Yoga & the Treatment of PTSD
Our culture is defined by stress and science has proven that stress changes us physiologically over time. Some adaptations to stress can be a good thing, things like larger muscles or some excess weight being lost. However for many, when the stress levels become exceedingly high in a single instance such as the life or death situations faced repeatedly overseas by service men and woman or any first responder, that stress adaptation literally “re-wires” that person's brain. As described in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM 5), PTSD is diagnosed by assessing for symptoms associated with a traumatic event that begin after the traumatic event occurs, persist for more than a month, and cause distress and/or impair function (5).
According to the Department of Veterans Affairs, the results of soldiers diagnosed with PTSD vary by military conflict. In Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF): About 11-20 out of every 100 Veterans (or between 11-20%) who served in OIF or OEF have PTSD in a given year. For Gulf War (Desert Storm), veterans about 12 out of every 100 Gulf War Veterans (or 12%) have PTSD in a given year and for Vietnam era veterans, about 15 out of every 100 Vietnam Veterans (or 15%) were currently diagnosed with PTSD. For soldiers currently serving in today’s conflict, that first statistic continues to rise as the current on-going conflicts in Iraq and Afghanistan have been the longest wars in our nation’s history. Treatment of these conditions has seen varying levels of success between western pharmaceuticals (which often produce more side effects needing more drugs) and other forms of psychological counseling. For myself, rather than try and suppress symptoms with drugs on restless nights, I turned to the teachings of yoga for the treatment of post traumatic stress.
As a former soldier, I have personally known many individuals who suffer from PTSD and in many ways that are far less dramatic than displayed in “horror stories” about guys waking up in the middle of the night and digging a foxhole in their front yard. According to Bessel Van Der Kolk, in the book “The Body Keeps Score” traumatic events include a feeling of a “loss of self”.(2). Before I joined the military, I lived a very uneventful and non-traumatic life. I came from a good, loving, upper-middle class family where suffering was avoided. My home and school life were fantastic, never getting into trouble or straying far from the beaten path. Interestingly enough, in my later adolescent years, I in fact, TURNED to stress, to jar me out of the box I felt I was in. Not only did I decide on the military but I wanted to join the Infantry, go to Ranger School and ultimately end up in the United States Army elite Special Operations unit, the Green Berets. I watched 9/11 unfold from my TV screen as a freshman in high school and at least cognitively was aware that being a part of the wars in Iraq and Afghanistan would result in some sort of “action”. It was around that time that I first became aware of yoga. I was very active growing up and used yoga in college after long training sessions to stretch my hamstrings out and recover. I never said “namaste” at the end, mostly because I didn’t want to be “one of those types”. For many veterans looking for healing, the traditional medical care system is considered “unacceptable”. Complementary and alternative medicine (CAM) includes practices or treatments that are not considered to be part of conventional medicine. A survey conducted in 2011 found that 50% of veterans under the care of the Veterans Administration use at least one form of CAM. The most utilized CAM therapies were mindfulness, stress management, progressive muscle relaxation, art therapy, yoga, and meditation. (5)
When breaking down post traumatic stress in the veteran community, you must expand your viewpoint to include more than just the stress surrounding the thought of death and dying. Other factors in a combat situation can add more stress to an already stressful situation. These factors include what you do in the war, the politics around the war, where the war is fought, and the type of enemy you face (1). My life as a military officer was stress. You were never technically “off” and taking the route I chose, Special Forces meant even more stress; as a matter of fact, most of my time away from loved ones wasn’t from deployment, it was from training. During my initial training, you were constantly evaluated. For two years of my life, in everything I did, I was tested and critiqued. As Dr. Van Der Kolk later states in her book, “stress rearranges your perception of reality”. Earlier forms of PTSD for myself was a constant state of hypersensitivity. My days in training felt heavy as I felt that even my actions at home were being judged, like an insecure teenager in their mid 20’s, my perception was that everyone was “looking at me”. This is where I learned what pranayama was.
The state of hypervigilance is very common amongst veterans suffering with acute PTSD. In many VA clinics, therapists will use similar pranayama techniques to lower blood pressure and heart rate, associated with sympathetic nervous responses to stimulus.(3). One of the most common critiques I heard from my family and loved ones was that I “was never present”. After some years of reflection, my belief is that it had something to do with the symptoms associated with hypervigilance. I was introduced to breath practices on a shooting range, mostly because they have such a tremendous crossover to the focus required for tactical marksmanship. It was again, reiterated in a regular yoga class I started attending how “breathing brings you into the present moment”. From personal experience, I can say that this most definitely works. According to Dr. Melanie Greenberg, the subsequent stimulus of traumatic events causes the brain to think its under attack, quite literally “re-living the incident”: “When your brain detects a threat, the amygdala initiates a quick, automatic defensive (“fight or flight”) response involving the release of adrenaline, norepinephrine, and glucose to rev up your brain and body. Should the threat continue, the amygdala communicates with the hypothalamus and pituitary gland to release cortisol. Meanwhile, the medial part of the prefrontal cortex consciously assesses the threat and either accentuates or calms down the “fight or flight” response.(4) In essence, during these episodes of hypervigilance, I was anywhere but present. Not only did I struggle to be present, I also struggled to be happy. Research shows overactivity of the amygdala-amygdala-insult circuit can suppress the medial PFC, thereby interfering with the ability to regulate negative emotions and assign more positive meaning to events (4). Hypervigilance kept moments of my life out of focus.
Thankfully, the culture of the military and society is changing and beginning to understand how to better prepare and handle service members dealing with many of these unseen demons. Many VA clinics in cities around the country with major military bases have yoga programs for veterans, not only to deal with the psychological wounds of war but also the physical rehabilitation that comes along with a career or service. Yoga in a variety of forms and fashions is currently being implemented across the active and veteran community. Many non-profit organizations are currently paving the way to make yoga available for all those who need it. Having worked with several of these programs myself, Warriors at Ease (WAE) is a non-profit organization that provides advanced training to certified yoga instructors based on a specialized approach that is trauma-informed, incorporates evidenced-based techniques, and is sensitive to the unique aspects of military culture. The WAE approach was initially developed in 2009 by four co-founders who were involved pilot yoga and meditation programs at Walter Reed Army Medical Center and VA Hospitals in Washington D.C. and Miami. There are more than 700 WAE teachers offering trauma-sensitive yoga to veterans along with other veteran service organizations such as Team Red, White, and Blue, Wounded Warrior Project, and Veterans of Foreign Wars. Not only is yoga currently being shown to be effective, it is also one of the most sustainable forms of care, because that’s ultimately the deal with PTSD. There isn’t a cure. Through the practice of mindfulness and yoga, the best we can hope for is a continued dampening of symptoms but the root cause will never go away however the best solution we’ve come up with for treatment, ironically, has been around forever.
Works Cited and Suggested Future Reading:
Department of Veterans Affairs: “How common is PTSD in Veterans?”: URL: https://www.ptsd.va.gov/understand/common/common_veterans.asp
Van Der Kolk, Bessel “The Body Keeps Score: The Brain, Mind and Body in the Healing of Trauma”: Penguin Books 2014
Friedman, Jennifer Yoga Journal “5 Ways Yoga Helps Veterans with PTSD” Aug 18 2015, URL: https://www.yogajournal.com/poses/5-ways-yoga-helps-treat-ptsd
Greenberg, Melanie Psychology Today “How PTSD and Trauma Affect Your Brain Functioning” September 2018: URL: https://www.psychologytoday.com/us/blog/the-mindful-self-express/201809/how-ptsd-and-trauma-affect-your-brain-functioning
MAJ Cushing, Robin, et. al “Military Tailored Yoga for Veterans Dealing with Post Traumatic Stress Disorder” August 10, 2018 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086130/