The skills learned during therapy sessions are practiced repeatedly and help support symptom improvement. CBT treatments traditionally occur over 12 to Treatments for Veterans With PTSD — Outside the Traditional Toolbox By Kate Jackson Social Work Today Vol. 14 No. 2 P. Evidence-based practice is the. Although efficacious treatments for PTSD have been established, “Integrative” is a term used to refer to the combination of traditional and.
PTSD Traditional Treatments for
When evaluating only those studies where a PTSD diagnosis was required, all grades remained the same except for three modalities. When evaluating only the RCTs, all grades remained the same except, again, yoga breath work was downgraded to Lack of Evidence because it did not include an RCT.
We believe that at this relatively young stage of CAM research it is important to evaluate all the available evidence for a particular modality, and inclusion criteria were deliberately kept broad to capture as many studies as possible.
Evidence was Unclear or Conflicting for biofeedback, relaxation, Emotional Freedom and Thought Field therapies, yoga breath work, and natural products. Studies included in this review were of variable quality. Important aspects of rigorous research design were often not conducted or not reported. In order to improve the quality of the CAM research field and accurately determine efficacy of CAM modalities, investigators are encouraged to consider the following when designing studies: Studies in this review recruited from a variety of settings e.
Participants were from the general population, combat veterans, firefighters, and sexual abuse survivors. About one-third of the studies were specific for combat-related trauma and another third enrolled participants with a diverse mix of trauma exposure. Studies varied widely with respect to participant gender. Some studies enrolled only men, other studies only women, and several had a diverse mix of male and female participants.
All-male studies most frequently targeted combat-related trauma whereas all-female studies more often addressed sexual abuse, thus reflecting gender differences associated with these trauma exposures. While the grades did not distinguish by trauma type or gender, the results lend preliminary support to the acceptability of CAM for people with a variety of trauma exposures and genders.
Additional research and synthesis of evidence is needed to address the efficacy of each modality by trauma exposure and gender. There is positive evidence of effectiveness for rTMS, acupuncture, hypnotherapy, meditation, and visualization for the treatment of PTSD symptoms.
Future TMS research would clarify dosing relationships to efficacy i. Acupuncture may help PTSD through its effects on the autonomic nervous system and prefrontal and limbic brain structures, systems that are intrinsically involved in PTSD pathophysiology. Meditation also appears to be helpful for PTSD. While there are various meditation styles, all types incorporate self-observation of mental activity, attention training, and cultivating an attitude that highlights process rather than content.
Hypnotherapy , another mind-body medicine, is a psychotherapeutic technique based on the hypnotist providing suggestions for changes in sensation, perception, cognition, affect, mood, or behavior. Visualization is a lived experience that is a dynamic, quasi-real, psychophysiological process.
At this point, the evidence is Unclear or Conflicting for biofeedback, Emotional Freedom and Thought Field Therapies, yoga breath work, relaxation, and natural products. Future studies are warranted to clarify results before practitioners should recommend them specifically for PTSD symptoms. Our work builds on a previous review conducted by Strauss et al. While our overall search strategy was not as comprehensive, both reviews highlight the importance of improved CAM clinical trial methods, more rigorous reporting, and the need for more RCTs in CAM research.
Various limitations must be considered when reviewing these results. Some modalities included in this review may not be considered CAM modalities e. Those definitions included magnet therapy under the Energy Medicine category and hypnotherapy under the Mind-Body Medicine category.
Although we included all languages in our search strategy we only found English papers. We searched only published papers; grey literature resources were not included and hand-searches of relevant bibliographies were not conducted.
Publication bias is present when positive trials are more frequently published over negative studies. It is possible that this impacted our review as we found 17 positive trials and five negative trials 7 neutral and four mixed. Another limitation is that we did not take into account outcome measure timing in our grading schema. For example, we were not able to distinguish if each modality had more or less evidence for PTSD symptoms immediately after the treatment versus at a longer-term follow-up.
Additional studies with less heterogeneity in methods, participants and outcomes need to be conducted before rigorous meta-analyses can be done. Because of this, the results from this study must be viewed as qualitative trends rather than conclusions. There is insufficient evidence to recommend biofeedback, Emotional Freedom and Thought Field Therapies, relaxation, yoga breath work, and natural products at this time.
Future research should include larger, properly randomized, controlled trials with appropriately selected control groups and rigorous methodology. The authors would like to thank Hannah Moshontz for her help with this project. The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflict of Interest statement No competing financial interests exist for all authors. National Center for Biotechnology Information , U. Author manuscript; available in PMC Sep Author information Copyright and License information Disclaimer. CR, Portland, Oregon , ude.
See other articles in PMC that cite the published article. Associated Data Supplementary Materials Supplementary data. Study eligibility Two reviewers independently screened titles and abstracts of all publications retrieved by the search strategies. Studies meeting the following inclusion criteria, and those with insufficient information to determine eligibility from the abstract, were selected for further review: Study design Randomized controlled trials RCTs , non-randomized controlled trials CTs , cross-over trials, prospective and retrospective observational studies with controls, case-control studies, and uncontrolled pre-post studies where the sample size was greater or equal to five.
Outcome measures Each study had to include at least one measure assessing PTSD symptoms such as intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Data extraction and management The following data were collected: Assessment of methodological quality Each study was evaluated for risk of bias and methodological quality. Instruments used to assess Risk of Bias and Methodological Quality The Cochrane Risk of Bias Tool evaluates selection, performance, detection, attrition, reporting and other biases and is the current gold standard for assessing bias in RCTs.
Each criterion are categorized as High risk of bias, Unclear risk of bias, or Low risk of bias and consider whether the risk of bias is sufficient enough to have a notable impact on the results or conclusions of the trial. A quantitative score is calculated that is adjusted for study design by removing questions about randomization, comparisons between groups, and blinding for non-RCT and uncontrolled trials. The result is an adjusted score on a scale of 0—, being a higher quality study.
Data synthesis and evidence grading A meta-analysis for this study was not possible because of substantial variation in participant type, interventions, implementation, and outcomes across studies.
Table 1 Natural Standard evidence-based validated grading rationale. D Fair negative scientific evidence Statistically significant negative evidence i. F Strong negative scientific evidence Statistically significant negative evidence i. Lack of evidence Unable to evaluate efficacy due to lack of adequate available human data. Open in a separate window. Table 2 Characteristics of included studies.
No diff 1Hz rTMS vs. EMDR group received 3. For example, Hollifield had a positive results compared to the waitlist Positiveb but a Neutral results compared to the active control because both active control groups had improvements from before to after the intervention.
Description of included studies All manuscripts were published between and Methodological quality of included studies Methodological quality for all studies as determined by the QAT is presented in Table 2. Quality of the body of evidence for each modality The body of evidence for each modality for PTSD was reviewed.
Acupuncture Two RCTs, both of which demonstrated significantly improved symptoms over control conditions were included. Hypnotherapy Three studies 2 RCTs and 1 pre-post were included. Meditation Nine studies were included, five RCTs and four pre-posts. Relaxation Four studies 2 RCTs, 1 pre-post, and 1 cross-over were included, three of which had significant methodological issues and showed mixed or negative results.
Visualization One large, high quality RCT was included. Yoga breath work One large non-randomized CT was included demonstrating that yoga breath work alone and in combination with exposure therapy is better than wait list for acute trauma survivors. Natural products Two RCTs were included. Implications for research Studies included in this review were of variable quality. Overall completeness and applicability of evidence Studies in this review recruited from a variety of settings e.
Implications for clinical practice There is positive evidence of effectiveness for rTMS, acupuncture, hypnotherapy, meditation, and visualization for the treatment of PTSD symptoms. Agreement and disagreements with other studies or reviews Our work builds on a previous review conducted by Strauss et al. Limitations Various limitations must be considered when reviewing these results. Supplementary Material Supplementary data Click here to view. Acknowledgment The authors would like to thank Hannah Moshontz for her help with this project.
Footnotes Conflict of Interest statement No competing financial interests exist for all authors. Archives of General Psychiatry The cost of treating anxiety: Psychoneuroimmunology and psychosomatic medicine: J Clin Psychiatry Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing Inc. An Assessment of the Evidence.
National Academies Press; Imagery rescripting and reprocessing therapy after failed prolonged exposure for post-traumatic stress disorder following industrial injury.
J Behav Ther Exp Psychiatry Emotional Processing of Traumatic Experiences. Oxford University Press; What Is Complementary and Alternative Medicine? Complementary and alternative medicine use among adults and children: Natl Health Stat Report Use of complementary and alternative medicine in a large sample of anxiety patients.
Meditative therapies for reducing anxiety: Depression and Anxiety Department of Veterans Affairs; The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. Aid to the evaluation of therapeutic studies. Evaluating non-randomised intervention studies. Natural Standard evidence-based validated grading rationale. Comparative efficacy, speed, and adverse effects of three PTSD treatments: J Consult Clin Psychol.
Hypnotherapy and cognitive behaviour therapy of acute stress disorder: Acupuncture for posttraumatic stress disorder: J Nerv Ment Dis. A controlled comparison of the effectiveness and efficiency of two psychological therapies for posttraumatic stress disorder: Clinical study on treatment of the earthquake-caused post-traumatic stress disorder by cognitive-behavior therapy and acupoint stimulation.
J Tradit Chin Med. Hypnotherapy in the treatment of chronic combat-related PTSD patients suffering from insomnia: The International journal of clinical and experimental hypnosis. Caspi O, Burleson KO. Methodological challenges in meditation research. Adv Mind Body Med Randomized, controlled, six-month trial of yoga in healthy seniors: Altern Ther Health Med The role of expectancies in the placebo effect and their use in the delivery of health care: Health Technol Assess Ann Intern Med Clinically meaningful efficacy and acceptability of low-frequency repetitive transcranial magnetic stimulation rTMS for treating primary major depression: Meditation practices for health: Mindfulness-based stress reduction and health benefits.
J Psychosom Res Mindfulness-based cognitive therapy for depression: J Consult Clin Psychol Mason O, Hargreaves I. A qualitative study of mindfulness-based cognitive therapy for depression. Br J Med Psychol Treatment-resistant depressed patients show a good response to Mindfulness-based Cognitive Therapy.
Behav Res Ther Finucane A, Mercer SW. An exploratory mixed methods study of the acceptability and effectiveness of Mindfulness-Based Cognitive Therapy for patients with active depression and anxiety in primary care. Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: Mindfulness meditation, anxiety reduction, and heart disease: Fam Community Health Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders.
Gen Hosp Psychiatry Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry Cogn Behav Ther Mindfulness-Based cognitive therapy for prevention of recurrence of suicidal behavior. J Clin Psychol The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: Impact of mindfulness-based stress reduction MBSR on sleep, mood, stress and fatigue symptoms in cancer outpatients.
Int J Behav Med Mindfulness meditation for posttraumatic stress disorder. The Wiley Blackwell Handbook of Mindfulness. Hypnosis for cancer care: Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnosed with fibromyalgia.
J Altern Complement Med Imagery in Healing Shamanism and Modern Medicine. Shambhala Publications, Inc; A new hypnotic technique for treating combat-related posttraumatic stress disorder: Noninvasive brain stimulation with high-frequency and low-intensity repetitive transcranial magnetic stimulation treatment for posttraumatic stress disorder.
The Journal of Clinical Psychiatry. Their initial pilot studies have shown positive results including reduced depression and an overall improved quality of life. Naturespace , an innovate 3-D holographic sound app, works as a tool for managing anxiety by playing calming nature sounds. This sensory mindfulness subconsciously tells the brain that the surrounding environment is safe, which triggers a calming bodily response.
Those who suffer from chronic anxiety have found the app very beneficial. Mind-body medicine trains your mind to focus on the body. These techniques use the power of thoughts and emotions to influence your overall physical well-being. Western medical views and practices stand in opposition to such practices and tend to focus on the opposite, yet many individuals find relief using these methods.
Meditation, acupuncture, yoga and other exercise training all fall in this category. Department of Veterans Affairs reports that around 40 percent of those diagnosed with PTSD use alternative, non-medicinal treatment methods to address their problems. Mind-body treatments, such as meditation or exercise therapy, were the most frequently reported alternative or complementary therapy method.
Mindfulness is a state of mind in which the individual maintains a moment-by-moment awareness of the body, surrounding environment, feelings and thoughts. This technique requires the patient to actively practice staying in the moment. The results were astonishing. Researchers could physically measure changes in brain activity in MRI scans of those veterans who went through mindfulness training. Five non-medical alternative treatments for PTSD include cognitive behavioral therapy, eye movement desensitization and reprocessing, sound therapy, mind-body medicine and practicing mindfulness.
Trauma symptoms are very specific for different individuals, so not all types of therapy may be appropriate in every case.
Post-traumatic Stress Disorder Treatment Program Options
When you have PTSD, it might feel like you'll never get your life back. But it can be treated. Therapy and medications can work very well and. Thus, the evaluation of PTSD treatments that could be used in conjunction with Medical Systems (acupuncture or traditional Chinese medicine, homeopathy. The National Center for PTSD explains that the most effective treatments for post traumatic stress disorder involve medication or different types of therapy.