A review of the literature concluded that yoga appears to have benefits for people with PTSD, particularly in relation to hyperarousal symptoms [1389]. The predominance of research to date has consisted of small, uncontrolled pilot studies; however, one RCT provides stronger evidence in support of yoga as an alternative therapy for PTSD. Van der Kolk and colleagues [1390] compared the efficacy of a 10-week yoga program to supportive health education (both delivered for one hour per week) among women with chronic treatment-resistant PTSD. Significantly greater reductions in PTSD symptom severity were observed among those randomised to undertake yoga compared to the supportive health education program, with effect sizes comparable to those observed for well-established psychological and pharmacological interventions. At the end of the program, 52% of those in the yoga group no longer met criteria for PTSD compared to 21% in the control group. The authors suggest that yoga may improve the functioning of traumatised people by helping them to tolerate physical and sensory experiences associated with fear and helplessness and to increase emotional awareness and affect tolerance [1390]. A long-term follow-up of this trial illustrated that the benefits of yoga relative to a control group were no longer evident 18 months after study completion, though an increased frequency of yoga practise was associated with reduced PTSD symptoms in both conditions [1391]. These findings are similar to those from a more recent RCT, which compared a holistic yoga intervention to a wellness lifestyle program among veterans and civilians with PTSD as a single disorder [1392]. People randomised to the yoga intervention experienced greater decreases in PTSD symptom severity directly following the intervention relative to people randomised to the lifestyle program, but these differences were no longer significant seven months after the study.
Studies examining the efficacy of yoga among people with co-occurring PTSD and AOD use disorders are lacking; however, there is some evidence to suggest that yoga may be beneficial among people with these co-occurring disorders. A small Australian RCT comparing a multicomponent yoga breath program to waitlist control among heavy drinking male veterans found a significantly greater reduction in PTSD symptoms in the yoga group compared to waitlist control, and a corresponding small, non-significant reduction in alcohol use [1393]. Another small trial of women with subthreshold and diagnostic levels of PTSD examined the impact of yoga on AOD use. Reductions in risky AOD use were observed; however, this study excluded women with AOD use disorders [1394]. One further qualitative study examined yoga among women in AOD treatment, most of whom reported a history of trauma [1395]. Women included in this study reported a wide variety of benefits for yoga, including improved mental health, emotional expression, improved sleep, and increased strength. Further research among people with co-occurring PTSD and AOD use disorders is needed, as well as research to determine the best style of yoga, and the optimal frequency and duration of practice.