Complementary and integrative health (CIH) practices have gained traction in recent years as ways to support coping in individuals with posttraumatic stress disorder (PTSD). Broadly, CIH approaches focus on the connection between mind and body, and include practices such as:
CIH practices have been used for thousands of years to promote well-being and reduce stress. Acupuncture has been found to relieve chronic pain, yoga is associated with reductions in blood pressure, and meditation can help to decrease symptoms of anxiety, depression, and insomnia.
The appeal of CIH practices among trauma patients and their providers is intuitive. PTSD profoundly undermines an individual’s sense of safety in the world, and is associated with marked physiological arousal. Health practices that promote relaxation and a sense of well-being therefore have obvious draw for those hoping to counteract PTSD symptoms. Proponents of adjunctive CIH approaches in trauma recovery also suggest that these practices help to facilitate affective regulation and attunement to internal responses to triggers, which may in turn enhance a traumatized individual’s ability to fully engage in trauma-focused treatment.
In addition to CIH approaches as a supplement to treatment as usual, there has also been interest in acupuncture, meditation, and yoga as standalone treatments for PTSD. Advocates for CIH interventions argue that existing evidence-based trauma treatments can be daunting, and point to the fact that some individuals leave treatment early or experience residual symptoms even after successfully completing a manualized protocol. By offering an alternative to existing treatments, they suggest, more people could benefit.
Before recommending any course of treatment, however intuitive, it is important to consider the research evidence. The VA/DoD Clinical Practice Guideline for the Management of PTSD and Acute Stress Disorder provides a detailed review of the research support for a wide range of therapeutic interventions for trauma and stressor-related disorders. With respect to acupuncture, yoga, and mindfulness meditation, the Management of Posttraumatic Stress Disorder Work Group reviewed randomized clinical trials evaluating the effectiveness of CIH approaches for treating PTSD. While studies suggest that these interventions can yield a meaningful reduction in PTSD symptoms, the work group noted a number of methodological limitations in the existing research that reduced their confidence in the generalizability of these findings. These methodological considerations included sample size, participant attrition, treatment adherence, control conditions, and post-treatment follow-up.
The bottom line for mental health providers: There is currently insufficient evidence to recommend CIH practices to patients as standalone or primary treatments for PTSD.
That said, patients may find CIH practices to be a helpful supplement to individual or group therapy for PTSD. Indeed, the work group found that yoga and meditation statistically significantly reduced PTSD symptoms across all sources of trauma when offered as augmentation to treatment as usual.
Thinking about incorporating CIH practices into treatment planning? Here are some considerations for recommending CIH approaches to supplement PTSD treatment:
- Be ready to advocate. Due to our Western medical model, some patients may be quite skeptical of CIH approaches. Being prepared to describe what is involved in each practice, as well as the research support for its benefits, can go a long way in getting patients to seriously consider supplementing treatment with a CIH approach.
- Do the legwork. Learn when and where various CIH interventions are offered in your medical center or the surrounding area, and be prepared to discuss options with your patients. Patients may be more likely to follow through if you can give them a solid recommendation.
- Consider patient preference. No one CIH practice has emerged as superior to others in reducing PTSD symptoms, so patient preference (and treatment availability) should guide treatment planning decisions. For example, there is a wide range of options for mindfulness and meditation, from unstructured at-home practice to a manualized protocol like mindfulness-based stress reduction.
- Encourage trauma-sensitive options. Trauma-sensitive yoga modifies the environment and delivery of a yoga class to address the relaxation needs and preferences of individuals with PTSD; for example, covering windows, minimizing visual distractions, and correcting postures verbally rather than through touch. Patients with PTSD may have a more positive experience in an environment that minimizes triggers.
Kelly is a contracted psychological health subject matter expert at the Psychological Health Center of Excellence. She has a master’s degree in counseling and psychological services and a doctorate in counseling psychology. She specializes in trauma, vocational psychology, and multicultural counseling.
The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.