THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume 21, Number 7, 2015, pp. 1–8 Original Article

ª Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2014.0262

A Yoga Intervention Program for Patients Suffering

from Symptoms of Posttraumatic Stress Disorder:
A Qualitative Descriptive Study

Farah A. Jindani, PhD,1 and G.F.S. Khalsa, BA 2

Abstract

Objective: To understand how individuals with symptoms of posttraumatic stress disorder (PTSD) perceive a
trauma-sensitive Kundalini yoga (KY) program.
Methods: Digitally recorded telephone interviews 30–60 minutes in duration were conducted with 40 indi-
viduals with PTSD participating in an 8-week KY treatment program. Interviews were transcribed verbatim and
analyzed using qualitative thematic analysis techniques.
Results: Qualitative analysis identifies three major themes: self-observed changes, new awareness, and the yoga
program itself. Findings suggest that participants noted changes in areas of health and well-being, lifestyle,
psychosocial integration, and perceptions of self in relation to the world. Presented are practical suggestions for
trauma-related programming.
Conclusion: There is a need to consider alternative and potentially empowering approaches to trauma treat-
ment. Yoga-related self-care or self-management strategies are widely accessible, are empowering, and may
address the mind–body elements of PTSD.

Introduction been increased interest in complementary treatments for

PTSD that consider the relationship between mind and body.

P osttraumatic stress disorder (PTSD) is a significant

health issue resulting from exposure to traumatic events.
Prior traumas are often re-experienced in the present with
Yoga is a comprehensive system of practices for physical/
psychological health and well-being. Brown et al.6 sug-
gest that mind–body interventions benefit both mental and
accompanying psychological and physiological distress. physical stress-related disorders. Positive effects of yoga in
These can manifest as intrusive and distressing recollections patients with stress-related conditions in primary healthcare
of the original event, sleep disturbances, flashbacks or hal- are demonstrated.7,8 Studies further substantiate the efficacy
lucinations, distress, and reactivity when exposed to trig- of yoga as a primary or adjunctive treatment for a number
gering cues of the original trauma.1 of psychiatric disorders.9–11 Participants in the present study
Prevalent interventions for PTSD include cognitive be- were intervention group and wait-list control participants
havioral therapy and prolonged exposure treatments. Out- suffering from PTSD symptoms in our Kundalini yoga (KY)
comes of some verbal therapies are favorable,2 but many & PTSD randomized control trial (RCT), in which 80 par-
clinicians hesitate to use exposure therapies concerned that ticipants were randomized to either a KY PTSD interven-
patient symptoms will worsen, resulting in treatment attri- tion group (n = 59) or wait-list control (n = 21). Both groups
tion.3 Some early exposure therapies are contraindicated for demonstrated changes, but the yoga group showed greater
trauma survivors at the onset of therapy as they may awaken symptom reduction.12
implicit memories or trauma-related bodily sensations, While mind–body practices may offer vast benefits for
thereby retraumatizing the individual rather than resolving PTSD, few studies explore the qualitative perceptions of
the trauma.4 While exposure treatment can be beneficial in those participating in yoga treatment.8,13,14 To our knowl-
reducing PTSD symptoms, studies generally find that this edge, no studies have investigated the experiences of yoga
reduction is not associated with overall improvement in treatment for patients suffering from PTSD. Rather than
social, health, and occupational functioning.5 There has evaluating the effectiveness of yoga, the primary objective

1
Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
2
University of Toronto Mult-Faith Centre for Spiritual Study and Practice, Toronto, Ontario, Canada.

1
2 JINDANI AND KHALSA

of the current study was to understand the experiences of Qualifying participants met in person with a researcher
participants with PTSD symptoms partaking in trauma- (F.J.) to determine PTSD eligibility using the Post-Traumatic
sensitive KY treatment. Stress Disorder Checklist (PCL-17). Participants with a PCL-
17 score under 57, a current yoga/meditation practice, in-
Methods ability to abstain from substance consumption 24 hours
before class, or those at safety risk were ineligible.
The University of Toronto Office of Research Ethics
Participants were randomly assigned to either the exper-
(protocol reference #26992) approved the study procedures.
imental (yoga) or the waitlist control group. Waitlist control
Informed consent was obtained at program onset. Schedul-
participants were offered KY participation after the 8-week
ing conflicts and medical reasons were primary causes of
waiting period, and the responses of both groups after yoga
participant dropout. The RCT was conducted between
participation are included in present study analysis. Parti-
March and August 2012 at the University of Toronto.
cipants were 18 years or older and fluent in English. Inter-
Interviews were completed within 1 week following con-
views were conducted within one week of study completion.
clusion of the RCT. All 40 participants who completed the
8-week KY program were invited to participate in telephone
interviews. Intervention
The lead researcher, a psychologist working with war
Eligibility criteria veterans, a war veteran, and KY yoga teachers designed the
Individuals not residing in a treatment facility with self- intervention. Seven yoga groups were conducted and taught
perceived symptoms of PTSD were recruited for study par- by three female KY teachers. Two of the instructors each
ticipation via (1) postering in public locations in the Greater taught one class and the third teacher taught five classes.
Toronto area (GTA), (2) an online bulletin for patients at the The style of yoga was consistent with KY, a form of yoga
Centre for Addiction and Mental Health (CAMH), and (3) that emphasizes integration of the endocrine and nervous
advertisements at social services agencies in the GTA. systems and includes breathing, physical postures, and
Participants able to commit to an 8-week yoga program meditation. The program was designed using guidelines for
were scheduled for a telephone screening to assess prelim- trauma-sensitive yoga,15 inviting participants to try poses
inary entry criteria. Demographic information was collected with ample modifications and focusing on mind–body
and is presented in Table 1. awareness, safety, and nonjudgment.
The intervention consisted of weekly 90-minute group
practice sessions over the course of the 8-week program.
Groups ranged in size from 3 to 8 participants. Participants
Table 1. Characteristics of Subjects
practiced warm-up exercises, postures, relaxation, breathing
Total, techniques, and meditation. The practice sessions consisted
Characteristic n = 40 of yogic mind–body techniques of increasing rigor, dedi-
cated to cultivating self-efficacy, self-awareness, and re-
Sex laxation skills. A 15-minute home practice was assigned to
Male 9 the participants. The home practice consisted of three KY
Female 31 meditations with designated breathwork, mantra, mudra, and
Age (range in years) 18–63 postures.
Median age (years) 44 The program was designed to begin with short postures
Type of trauma and meditation. To enable capacity for self-mastery,
Sexual abuse (including childhood sexual abuse) 11 length of time for postures, meditations, and relaxation
Physical trauma (e.g., illness, motor vehicle 8 increased throughout the program. The protocol is avail-
accidents) able by request.
Emotional abuse 13
Compassion fatigue (e.g., vicarious trauma, 4
secondary trauma) Interview approach
Adverse life circumstances (e.g., employment, 4
relationships) All participants who completed the yoga program took
part in a semistructured, audio-recorded telephone inter-
Medication view. Participants were invited to discuss the yoga program
Antipsychotics 3
Mood stabilizers 2 in which they had participated. The average length of in-
Benzodiazepines 7 terviews was 30 minutes.
Total 12 The semistructured interview guide included the following:
No medication 28 1. What are your overall thoughts/feelings about the
Education yoga classes?
Less than high school 2 2. Describe your general feelings of well-being at this
Undergraduate/college 33 point in your life.
Postgraduate 5
3. How do you perceive your stress in relation to your
Employment status stress 8 weeks ago?
Unemployed/retired 16 4. Have you noticed any shifts in relation to your
Part time 17
Full time 7 thoughts, feelings, emotions, behaviors, etc., over the
course of the program?
YOGA FOR PTSD 3

Table 2. Representative Quotes from Self-Observed Changes Themes

Mind–body relationship ‘‘In the past, I was consumed by emotions. With yoga, I could breathe and link my
(Participant #13) body and mind. I could feel my legs shaking at times, my arms aching. For the first
time, I could sense my breath. I noticed that with this yoga, overall, I felt better
afterwards. Everywhere in me.my mind and body.’’
Emotional (Participant #10) ‘‘I would say my biggest benefit has been that I am more emotionally balanced. Often
after class, I would feel really strong and balanced and really, really alert, but like
deep calm. I would be able to return to that feeling the days I wasn’t in class.’’
Self-reflection (Participant #11) ‘‘Emotional shifts were coming from the practice. I would have emotional patterns
come up especially like kind of the middle point of the class. I would be more aware
and could then think more clearly how best to respond. When I would do that I’d feel
really peaceful after and just be able to work with my emotions and experiences
in a healthier way.’’
Cognitive (Participant #04) ‘‘There are certain practices and techniques that make total sense. That in itself has
stopped a lot of my negative thought loops.’’
Action/behavioral ‘‘When things happen, you know I get really annoyed and aggravated, I would walk
(Participant #36) away and get away from the situation. But now I would say ‘Oh, that is really
annoying.’ I would verbalize it, to try to change and improve the situation. It’s
definitely a lot better, but like I said, sometimes I wonder, ‘Is this me?’ So it’s kind
of strange and it’s amusing. I am finding myself kind of like.laughing at my
behavior because it’s just so different from where I was a few months ago.’’
Psychosocial (Participant #33) ‘‘I feel stronger.also more, gentle.just a lot more hope. A lot of my.thinking
was very.stunted. This was very empowering. I do not feel so small anymore.
It brought me a long way.a lot more positive behaviors and helped me to be more
independent and less needy.’’

5. What have been your recent experiences of feeling approach also allows for the emergence of new themes and
down, anxious, angry, anxiety, and problems sleeping? was deemed the most appropriate analytical approach.
6. Did you learn any techniques/ways to calm yourself Data collection and analysis was carried out in an itera-
when feeling overwhelmed? tive manner by the principal investigator (F.J.). Forty in-
7. Were you able to maintain the home practice? terviews were transcribed and the accuracy of the transcripts
8. Were you participating in any other form of treat- was verified. Inductive thematic analysis described by Braun
ment/therapy over the last 8 weeks? and Clark17 was utilized to understand participant percep-
9. Is there any additional support that I can provide you tions of the yoga program. The transcribed data were read
at this point/resources? and re-read, and the recordings were listened to several
10. Do you have any recommendations/final thoughts? times to ensure transcription accuracy. This process of
‘‘repeated reading’’18 and using audio recordings of the data
promotes data immersion and researcher closeness with the
Methods of analysis for qualitative data
data.
Qualitative thematic analysis is well accepted for yielding Using Nvivo10 (QSR International, 2010) software, in-
useful information for policy makers and healthcare prac- terview transcripts were initially coded, giving full attention
titioners regarding topics about which little is known.16 This to all data. Codes, categories, themes, and outlier data were

Table 3. Representative Quotes from New Awareness Theme

Perceptions of prior trauma ‘‘I’ve had all this really, really deep opportunity for learning and it’s kind of come full circle,
(Participant #19) to me being able to identify the lessons and feel more at peace with it. Like some of it’s
really old stuff that I’ve been you know, kind of identifying for years and now, now
the way I feel is part of my experiences is just like, ‘Wow, okay so I had this really, really
deep opportunity for growth.’ Like, okay, this actually needed to happen that way for me
to be able to kind of come to this process and understand myself more deeply.’’
Medical interventions ‘‘Psychotherapy is very emotionally taxing because you have to rehash and rehash and
(Participant#2) bring it up again, the trauma. I stopped going to a psychotherapist because I did not
want to talk about things anymore, and that’s what I liked about this because I did not
have to talk about those things ’cause that can get exhausting! And it re-traumatizes.
In this, you didn’t have to rehash the story.’’
Spirituality (Participant# 11) ‘‘With yoga, I had a connection of mind, body, and spirit. During the practice and when
you become aware of those three things, or be aware of them, it seems like things
are more possible. I had more peace, the idea of finding increased peace of mind.
I mean what could be richer than a sense of you know a spirit; my spiritual self.’’
4 JINDANI AND KHALSA

Table 4. Representative Quotes from Yoga Program Theme

The program (Participant #4) ‘‘I was really pleased with the way everything was structured; I thought it was very
simple and well laid out. I felt really well supported through the program. It was
a really beautiful experience to do intentional work as part of a study, because we
did have the questions at the beginning and then in the middle and then in the end,
so it was really neat to have this reference throughout.’’
Home practice (Participant #22) ‘‘At the end of the home practice, the feeling that I actually get when I let myself
do them.is really powerful. Part of it was just spending ten minutes of your day by
being really present by, you know, doing something you focus on. I think of the brain
like any other muscle and it is practicing something again and that’s part of it. It’s like
mental hygiene. I was able to do the exercises, like sometimes I was just doing them,
but I think it kind of improved my self-esteem overall you know quite consistently.
I did them every day for a month at least, I kept doing it, I found it very helpful.
I felt more energy, I felt better and it helps center me, you know, it really did. I think
these exercises are helping on a physical level as well as on emotional level.’’
Group support (Participant #26) ‘‘There was really incredible value of going through that process with the group and
having the opportunity to hear other peoples experiences of what it is that comes
up and where they were experiencing shifts and changes. It was therapeutic to be in
a class, of people who I knew and we knew about each other very little, except
that we all survived trauma and we were all committed to being in this class.’’

identified in this process. The initial coding phase resulted in together according to similar motifs. A coding framework
the emergence of over 300 codes from the data. Following was developed and subsequently used to code all transcripts.
the extensive exploratory coding process, three final and
purposeful distillation processes occurred. The original 300 Results
codes were reduced to 12 major codes. Codes were clustered
Sample characteristics
into groups or categories (i.e., codes that shared similar
meanings) with predominant themes identified as indicated A total of 40 interviews were conducted. Characteristics
in Figure 1. Emerging themes were analyzed and grouped of participating individuals are reported in Table 1.

300 Codes

12 Major codes identified:

1. Action-behavioral change
2. Emotional change
3. Group support
4. Home practice
5. Mind-body perspectives
6. Program development
7. View of self
8. Medical
9. Perceptions of prior trauma
10. Spirituality
FIG. 1. Methods of analy- 11. Cognitive changes
sis for qualitative data. 12. Awareness

Themes & sub-themes

Self-Observed changes New awareness Yoga Program

a. Mind, body relationship a. Perceptions of prior trauma a. Program development
b. Emotional changes b. Medical interventions b. Home practice
c. Self-reflection c. Spirituality c. Group support
d. Cognitive
e. Action-behavioral
f. Psychosocial
YOGA FOR PTSD 5

Themes Psychosocial. Another theme related to the category of

Analysis of interviews reveals three themes of interest self-observed changes and overlapping with the mind–body
shared by all participants: (1) self-observed changes, (2) dimension includes participants’ experiences of psycho-
new awareness, and (3) the yoga program. These themes social changes. This theme included subthemes of confi-
include subthemes that were identified during the data dence/self-esteem, self-care, openness to new experience,
analysis. motivation/determination, resilience, and feeling better
about themselves.
Self-observed changes. Consideration of linkages be- New awareness. Data reveal that program participation
tween associated themes of mental, physical, and social was associated with new perceptions of life experiences and
awareness as noted by participants allows for an under- these life views had changed since program start. New
standing of the overall dynamic of personal transformation awareness subthemes are defined as those related to (a) prior
in this program. Data reveal that participants experienced trauma perceptions, (b) medical stigmatization, and (c)
life changes that included (1) changes in the mind–body spirituality. Representative participant quotes may be found
relationship, (2) emotional changes, (3) changes in their in Table 3.
capacity for self-reflection, (4) cognitive changes, (5) action-
behavioral changes, and (6) psychosocial changes. Re- Perceptions of prior trauma. Participants shared that they
presentative participant quotes may be found in Table 2. were identifying new ways to relate to their prior traumatic
experiences that included self-compassion, attending to
Mind–body relationship. Across 39 of the 40 interviews, health needs, and learning to not blame themselves for
participants reported that the physical practice of yoga negative life circumstances. For some, traumatic life expe-
supported an intimate mind–body connection that for many riences were viewed as opportunities for growth and de-
was a very new experience. Rather than feeling consumed velopment of purpose. Reports of forgiveness of others were
by emotions, participants stated learning ways to connect noted.
emotions and feelings within mind and body (i.e., feeling
anxiety within stomach) and then choosing a healthy re- Medical interventions. Participants spoke about how la-
sponse. Study participants discussed additional subthemes bels of PTSD were stigmatizing leading to negative views of
of (i) physical exercise, (ii) clarity/cleansing, (iii) breath, self. The yoga program offered an opportunity to recover in
(iv) relaxation, (v) body awareness, (vi) diet, (vii) sleep, and an empowering manner.
(viii) energy.
Spirituality. A new relationship with self and prior trau-
Emotional. All participants noted changes in mood mas led to new awareness of spirituality as an empowering
(n = 40). Descriptions of life stressors and changing re- process. Some stated feeling a connection to a higher self
sponses were reported. Participants associated emotional and many expressed that, in light of all that had been ex-
regulation shifts with feelings of enhanced wellness (i.e., perienced, they were extremely grateful to be alive. This
calmness, stability, hope, and balance) and confidence. realization was profoundly empowering.

Self-reflection. Heightened awareness of body, mind, and Perceptions of the yoga program. Participants provided
emotions was related to developing new habits of self- an understanding of valued aspects of the program by dis-
reflection. Several participants noted the ability to sit with cussing subthemes of (a) program development, (b) home
emotions and act with awareness, behaviors that had been practice, and (c) group support. Representative participant
challenging to achieve in the past. The ability to respond quotes may be found in Table 4.
nonreactively by first becoming aware of thoughts and
feelings was a new experience for the majority of partici- Program development. Participants stated that they found
pants. the yoga program to be helpful and effective for their re-
covery. This theme was discussed in all 40 interviews and
Cognitive. The implementation of self-reflection strategies was the third most frequent theme. Participants shared that
was related to mindfulness and present moment awareness. physically, emotionally, mentally, and spiritually, they were
Toward the end of the program, 30 participants reported feeling more connected to themselves and the world, ex-
greater control of thought patterns and mental clarity. When a pressing that strategies had been learnt in the program that
disturbing thought arose in the present, participants reported they could practically implement in their lives.
becoming aware and labeling it as a ‘‘thought’’ and breathing
deeply to gain present moment control. Home practice. Thirty-seven of 40 interviewees discussed
the home practice theme. Overall, participants stated that the
Action/behavioral. Thirty-seven participants expressed home practice was critical to the yoga program. It was ex-
generally positive behaviors at program completion, attrib- pressed that while initially a challenge to discipline oneself,
uting changes to emotional well-being and self-perception. the consistency, structure, and routine of having a self-
Some participants were making lifestyle changes that included healing practice that could be done anytime were vital to
career transitions, communicating in new and productive ways, feelings of self-improvement and well-being.
and dealing explicitly with challenging situations as they arose.
Participants expressed surprise and awe at their own positive Group support. Thirty-five of 40 participants discussed
feelings and behaviors. aspects of group support extending to teacher connection,
6 JINDANI AND KHALSA

group relationships, and overall programmatic support. felt in control of their bodies and felt safe to participate or
Shared feelings of strong connectedness, openness, and decline from participating. This finding is important in
transparency within the group fostered a sense of security trauma programming because self-mastery and locus of
for the majority of program participants. control are crucial for the re-learning of responses and be-
haviors and to develop comfort with the body.
As individuals presenting PTSD symptoms are generally
Discussion
isolated due to physiological and emotional struggles, an
In exploring treatment options for PTSD, it is important opportunity to belong to a group and feel socially supported
to understand the perceptions of program recipients. This by others is also crucial for PTSD treatment. Participants
study assesses the experiences of participants suffering from expressed that, while the group did not process traumatic
PTSD symptoms involved in a trauma-sensitive yoga pro- experiences verbally, their involvement allowed for feelings
gram. The qualitative analysis revealed three themes with of normalcy, peer support, and commitment to both one’s
subthemes. A summary of aspects of the yoga program in own growth and the healing of the group.
relation to self-care strategies for trauma programming is Home practice was also vital to the yoga program and
presented in Table 5. emphasizes the importance of repetition, consistency, and
Anxiety and emotional overwhelm associated with PTSD self-care for individuals with PTSD symptoms. As a be-
lends to difficulty attuning to the body. At program outset, havior is repeated and practiced, it becomes automatic and is
participants expressed high amounts of stress and inability empowering. Those that completed the practices expressed
to cope with situations of daily life. Awareness of breath and heightened well-being in various facets of life.
body attunement may be skills learned that supported feel- Comparison of the findings with other qualitative studies
ing reduced stress at program completion. of yoga demonstrates many interesting points of similarity
Yoga practice allowed those with PTSD symptoms to and divergence. One similarity is the increased awareness of
learn strategies to slow down, attune to mind and body, the mind–body. Here, as well as in previous studies, yoga
become aware of thought patterns, and regulate emotions. supported individuals in developing enhanced awareness of
Application of strategies learned in the program resulted in stress-related bodily sensations and strategies to effectively
skills of self-mastery and internal locus of control. Yoga cope.9,14 Overall participants in yoga treatment report
self-care strategies were reported to be empowering, ac- greater self-efficacy and the capacity to regulate symptoms
cessible, and healing. Findings substantiate prior literature irrespective of health condition. This is demonstrated by a
suggesting that successful environmental adaptation and range of recent studies on the effects of yoga for a minority
feelings of self-efficacy require understanding of self, and population with lower back pain and stress-related symp-
emotions as well as adequate coping skills.19,20 toms, as a treatment for smoking cessation among women,
As helplessness is a defining emotion experienced during and as a treatment to help an elderly population regain
and after an original traumatic event, the yoga teachers balance self-efficacy after a stroke.21–23
made an effort to help participants feel empowered and in Where the KY program seems to differ from prior studies
control of their own healing. Participants, in turn, said that was participant formation of new self-reflective habits.
they found the program to be helpful because, while the Greater self-awareness was often expressed as being related
yoga teachers instructed them to try their best, they always to the meditation component of the program and the regular

Table 5. Summary of Identified Yoga Benefits, Corresponding Self-Management/Care Components,

and Implementation Considerations for Posttraumatic Stress Program
Identified benefits of Suggested self-management/self-care
yoga program program components/modules Implementation considerations
Teacher/facilitator support Empathic Adequate trauma training
Encouraging and empowering Mind–body knowledge
Compassionate
Group support and feedback Peer support component Peer matching based on demographics and
clinical characteristics/mentorship model
Program logistics and Clear vision and programmatic goals Structure and continuity between sessions
organization and instructors/facilitators
Empowerment/positive Focus on strengths of participants Focus on resilience and traumatic growth
outlook and acceptance with PTSD, self-efficacy rather than trauma narrative
Physical exercise Mindful breathing and movement Focus on movement and breath, mind–body
awareness, relaxation
Breathing techniques Focus on various breath practices Slow deep breathing/specific breathing
practices for PTSD
Accessibility Creation of funding models for Health system factors (funding, space
integrative therapies and physical accessibility, safety, etc.) Optimized for
spaces to support them individuals with PTSD
PTSD, posttraumatic stress disorder.
YOGA FOR PTSD 7

home practice. Overall, participants also expressed new, 2. Resnick PA, Williams LF, Suvak MK, et al. Long-term
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A Qualitative Study of Yoga for Patients with Chronic Neck
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No competing financial interests exist. imitation. Dev Psychol 1971;5:244.
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