Healing Combat Trauma

The Dept. of "No Real Surprises Here": Chiropractic Doesn't Help Veterans Suffering from PTSD

An article in the current issue -- June, 2009 -- of Military Medicine takes a look at the effects of chiropractic on veterans with PTSD, and finds the results lacking.  The study is called "A cross-sectional analysis of clinical outcomes following chiropractic care in veterans with and without post-traumatic stress disorder,” and it was authored by Drs. Andrew Dunn, Steven Passmore, Jeanmarie Burke and New York Chiropractic College student David Chicoine.

According to an article in trade publication ChiroEco.com, that study "investigates clinical outcomes for 130 veteran patients with neck or low back complaints at the VA of Western New York. This study found that patients with post-traumatic stress disorder had significantly lower lower levels of improvement than those without post-traumatic stress disorder on self-reported outcome measures of neck and low back disability."

These results are not really surprising, because -- unlike another form of bodywork, massage therapy, which does have proven results for helping PTSD symptoms -- there's nothing about chiropractic per se that indicates it would be helpful. Spinal subluxations, while combat veterans may be experiencing them, aren't really part of the PTSD profile, and relieving them wouldn't necessarily have any effect whatsoever on reducing PTSD symptoms.  They're just not related. That said, it's progress that chiropractic is offered in military health care settings, and we're sure it brings combat veterans some relief -- in the appropriate context, which PTSD is not.

For a look at complementary and alternative medicine therapies ("CAM") that have shown benefit in treating PTSD, click here.  For a look at bodywork therapies, click here.  For a look at mind-body medicine approaches, click here.  To read the article in ChiroEco.com, click here.

What Would Hope Regained Do for Combat Veterans?

I was in a conversation the other day with a Vietnam era psychologist, who I respect and admire a great deal, but who was nonetheless giving me static for the way I talked about "hope" in a previous blog post, as it concerned combat veterans.  "You talk about it as though it's an abstract, but then immediately move into talking about its RESULTS," he said (I'm paraphrasing.)  Rrrright.  And that would be exactly the point.  Hope is a great and a necessary thing -- but our goal here is to find ways to get over combat trauma, to the extent possible -- at least to reduce its effects on veterans -- and in that regard, yes, we're all about the results.  Are there any?  And what can those be?  Because if they're legitimate at all, in the vacuum of hope-lessness and despair created by a complete lack of reasonable solutions, let's figure out what those are, and let's try them out.  Are combat veterans game?  Many are.

Here's something I ran across the other day, in the middle of a [draft] journal article.  The author was talking about a type of therapy he used -- a therapy he's famous for developing, and which has been around and in use for decades -- on combat veterans, mostly from the Vietnam era, and the results he was able to achieve with them.  I have some inside knowledge of his program, but this was the first time I'd read something in print about it.  In the middle of quite an extensive article, charting this result and that, he happened to mention the results of one of the tests he did on the 22 vets, both before and after the two weeks of treatment.  This is what he wrote:

"Scores on the Beck Hopelessness Scale fell from an average of 11 before treatment to 3 following treatment.  In clinical practice, scores of 9 or more are used to indicate serious hopelessness.  A score of 4 is expected in the general population.  The veterans went from having pre-test scores characteristic of hopelessness, suicidal ideation and predictive of suicide attempts, to having scores typical of the general population.  Thirteen veterans had scores above 9 before treatment, one had a score above 9 after treatment. (That individual's score had dropped from 17 to 10.)  Nineteen out of 22 scores dropped; two remained the same (scores of 1 and 2); and one score increased [negligibly] (from 4 5o 5).  Marked decreases in pessimism are indicated, and it seems safe to conclude that the treatment group felt considerably more hopeful at the program's conclusion."

Do you see what's embedded in that, if true?  In two weeks of treatment, combat veterans with PTSD that went back decades started feeling better to a degree, on average, better than the general population?  That's remarkable...

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So I ask you, what would HOPE do for veterans today, and their families?  It's pretty clear that when it comes to suicide, people are able to go forward with the act because they've given UP hope.  (That's why the Beck test, for example, is able to link the two: hopelessness and suicide, both ideation and attempts.)  We've seen in previous blog posts how the "focus" of a suicidal person becomes narrower -- it's not that they "don't love their family" or "aren't thinking about the consequences to others," they simply have narrowed their focus down to an either/or choice, and the rest of the considerations, no matter how otherwise dear, are simply "not in the picture." 

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Now it's entirely possible that the veterans in the above-mentioned program didn't functionally "stay" that perky and optimistic, and that's why more follow-up studies, such as retests at longer intervals, would have contributed more information worth knowing.  Many times, at the end of a program, irrespective of what type of program it is, participants feel most buoyed and optimistic about future performance, lighter about their burdens, and more likely to discount the negative effect of future obstacles they may encounter.  However, even so it's significant to note how good those scores seemed to be, given the great degree of difficulty the same participants had having hope beforehand.

It's not just veterans -- it's also their families.  How often do family members say things like, "But you were only in the war for two years...how can you let it affect you for the whole rest of your life?"

If combat veterans are able to access health care that adequately deals with their symptoms, and reduces their symptom load to a manageable extent, and gives them back HOPE -- they will have the ability to resume their lives with some degree of normality, and prevent any number of negative consequences that come from NOT having hope, from having given up.  The tremendous societal costs from combat trauma we have to start understanding not only affect the veterans involved -- they affect their families, the communities in which they live, future generations, etc.  Veterans with hope -- who get their hope back -- will be functional and integrated into all aspects of their lives, and actively participate in their various roles as spouses, parents, employees, citizens, etc.  Veterans who lose hope, and who we do not help to regain hope, will lose out.  And this loss will affect them first, and then like the ripple effect of a pebble thrown into a pond, concentric circles of effect will spread out from them to others in their lives: their immediate families, their workplaces, their schools, their communities, even future generations in their families.

Far from being an abstraction, I believe HOPE is pretty central to the whole concept of "healing combat trauma."  We've got to help combat veterans to hang on and have some, and they themselves have to believe it's possible to get better.  Then we have to make sure we're connecting them with the very resources that can deliver the results.

"Yoga for the Nervous System: Healing Anxiety, Insomnia and PTSD"

The above title -- promising, no?! let's hope it also delivers -- is the name of a "weekend intensive" class being given in mid-November at the famous Kripalu Center for Yoga and Health in the Berkshires (Western Massachusetts, close to the New York border.)  Information about the class is linked here.

(For more links to blog posts where we've talked about yoga and PTSD, click here. For more about the larger topic of mind-body medicine, which includes yoga, click here. For more on a yet still more comprehensive topic, PTSD and Complementary and Alternative Medicine, which includes mind-body medicine, click here.)

According to the Kripalu Center's brochure:

"Unlock the power of your mind-body network to relax your physical body, calm your mind, and quiet your nervous system.  Conditions such as anxiety, insomnia and post-traumatic stress disorder (PTSD) involve hyperarousal of the nervous system along with the mental, emotional and physical [aspects of our] bodies.  If this activation becomes chronic, the neuro-emotional patterns that result can compromise your physical health, emotional well-being, and creative potential.

Fortunately, the neural pathways to relaxation and calm exist in each one of us.  Those pathways simply need to be discovered and activated repeatedly to alter the state of the nervous system.

This transformative weekend intensive will include:

• Elemental Yoga, a transformative, therapeutic, alignment-based, slow vinyasa practice;
• Meditation;
• Restorative yoga; and
• Pranayama (breathing) exercises designed to balance the nervous system and emotional [aspects of the] body;

Psychologist and yoga therapist Bo Forbes will draw from her extensive experience in clinical psychology and mind-body therapeutics to help you learn to activate the neural pathway[s] to relaxation and catalyze the emergence of your extraordinary inner potential.

About Bo Forbes:
Bo Forbes, PsyD, E-RYT500, is a leading clinical psychologist, yoga teacher, and yoga therapist in the Boston area.  She is the founder of Elemental Yoga, director of the Center for Integrative Yoga Therapeutics in Cambridge, Massachusetts, and a contributing writer for Yoga Journal and Body & Soul magazines. 

(There's also an interesting interview with Bo Forbes on the topic of "Narrowing the Gap between Insight and Change: Yoga, Psychotherapy and the Body," linked here.

NOTE: The class says it is for those with "some yoga experience" as a pre-requisite.

Editor's note: For general yoga instructional videos, or yoga for stress videos, see thefollowing, mentioned in the sidebar (column to the left): Gaiam: Yoga For Beginners; Gaiam: Yoga for Stress Relief (With The Dalai Lama); Gaiam: AM/PM Yoga For Beginners (with The Dalai Lama & 10 Routines); and Yoga Journal: Yoga Journal's Yoga for Stress With Dr. Baxter Bell.

A Mind-Body Medicine Approach to PTSD - Conference Oct. 11th and 12th - West Coast

The Institute for Transpersonal Psychology in Palo Alto, CA will hold a seminar on 

Mind-Body Approach to PTSD," October 11th and 12, 2008, featuring a Center for Mind-Body Medicine faculty member, Gjorgji Nikoloski, M.D..  According to the ITP's website, linked here, the program will be a 

"one and a half day workshop that teaches: the scientific basis for mind-body medicine; the depth and power of our unique small group approach; and the use of a range of the most effective tools for self-care and stress management.

Comprehensive materials and hands-on experience will prepare you to integrate our mind-body model into your work in a wide variety of settings, including private practice with individuals and groups, hospital work, educational programs and work with populations affected by war, abuse, terrorism and other forms of trauma.

Our approaches are fundamental to relieving the stress that contributes so significantly to all chronic illnesses, and to comprehensive and integrative approaches to the treatment of PTSD.

The featured presenter, Dr. Nikoloski is a Psychiatrist and Mental health clinician who has worked with child adolescent services and the Community Mental Health Clinic in Guelph, Ontario Canada. He began as Faculty of Mind-Body Medicine in Kosovo in 1999 and Founded the Center for Mental Health and Psychosocial Support in Skopje, Macedonia in1999. He is on the Board of Directors of the Coalition for Work with Psycho-trauma and Peace (CWWPP) in Vukovar, Croatia.  (A more extensive bio for Dr. Nikoloski is linked here.)

To purchase tickets to this event, click here."

There's a Revolution Going On: Users Rate Their Drug and Non-Drug Treatments for PTSD

We're just about to wrap up our series here -- a cycle of blog posts about the various treatments available for PTSD from the pharmaceutical, Complementary and Alternative Medicine ("CAM"), and mind-body medicine worlds. We've talked about bodywork therapies that show promise. Heck, we've even talked about street drugs like marijuana and ecstasy that appear to have some beneficial effects as well! (Sheesh -- we're not recommending them, per se -- we're just trying to do a comprehensive look at everything reasonable that's out there, that might help sufferers.)

We started this cycle of blog posts back in the beginning of June, with one about how the military was expanding its concept of treatment options to include some "revolutionary" non-drug approaches, linked here.  (We'll add to the cycle of posts over time as the need indicates, but the bulk of it is already done on this topic. This post also builds on a previous post, which talked about how a layperson can learn more about the effects and side-effects of medications prescribed, as well as where to learn about possible warnings when used in combination with other medications.  That post is linked here.) 

One of the most interesting developments is something I get to share with you now -- that a year or so ago when I first learned about it, was not robust enough to be of much value to PTSD sufferers.  Perhaps by now it really is.  The "it" I'm talking about here is something called "Revolution Health," the brainchild of AOL co-founder and marketing genius Steve Case, a project he began in 2005, after he left AOL.

Revolution Health is a number of things, but particularly for our purposes here's it's an online "community" of other patients who give their impressions, pro and con, of the treatments they're using for various illnesses and conditions -- including PTSD -- and not just of all the popular pharmaceutical medications, but also the non-drug therapies as well.  Finally, in one place, patients can check out what other people's experiences of the same drugs or therapies they've been prescribed, along with more straightforward information about the treatments themselves, the possible side-effects.  Clearly, for something like this to work, there need to be a LOT of people checking in and providing their impressions. 

When I first checked out the site, those numbers just weren't there.  It's not so exciting, interesting, or frankly even helpful to learn what three people think of a medication or a non-drug treatment like acupuncture or craniosacral therapy -- it gets a LOT more interesting as more people participate.  Such seems to be the case these days (no pun intended) -- but act quickly -- the site has been experiencing layoffs, and with Web businesses, even those founded by geniuses like Steve Case, you never really can count on how long they'll be around.  So be sure to check out what interests you while you still can.

This is what the site said a year ago about itself, which is still good advice:

This service is in its infancy, but our philosophy is that if millions of people participate, it will emerge as a useful tool for people as they consider their treatment options. Please note that treatments include a mix of some that are designed to directly treat a condition, some that treat side effects, some that provide symptomatic relief.

While individual real-life experiences can be a valuable health resource, they must be viewed in the context of evidence-based data and are not a substitute for medical advice. You should always consult a qualified health care professional before beginning, changing or stopping a treatment.

Now let's get down to business:

Want to learn how other participants rank, rate and review the various treatments for PTSD, both drug and non-drug? (Currently there are dozens suggested!), say, Duloxetine? Click here, for a list of the various, searchable treatments. (Better yet, click herefor them ranked by users in order of effectiveness!)  Want to take a look specifically at the pharmaceutical drugs for PTSD? Click here.  How about the various non-drug treatments for PTSD?  They're there, too, by name.  (You can sort either set of results by "most helpful," "most recent," and "highest effectiveness" on any individual treatment (of the 363) or on the category as a whole.)

Note: Be aware that not everyone who's weighing in with their opinion on what treatment they're loving or hating for PTSD has combat trauma-induced PTSD.  They may have PTSD from some completely other cause.  However, as far as relatabilty goes, this is the best we're gonna get for now -- a "Revolution Health" for veterans only does not appear to be in the works.  Ahhh, but we can dream, can't we?!

To reinforce the warning, though -- given the fact that nothing's permanent on the Web, especially "revolutionary business models," get in -- get your information -- and get out -- in case the website goes away, and/or the company goes out of business.  We sincerely hope that Revolution Health sticks around, because it's performing a useful AND innovative, visionary function --  but even more than that, we want YOU to get the information you're looking for, while you still can.  Oh, and if you sign up to be a member -- I believe that it's free -- you can also contribute your ratings to the user-generated rankings.

There's a Revolution going on...in health care.  Get yours now, while it lasts.

Editor's note: The usual "yada."  Be sure to consult with a qualified health care practitioner before changing or implementing a course of treatment, to make sure that the choices you make are appropriate and best for you.  We are presenting this material as information only, and it's not to be construed as medical advice.  If we could, we would; but we can't, so we won't.  There, we've said it.

Healing Hands: Cranio-Sacral Therapy, Veterans and PTSD

Before we leave off talking about Complementary and Alternative Medicine (CAM) therapeutic strategies for dealing with PTSD (usually, in addition to other approaches, not instead of other approaches) -- as we have been discussing lately on this blog, an index to which is linked, here -- it's important to mention one other therapeutic technique: Cranio-Sacral Therapy, developed by Dr. John Upledger (pictured at left).  You'll have to go elswhere -- like the Upledger Institute's website, linked here -- to learn more about the practice -- it would take too long to explain here, because there are several schools of thought on why it might work, and it's a fairly esoteric practice to begin with.  But...an important but...it is a bodywork therapy, akin to massage but not the same as massage, which has shown some effectiveness in improving the symptoms of PTSD.   Digging around on the Upledger Institute's site may help you learn about who practices it in your area of the country, but that is unlikely to be a completely comprehensive list.

For those who believe -- and it surely isn't everyone who does, but many do -- that the physical body "stores" trauma, craniosacral therapy attempts to "release" the stored trauma through the very light, deft touch of the craniosacral therapist.  Not everyone who's been through trauma wants to "talk about it," or "take medications for it" -- for those who are comfortable with a massage-like experience, craniosacral therapy is an opportunity to see if trauma can be cleared, lightly or substantially, using a different method.  (Rumor has it that the Navy and/or the Marine Corps, on the West Coast, is experimenting with using craniosacral therapy to treat PTSD -- more news as that develops.)

Dr. Upledger, and another West Palm Beach, FL-area craniosacral therapist, who I have known for years, and who used to practice together, worked in a novel program years ago to treat Vietnam veterans who were struggling with the effects of PTSD.  In their program were a handful of veterans and at least one medical nurse who had served during Vietnam.  The treatment program allegedly helped some, didn't help some others, and had at least one anomaly as a result: a patient who died in an unrelated car accident, soon after he reported to his family, unfortunately, how much relief he was gaining from the program.  So the results were mixed, but in general, more positive than negative.  (There was even some interest from a famous Hollywood filmmaker, who shall remain anonymous, but who's a big fan of veterans and the Vietnam experience, in filming the experience of veterans undergoing the treatments, but that created controversy for the program, and the idea was eventually dropped.)

Years later, Dr. Upledger did more work with other veterans, and at least one of them, Steve Shumelda, LMT, an ex-military guy with injuries of his own, including PTSD -- was so impressed by the treatments that he gave up whatever he was doing for a living before, and studied craniosacral therapy instead.  He has a practice in South Florida now, and has written about his experience with craniosacral therapy.  You can read more about the Upledger Institute's work with veterans and PTSD, here.

Dr. Upledger has apparently done a video that is available via his Institute on PTSD and veterans and craniosacral therapy.  You can contact their office to see about purchasing a copy.  For additional resources to read up on the topic of craniosacral therapy, veterans and PTSD, click here for a separate blog entry we did recently that consolidates a few in one place.  To read about Vietnam veteran and former Navy corpsman Steve Shumelda, LMT's experience with PTSD and craniosacral therapy, click here.

CranioSacral Therapy, PTSD and Veterans Resources

(This is a drawing by a young child who had PTSD but clearly was not a veteran, given to his CranioSacral practitioner, illustrating what he felt to be her "healing hands.") 

Some resources about CranioSacral therapy and PTSD (this list is not meant to be exhaustive):

An article written by Dr. John Upledger, founder of CranioSacral Therapy, published in the November, 2001 issue of Massage Today magazine, on "The Role of CranioSacral Therapy in Addressing Post-Traumatic Stress," linked here;

An article from the January, 2001 issue of Massage Today magazine, written by the magazine's editorial staff, called "The Power of Touch: Promising Studies on Treatment of Post-Traumatic Stress Disorder," linked here;

An article from the Internationa Alliance of Healthcare Educators (IAHE) newsletter, date unknown but possibly current/2008, written by the Upledger Institute, called "Upledger Research Effective for Vietnam Vets," linked here;

An article from the Upledger Institute's newsletter, apparently from 2007, entitled "CranioSacral Therapy Breaks 20 Year Cycle of PTSD," linked here.  That's the article that talks about Vietnam veteran and former Navy corpsman Steve Shumelda, LMT's experience with PTSD and craniosacral therapy, which predated his career path change.  That article is linked here.

Just Say "Om" - Yoga and Meditation for PTSD

Long before Mehmet Oz, M.D., was a regular guest on "Oprah" -- long before the Army started contemplating whether Complementary and Alternative Medicine had a place in treating PTSD, blogged about here -- there was yoga, and there was meditation.  For thousands of years, these techniques for helped adherents gain flexibility, quiet the mind, and often, restore some inner peace.  CAM for PTSD is in the news recently, but a book by well-regarded Rodale Press, from a dozen years ago, mentions both yoga and meditation, as well as sound healing, as possible therapies for PTSD.  Here's what they have to say:

Stress reduction is an essential part of recovery from post-traumatic stress disorder, says Stephen A. Nezezon, M.D., yoga teacher and staff physician at the Himalayan International Institute of Yoga Science and Philosophy in Honesdale, Pennsylvania.  To lower stress, he says, you can try a daily routine of breathing exercises, mediation, and yoga poses.

Do the complete Yoga breath exercise (see link here) whenever you’re feeling stressed, suggests Alice Christensen, founder and executive director of the American Yoga Association.  Meditation helps clear your mind and teaches you to relax, she says.  For the poses, select three or four from a Yoga daily routine.  Christensen recommends varying the poses daily to keep your interest high and to strengthen different parts of your body.  Dr. Nezezon says you should include at least one relaxation pose, such as "the corpse" (pictured above), "knee squeeze," or "baby," in your daily yoga routine.

Dr. Nezezon also recommends doing the "alternate nostril breath" (explanation linked here) each day as a way of helping you regain emotional balance. 

Source: New Choices in Natural Healing: Over 1,800 of the Best Self-Help Remedies from the World of Alternative Medicine, Edited by Bill Gottlieb, Editor-in-Chief, Prevention Magazine Health Books.  Emmaus, PA: Rodale Press, Inc. (1995).

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For more information about yoga, try these highly-rated instructional videos, produced by Gaiam, an excellent source for such material: Yoga for Beginners, Yoga for Stress Relief (with the Dalai Lama), and AM/PM Yoga For Beginners (with The Dalai Lama & 10 Routines),  You can also try reading about Yoga on About.com (linked here), subscribe to the Yoga Journal, or watch the Yoga Journal's video on Yoga for Stress.  (All hyperlinks lead you to the material described.)

 

For more information about meditation, sometimes referred to as "the inner Yoga," try these videos by Gaiam, an internationally-recognized source of high-quality instructional material about various bodywork therapies, including yoga.  Meditation for Beginners, and/or Relaxation and Breathing for Meditation.  You can also try books at Amazon.com by American author, Jon Kabat-Zinn, Ph.D., featured in an excellent Bill Moyers series on PBS years ago called Healing and the Mind.  Kabat-Zinn is Professor of Medicine Emeritus and founding director of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School in Worcester, Massachusetts.  Kabat-Zinn teaches mindfulness meditation as a technique to help people cope with stress, anxiety, pain and illness, and leads workshops and retreats on the power of mindfulness, such as the one linked here (registration is full, but there is a waiting list).

Back from Hell: Treating PTSD with Massage and Other Bodywork Therapies

An interesting article recently published online talks about the therapeutic benefits of touch (massage therapy, in this case) for PTSD, without making it seem like either a panacea, or a complete walk in the park.  Kudos to the article's author for acknowledging the difficulties faced by this client population, and the special sensitivities needed.  Bodywork modalities like massage therapy, craniosacral therapy, possibly even Reiki and therapeutic touch, hold some promise for treating combat veterans, provided the practitioners are educated about the special challenges of that population, and provided the participants are willing.  (The attached photo is of a crayon drawing, done by one appreciative child patient, depicting his practitioner's healing hands.)

The article is well worth reading, and is excerpted in part below:

Traumatized in war, often faced with family and job relationship difficulties, and also frequently confronted with government bureaucracy, veterans deal with high levels of anger. One study stated, "Anger management intervention is an integral part of post-traumatic stress disorder treatment in the Department of Veterans Affairs facilities across the country."11 The presence of intense anger, along with other deep emotions, can cause a veteran -- triggered during therapy -- to undergo an explosive emotional release. "PTSD may cause a person to fly into a rage for no apparent reason or strike out in fear at inappropriate targets."12

"Vets tend to have a more violent type of reaction if a memory comes up," explained Chris Smith, director of education at the Colorado School of Healing Arts in Lakewood, Colorado. Smith, who is also a massage therapist and instructor for the school's 100-hour program in Trauma Touch Therapy, explained, "It takes a therapist who can stay grounded and isn't afraid of the intense emotional outbursts." Because of their war-time experiences, she said, veterans in therapy may tend to be "less resourced" in how to handle stress and "more hyperaroused" than other trauma clients.

According to some therapists who work closely with veterans, the VA and other group programs provide only limited help for veterans. After a certain amount of time has passed, these therapists say talking about the trauma in a group setting can become a useless "rehashing" of the horrors. To emerge from the sense of victimization may likely demand hard, individual work in therapy on the part of the patient. It generally requires facilitation by an extremely grounded and well-versed therapist. If the veteran chooses to try an alternative therapy, such as massage, the process will likely necessitate participation not only in bodywork sessions, but also in simultaneous sessions with a psychotherapist.

One massage therapist who has worked with veterans visited a VA hospital to learn more about PTSD and observed that many of the veterans were in extremely serious condition. "For many vets, the only answer is a great deal of isolation and seclusion and often medication that can have so many other side effects. They often cope by removing stimulation as much as possible," she said.

It seems like a good time to re-mention the fabulous Claude Anshin Thomas passage in his book, At Hell's Gate (see sidebar), about suffering not being the enemy.  Click this link to bring back that earlier blog entry.