How yoga, meditation and yoga nidra help with PTSD
Name of the Student
Evaluation of the effects of Yoga, Meditation and Yoga-Nidra for management of PTSD
For creating a Contract Proposal
Posttraumatic Stress Disorder refers to an anxiety disorder which may develop in an individual after being exposed to traumatic events. The traumatic events may be assault/combat related which directly affects an individual. However, the individual may witness such assault or combat on others, which may cause PTSD in him or her. Individuals with PTSD experience recurrent flashbacks of the traumatic event, hyper arousal, avoidance of memories, and suicidal attempts which may or may not be associated with depression. If such symptoms remain unaddressed, it may remain chronic for the entire life time. There are various approaches, including pharmacological and non-pharmacological, which are implemented to alleviate the symptoms of PTSD and improving the quality of life in an affected individual (Cahill and Foa 267-313).
Recent developments in non-pharmacological interventions include the use of yoga and meditation-based therapies for the treatment of PTSD. Such interventions provide better coping strategies, in individuals suffering from PTSD. The guiding principle of such therapies is to harness the positive energy present in an individual with PTSD and redirecting the same for the purpose of healing. The present article will evaluate the usefulness of such therapies in PTSD care from theoretical frameworks and literature review. Upon such analysis a contract proposal for implementing yoga and meditation-based therapies would be framed (Stankovic 23-37).
Epidemiology and Pathophysiology of Post Traumatic Stress Disorder
With the changing geopolitical scenario, increased war against terrorism, natural disasters and social abuses there has been an increase in violence and trauma. Such violence and trauma have resulted in increased prevalence of PTSD all across the globe. It is speculated that around 5.2 million American adults suffer from PTSD each year and around 7% to 8% of the population in United States experience some form of PTSD in their lifespan. Studies indicated that around 11% to 30% of US military veterans who were deployed in Iraq, Afghanistan and Vietnam suffered from PTSD. Issues like sexual assault, rape, and bullying also leads to the development of PTSDs (Stankovic 23-37).
PTSD occurs as a consequence of direct combat trauma to an individual or from an indirect trauma that occurs in other individuals. The disease is featured by various physical, mental and emotional extremes. This includes signs of increased exhaustion, insomnia, emotional numbness, hyper arousal, difficulty in concentrating, and avoidance of places, feelings or memories which can trigger the traumatic event (Andreasen 67-71).
Such individuals often suffer from agoraphobia, depression and may have increased suicidal thoughts. Hence, the quality of life of an individual suffering from PTSD is significantly compromised. Moreover, Combat-Related PTSDs are more severe and affects individuals significantly than non combat-related traumas. Combat-Related PTSDs are very difficult to manage through treatments that have been effective for treating acute trauma or chronic PTSDs that are not combat related (Stankovic 23-37).
The symptoms of PTSD occur due to an alteration of various neuro-endocrine pathways. Hyper arousal is associated with increased secretion of adrenaline which occurs as a consequence of increased activation of the sympathetic nervous system during the stressful episodes. Further, increased stress of the traumatic event causes over-activity of the hypothalamic-pituitary-adrenal axis that leads to increased cortisol secretion. Increased secretion of cortisol inhibits the HPA axis through feedback mechanisms. This results in increased sensitivity and hyperactivity of the HPA axis and Locus Ceruleus-Nor epinephrine pathway, which leads to an increase in nor-epinephrine/cortisol ratio. Low levels of cortisol predispose individuals to PTSD. Further, a decrease in serotonin levels is also associated with the symptoms of PTSD (Andreasen 67-71).
The diagnosis of PTSD includes persistent thoughts of the traumatic event leading to hyper arousal, a complete or partial loss of memory, difficulty in falling asleep, panic disorder, depression, and physical outbursts. The diagnoses of PTSD are based on DSM-IV guidelines. Management of PTSD is executed through both pharmacological and non-pharmacological interventions (American Psychiatric Association 467-468).
Pharmacological interventions include treatment with selective serotonin reuptake inhibitors like citalopram and sertraline. Both these medications inhibit the reuptake of serotonin in pre-synaptic neurons, and cause increased availability of serotonin in the synapse, which causes elevation of mood and decreased symptoms of depression associated with PTSD. Benzodiazepines like alprazolam are used for treating the anxiety symptoms associated with PTSD. These drugs are GABA agonists and help to reduce the insomnia and hyperarousal associated with PTSD. Dexamethasone or other glucocorticoids are administered to prevent neurodegenerative symptoms associated with PTSDs (Andreasen 67-71).
Although medications provide symptomatic relief of various PTSDs, it cannot eliminate PTSD in an individual completely. Hence, non-pharmacological interventions through psychotherapy and cognitive behavioral therapy (CBT) are extremely important in the management of PTSDs (Andresen 17-73). Psychotherapy includes counseling of the affected individual and extending social and family support to inculcate improved coping strategies. CBT helps to change the thinking pattern of an affected individual with PTSD, to the recurrent thoughts of trauma.
Such re-experiencing episodes of trauma may lead to habituation and decrease the severity of symptoms of PTSD in the longer run. Another approach called Eye Movement Desensitization and reprocessing therapy is commonly used to manage the symptoms of PTSD. It is speculated that fixing the orientation or gaze of the eye helps to avoid traumatic experiences or symptomatic outbursts of PTSD (Andresen 17-73).
Yoga and Meditation-Based Therapies
Over the last two decades, the clinical application of meditation has provided various therapeutic approaches, for the management of PTSD. Mindfulness based-Stress reduction, Mindfulness-Based CBT, Acceptance and Commitment therapy, Eye movement therapy and Dialectical therapies have been successfully implemented for managing PTSD (Stankovic 23-37).
Mindfulness-based meditation is based on Swami Satyananda Saraswati’s “Yoga Nidra” therapy. The principle of such therapy relies on excavating the self-potential and coping strategies of an individual. Such therapy includes evaluation of “koshas” (different layers of the self). These include awareness of the physical body (anamaya kosha), breathe/ energy potential of the body (pranayama kosha), feelings awareness (manomaya kosha), intellect evaluation (vijnanamaya kosha) and qualities of bliss (anandamaya kosha) (Stankovic 23-37).
The basis of this therapy involves the awareness of an individual regarding his self-emotions, self-sensations, and the way such sensations, emotions and energy may be harnessed to provide coping strategies. The “Tantric Tradition of Kashmir Shaivist Nodualism” endorses that any emotions which are welcomed into the mind of an individual without resistance will transform spontaneously. Such welcoming of emotions improves the receptivity and habituation of the sensations (Stankovic 23-37).
Further, yoga-based physical exercises helps to stimulate the parasympathetic system. The increased stimulation of parasympathetic system helps in balancing the sympathetic discharge of adrenaline. This leads to decrease in arousal phenomenon, improved depth of sleep and reduction in anxiety symptoms which are commonly associated with PTSD. Thus, Yoga and/or meditation based therapies have the potential of not only alleviating the symptoms of PTSD, but also provide improved coping strategies to an individual affected with PTSD (Andresen 17-73).
Existing Literature on Implementation of Yoga-Based Therapy in PTSD
An eight-week study examined the feasibility of offering weekly classes in Integrative Restoration therapy. The study was conducted in San Francisco Bay Area and involved 16 male combat veterans (15 involved in Iraq war and 1 involved in Vietnam War). The intervention strategy implemented was an Integrative Restoration Therapy (iRest). This therapy involved the principles of “Yoga Nidra” and other mindfulness-based meditation techniques including those related to CBT, Eye movement desensitization therapy and others. The protocol for intervention was based on improving the self-efficacy of individuals towards coping with thoughts of the traumatic episodes. The physician was provided absolute flexibility to orient various behavioral and cognitive therapies based on the immediate needs of the individuals (Stankovic 23-37).
11 participants completed the study and it was noted that there was a reduction of overall rage, anxiety, and emotional reactivity in the individuals considered for the study. The study further indicated that the individuals had increased feelings of relaxation, peace, self-awareness, self- control, and self-efficacy despite challenges with mental focus, intrusive memories and other concerns. Further, all the participants who completed the study showed greater inclination of attending weekly classes in Integrative Restoration therapy (Stankovic 23-37).
Vision and Mission of a Contract Proposal
Considering the growing prevalence of PTSD, it would be prudent to initiate community centers for managing PTSD patients. The theoretical frameworks clearly indicated that PTSD is a growing concern and should be significantly addressed. It is also noted that pharmacological interventions have their own limitations and mostly provide symptomatic relief in patients suffering from PTSD, but does not improve coping strategies in such individuals to prevent recurrent symptoms of trauma. The existing literature suggests that Yoga –based meditation therapies are useful options for managing PTSD patients. Even the study considered in this article indicated the feasibility and success of implementing such meditation-based therapies in community settings.
Thus, our proposal is to open a community centric approach with individuals suffering from PTSD. The care unit will consist of a Yoga expert, a Psychotherapist, and a Psychiatrist for implementing and designing intervention strategy based on a multi-disciplinary approach. A pilot study with 15 individuals with PTSD will be conducted and qualitative end points will be assessed to judge the usefulness of the approach. If the pilot study is feasible and reflects statistically significant results, the initiative for starting such approaches in the community may be finalized.
Andresen J. “Meditation meets behavioral medicine: the story of experimental research on
meditation”. Journal of Consciousness Studies 7.11-12(2000):17-73. Print
Andreasen, N. “Posttraumatic stress disorder: a history and a critique”. Annals of the New
York Academy of Sciences 1208 (2010): 67–71. Print
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders
DSM-IV-TR. 4th edition (text revision). Washington, DC: American Psychiatric
Publishing, 2000. 467-468. Print
Cahill, S. & Foa, E. Advances in the Treatment of Posttraumatic Stress Disorder: Cognitive-
behavioral perspectives. New York: Springer, 2004.267–313. Print
Stankovic, L. “Transforming Trauma: A Qualitative Feasibility Study of Integrative
Restoration (iRest) Yoga Nidra on Combat Related Post-Traumatic Stress Disorder”.
International Journal of Yoga Therapy 21 (2011):23-37