WASHINGTON — A shortage providers and the perceived stigma attached to mental-health care may prevent troops from seeking services. Complementary and alternative medicine (CAM) can help fill the gaps, according to a recent webinar on integrative health options for military healthcare.
“Complementary and alternative medicine seems to be one of those additional options to increase access to care and also to reduce stigma,” said Dr. Nisha Money, DCoE chief medical officer of Complementary Alternative Medicine-Integrative Health.
Money and other panelists recently spoke at a DCoE webinar on integrative health, the application of holistic and integrated approaches to improve mind-body wellness. Money said about one-third of active-duty servicemembers and one-half of the veteran population are using CAM.
DCoE wants to create a hub for CAM and integrative-health approaches for TBI and psychological injuries.
“Now, with the current operational tempo in our military culture, there is a high level of physical and mental stress, as we are probably well aware of. So there has also been more interest in looking at some of these complementary modalities as a result of that,” she said.
Yoga is one mind-body practice that is growing in popularity but often misperceived by troops, according to Robin Carnes, a yoga and meditation instructor for the Deployment Health Clinical Center’s (DHCC) Specialized Care Program.
Troops often think that yoga is painful, only for “human pretzels,” will change their sexual orientation or is a religion or cult, she said during the webinar.
“They come in with understandable confusions and misgivings about what yoga actually is and who it might be for. My first job, then, is to begin to translate in a way how this might possibly be useful to them,” she explained.
The DHCC’s Specialized Care Program offers troops yoga and meditation sessions as part of its three-week program for troops with PTSD. The yoga sessions focus on gentle stretching, gentle breath awareness, breath exercises and mindfulness.
One type of trauma-sensitive meditation used at DHCC is Integrative Restoration, which is based on Yoga Nidra, an ancient meditative practice, Carnes said. In 2006, DoD conducted research at Walter Reed Army Medical Center on the efficacy of Yoga Nidra and developed a protocol to integrate into the DHCC’s treatment program. It is now used by other DoD and VA facilities.
iRest class typically entails a 30- to 45-minute guided meditation and a few minutes for questions at the end. A DCoE report, Mind-Body Skills for Regulating the Autonomic Nervous System stated that participants of iRest report “decreases in insomnia, depression, anxiety, hyper‐vigilance, angry outbursts and pain and increases in energy level, perceived control in life, and, paradoxically, acceptance of circumstances beyond their control.”
Carnes said that not all forms of yoga and meditation practices are equal when it comes to relieving combat stress and trauma, so yoga instructors working with troops should have specialized trauma training.
“Because every posture, breathing practice and meditation is designed to have a particular impact on the nervous system, some practices would not be helpful for someone who is suffering from trauma symptoms,” she pointed out.
Therapeutic Use of Canines
In another presentation at the webinar, Elspeth Cameron Ritchie, MD, a recently retired Army psychiatrist, said the therapeutic use of canines in medicine and psychiatry may hold promise for wounded troops.
“One of the anecdotal pieces I have heard over and over again is that a patient has so many surgeries, has lost their motivation, and they don’t need any more dignitaries or VIPs coming to talk to them. Even their family doesn’t arouse them, but the dog puts its muzzle to their nose and they just brighten up,” said Ritchie, a psychiatry professor at the Uniformed Services University, and chief clinical officer for the District of Columbia Department of Mental Health.
Ritchie said the dogs specifically may be able to help with PTSD symptoms by bringing back to the present a patient who is having a flashback or intrusive memory. In addition, dogs also can help people with PTSD navigate crowds better. In addition, Ritchie noted that soldiers have reported how dogs can sense when they are having a nightmare and wake them up.
“What I find fascinating is that the servicemember gets a dog for their back problem or TBI or mobility, but then they say my symptoms of PTSD are so much less,” she said.
While the use of canines for those who are wounded or have disabilities is not new, more research is needed on their therapeutic benefits, Ritchie said.
“The challenge before us is I think is that we don’t have good scientific research. We don’t have evidence-informed or evidence-based practice. The real next step is to try to do more research and that will be happening at the National Intrepid Center of Excellence.”
Ritchie said one of the recommendations in the Army Action Family Plan was to fund service dogs for wounded warriors. Policy to govern animal-assisted therapy in theater and their use in military hospital facilities is still needed, she said.
Programs already are in place to connect wounded troops with dogs. Paws for Purple Hearts has partnered with the Walter Reed Army Medical Center to give troops with PTSD opportunities to train service dogs. Organizations such as VETDOGS, New England Assistance Dogs and Canine Companions for Independence also provide dogs to veterans.