Holistic and Integrative Care for Treating Ptsd

Introduction

The use of holistic approaches to mind and body wellness can be significantly helpful to mentally ill clients and their diseases. The United States military have for years have tried to implement different holistic methods in an attempt curve the high rates of PTSD and suicides associated with being in the military. In general, mainstream medicine tends to focus of treating or getting rid of the physical symptoms. While this is great and helpful for soldiers, it offers little to quill the mental scars that most soldiers suffer. The Holistic approach attempts to empower the patient to not only heal from these wounds, but also try to develop a system by which the patients can maintain a level of normality. The combination of these two methods known as integrative care involves using both holistic health treatments and conventional medicine as an approach to improve the physical and mental health of soldiers.

Holistic approach

The idea of holistic health stems from trying to truly live in harmony with nature. Holistic healing practitioners propagated the idea of healthy way of living as far back as 5000 years ago. Even with this large history of holistic medicinal practice, it is hard to pinpoint one specific area that most practitioners agree upon. The focal point however of all these different holistic methods has revolved around the individual. Holistic care is individual care.

The rise of the holistic movement in this modern generation has been due to many different factors. One main factor has been a gradually increasing dissatisfaction with current medical care. “The development of the holistic health movement and the new health consciousness had been accompanied by an increasing dissatisfaction with certain aspects of medical care delivery. Individuals complain about impersonal professional care and high fees.” (Guttmacher, 1979). Many people expect more from our medical system due to its high technological and academic advances over the years. These advances however generally have not produced a healthier population, leading people to seek out alternative methods of improving their health.

A very important area of our population that have started to seek out the benefits of holistic care is the United States Military. The ineffectiveness of its old medical system has led many soldiers to seek out alternative methods of care. One of the programs that was developed to help veterans who were not being fully treated by traditional medicine is the National Institutes of Health’s National Center for Complementary and Alternative Medicine called “CAM”. According to (Elwy, 2014) CAM is defined as “simply as a group of diverse medical and health care interventions, practices, products, or disciplines that are not generally considered part of conventional medicine. CAM may include acupuncture, massage, biofeedback, meditation, guided imagery, qi gong, herbs and nutritional supplements, aromatherapy, and energy healing.” Over the past decade, the use of CAM in combination with (integrative) or as a replacement to conventional medicine has increased steady. “Studies report that per-year CAM usage among veterans or active military personnel ranges from 27% to 82%, which is similar to or slightly higher than that of the general population” (Elwy, 2014).

Meditation can be very effective treatment for some victims of PTSD. The treatments might contain yoga or other form of focused exercise, which can be valuable for those suffering from depression or another mood disorder. Meditation is as a form of holistic care can be calming, relaxing, and allows the person to focus on being in the moment instead of living in their past trauma. Not all people who have PTSD present with the same needs or the same symptoms, and no one prescriptive approach works for everyone. Treating the symptoms of PTSD that are experienced by veterans, active military personnel and others varies by individual. Natural methods like yoga and meditation, massage and acupuncture have proven helpful. According to (Ewly, 2014) “89 studies of CAM mind and body-practice interventions conducted in 8 countries with veterans and military personnel. Meditation practices, relaxation techniques, spinal manipulation, and acupuncture were the most frequently studied practices, whereas yoga, one of the most offered practices at the VA, is relatively understudied”.

Integrative medicine

Integrative medicine is a type of care that uses both conventional and nonconventional therapies. Integrative medicine tries to focus on the “whole person” approach to achieve optimum mental, physical, and emotional health and is steadily getting more popular amongst patients and providers seeking to relieve chronic or multifactorial conditions. The United states military has been showing specific interest in integrative medicine for managing chronic conditions. Some of these chronic conditions include chronic pain, traumatic brain injury, and posttraumatic stress disorder. With the recent opiate epidemic, the use of unconventional methods is becoming more attractive. The goal then, is to treat symptoms without relying on any opiates. Opiates impair performance and being abused, they also fail to provide full relief. This shift in culture has a direct effect on the rise of alternative medicines. Recent statistics have been showing this new trend, for example; “In 2010, 39 percent of individuals with PTSD reported using complementary and alternative medicine (CAM) interventions, including mind-body practices that incorporate various types of stretching movements and postures combined with deep breathing” (Kim, 2013). The new rise in the use of alternative and integrative medicine is a promising one. Another factor that is affecting the rise in the methods, both for military service members and the general public is the cost of traditional medicine. The rising cost of health care is outdoing inflation and incomes, people who can’t afford to pay for expensive narcotics are turning to cheaper methods of achieving mind and body health.

There is disagreement on how helpful these types of treatments are for achieving clear results. Some experts believe that the evidence that holistic treatments provide effective treatment or increase the chances towards longer-term recovery are little to none. There also seems to be little to no body of research that has verified the effectiveness of these treatments; on the other hand, there is research some research that shows that the connection between mind and body health is essential and effective. Some of these researches demonstrate that a person’s satisfaction with treatment is a reason to remain in treatment. Hopefully this satisfaction motivates them to finish the programs. Finishing these programs are very important when attaining and preserving recovery in the long-term. Holistic treatments however, attracts people who might otherwise not be interested in conventional treatments. It makes them more comfortable with entering treatment, and may make them more willing to try other research-based treatments that provide a greater chance of long-term recovery. In addition, the use of these therapies can help people feel more at ease, more productive in their treatment response, and generally better able to cope with the challenges of their many different ailments such as PTSD. For these reasons, holistic practices can complement a more research-based traditional method that experts support.

Some prior research into the effectiveness of holistic methods yielded some positive results. According to (Kim, 2013) “A randomized non-controlled study conducted in 1981 on Vietnam veterans found a significant positive treatment effect for transcendental meditation in comparison with traditional psychotherapy on the symptoms of post-Vietnam stress disorder. This study also revealed a significant decrease in anxiety, depression, alcohol consumption, insomnia, and family problems in the meditation group”. The results here show that the growing trends in the use of holistic medicine can yield a positive result when it comes to treating people suffering from PTSD.

Holistic and integrative approaches to PTSD

The growth of holistic medicine and integrative care couldn’t have come at a better time. In recent years the side effects of a nation who depends on “chemical intervention” has been devastating on the country. According to the CDC there has been a rapid growth in opioid use that ends up turning into heroin use and overdosages. The CDC website states that “the use of heroin has been increasing in recent years among men and women, most age groups, and all income levels. Some of the greatest increases have occurred in demographic groups with historically low rates of heroin use: women, the privately insured, and people with higher incomes. In 2017, nearly 494,000 people in the United States (12-years old or older) reported using heroin in the past year, which is an estimated rate of 0.2 per 100 persons and in 2015, 81,326 emergency department visits occurred for unintentional, heroin-related poisonings in America, which is an estimated rate of almost 26 per 100,000 people”. The CDC’s website also talks about the leading reason people turn to heroin. 'Past misuse of prescription opioids is the strongest risk factor for starting heroin use, especially among people who became dependent upon or abused prescription opioids in the past year. This indicates that widespread opioid exposure and increasing rates of opioid addiction have played a major role in the growth of heroin use. Among new heroin users during 2000 to 2013, approximately three out of four report having misused prescription opioids prior to using heroin” (Opioid overdose, CDC). Traditional medicine’s push to find quick solutions and fast relief to serious issues has let them to over prescribe, which then leads to issues with dependency and misuse. We have been trained as a nation to expect quick and effect results from our medical system, and this train of thought is what pushed doctors to try and find instant solutions to broad problems. We have seen this issue in many different parts of our medical system. When we look at how traditional medicine tackles the problem of depression and PTSD, we can see the model of “quick fixes” that intern create lifelong dependency and dangerous side effects. (Guttmacher, 1979 pg. 18) “To take the clearest and most worrisome instance: chemical intervention, medicine's most advanced technology, is fast becoming the accepted mode for dealing with the daily problems of life, and in turn, dealing with a problem by pharmaceutical means gives strong impetus to thinking of it as a disease-like disorder. Instead of being provided with employment, a good education, or social supports, adolescents are prescribed drugs to help them cope with 'Emancipation Disorder.' In lieu of dealing with the causes of depression, psychoactive drugs are increasingly prescribed for women who may in fact be reacting to 'natural' events such as menopause or for those who feel unrewarded in their role of housewife or chief domestic consumer.” What Guttmacher is saying is that we are treating “natural” issues that most people suffer from with hard medicine. This is a side effect of the “quick fix” notion that has turned our medical system into more of a business than a place of healing. Holistic medicine is trying to retrain how we look at medicine and medical care. If we change our outlook and focus on the lifelong benefits of holistic and integrative care, then we can potentially limit the misuse of prescription drugs and opioids.

A very important aspect of making holistic care sustainable is called “self-care”. Self-care is what people do for themselves to establish and maintain health and prevent and deal with illness while trying to find balance in your life. Self-care, while broad, covers some very important facets of healthy living. Some of these methods include hygiene, nutrition, lifestyle environmental factors, socioeconomic factors, different means of Self-medication. If we explore further into some of these aspects, we can see how important they are to achieving effective holistic care. The socioeconomic factors of holistic care are very important when accessing the levels of care someone is able to afford. Guttmacher talks about the “paradox” of self-help and about the different socioeconomic factors that affects who gets help. She states that “Elements of the holistic critique of biomedicine, particularly its emphasis upon individual self-awareness and its stress on the failure of medical services, have been used by those who appear to advocate self-help as an alternative to ineffective, poorly financed public services. Few would argue with the notion that people should take an active role in looking after their own health, but in addition, the concept of self-help is regularly invoked to justify policy proposals that would curtail publicly financed health services in the interest of controlling cost” (Guttmacher, 1979 pg. 19). The factor of cost is a recurring topic when talking about the introduction of holistic and integrative medicine on a broader scale. Cost does not only pertain to financial cost however; cost can include the effects on a person’s quality of life based on the choices they make throughout their lives. The live of people in the military is a great example of a cost and effect system. The military can provide great benefits to people who are unsure of what they want to do in life. It can also help those who know what they want to do and want financial help with college and other programs that the military readily provides. The allure and financial stability that the military provide does however come at a cost to many. War has left many people physically and mentally damaged for life which can cost you a lifetime of recovery. “By ignoring the impact of social and economic factors on an individual's physical and psychological status, we fail to recognize that what may be viewed by some as self- destructive behavior actually may be adaptive to highly stressful conditions. For example, some people take drugs while working on an assembly line to provide relief from deadening routine. Others regularly use alcohol to 'un- wind' from a day at the office or because they have given up hope of finding a decent job. People smoke cigarettes even though aware of the risks to their health in part because they learn from advertising and social practice that smoking is an acceptable way to deal with stress and boredom” (Guttmacher, 1979 pg. 19).

The physical aspects of holistic care are also very important. It is an accepted fact that physical health has an effect on a person’s mental health. We are told from a very young age to eat healthy and stay active. The studies into the relationships of mind-body health show how closely they coincide. According to (Latorre, 2000) “research has shown the connection between the mind-and the body. She states that “feelings and emotions are felt in many places of the body, not just the mind. When a client is depressed, chemicals released in many organs of the body mirror the same chemicals that are released in the brain. Mind and body are intimately connected chemically and share a vital energetic force that cannot be separated into parts. It is this energy, this circulation of emotional information throughout the body and mind, that supports health and well-being. Therefore, we are dealing with a system, not just a collection of parts, a system that continually strives to balance itself using symptoms as a way to self-heal”.

The push for an alternative method treatment for military soldiers who are currently living with work related PTSD has been fueled partly by the long-term side effects of traditional medicine. long-term effects may take months or years after starting or stopping the medicine. The medicine might have been taken for a short period of time yet several years later an unanticipated outcome might emerge. A medicine might be taken for a long time and the cumulative effect of long-term exposure might have consequences. Holistic approaches have little to no side effects, and the side effects they do have are usually positive ones. Both long-term effects and side effects can be beneficial or harmful. “Medicine, such as drugs, is often perceived to be of benefit to humans as it is used to cure various diseases. On the other hand, medicine can also be highly damaging. Using medicine incorrectly; consuming it in small dosages, in excess, or using it abusively; can be injurious to peoples’ health. Modern medical technology can also be damaging for human well-being but this effect is not restricted to health” (7).

In 2013, the question of how effective the military’s current system of treatment was brought up to the senate. The findings of this report show the effects of traditional medicine and the need and implementation of holistic care. It also shows the cooperation need for effective integrative care. This report was in response to Senate Report 112-196, page 231, supplementary to H.R. 5856, the Department of Defense Appropriations Bill, 2013, page 231, which requested that the Secretary of Defense submit a detailed report explaining the criteria used to evaluate the effectiveness of integrative medicine programs, the result of those evaluations, and the number of Service members receiving integrative medical treatment by Service and location of medical care within the Military Health System (MHS). The report also includes plans for future expansion of these programs (Wright, 2013). This report found that 120 Military Treatment Facilities (MTFs), 99 in the continental United States (CONUS) and 21outside the continental United States (OCONUS), offer a total of 275 complementary and alternative medicine (CAM) programs. Active duty (AD) military members used 213,515 CAM patient visits in calendar year (CY) 2012 with the most visits for chiropractic care (73%) and acupuncture therapy (11%). In addition, the United States Army (USA) Medical Research and Materiel Command (MRMC) funds CAM related research to identify safe and effective therapies to treat MHS patients (Wright, 2013).

An important way of tracking the results obtained in this report is self-reporting. Customer feedback is vital in a field that unfortunately is not 100% evidence based. People’s interest in these new methods of care is what has been pushing the DOD to take a closer look at integrative care. According to the report, numerous assessment tools are being utilized by many of the sites that offer integrative and alternative therapies. “Patient assessment/feedback, qualitative assessment by the provider, pre- and post-appointment questionnaires, patient satisfaction questionnaires, and measurement of physical improvement are being used to evaluate the CAM therapies offered to AD military members. Patients reported improvement in symptoms, reduction in anxiety, improved sleep and decline in psychological symptoms across the CAM modalities in use” (Wright, 2013).

Conventional medicine has been the way of the western world for decades, mainly due to the fact that they are evidence based. This means that before a method of treatment is recommended for public use, rigorous tests and trials are ran to make sure that these medications are safe to use. Evidence based medicine is logical, but the effectiveness and side effects are leading soldiers and people in general to seek out alternative care. “Integrative medicine is a response to these patient demands” (Wright, 2013). In the year 2000, the White House Commission on Complementary and Alternative Medicine Policy report documented the growing use of CAM, revealing that most people used CAM in conjunction with, rather than as a replacement for, conventional medical therapy. The report also noted that patients sought conventional medical treatment first before turning to CAM practitioners, and that many patients combined care from a variety of approaches (White House Commission on Complementary and Alternative Medicine Policy, 2001). This growth of CAM has been documented in many different departments within the DOD. Data gathered by military departments showed the types of therapies that were provided in different branches; The most commonly offered CAM programs are acupuncture and clinical nutrition therapy followed by chiropractic care. Sixty-nine US Air Force (USAF) MTFs offered acupuncture, chiropractic, and/or clinical nutrition programs. Twenty-five US Navy (USN) MTFs offered acupuncture and/or chiropractic programs. Fourteen (58%) offered both therapies. The US Army (USA) MTFs offered the greatest variety of CAM programs with chiropractic programs having the highest utilization. The MTFs in the Joint Task Force National Capital Region Medical Command (JTF-CapMed) offered 3 CAM programs: two acupuncture and one chiropractic (Wright, 2013). The most commonly utilized CAM programs are chiropractic care and acupuncture followed by clinical nutrition therapy. Seventy-three percent of the 213,515 patient visits made by AD patients were for chiropractic care. The remaining 27% of visits were distributed among ten types of CAM programs (Wright, 2013).

Another form of integrative care is psychological care. A report showed the link between psychological care and its connection to how the body recovers. Several psychological interventions have shown to be useful by athletics trainers when an athlete is returning to play. Psychological interventions enhance the rate or quality of sport injury rehabilitation, these interventions include goal setting, imagery and relaxation, and overall stress management (Kim, 2013). When looking at how PTSD affects people in the military, it is important to look at ways to treat the psychological trauma that they are afflicted with. Most veterans suffer from what is known as “chronic trauma”. According to (lifelenscounseling.com), “chronic trauma occurs when a person is subject to multiple trauma situations, often as found in combat service, in on-going abusive relationships, or sometimes in situations where a person simply suffers one unrelated trauma after another”. To treat people suffering from these forms of ailments, you have start by trying to understand why and how the trauma gets triggered. Conventional medicine, while effective in some aspects, falls short when it comes to long-term treatment plans for people suffering from these conditions.

Luckily, the military has been very open to the prospects and potential benefits of holistic care. The VA (Veterans Affairs) has launched a new program called the “Whole health initiative”. This program aims to create a personalized health plan that considers the physical, mental, emotional, spiritual and environmental needs of veterans. The VA says the Whole Health System 'acknowledges that health care involves more than the physical human body.' This program offers many new ways to treat wounded soldiers. They offer peer to peer treatment programs utilizing other veterans who can connect to patients on a deeper level. They also offer well-being programs like yoga, tai chi, and mindfulness. This new approach focuses on whole health clinical care utilizing a holistic approach rather than just handing out pills.

The VA is “shifting from a health care system focused primarily on treating disease to one rooted in forming continuous healing relationships and partnerships that 'support you in achieving your greatest overall well-being.' The result is a whole health approach, which is a radical redesign of health care focused on empowering you”. This new push from the VA brings hope to those who support and enjoy the benefits of holistic treatment methods.

Conclusion

To conclude, we have seen a massive push in recent years to a more holistic centered health care system. The benefits of holistic and integrative care are steadily beginning to be mentions alongside many older conventional methods of care. With these new initiatives, the future of holistic care seems to be very bright. Focusing on the whole body instead of just treating the root disease will change the way people suffering from many different illnesses start and maintain the healing process. Hopefully more research will be focused into the methods of care already established, and into the discovery of new alternative methods of care.

References

• Guttmacher, Sally. “Whole in Body, Mind & Spirit: Holistic Health and the Limits of Medicine.” The Hastings Center Report, vol. 9, no. 2, 1979, pp. 15–21. JSTOR, www.jstor.org/stable/3560273.
• Latorre, Mary Anne. 'A holistic view of psychotherapy: Connecting mind, body, and spirit.' Perspectives in psychiatric care 36.2 (2000): 67.
• Kroesen, Kendall, et al. 'US military veterans' perceptions of the conventional medical care system and their use of complementary and alternative medicine.' Family Practice 19.1 (2002): 57-64.
• Elwy, A. Rani, et al. 'A systematic scoping review of complementary and alternative medicine mind and body practices to improve the health of veterans and military personnel.' Medical care 52 (2014): S70-S82.
• Kim, Sang Hwan, et al. 'Mind-body practices for posttraumatic stress disorder.' Journal of Investigative Medicine 61.5 (2013): 827-834.
• “Opioid Overdose.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 19 Dec. 2018, www.cdc.gov/drugoverdose/data/heroin.html.
• “Negative Effects of Modern Medicine.” Actforlibraries.org, www.actforlibraries.org/negative-effects-of-modern-medicine/.
• Wright, Jamie, “Integrative medicine in the military health system report to Congress” Department of defense reporting; (2013).
• “White House Commission on Complementary and Alternative Medicine Policy; Notice of Meeting.” Federal Register, 8 Jan. 2001, www.federalregister.gov/documents/2001/01/08/01-409/white-house-commission-on-complementary-and-alternative-medicine-policy-notice-of-meeting.
• “Chronic Trauma Symptoms and Treatment.” LifeLens, lifelenscounseling.com/chronic-trauma/.
• Absher, Jim. “VA Expanding New Holistic Health Programs.” Military.com, 15 May 2018, www.military.com/militaryadvantage/2018/05/15/va-expanding-new-holistic-health-programs.html.