Complementary and Alternative Medicine for Posttraumatic Stress Disorder Symptoms

A Systematic Review

1. Helané Wahbeh, ND, MCR1,2⇑
2. Angela Senders, ND1,2
3. Rachel Neuendorf, MS2
4. Julien Cayton, BA1

1. ¹Oregon Health and Science University, Portland, OR, USA
2. ²National College of Natural Medicine, Portland, OR, USA

1. Helané Wahbeh, ND, MCR, Oregon Health and Science University, 3181 SW Sam Jackson Park Road CR120, Portland, OR 97239, USA. Email: wahbehh@ohsu.edu

Abstract

Objectives. To (1) characterize complementary and alternative medicine studies for posttraumatic stress disorder symptoms, (2) evaluate the quality of these studies, and (3) systematically grade the scientific evidence for individual CAM modalities for posttraumatic stress disorder.

Design. Systematic review. Eight data sources were searched. Selection criteria included any study design assessing posttraumatic stress disorder outcomes and any complementary and alternative medicine intervention. The body of evidence for each modality was assessed with the Natural Standard evidence-based, validated grading rationale.

Results and Conclusions. Thirty-three studies (n = 1329) were reviewed. Scientific evidence of benefit for posttraumatic stress disorder was strong for repetitive transcranial magnetic stimulation and good for acupuncture, hypnotherapy, meditation, and visualization. Evidence was unclear or conflicting for biofeedback, relaxation, Emotional Freedom and Thought Field therapies, yoga, and natural products. Considerations for clinical applications and future research recommendations are discussed.

Acupuncture enhances antidepressant effect of Seroxat

Acupuncture is more effective than oral antidepressants in improving depressive symptoms, and produces fewer side effects than tricyclic antidepressants. Despite the continued development of antidepressants and alternative/synergistic therapies, major depressive disorder has not been comprehensively recognized and treatment outcome is often insufficient. An epidemiological study addressing depression showed that poor recognition and treatment are largely linked to the lack of an accurate assessment tool and to patients' economic situation.

Prof. Yong Huang and team from Southern Medical University in China compared the clinical efficacy of acupuncture/electroacupuncture combined with an antidepressant drug, with that of an antidepressant drug alone, using the Symptom Checklist-90. Researchers found that administration of Seroxat alone or in combination with acupuncture/electroacupuncture can produce a significant effect in patients with primary unipolar depression. Furthermore, acupuncture/electroacupuncture has a rapid onset of therapeutic effect and produces a noticeable improvement in obsessive-compulsive, depressive and anxiety symptoms. These findings have been published in the Neural Regeneration Research (Vol. 9, No. 2, 2014).

###
Article: "Acupuncture/electroacupuncture enhances anti-depressant effect of Seroxat: the Symptom Checklist-90 scores " by Junqi Chen1, Weirong Lin2, Shengxu Wang3, Chongqi Wang3, Ganlong Li1, Shanshan Qu3, Yong Huang3, Zhangjin Zhang4, Wei Xiao3 (1 The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province, China; 2 The Shenzhen TCM hospital, Shenzhen, Guangdong Province, China; 3 School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; 4 School of Chinese Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China)

Chen JQ, Lin WR, Wang SX, Wang CQ, Li GL, Qu SS, Huang Y, Zhang ZJ, Xiao W. Acupuncture/electroacupuncture enhances anti-depressant effect of Seroxat: the Symptom Checklist-90 scores. Neural Regen Res. 2014;9(2):213-222.

Yoga-based interventions hold promise for smoking cessation

This study provided a review of evidence-based yoga interventions’ impact on smoking cessation. The researchers reviewed articles obtained from MEDLINE (PubMed), EBSCOHOST, PROQUEST, MEDINDIA, CINAHL, Alt HealthWatch, and AMED databases. Inclusion criteria were as follows: (a) study published between 2004 and 2013, (b) study published in English language, (c) study used yoga-based interventions, (d) study involved smokers with varying level of smoking, (e) study used any quantitative design, and (f) study had physiological and/or psychological outcomes. 

A total of 10 studies met the inclusion criteria. Designs were 2 pre–post tests and 8 randomized controlled trials. 

A majority of the interventions were able to enhance quitting smoking rates in the participants under study. 

Adequate Doses of Massage Treatment Necessary for Relief of Neck Pain

Neck pain is a common and debilitating condition, and massage therapy is commonly used to treat it, yet there is little quality research on the optimal dose of therapeutic massage for neck pain. Randomizing 228 patients with chronic neck pain to five different groups receiving various doses of massage for a five-week period, researchers found the benefits of massage treatments for chronic neck pain increase with dose. Specifically, they found that patients who received 30-minute treatments two or three times weekly were not significantly better than a wait-listed control group in terms of achieving a clinically meaningful improvement in neck dysfunction or pain. In contrast, patients who received 60-minute treatments two or three times weekly showed significant improvement in neck dysfunction and pain intensity compared to the control group. Compared with their control counterparts, massage participants were three times more likely to have clinically meaningful improvement in neck function if they received 60 minutes of massage twice a week and five times more likely if they received 60 minutes of massage three times a week. The authors conclude patients who receive massage treatment for chronic neck pain may not be realizing benefits from treatment because they are not receiving an effective treatment dose.

Yoga regulates stress hormones and improves quality of life for women with breast cancer undergoing radiation therapy

For women with breast cancer undergoing radiation therapy, yoga offers unique benefits beyond fighting fatigue, according to research from The University of Texas MD Anderson Cancer Center.

The preliminary findings were first reported in 2011 by Lorenzo Cohen, Ph.D., professor and director of the Integrative Medicine Program at MD Anderson, and are now published in the Journal of Clinical Oncology. This research is part of an ongoing effort to scientifically validate mind-body interventions in cancer patients and was conducted in collaboration with India's largest yoga research institution, Swami Vivekananda Yoga Anusandhana Samsthana in Bangalore, India.

Researchers found that while simple stretching exercises counteracted fatigue, patients who participated in yoga exercises that incorporated controlled breathing, meditation and relaxation techniques into their treatment plan experienced improved ability to engage in their daily activities, better general health and better regulation of cortisol (stress hormone). Women in the yoga group were also better equipped to find meaning in the illness experience, which declined over time for the women in the other two groups.

The study also assessed, for the first time, yoga benefits in cancer patients by comparing their experience with patients in an active control group who integrated simple, generic stretching exercises into their lives.

"Combining mind and body practices that are part of yoga clearly have tremendous potential to help patients manage the psychosocial and physical difficulties associated with treatment and life after cancer, beyond the benefits of simple stretching," said Cohen.

To conduct the study, 191 women with breast cancer (stage 0-3) were randomized to one of three groups: 1) yoga; 2) simple stretching; or 3) no instruction in yoga or stretching. Participants in the yoga and stretching groups attended sessions specifically tailored to breast cancer patients for one-hour, three days a week throughout their six weeks of radiation treatment.

Participants were asked to report on their quality of life, including levels of fatigue and depression, their daily functioning and a measure assessing ability to find meaning in the illness experience. Saliva samples were collected and electrocardiogram tests were administered at baseline, end of treatment, and at one, three and six months post-treatment.

Women who practiced yoga had the steepest decline in their cortisol levels across the day, indicating that yoga had the ability to help regulate this stress hormone. This is particularly important because higher stress hormone levels throughout the day, known as a blunted circadian cortisol rhythm, have been linked to worse outcomes in breast cancer.

Additionally, after completing radiation treatment, only the women in the yoga and stretching groups reported a reduction in fatigue. At one, three and six months after radiation therapy, women who practiced yoga during the treatment period reported greater benefits to physical functioning and general health. They were more likely to find life meaning from their cancer experience than the other groups.

According to Cohen, research shows that developing a yoga practice also helps patients after completing cancer treatment.

"The transition from active therapy back to everyday life can be very stressful as patients no longer receive the same level of medical care and attention. Teaching patients a mind-body technique like yoga as a coping skill can make the transition less difficult."

Through a grant from the National Cancer Institute, Cohen and his team are now conducting a Phase III clinical trial in women with breast cancer to further determine the mechanisms of yoga that lead to improvement in physical functioning, quality of life and biological outcomes during and after radiation treatment. A secondary aim of the trial, but one of great importance, stressed Cohen, is assessing cost efficiency analysis for the hospital, health care usage costs in general and examining work productivity of patients.

New therapy helps to improve audio and visual perception in stroke patients

 
A stroke can cause permanent damage to important parts of the brain, with the result that many stroke survivors require lifelong care and support. 'It is not uncommon for stroke patients to suffer from an awareness deficit or a reduced response to stimuli on one side of their body. This condition, known as hemispatial neglect, can mean that patients are unable to properly perceive people, images or sounds on that side,' explains Professor Georg Kerkhoff from the Department of Clinical Neuropsychology at Saarland University. 'These phenomena tend to be observed when the right side of the brain is damaged, in which case, the left side of the body is affected.' Another factor that complicates the situation is that patients are often unable to correctly assess their own state of health or even deny that they have a deficit in this area. Experts refer to this aspect of hemispatial neglect as patient unawareness. 'This lack of awareness reduces the chances of therapeutic success and makes treatment more difficult,' says Kerkhoff. 'So far there have only been limited therapeutic options for this group of patients.'

The team of neuropsychologists at Saarbrücken have developed a novel therapeutic approach that has now been tested in two separate studies. In optokinetic stimulation therapy (OKS), patients are shown a cloud of dots on a large screen in which one of the dots is highlighted in a different colour. The dots move horizontally at a constant speed from one side of the screen to the other. Patients must follow the movement of the dots with their eyes. The direction of motion depends on which side of the patient's body is affected. 'If the left side is affected, the dots move from the right side of the screen to the left,' explains Professor Kerkhoff. The dots therefore move from the healthy side of the body to the neglected side. 'This effectively forces the patient to become aware of his neglected side,' says Kerkhoff. Once the dot has reached the edge of the screen, the patient has to move his or her eyes back to the initial fixation point and the exercise begins again.

In order to check how efficient this new method is, the research team ran a study with 50 subjects in which they compared OKS with visual exploration training (VET), which is currently the most commonly used therapeutic procedure for patients with neglect. 'Up until now, patients using VET therapy have only been shown rigid patterns, but patients are generally better able to perceive motion,' explains Kerkhoff. The use of visual motion stimuli activates areas of the stroke patient's brain that are involved in eye movements and that facilitate attention towards the neglected side. 'After five OKS sessions, the subjects had measurably improved perception of sounds and images on the neglected side,' says Professor Kerkhoff. 'And the effect was sustained at follow-up.' In contrast, there was no improvement in symptoms using VET.

In a further study, the research team was able to show that OKS not only trains the senses, but also makes patients better able to deal with day-to-day problems such as locating objects and helps to improve their spatial orientation. After undergoing OKS therapy, patients were also better able to assess their own state of health and were no longer in denial about their functional impairments.

'OKS has been shown to be a very effective method of treatment,' says Kerkhoff, summarizing the results of the two studies. 'OKS speeds up recovery and can be deployed early on in stroke rehabilitation programmes, particularly in the case of patients with a severe lack of awareness.'

Details of the studies have recently been published in the following papers:

Kerkhoff et al, Smooth pursuit eye movement training. Neurorehabilitation & Neural Repair, 2013, DOI: 10.1177/1545968313491012

Kerkhoff et al, Smooth pursuit „bedside" training. Neurorehabilitation & Neural Repair, 2014, DOI: 10.1177/1545968313517757