QUANTITATIVE RESEARCH

METHODS USED IN QUANTITATIVE RESEARCH

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As you have explored this week, there are various methods a researcher may use to engage in quantitative research design. While the methods presented this week are not exhaustive, they do introduce numerous features that you will likely encounter when reviewing, accessing, and researching the nursing practice literature. Whether you are creating new research or searching the literature to add support for a research question you are interested in, understanding the quantitative research designs that may be used for nursing practice will likely inform how you will conduct research for your health care setting. As you continue to build upon your research skills as a nursing researcher and professional, understanding how to engage in quantitative research design is a valuable asset.

For this Assignment, view this week’s Quantitative Research Designs PowerPoint webinar and pay close attention to its content on the basic elements of research methods (e.g., sample, data collection, measurement, analysis). Then, be sure to review the research study by Latour, O’Byrne, McCarthy, Chacko, Russell, & Price (2020), included in this week’s resources.


Note

: While not a required resource, you might find the definitions in the Encyclopedia of Nursing Research helpful for this assignment.

This assignment involves identifying and describing the strengths and weaknesses of the research method used in the Latour, O’Byrne, McCarthy, Chacko, Russell, & Price (2020) research article in this week’s resources.

· Focus on the research design, sample data collection methods, tools used for data collection, and the plan for data analysis as discussed in the Latour, O’Byrne, McCarthy, Chacko, Russell, & Price (2020) article.

· Identify at least two strengths and two weaknesses of the study based on reliability and validity by including additional support with citations from resources not assigned this week.

· Use the copy of the Journal Club Template for Quantitative Research located in this week’s resources. The template includes an area for each element discussed in the study. Note: Assignments will not be accepted unless the required template is used.

· Be brief, paraphrase and summarize each of the elements clearly on the form.

· Provide the full citation of the article used for this Assignment on the template.

Once this is complete, save your file and submit the Journal Club Template for Quantitative Research to the submission link. Note that the template provided must be used.


WEEKLY RESOURCES

https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/3150/CH/mm/quantitative_research/index.html

Research Methods – Overview (waldenu.edu)

Gray, J. R, & Grove, S. K. (2021). 
Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Elsevier.

Chapter 3, “Introduction to Quantitative Research” (pp. 46–74)

Chapter 10, “Quantitative Methodology: Noninterventional Designs and Methods” (pp. 234–260)

Chapter 11, “Quantitative Methodology: Interventional Designs and Methods” (pp. 261–313)

Chapter 15, “Sampling” (pp. 410–449)

SAML Login | SAGE Publishing

Rubric

NURS_3150_Week_3_Assignment_Rubric

15 pts

15 pts

15 pts

5 pts

5 pts

NURS_3150_Week_3_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeResearch Design

15 to >13.0 pts

Excellent

Student provided a fully developed explanation of the research design with insightful analysis of concepts and related issues.

13 to >11.0 pts

Proficient

Student provided a developed discussion of the research design with reasonable analysis of concepts and related issues.

11 to >10.0 pts

Basic

Student provided a minimally developed discussion of the research design with limited analysis of concepts and related issues.

10 to >0 pts

Needs Improvement

Student provided an under-developed discussion of the research design with little or no analysis of concepts and related issues.

1

5 pts

This criterion is linked to a Learning OutcomeSample Selection

15 to >13.0 pts

Excellent

Student provided a fully developed explanation of the sample selection with insightful analysis of concepts and related issues.

13 to >11.0 pts

Proficient

Student provided a developed explanation of the sample selection with insightful analysis of concepts and related issues.

11 to >10.0 pts

Basic

Student provided a minimally developed explanation of the sample selection with insightful analysis of concepts and related issues.

10 to >0 pts

Needs Improvement

Student provided an under-developed explanation of the sample selection with insightful analysis of concepts and related issues.

This criterion is linked to a Learning OutcomeData Collection Methods, Measures, & Tools

15 to >13.0 pts

Excellent

Student provided a fully developed explanation of the data collection methods, measures, and tools with insightful analysis of concepts and related issues.

13 to >11.0 pts

Proficient

Student provided a developed explanation of the data collection methods, measures, and tools with insightful analysis of concepts and related issues.

11 to >10.0 pts

Basic

Student provided a minimally developed explanation of the data collection methods, measures, and tools with insightful analysis of concepts and related issues.

10 to >0 pts

Needs Improvement

Student provided an under- developed explanation of the data collection methods, measures, and tools with insightful analysis of concepts and related issues.

This criterion is linked to a Learning OutcomePlan for Data Analysis

15 to >13.0 pts

Excellent

Student provided a fully developed explanation of the plan for data analysis with insightful analysis of concepts and related issues.

13 to >11.0 pts

Proficient

Student provided a developed explanation of the plan for data analysis with insightful analysis of concepts and related issues.

11 to >10.0 pts

Basic

Student provided a minimally developed explanation of the plan for data analysis with insightful analysis of concepts and related issues.

10 to >0 pts

Needs Improvement

Student provided an under-developed explanation of the plan for data analysis with insightful analysis of concepts and related issues.

This criterion is linked to a Learning OutcomeIdentifies and describes the strengths and weaknesses of the research method used. Include at least 2 strengths and two weakness based on reliability and validity.

25 to >22.0 pts

Excellent

Student provided a fully developed discussion of at least two strengths and two weaknesses of the research methods based on the reliability and validity and supported with a citation for each with insightful analysis of concepts and related issues.

22 to >19.0 pts

Proficient

Student provided a developed discussion of at least two strengths and two weaknesses of the research methods based on the reliability and validity and supported with a citation for each with insightful analysis of concepts and related issues.

19 to >17.0 pts

Basic

Student provided a minimally developed discussion of at least two strengths and two weaknesses of the research methods based on the reliability and validity and supported with a citation for each with insightful analysis of concepts and related issues.

17 to >0 pts

Needs Improvement

Student provided an under developed discussion of at least two strengths and two weaknesses of the research methods based on the reliability and validity and supported with a citation for each with insightful analysis of concepts and related issues.

25 pts

This criterion is linked to a Learning OutcomeProfessional Writing: Clarity, Flow, and Organization

5 to >4.0 pts

Excellent

Content is free from spelling, punctuation, and grammar/syntax errors. Writing demonstrates very well-formed sentence and paragraph structure. Content presented is completely clear, logical, and well-organized.

4 to >3.5 pts

Proficient

Content contains minor spelling, punctuation, and/or grammar/syntax errors. Writing demonstrates appropriate sentence and paragraph structure. Content presented is mostly clear, logical, and well-organized.

3.5 to >3.0 pts

Basic

Content contains moderate spelling, punctuation, and/or grammar/syntax errors. Writing demonstrates adequate sentence and paragraph structure and may require some editing. Content presented is adequately clear, logical, and/or organized, but could benefit from additional editing/revision.

3 to >0 pts

Needs Improvement

Content contains significant spelling, punctuation, and/or grammar/syntax errors. Writing does not demonstrate adequate sentence and paragraph structure and requires additional editing/proofreading. Key sections of presented content lack clarity, logical flow, and/or organization.

5 pts

This criterion is linked to a Learning OutcomeProfessional Writing: Context, Audience, Purpose, and Tone

5 to >4.0 pts

Excellent

Content clearly demonstrates awareness of context, audience, and purpose. Tone is highly professional, scholarly, and free from bias, and style is appropriate for the professional setting/workplace context.

4 to >3.5 pts

Proficient

Content demonstrates satisfactory awareness of context, audience, and purpose. Tone is adequately professional, scholarly, and/or free from bias, and style is consistent with the professional setting/workplace context.

3.5 to >3.0 pts

Basic

Content demonstrates basic awareness of context, audience, and purpose. Tone is somewhat professional, scholarly, and/or free from bias, and style is mostly consistent with the professional setting/workplace context.

3 to >0 pts

Needs Improvement

Content minimally or does not demonstrate awareness of context, audience, and/or purpose. Writing is not reflective of professional/scholarly tone and/or is not free of bias. Style is inconsistent with the professional setting/workplace context and reflects the need for additional editing.

This criterion is linked to a Learning OutcomeAPA Attributions and Formatting: cover page, title of paper on second page, level headings, Times New Roman 12 font, 1″ margins, and page numbers. APA References: Uses in-text citations appropriately and format correctly. Paraphrases to avoid plagiarizing the source.

5 to >4.0 pts

Excellent

Demonstrates fully developed APA formatting with no errors using the template provided.

4 to >3.5 pts

Proficient

Demonstrates developed APA formatting with few formatting errors in the template provided.

3.5 to >3.0 pts

Basic

Demonstrates minimally developed APA formatting with several formatting errors in the template provided.

3 to >0 pts

Needs Improvement

Demonstrates limited APA formatting with multiple formatting errors or fails to use the template provided.

Total Points: 100

Previous

Next

1

Title of the Paper in Full Goes Here

Student Name Here

Program Name or Degree Name, Walden University

Course Number, Section, and Title

(Example: NURS 0000 Section 01, Title of Course)

Instructor Name

Month, Day, Year

(enter the date submitted to instructor)

Journal Club Template for Quantitative Research Article

The purpose of this assignment is to describe the research design and methodology. Please discuss the research design, the sample selection, the data collection methods and the plans for data analysis. Please do not focus on or include the results of the study. The use of this template is required. Any other format will not be accepted. Each section should be fully developed and written in your own words. Avoid quoting the article’s content. The article should be cited within the response in APA format. At the end, include this article in the reference section using APA format. Any other resources used should also be cited and referenced appropriately.

Research Design

Sample Selection

Data Collection Methods, Measures and Tools

Plans for Data Analysis

Strengths (include two strengths)

Weaknesses (include two weaknesses)

References

List references in alphabetical order and in APA format. References should be published within the last
five years. In your paper, be sure every reference entry matches a citation, and every citation refers to an item in the reference list.

Zaccari, B., Callahan, M.L., Storzback, D., & McFarlane, N. (2020)

Title:

Yoga for veterans with PTSD: Cognitive functioning, mental health, and salivary cortisol.

Authors:

Zaccari, Belle, ORCID 0000-0003-2260-6620. Veterans Affairs Portland Health Care System, Portland, OR,

US

, belle.zaccari@va.gov
Callahan, Megan L.. Veterans Affairs Portland Health Care System, Portland, OR, US
Storzbach, Daniel. Veterans Affairs Portland Health Care System, Portland, OR, US
McFarlane, Nancy. Veterans Affairs Portland Health Care System, Portland, OR, US
Hudson, Rebekah. Department of Psychiatry, Oregon Health & Science University, OR, US
Loftis, Jennifer M.. Department of Psychiatry, Oregon Health & Science University, OR, US

Address:

Zaccari, Belle, Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Road P3MHR, Portland, OR, US, 97239, belle.zaccari@va.gov

Source:

Psychological Trauma: Theory, Research, Practice, and Policy, Vol 12(8), Nov, 2020. Special Issue: Complementary Medicine and Integrative Approaches to Trauma Therapy and Recovery. pp. 913-917.

NLM Title Abbreviation:

Psychol Trauma

Publisher:

US : Educational Publishing Foundation

ISSN:

1942-9681 (Print)
1942-969X (

Electronic

)

ISBN:

978-1-4338-9429-9

Language:

English

Keywords:

Veterans, trauma, cortisol, cognitive functioning, trauma sensitive yoga

Abstract (English):

Objective: Research indicates that cognitive functioning is negatively impacted by exposure to chronic stress due to overactivation of the stress response. Yoga has demonstrated benefits when practiced by individuals diagnosed with posttraumatic stress disorder (PTSD). This quasi-experimental pilot study examined the impact of a yoga intervention on cognitive functioning, symptoms of PTSD, and the biological stress response in Veterans diagnosed with PTSD. Method: Cognitive functioning, self-report measures of mental health symptoms, and salivary cortisol were measured within two weeks prior to beginning and following completion of a 10-week yoga protocol. Veterans with PTSD participated in gender-specific groups of the yoga intervention. Paired t tests and correlational analyses were used to analyze quantitative data. Results: Statistically significant improvements were observed between baseline and postintervention scores on measures of response inhibition, PTSD, depression, sleep, quality of life, and subjective neurocognitive complaints. Positive correlations were found between baseline and postintervention changes in sleep and depression, and between change in cortisol output and a measure of life satisfaction. Statistically significant differences (baseline to postintervention) for other objective measures of cognitive performance and cortisol were not detected. Conclusions: Results provide preliminary support for the practice of yoga to improve cognitive functioning (response inhibition) related to symptoms of PTSD while also improving mental health symptoms, sleep, and quality of life. Positive correlations affirm the role of sleep in mood symptoms and indicate the need for further examination of the role of cortisol in life satisfaction. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Impact Statement:

Clinical Impact Statement—Individuals with PTSD report social, emotional, and cognitive problems related to living with this disorder. Overactivity of the stress response contributes to these problems. Research examining the therapeutic effects of yoga identifies positive changes to the stress response that are associated with improvements in daily functioning (e.g., sleep, memory, concentration). The current study offered trauma-sensitive yoga to Veterans with PTSD and found improvements in response inhibition, depression, sleep, and life satisfaction after participating in yoga. These findings add to the body of literature supporting yoga as a promising intervention for symptoms of trauma with widespread benefits to functioning. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Document Type:

Journal Article

Subjects:

*Cognitive Ability; *Hydrocortisone; *Posttraumatic Stress Disorder; *Yoga; Mental Health; Military Veterans; Saliva; Test Construction

PsycInfo Classification:

Specialized Interventions (3350)
Military Psychology (3800)

Population:

Human
Male
Female

Location:

US

Age Group:

Adulthood (18 yrs & older)

Tests & Measures:

TSY Participant Questionnaire – Pretreatment
Color Word Interference Test
PTSD Checklist for DSM–5
Beck Depression Inventory—Second Edition
Multiple Sclerosis Neuropsychological Questionnaire
Perceived Benefits of Yoga Questionnaire
Delis-Kaplan Executive Function System   DOI: 10.1037/t15082-000
Wechsler Adult Intelligence Scale–Fourth Edition   DOI: 10.1037/t15169-000
Pittsburgh Sleep Quality Index   DOI: 10.1037/t05178-000
Satisfaction With Life Scale   DOI: 10.1037/t01069-000

Grant Sponsorship:

Sponsor: Veterans Affairs Portland Health Care System, US
Recipients: No recipient indicated
Sponsor: Oregon Health & Science University, US
Recipients: No recipient indicated
Sponsor: Methamphetamine Research Center, US
Grant Number: NIDA P50DA018165
Recipients: No recipient indicated
Sponsor: U.S. Department of Veterans Affairs, US
Grant Number: I01 BX002061
Other Details: Biomedical Laboratory Research and Development Merit Review Grant
Recipients: Loftis, Jennifer M.

Methodology:

Empirical Study; Quantitative Study; Treatment Outcome

Supplemental Data:

Experimental Materials Internet
Tables and Figures Internet
Text Internet

Format Covered:

Electronic

Publication Type:

Journal; Peer Reviewed Journal

Publication History:

First Posted: Aug 10, 2020; Accepted: May 6, 2020; Revised: Mar 10, 2020; First Submitted: Nov 1, 2019

Release Date:

20201221

Correction Date:

20201221

Copyright:

In the public domain.

Digital Object Identifier:

http://dx.doi.org/10.1037/tra0000909; http://dx.doi.org/10.1037/tra0000909.supp(Supplemental)

PMID:

32772534

PsycARTICLES Identifier:

tra-12-8-913

Accession Number:

2020-58802-001

Persistent link to this record (Permalink):

https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=pdh&AN=2020-58802-001&site=ehost-live&scope=site&custid=s6527200

Cut and Paste:

Yoga for veterans with PTSD: Cognitive functioning, mental health, and salivary cortisol.

Database:

APA PsycArticles

Yoga for Veterans With PTSD: Cognitive Functioning, Mental Health, and Salivary Cortisol

By: Belle Zaccari
Veterans Affairs Portland Health Care System, Portland, Oregon, and Department of Psychiatry, Oregon Health & Science University;
Megan L. Callahan
Veterans Affairs Portland Health Care System, Portland, Oregon, and Department of Psychiatry, Oregon Health & Science University
Daniel Storzbach
Veterans Affairs Portland Health Care System, Portland, Oregon, and Department of Psychiatry, Oregon Health & Science University
Nancy McFarlane
Veterans Affairs Portland Health Care System, Portland, Oregon
Rebekah Hudson
Veterans Affairs Portland Health Care System, Portland, Oregon, and Department of Psychiatry, Oregon Health & Science University
Jennifer M. Loftis
Veterans Affairs Portland Health Care System, Portland, Oregon, and Department of Psychiatry, Oregon Health & Science University

Acknowledgement: This material is the result of work supported with resources and the use of facilities at Veterans Affairs Portland Health Care System, Oregon Health & Science University, and the Methamphetamine Research Center (NIDA P50DA018165), Portland, Oregon. This work was supported in part by the U.S. Department of Veterans Affairs Biomedical Laboratory Research and Development Merit Review Grant (I01 BX002061) to Jennifer M. Loftis and with resources and the use of facilities at the Veterans Administration Portland Health Care System. Belle Zaccari (Psychologist: Mental Health & Clinical Neurosciences), Megan L. Callahan (Psychologist: Mental Health & Clinical Neurosciences), Daniel Storzbach (Neuropsychologist: Mental Health & Clinical Neurosciences), Nancy McFarlane (Recreational Therapist: Mental Health & Clinical Neurosciences). Rebekah Hudson (Biological Science Lab Technician: Research & Development), Jennifer M. Loftis (Research Scientist: Research & Development) acknowledge their appointments at the Veterans Affairs Portland Health Care System, Portland, Oregon. The contents of this article do not represent the views of the U.S. Department of Veterans Affairs or the United States government. All authors approved this article submission. There are no conflicts of interest to report.

Posttraumatic stress disorder (PTSD) is associated with global impairments in inhibitory responses—cognitive processes that impact the regulation of neuropsychological and emotional functioning (
Wrocklage et al., 2016). These impairments may be mediated by dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, which is common in PTSD and other mental health conditions (

Morris, Compas, & Garber, 2012

Wichmann, Kirschbaum, Böhme, & Petrowski, 2017

). Activation of the HPA axis (the primary physiological mediator of the body’s stress response) results in the secretion of the adrenal hormone cortisol (

Wichmann et al., 2017

). In Veterans, high levels of cortisol are associated with impairments in cognitive performance (e.g., executive functions, processing speed, and response inhibition), but the effects of cortisol on cognition in PTSD is complex and less is known about the relationship among PTSD symptoms, cortisol, and cognitive performance (i.e., response inhibition; 

Franz et al., 2011


Wingenfeld & Wolf, 2015).

Cognitive-based psychotherapies and pharmacotherapies are effective PTSD treatments (

Watts et al., 2013

). However, research indicates that 60%–72% of patients retain a diagnosis of PTSD following cognitive processing therapy or prolonged exposure, and dropout rates in these therapies can be high (

Steenkamp, Litz, Hoge, & Marmar, 2015

). Mind–body interventions (e.g., acupuncture, meditation, and yoga) are receiving increasing empirical attention and support as alternatives. Recent systematic reviews and meta-analyses of yoga studies indicate that, although only seven randomized controlled trials have been conducted to date, results for yoga are promising—in some cases with effect sizes comparable to psychotherapeutic and psychopharmacologic approaches (

Cramer, Anheyer, Saha, & Dobos, 2018

, Jindani et al., 2108, 

Mitchell et al., 2014

Reinhardt et al., 2018

van der Kolk et al., 2014

). Within this larger body of evidence examining yoga as an adjunctive therapy for PTSD, a smaller number of studies use trauma-sensitive (also called trauma-informed) yoga (TSY) or use physiological outcome measures (

Kelly, Evans, Baker, & Taylor, 2018

Nolan, 2016

). A key proposed benefit of yoga is the downregulation of physiological arousal including HPA axis activation, but less is understood about the stress mechanisms associated with TSY therapeutic benefits (

Kelly et al., 2018

).

The current pilot study used TSY that was a hatha-based yoga with modifications for trauma sensitivity made to instruction style (e.g., using language of invitation and inquiry and omission of hands-on adjustments), class setup (e.g., use of a semicircle so all participants can see one another and teacher remains at the front of the classroom), and postures used in class (e.g., omission of adrenal-activating poses; 

Emerson, Sharma, Chaudhry, & Turner, 2009

). The overall goal was to examine the effects of TSY on response inhibition (as an indicator of cognitive performance), PTSD symptoms, and cortisol levels (as an indicator of the stress response) among Veterans diagnosed with PTSD. It was hypothesized that TSY would improve response inhibition, reduce posttraumatic stress symptoms, and have a positive impact on cortisol production. To our knowledge, this is the first Veterans Affairs (VA) facility study to examine the effect of TSY on measures of mental health changes accompanying PTSD using a prepost design that incorporated measures of cortisol.


Method

Overview

This quasi-experimental pilot study used a prepost design to examine the impact of TSY on cognitive performance, self-reported symptoms of PTSD, and salivary cortisol levels in Veterans diagnosed with PTSD. The research was carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) and approved by the Institutional Review Board at the Veteran Affairs Portland Health Care System (VAPORHCS).

Participants

Seventeen of the 27 enrolled Veterans completed the intervention and postintervention assessment. Participants who were diagnosed with PTSD (determined by medical chart review) and had attempted some form of trauma therapy previously (but were not currently engaged in a trauma processing therapy) were referred by their providers. Participants were recruited from mental health clinics of the VAPORHCS.

Measures

At baseline, participants completed a form requesting information on age, gender, race, ethnicity, service era, service branch, history of military sexual trauma, years of education, and comorbidity of other psychiatric conditions. Cognitive performance and mental health symptoms were assessed at baseline (preintervention) and postintervention. Descriptions, references, and psychometric properties of all measures, along with the scores/scales used for analyses, can be found in the online supplemental materials. The Delis-Kaplan Executive Function System, Color Word Interference Test (DKEFS-CWIT; 

Delis, Kaplan, & Kramer, 2001

), Digit Span (DS) from the Wechsler Adult Intelligence Scale—Fourth Edition (

Wechsler, 2008

), and the Trail Making Test A & B (TMT-A & – B; 

Army Individual Test Battery, 1944

) were administered to assess cognitive performance. Self-report symptom questionnaires, the PTSD Checklist for 
DSM–5 (PCL-5; 

Weathers et al., 2013

), the Beck Depression Inventory—Second Edition (BDI-II; 

Beck, Steer, & Brown, 1996

), the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ; 

Benedict et al., 2004

), the Pittsburgh Sleep Quality Index (PSQI; 
Buysse, Reynolds, Monk, Berman, & Kupfer, 1989), and the Satisfaction with Life Scale (SLS; 

Diener, Emmons, Larsen, & Griffin, 1985

) were used to measure mental health symptoms and quality of life. Cognitive performance measures and symptom questionnaires were scored and interpreted in accordance with their instruction manuals. To evaluate participants’ perceptions of the yoga intervention, the Perceived Benefits of Yoga Questionnaire (see 

Baker et al., 2015

) and a questionnaire developed by the study team were administered postintervention to collect feedback about the yoga intervention. Participant feedback is presented in the online supplemental materials.

Cortisol Measurement

Saliva samples (∼0.5 mL per sample) were obtained using Salivette for Cortisol Testing tubes (Starstedt, Germany). Veterans were provided verbal instructions and practice demonstrations on saliva collection methods; they were given an instructional take-home sheet with pictures and a description of the saliva collection procedure. Veterans were instructed to refrigerate collected samples and to keep them refrigerated until they were ready to bring to the VA lab where samples were processed and stored according to the manufacturer’s instructions. Refrigeration of samples was a precaution taken although salivary cortisol samples are relatively stable at a variety of storage conditions and at room temperature (

Nalla, Thomsen, Knudsen, & Frokjaer, 2015

). Veterans collected three saliva samples from the same day (waking, 30 min. postwaking, and bedtime) pre- and postintervention. Cortisol awakening response (CAR), area under the curve with respect to increase (AUCi; an indicator of cortisol reactivity), and area under the curve with respect to the ground (AUCg; an indicator of total systemic cortisol output) were calculated (

Clow, Thorn, Evans, & Hucklebridge, 2004


Pruessner, Kirschbaum, Meinlschmid, & Hellhamer, 2003). Baseline samples were collected within two weeks prior to starting TSY (
M = 4 days, 
SD = 4.98); postintervention samples were collected within two weeks of completing the final class (
M = 12 days, 
SD = 6.06). Saliva samples were analyzed in triplicate for cortisol levels using enzyme-linked immunosorbent assay (ELISA) kits per manufacturer’s instructions (high sensitivity EIA kits; Salimetrics, LCC, State College, Pennsylvania).

Intervention

The TSY intervention protocol consisted of 10 weekly, 60-min sessions; groups were separated by gender and received identical yoga protocols. The facilitator of the yoga intervention was a recreational therapist and a registered yoga teacher with additional TSY training.

Statistical Analyses

Paired 
t tests were used to examine the treatment effect for all outcome measures. Due to the small sample size, no corrections for multiple analyses were performed. Effect sizes were measured using Cohen’s 
d (

Cohen, 1988

). Pearson’s correlations using change scores (calculated by subtracting the postintervention score from the baseline score except on the SLS, where a lower score postintervention indicated improvement) were performed to examine associations between outcome measures. Analyses were performed using STATA 14.2 and SPSS Version 14.2. 
p values less than 0.05 were considered statistically significant.


Results

Twenty-seven men and women Veterans with PTSD were enrolled. Of the final sample (
N = 17), 41% endorsed military sexual trauma (85% of women and 10% of men). Of participants who completed postintervention assessment (male 
n = 10 and female 
n = 7), 11 attended eight or more classes, four attended five to seven classes, and two attended three classes. 

Table 1

 summarizes baseline and postintervention outcome measures. Statistically significant improvements were found for DKEFS-CWIT (
p = .04), PCL-5 (
p = .02), BDI-II (
p = .00), PSQI (
p = .01), SLS (
p = .01), and MSNQ (
p = .01). Statistically significant differences for the other cognitive measures (TMT-B and DS) and cortisol were not detected.

Evaluation of Outcome Measures Following TSY Intervention in Veterans With PTSD

A correlation matrix was generated to examine the relationships among changes in outcome measures (Table 2 in the online supplemental materials). Improvements in sleep correlated significantly with improvements in symptoms of depression (
r = .66; 
p < .05), supporting the known relationship between sleep and depression. An exploration of the cortisol variables found that change in total cortisol output (AUCg) was positively correlated with improvements in life satisfaction ( r = .73;  p < .01). As would be expected since both are indicators of cortisol change over time, changes in cortisol measure AUCi correlated with changes in CAR,  r = .66,  p < .01. Significant correlations were not found between cortisol variables and measures of cognitive performance (supplemental Table 2). Qualitative results are reported in supplemental Tables 3 and 4.


Discussion

The results of this pilot study support TSY as a feasible, acceptable intervention for Veterans with PTSD. Improvements in quality of life, attendance, and the qualitative responses of the completers support the acceptance of this intervention for Veterans of various service eras and branches. It was hypothesized that TSY would improve response inhibition, reduce self-reported symptoms of PTSD, and improve cortisol output and reactivity. Statistically significant improvements in response inhibition (but not other measures of cognitive performance) and self-reported symptoms of PTSD were found. Reported improvements in sleep and depression may have contributed to better performance on cognitive tasks of response inhibition. Future studies should use adjusted models controlling for the effects of these covariates on treatment outcomes while controlling for demographic variables (e.g., age and education).

Significant changes in response inhibition, sleep, and depression following TSY were not accompanied by statistically significant changes in cortisol, but there was a statistically significant relationship between the change in AUCg and self-reported improvement in life satisfaction. Cortisol production can be difficult to measure and interpret. One of the challenges in using salivary cortisol as a biomarker is the large number of confounding factors that can affect cortisol measurements (e.g., differences in circadian regulation, comorbid mental and physical health conditions, and other factors; 

Clow et al., 2004

). Veterans’ diurnal cycles show different patterns than non-veterans (
Wahbeh & Oken, 2013). Furthermore, individuals with PTSD trend toward lower salivary cortisol levels than controls (

Pan, Wang, Wu, Wen, & Liu, 2018

). Sample collection frequency and timing are also important considerations. In the current study, the number of samples collected may have contributed to a lack of statistically significant differences in cortisol. Given the scope of this pilot study, additional saliva sample collection was not feasible.

Other studies have used yoga as an intervention to examine functional outcomes correlated with reductions in PTSD symptomatology, especially hyperarousal, in Veterans populations. Findings of a randomized, longitudinal study correlated reductions in eyeblink startle with reductions in hyperarousal symptoms after practicing breathing-based yoga (
Seppälä et al., 2014). In a pilot study, Veteran participants reported fewer symptoms of hyperarousal, which correlated with improved sleep quality after participating in a yoga intervention (

Staples, Hamilton, & Uddo, 2013

). This study adds to the existing body of literature by examining the relationship of another type of yoga intervention (TSY), proposed to downregulate physiological arousal, and improvements in functional outcomes (
Jindani, Turner, & Khalsa, 2015; 

Reinhardt et al., 2018
). Given the heterogeneity in the content of different yoga interventions used in trauma populations, more research is needed to determine which intervention type(s) are most efficacious in reducing PTSD symptoms and regulating stress responses/HPA axis function with correlated improvements in functioning.

Results of this study are limited by a small sample size, potential self-report bias, demand characteristics that may have affected posttreatment responses, practice effects on the DKEFS-CWIT, reliance on historical diagnosis of PTSD, and potential lack of compliance with collection and storage of saliva. Statistical methods and other elements of the study design were selected keeping such limitations in mind and in an attempt to address them where possible. This project focused on Veterans with PTSD; thus, results are not necessarily generalizable to a non-veteran population.

Despite the limitations, this pilot study adds to existing literature and indicates that yoga interventions, like TSY, may improve response inhibition, PTSD symptoms, sleep quality, depression symptoms, and subjective cognitive complaints.


References

American Psychiatric Association. (2013). 
Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Army Individual Test Battery. (1944). 
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Submitted: November 1, 2019
 Revised: March 10, 2020
 Accepted: May 6, 2020

This publication is protected by US and international copyright laws and its content may not be copied without the copyright holders express written permission except for the print or download capabilities of the retrieval software used for access. This content is intended solely for the use of the individual user.

Source: Psychological Trauma: Theory, Research, Practice, and Policy. Vol. 12. (8), Nov, 2020 pp. 913-917)
Accession Number: 2020-58802-001
Digital Object Identifier: 10.1037/tra0000909


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