Body-based interventions for the treatment of post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) can occur after a person has experienced or witnessed one or more traumatic events. People who develop PTSD may experience intrusive symptoms with recurring, involuntary and distressing memories of what they have been through. If PTSD is not treated, it can lead to other or aggravated mental illness and disease. Body-based interventions such as physical therapy, exercise, yoga and mindfulness in which people actively participate have become more popular as treatment options for PTSD.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202331 Registration no: SBU 2023/116

Question

What systematic reviews are there on body-based interventions for the treatment of PTSD?

Method

A systematic literature search was performed using the following databases: Medline (ovid), Scopus and PsycInfo (ebsco).
Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

Two relevant systematic reviews with moderate risk of bias were identified [1, 2]. The results and conclusions are presented in Table 1. In 34 relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [3-36].

Table 1. Systematic reviews with low/medium risk of bias
CI = Confidence interval; GRADE = Grading of Recommendations, Assessment, Development and Evaluations; PTSD = Post-traumatic stress disorder; RCT = Randomized controlled trial; SMD = Standardized mean difference
Included studies Population, Intervention, Control Outcome and Results
Cramer et al, 2018 [1]
Yoga for posttraumatic stress disorder - a systematic review and meta-analysis
Study design:
7 RCT(284 subjects)

Setting:
USA: 4 studies
Australia: 1 study
Canada: 1 study
Colombia: 1 study		 Population:
Adults with diagnosed PTSD

Intervention:
Sudarshan Kriya Yoga: 2 studies
Kundalini Yoga: 1 studyKripalu-based Yoga: 2 studies
Satvananda Yoga: 1 study
Trauma-informed Yoga: 1 study

Control (intervention)/Comparison:
Wait-list: 4 studies
No treatment: 1 study
Attention control: 2 studies		 PTSD symptoms
Yoga (Sudarshan Kriya, Kundalini, Kripalu-based, Satvananda) compared to no treatment;
5 studies, 206 subjects:Statistically significant effects and clinically relevant1.

SMD: –1.10
(95% CI, –1.72 to –0.47)

Yoga (Kripalu-based, Trauma-informed) compared to attention control;
2 studies, 102 subjects:Not statistically significant

SMD: –0.31
(95% CI, –0.84 to 0.22)
Authors' conclusion:
”There is low quality evidence that yoga interventions including physical postures could be an effective, acceptable and safe intervention for PTSD. According to the GRADE guidelines, only a weak recommendation for the use of yoga as an adjunctive intervention for PTSD can be made because the true effect may be substantially different from the effect estimated in this analysis. Therefore, more high quality studies are needed to confirm or disconfirm these findings.”
Yu et al, 2022 [2]
Comparative Effectiveness of Multiple Exercise Interventions in the Treatment of Mental Health Disorders: A Systematic Review and Network Meta-Analysis
Study design:
117 RCT(6456 subjects)

Relevant studies:
11 RCT(576 subjects)		 Population:
People with diagnosed depression, anxiety disorder, PTSD, or schizophrenia

Intervention:
Any type of exercise

Control (intervention)/Comparison PTSD studies:
Usual care: 10 studies
Health education: 1 study		 PTSD symptoms
Mind-body exercise compared to usual care or health education (7 studies, 395 subjects):
SMD: 0.83
(95% CI, 0.30 to 1.35)
-Only including studies using the Clinician Administered PTSD Scale (3 studies, 149 subjects):
SMD: 0.80
(95% CI, 0.47 to 1.13)
Multimodal exercise compared to usual care
(3 studies, 159 subjects)

SMD: 1.25
(95% CI, 0.78 to 1.72)
Authors' conclusion: “Multimodal exercise ranked best for treating depressive and negative schizophrenic symptoms, while resistance exercise seemed to be more beneficial for those with anxiety-related and positive schizophrenic symptoms. Mind–body exercise was recommended as the most promising exercise type in the treatment of PTSD…The certainty of evidence for outcomesranged from very low-to-moderate levels.”2.

1. The mean difference was above the defined threshold of 10 points indicating clinical relevance

2. The review authors assessed the certainty of evidence (based on GRADE) for all PTSD outcomes to be of very low certainty.

References

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  2. Yu Q, Wong KK, Lei OK, Nie J, Shi Q, Zou L, et al. Comparative Effectiveness of Multiple Exercise Interventions in the Treatment of Mental Health Disorders: A Systematic Review and Network Meta-Analysis. Sports Med Open. 2022;8(1):135. Available from: https://doi.org/10.1186/s40798-022-00529-5.
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Search strategies

Medline via OvidSP 15 February 2023

Title: PTSD and mind-body related interventions
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp= Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf.; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other.; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase  
Search terms Items found
Population:  
1. exp Stress Disorders, Post-Traumatic/ OR (posttraumatic or post traumatic or ptsd OR desnos).ab,ti 91 318  
Intervention:  
2. exp "Exercise Movement Techniques"/ or exp "Exercise Therapy"/ or exp "Mind-Body Therapies"/ or exp "Holistic Health"/ or (Somatic or qigong or qi gong or chi kung or chikunga or tai ji or tai chi or relaxation or breathing or exercise or exercises or physical activity or meditation or mental healing or mind body or mindfulness or yoga or body awareness or holistic or physiotherapy or physical therapy).ab,ti. 905 244  
Study types: systematic reviews and meta-analysis / randomized controlled trials1  
3. ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/))    
Combined sets:  
4. 1 AND 2 4329  
5. 3 AND 4 250  
Final result  
6. 5 250  

1. Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE: sensitivity- and precision-maximizing version (2008 revision); Ovid format. The Cochrane Collaboration; 2008. Available from: https://training.cochrane.org/handbook/current/chapter-04-technical-supplement-searching-and-selecting-studies#section-3-6-1. with modifications: the following terms are added: clinical trial, phase iii.pt. ; randomised.ab. ; ("Phase 3" or "phase3" or "phase III" or P3 or "PIII").ti,ab,kw.

Scopus via scopus.com 15 February 2023

Title: PTSD and mind-body related interventions
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other.; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words.; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range.; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase  
Search terms Items found
Population:  
1. TITLE-ABS-KEY ( post-traumatic  OR  ptsd OR  posttraumatic OR desnos ) 134 933  
Intervention:  
2. TITLE-ABS-KEY ( somatic OR qigong OR "qi gong" OR "chi kung" OR chikunga OR "tai ji" OR "tai chi" OR relaxation OR "breathing exercise" OR "breathing exercises" OR "physical activity" OR exercise OR exercises OR meditation OR "mental healing" OR "mind body" OR mindfulness OR yoga OR "body awareness" OR physiotherapy OR "physical therapy" ) 1 751 698  
Study types: systematic reviews and meta-analysis / randomized controlled trials  
3. TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”))    
Combined sets:  
4. 1 AND 2 7660  
5. 3 AND 4 568  
Final result  
6. 5 568  

PSYCINFO via EBSCO 15 February 2023

Title: PTSD and mind-body related interventions
TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); DE = Exact keyword; TX = All text; MR = Methodology; Nn = Near. Proximity operator retrieving terms within n words from each other.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase  
Search terms Items found
Population:  
1. (DE "Posttraumatic Stress Disorder" OR TI (Post-Traumatic OR PTSD OR Posttraumatic OR DESNOS) OR AB (Post-Traumatic OR PTSD OR Posttraumatic OR DESNOS)) 61 547  
Intervention:  
2. (DE "Mindfulness-Based Interventions" OR DE "Meditation" OR DE "Mindfulness" OR DE "Yoga" OR DE "Exercise" OR DE "Relaxation Therapy" OR DE "Progressive Relaxation Therapy" OR DE "Mind Body Therapy" OR DE "Holistic Health" OR DE "Physical Therapy" OR TI (Somatic OR qigong OR qi gong OR chi kung OR chikunga OR tai ji OR tai chi OR relaxation OR breathing OR exercise OR exercises OR meditation OR mental healing OR mind body OR mindfulness OR yoga OR body awareness OR holistic OR physical activity OR physiotherapy OR physical therapy) OR AB (Somatic OR qigong OR qi gong OR chi kung OR chikunga OR tai ji OR tai chi OR relaxation OR breathing OR exercise OR exercises OR meditation OR mental healing OR mind body OR mindfulness OR yoga OR body awareness OR holistic OR physical activity OR physiotherapy OR physical therapy)) 221 176  
Study types: systematic reviews and meta-analysis / randomized controlled trials  
3. TI((systematic n3 review) OR "meta analys*" OR metaanalys*) OR AB((systematic n3 review) OR "meta analys*" OR metaanalys*) OR SU((systematic n3 review) OR "meta analys*" OR metaanalys*) OR (MR "Systematic Review" OR MR "meta analysis")    
Combined sets:  
4. 1 AND 2 3372  
5. 3 AND 4 185  
Final result  
6. 5 185  
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