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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)."