Introduction
This research focuses on the impact of yoga on combat veteran population. In order to provide a full insight on the same, the research has explored and focused in details on combat veterans having PTSD, a few years after deployment from various military missions. Military members who had been assigned in Middle East to support (OIF / OND/ OEF), that is, Operation Iraqi Freedom, Operation New Dawn and Operation Enduring Freedom had an increased risk regarding experiencing traumatic scenarios including witnessing a colleague or friend die or being shot at (Wilkins, Lang, & Norman, 2011). Approximations of PTSD among veterans associated with the said operations start from 9 percent a short period after accomplishing their mission to 31 percent one year after having been released for deployment. Similarly, between 17 and 20 percent among Vietnam combat veterans either are currently or have been diagnosed with the disorder in question (Cushing, Braun, & Katz, 2018). Basically, the diagnosis of PTSD is done through examining for symptoms related to traumatic event which starts following the occurrence of the event thereby causing impaired function or distress. CAM (complementary and alternative medicine) such as yoga has been found to be very effective in promoting the wellness of the veterans especially those ones diagnosed with PTSD (Polusny, Erbes, & Thuras, 2015).
To begin with, while diagnosing PTSD, mental health practitioners focus on the presence of intrusion symptoms (recurring dreams, flashbacks etc.), persistence avoidance with regard to stimuli related to the event, notable alterations regarding reactivity and arousal as well as negative alterations in mood and cognition. Generally, PTSD victims experience intensified sympathetic activation that raises their blood pressure and heart rate, reduces the flow of blood to extremities, interferes with digestive functioning as well as increasing stress hormones like cortisol. It should be noted that PTSD has the potential of causing mental, emotional as well as behavioral disturbances not mentioning its close association with suicidal ideations (Kearney, McDermott, & Malte, 2013). The existing PTSD treatments include pharmacological and psychotherapy treatment. Some of the most successful evidence-based psychotherapies are cognitive-oriented therapies, exposure-oriented therapies, reprocessing therapy and eye movement desensitization. On the other hand, pharmacological treatment incorporates various medications like alpha blocker and prazosin (Bhatnagar, Phelps, & Rietz, 2013).
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CAM encompasses treatments or practices which are considered as conventional medicine components. A study undertaken in 2011 revealed that fifty percent of veterans who were under Veteran Administration’s care use various forms of CAM (Stoller, Greuel, Cimini, Fowler, & Koomar, 2012). Among the mostly used CAM therapies include yoga, stress management, art therapy, progressive relaxation of muscles and meditation. Even though yoga and other CAM therapies could have more acceptability compared to conventional treatments among PTSD veterans, most of the CAM treatments are neither manualized nor standardized, which is a reproducibility barrier. However, yoga in particular could be tailored or adapted to patients who are trauma-sensitive, something that is very beneficial to veteran population having PTSD (Stankovic, 2011).
As a matter of fact, complimentary practices have grown in popularity among combat veteran as well as civilian populations. For example, the utilization of yoga, qi gong and tai chi rose to 10 percent from 6 percent between 2002 and 2012 (Staples, Hamilton, & Uddo, 2013). Among the aforementioned mind-body therapies, the mostly used during that period was yoga. Slow rhythmic breathing which is coordinated to the yoga’s body movement has the potential of activating and stimulating parasympathetic nervous system and vagal activity respectively. It is important to understand that parasympathetic nervous system has crucial functions including reducing blood pressure and heart rate, catalyzing digestive functioning as well as stabilizing (normalizing) stress hormones. For this reason, yoga has proved to be very beneficial among service members and combat veterans who have PTSD as it triggers the activation of parasympathetic nervous system thereby tamping down the hyperarousal-related symptoms. In addition to this, yoga has the potential of reducing stress hormone (cortisol) levels thereby assisting in the restoration of balance within the pituitary-hypothalamic-adrenal axis (Seppala, Nitschke, Tudorascu, Haves, & Wright, 2014).
In fact, besides yoga having positive effects with regard to the mental well-being’s improvement whether as adjunctive or stand-alone therapies for war veterans having PTSD, it has also shown positive effects on various health conditions (Spelman, Hunt, & Seal, 2012). These include among others; postpartum and prenatal depression, pregnancy, cardiovascular conditions, low back pain, stress, arthritis, asthma, anxiety, multiple sclerosis, headaches, HIV, osteoporosis, type II diabetes, Parkinson’s disease and breast cancer. To be specific to post-traumatic stress disorder, trauma-sensitive yoga continues to be utilized because of its positive effects in varied populations including women who suffer the post-effects pertaining to interpersonal violence, communities distressed by natural calamities as well as children who have faced interpersonal trauma within urban settings (Cushing, Braun, & Katz, 2018).
A very common body-mind therapy which has not only been manualized but also utilized by these veterans is MBSR (body-mind stress eradication). MBSR is aimed at teaching participants handle or deal with the current moment in a manner that is nonjudgmental. The MBSR components include gentle yoga, slow breathing as well as mindful meditation. This particular course is undertaken for a minimum of eight weeks with an extra all-day retreat. MBSR has over the years been highly attributed to reduction of symptoms of PTSD among combat veterans. However, in most of the studies published regarding MBSR, at least 85 percent of the participants have been Vietnam veterans (Wahbeh & Oken, 2014). This means that there is a research gap with regard to the effects of MBSR on OIF / OND/ OEF veterans who are usually younger, less likely to be unemployed or retired compared to Vietnam veterans.
WAE (Warriors at Ease) as a not-for-profit organization offers certified yoga instructors’ advanced training on the basis of specialized approach which is trauma-informed, is sensitive to the military culture’s unique aspects and which incorporates techniques that are based on evidence. It is good to note that WAE approach came into being in 2009 through the efforts of four individuals who were involved in mediation programs an yoga pilot at VA Hospitals and Walter Reed Army Medical Center in Miami alongside Washington D.C. Currently, there are at least seven hundred and twenty five WAE trainers who provide the combat veterans, military families and service members with trauma-sensitive yoga (Fiore, Nelson, & Tosti, 2014). In particular, WAE instructors provide meditation and yoga within VA healthcare facilities, military installations as well as various veteran service organizations like Team Blue, White and Red, Veterans of Foreign Wars, Wounded Warrior Project and Meghan’s Foundation. However, the above offerings have not been examined with regard to their effectiveness as far as reduction of PTSD is concerned. Their popularity, however, shows that yoga is very crucial in promoting the well-being of combat veterans particularly those that have PTSD (Paulson & Krippner, 2007).
When particular focus is given to Vinyasa-style yoga that is most appropriate for combat veterans, positive results regard yoga on reduction of PTSD symptoms on the war veterans are realized. The three critical components with regard to Vinyasa yoga include physical postures, meditation and breath work. This particular yoga style mostly focuses on the movement form one pose to another while still having coordination with the breath. It is critical to note that trauma-sensitive procedure recommended by Meghan’s Foundation and WAE is a technique that is aimed at creating a welcoming space in which participants are capable of accessing the current moment as well as reclaiming a sense of wellness (Emerson & Hopper, 2012). The procedure incorporates modifications to favor participants who have wounds that are combat-related, traumatic injuries as well as various health conditions which could require adaptive practices of yoga.
In a specific intervention aimed for able-bodied military veterans, a session of yoga could incorporate a warm-up of 10 minutes that includes three minutes of meditation. The purpose of a seated meditation is to bring a mindful understanding or consciousness to internal signals or cues (like breath, emotions, bodily sensations and thoughts) as well as external signals like sounds and sights. After a seated meditation, a standing yoga, balancing yoga and mat yoga could follow for 25 minutes, 10 minutes and 10 minutes respectively (Birch, 2014). In this kind of intervention, the final yoga pose is called Savasana (in Sanskrit) or “corpse” pose or resting pose.
A study of an intervention of trauma-sensitive yoga for combat veterans has demonstrated a reduction of PTSD’s symptoms, for example, re-experiencing, hyperarousal or avoidance/numbness. According to the same study, the degree of improvement following the yoga intervention was not only statistically significant but also clinically meaningful (Birch, 2014). In addition to this, the study revealed that the said intervention improved mindfulness while at the same time reducing anxiety, depression along with insomnia symptoms. This study’s results confirm that there is a high possibility of alleviating negative psychological health symptoms among OIF / OND/ OEF veterans who possess combat-related post-traumatic stress disorder (Fiore, Nelson, & Tosti, 2014).
Further from this, research regarding body-mind therapies like mediation or MBSR proves that CAM techniques have the potential of reducing PTSD symptoms among OIF / OND/ OEF veterans (Emerson & Hopper, 2012). These positive results are attributed mostly to Vinyasa yoga which is sufficiently strenuous for the improvement of cardiorespiratory fitness especially in sedentary and unfit persons. An analysis evaluating the physical exercise’s influence as a kind of treatment for PTSD revealed that physical exercise is indeed successful when it comes to the reduction of both depressive and PTSD symptoms (Birch, 2014). Like it was noted earlier in this research, trauma-sensitive yoga is not only effective for combat veterans but among other populations like interpersonal violence victims as well as victims of natural calamities.
In another qualitative study conducted for 23 combat veterans diagnosed with PTSD, the participants revealed that they had developed positive feelings with regard to peer support interventions in addition to anticipating benefits like stabilization of symptoms, compliance with adjuvant treatment, social support and increased initiation (Fiore, Nelson, & Tosti, 2014). In essence, utilization of yoga as a CAM approach to combat veterans having PTSD has the potential of improving or promoting the wellness of the veterans, military families and service members especially if Vinyasa trauma yoga sensitive style is adopted. This is because it is the most appropriate yoga style for military veterans.
Conclusion
The study like WAE protocol shows that an intervention, particularly, yoga which is trauma-sensitive could be very beneficial for combat veterans having PTSD’s symptoms. Actually, it is expected that most war veterans may suffer from PTSD as a result of witnessing traumatic events during their missions, for example, those ones deployed in war bound zones like the Middle East. Although there are conventional treatments to treat PTSD, CAM approaches like trauma-sensitive yoga have proved to be very beneficial for combat veterans. As a matter of fact, yoga also works towards reducing the symptoms of many other health conditions as noted in this research. Therefore, utilization of yoga is very effective as a far as promotion of wellness among combat veteran population is concerned.
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