This study assessed the feasibility and acceptability of a yoga intervention for veterans with comorbid posttraumatic stress disorder (PTSD) and chronic pain (CP) that was adapted for virtual implementation.
Research Method/Design:
This pilot feasibility study at a large, mid-Atlantic Veteran’s Affairs (VA) Medical Center with veterans with both PTSD and CP examined the adaptation of an eight-session virtual yoga group intervention. Participants (n = 18, 11 completers) were primarily male (82.4%), African American (76.5%), with no prior yoga experience (70.6%). A measure of client satisfaction was administered at completion and attendance rates were examined. Self-reported symptom measures were also assessed.
Results:
There were no instances of injuries or other adverse effects related to the study. This study yielded a 39% attrition rate, consistent with in-person yoga interventions. Mean number of sessions attended was 5.53 (SD = 1.73). Participants rated overall satisfaction as high (M = 28.09; SD = 3.96; potential range 8–32).
Conclusions/Implications:
This study provides initial data on the acceptability of a virtual yoga intervention for veterans with comorbid PTSD and CP, with attrition and satisfaction rates in line with prior in-person iterations. Implications of virtual adaption and considerations for future efforts will be discussed. This study was not preregistered but has been registered subsequently on ClinicalTrials.gov [CTR #: NCT06123065].
Get full access to this article
View all access options for this article.
References
1.
BoscoMA, GallinatiJL, ClarkME. Conceptualizing and treating comorbid chronic pain and PTSD. Pain Res Treat, 2013; 2013:174728; doi: 10.1155/2013/174728
2.
OtisJD, KeaneTM, KernsRD. An examination of the relationship between chronic pain and post-traumatic stress disorder. J Rehabil Res Dev, 2003; 40(5):397–405; doi: 10.1682/jrrd.2003.09.0397
3.
FishbainDA, PulikalA, LewisJE, et al.Chronic pain types differ in their reported prevalence of Post-Traumatic Stress Disorder (PTSD) and there is consistent evidence that chronic pain is associated with PTSD: An evidence-based structured systematic review. Pain Med, 2017; 18(4):711–735; doi: 10.1093/pm/pnw065
4.
PalyoSA, BeckJG. Post-traumatic stress disorder symptoms, pain, and perceived life control: Associations with psychosocial and physical functioning. Pain, 2005; 117(1–2):121–127; doi: 10.1016/j.pain.2005.05.028
5.
GerritsMMJG, VogelzangsN, van OppenP, et al.Impact of pain on the course of depressive and anxiety disorders. Pain, 2012; 153(2):429–436; doi: 10.1016/j.pain.2011.11.001
6.
BernardyNC, LundBC, AlexanderB, et al.Increased polysedative use in veterans with posttraumatic stress disorder. Pain Med, 2014; 15(7):1083–1090; doi: 10.1111/pme.12321
7.
BernardyN, MontañoM. Opioid use among individuals with posttraumatic stress disorder. PTSD Research Quarterly, 2019; 30(1).
8.
BileviciusE, SommerJL, AsmundsonGJG, et al.Posttraumatic stress disorder and chronic pain are associated with opioid use disorder: Results from a 2012-2013 American nationally representative survey. Drug Alcohol Depend, 2018; 188:119–125; doi: 10.1016/j.drugalcdep.2018.04.005
9.
American Psychological Association. Clinical practice guideline for the treatment of Posttraumatic Stress Disorder (PTSD) in adults. 2017. Available from: https://www.apa.org/ptsd-guideline [Last accessed: November30, 2023].
10.
LouwA, PuenteduraEJ, DienerI, et al.Pain neuroscience education: Which pain neuroscience education metaphor worked best? S Afr J Physiother, 2019; 75(1):1329; doi: 10.4102/sajp.v75i1.1329
11.
MurphyJL, CordovaMJ, DedertEA. Cognitive behavioral therapy for chronic pain among Veterans: Therapist manual. Psychological Services, 2022; 19(1):95–102.
12.
OtisJD, KeaneTM, KernsRD, et al.The development of an integrated treatment for veterans with comorbid chronic pain and posttraumatic stress Malden Mass disorder. Pain Med, 2009; 10(7):1300–1311; doi: 10.1111/j.1526-4637.2009.00715.x
LiY, LiS, JiangJ, et al.Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis. Medicine (Baltimore), 2019; 98(8):e14649; doi: 10.1097/MD.0000000000014649
15.
KimS-D. Twelve weeks of yoga for chronic nonspecific lower back pain: A meta-analysis. Pain Manag Nurs, 2020; 21(6):536–542; doi: 10.1016/j.pmn.2020.07.002
16.
SaperRB, ShermanKJ, Cullum-DuganD, et al.Yoga for chronic low back pain in a predominantly minority population: A pilot randomized controlled trial. Altern Ther Health Med, 2009; 15(6):18–27.
17.
ShermanKJ, CherkinDC, WellmanRD, et al.A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain. Arch Intern Med, 2011; 171(22):2019–2026; doi: 10.1001/archinternmed.2011.524
18.
AprilKT, StinsonJ, CavalloS, et al.Yoga and aerobic dance for pain management in juvenile idiopathic arthritis: Protocol for a pilot randomized controlled trial. JMIR Res Protoc, 2020; 9(7):e12823; doi: 10.2196/12823
19.
BrinsleyJ, SchuchF, LedermanO, et al.Effects of yoga on depressive symptoms in people with mental disorders: A systematic review and meta-analysis. Br J Sports Med, 2021; 55(17):992–1000; doi: 10.1136/bjsports-2019-101242
20.
MacyRJ, JonesE, GrahamLM, et al.Yoga for trauma and related mental health problems: A meta-review with clinical and service recommendations. Trauma Violence Abuse, 2018; 19(1):35–57; doi: 10.1177/1524838015620834
21.
JohnsonJE, PeabodyME, WechsbergWM, et al.Feasibility of an HIV/STI risk-reduction program for incarcerated women who have experienced interpersonal violence. J Interpers Violence, 2015; 30(18):3244–3266; doi: 10.1177/0886260514555013
22.
StaplesJK, HamiltonMF, UddoM. A yoga program for the symptoms of post-traumatic stress disorder in veterans. Mil Med, 2013; 178(8):854–860; doi: 10.7205/MILMED-D-12-00536
23.
KliglerB, KhungM, SchultT, et al.What we have learned about the implementation of whole health in the Veterans administration. J Integr Complement Med, 2022; 29(12):774–780; doi: 10.1089/jicm.2022.0753
24.
VlaeyenJWS, LintonSJ. Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain, 2012; 153(6):1144–1147; doi: 10.1016/j.pain.2011.12.009
25.
FoaEB, HembreeE, RothbaumB. Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences, Therapist Guide. Oxford University Press; 2007; doi: 10.1093/med:psych/9780195308501.001.0001
van der KolkBA, StoneL, WestJ, et al.Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. J Clin Psychiatry, 2014; 75(6):e559–e565; doi: 10.4088/JCP.13m08561
28.
MatthiasMS, BurgessDJ, EliacinJ. Healthcare access and delivery during the COVID-19 pandemic for black veterans with chronic pain: A qualitative study. J Gen Intern Med, 2023; 38(4):1024–1029; doi: 10.1007/s11606-022-07884-9
29.
Nana-SinkamP, KraschnewskiJ, SaccoR, et al.Health disparities and equity in the era of COVID-19. J Clin Transl Sci, 2021; 5(1):e99; doi: 10.1017/cts.2021.23
30.
BakerE. First do no harm: The impact of telemedicine on health disparities. Thmt, 2024; 9(3); doi: 10.30953/thmt.v9.493
31.
MathewsCP, ConvoyS, HeyworthL, et al.Evaluation of the use of telehealth video visits for veterans with chronic pain. Pain Manag Nurs, 2022; 23(4):418–423; doi: 10.1016/j.pmn.2022.02.006
32.
FortierCB, CurraoA, KennaA, et al.Online telehealth delivery of group mental health treatment is safe, feasible, and increases enrollment and attendance in post-9/11 U.S. veterans. Behav Ther, 2022; 53(3):469–480; doi: 10.1016/j.beth.2021.11.004
33.
WernekeMW, DeutscherD, HayesD, et al.Is telerehabilitation a viable option for people with low back pain? Associations between telerehabilitation and outcomes during the COVID-19 pandemic. Phys Ther, 2022; 102(5):pzac020; doi: 10.1093/ptj/pzac020
34.
SundstromMJ, AsplundAL, Nguyen-FengVN. Evaluation of online adaptive yoga for psychological well-being in adults with disabilities. Rehabil Psychol, 2024; 69(1):55–60; doi: 10.1037/rep0000520
35.
Der-MartirosianC, ShinM, UphamML, et al.Telehealth complementary and integrative health therapies during COVID-19 at the U.S. department of veterans affairs. Telemed J E Health, 2023; 29(4):576–583; doi: 10.1089/tmj.2022.0209
36.
LeungLB, RubensteinLV, JaskeE, et al.Contrasting care delivery modalities used by primary care and mental health specialties in VA’s telehealth contingency staffing program during the COVID-19 pandemic. J Gen Intern Med, 2022; 37(10):2607–2610; doi: 10.1007/s11606-022-07527-z
37.
ChopinSM, SheerinCM, MeyerBL. Yoga for warriors: An intervention for veterans with comorbid chronic pain and PTSD. Psychol Trauma, 2020; 12(8):888–896; doi: 10.1037/tra0000649
38.
AnagnostisC, GatchelRJ, MayerTG. The pain disability questionnaire: A new psychometrically sound measure for chronic musculoskeletal disorders. Spine (Phila Pa 1976), 2004; 29(20):2290–2302; discussion 2303; doi: 10.1097/01.brs.0000142221.88111.0f
39.
WeathersF, LitzBT, KeaneTM, et al.PTSD Checklist for DSM-5 (PCL-5). Scale Available Natl Cent PTSD. 2013. Available from: www.ptsd.va.gov
40.
TeresiJA, YuX, StewartAL, et al.Guidelines for designing and evaluating feasibility pilot studies. Med Care, 2022; 60(1):95–103; doi: 10.1097/MLR.0000000000001664
41.
AttkissonCC, ZwickR. The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Program Plann, 1982; 5(3):233–237; doi: 10.1016/0149-7189(82)90074-x
42.
PearsonN, ProskoS, SullivanM, et al.White paper: Yoga therapy and pain—How yoga therapy serves in comprehensive integrative pain management, and how it can do more. Int J Yoga Therap, 2020; 30(1):117–133; doi: 10.17761/2020-D-19-00074
43.
MalleryD, GeorgeP. IBM SPSS Statistics 25 Step by Step: A Simple Guide and Reference. 15th ed. Routledge: New York; 2018; doi: 10.4324/9781351033909
44.
KnoerlR, Giobbie-HurderA, BerfieldJ, et al.Yoga for chronic chemotherapy-induced peripheral neuropathy pain: A pilot, randomized controlled trial. J Cancer Surviv, 2022; 16(4):882–891; doi: 10.1007/s11764-021-01081-z
45.
ReinhardtKM, Noggle TaylorJJ, JohnstonJ, et al.Kripalu yoga for military veterans with PTSD: A randomized trial. J Clin Psychol, 2018; 74(1):93–108; doi: 10.1002/jclp.22483
46.
FoaEB, McLeanCP, ZangY, et al.STRONG STAR Consortium. Effect of prolonged exposure therapy delivered over 2 weeks vs 8 weeks vs present-centered therapy on PTSD symptom severity in military personnel: A randomized clinical trial. JAMA, 2018; 319(4):354–364; doi: 10.1001/jama.2017.21242
47.
GutnerCA, GallagherMW, BakerAS, et al.Time course of treatment dropout in cognitive-behavioral therapies for posttraumatic stress disorder. Psychol Trauma, 2016; 8(1):115–121; doi: 10.1037/tra0000062
48.
GlombiewskiJA, Hartwich-TersekJ, RiefW. Attrition in cognitive-behavioral treatment of chronic back pain. Clin J Pain, 2010; 26(7):593–601; doi: 10.1097/AJP.0b013e3181e37611
49.
MaceaDD, GajosK, Daglia CalilYA, et al.The efficacy of Web-based cognitive behavioral interventions for chronic pain: A systematic review and meta-analysis. J Pain, 2010; 11(10):917–929; doi: 10.1016/j.jpain.2010.06.005
50.
LicciardoneJC. Demographic characteristics associated with utilization of noninvasive treatments for chronic low back pain and related clinical outcomes during the COVID-19 pandemic in the United States. J Am Board Fam Med, 2021; 34(Suppl):S77–S84; doi: 10.3122/jabfm.2021.S1.200352
51.
ShanahanML, RandKL, GallowayA, et al.Treatment goals and preferences of black veterans with chronic musculoskeletal pain. J Pain, 2024; 25(7):104487; doi: 10.1016/j.jpain.2024.02.001
52.
BrinsleyJ, SmoutM, DavisonK. Satisfaction with online versus in-person yoga during COVID-19. J Altern Complement Med, 2021; 27(10):893–896; doi: 10.1089/acm.2021.0062
53.
AndersonE, DvorinK, EtingenB, et al.‘It makes you sit back and think where you wanna go’: Veteran experiences in virtual whole health peer-led groups. Health Expect, 2022; 25(5):2548–2556; doi: 10.1111/hex.13581
54.
HibbardJH, GreeneJ. What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood), 2013; 32(2):207–214; doi: 10.1377/hlthaff.2012.1061
55.
LazaridouA, MartelMO, CorneliusM, et al.The association between daily physical activity and pain among patients with knee osteoarthritis: The moderating role of pain catastrophizing. Pain Med, 2019; 20(5):916–924; doi: 10.1093/pm/pny129
56.
SullivanMJ, RodgersWM, KirschI. Catastrophizing, depression and expectancies for pain and emotional distress. Pain, 2001; 91(1–2):147–154; doi: 10.1016/s0304-3959(00)00430-9
57.
VlaeyenJWS, LintonSJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 2000; 85(3):317–332; doi: 10.1016/S0304-3959(99)00242-0
58.
SmithSL, LangenWH. A systematic review of mindfulness practices for improving outcomes in chronic low back pain. Int J Yoga, 2020; 13(3):177–182; doi: 10.4103/ijoy.IJOY_4_20
59.
HaegeleJA, ZhuX. Physical activity, self-efficacy and health-related quality of life among adults with visual impairments. Disabil Rehabil, 2021; 43(4):530–536; doi: 10.1080/09638288.2019.1631397
60.
WoodyardC. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga, 2011; 4(2):49–54; doi: 10.4103/0973-6131.85485
61.
HirkoKA, KerverJM, FordS, et al.Telehealth in response to the COVID-19 pandemic: Implications for rural health disparities. J Am Med Inform Assoc, 2020; 27(11):1816–1818; doi: 10.1093/jamia/ocaa156
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
