Discussion
MST, sexual abuse, treatment-resistant PTSD, TCTSY, PTSD, trauma
The significant effectiveness of TCTSY for PTSD and the equivalence of TCTSY to CPT in improving PTSD outcomes confirm and extend our earlier findings.The TCTSY within-group effect sizes in this study (CAPS-5 ITT Cohen The TCTSY treatment completion rate was 42.6% higher than the CPT rate and is perhaps the most valuable finding, given the limited engagement in and completion of EBTs, particularly among women veterans.Yoga modulates the stress response, regulates the sympathetic nervous system, and activates the parasympathetic nervous system.Treatment for PTSD that uses different theoretical frameworks and mechanisms of action is needed for veterans for whom existing EBTs are unacceptable or ineffective. Our premise was that sexual trauma is experienced by the body first and primarily. As such, an embodied treatment approach provides a direct trajectory for healing as opposed to the indirect pathway of cognitively based EBTs. However, yoga modalities in studies of yoga for PTSD have varied widely. The TCTSY modality was designed for women with complex trauma (childhood sexual abuse) and chronic, treatment-resistant PTSD, features shared by the clinical population of VA-using women veterans with PTSD related to MST. This design of TCTSY might explain the more robust CAPS-5 and PCL-5 change scores in the TCTSY group compared with those in a study by Davis et alTreatment of PTSD that is acceptable and effective is medical care to which all veterans are entitled and that is currently lacking. The robust equivalence results combined with the notably higher TCTSY completion rate indicate that TCTSY is such a treatment. While no single PTSD treatment will be acceptable and effective for everyone, TCTSY may help women veterans overcome resistance to seeking care at the VA and provide effective PTSD treatment, an acceptable first option for PTSD treatment, or an option for those who withdraw from or do not improve sufficiently with EBTs. Additionally, TCTSY is more widely available in community settings, such as wellness programs, yoga programs, and independent TCTSY facilities, than CPT, providing improved access to treatment for a broader population of women veterans and civilian women with PTSD related to sexual trauma.