Julia Shepherd Tang

All Publications

• Randomised clinical non-inferiority trial of breathing-based meditation and cognitive processing therapy for symptoms of post-traumatic stress disorder in military veterans. BMJ open Bayley, P. J., Schulz-Heik, R. J., Tang, J. S., Mathersul, D. C., Avery, T., Wong, M., Zeitzer, J. M., Rosen, C. S., Burn, A. S., Hernandez, B., Lazzeroni, L. C., Seppala, E. M. 2022; 12 (8): e056609

  Abstract

  OBJECTIVE: Test whether Sudarshan Kriya Yoga (SKY) was non-inferior to cognitive processing therapy (CPT) for treating symptoms of post-traumatic stress disorder (PTSD) among veterans via a parallel randomised controlled non-inferiority trial.SETTING: Outpatient Veterans Affairs healthcare centre.PARTICIPANTS: 85 veterans (75 men, 61% white, mean age 56.9) with symptoms of PTSD participated between October 2015 and March 2020: 59 participants completed the study.INTERVENTIONS: SKY emphasises breathing routines and was delivered in group format in a 15-hour workshop followed by two 1-hour sessions per week for 5 weeks. CPT is an individual psychotherapy which emphasises shifting cognitive appraisals and was delivered in two 1-hour sessions per week for 6 weeks.MEASURES: The primary outcome measure was the PTSD Checklist-Civilian Version (PCL-C). The secondary measures were the Beck Depression Inventory-II (BDI-II) and Positive and Negative Affect Scale (PANAS).RESULTS: Mean PCL-C at baseline was 56.5 (±12.6). Intent-to-treat analyses showed that PCL-C scores were reduced at 6weeks (end of treatment) relative to baseline (SKY, -5.6, d=0.41, n=41: CPT, -6.8, d=0.58, n=44). The between-treatment difference in change scores was within the non-inferiority margin of 10 points (-1.2, 95%CI -5.7 to 3.3), suggesting SKY was not inferior to CPT. SKY was also non-inferior at 1-month (CPT-SKY: -2.1, 95%CI -6.9 to 2.8) and 1-year (CPT-SKY: -1.8, 95%CI -6.6 to 2.9) assessments. SKY was also non-inferior to CPT on the BDI-II and PANAS at end of treatment and 1month, but SKY was inferior to CPT on both BDI-II and PANAS at 1year. Dropout rates were similar (SKY, 27%, CPT, 34%: OR=1.36, 95%CI 0.51 to 3.62, p=0.54).CONCLUSIONS: SKY may be non-inferior to CPT for treating symptoms of PTSD and merits further consideration as a treatment for PTSD.TRIAL REGISTRATION NUMBER: NCT02366403.

  View details for DOI 10.1136/bmjopen-2021-056609

  View details for PubMedID 36008059

• Valued living among veterans in breath-based meditation treatment or cognitive processing therapy for posttraumatic stress disorder: Exploratory outcome of a randomized controlled trial. Global advances in health and medicine Schulz-Heik, R. J., Lazzeroni, L. C., Hernandez, B., Avery, T. J., Mathersul, D. C., Tang, J. S., Hugo, E., Bayley, P. J. 2022; 11: 2164957X221108376

  Abstract

  Valued living is the extent to which an individual's behavior is consistent with what they believe is important or good. It is unknown whether many complementary and integrative treatments and psychotherapies for posttraumatic stress disorder enhance valued living, and for whom.Measure within- and between-group changes in valued living in Veterans who completed cognitive processing therapy (CPT) and sudarshan kriya yoga (SKY) for posttraumatic stress disorder (PTSD); evaluate moderators of improvement.Participants with clinically significant symptoms of PTSD were assigned to CPT, a first line, evidence-based psychotherapy for PTSD or SKY, an emerging breath-based meditation with strong preliminary empirical support in a parallel-groups randomized controlled trial at a single Veterans Affairs healthcare center. The Valuing Questionnaire subscales for progress in valued living (VQ-P) and obstruction in valued living (VQ-O) were exploratory outcome measures. Assessors were blind to treatment assignment.59 participants completed treatment (29 CPT, 30 SKY). Participants in the CPT group improved from baseline to end of treatment in both VQ-Progress (d=0.55, p=0.02) and VQ-Obstruction (d=-0.51, p=0.03), while the SKY group did not improve on either subscale (d=0.08, p=0.69; d=0.00, p=1.00). However, differences between treatments were not statistically significant (p=0.16, 0.11, respectively). Participants reporting less valued living and more depression symptoms at baseline reported greater improvements in valued living following treatment.CPT may have a positive effect on valued living. Individuals lower in valued living and with more depression may derive relatively more benefit.

  View details for DOI 10.1177/2164957X221108376

  View details for PubMedID 35770246

  View details for PubMedCentralID PMC9234823

• Yoga is effective in treating symptoms of Gulf War illness: A randomized clinical trial. Journal of psychiatric research Bayley, P. J., Schulz-Heik, R. J., Cho, R., Mathersul, D., Collery, L., Shankar, K., Ashford, J. W., Jennings, J. S., Tang, J., Wong, M. S., Avery, T. J., Stanton, M. V., Meyer, H., Friedman, M., Kim, S., Jo, B., Younger, J., Mathews, B., Majmundar, M., Mahoney, L. 2020

  Abstract

  Many Veterans of the 1990-1991 Gulf War report symptoms of Gulf War Illness, a condition involving numerous chronic symptoms including pain, fatigue, and mood/cognition symptoms. Little is known about this condition's etiology and treatment. This study reports outcomes from a randomized controlled single-blind trial comparing yoga to cognitive behavioral therapy for chronic pain and other symptoms of Gulf War Illness. Participants were Veterans with symptoms of GWI: chronic pain, fatigue and cognition-mood symptoms. Seventy-five Veterans were randomized to treatment via selection of envelopes from a bag (39 yoga, 36 cognitive behavioral therapy), which consisted of ten weekly group sessions. The primary outcomes of pain severity and interference (Brief Pain Inventory- Short Form) improved in the yoga condition (Cohen's d=.35, p=0.002 and d=0.69, p<0.001, respectively) but not in the CBT condition (d=0.10, p=0.59 and d=0.25 p=0.23). However, the differences between groups were not statistically significant (d=0.25, p=0.25; d=0.43, p=0.076), though the difference in an a-priori-defined experimental outcome variable which combines these two variables into a total pain variable (d=0.47, p=0.047) was significant. Fatigue, as indicated by a measure of functional exercise capacity (6-min walk test) was reduced significantly more in the yoga group than in the CBT group (between-group d=.27, p=0.044). Other secondary outcomes of depression, wellbeing, and self-reported autonomic nervous system symptoms did not differ between groups. No adverse events due to treatment were reported. Yoga may be an effective treatment for core Gulf War Illness symptoms of pain and fatigue, making it one of few treatments with empirical support for GWI. Results support further evaluation of yoga for treating veterans with Gulf War Illness. CLINICAL TRIAL REGISTRY: clinicaltrials.gov Registration Number NCT02378025.

  View details for DOI 10.1016/j.jpsychires.2020.11.024

  View details for PubMedID 33218747

• Study protocol for a non-inferiority randomised controlled trial of SKY breathing meditation versus cognitive processing therapy for PTSD among veterans BMJ OPEN Mathersul, D. C., Tang, J. S., Schulz-Heik, R., Avery, T. J., Seppala, E. M., Bayley, P. J. 2019; 9 (4)

  View details for DOI 10.1136/bmjopen-2018-027150

  View details for Web of Science ID 000471157200229