Advertisement

Incorporating Complementary and Alternative Practices into Treatment of PTSD

  • Janina Scarlet
  • Ariel J. Lang
Living reference work entry

Abstract

This chapter examines evidence for the effectiveness of complementary and alternative medicine (CAM) for posttraumatic stress disorder (PTSD). There is high demand for CAM among both military and civilian consumers and thus CAM for PTSD warrants thorough analysis. The CAM interventions reviewed herein include mindfulness and other meditative practices, acupuncture, yoga, relaxation, breathing training, and physical exercise. Although there are few rigorous studies of CAM for PTSD, available evidence suggests that these approaches are moderately effective. They would generally not be considered a first line intervention for PTSD at this point, but rather would be recommended as an adjunct to established approaches. The limited number of studies available, however, precludes drawing firm conclusions. Thus, future work should focus on better understanding the optimal uses of CAM for PTSD.

Keywords

Posttraumatic stress disorder PTSD Anxiety Depression Complementary and alternative medicine Meditation Mindfulness Acupuncture Massage Relaxation Compassion 

List of All Abbreviations

BDI

Beck’s Depression Inventory

BDNF

Brain-derived Neurotropic Factor

CAM

Complementary and Alternative Medicine

CBT

Cognitive-Behavioral Therapy

DBT

Dialectical Behavioral Therapy

HPA Axis

Hypothalamus-Pituitary and Adrenal Axis

HRV

Heart Rate Variability

LKM

Loving Kindness Meditation

MBSR

Mindfulness-based Stress Reduction

MRP

Mantram Repetition Program

MT

Massage Therapy

PCL

PTSD Checklist

PE

Prolonged Exposure

PMR

Progressive Muscle Relaxation

PTSD

Posttraumatic Stress Disorder

RCT

Randomized Controlled Trial

VA

Department for Veterans Affairs

References

  1. Arch J, Ayers C. Which treatment worked better for whom? Moderators of group cognitive behavioral therapy versus adapted mindfulness based stress reduction for anxiety disorders. Behav Res Ther. 2013; 51(2013):434–42. Doi: 10.1016/j.brat.2013.04.004.Google Scholar
  2. Asmundson G, Fetzner M, DeBoer L, et al. Let’s get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders. Depress Anxiety. 2013;30(4):362–73. doi:10.1002/da.22043.PubMedCrossRefGoogle Scholar
  3. Barnes P, Bloom B, Nahin R. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Rep. 2008;12:1–23.Google Scholar
  4. Bormann J, Thorp S, Wetherell J. A spiritually based group intervention for combat veterans with posttraumatic stress disorder: feasibility study. J Holist Nurs. 2008;26(2):109–16. doi:10.1177/0898010107311276.PubMedCentralPubMedCrossRefGoogle Scholar
  5. Bormann J, Hurst S, Kelly A. Responses to mantram repetition program from veterans with posttraumatic stress disorder: a qualitative analysis. J Rehabil Res Dev. 2013;50(6):769–84. doi:10.1682/JRRD.2012.06.0118.PubMedCrossRefGoogle Scholar
  6. Brooks JS, Scarano T. Transcendental meditation in the treatment of post-vietnam adjustment. J Couns Dev. 1985;64(3):212–5. doi:10.1002/j.1556-6676.1985.tb01078.x.CrossRefGoogle Scholar
  7. Collinge W, Kahn J, Soltysik R. Promoting reintegration of national guard veterans and their partners using a self-directed program of integrative therapies: a pilot study. Mil Med. 2012;177(12):1477–85.PubMedCentralPubMedCrossRefGoogle Scholar
  8. Descilo T, Vedamurtachar A, Gerbarg P, et al. Effects of a yoga breath intervention alone and in combination with an exposure therapy for post-traumatic stress disorder and depression in survivors of the 2004 South-East Asia tsunami. Acta Psychiatr Scand. 2009:1–12. doi: 10.1111/j.1600-0047.2009.01466.x.Google Scholar
  9. 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.PubMedGoogle Scholar
  10. Eardley S, Bishop FL, Prescott P, et al. A systematic literature review of complementary and alternative medicine prevalence in EU. Forsch Komplementmed. 2012;19 suppl 2:18–28.PubMedCrossRefGoogle Scholar
  11. Echeburua E, de Corral P, Zubizarreta I, et al. Psychological treatment of chronic posttraumatic stress disorder in victims of sexual aggression. Behav Modif. 1997;21(4):433–56.PubMedCrossRefGoogle Scholar
  12. Engel C. Efficacy of acupuncture for PTSD in military personnel: a randomized controlled trial. 2013. http://www.pdhealth.mil/downloads/Evaluating_the_Efficacy_of_Acupuncture_as_a_Treatment_for_Posttraumatic_Stress_in_Military_Personnel.pdf. Accessed 11 April 2014.
  13. Field T, Hernandez-Reif M, Diego M, et al. Cortisol decreases and serotonin and dopamine increase following massage therapy. Int J Neurosci. 2005;115(10):1397–413.PubMedCrossRefGoogle Scholar
  14. Foa E, Dancu C, Hembree E, et al. A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. J Consult Clin Psychol. 1999;67:194–200.PubMedCrossRefGoogle Scholar
  15. Goroll A. Moving toward evidence-based complementary care. JAMA Intern Med. 2014;174(3):368–9. doi:10.1001/jamainternmed.2013.12995.PubMedCrossRefGoogle Scholar
  16. Goyal M, Singh S, Sibinga E, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–68. doi:10.1001/jamainternmed.2013.13018.PubMedCentralPubMedCrossRefGoogle Scholar
  17. Hagen J. Complementary and alternative medicine: history, benefits, and use by patients with cancer. La Crosse, WI: University of Wisconsin – La Crosse; 2011.Google Scholar
  18. Harman R, Lee D. The role of shame and self-critical thinking in the development and maintenance of current threat in post-traumatic stress disorder. Clin Psychol Psychother. 2010;17(1):13–24. doi:10.1002/cpp.636.PubMedGoogle Scholar
  19. Hollifield M, Sinclair-Lian N, Warner T, et al. Acupuncture for posttraumatic stress disorder: a randomized controlled pilot trial. J Nerv Ment Dis. 2007;195(6):504–13.PubMedCrossRefGoogle Scholar
  20. Hutcherson C, Seppala E, Gross J. Loving-kindness meditation increases social connectedness. Emotion. 2008;8:720–4.PubMedCrossRefGoogle Scholar
  21. Jacobson I, White M, Smith T, et al. Self-reported health symptoms and conditions among complementary and alternative medicine users in a large military cohort. Ann Epidemiol. 2009;19(9):613–22. doi:10.1016/j.annepidem.2009.05.001.PubMedCrossRefGoogle Scholar
  22. Kabat-Zinn J. An outpatient program in behavioral medicine chronic pain patients based on the practice of mindfulness meditation. Gen Hosp Psychiatry. 1982;4(1):33–47.PubMedCrossRefGoogle Scholar
  23. Kam J, Xu J, Handy T. I don’t feel your pain (as much): the desensitizing effect of mind wandering on the perception of others’ discomfort. Cogn Affect Behav Neurosci. 2013; online, doi:10.3758/s13415-013-0197-z.Google Scholar
  24. Kearney D, McDermott K, Malte C, et al. Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a veteran sample. J Clin Psychol. 2012;68(1):101–16. doi:10.1002/jclp.20853.PubMedCrossRefGoogle Scholar
  25. Kearney D, Malte C, McManus C, et al. Loving-kindness meditation for posttraumatic stress disorder: a pilot study. J Trauma Stress. 2013;26(4):426–34. doi:10.1002/jts.21832.PubMedCrossRefGoogle Scholar
  26. Kessler R, Davis R, Foster D, et al. Long-term trends in the use of complementary and alternative medical therapies in the United States. Ann Intern Med. 2001a;135(4):262–8.PubMedCrossRefGoogle Scholar
  27. Kessler R, Soukup J, Davis R, et al. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Am J Psychiatry. 2001b;158(2):289–94.PubMedCrossRefGoogle Scholar
  28. Kim S, Schneider S, Bevans M, et al. PTSD symptom reduction with mindfulness-based stretching and deep breathing exercise: randomized controlled clinical trial of efficacy. J Clin Endocrinol Metab. 2013a;98(7):2984–92. doi:10.1210/jc.2012-3742.PubMedCentralPubMedCrossRefGoogle Scholar
  29. Kim S, Schneider S, Kravitz L, et al. Mind-body practices for posttraumatic stress disorder. J Invest Med. 2013b;61(5):827–34. doi:10.231/JIM.0b013e3182906862.Google Scholar
  30. Kim Y, Heo I, Shin B, et al. Acupuncture for posttraumatic stress disorder: a systematic review of randomized controlled trials and prospective clinical trials. Evid Based Complement Alternat Med. 2013; 2013. doi:10.1155/2013/615857.Google Scholar
  31. Kimbrough E, Magyari T, Langenberg P, et al. Mindfulness intervention for child abuse survivors. J Clin Psychol. 2010;66(1):17–33. doi:10.1002/jclp.20624.PubMedGoogle Scholar
  32. Lang A, Strauss J, Bomyea J, et al. The theoretical and empirical basis for meditation as an intervention for PTSD. Behav Modif. 2012;36(6):759–86. doi:10.1177/0145445512441200.PubMedCrossRefGoogle Scholar
  33. Libby D, Pilver C, Desai R. Complementary and alternative medicine in VA specialized PTSD treatment programs. Psychiatr Serv. 2012;63(11):1134–6. doi:10.1176/appi.ps.201100456.PubMedCrossRefGoogle Scholar
  34. Manger T, Motta R. The impact of an exercise program on posttraumatic stress disorder, anxiety, and depression. Int J Emerg Ment Health. 2005;7(1):49–57.PubMedGoogle Scholar
  35. Merom D, Phongsavan P, Wagner R, et al. Promoting walking as an adjunct intervention to group cognitive behavioral therapy for anxiety disorders: a pilot group randomized trial. J Anxiety Disord. 2008;22(6):959–68.PubMedCrossRefGoogle Scholar
  36. Micek M, Bradley K, Braddock C, et al. Complementary and alternative medicine use among veterans affairs outpatients. J Altern Complement Med. 2007;13(2):190–3.PubMedCrossRefGoogle Scholar
  37. Moyer C, Rounds J, Hannum J. A meta-analysis of massage therapy research. Psychol Bull. 2004;130(1):3–18.PubMedCrossRefGoogle Scholar
  38. National Center for Complementary and Alternative Medicine. Complementary, alternative, or integrative health: what’s in a name? In: Health information. National Institutes of Health. 2013. http://nccam.nih.gov/health/whatiscam. Accessed 24 April 2014.
  39. Neff K, Germer C. A pilot study and randomized controlled trial of the mindful self-compassion program. J Clin Psychol. 2013;69(1):28–44. doi:10.1002/jclp.21923.PubMedCrossRefGoogle Scholar
  40. 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.PubMedGoogle Scholar
  41. Niles B, Klunk-Gillis J, Ryngala D, et al. Comparing mindfulness and psychoeducation treatments for combat-related PTSD using a telehealth approach. Psychol Trauma. 2012;4(5):538–47. doi:10.1037/a0026161.CrossRefGoogle Scholar
  42. Orsillo SM, Batten SV. Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behav Modif. 2005;29(1):95–129. doi:10.1177/0145445504270876.PubMedCrossRefGoogle Scholar
  43. Price C. Body-oriented therapy in recovery from child sexual abuse: an efficacy study. Altern Ther Health Med. 2005;11(5):46–57.PubMedCentralPubMedGoogle Scholar
  44. Reber C, Boden M, Mitragotri N, et al. A prospective investigation of mindfulness skills and changes in emotion regulation among military veterans in posttraumatic stress disorder treatment. Mindfulness (NY). 2013;4(4):311–7. doi:10.1007/s12671-012-0131-4.CrossRefGoogle Scholar
  45. Resick PA, Schnicke MK. Cognitive processing therapy for rape victims. Newberry Park: Sage Publications; 1996.Google Scholar
  46. Rosenbaum S, Nguyen D, Lenehan T, et al. Exercise augmentation compared to usual care for posttraumatic stress disorder: a randomised controlled trial (the REAP study: randomised exercise augmentation for PTSD). BMC Psychiatry. 2011;11:115. doi:10.1186/1471-244X-11-115.PubMedCentralPubMedCrossRefGoogle Scholar
  47. Rosenthal J, Grosswald SJ, Ross R, Rosenthal N. Effects of transcendental meditation (TM) in Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) with posttraumatic stress disorder (PTSD) A pilot study. Mil Med. 2011;176(6):626–30.PubMedCrossRefGoogle Scholar
  48. Smith T, Ryan M, Smith B, et al. Complementary and alternative medicine use among US Navy and Marine Corps personnel. BMC Complement Altern Med. 2007; 7:16. doi:10.1186/1472-6882-7-16 doi:10.1186%2F1472-6882-7-16#pmc_ext.Google Scholar
  49. Staples J, Hamilton M, Uddo M. A yoga program for the symptoms of post-traumatic stress disorder in veterans. Mil Med. 2013;178(8):854–60. doi:10.7205/MILMED-D-12-00536.PubMedCrossRefGoogle Scholar
  50. Strauss J, Lang A. Complementary and alternative treatments for PTSD. PTSD Res Q. 2012;23(2):1–7.Google Scholar
  51. Taylor S, Thordarson D, Maxfield L, et al. Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. J Consult Clin Psychol. 2003;71(2):330–8.PubMedCrossRefGoogle Scholar
  52. Telles S, Naveen K, Dash M. Yoga reduces symptoms of distress in tsunami survivors in the Andaman Islands. J. Evidence-Based Complementary Altern. Med. 2007; 4(4):503–9. doi:10.1093/ecam/nem069 doi:10.1093%2Fecam%2Fnem069#pmc_ext.Google Scholar
  53. Telles S, Singh N, Joshi M, Balkrishna A. Posttraumatic stress symptoms and heart rate variability in Bihar flood survivors following yoga: a randomized controlled study. BMC Psychiatry, 2010; 10:18. http://www.biomedcentral.com/1471-244X/10/18.Google Scholar
  54. Telles S, Singh N, Balkrishna A. Managing mental health disorders resulting from trauma through yoga. Depress Res Treat. 2012; 2012. doi:10.1155/2012/401513.Google Scholar
  55. Thompson B, Waltz J. Self-compassion and PTSD symptom severity. J Trauma Stress. 2008;21(6):556–8. doi:10.1002/jts.20374.PubMedCrossRefGoogle Scholar
  56. Unutzer J, Klap R, Sturm R, et al. Mental disorders and the use of alternative medicine: results from a national survey. Am J Psychiatry. 2000;157(11):1851–7.PubMedCrossRefGoogle Scholar
  57. Van der Kolk B. Clinical implications of neuroscience research in PTSD. Ann NY Acad Sci. 2006;1071:277–93.PubMedCrossRefGoogle Scholar
  58. Vaughan K, Armstrong M, Gold R, et al. A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder. J Behav Ther Exp Psychiatry. 1994;25(4):283–91.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland (outside the USA) 2015

Authors and Affiliations

  1. 1.UCSD Department of PsychiatryUCSD and VA San Diego Healthcare System, VASDHS Center of Excellence for Stress and Mental HealthLa JollaUSA
  2. 2.Veterans Medical Research FoundationSan DiegoUSA

Personalised recommendations