Perceptions of Service Users of Trauma-Sensitive Yoga as an Adjunct Treatment Option for Post-Traumatic Stress Disorder (PTSD) in the South African Setting

Abstract

Introduction: Low and middle income countries (LMIC) including South Africa face a mental health treatment gap where the burden of mental, neurological or substance abuse exceeds those who access treatment. Up to 50% of those that access treatment for post-traumatic stress disorder (PTSD) locally, fail to respond adequately to treatment. A growing body of research suggests utilizing yoga as effective treatment for PTSD. Yoga has the dual possibility of providing more effective treatment and being a low-cost resource option, both of which are important considerations in the South African context. This research report fills a gap in the field and takes the user’s perspective to provide deep and valuable understanding of the experiences and needs of PTSD service users and the possible openness towards trauma-sensitive yoga (TSY) as a PTSD treatment option in South Africa. Methods: Qualitative methods were employed, where in-depth interviews were conducted with PTSD service users (n = 9). Purposive and snowball sampling were used in recruiting participants. Informed consent was received from all participants. The framework approach was applied to the data analysis. This entailed (1) preliminary data analysis, (2) creation and refinement of a coding matrix, (3) application of the coding matrix to the entire dataset, (4) chartering of data and (5) exploring the relationships between the core aspects, available literature and theoretical perspectives. Results: The majority of PTSD service users reported a lack of clarity on PTSD diagnoses and PTSD treatment approaches being used in their treatment. Furthermore, they perceived interpersonal harm from their healthcare professionals, such as physical and psychological abuse. Financial barriers to care were mentioned mainly for psychological treatment of PTSD, and personal resistance was mentioned mainly for pharmacological treatment of PTSD. Alternative and complementary approaches to treatment were popular among PTSD service users. Benefits were found in biological, spiritual and nature-oriented approaches. However, yoga as a PTSD treatment option received mixed results, particularly as different forms of yoga that were not TSY were 5 experienced. There was also particular concern raised on the use of TSY where comorbid psychiatric diagnoses are present. Conclusion: Clear communication on PTSD diagnoses and shared-decision making in PTSD treatment is an important part of improving health outcomes. PTSD service users in this sample do not perceive this to be occurring. While there was an openness to alternative and complementary PTSD treatment options, yoga received mixed results. There was a clear distinction in experience between general forms of yoga and TSY. Differentiating and protocolising yoga for PTSD treatment from other forms of yoga in South Africa, is an important next step as the experiences differ greatly. Furthermore, better understanding the adaptation of TSY for patients with psychiatric comorbidities is another important research priority in this field.