Trauma-Informed Yoga for Mental Health with Survivors of Human Trafficking in Uganda: A Pilot Study

Background and Purpose

Survivors of human trafficking experience increased risk for mental health problems. Yet, very little mental health intervention research exists with this population. Somatic interventions—including yoga—to address mental health has received growing attention, but limited research on this topic exists from the Global South or with survivors of human trafficking. This study aimed to determine preliminary effectiveness of a trauma-informed yoga intervention with women and girl survivors of human trafficking in Uganda.

Methods

The study occurred between February and October 2020 with 19 participants originally residing in a shelter for survivors of human trafficking in Kampala, Uganda. The study utilized an interrupted six-wave time series design with comparison group. The study was not intended to have control group. However, the coronavirus pandemic began after the second wave of data collection and half of participants (n=10) left the shelter; those became our comparison condition (CC). The other half stayed at the shelter (n=9); these became the yoga condition (YC). The YC received a 12-week trauma-informed group yoga intervention (www.hartyoga.org) delivered live and via pre-recorded video sessions. Data collection occurred at three baselines, midline, endline, and 1 month follow-up. Mental health assessments included Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5), Patient Health Questinnaire-9 (PHQ-9) for depression, and General Anxiety Disorder-7 (GAD-7). Data analysis included descriptive and bivariate statistics, along with graphical representations. Fixed-effect models were used to evaluate whether mental health outcomes are different between participants in the YC and the CC before and after the intervention.

Results

Participants in the yoga condition (YC; average age=16.22, SE=1.72) were younger and more likely to have children (n=8, 80%) than participants in the comparison condition (CC; average age=25.4, SE=3.89; Has children: n=1, 11%). Participants from both groups reported elevated levels of PTSD (CC=90%;YC=70%), depression (CC=60%; YC=73%), and anxiety (CC=30%; YC=55%) at wave one. CC participants reported higher rates of mental health issues across all six waves. However, line graphs of all six waves present similar trajectories for both groups, until the initiation of the yoga intervention immediately after wave 3. The CC PTSD scores increased by 10.3 points on average between waves 3 and 6, while YC on average decreased by 20.89 points (=10.3 – 31.19). In terms of depression, the CC on average increased by 2.5 points, while the YC decreased by -2.67 points (= 2.5 – 5.17). The CC didn’t show a significant change in anxiety, while the YC reduced by -4.89 points (=1.8 – 6.69). Fixed-effect model comparing the YC with the CC found significant intervention effects on PTSD (p = .000), depression (p = .000), and anxiety (p = .000).

Conclusions and Implications

Our study addresses a critical gap in the literature by determining preliminary effectiveness of a trauma-informed yoga intervention for survivors of human trafficking. To our knowledge, this study is the first mental health intervention, yoga or otherwise, with this population in Africa. Subsequent research is needed to establish treatment effectiveness in larger, randomized samples, understand mechanisms of change, and assess applicability to other contexts.