based stress reduction techniques as yoga and meditation has the potential to treat current trauma-related symptomatology, as well as potentially decrease the likelihood of progression into the full-blown disorder by reducing hyperarousal early enough to prevent the emergence of avoidance and re-experiencing.