An Online Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga (CBT-MY) Intervention for Posttraumatic Stress Disorder: Psychometric and Psychophysiology Outcomes.

Background Posttraumatic Stress Disorder (PTSD) is a debilitating condition that remains undertreated. Online delivery of cognitive behavioural therapy supplemented with mindfulness meditation and yoga can be a viable treatment that emphasizes self-directed practice. Objective This study examined the effectiveness of an online cognitive behaviour therapy program combined with mindfulness and yoga methods (CBT-MY) designed for daily use. Methods An 8-week single-arm experimental registered clinical trial (www.clinicaltrials.gov ID: NCT03684473) was conducted on a sample of adults, ages 18-35 years, with PTSD symptoms (n = 22). Each participant received online CBT-MY content and an hour of online counselling each week. Pre-post psychological outcomes were self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes were pupillometry and heart rate variability (HRV) measured during a lab protocol. The HRV and pupillometry outcomes were also compared with cross-sectional data from a non-PTSD comparison group that did not receive the intervention and reported no history of clinical mental health diagnoses (n = 46). Results Pre-post intention-to-treat analyses revealed substantial improvements in PTSD severity (d = 1.60), depression (d = 0.83), anxiety (d = 0.99), and mindfulness (d = 0.88). Multilevel mixed models revealed significant pre-post reductions in peak pupil diameter (PPD) at 8-week follow-up (F(1,58) = 27.0, p = .000, partial eta squared = .32) but no significant changes in pre-post HRV (p = .87). Participants spent a mean of 12-minutes/day in self-directed mindfulness practice (M = 38.89 mins/week, SD = 28.16), guided yoga (M = 31.94 mins/week, SD = 28.24), and breath awareness techniques (M = 9.89 mins/week, SD = 11.87). Conclusions 8-weeks of online CBT-MY program participation was associated with clinically significant PTSD symptom reduction in combination with significant PPD changes reflecting more normalized autonomic function. Future RCT research is needed to further examine the gains apparent in this single-arm study. Clinicaltrial This study was a registered, single-arm experimental clinical trial (www.clinicaltrials.gov ID: NCT03684473).