By Annette M. Boyle
— Wayne Jonas, MD
SAN DIEGO — Only a few sessions of two complementary medicine techniques worked as well or better than more standard therapies for post-traumatic stress disorder in active-duty servicemembers, according to a recent study.
Six sessions over three weeks of guided imagery and healing touch significantly reduced PTSD symptoms, according to the study published recently in Military Medicine.
“The intervention was not just statistically significant but actually decreased symptoms below the threshold for PTSD diagnosis,” according to Erminia “Mimi” Guarneri, MD, a principal investigator in the study and cofounder of the Scripps Center for Integrative Medicine in San Diego, CA.
In the two-armed, randomized controlled trial, 55 Marines with PTSD from Camp Pendleton, CA, continued with treatment as usual (TAU), and 68 additionally received the combination of healing touch (HT) and guided imagery (GI) between July 2008 and August 2010. Patients receiving the six complementary treatments experienced a drop of 14 points in PTSD Checklist (PCL)-Military scores, from 54 to 40.
Patients in the TAU arm had a decline of less than 4 points, from 55.6 to 52. The gold-standard measurement scale for combat-related PTSD, PCL scores range from 17 to 85, with 50 considered the clinical cutoff for PTSD.
“The results were about in the middle of any proven therapy for PTSD,” Wayne Jonas, MD, president and chief executive officer of Samueli Institute in Alexandria, VA, told U.S. Medicine. “It was a very short intervention, with a surprisingly large magnitude of response. It took much less time than cognitive behavioral therapy (CBT) or other standard therapies, which also typically achieve a drop of 10 to 20 points.”
In addition to the improvement in PTSD symptoms, patients in the intervention arm also reported a 10-point drop in scores on the Beck Depression Inventory, from 26 to 16, compared with a decline (27 to 24) among those receiving treatment as usual. Scores above 18 are considered indicative of major depressive disorder. Researchers also noted improvements in quality-of-life measures, as well as reduced cynicism and hostility.
Improved Sleep and Promoted Deep Relaxation
Healing touch is a noninvasive treatment that works with the “body’s vital energy system to stimulate a healing response,” according to the study. In the trial, practitioners combined several HT techniques: one designed to stimulate movement of vital energy through the body, another intended to stimulate mental relaxation, and a third to promote deep healing.
Guided imagery uses visualization to reduce stress, decrease pain and induce relaxation. In this study, participants listened to a recording that used imagery and affirmations to reduce negative emotions, increase a sense of security and enhance relaxation while experiencing healing touch with a practitioner and then practiced GI at least once a day on their own. Pairing the two techniques was designed to allow patients to experience deeper relaxation than they would get at home using GI only.
“The study was not designed to look at how it works, but the rationale was that deep relaxation can help train individuals in skills that allow them to counter stress responses. In PTSD, patients have difficulty managing stress. Inducing relaxation is a fairly simple way to facilitate learning how to reset stress signals,” Jonas said.
That focus on relaxation quickly produced at least one additional benefit for participants. “The first thing we saw was that the treatment helped patients sleep better. Insomnia and restlessness are big issues for people with PTSD, but the combination therapy helped them achieve a deep state of relaxation and fall asleep,” Guarneri added.
Lower Attrition Rate
The HT/GI intervention had a significantly lower attrition rate than most therapies for PTSD. In the study, only six patients (12.2%) in the treatment group dropped out, compared with 15 patients (28.3%) in the control group.
According to retired Col. Charles W. Hoge, MD, U.S. Army neuropsychiatry research consultant, 20% to 40% of veterans who begin PTSD treatment in randomized controlled trials fail to complete the treatment; attrition rates are even higher in routine practice.
“This is a gentle approach,” said Jonas. “Desensitization or exposure therapy is a rough thing; medications have side effects. Some people don’t want to see a counselor for [cognitive behavioral therapy]. In contrast, this is pleasant to do. People look forward to the sessions and are eager to keep appointments.”
Patients in the study “were incredibly receptive,” Gaurneri told U.S. Medicine. “Those assigned to usual care were very disappointed; so much so, in fact, that we offered the guided imagery CD to everyone after the study finished.”
One advantage, she added, is the ease of use at home. “We were up against a deployment clock during the study and had just a small window of time to work with the Marines, but we encouraged them to continue to use the CD afterward,” she noted.
“Servicemembers don’t want to be labeled with mental condition or see a psychologist or psychiatrist, so they often don’t get the treatment they need,” Jonas explained. “If the effect of this therapy is primarily due to deeper relaxation, perhaps it could be done without pairing it with healing touch. Maybe family members or social workers could do it. That would lower costs and allow accessto a wider population.”
From Guarneri’s experience, healing touch could continue to be part of treatment as knowledge of the therapy becomes more widespread.
“Many family members expressed interest in learning healing techniques, because the therapy was so helpful for improving sleep and reducing anger. We’re looking at doing follow-up work with family and servicemembers to do healing techniques on themselves,” she noted.
Jonas suggested the treatment be studied further to determine whether it can be generalized to a larger population and other practitioners. “The military is looking for non-pharmaceutical and simpler treatments for PTSD. We are in discussion with folks in the Department of Defense about conducting a multisite study and would like to find sites in the VA that are interested as well,” he said.