{"paper_id":"1cd108e6-d1b7-4a4c-8608-76fdbc61eb11","body_text":"Group Integrated Exercise versus Recovery Class for Veterans with Posttraumatic Stress Disorder: A Randomized Clinical Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Group Integrated Exercise versus Recovery Class for Veterans with Posttraumatic Stress Disorder: A Randomized Clinical Trial Thomas C. Neylan, Laura A. Muratore, Chanda L. Williams, Martha Schmitz, and 13 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4427468/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Feb, 2025 Read the published version in BMC Psychiatry → Version 1 posted 4 You are reading this latest preprint version Abstract There are no reported randomized trials testing exercise versus an active comparator for Posttraumatic Stress Disorder (PTSD). This randomized clinical trial assessed the effectiveness of group exercise versus psychoeducation to improve quality of life and reduces symptomatic severity in Veterans with PTSD. Veterans who met criteria for current PTSD (DSM-5) and/or endorsed moderate levels of PTSD symptoms (CAPS 5 score ≥ 23) were randomly assigned to treatment. Integrative Exercise (IE) combines fitness exercises (aerobics, resistance training, stretching) with mindful body/breath awareness versus Recovery Class (REC) psychoeducation control condition. A total of 84 participants were enrolled of which 41 participants were randomized to IE and 43 participants to REC. There were no significant pre-post differences in change in the WHOQOL Psychological Domain in either group. There was a modest reduction in the total CAPS-5 score in both groups (IE: -8.2 (9.9), p < .001: REC: -7.8 (2.0), p < .001) but no differences across the two conditions. In the IE subsample that was remote, there was a greater improvement in PTSD symptom severity (F[1, 50] = 4.62, p = .036) and in in the WHOQOL Psychological Domain (F(1, 47) = 6.46, p = .014) in those who attended more sessions. Trial Registration: ClinicalTrials.gov Identifier: NCT02856412 (registration date: February 27, 2017) PTSD Veteran Randomized Controlled Trial Exercise Psychoeducation Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction There is evidence that aerobic exercise effectively improves many outcomes relevant to Posttraumatic Stress Disorder (PTSD) including fear memory, anxiety, depression, insomnia, cognition, and cardiovascular disease[ 1 – 7 ]. Given that aerobic exercise improves brain health and neurogenesis[ 8 ], cognitive function[ 9 ], mood[ 10 ], sleep[ 11 ], and cardiovascular health[ 12 ], there is a strong rationale to determine whether exercise may be an effective intervention for Veterans with combat-related PTSD. Individuals with PTSD have lower rates of exercise compared to others without PTSD of the same age and sex[ 13 , 14 ], suggesting they may particularly benefit from a focus on exercise. Despite the high acceptance of exercise therapy for PTSD[ 15 ] and the advantage of a treatment lacking stigma for this population[ 16 ], to date there are no reported randomized trials testing exercise versus an active comparator arm in any population with PTSD. There is limited published data on the effects of exercise in Veterans with PTSD. There are several pilot studies suggesting that exercise reduces PTSD and associated mood and anxiety symptoms in children[ 17 ], adolescents[ 18 ], and civilian adults[ 19 – 21 ]. These studies are limited by lack of control conditions and small sample sizes[ 22 ]. Nevertheless, these pilot studies indicate acceptability, feasibility, and promise of efficacy[ 23 ]. Integrative Exercise (IE) combines traditional fitness exercises (aerobics, resistance training, stretching) with mindfulness, yoga, and mindful body/breath awareness[ 24 , 25 ]. Group aerobic exercises are a part of daily life of military personnel during their service time. Group exercise is familiar and appealing to Veterans as a self-image boosting and mood enhancing physical practice. In the past decade, while physical activity and aerobic exercise are still emphasized, mindfulness-based practices have increasingly been adopted in military settings[ 26 ], and controlled trials of Mind-Body skills[ 27 ] and Mindfulness-Based Stress Reduction (MBSR) have demonstrated moderate efficacy for PTSD[ 28 , 29 ]. Prior pilot testing with a waitlist control demonstrated evidence supporting IE as an effective treatment option for Veterans with symptoms of PTSD[ 24 , 25 ]. The purpose of the present study was to expand this knowledge and investigate whether IE improves Veteran’s quality of life and PTSD symptoms in comparison to an active current psychoeducation treatment. As an exploratory aim, we investigated differences between the two treatment groups in relation to other health outcomes, including mood, subjective sleep quality, and emotion regulation. Results A total of 84 participants were enrolled of which 41 participants were randomized to IE and 43 participants to REC (see Fig. 1 for consort diagram ) . Participants assigned to IE had a mean age of 52.7 (SD = 11.6) and were 73% male. Participants assigned to REC had a mean age of 50.8 (SD = 12) and were 65% male. Clinical and demographic characteristics are summarized in Table 1 . Table 1 Demographic and Clinical Characteristics REC IE p-value N = 43 N = 41 Age 50.8 (12.0) 52.7 (11.6) 0.47 Sex 0.42 Male 28 (65%) 30 (73%) Female 15 (35%) 11 (27%) Race 0.11 American Indian/Alaska Native 2 (5%) 2 (5%) Asian 5 (12%) 2 (5%) Black or African American 9 (21%) 12 (29%) White 26 (60%) 18 (44%) Other 1 (2%) 7 (17%) Ethnicity 0.45 Hispanic or Latino 5 (12%) 9 (22%) Non-Hispanic or Latino 32 (74%) 27 (66%) Unknown 6 (14%) 5 (12%) Education 0.65 High School Graduate / GED 2 (5%) 2 (5%) Some College 17 (40%) 12 (31%) Associates Degree 4 (9%) 5 (13%) Bachelors Degree 8 (19%) 6 (15%) Some Graduate School 4 (9%) 1 (3%) Masters Degree 7 (16%) 12 (31%) Doctoral Degree 1 (2%) 1 (3%) VA Service-Connected Disability 0.85 No 10 (23%) 10 (25%) Yes 33 (77%) 30 (75%) ASI Alcohol 0.3 (0.3) 0.4 (0.4) 0.10 Smoking History 0.73 Current Smoker 7 (17%) 7 (18%) Former Smoker 13 (31%) 9 (23%) Never Smoked 22 (52%) 23 (59%) CAPS_Total_baseline 29.8 (7.7) 33.1 (8.5) 0.07 PCL5 Total 40.3 (12.9) 43.5 (15.4) 0.31 WHOQOL Physical Health 51.9 (16.0) 51.2 (13.9) 0.82 WHOQOL Psychological 44.4 (14.9) 41.1 (18.5) 0.38 WHOQOL Social Relationships 44.2 (21.6) 45.0 (26.3) 0.88 WHOQOL Environment 59.3 (15.7) 55.9 (16.4) 0.33 WHOQOL Overall Heatlth (Q. 2) 41.9 (25.4) 41.3 (26.3) 0.91 FFMQ Observing 24.6 (7.6) 24.9 (9.6) 0.88 FFMQ Describing 22.8 (8.2) 23.4 (8.7) 0.72 FFMQ Acting with Awareness 23.9 (7.7) 22.8 (8.6) 0.52 FFMQ Nonjudging of Inner Experience 25.0 (9.2) 22.3 (9.4) 0.18 FFMQ Nonreactivity to Inner Experience 19.2 (5.6) 18.9 (6.9) 0.80 GLTEQ Activity Score 27.5 (23.7) 35.2 (35.8) 0.25 Physical Activity Self-Efficacy 2.6 (0.7) 2.9 (1.0) 0.15 DERS Total Score 87.2 (17.4) 88.3 (24.8) 0.81 Emotion Regulation - Cognitive Reappraisal 4.8 (1.0) 4.8 (1.2) 0.87 Emotion Regulation - Expressive Suppression 4.1 (1.4) 4.3 (1.3) 0.46 MAIA Noticing 3.1 (1.2) 3.3 (1.0) 0.31 MAIA Not-Distracting 1.9 (0.8) 1.8 (0.8) 0.55 MAIA Not-Worrying 2.8 (0.6) 2.7 (0.9) 0.48 MAIA Attention Regulation 2.7 (0.9) 3.1 (1.0) 0.08 MAIA Emotional Awareness 3.2 (1.0) 3.4 (1.0) 0.22 MAIA Self-Regulation 2.8 (1.0) 3.0 (1.1) 0.43 MAIA Body Listening 2.3 (1.1) 2.5 (1.3) 0.39 MAIA Trusting 2.9 (1.1) 3.0 (1.0) 0.77 Positive States of Mind 10.6 (3.7) 9.4 (4.5) 0.17 SCL90 Global Severity Index 1.1 (0.4) 1.4 (0.7) 0.02 PSQI_baseline 11.3 (3.4) 12.0 (4.2) 0.39 PSQI PTSD Addendum Global Score 8.0 (4.0) 8.1 (4.1) 0.91 Insomnia Severity Index 14.7 (5.5) 16.8 (6.4) 0.12 PROMIS Pain Intensity T-Score 54.3 (10.7) 58.6 (8.2) 0.05 PROMIS_8A Pain Interference T-Score 54.3 (9.7) 56.3 (6.7) 0.28 Physical Activity Self-Efficacy 2.6 (0.7) 2.9 (1.0) 0.15 Data are presented as mean (SD) for continuous measures, and n (%) for categorical measures. Acronyms: REC- Recovery Class, IE- Integrated Exercise, CAPS- Clinician Administered PTSD Scale, PCL-5- PTSD Checklist for DSM5, WHOQOL- World Health Organization Quality of Life, FFMQ- Five Facet Mindfulness Questionnaire, GLTEQ- Godin Leisure-Time Exercise Questionnaire, DERS- Difficulties in Emotion Regulation Scale, MAIA- Multidimensional Assessment of Interoceptive Awareness, SCL-90- Symptom Check-List-90-Revised, PSQI- Pittsburgh Sleep Quality Index The sample included 60% and 44% (REC and IE respectively) of white, 21% and 29% black, and 12% and 22% Latin participants. The two groups demonstrated comparable baseline scores on the WHOQOL, CAPS-5, and PCL-5. Table 1 also shows comparable distribution of baseline values on our secondary clinical outcomes. Participants who participated in the trial in person prior to the COVID pandemic were older and more likely to be male, compared to those who participated remotely during the pandemic. Baseline clinical characteristics were otherwise similar in the in person versus remote cohorts. See Supplemental Table 1S. Table 2 provides information about treatment characteristics in the 2 groups. IE participants who completed the study attended a mean of 20.3 sessions (SD = 10.2) out of the 36 possible. REC participants who completed the study attended a mean of 27.5 sessions (SD = 8.7). Eleven of 41 IE participants dropped out which is similar in ratio to the 9 out of 43 REC participants (X 2 (1) = 0.40, p = .53). Table 2 Treatment Characteristics REC IE Contrast Completion Status c 2 (1) = 0.40, p = .53 Completed Treatment 34 (79%) 30 (73%) Dropped Out 9 (21%) 11 (27%) Treatment Location Fisher Exact p = .69 In-Person 15 (37%) 20 (47%) Remote 25 (61%) 22 (51%) Hybrid In-Person/Remote 1 (2%) 1 (2%) Sessions Attended Completed, mean (sd) [range] 27.5 (8.7) [ 6 – 37 ] 20.3 (10.2) [ 3 – 37 ] Dropped out, mean (sd) [range] 4.9 (4.4) [0–13] 2.7 (3.2) [0–9] Feasibility and Acceptance Rating (0–6 Scale) 3.9 (0.8) [1.9–5.0] 3.7 (1.0) [1.3–4.9] t( 58) = 0.76, p = .45 Dropouts did not differ significantly on the primary outcome measures at baseline, nor on any demographics except for sex. Dropouts were 95% male (19/20) compared to 61% (39/64) for completers, X 2 (1) = 8.27, p = .004. The single female dropout was from the REC group. Twenty of the 41 IE participants (47%) and 15 of the 43 REC participants (37%) completed the intervention in person prior to the COVID pandemic. Two participants, one in each group, completed the intervention in a hybrid of in-person and remote participation. Feasibility and acceptability ratings were mixed, but overall satisfaction with both interventions was high. See Supplemental Figs. 1S and 2S. Primary Outcome Analyses There were no differences in IE versus REC in change in the WHOQOL Psychological Domain (see Table 3 and Supplemental Fig. 3S). Further, there were no significant pre-post changes in WHOQOL Psychological Domain in the combined sample. There were no significant differences in changes in the CAPS-5 total score in IE versus REC (see Table 3 and Fig. 2 ). There was a modest reduction in the total CAPS-5 score in both groups (IE: -8.2 (9.9), p < .001: REC: -7.8 (2.0), p < .001). In the IE subsample that was remote, there was a significantly greater improvement in PTSD symptom severity (F[ 1 , 50 ] = 4.62, p = .036; Fig. 3 ) and in in the WHOQOL Psychological Domain (F(1, 47) = 6.46, p = .014; Fig. 4 S) in those who attended a greater number of sessions. Table 3 Major Outcomes by Treatment Group (See separate doc for Table 3 for full view) PTSD Recovery Group (Control) Integrative Exercise Group (Treatment) Between-Group Contrast 1 Outcome Baseline Post Tx Pre-Post Change Baseline Post Tx Pre-Post Change WHOQOL-Psychological 44.1 (15.1) 45.2 (16.8) 1.1 (12.0), p = .59 39.4 (16.8) 41.5 (19.4) 2.2 (16.2), p = .49 t (55) = 0.01, p = .989 WHOQOL-Physical 52.2 (16.1) 54.8 (15.8) 2.6 (12.5), p = .24 50.5 (14.1) 54.5 (15.9) 4.0 (14.1), p = .16 t (55) = 0.52, p = .602 CAPS Total 29.8 (7.9) 22.0 (11.3) -7.8 (2.0), p < .001 32.7 (7.9) 24.4 (11.1) -8.2 (9.9), p < .001 t (58) = 0.39, p = .699 PCL5 38.9 (13.3) 39.9 (15.7) 1.0 (13.4), p = .67 40.8 (15.6) 36.3 (17.5) -4.4 (12.5), p = .08 t (55) = 1.45, p = .152 SCL-90 Global Severity 1.09 (0.43) 1.13 (0.57) 0.04 (0.43), p = 59 1.27 (0.66) 1.14 (0.68) -0.16 (0.40). p = .06 t (54) = 1.53, p = .133 FFMQ - Obs 25.2 (7.2) 26.4 (7.1) 1.2 (4.4), p = .12 25.5 (7.5) 22.2 (11.4) -3.2 (11.0), p = .12 t (59) = 2.16, p = .035 FFMQ - Desc 22.6 (7.6) 24.4 (7.6) 0.8 (4.1), p = .26 24.4 (6.7) 21.8 (11.3) -2.6 (11.6), p = .23 t (59) = 1.46, p = .149 FFMQ - Aware 23.6 (6.9) 24.0 (7.1) 0.4 (3.3), p = .47 23.8 (6.9) 20.1 (10.1) -3.7 (9.8), p = .04 t (59) = 2.26, p = .028 FFMQ - Nonjudge 25.4 (8.6) 25.5 (7.8) 0.2 (5.4), p = .85 25.0 (8.2) 21.2 (11.5) -3.8 (7.9), p = .01 t (59) = 2.31, p = .024 FFMQ - Nonreact 19.2 (4.7) 19.9 (5.3) 0.7 (2.7), p = .12 19.9 (5.7) 17.7 (8.9) -2.2 (8.6), p = .16 t (59) = 1.80, p = .077 GLTQ 25.7 (20.8) 43.8 (36.0) 18.1 (29.7), p < .01 30.6 (29.2) 44.2 (40.2) 13.6 (27.2), p = .02 t (53) = 0.59, p = .559 PASE 2.4 (0.7) 2.6 (0.7) 0.2 (0.5), p = .08 2.7 (0.8) 2.7 (0.9) 0.0 (0.0), p = .99 t (53) = 0.21, p = .834 DERS Total 89.1 (16.7) 91.3 (20.2) 2.2 (14.3), p = .39 85.9 (17.7) 85.7 (19.4) -0.2 (17.1), p = .94 t (53) = 0.84, p = .407 ERQ - Reappraisal 4.7 (0.9) 4.7 (1.1) 0.0 (1.0), p = .84 4.7 (1.1) 4.7 (1.5) 0.1 (1.0), p = .99 t (52) = .070, p = .947 ERQ – Suppression 4.0 (1.5) 3.7 (1.3) -0.3 (0.9), p = .12 4.1 (1.1) 4.1 (1.4) 0.0 (0.9), p = .87 t (52) = 1.18, p = .245 MAIA – Emot. Awareness 3.1 (1.1) 3.5 (0.8) 0.4 (1.0), p = .03 3.3 (1.0) 3.3 (0.8) 0.1 (0.8), p = .64 t (53) = 1.16, p = .25 MAIA – Attention Reg. 2.7 (0.9) 2.9 (0.9) 0.2 (0.8), p = .09 2.8 (0.9) 3.0 (0.8) 0.2 (0.8), p = .29 t (53) = 0.18, p = .860 MAIA - Noticing 3.0 (1.1) 3.2 (1.0) 0.2 (1.0), p = .32 3.3 (1.0) 3.3 (1.0) 0.0 (0.9), p = .87 t (53) = 0.13, p = .896 MAIA – Not Distracted 2.0 (0.8) 1.6 (0.7) -0.4 (0.6), p < .01 1.8 (0.9) 1.7 (0.9) -0.1 (0.6), p = .65 t (53) = 1.55, p = .126 MAIA – Not Worry 2.7 (0.6) 2.7 (0.7) -0.1 (0.5), p = .44 2.8 (0.8) 2.9 (0.6) 0.2 (0.6), p = .22 t (53) = 0.26, p = .055 MAIA – Self Regulation 2.7 (1.0) 3.0 (0.7) 0.3 (0.8), p = .06 2.9 (1.1) 3.1 (1.0) 0.2 (1.1), p = .42 t (53) = 0.03, p = .975 MAIA – Body Listening 2.3 (1.1) 2.7 (1.0) 0.4 (1.0), p = .023 2.4 (1.3) 2.7 (1.1) 0.3 (1.1), p = .12 t (56) = 0.01, p = .993 MAIA - Trust 2.9 (1.2) 3.1 (1.1) 0.2 (0.9), P = .23 2.9 (1.0) 3.1 (0.9) 0.2 (1.0), P = .28 t (55) = 0.22, p = .830 PSOM 10.9 (3.6) 11.3 (3.9) 0.4 (2.4), p = .33 9.7 (3.9) 8.9 (6.9) -0.8 (4.9), p = .38 t (59) = 1.55, p = .127 PSQI 11.1 (3.7) 10.7 (4.2) 0.4 (4.0), p = .61 11.9 (4.5) 11.4 (5.2) 0.4 (4.1), p = .58 t (55) = 0.18, p = .858 ISI 15.0 (5.9) 13.2 (5.4) -1.8 (5.0), p = .04 16.0 (6.2) 13.6 (6.8) -2.4 (5.3), p = .029 t (54) = 0.24, p = .810 PROMIS 3A 54.9 (10.4) 57.4 (11.9) 2.5 (6.9), p = .05 58.8 (7.3) 60.2 (5.8) 1.5 (9.0), p = .446 t (50) = 0.16, p = .872 PROMIS 8A 54.5 (9.4) 56.4 (9.5) 1.9 (6.0), p = .09 57.6 (5.4) 59.5 (6.9) 1.9 (9.1), p = .307 t (53) = 0.61, p = .542 1 Group difference in post-treatment scores adjusted for baseline. Responder Analyses Table 4 shows that there were no differences in response rate (10-point drop in CAPS-5: IE = 41%, REC = 44%), loss of diagnosis, or remission status on the CAPS-5 outcome for the 2 groups. Table 4 Response Rate 1 , Loss of Diagnosis, Remission 2 Across Treatment Groups Number (%) Posttreatment IE n = 29 REC n = 34 Response 12 (41%) 15 (44%) Loss of Diagnosis 10 (32%) 10 (29%) Remission 4 (13%) 5 (15%) Note : 1 Defined as an improvement of at least 10 points on CAPS-5, 2 Defined as loss of diagnosis and CAPS-5 < 12. Secondary Outcomes Self-reported physical activity as indexed by the Godin Leisure Time Questionnaire showed comparable levels of physical activity at baseline (See Table 1 and Fig. 4 ). However, post-randomization scores on this measure did not demonstrate that IE participants became more physically active than REC participants. Both groups showed an increase in vigorous activity from pre- to post- treatment (See Fig. 4 ). Six-month follow-up data showed some regression toward baseline levels of activity. Self-report PTSD symptoms on the PCL-5 did not change significantly over the trial (See Table 3 ). Mindfulness as indexed on the FFMQ showed that in the condition (IE) where they were taught mindfulness attitudes, participants self-reported feeling less skilled in this domain over the course of the trial. The REC group reported some modest improvement in interoceptive awareness on several items of the Multidimensional Assessment of Interoceptive Awareness (MAIA) scale. Both groups had small reductions in self-reported insomnia. Other secondary outcomes as described in the Supplement did not show significant changes over the trial (See Table 3 ). Participant Feedback The PI interacted with 46 participants who accepted the invitation to meet after the 12-week intervention either in person or by phone. He encouraged candid feedback and asked for suggestions to improve the IE or REC programs. Participants commented on the class instructors, scheduling issues, class timing such as 3-hour later evening hours on the East Coast, logistical difficulties with in-person classes, and limited peer interaction with the Zoom version of IE. The staggered entry into ongoing classes due to rolling enrollment was challenging for some participants, and peer interaction was limited when group sizes went beyond five or six. The great majority commented very positively about enjoying the classes, the instructors, the class content, and the ability to participate remotely from their home. Several participants also described greater physical fitness after completing the classes. Discussion Contrary to our hypotheses, we did not show that participation in either group IE or REC resulted in a significant improvement in psychological quality of life as indexed by the WHOQOL. Participation did result in a modest decline in PTSD symptom severity as indexed by the CAPS-5. Response rates in both groups were below 50% and remission from treatment was uncommon (13–15%). Surprisingly, both groups reported an increase in physical activity over the course of the 12-week intervention. Both treatment arms were associated with mixed responses on some aspects of feasibility and acceptability, though there was overall high satisfaction with both treatment arms. The conduct of this study was impacted by the COVID pandemic and both arms were converted from an in person to a remote telehealth format. Preliminary data suggest that higher attendance was associated with greater reduction in the CAPS-5 total score in the remote condition for the IE condition. This may have been due to the convenience offered by the telehealth format, in contrast to Veterans having to drive considerable distances to attend classes at the location where the IE condition was taught. A notable contrast between the two study interventions is that the IE groups were led by exercise instructors who were not clinically trained. In contrast, the REC condition was led by experienced PTSD psychologists who delivered the same intervention focused on education and skills training commonly used as a present-focused treatment in VA PTSD treatment clinics. Although both study arms were highly rated by participants for treatment satisfaction, the magnitude of symptom reduction was small in the full sample, but substantial in those who engaged in greater than 20 sessions in the remote IE condition. There was an unexpected difference across the two treatment arms on the self-report measure of mindfulness. The IE participants who were specifically taught initial mindfulness techniques or attitudes, rated themselves as less mindful at the end of the 12-week condition. Experience with conducting mindfulness trials has shown that untrained participants may initially overestimate and post-intervention rate themselves lower on specific skills as they become more aware of different aspects of mindfulness[ 30 , 31 ]. This suggests that the amount of mindfulness training incorporated into the IE intervention is insufficient to produce durable improvements in mindfulness skills. The modest reduction in the CAPS-5 score in the IE condition was considerably smaller than the magnitude of improvement in the pilot trial using the same intervention[ 24 ]. Overall, there was a compression of change scores in both arms compared to both arms of the pilot trial, which had a waitlist control. There are several differences in treatment delivery across the two trials. First, the IE condition was delivered in evening hours in the pilot study, compared to afternoon hours in the current study. Second, the mean age of participants in the IE arm was older in the current trial (mean age = 52.7) versus the IE condition of the pilot study (mean age = 47.4). Third, the pilot was conducted prior to the pandemic. Results from current study show a possible impact of attendance on clinical outcomes and it is notable that participants randomized to IE attended fewer sessions (mean = 20.3) than REC participants (mean = 27.5). It is possible that the IE condition involves more frustration and possibility for self-critical responses for some participants when engaged in vigorous exercise. Finally, compared to the in-person pilot study, opportunities for social interaction during or around the remote classes were more limited in the IE condition. Conclusion The study results do not demonstrate that an exercise condition that integrates mindful breathing, aerobic and strengthening activity, produces a greater change in self-reported psychological quality of life or reduction in PTSD symptoms relative to an active intervention that is comparable to present-focused treatments offered in many PTSD specialty clinics in the VA. Both current standard treatment by experienced psychologists and an integrative exercise program led by fitness and yoga instructors had similar effects. Despite high overall satisfaction of study participants, the magnitude of change in PTSD symptom severity is modest and response rates are below 50%. Higher attendance in the remote IE condition was associated with greater symptom improvement. Future work should attempt to incentivize more consistent engagement in exercise sessions to promote more clinically meaningful symptom reduction. Methods Trial Design and Procedures Participants who met eligibility for enrollment were randomly assigned to either 12 weeks of integrative exercise (IE) or PTSD Recovery Class (REC) classes. This research was approved by the Institutional Review Board of the University of California, San Francisco, and the Human Research Protection Program at the San Francisco Veterans Affairs Medical Center. All participants provided written or electronic informed consent. This trial was registered on ClinicalTrials.gov (NCT02856412). Participants A total of 84 Veterans who met criteria for current PTSD of at least 3-months duration, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association[32]) and/or endorsed moderate levels of PTSD symptoms (CAPS 5 score ≥ 23[33]) were randomly assigned to treatment.Veterans currently receiving mental health treatment (e.g., individual therapy, psychiatric medication) were included if they were treatment stable for at least two months before beginning the trial and maintained this treatment throughout the trial. All study participants completed a medical screen to ensure they were physically capable of participating. Medical clearance was determined by examining the participant’s medical history, a physical examination by the study doctor or study nurse, and completion of the Physical Activity Readiness Questionnaire[34]. See Figure 1 for a detailed diagram of study enrollment and reasons for exclusion. Procedures Recruitment, screening, and baseline. Study recruitment and enrollment began in November 2017 and ended in March 2022. Within this enrollment period, study procedures were modified, as described in detail below, due to the COVID-19 pandemic and subsequent restrictions to in-person research. In March 2020, the study transitioned from in-person to a fully remote trial for the duration of enrollment to maintain subject safety. An extensive outreach plan was implemented to recruit a diverse sample of U.S. Veterans. For veterans participating locally, in-person, we recruited primarily by mailing letters to veterans within and surrounding the San Francisco Bay Area, with a smaller number recruited by provider referrals. We expanded recruitment to a national scale when the trial shifted to remote-only procedures in response to the COVID pandemic.For veterans participating nationwide, remotely, we recruited primarily via TrialFacts, with smaller numbers coming from provider referrals or ResearchMatch. Interested Veterans completed an initial pre-screen interview with study staff to determine whether they met study inclusion (n=540; see CONSORT diagram, Figure 1). Potentially eligible Veterans (n=230) provided informed consent and participated in an in-depth clinician-administered diagnostic assessment. Following these assessments, 84 participants were eligible and were randomized. Self-report questionnaires measured subjective sleep quality, PTSD symptoms, mood states, and quality of life. Transition from in-person classes to remote delivery Before COVID, IE group classes were delivered in-person at the San Francisco YMCA. With onset of the epidemic this setting became unsafe for our participants and was changed to online delivery to participants’ homes and their computer or smart phone screens. This limited classes to participants with a minimal amount of electronic equipment and literacy (detailed instructions were delivered as needed by study staff) but at the same time allowed for participation from anywhere in the US with internet connectivity. At the YMCA space, exercise instructors made use of larger equipment such as stepping platforms and wall mounted TRX exercise equipment. Online classes fully relied on yoga mats, elastic resistance bands, dumbbells, and foam rollers that were provided by study staff and sent to participants by mail delivery. Using the zoom platform, participants could see both instructors and all group members in separate screen displays, using either speaker or gallery view. To enable some minimal social group element, which was naturally intrinsic to the in-person interactions before and after classes at the YMCA, participants in online delivered classes spent the last 5 minutes of each class following the cool-down in group chat on screen. Assessment. Clinicians administering the psychological interviews were blind to treatment condition. Randomization. Eligible participants were randomized (1:1) to either IE or REC treatment classes. A stratified randomization strategy (i.e., engaged versus non-engaged in current mental health treatment) was employed to ensure conditions did not differ based on current treatment status. Treatment and follow-up. Participants assigned to either IE or REC were asked to attend assigned treatment classes 3 times per week for 12 weeks. Each class was 1 hour in duration, for a total of 36 treatment hours. Both treatment conditions were group interventions with rolling admission. Treatment adherence was measured by class attendance. Participants completed mid-treatment self-report measures at Weeks 4 and 8 and completed post-treatment assessments immediately following the end of treatment. The post-treatment assessments repeated those at eligibility screening, as described above. Participants were invited to meet with the PI after the 12-week intervention to provide feedback about their experiences. Participants were given the option to electively participate in the alternate arm following the initial 12-week trial. Interventions- Integrated Exercise (IE): The IE exercise program was 12 weeks in duration, integrating a combination of aerobic and strength training, stretching and myofascial release exercises with concentration training based on mindful breathing techniques (from yoga and mindfulness approaches recommended by Hoge[35]) aiming at an experiential sense of mind-body integration. Participants exercised in class 3 times weekly, with each total workout being approximately 60 minutes in length. These sessions initially took place at the Embarcadero YMCA in San Francisco and later in their homes by remote instruction using the Zoom platform. The platform allows for all participants in a class to see each other as well as the instructor(s), attempting to create a group feeling comparable to the in-person classes. All exercise was supervised and documented by two trained professionals to validate adherence and allow for program replications by others as part of an intervention program for PTSD. Exercises were adapted to individual participants’ fitness levels and pre-existing health conditions or injuries. The IE program was designed to be accessible to veteran from all socio-economic and educational backgrounds, including those who have been in combat, and safe for those with injuries. Specifically, the exercises do not require a gym setting, but can be safely taught indoors as well as outdoors in a group setting and with individuals with a wide range of fitness levels. The exercises do not require machines, but make use of low-cost equipment including yoga mats, hand-held weights (e.g., 2 to 10 pounds) stretch bands of varying elasticity, foam rollers and (only initially in the YMCA setting) stepping platforms and TRX equipment. The IE program is sufficiently different from usual fitness center programs in that it can be conducted in a virtual group setting delivered over an internet platform into a private home[36-39]. Each class followed the same sequence of procedures. Following a moment of welcoming of participants with a brief review of the previous session, every session started and ended with a centering exercise and 3-5 minutes of mindful breathing. This was followed by the exercise instructor presenting the “password of the week”. In a few sentences they introduced one of the eight attitudes of mindfulness that were reformulated themes based on the weekly topics of the 8-week MBSR program[40]. These included short explanations of the principles of breath awareness, acceptance of the current situation, beginners mind, being non-judgmental about one’s own capacities, etc. Instructors reminded the participants of these attitudes repeatedly as they were to be applied to the exercises in real-time. The sequence of exercises included a variation of movements and loads for strength training and aerobic activities performed in a variety of ways, including continuous and interval training, as recommended by the American College of Sports Medicine (ACSM)[36-39] and using nonlinear periodization[38]. The aerobic and strength program began with myofascial release exercises, aerobic warm-up exercises, and instructions for postural alignment supporting core engagement. Exercises when feasible engaged all major muscle groups in a systematic fashion that chains body parts together, but varied between sessions, starting with small weights or low-resistance bands, and adding weights, resistance, and aerobic intensity to pre-exhaust levels. Yoga moves and stretches, reminders about breathing and mindfulness are woven into the program. Exercise sessions ended with a 5-minute cool-down period that returned to guided mindful breathing, fostering a physically experienced sense of body-based centeredness and relaxed concentration. As described above, props for these exercises include yoga mats, dumbbells, stretch bands, foam rollers, and (initially) stepping platforms. During the exercises, participants were introduced to deep abdominal breathing and repeatedly reminded to pay attention to their breathing while working out and to dose the intensity of their exercising according to their ability to maintain breathing through his or her nose. Throughout, exercise movements were closely coordinated with breathing phases, e.g., stretches with inhalation and weight pushes or other efforts with exhalation. The mental focus on breathing and exercise-related bodily sensations during all exercises was a key ingredient of this integrative program to provide an embodied sense of mental centeredness and concentration. Mindful breathing is the cornerstone of mindfulness-based intervention for anxiety and depression[41-43]. Generally, classes were led by two instructors, one teaching, the other primarily observing the participants and correcting participants’ exercise form as needed. This became particularly important during the Zoom classes with the relatively small individual zoom frames of the group of participants. Instructors were hired based on long-time experience as both professional fitness and yoga instructors. PTSD Recovery Class: The REC control condition was a present-focused, CBT, coping skills treatment based on the concept of recovery and predicated on a stress-vulnerability model of mental illness. The curriculum incorporated PTSD psychoeducation, risk management, emotion regulation and distress tolerance skills. It emphasized the practice of coping skills for improving PTSD symptoms[44] and reaching recovery goals. The curriculum included 6 modules from the Illness Management and Recovery Group manual adapted for PTSD: recovery strategies, reducing stress, coping with persistent symptoms, reducing alcohol and drug use, building social support, and strategies for getting closer to people. The remaining sessions were CBT-focused skills for improving the 4 symptom clusters of PTSD: managing distress related to trauma memories, decreasing avoidance and numbness, reducing hyperarousal and anger, facilitating sleep, reframing negative cognitions, improving trust, communication, and intimacy, addressing moral injury, and increasing self-compassion. Other topics included practical facts about PTSD and complex trauma, stress-vulnerability, interpersonal effectiveness, getting needs met in the VA healthcare system, and living a healthy, values-based lifestyle[45, 46]. Measures- Primary Outcomes World Health Organization Quality of Life (WHOQOL-BREF-26 [47, 48]). The 26-item WHOQOL-BREF-26 was used as a self-report measure of quality of life. It comprises four broad domains: physical health (7-items), psychological health (6-items), social relationships (3-items), and environment (8-items). The psychological health domain was used as the primary outcome measure. All items were rated on a 5-point scale with higher scores indicating higher quality of life. Clinician Administered PTSD Scale for DSM-5 (CAPS-5[33]). The CAPS-5 is a clinician-administered measure of PTSD symptom severity that aligns with the DSM-5. The CAPS-5 was used to assess participants current PTSD symptoms (i.e., past 30 days). PTSD diagnoses and total symptom severity scores were used both as a screening assessment for eligibility with CAPS-5 ≥ 23 meeting inclusion criteria, as well as a primary outcome for treatment efficacy. Secondary Outcomes- Secondary Measures PTSD Checklist for DSM-5 (PCL-5) [49]. The 20-item PCL-5 was used as a self-report measure of PTSD symptoms. The PCL-5 aligns with the DSM-5 descriptions of PTSD symptoms and has been validated in Veteran samples. Godin Leisure-Time Exercise Questionnaire (GLTEQ) [50, 51]. The GLTEQ is a validated brief inventory assessing sedentary, work, recreational, and aerobic activity in a typical week. This metric was used to measure time spent in vigorous activity and was intended to serve multiple purposes: a) It was used to test if randomization effectively balances levels of baseline vigorous activity across the two groups; b) It was used as a manipulation check to ensure that participants randomized to IE engage in more vigorous activity after randomization than participants randomized to REC; c) It was used as a secondary predictor of treatment response. Pittsburgh Sleep Quality Index (PSQI) [52]. The 9-item PSQI was used as our primary measure of subjective sleep quality. Participants were asked to provide self-reported assessments of sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sedative-hypnotics, and daytime energy over the past week. PSQI Addendum for PTSD (PSQI-A) [53]. The 2-item PSQI-A was used to measure participants’ experiences with disruptive nocturnal behaviors related to PTSD (e.g., hot flashes, nightmares related to traumatic memories) over the past week. The PSQI-A was used as a secondary measure of sleep quality in exploratory analyses. Insomnia Severity Index (ISI) [54]. The 5-item ISI was used as a self-report measure of perceived insomnia severity and was used as a secondary measure of sleep quality in exploratory analyses. Participants responded on a 5-point scale where higher scores indicated greater insomnia severity within the past week. Five Facet Mindfulness Questionnaire (FFMQ) [55, 56]: The FFMQ is a 39-item questionnaire derived from a factor analysis of other mindfulness questionnaires. It assesses five facets of mindfulness: observing, describing, acting with awareness, non-judging and non-reactivity to inner experience which represent elements of mindfulness as it is currently conceptualized. Items are rated on a Likert scale ranging from 1 (never or very rarely true) to 5 (very often or always true). The FFMQ has been shown to have good internal consistency (alpha coefficient range .72 to .92) in several samples and significant relationships in the predicted directions with domains related to mindfulness[55, 56]. The FFMQ allows a detailed assessment of changes as a function of mindfulness and therefore was be used as a secondary outcome. Physical Activity Self-Efficacy scale (PASE) [57]: The PASE was used as an exploratory measure of perceived confidence to continue exercising in the face of competing day-to-day conditions. Difficulties in Emotion Regulation Scale (DERS) : The 36-item DERS was used as a self-report measure of emotion dysregulation. Items were rated on a 5-point scale, 1 (almost never) to 5 (almost always). Multidimensional Assessment of Interoceptive Awareness (MAIA) [58]. The MAIA is a self-report measure recently developed to capture changes in interoception associated with mind–body interventions. The MAIA is a 32-item instrument comprising eight subscales: Noticing, Not-Distracting, Not-Worrying, Attention Regulation, Emotional Awareness, Self-Regulation, Body Listening, and Trusting. Participants rated the items on a 6-point Likert scale, with higher scores indication higher interoceptive awareness. The MAIA assesses regulatory aspects of interoceptive processing and can differentiate between clinically relevant attention styles toward bodily symptoms: anxiety and hypervigilance-driven versus acceptance and mindfulness-based attention[59, 60]. Positive States of Mind (PSOM) [61]. The PSOM assesses the capacity for positive states of mind: focused attention, productivity, responsible caretaking, restful repose, sharing, sensuous nonsexual pleasure, and sensuous sexual pleasure. Participants rated the items on a 4-point Likert scale ranging from 0 (unable to have it) to 3 (have it easy). It was found to be internally consistent and sensitive to degrees of life stress. Symptom Check-List-90-Revised (SCL-90-R) [62]. The SCL-90-R is a standard self- report measure of general psychopathology. Scored for nine primary dimensions and three summary indices, the SCL-90-R manual reports extensive reliability and validity data. Feasibility and Acceptability Questionnaires . This self-report questionnaire was completed by IE and REC condition completers at post-treatment. Sixteen items were grouped into three main categories: overall treatment impressions, content of intervention, and length of intervention. Participants responded to each statement on a 6-point Likert type scale, with 0-2 scores indicating disagreement and 3-5 indicating agreement. Two versions were used so that questions aligned with group assignment (e.g., “exercise” was modified to “topics” for the REC condition when items specified condition content and vice versa). Modified questions included items 5-8 and 13. Statistical Analysis We used intent-to-treat analyses, with all participants randomized included in the analyses, including only the stratification variable (concurrent treatment yes/no) and the baseline value of the outcome variable as covariates. All available time point data from any participants lost to follow up were included in the primary analyses, using mixed models (LMM) to accommodate the missing data where possible. The frequency and timing at which outcomes are obtained varies by measure. Some key measures, including the CAPS, were measured at two time points, pre- and post-treatment, while self-report measures such as the WHOQOL, were measured at two additional mid-treatment time points. Measures with more than two measurement occasions make full use of the LMM strategy, whereas LMM’s for pre-post measures reduce to ANCOVA as a special case, except for the added flexibility of modeling heterogeneous group variances. See Supplement for additional details of the analysis plan. In analyses with intermediate time points, several modeling choices were considered, including whether to treat the time variable as continuous or categorical, the form of the within-subjects correlation matrix, and whether to allow for heterogeneity of variance across groups and/or time points. For each outcome, the best fitting model was selected according to likelihood ratio tests (for nested models) or the Akaike Information Criterion (AIC; for non-nested models) before examining any coefficients or test statistics. In each case, the best fitting model was one that treated time points as a categorical variable, included participants as the only random effect, and included no additional parameters to accommodate within-participant correlation or heterogeneous group variances. Models were fit using the “mixed” command in Stata v. 16.1[63]. Residuals were examined to screen for outliers and to ensure that model assumptions were met. No influential outliers were observed, and residual distributions were approximately normal. Secondary analyses focused on effects of attendance and site of delivery (in-person versus remote) on clinical outcomes. Sample size. Power calculations were conducted a priori to determine the adequate sample size needed to detect clinically meaningful between-group effects on our primary variables at pre- and post-treatment time points. Results indicated a sample size of 80 completers (40 per group) was sufficient to yield power of 80% (α = .05) to detect standardized effects of d = 0.5, assuming 0.7 within-participant correlations. Obtained sample sizes per group were 30 (IE) and 34 (REC); observed within-participant correlations were r = .67 for WHOQOL and r = .45 for CAPS. Actual power to detect an effect of d = .50 was .64 for the primary WHOQOL outcome and .45 for CAPS scores. Declarations This research was approved by the Institutional Review Board of the University of California, San Francisco, and the Human Research Protection Program at the San Francisco Veterans Affairs Medical Center in accordance with the Declaration of Helsinki. All participants provided written or electronic informed consent. Consent for publication- Not applicable Availability of data and materials. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests- The authors declare that they have no competing interests. Funding. This study was supported by a grant from the Veterans Affairs Office of Research and Development (5I01RX001939). Authors' contributions. Design of study and grant application (TCN, SM, TJM, BEC, MAC, WEM), Acquisition and analysis of data (TCN, LAM, CLW, MS, CVV, SM, AO, DPK, TJM, BEC, ACW, JDVP, VA, OM, JAH, MAC, WEM). All authors have reviewed and approved the submitted manuscript. Acknowledgements. The authors are grateful to the Heart and Armor Foundation which provided funding for the pilot project that preceded this study. References Rethorst CD, Trivedi MH. Evidence-based recommendations for the prescription of exercise for major depressive disorder. J Psychiatr Pract. 2013;19(3):204–12. Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead GE. Exercise for depression. Cochrane database Syst reviews (Online). 2013;9:CD004366. Wipfli BM, Rethorst CD, Landers DM. The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose-response analysis. J Sport Exerc Psychol. 2008;30(4):392–410. Steptoe A, Edwards S, Moses J, Mathews A. The effects of exercise training on mood and perceived coping ability in anxious adults from the general population. J Psychosom Res. 1989;33(5):537–47. Larun L, Nordheim LV, Ekeland E, Hagen KB, Heian F. Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane database Syst reviews (Online). 2006;3:CD004691. Driver HS, Taylor SR. Exercise and sleep. Sleep Med Rev. 2000;4(4):387–402. Crombie KM, Adams TG, Dunsmoor JE, Greenwood BN, Smits JA, Nemeroff CB, Cisler JM. Aerobic exercise in the treatment of PTSD: An examination of preclinical and clinical laboratory findings, potential mechanisms, clinical implications, and future directions. J Anxiety Disord. 2023;94:102680. Meerlo P, Mistlberger RE, Jacobs BL, Craig Heller H, McGinty D. New neurons in the adult brain: The role of sleep and consequences of sleep loss. Sleep Med Rev. 2009;13(3):187–94. Liu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC. Resistance training and executive functions: a 12-month randomized controlled trial. Arch Intern Med. 2010;170(2):170–8. Babyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, Craighead WE, Baldewicz TT, Krishnan KR. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000;62(5):633–8. Yang PY, Ho KH, Chen HC, Chien MY. Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. J physiotherapy. 2012;58(3):157–63. Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, Berra K, Blair SN, Costa F, Franklin B, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. 2003;107(24):3109–16. Zen AL, Whooley MA, Zhao S, Cohen BE. Post-traumatic stress disorder is associated with poor health behaviors: Findings from the Heart and Soul Study. Health Psychol. 2012;31(2):194–201. Gnall KE, Sacco SJ, Sinnott SM, Park CL, Mazure CM, Hoff RA. Physical activity, posttraumatic stress, and gender: A longitudinal study of post-9/11 veterans. J Health Psychol 2024:13591053241233380. Otter L, Currie J. A long time getting home: Vietnam Veterans' experiences in a community exercise rehabilitation programme. Disabil Rehabil. 2004;26(1):27–34. Mittal D, Drummond KL, Blevins D, Curran G, Corrigan P, Sullivan G. Stigma associated with PTSD: perceptions of treatment seeking combat veterans. Psychiatr Rehabil J. 2013;36(2):86–92. Newman CL, Motta RW. The effects of aerobic exercise on childhood PTSD, anxiety, and depression. Int J Emerg Ment Health. 2007;9(2):133–58. Diaz AB, Motta R. The effects of an aerobic exercise program on posttraumatic stress disorder symptom severity in adolescents. Int J Emerg Ment Health. 2008;10(1):49–59. Manger TA, Motta RW. The impact of an exercise program on posttraumatic stress disorder, anxiety, and depression. Int J Emerg Ment Health. 2005;7(1):49–57. Kim SH, Schneider SM, Bevans M, Kravitz L, Mermier C, Qualls C, Burge MR. PTSD symptom reduction with mindfulness-based stretching and deep breathing exercise: randomized controlled clinical trial of efficacy. J Clin Endocrinol Metab. 2013;98(7):2984–92. Fetzner MG, Asmundson GJ. Aerobic Exercise Reduces Symptoms of Posttraumatic Stress Disorder: A Randomized Controlled Trial. Cogn Behav Ther. 2015;44(4):301–13. van de Kamp MM, Scheffers M, Emck C, Fokker TJ, Hatzmann J, Cuijpers P, Beek PJ. Body-and movement-oriented interventions for posttraumatic stress disorder: An updated systematic review and meta-analysis. J Trauma Stress 2023. Hall KS, Morey MC, Bosworth HB, Beckham JC, Pebole MM, Sloane R, Pieper CF. Pilot randomized controlled trial of exercise training for older veterans with PTSD. J Behav Med. 2020;43(4):648–59. Goldstein LA, Mehling WE, Metzler TJ, Cohen BE, Barnes DE, Choucroun GJ, Silver A, Talbot LS, Maguen S, Hlavin JA, et al. Veterans Group Exercise: A randomized pilot trial of an Integrative Exercise program for veterans with posttraumatic stress. J Affect Disord. 2018;227:345–52. Mehling WE, Chesney MA, Metzler TJ, Goldstein LA, Maguen S, Geronimo C, Agcaoili G, Barnes DE, Hlavin JA, Neylan TC. A 12-week integrative exercise program improves self-reported mindfulness and interoceptive awareness in war veterans with posttraumatic stress symptoms. J Clin Psychol. 2018;74(4):554–65. Crawford C, Wallerstedt DB, Khorsan R, Clausen SS, Jonas WB, Walter JA. A Systematic Review of Biopsychosocial Training Programs for the Self-Management of Emotional Stress: Potential Applications for the Military. Evidence-based complementary and alternative medicine: eCAM 2013, 2013:747694. Staples JK, Gordon JS, Hamilton M, Uddo M. Mind-body skills groups for treatment of war-traumatized veterans: A randomized controlled study. Psychol Trauma. 2022;14(6):1016–25. Goldberg SB, Riordan KM, Sun S, Kearney DJ, Simpson TL. Efficacy and acceptability of mindfulness-based interventions for military veterans: A systematic review and meta-analysis. J Psychosom Res. 2020;138:110232. Liu Q, Zhu J, Zhang W. The efficacy of mindfulness-based stress reduction intervention 3 for post-traumatic stress disorder (PTSD) symptoms in patients with PTSD: A meta-analysis of four randomized controlled trials. Stress Health. 2022;38(4):626–36. Evans DR, Eisenlohr-Moul TA, Button DF, Baer RA, Segerstrom SC. Self-Regulatory Deficits Associated with Unpracticed Mindfulness Strategies for Coping with Acute Pain. J Appl Soc Psychol. 2014;44(1):23–30. Britton WB. Can mindfulness be too much of a good thing? The value of a middle way. Curr Opin Psychol. 2019;28:159–65. American Psychiatric A, American Psychiatric A, Force DSMT. Diagnostic and statistical manual of mental disorders: DSM-5. 2013. Weathers FW, Bovin MJ, Lee DJ, Sloan DM, Schnurr PP, Kaloupek DG, Keane TM, Marx BP. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychol Assess. 2018;30(3):383–95. American College of Sports Medicine RDEJKLGMM. ACSM's guidelines for exercise testing and prescription; 2018. Hoge CE. Once a warrior, always a warrior. Guilford, CT: Globe Pequote; 2010. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998;30(6):975–91. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687–708. Kraemer WJ, Fleck SJ. Optimizing Strength Training: Designing Nonlinear Periodization Workouts. Champagne, IL: Human Kinetics; 2007. Fleck SJ, Kraemer WJ. Designing Resistance Training Programs. 3rd ed. Champagne, IL: Human Kinetic; 2004. Stephenson KR, Simpson TL, Martinez ME, Kearney DJ. Changes in Mindfulness and Posttraumatic Stress Disorder Symptoms Among Veterans Enrolled in Mindfulness-Based Stress Reduction. J Clin Psychol. 2017;73(3):201–17. Kabat-Zinn J. Full catastrophe living. Using the wisdom of the body and mind to face stress, pain, and illness. New York, NY: Delta/Random House; 1990. Arch JJ, Craske MG. Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behav Res Ther. 2006;44(12):1849–58. Miller JJ, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry. 1995;17(3):192–200. Staudenmeyer AH, Maxwell S, Mohlenhoff B, Yasser J, Schmitz M, Metzler T, Maguen S, Neylan T, Wolfe W. Pretreatment stabilization increases completion of trauma-focused evidence-based psychotherapies. Psychol Trauma 2022. McGuire AB, Kukla M, Green A, Gilbride D, Mueser KT, Salyers MP. Illness management and recovery: a review of the literature. Psychiatr Serv. 2014;65(2):171–9. Mueser KT, Meyer PS, Penn DL, Clancy R, Clancy DM, Salyers MP. The Illness Management and Recovery program: rationale, development, and preliminary findings. Schizophr Bull. 2006;32(Suppl 1):S32–43. Development of the World Health Organization WHOQOL-BREF quality of life assessment. WHOQOL Group Psychol Med. 1998;28(3):551–8. Skevington SM, Lotfy M, O'Connell KA, Group W. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004;13(2):299–310. Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). In.; 2013. Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl sport Sci. 1985;10(3):141–6. Gionet NJ, Godin G. Self-reported exercise behavior of employees: a validity study. J Occup medicine: official publication Industrial Med Association. 1989;31(12):969–73. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213. Germain A, Hall M, Krakow B, Katherine Shear M, Buysse DJ. A brief sleep scale for Posttraumatic Stress Disorder: Pittsburgh Sleep Quality Index Addendum for PTSD. J Anxiety Disord. 2005;19(2):233–44. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297–307. Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006;13(1):27–45. Baer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S, Walsh E, Duggan D, Williams JM. Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. 2008;15(3):329–42. Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport. 1992;63(1):60–6. Mehling WE, Price C, Daubenmier JJ, Acree M, Bartmess E, Stewart A. The Multidimensional Assessment of Interoceptive Awareness (MAIA). PLoS ONE. 2012;7(11):e48230. Bornemann B, Herbert BM, Mehling WE, Singer T. Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training. Front Psychol. 2014;5:1504. Mehling W. Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility. Philos Trans R Soc Lond 2016, 371(1708). Horowitz M, Adler N, Kegeles S. A scale for measuring the occurrence of positive states of mind: a preliminary report. Psychosom Med. 1988;50(5):477–83. Derogatis LR. SCL-90-R administration, scoring, and procedures manual. 3rd ed. Minneapolis: National Computer Systems, Inc.; 1994. 2020 S. Stata Statistical Software: Release 16.1. In. College Station. TX: StataCorp LLC; 2020. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterials.docx Cite Share Download PDF Status: Published Journal Publication published 28 Feb, 2025 Read the published version in BMC Psychiatry → Version 1 posted Editorial decision: Revision requested 13 Jun, 2024 Editor assigned by journal 13 Jun, 2024 Submission checks completed at journal 13 Jun, 2024 First submitted to journal 15 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4427468\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":314118083,\"identity\":\"009f88d9-856d-4570-a0da-6cc354622eb6\",\"order_by\":0,\"name\":\"Thomas C. Neylan\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYBAC+xsQOrGBgbmBgaECyGQ+wMDAg0cLmwSELmxgYARqOQMSSiBOSyVYC2MbMVqkm49u+PGHobJfIrHxc+G8w/LybQyMD9624dEicyztZm8bQ+7MGYnN0jO3HTbccIyB2XAuPi0SOWY3eBsYcjfcSGyQ5t12OMFAvoFNmpeAlpt//jCk77+R2Pybd87hBKDD2H8T0nKbh40heYNEYps0b8PhBIZjDGzM+LWkpd2WbZNInnHmYZs1z7F0oF8YmyXnnMOnJfnYzTd/bBL725MP3+apsQaGGPPBD2/KcGuBAmDsCCTAOKA4JQrwHyBS4SgYBaNgFIw4AAALTFPVhdCXzAAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"San Francisco VA Health Care System\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Thomas\",\"middleName\":\"C.\",\"lastName\":\"Neylan\",\"suffix\":\"\"},{\"id\":314118085,\"identity\":\"ab4a3d41-772d-4ab4-9cdc-8550f016b907\",\"order_by\":1,\"name\":\"Laura A. Muratore\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"San Francisco VA Health Care System\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Laura\",\"middleName\":\"A.\",\"lastName\":\"Muratore\",\"suffix\":\"\"},{\"id\":314118088,\"identity\":\"9a88c5e4-c3b6-4c48-bf9a-88845781066b\",\"order_by\":2,\"name\":\"Chanda L. Williams\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of California, San Francisco\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Chanda\",\"middleName\":\"L.\",\"lastName\":\"Williams\",\"suffix\":\"\"},{\"id\":314118089,\"identity\":\"607403b8-23c0-4b1e-8e1f-7a607fdcda7a\",\"order_by\":3,\"name\":\"Martha Schmitz\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"San Francisco VA Health Care System\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Martha\",\"middleName\":\"\",\"lastName\":\"Schmitz\",\"suffix\":\"\"},{\"id\":314118092,\"identity\":\"c15c7405-4213-4c1a-9433-472ee5479482\",\"order_by\":4,\"name\":\"Courtney V. Valdez\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"San Francisco VA Health Care System\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Courtney\",\"middleName\":\"V.\",\"lastName\":\"Valdez\",\"suffix\":\"\"},{\"id\":314118094,\"identity\":\"0b2193b3-0960-4505-a453-776da5beab8d\",\"order_by\":5,\"name\":\"Shira Maguen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"San Francisco VA Health Care System\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Shira\",\"middleName\":\"\",\"lastName\":\"Maguen\",\"suffix\":\"\"},{\"id\":314118096,\"identity\":\"ead786bd-5e49-4c68-8427-cfecb9b064dd\",\"order_by\":6,\"name\":\"Aoife O’Donovan\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of California, San Francisco\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Aoife\",\"middleName\":\"\",\"lastName\":\"O’Donovan\",\"suffix\":\"\"},{\"id\":314118099,\"identity\":\"429fd4ce-a2e5-4ddb-868e-44467617ef05\",\"order_by\":7,\"name\":\"D. Parker Kelley\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of California, San Francisco\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"D.\",\"middleName\":\"Parker\",\"lastName\":\"Kelley\",\"suffix\":\"\"},{\"id\":314118100,\"identity\":\"4550536e-ec1c-4127-ac90-61224e1f8f15\",\"order_by\":8,\"name\":\"Thomas J. Metzler\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"San Francisco VA Health Care System\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Thomas\",\"middleName\":\"J.\",\"lastName\":\"Metzler\",\"suffix\":\"\"},{\"id\":314118101,\"identity\":\"6d9827dd-a543-42b1-a9cd-52b32d470121\",\"order_by\":9,\"name\":\"Beth E. Cohen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of California, San Francisco\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Beth\",\"middleName\":\"E.\",\"lastName\":\"Cohen\",\"suffix\":\"\"},{\"id\":314118103,\"identity\":\"0b3448e5-b558-4d83-94c7-610b7aee6ebb\",\"order_by\":10,\"name\":\"Anna C. West\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"San Francisco VA Health Care System\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Anna\",\"middleName\":\"C.\",\"lastName\":\"West\",\"suffix\":\"\"},{\"id\":314118105,\"identity\":\"0e8610dd-d7ae-4919-bf3e-050cd7f58ea7\",\"order_by\":11,\"name\":\"Jordan D.V. Phan\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"San Francisco VA Health Care System\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jordan\",\"middleName\":\"D.V.\",\"lastName\":\"Phan\",\"suffix\":\"\"},{\"id\":314118107,\"identity\":\"a84125f2-101e-49fa-bd1a-b3fd2c3f63fd\",\"order_by\":12,\"name\":\"Victor Antonetti\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Northern California Institute for Research and Education\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Victor\",\"middleName\":\"\",\"lastName\":\"Antonetti\",\"suffix\":\"\"},{\"id\":314118109,\"identity\":\"9b0c7755-a4f4-4212-af35-9a08888ea801\",\"order_by\":13,\"name\":\"Olga Mayzel\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"San Francisco VA Health Care System\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Olga\",\"middleName\":\"\",\"lastName\":\"Mayzel\",\"suffix\":\"\"},{\"id\":314118111,\"identity\":\"f7a49c67-1ed9-44e0-b82a-f64e724be26e\",\"order_by\":14,\"name\":\"Jennifer A. Hlavin\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"San Francisco VA Health Care System\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jennifer\",\"middleName\":\"A.\",\"lastName\":\"Hlavin\",\"suffix\":\"\"},{\"id\":314118113,\"identity\":\"84f4b077-ba06-48ed-89c2-ac46a3c51719\",\"order_by\":15,\"name\":\"Margaret A. Chesney\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of California, San Francisco\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Margaret\",\"middleName\":\"A.\",\"lastName\":\"Chesney\",\"suffix\":\"\"},{\"id\":314118114,\"identity\":\"8bb705d8-0959-49aa-bdf0-80b3e1a8e0f4\",\"order_by\":16,\"name\":\"Wolf E. Mehling\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of California, San Francisco\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Wolf\",\"middleName\":\"E.\",\"lastName\":\"Mehling\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-05-15 22:56:39\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4427468/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4427468/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12888-025-06638-1\",\"type\":\"published\",\"date\":\"2025-02-28T15:58:22+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":60187902,\"identity\":\"ad18d27f-df36-49cc-b1d6-f89f39a0eed2\",\"added_by\":\"auto\",\"created_at\":\"2024-07-12 19:13:55\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":163570,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCONSORT Flow Diagram\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4427468/v1/fd1639abc068c0b478861911.png\"},{\"id\":60187900,\"identity\":\"b6d82272-6586-43a3-8992-9671e05be337\",\"added_by\":\"auto\",\"created_at\":\"2024-07-12 19:13:55\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":21324,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eClinician Administered PTSD Scale\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4427468/v1/8528ac1b011205272a8ab505.png\"},{\"id\":60188985,\"identity\":\"33446ceb-1322-4fdf-9601-28b6211594be\",\"added_by\":\"auto\",\"created_at\":\"2024-07-12 19:21:55\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":8985,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eChange in CAPS 5 in IE and REC conditions by setting and number of sessions attended\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4427468/v1/03f9e5b721477ce9d6f78948.png\"},{\"id\":60187904,\"identity\":\"7be84e70-73e1-4146-96eb-9c90ca6b4f36\",\"added_by\":\"auto\",\"created_at\":\"2024-07-12 19:13:55\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":21202,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eGodin Leisure-Time Exercise Questionnaire\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4427468/v1/0947e3ad6f16ab05c6a7f6db.png\"},{\"id\":77622647,\"identity\":\"8e19fe35-1ca0-4fb6-8c9a-930960fd93d9\",\"added_by\":\"auto\",\"created_at\":\"2025-03-03 16:08:52\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1691050,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4427468/v1/473029ac-295a-4e17-a9c9-d640a104d23f.pdf\"},{\"id\":60188986,\"identity\":\"5a3a112f-5855-499e-867c-5cf90e395f3f\",\"added_by\":\"auto\",\"created_at\":\"2024-07-12 19:21:55\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":107014,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementaryMaterials.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4427468/v1/125ecf88495da9c1bd0a2954.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Group Integrated Exercise versus Recovery Class for Veterans with Posttraumatic Stress Disorder: A Randomized Clinical Trial\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eThere is evidence that aerobic exercise effectively improves many outcomes relevant to Posttraumatic Stress Disorder (PTSD) including fear memory, anxiety, depression, insomnia, cognition, and cardiovascular disease[\\u003cspan additionalcitationids=\\\"CR2 CR3 CR4 CR5 CR6\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. Given that aerobic exercise improves brain health and neurogenesis[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e], cognitive function[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e], mood[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e], sleep[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e], and cardiovascular health[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e], there is a strong rationale to determine whether exercise may be an effective intervention for Veterans with combat-related PTSD. Individuals with PTSD have lower rates of exercise compared to others without PTSD of the same age and sex[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e], suggesting they may particularly benefit from a focus on exercise. Despite the high acceptance of exercise therapy for PTSD[\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e] and the advantage of a treatment lacking stigma for this population[\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e], to date there are no reported randomized trials testing exercise versus an active comparator arm in any population with PTSD.\\u003c/p\\u003e \\u003cp\\u003eThere is limited published data on the effects of exercise in Veterans with PTSD. There are several pilot studies suggesting that exercise reduces PTSD and associated mood and anxiety symptoms in children[\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e], adolescents[\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e], and civilian adults[\\u003cspan additionalcitationids=\\\"CR20\\\" citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. These studies are limited by lack of control conditions and small sample sizes[\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. Nevertheless, these pilot studies indicate acceptability, feasibility, and promise of efficacy[\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIntegrative Exercise (IE) combines traditional fitness exercises (aerobics, resistance training, stretching) with mindfulness, yoga, and mindful body/breath awareness[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. Group aerobic exercises are a part of daily life of military personnel during their service time. Group exercise is familiar and appealing to Veterans as a self-image boosting and mood enhancing physical practice. In the past decade, while physical activity and aerobic exercise are still emphasized, mindfulness-based practices have increasingly been adopted in military settings[\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e], and controlled trials of Mind-Body skills[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e] and Mindfulness-Based Stress Reduction (MBSR) have demonstrated moderate efficacy for PTSD[\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003ePrior pilot testing with a waitlist control demonstrated evidence supporting IE as an effective treatment option for Veterans with symptoms of PTSD[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. The purpose of the present study was to expand this knowledge and investigate whether IE improves Veteran\\u0026rsquo;s quality of life and PTSD symptoms in comparison to an active current psychoeducation treatment. As an exploratory aim, we investigated differences between the two treatment groups in relation to other health outcomes, including mood, subjective sleep quality, and emotion regulation.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eA total of 84 participants were enrolled of which 41 participants were randomized to IE and 43 participants to REC (see Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e for consort diagram\\u003cb\\u003e)\\u003c/b\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eParticipants assigned to IE had a mean age of 52.7 (SD\\u0026thinsp;=\\u0026thinsp;11.6) and were 73% male. Participants assigned to REC had a mean age of 50.8 (SD\\u0026thinsp;=\\u0026thinsp;12) and were 65% male. Clinical and demographic characteristics are summarized in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eDemographic and Clinical Characteristics\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eREC\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eIE\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;43\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;41\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e50.8 (12.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e52.7 (11.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.47\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSex\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e28 (65%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30 (73%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15 (35%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11 (27%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRace\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAmerican Indian/Alaska Native\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2 (5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAsian\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5 (12%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2 (5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBlack or African American\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9 (21%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12 (29%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWhite\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e26 (60%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18 (44%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOther\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7 (17%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEthnicity\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.45\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHispanic or Latino\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5 (12%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9 (22%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNon-Hispanic or Latino\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e32 (74%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27 (66%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eUnknown\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6 (14%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5 (12%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEducation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.65\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHigh School Graduate / GED\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2 (5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSome College\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17 (40%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12 (31%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAssociates Degree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5 (13%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBachelors Degree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8 (19%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6 (15%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSome Graduate School\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMasters Degree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7 (16%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12 (31%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDoctoral Degree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVA Service-Connected Disability\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.85\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10 (23%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10 (25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e33 (77%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30 (75%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eASI Alcohol\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.3 (0.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.4 (0.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.10\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSmoking History\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.73\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCurrent Smoker\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7 (17%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7 (18%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFormer Smoker\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e13 (31%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9 (23%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNever Smoked\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22 (52%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e23 (59%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCAPS_Total_baseline\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e29.8 (7.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e33.1 (8.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.07\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePCL5 Total\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e40.3 (12.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e43.5 (15.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWHOQOL Physical Health\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e51.9 (16.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e51.2 (13.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.82\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWHOQOL Psychological\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e44.4 (14.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e41.1 (18.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.38\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWHOQOL Social Relationships\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e44.2 (21.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e45.0 (26.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.88\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWHOQOL Environment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e59.3 (15.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e55.9 (16.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.33\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWHOQOL Overall Heatlth (Q. 2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e41.9 (25.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e41.3 (26.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.91\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFFMQ Observing\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e24.6 (7.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24.9 (9.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.88\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFFMQ Describing\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22.8 (8.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e23.4 (8.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.72\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFFMQ Acting with Awareness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e23.9 (7.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22.8 (8.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.52\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFFMQ Nonjudging of Inner Experience\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25.0 (9.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22.3 (9.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.18\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFFMQ Nonreactivity to Inner Experience\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19.2 (5.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18.9 (6.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.80\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGLTEQ Activity Score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e27.5 (23.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e35.2 (35.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.25\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePhysical Activity Self-Efficacy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.6 (0.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.9 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.15\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDERS Total Score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e87.2 (17.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e88.3 (24.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.81\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEmotion Regulation - Cognitive Reappraisal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.8 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4.8 (1.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.87\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEmotion Regulation - Expressive Suppression\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.1 (1.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4.3 (1.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.46\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA Noticing\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.1 (1.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.3 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA Not-Distracting\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.9 (0.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.8 (0.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.55\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA Not-Worrying\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.8 (0.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.7 (0.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.48\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA Attention Regulation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.7 (0.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.1 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.08\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA Emotional Awareness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.2 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.4 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.22\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA Self-Regulation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.8 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.0 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.43\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA Body Listening\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.3 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.5 (1.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.39\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA Trusting\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.9 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.0 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.77\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePositive States of Mind\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10.6 (3.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9.4 (4.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.17\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSCL90 Global Severity Index\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.1 (0.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.4 (0.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.02\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePSQI_baseline\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11.3 (3.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12.0 (4.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.39\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePSQI PTSD Addendum Global Score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8.0 (4.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8.1 (4.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.91\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInsomnia Severity Index\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e14.7 (5.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16.8 (6.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePROMIS Pain Intensity T-Score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e54.3 (10.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e58.6 (8.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePROMIS_8A Pain Interference T-Score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e54.3 (9.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e56.3 (6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.28\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePhysical Activity Self-Efficacy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.6 (0.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.9 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.15\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eData are presented as mean (SD) for continuous measures, and n (%) for categorical measures. Acronyms: REC- Recovery Class, IE- Integrated Exercise, CAPS- Clinician Administered PTSD Scale, PCL-5- PTSD Checklist for DSM5, WHOQOL- World Health Organization Quality of Life, FFMQ- Five Facet Mindfulness Questionnaire, GLTEQ- Godin Leisure-Time Exercise Questionnaire, DERS- Difficulties in Emotion Regulation Scale, MAIA- Multidimensional Assessment of Interoceptive Awareness, SCL-90- Symptom Check-List-90-Revised, PSQI- Pittsburgh Sleep Quality Index\\u003c/p\\u003e \\u003cp\\u003eThe sample included 60% and 44% (REC and IE respectively) of white, 21% and 29% black, and 12% and 22% Latin participants. The two groups demonstrated comparable baseline scores on the WHOQOL, CAPS-5, and PCL-5. Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e also shows comparable distribution of baseline values on our secondary clinical outcomes. Participants who participated in the trial in person prior to the COVID pandemic were older and more likely to be male, compared to those who participated remotely during the pandemic. Baseline clinical characteristics were otherwise similar in the in person versus remote cohorts. See Supplemental Table\\u0026nbsp;1S.\\u003c/p\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e provides information about treatment characteristics in the 2 groups. IE participants who completed the study attended a mean of 20.3 sessions (SD\\u0026thinsp;=\\u0026thinsp;10.2) out of the 36 possible. REC participants who completed the study attended a mean of 27.5 sessions (SD\\u0026thinsp;=\\u0026thinsp;8.7). Eleven of 41 IE participants dropped out which is similar in ratio to the 9 out of 43 REC participants (X\\u003csup\\u003e2\\u003c/sup\\u003e (1)\\u0026thinsp;=\\u0026thinsp;0.40, p\\u0026thinsp;=\\u0026thinsp;.53).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eTreatment Characteristics\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eREC\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eIE\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eContrast\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCompletion Status\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ec\\u003csup\\u003e2\\u003c/sup\\u003e (1)\\u0026thinsp;=\\u0026thinsp;0.40, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.53\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCompleted Treatment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e34 (79%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30 (73%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDropped Out\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9 (21%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11 (27%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTreatment Location\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eFisher Exact \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.69\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIn-Person\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15 (37%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20 (47%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRemote\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25 (61%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22 (51%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHybrid In-Person/Remote\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSessions Attended\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCompleted, mean (sd) [range]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e27.5 (8.7) [\\u003cspan additionalcitationids=\\\"CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32 CR33 CR34 CR35 CR36\\\" citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e20.3 (10.2) [\\u003cspan additionalcitationids=\\\"CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32 CR33 CR34 CR35 CR36\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDropped out, mean (sd) [range]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.9 (4.4) [0\\u0026ndash;13]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.7 (3.2) [0\\u0026ndash;9]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFeasibility and Acceptance Rating (0\\u0026ndash;6 Scale)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.9 (0.8) [1.9\\u0026ndash;5.0]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.7 (1.0) [1.3\\u0026ndash;4.9]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003et(\\u003c/em\\u003e58)\\u0026thinsp;=\\u0026thinsp;0.76, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.45\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eDropouts did not differ significantly on the primary outcome measures at baseline, nor on any demographics except for sex. Dropouts were 95% male (19/20) compared to 61% (39/64) for completers, X\\u003csup\\u003e2\\u003c/sup\\u003e (1)\\u0026thinsp;=\\u0026thinsp;8.27, p\\u0026thinsp;=\\u0026thinsp;.004. The single female dropout was from the REC group. Twenty of the 41 IE participants (47%) and 15 of the 43 REC participants (37%) completed the intervention in person prior to the COVID pandemic. Two participants, one in each group, completed the intervention in a hybrid of in-person and remote participation. Feasibility and acceptability ratings were mixed, but overall satisfaction with both interventions was high. See Supplemental Figs.\\u0026nbsp;1S and 2S.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePrimary Outcome Analyses\\u003c/h2\\u003e \\u003cp\\u003eThere were no differences in IE versus REC in change in the WHOQOL Psychological Domain (see Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e and Supplemental Fig.\\u0026nbsp;3S). Further, there were no significant pre-post changes in WHOQOL Psychological Domain in the combined sample. There were no significant differences in changes in the CAPS-5 total score in IE versus REC (see Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e and Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). There was a modest reduction in the total CAPS-5 score in both groups (IE: -8.2 (9.9), p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001: REC: -7.8 (2.0), p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001). In the IE subsample that was remote, there was a significantly greater improvement in PTSD symptom severity (F[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e]\\u0026thinsp;=\\u0026thinsp;4.62, p\\u0026thinsp;=\\u0026thinsp;.036; Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e) and in in the WHOQOL Psychological Domain (F(1, 47)\\u0026thinsp;=\\u0026thinsp;6.46, p\\u0026thinsp;=\\u0026thinsp;.014; Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003eS) in those who attended a greater number of sessions.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eMajor Outcomes by Treatment Group (See separate doc for Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e for full view)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"8\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003ePTSD Recovery Group (Control)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c7\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eIntegrative Exercise Group (Treatment)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eBetween-Group Contrast\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOutcome\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eBaseline\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePost Tx\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePre-Post Change\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eBaseline\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePost Tx\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePre-Post Change\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWHOQOL-Psychological\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e44.1 (15.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e45.2 (16.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.1 (12.0), p\\u0026thinsp;=\\u0026thinsp;.59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e39.4 (16.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e41.5 (19.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e2.2 (16.2), p\\u0026thinsp;=\\u0026thinsp;.49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (55)\\u0026thinsp;=\\u0026thinsp;0.01, p\\u0026thinsp;=\\u0026thinsp;.989\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWHOQOL-Physical\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e52.2 (16.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e54.8 (15.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.6 (12.5), p\\u0026thinsp;=\\u0026thinsp;.24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e50.5 (14.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e54.5 (15.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e4.0 (14.1), p\\u0026thinsp;=\\u0026thinsp;.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (55)\\u0026thinsp;=\\u0026thinsp;0.52, p\\u0026thinsp;=\\u0026thinsp;.602\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCAPS Total\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e29.8 (7.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22.0 (11.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-7.8 (2.0), p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e32.7 (7.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e24.4 (11.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-8.2 (9.9), p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (58)\\u0026thinsp;=\\u0026thinsp;0.39, p\\u0026thinsp;=\\u0026thinsp;.699\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePCL5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e38.9 (13.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e39.9 (15.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.0 (13.4), p\\u0026thinsp;=\\u0026thinsp;.67\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e40.8 (15.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e36.3 (17.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-4.4 (12.5), p\\u0026thinsp;=\\u0026thinsp;.08\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (55)\\u0026thinsp;=\\u0026thinsp;1.45, p\\u0026thinsp;=\\u0026thinsp;.152\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSCL-90 Global Severity\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.09 (0.43)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.13 (0.57)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.04 (0.43), p\\u0026thinsp;=\\u0026thinsp;59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.27 (0.66)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.14 (0.68)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-0.16 (0.40). p\\u0026thinsp;=\\u0026thinsp;.06\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (54)\\u0026thinsp;=\\u0026thinsp;1.53, p\\u0026thinsp;=\\u0026thinsp;.133\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFFMQ - Obs\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25.2 (7.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e26.4 (7.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.2 (4.4), p\\u0026thinsp;=\\u0026thinsp;.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e25.5 (7.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e22.2 (11.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-3.2 (11.0), p\\u0026thinsp;=\\u0026thinsp;.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (59)\\u0026thinsp;=\\u0026thinsp;2.16, p\\u0026thinsp;=\\u0026thinsp;.035\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFFMQ - Desc\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22.6 (7.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24.4 (7.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.8 (4.1), p\\u0026thinsp;=\\u0026thinsp;.26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e24.4 (6.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e21.8 (11.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-2.6 (11.6), p\\u0026thinsp;=\\u0026thinsp;.23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (59)\\u0026thinsp;=\\u0026thinsp;1.46, p\\u0026thinsp;=\\u0026thinsp;.149\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFFMQ - Aware\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e23.6 (6.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24.0 (7.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.4 (3.3), p\\u0026thinsp;=\\u0026thinsp;.47\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e23.8 (6.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e20.1 (10.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-3.7 (9.8), p\\u0026thinsp;=\\u0026thinsp;.04\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (59) = 2.26, p\\u0026thinsp;=\\u0026thinsp;.028\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFFMQ - Nonjudge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25.4 (8.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25.5 (7.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.2 (5.4), p\\u0026thinsp;=\\u0026thinsp;.85\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e25.0 (8.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e21.2 (11.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-3.8 (7.9), p\\u0026thinsp;=\\u0026thinsp;.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (59)\\u0026thinsp;=\\u0026thinsp;2.31, p\\u0026thinsp;=\\u0026thinsp;.024\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFFMQ - Nonreact\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19.2 (4.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19.9 (5.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.7 (2.7), p\\u0026thinsp;=\\u0026thinsp;.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e19.9 (5.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e17.7 (8.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-2.2 (8.6), p\\u0026thinsp;=\\u0026thinsp;.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (59)\\u0026thinsp;=\\u0026thinsp;1.80, p\\u0026thinsp;=\\u0026thinsp;.077\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGLTQ\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25.7 (20.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e43.8 (36.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e18.1 (29.7), p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e30.6 (29.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e44.2 (40.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e13.6 (27.2), p\\u0026thinsp;=\\u0026thinsp;.02\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (53)\\u0026thinsp;=\\u0026thinsp;0.59, p\\u0026thinsp;=\\u0026thinsp;.559\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePASE\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.4 (0.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.6 (0.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.2 (0.5), p\\u0026thinsp;=\\u0026thinsp;.08\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.7 (0.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2.7 (0.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.0 (0.0), p\\u0026thinsp;=\\u0026thinsp;.99\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (53)\\u0026thinsp;=\\u0026thinsp;0.21, p\\u0026thinsp;=\\u0026thinsp;.834\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDERS Total\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e89.1 (16.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e91.3 (20.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.2 (14.3), p\\u0026thinsp;=\\u0026thinsp;.39\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e85.9 (17.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e85.7 (19.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-0.2 (17.1), p\\u0026thinsp;=\\u0026thinsp;.94\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (53)\\u0026thinsp;=\\u0026thinsp;0.84, p\\u0026thinsp;=\\u0026thinsp;.407\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eERQ - Reappraisal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.7 (0.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4.7 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.0 (1.0), p\\u0026thinsp;=\\u0026thinsp;.84\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4.7 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e4.7 (1.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.1 (1.0), p\\u0026thinsp;=\\u0026thinsp;.99\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (52)\\u0026thinsp;=\\u0026thinsp;.070, p\\u0026thinsp;=\\u0026thinsp;.947\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eERQ \\u0026ndash; Suppression\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.0 (1.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.7 (1.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-0.3 (0.9), p\\u0026thinsp;=\\u0026thinsp;.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4.1 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e4.1 (1.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.0 (0.9), p\\u0026thinsp;=\\u0026thinsp;.87\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (52)\\u0026thinsp;=\\u0026thinsp;1.18, p\\u0026thinsp;=\\u0026thinsp;.245\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA \\u0026ndash; Emot. Awareness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.1 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.5 (0.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.4 (1.0), p\\u0026thinsp;=\\u0026thinsp;.03\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3.3 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3.3 (0.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.1 (0.8), p\\u0026thinsp;=\\u0026thinsp;.64\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (53)\\u0026thinsp;=\\u0026thinsp;1.16, p\\u0026thinsp;=\\u0026thinsp;.25\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA \\u0026ndash; Attention Reg.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.7 (0.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.9 (0.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.2 (0.8), p\\u0026thinsp;=\\u0026thinsp;.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.8 (0.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3.0 (0.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.2 (0.8), p\\u0026thinsp;=\\u0026thinsp;.29\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (53)\\u0026thinsp;=\\u0026thinsp;0.18, p\\u0026thinsp;=\\u0026thinsp;.860\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA - Noticing\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.0 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.2 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.2 (1.0), p\\u0026thinsp;=\\u0026thinsp;.32\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3.3 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3.3 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.0 (0.9), p\\u0026thinsp;=\\u0026thinsp;.87\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (53)\\u0026thinsp;=\\u0026thinsp;0.13, p\\u0026thinsp;=\\u0026thinsp;.896\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA \\u0026ndash; Not Distracted\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.0 (0.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.6 (0.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-0.4 (0.6), p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.8 (0.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.7 (0.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-0.1 (0.6), p\\u0026thinsp;=\\u0026thinsp;.65\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (53)\\u0026thinsp;=\\u0026thinsp;1.55, p\\u0026thinsp;=\\u0026thinsp;.126\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA \\u0026ndash; Not Worry\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.7 (0.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.7 (0.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-0.1 (0.5), p\\u0026thinsp;=\\u0026thinsp;.44\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.8 (0.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2.9 (0.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.2 (0.6), p\\u0026thinsp;=\\u0026thinsp;.22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (53)\\u0026thinsp;=\\u0026thinsp;0.26, p\\u0026thinsp;=\\u0026thinsp;.055\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA \\u0026ndash; Self Regulation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.7 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.0 (0.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.3 (0.8), p\\u0026thinsp;=\\u0026thinsp;.06\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.9 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3.1 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.2 (1.1), p\\u0026thinsp;=\\u0026thinsp;.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (53)\\u0026thinsp;=\\u0026thinsp;0.03, p\\u0026thinsp;=\\u0026thinsp;.975\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA \\u0026ndash; Body Listening\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.3 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.7 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.4 (1.0), p\\u0026thinsp;=\\u0026thinsp;.023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.4 (1.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2.7 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.3 (1.1), p\\u0026thinsp;=\\u0026thinsp;.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (56)\\u0026thinsp;=\\u0026thinsp;0.01, p\\u0026thinsp;=\\u0026thinsp;.993\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMAIA - Trust\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.9 (1.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.1 (1.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.2 (0.9), P\\u0026thinsp;=\\u0026thinsp;.23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.9 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3.1 (0.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.2 (1.0), P\\u0026thinsp;=\\u0026thinsp;.28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (55)\\u0026thinsp;=\\u0026thinsp;0.22, p\\u0026thinsp;=\\u0026thinsp;.830\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePSOM\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10.9 (3.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11.3 (3.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.4 (2.4), p\\u0026thinsp;=\\u0026thinsp;.33\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e9.7 (3.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e8.9 (6.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-0.8 (4.9), p\\u0026thinsp;=\\u0026thinsp;.38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (59)\\u0026thinsp;=\\u0026thinsp;1.55, p\\u0026thinsp;=\\u0026thinsp;.127\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePSQI\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11.1 (3.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10.7 (4.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.4 (4.0), p\\u0026thinsp;=\\u0026thinsp;.61\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e11.9 (4.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e11.4 (5.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.4 (4.1), p\\u0026thinsp;=\\u0026thinsp;.58\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (55)\\u0026thinsp;=\\u0026thinsp;0.18, p\\u0026thinsp;=\\u0026thinsp;.858\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eISI\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15.0 (5.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13.2 (5.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e-1.8 (5.0), p\\u0026thinsp;=\\u0026thinsp;.04\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e16.0 (6.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e13.6 (6.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e-2.4 (5.3), p\\u0026thinsp;=\\u0026thinsp;.029\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (54)\\u0026thinsp;=\\u0026thinsp;0.24, p\\u0026thinsp;=\\u0026thinsp;.810\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePROMIS 3A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e54.9 (10.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e57.4 (11.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.5 (6.9), p\\u0026thinsp;=\\u0026thinsp;.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e58.8 (7.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e60.2 (5.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.5 (9.0), p\\u0026thinsp;=\\u0026thinsp;.446\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (50)\\u0026thinsp;=\\u0026thinsp;0.16, p\\u0026thinsp;=\\u0026thinsp;.872\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePROMIS 8A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e54.5 (9.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e56.4 (9.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.9 (6.0), p\\u0026thinsp;=\\u0026thinsp;.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e57.6 (5.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e59.5 (6.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.9 (9.1), p\\u0026thinsp;=\\u0026thinsp;.307\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003et (53)\\u0026thinsp;=\\u0026thinsp;0.61, p\\u0026thinsp;=\\u0026thinsp;.542\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003csup\\u003e1\\u003c/sup\\u003e Group difference in post-treatment scores adjusted for baseline.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eResponder Analyses\\u003c/h2\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e shows that there were no differences in response rate (10-point drop in CAPS-5: IE\\u0026thinsp;=\\u0026thinsp;41%, REC\\u0026thinsp;=\\u0026thinsp;44%), loss of diagnosis, or remission status on the CAPS-5 outcome for the 2 groups.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eResponse Rate\\u003csup\\u003e1\\u003c/sup\\u003e, Loss of Diagnosis, Remission\\u003csup\\u003e2\\u003c/sup\\u003e Across Treatment Groups\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNumber (%)\\u003c/p\\u003e \\u003cp\\u003ePosttreatment\\u003c/p\\u003e \\u003cp\\u003eIE\\u003c/p\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;29\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eREC\\u003c/p\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;34\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eResponse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e12 (41%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e15 (44%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLoss of Diagnosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10 (32%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10 (29%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRemission\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (13%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5 (15%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"3\\\"\\u003e\\u003cem\\u003eNote\\u003c/em\\u003e: \\u003csup\\u003e1\\u003c/sup\\u003e Defined as an improvement of at least 10 points on CAPS-5, \\u003csup\\u003e2\\u003c/sup\\u003e Defined as loss of diagnosis and CAPS-5\\u0026thinsp;\\u0026lt;\\u0026thinsp;12.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSecondary Outcomes\\u003c/h2\\u003e \\u003cp\\u003eSelf-reported physical activity as indexed by the Godin Leisure Time Questionnaire showed comparable levels of physical activity at baseline (See Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e and Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e). However, post-randomization scores on this measure did not demonstrate that IE participants became more physically active than REC participants. Both groups showed an increase in vigorous activity from pre- to post- treatment (See Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eSix-month follow-up data showed some regression toward baseline levels of activity. Self-report PTSD symptoms on the PCL-5 did not change significantly over the trial (See Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). Mindfulness as indexed on the FFMQ showed that in the condition (IE) where they were taught mindfulness attitudes, participants self-reported feeling less skilled in this domain over the course of the trial. The REC group reported some modest improvement in interoceptive awareness on several items of the Multidimensional Assessment of Interoceptive Awareness (MAIA) scale. Both groups had small reductions in self-reported insomnia. Other secondary outcomes as described in the Supplement did not show significant changes over the trial (See Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eParticipant Feedback\\u003c/h2\\u003e \\u003cp\\u003e The PI interacted with 46 participants who accepted the invitation to meet after the 12-week intervention either in person or by phone. He encouraged candid feedback and asked for suggestions to improve the IE or REC programs. Participants commented on the class instructors, scheduling issues, class timing such as 3-hour later evening hours on the East Coast, logistical difficulties with in-person classes, and limited peer interaction with the Zoom version of IE. The staggered entry into ongoing classes due to rolling enrollment was challenging for some participants, and peer interaction was limited when group sizes went beyond five or six. The great majority commented very positively about enjoying the classes, the instructors, the class content, and the ability to participate remotely from their home. Several participants also described greater physical fitness after completing the classes.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eContrary to our hypotheses, we did not show that participation in either group IE or REC resulted in a significant improvement in psychological quality of life as indexed by the WHOQOL. Participation did result in a modest decline in PTSD symptom severity as indexed by the CAPS-5. Response rates in both groups were below 50% and remission from treatment was uncommon (13\\u0026ndash;15%). Surprisingly, both groups reported an increase in physical activity over the course of the 12-week intervention. Both treatment arms were associated with mixed responses on some aspects of feasibility and acceptability, though there was overall high satisfaction with both treatment arms.\\u003c/p\\u003e \\u003cp\\u003eThe conduct of this study was impacted by the COVID pandemic and both arms were converted from an in person to a remote telehealth format. Preliminary data suggest that higher attendance was associated with greater reduction in the CAPS-5 total score in the remote condition for the IE condition. This may have been due to the convenience offered by the telehealth format, in contrast to Veterans having to drive considerable distances to attend classes at the location where the IE condition was taught.\\u003c/p\\u003e \\u003cp\\u003eA notable contrast between the two study interventions is that the IE groups were led by exercise instructors who were not clinically trained. In contrast, the REC condition was led by experienced PTSD psychologists who delivered the same intervention focused on education and skills training commonly used as a present-focused treatment in VA PTSD treatment clinics. Although both study arms were highly rated by participants for treatment satisfaction, the magnitude of symptom reduction was small in the full sample, but substantial in those who engaged in greater than 20 sessions in the remote IE condition.\\u003c/p\\u003e \\u003cp\\u003eThere was an unexpected difference across the two treatment arms on the self-report measure of mindfulness. The IE participants who were specifically taught initial mindfulness techniques or attitudes, rated themselves as less mindful at the end of the 12-week condition. Experience with conducting mindfulness trials has shown that untrained participants may initially overestimate and post-intervention rate themselves lower on specific skills as they become more aware of different aspects of mindfulness[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. This suggests that the amount of mindfulness training incorporated into the IE intervention is insufficient to produce durable improvements in mindfulness skills.\\u003c/p\\u003e \\u003cp\\u003eThe modest reduction in the CAPS-5 score in the IE condition was considerably smaller than the magnitude of improvement in the pilot trial using the same intervention[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. Overall, there was a compression of change scores in both arms compared to both arms of the pilot trial, which had a waitlist control. There are several differences in treatment delivery across the two trials. First, the IE condition was delivered in evening hours in the pilot study, compared to afternoon hours in the current study. Second, the mean age of participants in the IE arm was older in the current trial (mean age\\u0026thinsp;=\\u0026thinsp;52.7) versus the IE condition of the pilot study (mean age\\u0026thinsp;=\\u0026thinsp;47.4). Third, the pilot was conducted prior to the pandemic. Results from current study show a possible impact of attendance on clinical outcomes and it is notable that participants randomized to IE attended fewer sessions (mean\\u0026thinsp;=\\u0026thinsp;20.3) than REC participants (mean\\u0026thinsp;=\\u0026thinsp;27.5). It is possible that the IE condition involves more frustration and possibility for self-critical responses for some participants when engaged in vigorous exercise. Finally, compared to the in-person pilot study, opportunities for social interaction during or around the remote classes were more limited in the IE condition.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThe study results do not demonstrate that an exercise condition that integrates mindful breathing, aerobic and strengthening activity, produces a greater change in self-reported psychological quality of life or reduction in PTSD symptoms relative to an active intervention that is comparable to present-focused treatments offered in many PTSD specialty clinics in the VA. Both current standard treatment by experienced psychologists and an integrative exercise program led by fitness and yoga instructors had similar effects. Despite high overall satisfaction of study participants, the magnitude of change in PTSD symptom severity is modest and response rates are below 50%. Higher attendance in the remote IE condition was associated with greater symptom improvement. Future work should attempt to incentivize more consistent engagement in exercise sessions to promote more clinically meaningful symptom reduction.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTrial Design and Procedures\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants who met eligibility for enrollment were randomly assigned to either 12 weeks of integrative exercise (IE) or PTSD Recovery Class (REC) classes. This research was approved by the Institutional Review Board of the University of California, San Francisco, and the Human Research Protection Program at the San Francisco Veterans Affairs Medical Center. All participants provided written or electronic informed consent. This trial was registered on ClinicalTrials.gov (NCT02856412).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eParticipants\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA total of 84 Veterans who met criteria for current PTSD of at least 3-months duration, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association[32]) and/or endorsed moderate levels of PTSD symptoms (CAPS 5 score \\u0026ge; 23[33]) were randomly assigned to treatment.Veterans currently receiving mental health treatment (e.g., individual therapy, psychiatric medication) were included if they were treatment stable for at least two months before beginning the trial and maintained this treatment throughout the trial. All study participants completed a medical screen to ensure they were physically capable of participating. Medical clearance was determined by examining the participant\\u0026rsquo;s medical history, a physical examination by the study doctor or study nurse, and completion of the Physical Activity Readiness Questionnaire[34]. See Figure 1 for a detailed diagram of study enrollment and reasons for exclusion.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eProcedures\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRecruitment, screening, and baseline.\\u0026nbsp;\\u003c/strong\\u003eStudy recruitment and enrollment began in November 2017 and ended in March 2022. Within this enrollment period, study procedures were modified, as described in detail below, due to the COVID-19 pandemic and subsequent restrictions to in-person research. In March 2020, the study transitioned from in-person to a fully remote trial for the duration of enrollment to maintain subject safety.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAn extensive outreach plan was implemented to recruit a diverse sample of U.S. Veterans. For veterans participating locally, in-person, we recruited primarily by mailing letters to veterans within and surrounding the San Francisco Bay Area, with a smaller number recruited by provider referrals. We expanded recruitment to a national scale when the trial shifted to remote-only procedures in response to the COVID pandemic.For veterans participating nationwide, remotely, we recruited primarily via TrialFacts, with smaller numbers coming from provider referrals or ResearchMatch. Interested Veterans completed an initial pre-screen interview with study staff to determine whether they met study inclusion (n=540; see CONSORT diagram, Figure 1). Potentially eligible Veterans (n=230) provided informed consent and participated in an in-depth clinician-administered diagnostic assessment. Following these assessments, 84 participants were eligible and were randomized. Self-report questionnaires measured subjective sleep quality, PTSD symptoms, mood states, and quality of life.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTransition from in-person classes to remote delivery\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eBefore COVID, IE group classes were delivered in-person at the San Francisco YMCA. With onset of the epidemic this setting became unsafe for our participants and was changed to online delivery to participants\\u0026rsquo; homes and their computer or smart phone screens. This limited classes to participants with a minimal amount of electronic equipment and literacy (detailed instructions were delivered as needed by study staff) but at the same time allowed for participation from anywhere in the US with internet connectivity. At the YMCA space, exercise instructors made use of larger equipment such as stepping platforms and wall mounted TRX exercise equipment. Online classes fully relied on yoga mats, elastic resistance bands, dumbbells, and foam rollers that were provided by study staff and sent to participants by mail delivery. Using the zoom platform, participants could see both instructors and all group members in separate screen displays, using either speaker or gallery view. To enable some minimal social group element, which was naturally intrinsic to the in-person interactions before and after classes at the YMCA, participants in online delivered classes spent the last 5 minutes of each class following the cool-down in group chat on screen.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAssessment.\\u003c/strong\\u003e Clinicians administering the psychological interviews were blind to treatment condition.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e Randomization.\\u0026nbsp;\\u003c/strong\\u003eEligible participants were randomized (1:1) to either IE or REC treatment classes. A stratified randomization strategy (i.e., engaged versus non-engaged in current mental health treatment) was employed to ensure conditions did not differ based on current treatment status.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTreatment and follow-up.\\u0026nbsp;\\u003c/strong\\u003eParticipants assigned to either IE or REC were asked to attend assigned treatment classes 3 times per week for 12 weeks. Each class was 1 hour in duration, for a total of 36 treatment hours. Both treatment conditions were group interventions with rolling admission. Treatment adherence was measured by class attendance. Participants completed mid-treatment self-report measures at Weeks 4 and 8 and completed post-treatment assessments immediately following the end of treatment. The post-treatment assessments repeated those at eligibility screening, as described above. Participants were invited to meet with the PI after the 12-week intervention to provide feedback about their experiences. Participants were given the option to electively participate in the alternate arm following the initial 12-week trial.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInterventions-\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eIntegrated Exercise (IE):\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe IE exercise program was 12 weeks in duration, integrating a combination of aerobic and strength training, stretching and myofascial release exercises with concentration training based on mindful breathing techniques (from yoga and mindfulness approaches recommended by Hoge[35]) aiming at an experiential sense of mind-body integration. Participants exercised in class 3 times weekly, with each total workout being approximately 60 minutes in length. These sessions initially took place at the Embarcadero YMCA in San Francisco and later in their homes by remote instruction using the Zoom platform. The platform allows for all participants in a class to see each other as well as the instructor(s), attempting to create a group feeling comparable to the in-person classes. All exercise was supervised and documented by two trained professionals to validate adherence and allow for program replications by others as part of an intervention program for PTSD. Exercises were adapted to individual participants\\u0026rsquo; fitness levels and pre-existing health conditions or injuries.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe IE program was designed to be accessible to veteran from all socio-economic and educational backgrounds, including those who have been in combat, and safe for those with injuries. Specifically, the exercises do not require a gym setting, but can be safely taught indoors as well as outdoors in a group setting and with individuals with a wide range of fitness levels. The exercises do not require machines, but make use of low-cost equipment including yoga mats, hand-held weights (e.g., 2 to 10 pounds) stretch bands of varying elasticity, foam rollers and (only initially in the YMCA setting) stepping platforms and TRX equipment. \\u0026nbsp;The IE program is sufficiently different from usual fitness center programs in that it can be conducted in a virtual group setting delivered over an internet platform into a private home[36-39].\\u003c/p\\u003e\\n\\u003cp\\u003eEach class followed the same sequence of procedures. Following a moment of welcoming of participants with a brief review of the previous session, every session started and ended with a centering exercise and 3-5 minutes of mindful breathing. This was followed by the exercise instructor presenting the \\u0026ldquo;password of the week\\u0026rdquo;. In a few sentences they introduced one of the eight attitudes of mindfulness that were reformulated themes based on the weekly topics of the 8-week MBSR program[40]. \\u0026nbsp; These included short explanations of the principles of breath awareness, acceptance of the current situation, beginners mind, being non-judgmental about one\\u0026rsquo;s own capacities, etc. Instructors reminded the participants of these attitudes repeatedly as they were to be applied to the exercises in real-time.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe sequence of exercises included a variation of movements and loads for strength training and aerobic activities performed in a variety of ways, including continuous and interval training, as recommended by the American College of Sports Medicine (ACSM)[36-39] and using nonlinear periodization[38]. The aerobic and strength program began with myofascial release exercises, aerobic warm-up exercises, and instructions for postural alignment supporting core engagement. Exercises when feasible engaged all major muscle groups in a systematic fashion that chains body parts together, but varied between sessions, starting with small weights or low-resistance bands, and adding weights, resistance, and aerobic intensity to pre-exhaust levels. Yoga moves and stretches, reminders about breathing and mindfulness are woven into the program. Exercise sessions ended with a 5-minute cool-down period that returned to guided mindful breathing, fostering a physically experienced sense of body-based centeredness and relaxed concentration. As described above, props for these exercises include yoga mats, dumbbells, stretch bands, foam rollers, and (initially) stepping platforms.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eDuring the exercises, participants were introduced to deep abdominal breathing and repeatedly reminded to pay attention to their breathing while working out and to dose the intensity of their exercising according to their ability to maintain breathing through his or her nose. Throughout, exercise movements were closely coordinated with breathing phases, e.g., stretches with inhalation and weight pushes or other efforts with exhalation. The mental focus on breathing and exercise-related bodily sensations during all exercises was a key ingredient of this integrative program to provide an embodied sense of mental centeredness and concentration. Mindful breathing is the cornerstone of mindfulness-based intervention for anxiety and depression[41-43].\\u003c/p\\u003e\\n\\u003cp\\u003eGenerally, classes were led by two instructors, one teaching, the other primarily observing the participants and correcting participants\\u0026rsquo; exercise form as needed. This became particularly important during the Zoom classes with the relatively small individual zoom frames of the group of participants. Instructors were hired based on long-time experience as both professional fitness and yoga instructors.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePTSD Recovery Class:\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe REC control condition was a present-focused, CBT, coping skills treatment based on the concept of recovery and predicated on a stress-vulnerability model of mental illness. \\u0026nbsp;The curriculum incorporated PTSD psychoeducation, risk management, emotion regulation and distress tolerance skills. It emphasized the practice of \\u0026nbsp;coping skills for improving PTSD symptoms[44] and reaching recovery goals. \\u0026nbsp;The curriculum included 6 modules from the Illness Management and Recovery Group manual adapted for PTSD: recovery strategies, reducing stress, coping with persistent symptoms, reducing alcohol and drug use, building social support, and strategies for getting closer to people. \\u0026nbsp;The remaining sessions were CBT-focused skills for improving the 4 symptom clusters of PTSD: managing distress related to trauma memories, decreasing avoidance and numbness, reducing hyperarousal and anger, facilitating sleep, reframing negative cognitions, improving trust, communication, and intimacy, addressing moral injury, and increasing self-compassion. Other topics included practical facts about PTSD and complex trauma, stress-vulnerability, interpersonal effectiveness, getting needs met in the VA healthcare system, and living a healthy, values-based lifestyle[45, 46].\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMeasures- Primary Outcomes\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eWorld Health Organization Quality of Life (WHOQOL-BREF-26\\u003c/strong\\u003e[47, 48]). The 26-item WHOQOL-BREF-26 was used as a self-report measure of quality of life. It comprises four broad domains: physical health (7-items), psychological health (6-items), social relationships (3-items), and environment (8-items). The psychological health domain was used as the primary outcome measure. \\u0026nbsp;All items were rated on a 5-point scale with higher scores indicating higher quality of life.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e Clinician Administered PTSD Scale for DSM-5\\u0026nbsp;\\u003c/strong\\u003e(CAPS-5[33]). The CAPS-5 is a clinician-administered measure of PTSD symptom severity that aligns with the DSM-5. The CAPS-5 was used to assess participants current PTSD symptoms (i.e., past 30 days). PTSD diagnoses and total symptom severity scores were used both as a screening assessment for eligibility with CAPS-5 \\u0026ge; 23 meeting inclusion criteria, as well as a primary outcome for treatment efficacy.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSecondary Outcomes-\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSecondary Measures\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e PTSD Checklist for DSM-5 (PCL-5)\\u003c/strong\\u003e[49]. The 20-item PCL-5 was used as a self-report measure of PTSD symptoms. The PCL-5 aligns with the DSM-5 descriptions of PTSD symptoms and has been validated in Veteran samples.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eGodin Leisure-Time Exercise Questionnaire (GLTEQ)\\u003c/strong\\u003e[50, 51]. The GLTEQ is a validated brief inventory assessing sedentary, work, recreational, and aerobic activity in a typical week. This metric was used to measure time spent in vigorous activity and was intended to serve multiple purposes: a) It was used to test if randomization effectively balances levels of baseline vigorous activity across the two groups; b) It was used as a manipulation check to ensure that participants randomized to IE engage in more vigorous activity after randomization than participants randomized to REC; c) It was used as a secondary predictor of treatment response.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePittsburgh Sleep Quality Index (PSQI)\\u003c/strong\\u003e[52]. The 9-item PSQI was used as our primary measure of subjective sleep quality. Participants were asked to provide self-reported assessments of sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sedative-hypnotics, and daytime energy over the past week.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePSQI Addendum for PTSD\\u003c/strong\\u003e \\u003cstrong\\u003e(PSQI-A)\\u003c/strong\\u003e[53]. The 2-item PSQI-A was used to measure participants\\u0026rsquo; experiences with disruptive nocturnal behaviors related to PTSD (e.g., hot flashes, nightmares related to traumatic memories) over the past week. The PSQI-A was used as a secondary measure of sleep quality in exploratory analyses.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInsomnia Severity Index (ISI)\\u003c/strong\\u003e[54]. The 5-item ISI was used as a self-report measure of perceived insomnia severity and was used as a secondary measure of sleep quality in exploratory analyses. Participants responded on a 5-point scale where higher scores indicated greater insomnia severity within the past week.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFive Facet Mindfulness Questionnaire (FFMQ)\\u003c/strong\\u003e[55, 56]: The FFMQ is a 39-item questionnaire derived from a factor analysis of other mindfulness questionnaires. It assesses five facets of mindfulness: observing, describing, acting with awareness, non-judging and non-reactivity to inner experience which represent elements of mindfulness as it is currently conceptualized. Items are rated on a Likert scale ranging from 1 (never or very rarely true) to 5 (very often or always true). The FFMQ has been shown to have good internal consistency (alpha coefficient range .72 to .92) in several samples and significant relationships in the predicted directions with domains related to mindfulness[55, 56]. The FFMQ allows a detailed assessment of changes as a function of mindfulness and therefore was be used as a secondary outcome.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePhysical Activity Self-Efficacy scale (PASE)\\u003c/strong\\u003e[57]: The PASE was used as an exploratory measure of \\u0026nbsp; perceived confidence to continue exercising in the face of competing day-to-day conditions.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eDifficulties in Emotion Regulation Scale (DERS)\\u003c/strong\\u003e: The 36-item DERS was used as a self-report measure of emotion dysregulation. Items were rated on a 5-point scale, 1 (almost never) to 5 (almost always).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMultidimensional Assessment of Interoceptive Awareness\\u003c/strong\\u003e\\u003cstrong\\u003e\\u0026nbsp;(MAIA)\\u003c/strong\\u003e[58]. The MAIA is a self-report measure recently developed to capture changes in interoception associated with mind\\u0026ndash;body interventions. The MAIA is a 32-item instrument comprising eight subscales: Noticing, Not-Distracting, Not-Worrying, Attention Regulation, Emotional Awareness, Self-Regulation, Body Listening, and Trusting. Participants rated the items on a 6-point Likert scale, with higher scores indication higher interoceptive awareness. The MAIA assesses regulatory aspects of interoceptive processing and can differentiate between clinically relevant attention styles toward bodily symptoms: anxiety and hypervigilance-driven versus acceptance and mindfulness-based attention[59, 60].\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePositive States of Mind (PSOM)\\u003c/strong\\u003e[61]. The PSOM assesses the capacity for positive states of mind: focused attention, productivity, responsible caretaking, restful repose, sharing, sensuous nonsexual pleasure, and sensuous sexual pleasure. Participants rated the items on a 4-point Likert scale ranging from 0 (unable to have it) to 3 (have it easy). It was found to be internally consistent and sensitive to degrees of life stress.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSymptom Check-List-90-Revised (SCL-90-R)\\u003c/strong\\u003e[62]. The SCL-90-R is a standard self- report measure of general psychopathology. Scored for nine primary dimensions and three summary indices, the SCL-90-R manual reports extensive reliability and validity data.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFeasibility and Acceptability Questionnaires\\u003c/strong\\u003e. This self-report questionnaire was completed by IE and REC condition completers at post-treatment. Sixteen items were grouped into three main categories: overall treatment impressions, content of intervention, and length of intervention. Participants responded to each statement on a 6-point Likert type scale, with 0-2 scores indicating disagreement and 3-5 indicating agreement. Two versions were used so that questions aligned with group assignment (e.g., \\u0026ldquo;exercise\\u0026rdquo; was modified to \\u0026ldquo;topics\\u0026rdquo; for the REC condition when items specified condition content and vice versa). Modified questions included items 5-8 and 13.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe used intent-to-treat analyses, with all participants randomized included in the analyses, including only the stratification variable (concurrent treatment yes/no) and the baseline value of the outcome variable as covariates. All available time point data from any participants lost to follow up were included in the primary analyses, using mixed models (LMM) to accommodate the missing data where possible. The frequency and timing at which outcomes are obtained varies by measure. \\u0026nbsp;Some key measures, including the CAPS, were measured at two time points, pre- and post-treatment, while self-report measures such as the WHOQOL, were measured at two additional mid-treatment time points. \\u0026nbsp;Measures with more than two measurement occasions make full use of the LMM strategy, whereas LMM\\u0026rsquo;s for pre-post measures reduce to ANCOVA as a special case, except for the added flexibility of modeling heterogeneous group variances. \\u0026nbsp;See Supplement for additional details of the analysis plan.\\u003c/p\\u003e\\n\\u003cp\\u003eIn analyses with intermediate time points, several modeling choices were considered, including whether to treat the time variable as continuous or categorical, the form of the within-subjects correlation matrix, and whether to allow for heterogeneity of variance across groups and/or time points. \\u0026nbsp;For each outcome, the best fitting model was selected according to likelihood ratio tests (for nested models) or the Akaike Information Criterion (AIC; for non-nested models) before examining any coefficients or test statistics. \\u0026nbsp;In each case, the best fitting model was one that treated time points as a categorical variable, included participants as the only random effect, and included no additional parameters to accommodate within-participant correlation or heterogeneous group variances. \\u0026nbsp;Models were fit using the \\u0026ldquo;mixed\\u0026rdquo; command in Stata v. 16.1[63]. Residuals were examined to screen for outliers and to ensure that model assumptions were met. No influential outliers were observed, and residual distributions were approximately normal. Secondary analyses focused on effects of attendance and site of delivery (in-person versus remote) on clinical outcomes.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e Sample size.\\u0026nbsp;\\u003c/strong\\u003ePower calculations were conducted a priori to determine the adequate sample size needed to detect clinically meaningful between-group effects on our primary variables at pre- and post-treatment time points. Results indicated a sample size of 80 completers (40 per group) was sufficient to yield power of 80% (\\u0026alpha; = .05) to detect standardized effects of d = 0.5, assuming 0.7 within-participant correlations. Obtained sample sizes per group were 30 (IE) and 34 (REC); observed within-participant correlations were r = .67 for WHOQOL and r = .45 for CAPS. \\u0026nbsp;Actual power to detect an effect of d = .50 was .64 for the primary WHOQOL outcome and .45 for CAPS scores.\\u003c/p\\u003e\\n\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eThis research was approved by the Institutional Review Board of the University of California, San Francisco, and the Human Research Protection Program at the San Francisco Veterans Affairs Medical Center in accordance with the Declaration of Helsinki. All participants provided written or electronic informed consent.\\u003c/p\\u003e\\n\\u003cp\\u003eConsent for publication- Not applicable\\u003c/p\\u003e\\n\\u003cp\\u003eAvailability of data and materials. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003eCompeting interests- The authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003eFunding. This study was supported by a grant from the Veterans Affairs Office of Research and Development (5I01RX001939).\\u003c/p\\u003e\\n\\u003cp\\u003eAuthors\\u0026apos; contributions. Design of study and grant application (TCN, SM, TJM, BEC, MAC, WEM), Acquisition and analysis of data (TCN, LAM, CLW, MS, CVV, SM, AO, DPK, TJM, BEC, ACW, JDVP, VA, OM, JAH, MAC, WEM). All authors have reviewed and approved the submitted manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003eAcknowledgements. The authors are grateful to the Heart and Armor Foundation which provided funding for the pilot project that preceded this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cbr\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eRethorst CD, Trivedi MH. Evidence-based recommendations for the prescription of exercise for major depressive disorder. J Psychiatr Pract. 2013;19(3):204\\u0026ndash;12.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead GE. Exercise for depression. Cochrane database Syst reviews (Online). 2013;9:CD004366.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWipfli BM, Rethorst CD, Landers DM. The anxiolytic effects of exercise: a meta-analysis of randomized trials and dose-response analysis. J Sport Exerc Psychol. 2008;30(4):392\\u0026ndash;410.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSteptoe A, Edwards S, Moses J, Mathews A. The effects of exercise training on mood and perceived coping ability in anxious adults from the general population. J Psychosom Res. 1989;33(5):537\\u0026ndash;47.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLarun L, Nordheim LV, Ekeland E, Hagen KB, Heian F. Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane database Syst reviews (Online). 2006;3:CD004691.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDriver HS, Taylor SR. Exercise and sleep. Sleep Med Rev. 2000;4(4):387\\u0026ndash;402.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCrombie KM, Adams TG, Dunsmoor JE, Greenwood BN, Smits JA, Nemeroff CB, Cisler JM. Aerobic exercise in the treatment of PTSD: An examination of preclinical and clinical laboratory findings, potential mechanisms, clinical implications, and future directions. J Anxiety Disord. 2023;94:102680.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMeerlo P, Mistlberger RE, Jacobs BL, Craig Heller H, McGinty D. New neurons in the adult brain: The role of sleep and consequences of sleep loss. Sleep Med Rev. 2009;13(3):187\\u0026ndash;94.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLiu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC. Resistance training and executive functions: a 12-month randomized controlled trial. Arch Intern Med. 2010;170(2):170\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBabyak M, Blumenthal JA, Herman S, Khatri P, Doraiswamy M, Moore K, Craighead WE, Baldewicz TT, Krishnan KR. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med. 2000;62(5):633\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYang PY, Ho KH, Chen HC, Chien MY. Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. J physiotherapy. 2012;58(3):157\\u0026ndash;63.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eThompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, Berra K, Blair SN, Costa F, Franklin B, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. 2003;107(24):3109\\u0026ndash;16.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eZen AL, Whooley MA, Zhao S, Cohen BE. Post-traumatic stress disorder is associated with poor health behaviors: Findings from the Heart and Soul Study. Health Psychol. 2012;31(2):194\\u0026ndash;201.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGnall KE, Sacco SJ, Sinnott SM, Park CL, Mazure CM, Hoff RA. Physical activity, posttraumatic stress, and gender: A longitudinal study of post-9/11 veterans. J Health Psychol 2024:13591053241233380.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eOtter L, Currie J. A long time getting home: Vietnam Veterans' experiences in a community exercise rehabilitation programme. Disabil Rehabil. 2004;26(1):27\\u0026ndash;34.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMittal D, Drummond KL, Blevins D, Curran G, Corrigan P, Sullivan G. Stigma associated with PTSD: perceptions of treatment seeking combat veterans. Psychiatr Rehabil J. 2013;36(2):86\\u0026ndash;92.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNewman CL, Motta RW. The effects of aerobic exercise on childhood PTSD, anxiety, and depression. Int J Emerg Ment Health. 2007;9(2):133\\u0026ndash;58.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDiaz AB, Motta R. The effects of an aerobic exercise program on posttraumatic stress disorder symptom severity in adolescents. Int J Emerg Ment Health. 2008;10(1):49\\u0026ndash;59.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eManger TA, Motta RW. The impact of an exercise program on posttraumatic stress disorder, anxiety, and depression. Int J Emerg Ment Health. 2005;7(1):49\\u0026ndash;57.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKim SH, Schneider SM, Bevans M, Kravitz L, Mermier C, Qualls C, Burge MR. PTSD symptom reduction with mindfulness-based stretching and deep breathing exercise: randomized controlled clinical trial of efficacy. J Clin Endocrinol Metab. 2013;98(7):2984\\u0026ndash;92.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFetzner MG, Asmundson GJ. Aerobic Exercise Reduces Symptoms of Posttraumatic Stress Disorder: A Randomized Controlled Trial. Cogn Behav Ther. 2015;44(4):301\\u0026ndash;13.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003evan de Kamp MM, Scheffers M, Emck C, Fokker TJ, Hatzmann J, Cuijpers P, Beek PJ. Body-and movement-oriented interventions for posttraumatic stress disorder: An updated systematic review and meta-analysis. J Trauma Stress 2023.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHall KS, Morey MC, Bosworth HB, Beckham JC, Pebole MM, Sloane R, Pieper CF. Pilot randomized controlled trial of exercise training for older veterans with PTSD. J Behav Med. 2020;43(4):648\\u0026ndash;59.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGoldstein LA, Mehling WE, Metzler TJ, Cohen BE, Barnes DE, Choucroun GJ, Silver A, Talbot LS, Maguen S, Hlavin JA, et al. Veterans Group Exercise: A randomized pilot trial of an Integrative Exercise program for veterans with posttraumatic stress. J Affect Disord. 2018;227:345\\u0026ndash;52.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMehling WE, Chesney MA, Metzler TJ, Goldstein LA, Maguen S, Geronimo C, Agcaoili G, Barnes DE, Hlavin JA, Neylan TC. A 12-week integrative exercise program improves self-reported mindfulness and interoceptive awareness in war veterans with posttraumatic stress symptoms. J Clin Psychol. 2018;74(4):554\\u0026ndash;65.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCrawford C, Wallerstedt DB, Khorsan R, Clausen SS, Jonas WB, Walter JA. A Systematic Review of Biopsychosocial Training Programs for the Self-Management of Emotional Stress: Potential Applications for the Military. \\u003cem\\u003eEvidence-based complementary and alternative medicine: eCAM\\u003c/em\\u003e 2013, 2013:747694.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eStaples JK, Gordon JS, Hamilton M, Uddo M. Mind-body skills groups for treatment of war-traumatized veterans: A randomized controlled study. Psychol Trauma. 2022;14(6):1016\\u0026ndash;25.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGoldberg SB, Riordan KM, Sun S, Kearney DJ, Simpson TL. Efficacy and acceptability of mindfulness-based interventions for military veterans: A systematic review and meta-analysis. J Psychosom Res. 2020;138:110232.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLiu Q, Zhu J, Zhang W. The efficacy of mindfulness-based stress reduction intervention 3 for post-traumatic stress disorder (PTSD) symptoms in patients with PTSD: A meta-analysis of four randomized controlled trials. Stress Health. 2022;38(4):626\\u0026ndash;36.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEvans DR, Eisenlohr-Moul TA, Button DF, Baer RA, Segerstrom SC. Self-Regulatory Deficits Associated with Unpracticed Mindfulness Strategies for Coping with Acute Pain. J Appl Soc Psychol. 2014;44(1):23\\u0026ndash;30.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBritton WB. Can mindfulness be too much of a good thing? The value of a middle way. Curr Opin Psychol. 2019;28:159\\u0026ndash;65.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAmerican Psychiatric A, American Psychiatric A, Force DSMT. Diagnostic and statistical manual of mental disorders: DSM-5. 2013.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWeathers FW, Bovin MJ, Lee DJ, Sloan DM, Schnurr PP, Kaloupek DG, Keane TM, Marx BP. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychol Assess. 2018;30(3):383\\u0026ndash;95.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAmerican College of Sports Medicine RDEJKLGMM. ACSM's guidelines for exercise testing and prescription; 2018.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHoge CE. Once a warrior, always a warrior. Guilford, CT: Globe Pequote; 2010.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAmerican College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998;30(6):975\\u0026ndash;91.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAmerican College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687\\u0026ndash;708.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKraemer WJ, Fleck SJ. Optimizing Strength Training: Designing Nonlinear Periodization Workouts. Champagne, IL: Human Kinetics; 2007.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFleck SJ, Kraemer WJ. Designing Resistance Training Programs. 3rd ed. Champagne, IL: Human Kinetic; 2004.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eStephenson KR, Simpson TL, Martinez ME, Kearney DJ. Changes in Mindfulness and Posttraumatic Stress Disorder Symptoms Among Veterans Enrolled in Mindfulness-Based Stress Reduction. J Clin Psychol. 2017;73(3):201\\u0026ndash;17.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKabat-Zinn J. Full catastrophe living. Using the wisdom of the body and mind to face stress, pain, and illness. New York, NY: Delta/Random House; 1990.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eArch JJ, Craske MG. Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behav Res Ther. 2006;44(12):1849\\u0026ndash;58.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMiller JJ, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry. 1995;17(3):192\\u0026ndash;200.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eStaudenmeyer AH, Maxwell S, Mohlenhoff B, Yasser J, Schmitz M, Metzler T, Maguen S, Neylan T, Wolfe W. Pretreatment stabilization increases completion of trauma-focused evidence-based psychotherapies. Psychol Trauma 2022.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMcGuire AB, Kukla M, Green A, Gilbride D, Mueser KT, Salyers MP. Illness management and recovery: a review of the literature. Psychiatr Serv. 2014;65(2):171\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMueser KT, Meyer PS, Penn DL, Clancy R, Clancy DM, Salyers MP. The Illness Management and Recovery program: rationale, development, and preliminary findings. Schizophr Bull. 2006;32(Suppl 1):S32\\u0026ndash;43.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDevelopment of the World Health Organization WHOQOL-BREF quality of life assessment. WHOQOL Group Psychol Med. 1998;28(3):551\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSkevington SM, Lotfy M, O'Connell KA, Group W. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004;13(2):299\\u0026ndash;310.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWeathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). In.; 2013.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGodin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl sport Sci. 1985;10(3):141\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGionet NJ, Godin G. Self-reported exercise behavior of employees: a validity study. J Occup medicine: official publication Industrial Med Association. 1989;31(12):969\\u0026ndash;73.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBuysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193\\u0026ndash;213.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGermain A, Hall M, Krakow B, Katherine Shear M, Buysse DJ. A brief sleep scale for Posttraumatic Stress Disorder: Pittsburgh Sleep Quality Index Addendum for PTSD. J Anxiety Disord. 2005;19(2):233\\u0026ndash;44.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297\\u0026ndash;307.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBaer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006;13(1):27\\u0026ndash;45.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBaer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S, Walsh E, Duggan D, Williams JM. Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment. 2008;15(3):329\\u0026ndash;42.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMarcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport. 1992;63(1):60\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMehling WE, Price C, Daubenmier JJ, Acree M, Bartmess E, Stewart A. The Multidimensional Assessment of Interoceptive Awareness (MAIA). PLoS ONE. 2012;7(11):e48230.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBornemann B, Herbert BM, Mehling WE, Singer T. Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training. Front Psychol. 2014;5:1504.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMehling W. Differentiating attention styles and regulatory aspects of self-reported interoceptive sensibility. Philos Trans R Soc Lond 2016, 371(1708).\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHorowitz M, Adler N, Kegeles S. A scale for measuring the occurrence of positive states of mind: a preliminary report. Psychosom Med. 1988;50(5):477\\u0026ndash;83.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDerogatis LR. SCL-90-R administration, scoring, and procedures manual. 3rd ed. Minneapolis: National Computer Systems, Inc.; 1994.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003e2020 S. Stata Statistical Software: Release 16.1. In. College Station. TX: StataCorp LLC; 2020.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-psychiatry\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bpsy\",\"sideBox\":\"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bpsy/default.aspx\",\"title\":\"BMC Psychiatry\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"PTSD, Veteran, Randomized Controlled Trial, Exercise, Psychoeducation\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4427468/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4427468/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eThere are no reported randomized trials testing exercise versus an active comparator for Posttraumatic Stress Disorder (PTSD). This randomized clinical trial assessed the effectiveness of group exercise versus psychoeducation to improve quality of life and reduces symptomatic severity in Veterans with PTSD. Veterans who met criteria for current PTSD (DSM-5) and/or endorsed moderate levels of PTSD symptoms (CAPS 5 score ≥ 23) were randomly assigned to treatment. Integrative Exercise (IE) combines fitness exercises (aerobics, resistance training, stretching) with mindful body/breath awareness versus Recovery Class (REC) psychoeducation control condition. A total of 84 participants were enrolled of which 41 participants were randomized to IE and 43 participants to REC. There were no significant pre-post differences in change in the WHOQOL Psychological Domain in either group. There was a modest reduction in the total CAPS-5 score in both groups (IE: -8.2 (9.9), p \\u0026lt; .001: REC: -7.8 (2.0), p \\u0026lt; .001) but no differences across the two conditions. In the IE subsample that was remote, there was a greater improvement in PTSD symptom severity (F[1, 50] = 4.62, p = .036) and in in the WHOQOL Psychological Domain (F(1, 47) = 6.46, p = .014) in those who attended more sessions.\\u003c/p\\u003e\\n\\u003cp\\u003eTrial Registration: ClinicalTrials.gov Identifier: NCT02856412 (registration date: February 27, 2017)\\u003c/p\\u003e\",\"manuscriptTitle\":\"Group Integrated Exercise versus Recovery Class for Veterans with Posttraumatic Stress Disorder: A Randomized Clinical Trial\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-07-12 19:13:50\",\"doi\":\"10.21203/rs.3.rs-4427468/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2024-06-13T15:35:58+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-06-13T07:53:48+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-06-13T07:52:44+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Psychiatry\",\"date\":\"2024-05-15T22:55:20+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-psychiatry\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bpsy\",\"sideBox\":\"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bpsy/default.aspx\",\"title\":\"BMC Psychiatry\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"80a18e93-7c74-4a21-ac1d-b08fc9a47b05\",\"owner\":[],\"postedDate\":\"July 12th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-03-03T16:03:54+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-4427468\",\"link\":\"https://doi.org/10.1186/s12888-025-06638-1\",\"journal\":{\"identity\":\"bmc-psychiatry\",\"isVorOnly\":false,\"title\":\"BMC Psychiatry\"},\"publishedOn\":\"2025-02-28 15:58:22\",\"publishedOnDateReadable\":\"February 28th, 2025\"},\"versionCreatedAt\":\"2024-07-12 19:13:50\",\"video\":\"\",\"vorDoi\":\"10.1186/s12888-025-06638-1\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12888-025-06638-1\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4427468\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4427468\",\"identity\":\"rs-4427468\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}