Alternative therapies for post-traumatic stress disorder offer new hope for servicemembers returning from combat.

It's gone by many names over the years - soldier's heart, shell shock, combat fatigue, and post-Vietnam syndrome. Most recently, it is known as post-traumatic stress disorder (PTSD), and according to a 2004 study by the Walter Reed Army Institute of Research in Washington, D.C., it affects one in eight servicemembers returning from combat in Iraq and Afghanistan. ///  PTSD symptoms are varied and potentially debilitating, psychologists warn. They include intrusive thoughts, nightmares, flashbacks, depression, hypervigilance, insomnia, irritability, and feelings of guilt. Secondary problems related to PTSD include substance abuse, fits of violence or rage, dangerous behaviors, and relationship difficulties.

Psychotherapy and medication have become the gold standard for PTSD treatment. However, they don't work for all patients. "PTSD is not a unitary condition," explains Lt. Col. Michael Russell, USA, Ph.D., command psychologist for the Training and Doctrine Command at Fort Monroe, Va. "Its primary symptoms and secondary issues make for a very complex picture within each individual. As a result, we have yet to find an ideal treatment that is a cure for everyone."

But there's hope. Military and other researchers are investigating alternative modalities, many of which show promise as effective complements to common treatments.

 

Transcendental meditation
Transcendental meditation (TM) is a centuries-old, mantra-based relaxation technique that has been studied as a therapeutic modality for a variety of disorders, including PTSD, reports Sarina Grosswald, who has a doctorate in education. She is president of SJ Grosswald & Associates, a medical education consulting firm based in Arlington, Va., and project director for a research study on the TM program at Kingsbury Day School in Washington, D.C.

"TM addresses not just the mental issues of PTSD but also the physical problems that accompany stress disorders, including hypertension and heart disease," Grosswald says. "There are many years of research showing the effectiveness of TM in reducing stress and anxiety and improving well-being and mental outlook."

Despite extensive research in other areas, only one study - conducted at the University of Colorado in Denver in the mid-1980s - has evaluated TM's effectiveness in treating military personnel affected by PTSD. In that study, published in 1985 in the Journal of Counseling and Development, researcher James Brooks and colleagues randomly assigned Vietnam veterans seeking treatment for PTSD to either a three-month TM program or psychotherapy.

At the end of the three months, the majority of the 10 participants in the TM program reported a significant reduction in overall symptoms, including depression, anxiety, and emotional numbness. Seven of the 10 participants said they thought they had improved enough to discontinue counseling at their local VA medical center.

TM can benefit victims of PTSD by giving their minds and bodies a deep rest, says Maj. D. Edwards Smith, USAR-Ret., a retired physician and current TM practitioner and instructor in Baltimore. "When you practice TM twice a day, you get rid of any accumulated stresses of the day, then you begin to go back and get rid of the backlog of stress," explains Smith. "It's a matter of giving the body the rest it needs to do its own self-repair."

Col. Brian Rees, USAR, battalion surgeon of the 310th MP Battalion, has practiced TM for 35 years. It has benefited him in many ways including helping him cope with the harsh realities of medical service in Afghanistan and Iraq.

"I feel fine when I'm there, an actual calm," Rees explains. "I still feel awful over some of the things I see, but that's just the way it is. I grieve, I shed tears, but as far as not being able to sleep or enjoy anything afterward, I really haven't had any of that."

Yoga nidra
Yoga nidra (YN) is an ancient, transformative meditative technique that can help PTSD patients release self-destructive patterns and achieve psychological, physical, and spiritual healing, says Dr. Richard Miller, a clinical psychologist in Sebastopol, Calif.

Miller studied the use of YN as a potential treatment for PTSD in July and August 2006 at Walter Reed Army Medical Center (WRAMC), Washington, D.C. Although the study group was just seven participants, the results were promising. "The trend we [saw] was very favorable in the direction of decreasing the participants' PTSD symptoms, and it seems comparable to cognitive behavioral therapy or exposure therapy," Miller says. "It was positive enough for us to want to continue the study with a larger population."

The technique, which Miller renamed "integrative restoration," or iRest, includes several components, including deep, progressive relaxation and breathing exercises, with the ultimate goal of deconstructing the thoughts and emotions that trigger and keep PTSD in place.

"The protocol eventually leads to a sense of equanimity and well-being that [patients] can carry into the rest of their lives and help them overcome triggering events or other stressful situations," explains Miller, director of the Center of Timeless Being, which offers YN instruction.

Virtual reality
The virtual reality (VR) technology used to create today's ultrarealistic video games and military simulators might one day be used to treat service personnel with PTSD, says Cmdr. Russell Shilling, USN, program officer for medical science and technology at the Office of Naval Research (ONR) in Arlington, Va.

In 2005, the ONR awarded $4 million to support tests of VR treatment at the Naval Medical Center in San Diego and at Tripler Army Medical Center in Hawaii. The funds also are being used to support related work at the University of Southern California's Institute for Creative Technologies, the University of Washington, and several high-tech companies.

VR therapy - done in the presence of a therapist - exposes patients to scenarios that trigger PTSD symptoms, bringing reactions into the open so the patient and the therapist can discuss how to deal with them effectively.

According to Shilling, the scenarios, which are experienced through a special helmet, goggles, and earphones, are very realistic. "It can put you on a street in Baghdad and pump in different noises, such as a helicopter passing overhead, calls to prayer, people on the street, or RPG sounds," he says. "Newer systems can even put smells into the environment, such as garbage or burned or rotting flesh.

"One of the things about combat stress and PTSD in particular is that patients start generalizing symptoms," Shilling says. "They come home and things in their natural environment start triggering unwanted memories and anxieties that were developed in country. VR therapy ... [helps] them work through those memories so that they can deal with them more easily."

VR therapy is not a panacea, Shilling says, but should prove particularly effective with what he calls the "computer generation" - young people who grew up playing video games. "It's a way of destigmatizing therapy," Shilling says. "This is not your stereotypical experience with a psychiatrist."

Acupuncture
Acupuncture is a traditional Chinese system of healing in which thin needles are inserted into selected points in the body to relieve pain and stimulate healing. Traditional practitioners believe the process treats a person's vital energy or qi (pronounced "chee"), which flows along natural pathways known as meridians. Western researchers theorize the needles activate deep sensory nerves, causing the pituitary gland and midbrain to release natural painkillers called endorphins.

Dr. Michael Hollifield, associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Louisville in Kentucky, conducted a study of acupuncture and PTSD from 2003-04 at the University of New Mexico in Albuquerque. The study involved 84 men and women with PTSD, including a handful of combat veterans, and was supported by the National Institutes of Health and the National Center for Complementary and Alternative Medicine.

"Acupuncture in this preliminary pilot study looked to be very helpful for PTSD and perhaps in some ways as helpful as the standard treatment of cognitive behavioral therapy," says Hollifield, who is waiting for the study results to be published in the Journal of Nervous and Mental Disease. "I can't give numbers pending publication, but acupuncture proved helpful enough to where some participants said they were significantly helped and/or did not have as much of their post-traumatic stress symptoms anymore."

Additional acupuncture and PTSD studies are in the works. Alaine Duncan, executive director of Crossings Healingworks in Silver Spring, Md., is the assessing acupuncturist with a PTSD study at the Deployment Health Clinical Center at WRAMC. In addition, she works as an acupuncturist in the War-Related Injuries and Illnesses Study Center at the Washington, D.C., VA Medical Center.

Officials at WRAMC approached Duncan about the acupuncture study. "My experience has been that the military is more open than civilian hospitals when it comes to the study of complementary medicine," she says.

Resource:  For a concise summary of the causes and effects of PTSD, see "Ask the Doctor," page 48. To find out what assistance programs are available to help treat patients with PTSD, visit www.moaa.org/magazine/november2005/f_aftershock.asp.