The words "Department of Defense" and "yoga" aren't often uttered in the same breath, let alone in a long, conscious, exhale.
But preliminary results from a small study funded by the U.S. Defense Department, and led by a Harvard Medical School assistant professor, found that veterans diagnosed with post-traumatic stress disorder showed improvement in their symptoms after ten weeks of yoga classes, including meditation and breathing, done twice a week, and fifteen minutes of daily practice at home.
William Haviland never considered himself a yoga kind of guy. He served in Vietnam in 1968 during the TET offensive. Ask him about his combat experience and out comes a torrent of trauma: "I remember the things that happened, I've seen people killed right before my eyes," he says. Among his vivid recollections, more than 40 years after the fact: a sergeant lured into a booby-trapped village, then castrated by shrapnel; the screams of a woman being raped and tortured all night. "I have a stream of memories," he says, many which come out during sleep. Haviland, 63, says he frequently attacked his wife in the middle of the night, after nightmares that he was being chased by a fast-approaching enemy. Yoga, he says "took me out of myself" and had a more profound calming effect than drugs or drinking.
"PTSD is a disorder involving dysregulation of the stress response system, and one of the most powerful effects of yoga is to work on cognitive and physiological stress," says Sat Bir S. Khalsa, Ph.D., an assistant professor of medicine at Brigham and Women's Hospital and Harvard Medical School, and the principal investigator of the yoga study.
"What we believe is happening, is that through the control of attention on a target — the breath, the postures, the body — that kind of awareness generates changes in the brain, in the limbic system, and these changes in thinking focus more in the moment, less in the past, and it quiets down the anxiety-provoking chatter going on in the head. People become less reactive and the hormone-related stress cycle starts to calm down."
One common symptom of PTSD is the dissociation of mind and body, feeling disconnected from oneself and one's surroundings, as well as an experience of time displacement. The brain portrays the traumatic event as though it is live and active in the present even though it may have happened decades ago. The practice of yoga combines physical exercises, postures and breath regulation together with meditation and awareness in the present moment and Khalsa says this integrative characteristic of yoga is likely important in resolving this dissociative aspect of PTSD.
Joseph Muxie served in the military from 1977-1984. While stationed in England, he said, he experienced an unbearable assault that is at the core of his PTSD. After years of alcoholism and a stint in rehab, he saw an ad about the Brigham yoga study and decided to try it. "I think what the yoga has really allowed me to do is give me the ability to ground myself," said Muxie, 51. "As a result, I'm more peaceful with myself in whatever moment I happen to be in."
According to the VA, as many as 20% of veterans of the Iraq and Afghanistan wars have PTSD; 10% of Gulf War vets and 30% of Vietnam vets are diagnosed with the disorder. In addition, approximately 23% of women reported they were sexually assaulted in the military and 55% of women and 38% of men experienced sexual harassment while serving. Military Sexual Assault (MSA) is a known factor in PTSD.
Because the incidence of trauma is so high, Khalsa says, the DOD's, Telemedicine & Advanced Technology Research Center, which paid a total of $600,000 for this study, is exploring new approaches to treatment.
In the Brigham study, which has so far evaluated only the first 9 subjects to complete the protocol, each veteran's PTSD severity was assessed using a tool called CAPS, the clinician-administered PTSD scale. The patient is scored by a trained psychologist using the CAPS scale both before and after the yoga intervention to determine any change in the scope and intensity of symptoms, which can include flashbacks, nightmares and a pervasive hyper-vigilance. According to Khalsa, the average baseline CAPS score before yoga in the subjects was 73.0, and the average score post-intervention was 43.6. (The average reduction in CAPS score pre-to-post was 29.4.) Here are the subject's individual scores, before and after yoga:
-- 113; 81
-- 81; 40
-- 111; 21
So, for 6 subjects, their scores improved quite a lot with yoga; for 3, there was little change. Khalsa said that typically even well-known, highly effective treatments don't work for every patient and he is still evaluating other measures to determine if the yoga had any other non-CAPS benefits. "These subjects may possibly have benefited in things like depression or anxiety, even though their overall PTSD CAPS score did not change much (as was observed in a preliminary yoga-PTSD study in Australia)... Human subject research is pretty messy."
Ultimately, he said he hopes to evaluate a total of 60 subjects, including a control group, but so far, recruitment has been slow, due to yoga's "new age" reputation and its association with women. "There's some sense that sissies do yoga," he said.
Jennifer Johnston, a yoga teacher, licensed mental health counselor and the project leader, said that beyond recruitment, yoga's "hot" reputation has in some sense eclipsed its greatest assets. "Because yoga is so sexy now, certain aspects get forgotten," she said. "Yoga is a path to reconnect all of the parts of yourself. It's a self-care strategy. The poses are important, but the philosophy is how we do our lives. The magic is in the meditation, integrating it and taking the yoga off the mat and into your life."
This program aired on December 8, 2010. The audio for this program is not available.