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Besides specific PTSD symptoms, such as intrusions, avoidance and negative alterations in thoughts and mood, PTSD is a disorder that involves problems with arousal regulation, body- and self-awareness. Current treatments, such as exposure, EMDR, and cognitive behavioral interventions, are proven effective, but they have high dropout rates and often residual symptoms remain. Body- and movement-oriented interventions (BMOIs) may form a valuable addition. BMOIs use movement activities and bodily experiences to reduce symptomatology, increase mental health and improve psychosocial functioning. Because BMOI’s receive increasing attention in clinical practice, we updated our systematic review and meta-analysis on the effectiveness of BMOIs for PTSD and comorbid depression (Van de Kamp et al., 2019). Additionally, we analyzed secondary outcomes currently regarded as clinically relevant, namely sleep quality and interoceptive awareness.
 
We found that BMOIs have a moderate effect on reducing PTSD symptoms, a small to moderate effect on depression, and a large effect on sleep quality. These findings are important, because PTSD and depression together cause a substantially higher psychological burden than either disorder alone. Moreover, sleep problems can worsen PTSD or cause other symptoms, such as depression or dissociation and often persist after treatment. Clearly, in view of these effects, adding BMOIs to current treatments is worthwhile. 
 
We also explored how BMOIs affect interoceptive awareness in PTSD patients. PTSD involves a fundamental dysregulation of arousal modulation and is associated with significant problems in interoceptive and emotional awareness, as alexithymia, dissociation and physical and emotional numbing. Adequate interoceptive awareness is considered necessary to achieve effective regulation of arousal and emotions. We found that interoceptive awareness increased slightly more in the control groups than in the BMOI groups. However, high levels of interoceptive awareness may not always be beneficial for people with PTSD. In a state of hyperarousal, body signals may be overwhelming and dysregulating. Yet, one aspect of interoceptive awareness may be important to increase for people with PTSD: physical self-regulation. This is the ability to calm oneself by paying attention to body sensations, such as the breath. This specific aspect of interoceptive awareness may be improved with BMOIs in people with PTSD.
 
The current guidelines recommend cognitive (behavioral) therapy and exposure based therapies for PTSD (APA, 2017). These guidelines look at four factors: 1) overall strength of the evidence for the treatment; (2) the balance of benefits versus harms or burdens; (3) patient values and preferences for treatment; and (4) the applicability of evidence-based effects to various populations. The updated meta-analysis shows the strengths of the evidence for BMOIs as therapies for PTSD. We see that most of the included studies report high participant satisfaction, and that there were no harms and no or few negative experiences with the BMOIs. The studies included many different groups of patients based on sex, trauma type, nationality or culture. As such, BMOIs appear to be applicable to various populations. Since people have different values and preferences, BMOIs should be added to the treatment options to provide an optimal fit for each patient.
 
Given the variation in the effect size of the follow up data, we suggest that it may be worthwhile to continue the BMOI in regular sport/movement settings after the formal therapeutic intervention. For instance, a study by Rhodes et al. (2016) demonstrated that doing yoga more often after treatment, was related to larger decreases in PTSD and depression symptoms, and a higher chance of remission of PTSD. Therefore, motivating patients with PTSD to keep practicing the BMOI as part of their lifestyle, may help them feel more confident in managing their symptoms of PTSD, depression and sleep problems.
 
In summary, this systematic review and meta-analysis suggests that BMOIs may be effective for patients with PTSD in reducing PTSD symptoms and secondary symptoms of depression and sleep problems. Therefore, treatment options should include BMOI’s and more high quality studies should shed more light on specific effects and working mechanisms.

Target Article

van de Kamp, M. M.,  Scheffers, M.,  Emck, C.,  Fokker, T. J.,  Hatzmann, J.,  Cuijpers, P., &  Beek, P. J. (2023). Body-and movement-oriented interventions for posttraumatic stress disorder: An updated systematic review and meta-analysis. Journal of Traumatic Stress,  36,  835–848. https://doi.org/10.1002/jts.22968

Discussion Questions

  •  How can patient values and preferences be taken into account when deciding on the use of BMOIs as treatment options for PTSD?
  • Should BMOIs be added to the current guidelines for PTSD, following this updated meta-analysis? Most of the included studies report high participant satisfaction, and there were no harms and no or few negative experiences with the BMOIs.
  • How can more high quality studies be conducted to shed more light on specific effects and working mechanisms of BMOIs for patients with PTSD?
  • What are the potential challenges and limitations of using BMOIs as treatment options for PTSD, and how can they be adressed?

About the Authors

Minke M. van de Kamp, MSc, is a PhD student and teacher at the Vrije Universiteit, Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands. She also works as a psychomotor therapist in a clinical psychiatric centre at the ParnassiaGroep. Minke van de Kamp can be contacted at m.m.vande.kamp@vu.nl.
 
Claudia Emck, PhD, psychomotor therapist, clinical and health psychologist, human movement scientist. Currently working as assistant professor at the Faculty of Behavioral and Movement Sciences, VU University, Amsterdam, the Netherlands. Research and education on psychomotor interventions for mental health in children, adolescents and adults. Claudia Emck can be contacted at c.emck@vu.nl. 
 
Pim Cuijpers is Professor of Clinical Psychology at the Vrije Universiteit Amsterdam, The Netherlands and director of the WHO Collaborating Centre for Research and Dissemination of Psychological Interventions in Amsterdam. He is specialised in conducting randomised controlled trials and meta-analyses on prevention and psychological treatments of common mental disorders across the life span. Pim Cuijpers is Editor-in-Chief of the Journal of Consulting and Clinical Psychology.

References Cited

American Psychiatric Association (APA, 2017). Clinical practice guideline for the treatment of PTSD.
Kamp, M. M. van de, Scheffers, M., Hatzmann, J., Emck, C., Cuijpers, P., & Beek, P. J. (2019). Body‚Äź and movement‚Äźoriented interventions for posttraumatic stress disorder: a systematic review and meta‚Äźanalysis. Journal of Traumatic Stress 32, 967–976. https://doi.org/10.1002/jts.22465

Rhodes, A. M., Spinazzola, J., & Kolk, B. v. d. (2016). Yoga for adult women with chronic PTSD: a long-term follow-up study. The Journal of Alternative and Complementary Medicine, 22(3), 189-196. https://doi.org/https://doi.org/10.1089/acm.2014.0407