Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials

Gallegos, Autumn M.; Crean, Hugh F.; Pigeon, Wilfred R.; Heffner, Kathi L.

doi:10.1016/j.cpr.2017.10.004

Cited by 136 publications

(99 citation statements)

References 53 publications

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“…For example, in a randomized control longitudinal study with veterans diagnosed with PTSD, breathing‐based meditation was associated with decreased hyperarousal and startle reflexes immediately following the intervention and at 1‐year follow‐up (Seppӓlӓ et al, ). Breathing‐based practices are often used in conjunction with yoga, neurofeedback, or exercise‐based interventions, further highlighting the duality of mind–body interactions that can promote symptom relief in PTSD (Corrigan, ; Gallegos, Crean, Pigeon, & Heffner, ; Gordon, Staples, He, & Atti, ; Polak, Witteveen, Denys, & Olff, ; van der Kolk et al, ; for a review, see Banks, Newman, & Saleem, ; Boyd, Lanius, & McKinnon, ). For example, mindful respiration appears to influence the expression of the autonomic nervous system and has been employed as a means to quell the physiological alterations that characterize defensive responses prior to their elicitation (for a review, see Jerath, Crawford, Barnes, & Harden, ).…”

Section: Neuroimaging the Midbrain In Ptsdmentioning

confidence: 99%

The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

Terpou

Harricharan

McKinnon

et al. 2019

J of Neuroscience Research

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Post-traumatic stress disorder (PTSD), a diagnosis that may follow the experience of trauma, has multiple symptomatic phenotypes. Generally, individuals with PTSD display symptoms of hyperarousal and of hyperemotionality in the presence of fearful stimuli. A subset of individuals with PTSD; however, elicit dissociative symptomatology (i.e., depersonalization, derealization) in the wake of a perceived threat. This pattern of response characterizes the dissociative subtype of the disorder, which is often associated with emotional numbing and hypoarousal. Both symptomatic phenotypes exhibit attentional threat biases, where threat stimuli are processed preferentially leading to a hypervigilant state that is thought to promote defensive behaviors during threat processing. Accordingly, PTSD and its dissociative subtype are thought to differ in their proclivity to elicit active (i.e., fight, flight) versus passive (i.e., tonic immobility, emotional shutdown) defensive responses, which are characterized by the increased and the decreased expression of the sympathetic nervous system, respectively. Moreover, active and passive defenses are accompanied by primarily endocannabinoid-and opioid-mediated analgesics, respectively. Through critical review of the literature, we apply the defense cascade model to better understand the pathological presentation of defensive responses in PTSD with a focus on the functioning of lower-level midbrain and extended brainstem systems. K E Y W O R D Sbrainstem, dissociation, periaqueductal gray, PTSD, trauma | INTRODUC TI ONIn this review, we integrate literature from trauma experiences, the defense cascade, and the threat-response neurocircuitry within a framework of post-traumatic stress disorder (PTSD). We begin by introducing the concepts of the hypothalamic-pituitary-adrenal (HPA) axis, general PTSD, and defensive responses. Following these primers, we discuss the influences of trauma onset and prolonged exposure to trauma and their effects on the development of PTSD and the dissociative subtype of PTSD. Next, we introduce the defense cascade model and its underlying neurocircuitry as described in the animal literature and relate it to PTSD. In addition, we discuss the current state of the neuroimaging literature, which Edited by Sandra Chanraud.All peer review communications can be found with the online version of the article. | 1111TERPOU ET al. suggests that functional alterations are detectable in the midbrain of individuals with PTSD and its dissociative subtype as compared to healthy controls. We conclude by presenting directions for future research and the clinical implications for treatment of persons with PTSD that arise from this review of the extant literature.

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Section: Neuroimaging the Midbrain In Ptsdmentioning

confidence: 99%

The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

Terpou

Harricharan

McKinnon

et al. 2019

J of Neuroscience Research

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“…This anatomical similarity suggests that a common deficit in vmPFC function may have negative consequences both for PRV/HRV and PTSD reexperiencing symptoms, although strong evidence for the specific mechanistic relationship linking these processes would require alternative designs to the current correlational study. For example, it would be informative to test whether the effectiveness of somatic interventions targeting PTSD symptoms-for example, aerobic exercise (Fetzner & Asmundson, 2015), meditation (Polusny et al, 2015), yoga (Gallegos, Crean, Pigeon, & Heffner, 2017), or HRV feedback training (Tan, Dao, Farmer, Sutherland, & Gevirtz, 2011)-is predicted by normalized vmPFC function and corresponding increases in HRV.…”

Section: Discussionmentioning

confidence: 99%

A common neural substrate for elevated PTSD symptoms and reduced pulse rate variability in combat‐exposed veterans

et al. 2019

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Previous studies have identified reduced heart rate variability (HRV) in post‐traumatic stress disorder (PTSD), which may temporally precede the onset of the disorder. A separate line of functional neuroimaging research in PTSD has consistently demonstrated hypoactivation of the ventromedial prefrontal cortex (vmPFC), a key aspect of a descending neuromodulatory system that exerts inhibitory control over heart rate. No research to date, however, has simultaneously investigated whether altered vmPFC activation is associated with reduced HRV and elevated PTSD symptoms in the same individuals. Here, we collected fMRI data during alternating conditions of threat of shock and safety from shock in 51 male combat‐exposed veterans with either high or low levels of PTSD symptoms. Pulse rate variability (PRV)—a HRV surrogate calculated from pulse oximetry—was assessed during a subsequent resting scan. Correlational analyses tested for hypothesized relationships between reduced vmPFC activation, lower PRV, and elevated PTSD symptomatology. We found that PTSD re‐experiencing symptoms were inversely associated with high‐frequency (HF)‐PRV, thought to primarily reflect parasympathetic control of heart rate, in veterans with elevated PTSD symptoms. Reduced vmPFC activation for the contrast of safety‐threat was associated both with lower HF‐PRV and elevated PTSD re‐experiencing symptoms. These results tie together previous observations of reduced HRV/PRV and impaired vmPFC function in PTSD and call for further research on reciprocal brain‐body relationships in understanding PTSD pathophysiology.

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“…This anatomical overlap provides tentative support for the idea that observations of reduced vmPFC function and decreased HRV/PRV in PTSD may be mechanistically related, although stronger support for this hypothesis would require alternative designs. For example, it would be informative to test whether the effectiveness of somatic interventions targeting PTSD symptoms -for example, aerobic exercise (Fetzner & Asmundson, 2015), meditation (Polusny et al, 2015), yoga (Gallegos et al, 2017), or HRV feedback training (Tan, Dao, Farmer, Sutherland, & Gevirtz, 2011) -is predicted by engagement of this hypothesized target mechanism, i.e., normalized vmPFC function and corresponding increases in HRV.…”

Section: Discussionmentioning

confidence: 99%

“…The investigation of relationships between the brain and periphery, and how these relationships are altered in trauma-exposed individuals, may elucidate novel candidate mechanisms of PTSD etiology. These candidate mechanisms can then be used as treatment targets for somatically focused, "alternative" treatments for PTSD (Gallegos, Crean, Pigeon, & Heffner, 2017;Polusny et al, 2015) that may be better tolerated or more effective for some traumatized individuals.…”

Section: Introductionmentioning

confidence: 99%

A common neural substrate for elevated PTSD symptoms and reduced pulse rate variability in combat-exposed veterans

Grupe

Imhoff‐Smith

Wielgosz

et al. 2018

Preprint

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Background. Previous studies have identified reduced heart rate variability (HRV) in posttraumatic stress disorder (PTSD), which may temporally precede the onset of the disorder.A separate line of functional neuroimaging research suggests that the ventromedial prefrontal cortex (vmPFC) -a key aspect of a descending neuromodulatory system that exerts inhibitory control over heart rate -shows functional and structural abnormalities in PTSD. No research to date, however, has simultaneously investigated whether altered vmPFC activation is associated with reduced HRV and elevated PTSD symptoms in the same individuals.Methods. We collected fMRI data during alternating conditions of threat of shock and safety from shock in 51 male, combat-exposed veterans with either high or low levels of PTSD symptoms. Pulse rate variability (PRV) -an HRV surrogate calculated from pulse oximetrywas assessed during a subsequent resting scan. Correlational analyses tested for hypothesized relationships between vmPFC activation, PRV, and distinct dimensions of PTSD symptomatology.Results. Re-experiencing PTSD symptoms were inversely associated with high-frequency (HF)-PRV, thought to primarily reflect parasympathetic control of heart rate, in veterans with elevated PTSD symptoms. Lower HF-PRV was associated with reduced vmPFC activation for the contrast of safety-threat in a region that also showed an inverse relationship with reexperiencing symptoms. Conclusions.Reduced vmPFC responses to safety vs. threat were associated with both reduced HF-PRV and increased re-experiencing symptoms. These results tie together previous observations of reduced HRV/PRV and impaired vmPFC function in PTSD and call for further research on reciprocal brain-body relationships in understanding PTSD pathophysiology.

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Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials

Cited by 136 publications

References 53 publications

The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray

A common neural substrate for elevated PTSD symptoms and reduced pulse rate variability in combat‐exposed veterans

A common neural substrate for elevated PTSD symptoms and reduced pulse rate variability in combat-exposed veterans

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