A new gold standard for the treatment of PTSD?

By Karen Schwartz

Our understanding of trauma has developed—and changed—significantly in the past 20 years, and so has our understanding of how to help people suffering from trauma. The concept of posttraumatic stress disorder (PTSD) was first included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. In the late 1990s the idea of working with the body, not just the mind, to support people with trauma was introduced in medical settings. In 2002 The Trauma Center in Brookline, Mass., started the program that became Trauma Center Trauma Sensitive Yoga (TCTSY), which combines clinical insights with yoga practice to help heal trauma.

A new randomized controlled trial published in JAMA Network Open showed that this type of yoga is as effective as cognitive processing therapy (CPT), the current gold standard of care at the Veterans Administration. In the study, almost twice as many people completed the TCTSY protocol as CPT, a finding with significant implications for outcomes and costs:

The TCTSY treatment completion rate was 42.6% higher than the CPT rate …This finding is critical given the personal burden and consequences of untreated PTSD… as well as the healthcare costs of PTSD. The total cost of PTSD for military populations in 2018 was $42.7 billion, driven by disability and direct healthcare costs.

TCTSY and other types of yoga are part of a recent movement in the mental health field to engage the body in healing from psychological trauma and PTSD—especially for the most severe trauma, where talk-based therapies may be less effective. The study points out that,

Treatment of PTSD that is acceptable and effective is medical care to which all veterans are entitled and that is currently lacking. The robust equivalence results combined with the notably higher TCTSY completion rate indicate that TCTSY is such a treatment.

Veterans and others suffering with PTSD clearly need a new theoretical framework, and we now have robust evidence as to the effectiveness of a body-based approach (vs. a cognitive- or talk-based approach alone). TCTSY is also available in community settings, such as wellness programs, yoga programs, and independent TCTSY facilities, providing access to care for a broader population.

Karen Schwartz, LMSW, C-IAYT, maintains a private practice in New York City, serves as director of operations for the Center for Trauma and Embodiment at Justice Resource Institute, and is a freelance writer.