Liz Shear--Yoga in the treatment of PTSD

Abstract

Great advances have been made in the study of yoga as medicine, now including the area of psychiatric cases. Yoga has shown much success in the treatment of Post-Traumatic Stress Disorder (PTSD) and even the depression that it is often accompanied by. Studies specifically target military war veterans, the survivors of the 2004 South-Asia tsunami, and children from abusive home environments. The question of how best to treat patients with PTSD is still unanswered. The resources primarily utilized at this point are drugs and talk therapy, both with reputable results, but failing to treat the mental and physical side effects of PTSD as a whole. Yoga has proven to be and adequate resource to those suffering from PTSD because of its ability to treat both these ailments simultaneously. Yoga in the treatment of PTSD has shown nothing but positive results and is still the subject of discussion amongst the medical world.

Yoga in the Treatment of PTSD

As yoga practice popularizes in America, the advertised positive effects of a regular practice are expanding beyond the physical. Psychiatrists have begun turning towards yoga practices to treat psychological disorders, more recently PTSD and the depression which often accompanies it. PTSD is a rising concern, especially in the United States, due to the war in Iraq and its returning soldiers often being affected; however studies on other situations where people are put under an extreme amount of stress are also beginning to be studied. Although the studies for yoga as therapy are only just beginning to surface, already notable success has been proven. Yoga’s meditative qualities, controlled breathing techniques, and physical exercise are shown to cumulate into a wonderful solution for a group of people who have an illness that is difficult to treat. So just how effective can yoga be in the treatment of Post Traumatic Stress disorder, and related depression symptoms? The following research will test any previous beliefs about the treatment of these disorders you may have previously had and yoga’s power in psychological health.

PTSD AND ITS ASSOCIATED SYMPTOMS

Studies on PTSD first appeared on the medical radar when large quantities of soldiers returning from the Franco-Prussian war began showing similar symptoms of exhaustion, anxiety, heart palpitations, chest pain, trembling, and disorientation (Rosalyn M. Bertram, 2008). In Rosalyn M. Bertramand Jennifer L. Dartt’s study of PTSD in children from violent and impoverished communities, they go on to explain the history of PTSD. At first when the soldiers were retuning from war with these symptoms, doctors speculated that when soldiers with a traumatic childhood entered the battlefield, the trauma would resurface. At the time, the only medical solution was basically just to wait it out—the symptoms would go away on their own. Modern studies of PTSD describe it as a result of situations where people experience severe “feelings of fear, helplessness, or horror” (Patricia A. Resick, 2009) and not in any particular relation to a violent childhood, but rather about the things that actually took place immediately at the time the symptoms were noticed. The description of the symptoms associated with the disease has also changed to include mental issues, and not only ones that physically manifest. This includes difficulty regulating affect and impulse, flashbacks, or nightmares, relation difficulties, as well as low self-esteem and self-efficiency (Rosalyn M. Bertram, 2008). Although it is a subject mostly studied for its effects on soldiers who have been to war (Rosalyn M. Bertram, 2008), it has recently been studied on victims of natural disasters (Richard P. Brown, 2005) and children who have experienced particularly horrible situations, such as abuse physically and sexually (Rosalyn M. Bertram, 2008).

HOW TO TREAT PTSD

The best treatment for PTSD is still a highly debated subject amongst those in the psychology field. Medicine has been a suggested solution, in the form of antidepressants, anti antipsychotics, or anti-anxiety pills, but these are only treatments for some of the symptoms PTSD patients endure (McAllister, 2009). Therapy in the form of cognitive and trauma therapy have also been arguable solutions since the diseases discovery (Bruce E. Wampold, 2010). Research by Patricia Gerbarg M.D and her husband, Richard P Brown M.D. (2005), is proving there may be alternative solutions, which they claim to be equally effective. Their work began with Tsunami victims the 2004 Tsunami in South Asia. After the devastating natural disaster, a wave of depression and PTSD swept over the countries populace. The couple began using yogic breathing to treat patients, the results both pleasing and surprising (Richard P. Brown, 2005).

THE GERBARG AND BROWN STUDY

One might ask how the couple came to the conclusion that yoga seemed like a possible solution to their patients PTSD symptoms—why yoga of all the complementary medical possibilities? Perhaps one may find this answer in and interview with Bessel van der Kolk, MD—a renowned authority in the study of PTSD (2009). He describes PTSD as a “residue of imprints left behind in peoples sensory and hormonal systems.” Based on his studies, he claims “most trauma-sensitive people need some sort of body-oriented psychotherapy or body work to regain a sense of safety in their bodies” something which is lost post-traumatic experience. With this knowledge, Gerbarg and Brown (2005) tested a group of patients with PTSD. One group of sixty took a four day yogic breathing course, another group of sixty took the yogic breathing course in conjunction with psychiatric counseling, the third group was a control. As a result, all participants taking the yogic breathing course benefitted more than those who did not, and even more surprisingly the counseling seemed to have no additional positive effect (Richard P. Brown, 2005).

The results of their studies with Tsunami victims lead to more in depth studies of yoga’s effects on various different types of psychological disorders. They tested a specific type of yoga regimen called Sydarshan Kriya Yoga (SKY) on patients suffering from moderate to severe depression which often accompanies PTSD patients many other symptoms. SKY sessions incorporate pranayama (breathing), asanas (postures), meditation, group processes and basic yogic knowledge. Their three-month study of persons with dysthymia and major depression proved reductions on both the Hamilton Rating Scales for depression and Beck Depression Inventory Scores after one week of SKY instruction and three weeks of practice. In private practice most patients with mild to moderate depression responded rapidly to SKY courses often feeling better in as little as five days. Many can discontinue medication with out remission through daily practice (Richard P. Brown, 2005).

YOGA VERSES MEDICINE AND TALK THERAPY

The possibility that a regular yoga practice could replace medicine opened up to additional studies on disorders more stubborn to treat through medical means, such as insomnia, addictions, and phobias (Richard P. Brown, 2005). The success varied, but in general a specific yoga regimen could be found for each disorder based on the patients needs. Gerbarg and Brown’s (2005) Studies concluded that when a specific yoga style was found, the general consensus was success. They even went as far to say that yoga could replace medicine for patients with moderate to severe symptoms of depression and anxiety related to PTSD. Dr. Swami Vivekananda Saraswati (1995), a doctor trained in allopathic medicine, writes at length about yoga’s undeniable abilities in the treatment of mental illness, but does not deny medicines place in this process. His studies focus mainly on four types of mental illness (epilepsy, schizophrenia, manic depression and bipolar affective disorder, and endogenous depression) and although PTSD is not studied directly, the associated depression is, which its patients often suffer from. Thompson agrees that yoga is undeniable a help to his patients, but they must be chemically stabilized before attempting to treat with yoga alone. When stabilized his patients are more mentally fit to integrate a yoga practice into their regimen, “which then will ensure they will get off the drugs quickly” (Saraswati D. S., 1995).

Yoga has proven to be a great compliment to medicine and talk therapy in most cases dealing with PTSD, and overcomes many of the failures of traditional medical procedures. In a study comparing the remission rates of yoga to the remission rates of ECT and imipramine, a popular antidepressant, yoga came out on top (David Shapiro, 2007). Its effect on the body is similar to medicines effect on brain chemicals and receptors in the brain. Gerbarg and Brown have found that Yogic breathing effects the nervous system through the vagus nerve, “the ‘rest and digest,’ or calming, pathway of the autonomic nervous system extending from brain stem to abdomen; when activated, it slows down breathing and heart rate and increases intestinal activity” (Tullis, 2009). Yoga can accomplish the same benefits of medicine without the cornucopia of side effects most anti-depressants have. Dr. Swami Vivekananda Saraswati (1995) mentions that one of yoga’s greatest advantages is its non-addictive or habit-forming nature, one of anxiety pills (like valum) greatest disadvantages. However, the success of medicine on plenty of psychological disorders is undeniable. As Dr. Swami Vivekananda Saraswati (1995) said, it is necessary for a patient to stablize, most likely through allopathic medical needs, before being able to replace medicine with yoga. While yoga is undeniably a great compliment to medicine and talk therapy, it should not be viewed as a replacement.

Where medicine and talk therapy have failed to fully treat this disorder, in the sense that they can only treat symptoms one at a time, yoga has proven to be an undeniable aid. The disorder is a combination of physical and mental disassociation which neither one of the previously mentioned solutions can treat simultaneously. Yoga is successful in the treatment of PTSD because of its specific ability to treat both the physical and mental troubles of patients. Van der Kolk (2009) describes PTSD patients as having a crippling rational mind. The rational mind enables us to “organize feelings and impulses but is not well equipped to abolish emotions thoughts and impulses” (2009). When a soldier returns from war, he cannot erase the disaster and horror he has experienced. He will continue to relive that fear every day because it has been ingrained in him for so long. Children with destructive home environments live their life in fear everyday, so when it stops, they don’t know how else to react to the things around them.

REASSOCIATING THE PHYSICAL AND THE MENTAL PARTS

After being paralyzed at the age of thirteen, Matt Sanford, now an inspirational yoga instructor, has insight to offer about his experience with PTSD and how it affects others. He claims the damage is not the pain you experience at the time of the incident, but that the “real damage is inflicted after the fact, by the ways we attempt to defend ourselves in the short and long term, both physically and mentally” (Utne, 2006). After going through such an experience, PTSD patients fall out of touch with physical sensations because they become overbearing, and have trouble taking care of their bodies. At the same time the “reptilian part [of their brain] is not good at taking care of the mind” (Kolk, 2009) meaning they are subject to uncontrolled thoughts and actions. Swami Ahimsadhara Saraswati (2006) describes PTSD as an “extreme disconnection.” She goes on to say that, “in this muddle we move further from rather than closer to the harmony of body and mind which guides us towards integration and connection with the spirit.”

YOGA IS THE SOLUTION

People who suffer from PTSD have trouble “taking pleasure in the present because their bodies keep replaying the past” (Kolk, 2009). Yoga is an excellent tool to refocus your mind on being in the present moment. When performing asanas (yoga postures) one is fully involved in the stretch they are performing and the balance and concentration involved in holding it. By focusing on ones bodily condition in that moment, PTSD sufferers are allowing relief to their minds reoccurring thoughts of the traumatizing experiences they have gone through. Asanas also offer relief from many of the physical side effects of PTSD on a superficial level. PTSD patients often experience digestive problems, joint pain, hernias, high blood pressure, and more (Saraswati S. A., 2006). Simple and accessible asanas can offer relief from these physical troubles (Saraswati S. A., 2006). PTSD patients also experience the sensation of condemning their bodies because of the physical aliments they face with PTSD. Yoga develops a body that is strong and “feels comfortable” (Kolk, 2009). Yoga also encourages the relief of deep muscle tension through relaxation, and healthy diets to meet these same ends (Saraswati S. A., 2006).

Many of yoga’s healing benefits occur in the mediation aspect of yoga. Because of the rapidly moving minds that PTSD patient’s experience, meditation offers a chance for the all the moving to stop, and for them to focus on what they are feeling in the present moment. During meditation, it is encouraged to allow your thoughts to wonder, not analyze them but allow them to happen. The sensation of one thought ending and another beginning, or even one posture ending and another one beginning, offers PTSD patients hope that what they are currently feeling in their life, especially their fear, will end (Kolk, 2009). Mediation also gives the person meditating the ability to recognize negative thoughts and intercept them. By being more aware of how your thoughts formulate, one is better able to control what thoughts resonate and which thoughts float away. This type of interception is key in overcoming PTSD and depression (Saraswati D. S., 1995).

THE FUTURE OF YOGA TO TREAT PTSD

In 2009 a study was conducted at the Walker Reed Army Medical Center and Veterans Administration hospitals in Miami and Washington, D.C., testing the possibility of yoga nidra (a type of yoga that uses meditation, deep relaxation and breathing and to reduce physical, emotional and mental tension) to help veterans with PTSD. The program was called iRest (Integrated Restoration) and was founded by Richard Miller. The test results were good enough to warrant further testing and consider yoga nidra as a part of deployment readiness training programs.

Although the effectiveness of yoga in the treatment of PTSD is still an unanswered question, the results are stirring up the medical world. In a time where complementary medicine is proving to fill in the gaps medicine and therapy have left open, the legitimacy of these studies is still debated. Yoga is truly a practice that encourages things all people can welcome as healthy steps towards living a better life: relaxation, meditation, being in the moment, positive thinking, and knowing your own body and mind. People who have suffered things worse than any of us can imagine carry a heavy burden in their day-to-day life. Yoga may come as a fundamental relief to people living with this burden as long as our minds remain open to the infinite power and possibilities of peace.

Bibliography

Bruce E. Wampold, Z. E. (2010, June). Determining what works in the treatment of PTSD. Clinical Psychology Review .

David Shapiro, I. A. (2007, February 28). Yoga as a Complementary Treatment of Depression: Effects of Traits and Moods on Treatment Outcome. Advance Access Publication.

Kolk, B. v. (2009). Yoga and Post-Traumatic Stress Disorder: An Interview with Bessel van der Kolk, MD. 12-13. (I. Y. Magazine, Interviewer)

McAllister, T. W. (2009). Psychopharmacological Issues in the Treatment of TBI and PTSD. The Clinical Neuropsychologist , 23, 1338-1367.

Patricia A. Resick, M. W. (2009). Post-Traumatic Stress Disorder: Anxiety or Traumatic Stress Disorder. Journal of Traumatic Stress , 22 (5), 384-390.

Richard P. Brown, M. a. (2005). Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part II--Clinical Application and Guidelines. The Journal of Alternative and Complementary Medicine , 11, 711-717.

Rosalyn M. Bertram, J. L. (2008). Post Traumatic Stress Disorder: A Diagnosis for Youth from Violent, Impoverished Communities. J Child Fam Stud , 18, 294-302.

Saraswati, D. S. (1995, July). Yogic Treatment of Mental Illness. Sivananda Math Yoga Magazine .

Saraswati, S. A. (2006, November/December). From War to Peace-Yoga for the Management of Post-Traumatic Stress Disorder. Yoga Magazine .

Tullis, P. (2009, May 01). Yoga: The Strongest Stretch. Retrieved November 14, 2010, from Psychology Today: http://www.psychologytoday.com/articles/200705/yoga-the-strongest-stretch

Utne, N. (2006, July/August). Transcending Trauma. Utne (136), p. 4.