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Kundalini yoga meditation shows promising effects for those suffering with PTSD.
Posttraumatic stress disorder (PTSD) has spread in plague proportions throughout many countries, especially those in the war-torn Middle East. However, in the U.S., we mostly only hear about PTSD since the VA Hospital system has been overloaded for nearly a decade and is failing to effectively treat the vast majority of military veterans who have returned from combat in Iraq and Afghanistan. The U.S. mainstream news is not covering the millions suffering from PTSD in Iraq, Afghanistan, Syria, Gaza, the West Bank, Yemen, and Libya, where war and terror are a daily, if not at least a constant threat. Death and mayhem have a way of imprinting the psyche such that the victims of war often relive their horrors at a high or near constant level, especially when escaping a war zone is not possible. This article gives a brief overview of the incidence rate in different populations, the defining factors of the disorder, a limited review of conventional treatment approaches, and finally, a powerful, accessible, novel, and new protocol using Kundalini Yoga meditation specific for treating PTSD.
The Incidence Rate of PTSD in the U.S. Military:
If we only consider U.S. veterans, and we use the recent figures of the National Center for PTSD1 (U.S. Department of Veteran Affairs), for those who served in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF): between 11-20% have PTSD in a given year; 12% of Gulf War (Desert Storm) veterans have PTSD in a given year. According to The National Vietnam Veterans Readjustment Study conducted between November 1986 and February 19882 "the estimated lifetime prevalence of PTSD among American Vietnam theater veterans is 30.9% for men and 26.9% for women. An additional 22.5% of men and 21.2% of women have had partial PTSD at some point in their lives. Thus, more than half of all male Vietnam veterans and almost half of all female Vietnam veterans - about 1,700,000 Vietnam veterans in all - have experienced "clinically serious stress reaction symptoms," and according the 1986-88 study "15.2% of all male Vietnam theater veterans (479,000 out of 3,140,000 men who served in Vietnam) and 8.1% of all female Vietnam theater veterans (610 out of 7,200 women who served in Vietnam) are currently diagnosed with PTSD. Another more recent study published in 2015 states slightly higher figures (23%) for returning OIF and OEF veterans.3 When left untreated, PTSD is associated with high rates of comorbidity, disability, suicide, and poor quality of life.
The Incidence Rate of PTSD in the General U.S. Population and Common Causes
The Nebraska Department of Veterans' Affairs (2007):4
"estimates 7.8 percent of Americans will develop PTSD at some point in their lives, with women (10.4%) twice as likely as men (5%). About 3.6 percent of U.S. adults aged 18 to 54 (5.2 million people) have PTSD during the course of a given year. This represents a small portion of those who have experienced at least one traumatic event; 60.7% of men and 51.2% of women reported at least one traumatic event. The traumatic events most often associated with PTSD for men are rape, combat exposure, childhood neglect, and childhood physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse."
The Prevalence Rate of Traumatic Events Globally for Non-Middle Eastern Countries
When we consider traumatic events that can occur in 8 classes as defined by the World Health Organization (WHO) Composite International Diagnostic Inventory (CIDI)5 there are: war events, physical violence, sexual violence, accidents, unexpected death of a loved one, network events (involving others in one's social network), witnessing trauma, and other trauma comprising other traumatic events not included in the CIDI list, and 'private events' that respondents did not report because of embarrassment. The WHO finds a lifetime traumatic event prevalence rate of 73.8% for South Africa6 which is higher than Europe and Japan where the rate was in the range of 54–64%, with Spain7 at the lowest at 54%, Italy8 at 56.1%, Japan's9 at 60%, and Northern Ireland's10 with the highest in Europe at 60.6%.
In general, according to a 2015 article:11
"Recent community studies show that trauma exposure is higher in lower-income countries compared with high-income countries. PTSD prevalence rates are largely similar across countries, however, with the highest rates being found in post conflict settings. Trauma and PTSD-risk factors are distributed differently in lower-income countries compared with high-income countries, with sociodemographic factors contributing more to this risk in high-income than low-income countries. Apart from PTSD, trauma exposure is also associated with several chronic physical conditions. These findings indicate a high burden of trauma exposure in low-income countries and post conflict settings, where access to trained mental health professionals is typically low."
The American Psychiatric Association's Defining Factors for PTSD
The APA12 defines PTSD as a psychiatric disorder where a person has:
"experienced, witnessed, or was confronted with an event(s) that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, the person's response involved intense fear, helplessness, or horror. The traumatic event is persistently re-experienced in one (or more) of the following ways: recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions; recurrent distressing dreams of the event; acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated); intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event; physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event."
A "Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: efforts to avoid thoughts, feelings, or conversations associated with the trauma; efforts to avoid activities, places, or people that arouse recollections of the trauma; inability to recall an important aspect of the trauma; markedly diminished interest or participation in significant activities; feeling of detachment or estrangement from others; a restricted range of affect; sense of a foreshortened future."
There must also be "persistent symptoms of increased arousal as indicated by two (or more) of the following: difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, exaggerated startle response." These symptoms must last for greater than a month and cause "significant distress or impairment in social, occupational, or other important areas of functioning." When they last for less than a month, this array of symptoms is defined as acute stress disorder.
Conventional Approaches for Treating PTSD
The US Department of Veterans Affairs (VA) has invested heavily in what they consider their first-line therapies, prolonged exposure therapy and cognitive processing therapy. However, both are labor intensive strategies that have much to be desired and psychotropic medications are not considered curative, and at best may help with some symptoms, and almost always have major side-effects. Thirty percent to 50% of veterans participating in prolonged exposure or cognitive processing therapy fail to show clinically significant improvements,13,14 and dropout is high, ranging from 30% to 38% in randomized trials and 32% to 44% in clinic-based studies.13-15 Others16 find that 60% of eligible OEF/OIF veterans failed to begin or dropped out of these treatments because of the difficulties tolerating trauma-focused material. Thus, research aimed at testing novel treatments for PTSD in this population is important.
One recent novel study at a VA Hospital used Mindfulness-Based Stress Reduction (MBSR) with 9 sessions consisting of 8 weekly 2.5 hour group sessions and a daylong retreat, compared to a control group with 9 weekly 1.5 hour group sessions (present-centered group therapy).17 They showed a 12% improvement using the gold standard for measuring PTSD symptoms, the "PTSD Checklist" for MBSR compared to a 6% improvement for the control group. After 2 months of follow up the improvements were 14% and 5%, respectively. The retention of patients in the study was high. However, the authors conclude, "the magnitude of the average improvement suggests a modest effect."
Research Using Kundalini Yoga for Treating PTSD
Two recent studies have used Kundalini Yoga (KY) to treat PTSD.18,19 However, only the second study19 used a "gold standard" for measuring PTSD treatment efficacy, both only used wait-listed control groups, which do not control for placebo or attentional effects, and neither described their randomization process. The first study consisted of weekly 90-minute group practice sessions over 8 weeks, 40 subjects (self-perceived PTSD symptoms, no official diagnosis), including a 15 minute home practice, taught by 3 different teachers, with groups ranging in size from 3 to 8. The authors do not report details or provide a reference for the techniques other than that they are "warm-up exercises, postures, relaxation, breathing techniques, and meditation" for the in-class practice, and that "The home practice consisted of three KY meditations with designated breath work, mantra, mudra, and postures." The authors state "The protocol is available by request." The analysis of subjects after treatment involved a 30-60 min qualitative phone interview and the authors conclude:
"Qualitative analysis identifies three major themes: self-observed changes, new awareness, and the yoga program itself. Findings suggest that participants noted changes in areas of health and well-being, lifestyle, psychosocial integration, and perceptions of self in relation to the world."
This study would not be included in a Cochrane Review, meta-analysis, or systematic review.
The second trial19 included 59 subjects (55 females) in the active group and 21 (16 females) in the wait-listed control group. In this study participants were allowed to concurrently undergo outside treatment as long as it did not have "a contemplative component. These included CBT and exposure therapies." The subjects were recruited through ads and had no official diagnosis. They report that during treatment "57% of the waitlist control group sought alternative treatment and that 39% of the yoga group was involved in other therapies." They had a 30% drop out in the yoga group and 100% retention in the wait-listed group. The program involved weekly 90 minute classes, taught by 3 teachers, and the subjects were encouraged to devote 15 minutes per day to home practice.
"Four KY yoga sets entitled Creating Internal Balance, Renew Your Nervous System and Build Stamina, Sahibi Kriya, and Adjust Your Flow were utilized in the curriculum. Each set was practiced for two consecutive weeks: week one at 1/2 time and the following week at full time (maximum of 45–50 minutes)."
However, when comparing the primary efficacy variable (PTSD Checklist) between groups at baseline there was greater severity in the yoga group. The yoga group showed a 30% improvement at study end on the PTSD Checklist and the wait-listed group showed no improvement.
Using a Kundalini Yoga Meditation Protocol Specific for Treating PTSD
Since the two KY studies cited above have major design flaws, we cannot draw conclusions from either trial. In addition, both failed to use a Kundalini Yoga Meditation (KYM) protocol specific for treating PTSD that was published openly in 200620 and in 2012.21 The Department of Defense was solicited for funding in 2006 for testing a PTSD-specific KYM protocol. However, to date, no clinical trials have been conducted employing this protocol. However, we have excellent results from two clinical trials that used a KYM protocol specific for treating obsessive compulsive disorder (OCD), supposedly one of the most difficult psychiatric disorders to treat, that may infer the potential for a marked success when employing a disorder-specific KYM protocol. This KYM OCD-Specific protocol has now been tested twice by this author in collaboration with faculty from the Department of Psychiatry, University of California San Diego. A third trial has been conducted elsewhere but the results are not yet submitted for publication. The first was an open uncontrolled trial with 8 patients diagnosed to have OCD for an OCD expert for a 12-month 2 hour weekly class with 1 hour of prescribed homework.22 Subjects improved on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) comparing baseline with three, six, nine, & 12 month results (one-way ANOVA for repeated measures, F(4,12) = 3.343, p = 0.046. Five patients completed the study with Y-BOCS results that showed a 83%, 79%, 65%, 61% improvement, and one at -18%, and a group mean improvement of 54%. The Symptoms Checklist-90-R showed significant improvement comparing baseline and 12 months using two-tailed T-tests for OCD (t = 13.856, p < 0.001), anxiety (t = 3.167, p < 0.051), and global severity indexes (t = 7.314, p= 0.005). Perceived Stress Scale scores showed significant improvement for the five patients completing the trial with a one-way ANOVA for repeated measures, F(4,12) = 9.114, p = 0.001. Five patients were well stabilized on fluoxetine prior to the study, three stopped medication after seven months or less, and two significantly reduced it, one by 25% and the other by 50%.
The second trial employing the KYM OCD-specific protocol was compared against a combination of the Relaxation Response for 30 minutes and additional 30 minutes of the Mindfulness Meditation (RRMM) taught by a therapist who was an expert with both the RR and MM techniques, and who practiced them herself. Patients were blinded to the contents and the names of "two different meditation protocols" prior to entry and to the name and content of the other group during the comparison stage. Here, the two groups, matched for sex/age/medication status, were randomized and blinded to the comparison protocol for a 12-month trial, unless one protocol proved to be more efficacious, then groups would merge for 12 additional months using the more efficacious protocol. Subjects were selected Diagnostic and Statistical Manual of Mental Disorders-III-Revised criteria) by advertisements and referral and a DSM diagnosis; at baseline, Group 1, 11 adults, 1 adolescent; Group 2, 10 adults. The baseline and 3-month interval testing for the Y-BOCS; Symptoms Checklist-90-Revised Obsessive Compulsive (SCL-90-R OC) and Global Severity Index (SCL-90-R GSI) Scales; Profile of Mood States (POMS); Perceived Stress Scale (PSS); and Purpose-in-Life (PIL). Seven adults in each group completed three months of therapy. KY demonstrated greater improvements (Student's Independent Groups T-test) on the Y-BOCS, SCL-90-R OC and GSI Scales, POMS, and greater but non-significant improvements on the PSS and PIL scales. An intent-to-treat analysis (Y-BOCS) for the baseline and 3-month tests showed that only the KY improved. Within group statistics (Student's paired T-tests) showed the KY group significantly improved on all six scales but the RRMM group had no improvements in 3 months. Groups were merged for an additional year using KY techniques. At 15 months, the final group (N=11 adults) improved 71% (Y-BOCS), 62% (SCL-90-R OC), 66% (SCL-90-R GSI), 74% (POMS), 39% (PSS), and 23% (PIL), on the six scales; p<0.003 (analysis of variance). The 71% Y-BOCS improvement is the highest improvement published in any OCD clinical trial. The authors conclude "Kundalini Yoga techniques show promise with OCD." The entire KY OCD protocol has been published in complete detail five times.20-21, 23, 25-26
The 8-part Kundalini Yoga Meditation PTSD-Specific Protocol
This protocol has been published in complete detail in two books by W. W. Norton & Co.21,22 and it is also available online as a rentable video for less than a dollar a day. In the video it is taught in complete detail and each of the 8 techniques are practiced for full times. The protocol is proceeded by an introduction, and the video includes designated rest periods, and finishes with frequently asked questions (FAQs) (see: http://sacredtherapies.com/videos/ptsd-treatment-videos/). Two versions of the video are available, one is the longer one with the detailed explanation of how to do each technique and the full times of practice for each with the respective rest periods, and finishes with the FAQs. The second video option is shorter and it only includes each technique practiced for full times once the practitioner has learned each technique, and the designated rest times are also included in the shorter version.
The 8-part KYM PTSD protocol has also been taught eight times since 2005 at 6-hour Full Day Continuing Medical Education Courses at the American Psychiatric Association Annual Meetings.
The 8 parts of the protocol include and the entire protocol is practiced while sitting in a chair or on the floor:
1) A 3 minute technique to Induce a Meditative State: "Tuning In"
2) An 11 minute technique – "Gan Puttee Kriya: - A Technique to Eliminate the Negativity from the Past, the Present, and the Future"
3) An 8 minute technique – "When You Do Not Know What to Do" (for deep relaxation & physical healing)
4) An 11 minute technique – "Meditation to Balance the Jupiter and Saturn Energies: A Technique for Treating Depression, Focusing the Mind, and Eliminating Self-Destructive Behavior"
5) A 3 minute technique – "Ganesha Meditation for Focus and Clarity"
6) A 3 minute technique – "Meditation for Deep Relaxation"
7) An 11 minute technique – "Tantric Meditation Technique to Create a Normal and Supernormal State of Consciousness"
8) An 11 minute technique – "Meditation for When You Want to Command Your Own Consciousness to a Higher Consciousness"
Get access to these video trainings here (non-affiliate link)
3) Fulton J.J., Calhoun P.S., Wagner H.R., et al. The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans: a meta-analysis. Journal of Anxiety Disorders. 2015; 31: 98-107).
5) World Health Organization. Composite International Diagnostic Interview (CIDI, Version 2.1). Geneva: World Health Organization, 1997.
6) Atwoli L, Stein DJ, Williams DR, et al. Trauma and posttraumatic stress disorder in South Africa: analysis from the South African Stress and Health Study. BMC Psychiatry 2013; 13:182. doi:10.1186/1471-244X-13-182.
7) Olaya B, Alonso J, Atwoli L, et al. Association between traumatic events and posttraumatic stress disorder: results from the ESEMeD-Spain study. Epidemiol Psychiatr Sci 2015; 24:172–183.
8) Carmassi C, Dell'Osso L, Manni C, etal. Frequency of trauma exposure and Post-Traumatic Stress Disorder in Italy: analysis from the World Mental Health Survey Initiative. J Psychiatr Res 2014; 59:77–84.
9) Kawakami N, Tsuchiya M, Umeda M, et al. Trauma and posttraumatic stress && disorder in Japan: Results from the World Mental Health Japan Survey. J Psychiatr Res 2014; 53:157–165.
10)Ferry F, Bunting B, Murphy S, etal. Traumatic events and their relative PTSD burden in Northern Ireland: a consideration of the impact of the 'Troubles'. Soc Psychiatry Psychiatr Epidemiol 2014; 49:435–446.
11)Atwoli L, Stein DJ, Koenen KC, and McLaughlin KA, Epidemiology of posttraumatic stress disorder: prevalence, correlates and consequences, Current Opinions of Psychiatry, 2015, 28:307-311.
12)Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text-Revised (DSM-IV- TR; (American Psychiatric Association, 2000).
13)Schnurr PP, Friedman MJ, Engel CC, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007;297(8):820-830.
14)Forbes D, Lloyd D, Nixon RD, et al. A multisite randomized controlled effectiveness trial of cognitive processing therapy for military-related posttraumatic stress disorder. J Anxiety Disord. 2012;26(3):442-452.
15)Surís A, Link-Malcolm J, Chard K, Ahn C, North C. A randomized clinical trial of cognitive processing therapy for veterans with PTSD related to military sexual trauma. J Trauma Stress. 2013;26(1):28-37.
16)Kehle-Forbes SM, Meis LA, Spoont MR, Polusny MA. Treatment initiation and dropout from prolonged exposure and cognitive processing therapy in a VA outpatient clinic [published online June 29, 2015]. Psychol Trauma. doi:10.1037 /tra0000065.
17)Polusny MA, Erbes CR, Thuras P, Moran A, Lamberty CJ, Collins RC, Rodman JL, Lim KO, Mindfulness-Based Stress Reduction for Posttraumatic Stress Disorder Among Veterans, A Randomized Clinical Trial, JAMA. 2015; 314(5): 456-465.
18)Jindani FA, Khalsa GFS, A Yoga Intervention Program for Patients Suffering from Symptoms of Posttraumatic Stress Disorder: A Qualitative Descriptive Study, The Journal of Alternative and Complementary Medicine, Vol 21, No. 7, 2015, pp. 401–408.
19)Jindani FA, Turner N, Khalsa SBS, A Yoga Intervention for Posttraumatic Stress: A Preliminary Randomized Control Trial, Evidence-Based Complementary and Alternative Medicine Vol 2015, Article ID 351746, 8 pages http://dx.doi.org/10.1155/2015/351746.
20)Shannahoff-Khalsa DS, Kundalini Yoga Meditation: Techniques Specific for Psychiatric Disorders, Couples Therapy, and Personal Growth. New York: W.W. Norton, (2006).
21)Shannahoff-Khalsa DS (2012) Sacred Therapies: The Kundalini Yoga Meditation Handbook for Mental Health. New York: W.W. Norton.
22)Shannahoff-Khalsa DS, Beckett LR, Clinical Case Report: Efficacy of Yogic Techniques in the Treatment of Obsessive Compulsive Disorders, International Journal of Neuroscience, 85:1-17, 1996.
23)Shannahoff-Khalsa DS. Yogic techniques are effective in the treatment of obsessive compulsive disorders. In: Hollander E and Stein D (eds.) Obsessive–Compulsive Disorders: Diagnosis, Etiology, and Treatment, pp. 283–329. New York: Marcel Dekker (1997).
24)Shannahoff-Khalsa DS, Ray LE, Levine S, et al. Randomized controlled trial of yogic meditation techniques for patients with obsessive compulsive disorders. CNS Spectrums: The International Journal of Neuropsychiatric Medicine 4: 34–46 (1999).
25)Shannahoff-Khalsa DS, Kundalini yoga meditation techniques in the treatment of obsessive compulsive and OC spectrum disorders. Brief Treatment and Crisis Intervention 3: 369–382 (2003).
26)Shannahoff-Khalsa DS, Kundalini yoga meditation techniques in the treatment of obsessive compulsive and OC spectrum disorders. In: Roberts AR (ed.) Social Workers' Desk Reference, 2nd edn., pp. 606–612. New York: Oxford University Press (2008).