Running head: PICOT PAPER
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PICOT Paper
Tayla Hasselbach
Group Name: The Scholars
University of San Francisco
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PICOT PAPER
Through much contemplation on what to research for our literature review, we
decided to examine the effects of yoga therapy in decreasing symptoms of post-traumatic
stress disorder among veterans. We originally wanted to investigate the effects of
‘mandatory socialization therapy,’ however we soon realized what a broad topic that was
and knew we needed to narrow our focus to one specific intervention. After a few key word
searches in evidence based literature databases, we found art therapy and yoga among the
most prominent non-pharmacological interventions studied in PTSD patients. We then
chose to focus solely on yoga out of personal interest as well as our knowledge of the rising
prevalence of the yoga practice today. Our question is: In adult veterans diagnosed with
post-traumatic stress disorder, does yoga therapy versus no yoga therapy decrease the
symptoms of PTSD?
The population we chose to research is adult veterans diagnosed with PTSD. We
chose veterans specifically due to the fact that PTSD is one of the most prominent wounds
of veterans returning from wars. According to Stankovic (2011), “up to 11% to 20% of
veterans of the Iraq and Afghanistan wars and 30% of Vietnam veterans have been affected
by PTSD.” Another reason for our interest is that one of our group members is in the ROTC
program here at USF and will soon be a nurse in the military. This seems to be a greatly
stigmatized subject, one which we will all have to face as nurses. The major features of
PTSD include:
(1) Re-experiencing of trauma through recurrent intrusive recollections of the
event, dreams about the event, and flashbacks–dissociative experiences during
which the event is relived, and the person behaves as though he or she is
experiencing the event at that time, (2) Avoidance of stimuli associated with the
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trauma, causing the individual to avoid talking about the event or avoid activities,
people, or places that arouse memories of the trauma, accompanied by feelings of
detachment, emptiness, and numbing, (3) Persistent symptoms of increased arousal
as evidenced by irritability, difficulty sleeping, difficulty concentrating, hypervigilance, or exaggerated startle response, and (4) Alterations in mood, such as
chronic depression or anxiety. (Halter, 2014, p. 310).
Traditional treatment modalities include psychoeducation aiming to normalize the
situation, psychopharmacology typically including anti-depressant medications, and
psychotherapy consisting of various cognitive and behavioral therapies, all of which will be
important to look into as we research a different form of treatment for PTSD.
We are interested in studying the effects of yoga in decreasing symptoms of PTSD.
According to Staples, Hamilton, & Uddo (2013), there are many studies showing that yoga
can improve sleep and reduce anger in a variety of populations. However, to what extent
can it reduce all of the others symptoms associated with PTSD is our question. Yoga is a
form of Complementary (adjunct) and Alternative (replacement) medicine (CAM) also
known as ‘integrative care,’ which is a care philosophy that “places the patient at the center
of care, focuses on prevention and wellness, and attends to the patient’s physical, mental,
and spiritual needs” (Halter, 2014, p. 636). There is a growing interest in and use of CAM in
the United States and in order to be effective nurses we should be up to date and
knowledgeable on all current evidence based practice in order to educate our patients and
advocate for their safety and autonomy during treatment. Yoga is a mental practice that
encompasses both physical poses (asanas) and breathing exercises (pranayama), as well as
mindfulness or “attending to the present moment in a non-judgmental, accepting manner”
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(Polusny et al., 2015). Steinberg and Eisner (2015) suggest that yoga helps veterans
recover from trauma by learning to calm down and self-regulate: “yoga practices including
mindfulness meditation can reduce autonomic sympathetic activation, muscle tension, and
blood pressure, and improve neuroendocrine and hormonal activity, and decrease physical
symptoms and emotional distress.” For these reasons yoga may very well be a promising
therapy for addressing emotional, cognitive, and physiological symptoms associated with
PTSD; however we have not yet specified whether we are viewing yoga as adjunct or
replacement therapy.
To measure the effects of yoga intervention we can use the PTSD Checklist (PCL)
which is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD that
can be completed in approximately 5-10 minutes (Weathers et al., 2013). A total symptom
severity score ranging 0-80 can be obtained by adding the scores for each of the 20 items
(higher scores indicate more severe symptoms) and the interpretation of the PCL should be
made by a clinician. According to Weathers et al., (2013), “A 5-10 point change represents
reliable change (i.e., change not due to chance) and a 10-20 point change represents
clinically significant change.”
At this time we have not specified time constraints within our question but rather
we want to complete our research and perhaps find an overall trend in the duration of yoga
practice with significant results.
We have identified our population of interest (veterans with PTSD), intervention
(yoga), comparison (no yoga), and outcome (decrease symptoms of PTSD). With this
focused and narrow PICOT formatted question we should be able to find reliable evidence
to answer our clinical question.
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PICOT PAPER
References
Halter, M. (2014). Varcarolis' foundations of psychiatric mental health nursing: A clinical
approach. (7th ed.) St. Louis, Mo.: Elsevier.
Polusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., Lim, K. O.
(2015). Mindfulness-based stress reduction for posttraumatic stress disorder
among veterans a randomized clinical trial. JAMA - Journal of the American Medical
Association, 314(5), 456-465. doi:10.1001/jama.2015.8361
Stankovic, L. (2011). Transforming trauma: A qualitative feasibility study of
integrative restoration (iRest) yoga nidra on combat-related post-traumatic stress
disorder. International Journal Of Yoga Therapy, 2123-37.
Staples, J. K., Hamilton, M. F., & Uddo, M. (2013). A yoga program for the symptoms of
post-traumatic stress disorder in veterans. Military Medicine, 178(8), 854-860.
doi:10.7205/MILMED-D-12-00536
Steinberg, C. A., & Eisner, D. A. (2015). Mindfulness-based interventions for veterans
with posttraumatic stress disorder. International Journal Of Behavioral Consultation
& Therapy, 9(4), 11-17.
Weathers, F.W., Litz, B.T., Keane, T.M., Palmieri, P.A., Marx, B.P., & Schnurr, P.P. (2013). The
PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD
at www.ptsd.va.gov.