Veteran Doctor - Episode 32 - Holistic Approaches for Veteran PTSD

As an educated veteran, I continue to search for alternatives for treating PTSD and TBI other than your traditional pharmaceuticals that seem only to mask the symptoms or cause additional health issues.

Evidence-based practice is the standard for treating PTSD. However, there is growing recognition that complementary and alternative therapies may be helpful adjuncts to meet the needs of some veterans who have experienced trauma.

According to the National Center for PTSD, there are three types of primary treatments for PTSD in veterans: trauma-focused cognitive-behavioral therapy, eye movement desensitization and reprocessing (EMDR), and pharmacological treatment. 

But there is growing acknowledgment among veterans and healthcare providers that these are not the only options for clinicians and therapists working with afflicted veterans. There is increasing recognition that these first-line treatments alone may not meet every need of all veterans who have experienced trauma. Even when they are successful, nontraditional therapies may be helpful adjuncts that boost overall wellness. 

Not all people with PTSD present with the exact needs or the same symptoms, and no one prescriptive approach works for everyone.

The VA is increasingly embracing various complementary and alternative medicine (CAM) techniques, such as yoga, meditation, acupuncture, tai chi, biofeedback, massage, hypnosis, guided imagery, and relaxation therapy, to treat veterans with PTSD.

These techniques help relieve and reduce medication dependency while motivating reluctant veterans towards traditional approaches that produce more engagement and compliance. Knowledge of using CAM techniques to treat PTSD can help bring peace to minds disquieted by the traumas of war and heal bodies battered by combat and emotional distress.

Acupuncture

Acupuncture involves using very thin needles through the skin at strategic points of the body. As a critical component of this traditional Chinese medicine, acupuncture was mainly used to treat pain. Over time it has been used to improve overall wellness, including stress management.

Acupuncture is a technique to balance the flow of energy or life force through pathways, or meridians, in your body. Practitioners believe your energy will re-balance by inserting needles into precise points in these meridians.

Western specialists view acupuncture points as stimulating nerves, muscles, and connective tissue to boost the body's natural painkillers.

Research leads to increased knowledge about brain plasticity, while medical technology opens a window on the brain and has shown how acupuncture influences hemodynamics. You can see the rerouting of blood to the frontal cortex away from the limbic system. Changes in blood flow promote cellular healing. The benefits produce reduced pain, stress, anxiety, and depression and improved sleep. These benefits allow veterans to reduce their use of medications, becoming an addiction treatment to reduce drug dependence and help the brain heal.

Acupuncture is most successful as a primary prevention mechanism when used immediately after trauma by changing the brain's blood flow, and the chemical cascade in the body, so morphological changes don't occur. It is typically used as an additional treatment for veterans with more long-term trauma patterns.

Tai Chi

Tai Chi is a mind-body exercise beginning in China, where it started as a martial art. These days, it's practiced worldwide as an effective exercise for health.

It is impossible to describe this complex art in a short description. Tai Chi can become many things for different people, but regular practice will improve well-being.

Tai Chi is a moving meditation with exercises that produce harmony between the mind and body. The ultimate purpose is cultivating our inner life energy to flow smoothly and powerfully throughout the body. This is as much of a spiritual experience as it is a physical one.

Movements are fluid, graceful, circular, and slow. Breathing is deep, aiding visual and mental concentration. This relaxes the body and allows the life force to flow freely. 
This practice is effective because it consists of exercises equally balanced between yin and yang (opposite forces that complement each other, such as dark and light or female and male).

Tai Chi is straightforward to learn. Many people embark on life-long journeys to increase their experience, as there are always levels of understanding to reveal. This is where there is an appeal.

Tai Chi is performed almost everywhere with a relatively low learning cost. It is suitable for anyone because exertion levels can be adjusted to suit your physical condition.

Physically, Tai Chi improves strength, flexibility, aerobic conditioning, and balance. Research has shown that it improves cardiovascular fitness, lower blood pressure, prevents falls, and helps people who have arthritis.

There are also enormous emotional and mental benefits. The deliberate movements help people to feel more relaxed, grounded, and present in their bodies. This lowers anxiety, stress, and depression; while improving memory, focus, and sleep.

Tai Chi is perhaps the most effective exercise that benefits your entire body and well-being. It is so enjoyable that millions worldwide practice it, regardless of age or physical condition. It is all about improving your quality of life and feeling empowered.

Numerous medical studies show the overwhelming benefits of Tai Chi, significantly when modified programs address specific health conditions. Research shows that a routine can prevent many health problems and help people better manage their needs.

Yoga & Meditation

Yoga and meditation are widely embraced in the active military and VA medical centers because they offer numerous benefits. Practicing yoga helps relieve pain, stretches the body, and brings comfort to people's bodies. Sleep is a challenge for many people with PTSD, especially chronic pain. Their nervous systems are hypervigilant; it is as if they are still on guard duty even though their home from the war for months or even years.

Among the main benefits of yoga and meditation is their ability to downregulate and soothe an overstimulated nervous system, to shift into the parasympathetic response and the relaxation response, as well as to help the nervous system reclaim resiliency and be able to change between the fight/flight/freeze response and the parasympathetic response. 

To be effective, yoga and meditation practices must be personalized to the needs of the individual with PTSD. For example, creating a safe space is crucial for people who have had trauma. And what might feel good to some might not work for someone with trauma. People with PTSD may not want their backs to a door and may need to know where everyone is before they can relax. 

Certain practices and approaches work better than others for individuals with trauma. Most people with PTSD have an overactivated sympathetic nervous system. It is as if the fight/flight/freeze response is often turned on, even when the external conditions are not an immediate threat.

Massage (for treatment)

Massage therapy has become very popular in reducing the stress of everyday life, injuries, and chronic/acute conditions while helping maintain health and wellness. According to Chinese records, massage days back 300 years and is one of the oldest healing arts.

Massage helps reduce stress and fatigue while improving overall circulation.  Massage also reduces pain and anxiety for people with chronic illnesses. It can help treat medical conditions, including stress-related tension, cancer-related fatigue, sleep disorders, high blood pressure, diabetes, low back pain, and depression.

Licensed massage therapists are trained to treat patients with complicated medical conditions and to enhance general health. Different massage styles include stroking, tapping, kneading, rocking, or holding steady pressure. The kinds of massage are deep tissue, Swedish, acupressure techniques, healing, and therapeutic touch.

Research shows that massage can reduce heart rate, lower blood pressure, and increase blood circulation. It also relaxes muscles, improves the range of motion, and enhances medical treatments.

Therapeutic massage is not a technique to increase muscle strength. However, it can stimulate weak and inactive muscles, which helps compensate for inactivity or a lack of exercise caused by illness or injury.

Massage can help treat stress-related physical conditions, including anxiety, depression, fatigue, headaches, migraines, back, shoulder, and neck pain, muscle tension, and repetitive stress injuries.

Guided imagery

Guided imagery is a relaxation technique focusing on a positive mental image. Psychotherapists use it as a tool, but people can also teach it to themselves and use it anytime. 

This technique is called visualization or guided meditation. Many benefits can be found by this technique, like reducing stress or improving one's sense of well-being.

People intentionally visualize peaceful scenarios. While some might choose to visualize a pleasant scene, others may picture white blood cells fighting illness and imagining desired outcomes.

Guided imagery is also a relaxation technique. People try to picture events and scenes that will cause feelings of relaxation and calm. Relaxation techniques are safe for healthy people to use to stimulate the body's natural relaxation response.

Biofeedback

Biofeedback teaches how to control the body's functions, such as your heart rate. During biofeedback, you connect to sensors that help read information about your body. This feedback helps you make subtle modifications within your body, like relaxing specific muscles, to achieve desired results, like reducing pain. Biofeedback allows you to practice new ways to control your body, often to improve a health condition or physical performance.

 Types of biofeedback

Depending on your health issues and goals, your therapist might use various biofeedback methods. Biofeedback types include:

• Brain waves.An electroencephalograph (EEG) uses scalp sensors to monitor your brain waves.
• During respiratory biofeedback, breathing patterns and respiration rates are monitored by bands around the abdomen and chest.
• Heart rate.An electrocardiograph (ECG) sensor is placed on your chest, lower torso, or wrists to measure the heart rate and how the heart rate varies. It also utilizes finger or earlobe sensors to detect blood volume changes (photoplethysmograph).
• Muscle contraction.An electromyograph (EMG) involves placing sensors over your skeletal muscles to monitor the electrical activity that causes muscle contraction.
• Sweat gland activity.An electrodermograph (EDG) sensor attached around your fingers or on your palm or wrist measures the sweat gland activity and the amount of skin perspiration, alerting anxiety levels.
• Sensors are attached to fingers or feet to measure the blood flow to your skin. The body's temperature often drops under stress so a low reading can prompt the beginning of relaxation techniques.

Clinical Hypnosis

Hypnotherapy is an approach licensed and trained clinicians use to treat a physical and psychological issue involving skills that facilitate an altered state of consciousness called a trance. During trance, the conscious, critical mind is usually relaxed and relatively inactive. In contrast, the subconscious mind can access resources, skills, and abilities that are unavailable to the conscious mind.  During trance, suggestibility is enhanced, senses are heightened, mental absorption is increased, and the imagination is activated in a controlled manner to promote insight, ego strengthening, and activation of solution-focused skills.

Hypnosis elicits and uses a highly relaxed state of inner absorption, concentration, and focused attention. Using hypnosis can allow people to have increased control over their behaviors, thoughts, and emotional responses. Learning self-hypnosis is an ultimate act of self-control, allowing people to achieve more of their potential Research supports that hypnotic suggestions effectively change aspects of the person's physiological and neurological functioning.

Healing Touch

Healing touch is a nurturing, relaxing energy therapy that uses gentle, intentional touch to assist in balancing physical, emotional, mental, and spiritual well-being. This is a collection of standardized, noninvasive techniques that clear, energize, and balance the human and environmental energy fields. Healing Touch assists in creating a coherent and balanced energy field, supporting one's inherent healing ability. It is safe for all ages and may be combined with standard medical care.

Healing Touch is beneficial in calming anxiety and reducing symptoms of depression, reducing pain, reinforcing the immune system, improving recovery from surgery, complementing care for neck and spine problems, intensifying spiritual connection, supporting cancer care, improving well-being, easing both acute and chronic conditions, and supporting resiliency.

Acupressure

Acupressure is a traditional Chinese medicine exercise that involves treating blocked energy by applying manual pressure to specific points on the body. It is like acupuncture; fingertip pressure is used instead of needles.

Acupressure is said to help with various conditions, from motion sickness to headache to muscle pain, by improving energy flow. Here are the uses, effectiveness, safety, and technique of acupressure:

• The exact working of acupressure is unknown. Many believe the pressure causes a release of endorphins, a natural pain-relieving chemical in the body.
• Others think the pressure may influence the autonomic nervous system that controls involuntary things like your heart, digestion, and breathing.
• Hidden pathways of energy called meridians flow throughout the body. There are at least 14 meridians that are thought to connect the organs with other body parts.
• Acupressure points lie along those meridians. If energy is blocked on a meridian, it will cause health problems along that pathway.
• Pressure is applied to specific acupressure points to restore healthy energy flow. The points chosen for treatment may depend on symptoms.

Alexander technique

This technique is a skill for self-development that teaches you to change long-standing habits that cause needless tension in all aspects of your life.

Whatever your age or ability, this technique can help boost your performance and relieve the pain and stress caused by bad postural habits like slouching or rounded shoulders.

Everyday things like tense like phone rings, picking up the children from school, or worrying about work deadlines can lead to physical and mental stress. Over the years, this accumulates, causing illness, injury, or common aches and pains.

Working with your instructor, you will learn to recognize your usual responses to the stresses of life. You will find out how you have been contributing to your problems and how to prevent them and regain control.

Reflexology

This therapy uses gentle pressure on specific points along your feet, hands, or ears to help you feel better. The theory is that this eases and that helps your body work better. It's also known as zone therapy.

Reflexology, like acupuncture and acupressure, connects spots outside your body to the inside. However, those therapies use points all over your body, not just your feet, hands, and ears.

Reflexology is complementary to traditional care, but it's not an alternative, and reflexologists don't diagnose or treat illnesses. Reflexology may help you feel less pain and discomfort and less stress.

Reiki

Reiki is a Japanese stress reduction and relaxation technique that promotes healing. It is based on the awareness that an unseen energy flows through every one of us and makes us alive. If your "life force energy" is low, you are prone to get ill or feel stressed, and if the energy is high, you are more capable of being happy and healthy.

Reiki is broken into two Japanese words - Rei means "God's Wisdom or the Higher Power," and Ki means "life force energy." Essentially, Reiki means "spiritually guided life force energy."

A treatment feels like a magnificent glowing radiance that flows inside and around you. Reiki treats the whole person, including body, mind, emotions, and spirit, creating many beneficial effects, including relaxation, peace, security, and well-being. Miraculous results have been seen.

Reiki is a simple, natural, and safe technique of spiritual and self-improvement healing that anyone can use. It is effective in helping virtually every illness and creates a beneficial effect. It also works with other medical techniques to help relieve side effects and promote recovery.

Therapeutic Touch

This technique is based on the concept that humans are energy in the form of a field. When you are healthy, that energy will freely flow and is balanced. In contrast, the disease is a condition of energy imbalance or disorder. The human energy field extends beyond skin level, and the practitioner connects with that energy using the hands as sensors.  A session is a process that is always individualized and usually does not exceed 20 minutes. Practitioners generally pass their hands 2 to 6 inches over your body from head to toe while lying down. They may use a rhythmical, sweeping motion with their hands as if they are re-balancing the body's energy. Practitioners are conduits of energy.

Emotional Freedom Technique

This technique is an innovative treatment method that offers healing from physical and emotional pain. This treatment uses the fingertips to stimulate energy points in the body. This easily mastered technique can be performed almost anywhere. This treatment was developed based on the idea that all negative emotions in the body disrupt the body's energy systems.

This technique works by tapping on acupressure meridians to release blockages. When these blockages are released, the problem is released from the body. The process begins with an initial statement of what the problem feeling is and includes a complete acceptance of that problem. To start the process of this technique, the patient would say something like, "Even though I have this (fear), I completely accept myself anyway." The client says this statement three times while tapping on trigger points. In the second part of this treatment, the client will focus on the feeling (fear) in the body and rate its intensity on a scale from 1 to 10. Then the client begins to tap on different points around the face while saying "this fear" concurrently. Several rounds are done until the fear is rated at zero. Once this fear is gone, the therapist will guide the client to other concerns.

This technique is a very effective way of clearing feelings, and once gone, the limiting beliefs that the client holds are released. More positive beliefs about themselves can emerge. Learning this technique can empower clients to manage their emotional state by tapping into their feelings whenever they want to move out of a painful issue.

Animal-Assisted Therapy

Animal-assisted therapy is a therapeutic intervention that incorporates animals into the treatment plan. The client, therapist, and animal work in conjunction in therapeutic activities, summarized by a treatment plan, with clear goals for change, measurable objectives, and the expectation of identifiable progress toward the treatment goals. The therapy can take many forms based on the patient, the animal, and the goals for treatment. Animal-assisted therapy is used to enhance and complement the benefits of traditional therapy.

Animal-assisted therapy is rooted in the bond that can develop between people and animals. Animals can provide a sense of calm, comfort, or safety to divert attention away from stressful situations. Animals can help battle loneliness and boost social support through interactions with the animal and interactions involving other people. Animals can guide people to get more physical activity.

Advocates say that developing a connection with an animal can help people improve a better sense of self-worth and trust, emotional stabilization, communication, self-regulation, and socialization skills. Animal-assisted therapy often combines traditional treatments conducted by a licensed psychotherapist, social worker, or mental health care provider.