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Mind-Body-Spirit Interventions for Patients With PTSD

Mind-Body-Spirit Interventions for Patients With PTSD

© Nejron Photo/shutterstock.com© Nejron Photo/shutterstock.com
SIGNIFICANCE FOR THE PRACTICING PSYCHIATRISTSIGNIFICANCE FOR THE PRACTICING PSYCHIATRIST

PTSD is the quintessential mind-body-spirit (MBS) disorder that alters physiological, biological, and psychological homeostasis. People with PTSD and complex trauma often experience dysregulation of multiple systems that impairs physical, affective, and cognitive function, which can lead to a profound sense of disconnection from others and loss of purpose and hope.

Dissociation is common in PTSD and is associated with disabling sequelae, including substance abuse, self-harming behaviors, eating disorders, and chronic pain. In his analysis of the whiplash model of pain, Scaer1 suggests that the chronic pain syndrome that results from minor motor vehicle accidents does not correspond with the actual events—that it more likely represents dissociated memory that was laid down at the time of impact because of intense fear. Chronic illnesses and autoimmune disorders, such as rheumatoid arthritis, multiple sclerosis, lupus, and inflammation of the thyroid; digestive disorders, such as GERD and microbiome imbalance; diabetes; cardiovascular disease; and mitochondrial illnesses, such as chronic fatigue syndrome and fibromyalgia, all occur at higher rates in persons with PTSD.

MBS methods provide integrated approaches to psychophysiological self-regulation and promote self-care behaviors. These methods facilitate deep rest, help to reset circadian rhythm, and release endogenous opioids and cannabinoids that lead to a reduction in anxiety and an enhanced sense of well-being. Some may also offer a strategy (meditation, chanting, aerobic exercise, hot yoga) to gain awareness and control over the dissociative process. Relaxation techniques (eg, breathing exercises, guided imagery, progressive muscle relaxation) and energy psychology (eg, tapping, tai chi, qi gong) are practical and beneficial methods that are easily incorporated into daily routines.

Botanical therapies may be used to address symptoms of PTSD, most notably cannabis, kava, and St John’s wort. Touch therapies, animal-assisted therapies, and group rituals are used to facilitate a complex psychobiological response that may improve the capacity for attachment through structured affective and sensory engagement with other caring beings. Group spiritual rituals and entheogenic (ie, psychedelic) rituals emphasize transpersonal approaches to engender self-compassion and meaning-making as the patient reevaluates his or her place in the cosmos following traumatic events.

MBS approaches

MBS beliefs and methods should be identified and prioritized during assessment and treatment when working with recent immigrants, refugees, indigenous populations, or people for whom cultural/ethnic identity may be significant. When stigma about seeking mental health care exists, MBS methods may be especially useful because they engage the somatic and spiritual narrative as a pathway to the psyche. The DSM-5 Cultural Formulation Interview provides modules designed to elicit information on the use of MBS methods and traditional cultural practices using a person-centered approach.

Research on recreational, adventure, and nature-based therapies for PTSD—while promising—is inconclusive.2 Yet these therapies may be valuable for their combination of physical exercise, the exposure to the light/dark cycles of natural light that entrain circadian rhythm, and the opportunity to share nature with others.

Animal-assisted therapies

Animal-assisted and equine therapies show a diverse range of results and offer techniques to harness the human-animal bond. Equine therapies provide for physical rehabilitation with riding, grooming, and trust building via the “affective mirror” that horses reflect back to humans. In some equine programs, veterans help rehabilitate horses that have been wounded and traumatized, leading to awareness of their own “wounded-healer” identity to be used as a pathway to mutual helping and healing.

Canine animal assistants help reduce anxiety in sexual abuse survivors and rape victims. Animal-assisted therapies renew the capacity to develop attachment, to tolerate sensation and pleasure, and to give and receive non-sexual, caring touch through physical contact.3,4

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