Abstract
The prevalence rates of post-traumatic stress disorder (PTSD) have been estimated to be several times higher in military populations compared to the national average. Special Tactics operators are a group that is more likely to avoid seeking psychological care due to the stigma and other consequences the diagnosis may have on their military careers. There is a need for more effective and less stigmatizing interventions to treat this population. Psychophysiological methods have been proven to be efficacious in treating PTSD, yet have received less attention as an adjunctive intervention. Resonance frequency (RF) biofeedback is a form of cardiorespiratory intervention that has shown promise as an effective treatment. The current case study examined the use of RF biofeedback in combination with other physiological and evidence-based methods as part of a comprehensive treatment approach. The client showed a significant drop from his initial scores on a screening assessment by the end of treatment, and demonstrated continued progress despite a 3-month break from the therapy. This author proposed that the synergistic effects of the multi-phased treatment approach contributed to the client’s progress. Furthermore, a case was made for using multiple techniques when treating subthreshold PTSD and related symptoms within a treatment resistant population.
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
Bliese, P. D., Wright, K. M., Adler, A. B., Cabrera, O., Castrol, C. A., & Hoge, C. W. (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology, 76, 272–281.
Hickey, A. H., Navaie, M., Stedje-Larsen, E. T., Lipov, E. G., & McLay, R. N. (2013). Stellate ganglion block for the treatment of posttraumatic stress disorder. Psychiatric Annals, 43(2), 87–92.
Hines, L. A., Sundin, J., Rona, R. J., Wesseley, S., & Fear, N. T. (2014). Posttraumatic stress disorder post Iraq and Afghanistan: Prevalence among military subgroups. Canadian Journal of Psychiatry, 59(9), 468–479.
Institute of Medicine of the National Academies. (2014). Treatment for posttraumatic stress disorder in military and veteran populations. Washington DC: National Academy of Sciences.
Lehrer, P. M. (2007). Biofeedback training to increase heart rate variability. In P. M. Lehrer, R. L. Woolfolk & W. E. Sime (Eds.), Principles and practice of stress management (3rd ed.). (pp 227–248). New York: Guilford Press.
Lehrer, P. M., & Gevirtz, R. (2014). Heart rate variability biofeedback: How and why does it work? Frontiers in Psychology, 5, 1–9.
Lipov, E. G., Joshi, J. R., Sanders, S., & Slavin, K. V. (2009). A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD). Medical Hypotheses, 72(6), 657–661.
Litz, B. T., & Schlenger, W. E. (2009). PTSD in service members and new veterans of the Iraq and Afghanistan wars: A bibliography and critique. PTSD Research Quarterly, 20(1), 1–8.
McLean, C. P., & Foa, E. B. (2011). Prolonged exposure therapy for post-traumatic stress disorder: A review of evidence and dissemination. Expert Review of Neurotherapeutics, 11(8), 1151–1163.
Morin, C. M., Belleville, G., Belanger, L., & Ivers, H. (2011). The insomnia severity index: Psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 34(5), 601–608.
Mulvaney, S. W., Lynch, J. H., Hickey, M. J., Rawlins, T. R., Schroeder, M., Kane, S., & Lipov, E. (2014). Stellate ganglion block used to treat symptoms associated with combat-related posttraumatic stress disorder: A case series of 166 patients. Military Medicine, 179(10), 1133–1140.
Polak, A. R., Witteveen, A. B., Denys, D., & Olff, M. (2015). Breathing biofeedback as an adjunct to exposure in cognitive behavioral therapy hastens the reduction of PTSD symptoms: A pilot study. Applied Psychophysiology & Biofeedback, 40, 25–31.
Pole, N. (2007). The psychophysiology of posttraumatic stress disorder: A meta-analysis. Psychological Bulletin, 133, 725–746.
Porges, S. (2011). The polyvagal theory. New York: Norton.
Schnurr, P. P., & Green, B. L. (2004). Understanding relationships among trauma, posttraumatic stress disorder, and health outcomes. Advances in Mind-Body Medicine, 20, 18–29.
Shanker, T., & Oppel, A. (2014). War’s elite tough guys, hesitant to seek healing. The New York Times. Retrieved June 5, 2014 from http://www.nytimes.com.
Tan, G., Dao, T. K., Farmer, L., Sutherland, R. J., & Gevirtz, R. (2011). Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): A pilot study. Applied Psychophysiology & Biofeedback, 36, 27–35.
Tan, G., Wang, P., & Ginsberg, J. (2013). Heart rate variability and posttraumatic stress disorder. Biofeedback, 41(3), 131–135.
Weathers, F. W., Huska, J. A., Keane, T. M., (1991). PCL-M for DSM-IV. Boston: National Center for PTSD- Behavioral Science Division.
Yucha, C. & Montgomery, D. (2008). Evidence-based practice in biofeedback and neurofeedback. Wheat Ridge, CO: Association for Applied Psychophysiology & Biofeedback.
Acknowledgements
This author would like to thank the wing and unit level command psychologists for their support and guidance throughout the process of publishing this case study. A special thanks is also extended to the unit Commander. His genuine desire to help the men and women, and their families, in this unit provided the command level support that made this project possible.
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Consent to publish this case study was obtained from the client and his spouse.
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Petta, L.M. Resonance Frequency Breathing Biofeedback to Reduce Symptoms of Subthreshold PTSD with an Air Force Special Tactics Operator: A Case Study. Appl Psychophysiol Biofeedback 42, 139–146 (2017). https://doi.org/10.1007/s10484-017-9356-2
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DOI: https://doi.org/10.1007/s10484-017-9356-2