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By Dixie Wall, Contributing Editor

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Massage Combats PTSD

Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops in response to a traumatic event. The event often includes physical and/or psychological harm to an individual or a loved one. Triggers of PTSD include violent personal assaults, natural or man-made disasters, accidents, or military combat. Post-traumatic stress is the inability to dissociate the trauma from the past and live without fear of the future. Evidence demonstrates that massage therapy eases suffering caused by this disorder and assists in the recovery process.

Trauma and PTSD

After the September 11th terrorist attacks on the United States, the perspective of the world changed forever. Since, the Indian Ocean tsunami, the Chilean and Kasuri earthquakes, hurricane Katrina, countless wars and famine, PTSD has risen to unprecedented levels. According to the National Center for PTSD, 7.7 million in the United States have suffered from PTSD.

Military

Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq, according to a major RAND study.1 Most of the 1.64 million will return home from war without problems and readjust successfully. However, 18.5 percent of all returning service members meet criteria for either PTSD or depression.1

PTSD - Copyright – Stock Photo / Register Mark Symptoms

Symptoms include: flashbacks and/or nightmares, avoidance/numbing, a feeling of estrangement from others, hyperarousal/hypervigilance, and a feeling of constantly being in danger. Other common symptoms include: sleep disturbance, physical pain, irritability, depression, suicidal thoughts, and no longer feeling at home in one's body.2

Stigma

However common the disorder, stigma may hinder individuals from receiving treatment. In 2008, it was reported that only half of military service members who have returned from Iraq with PTSD or major depression have sought treatment.1 Stigma includes factors such as being concerned that one will be viewed or treated differently by peers or military leaders if they are receiving mental health treatment. Other barriers to receiving care include not being able to get time off work, lack of information about where to find help and not having adequate transportation to get to the location where care is available. Stigma and barriers seem to affect both genders, especially males, who are not as likely to pursue professional help as females.3

Sgt. Travis Runnels, Combat Veteran of the 1st Infantry Division, U.S. Army, (himself a sufferer of PTSD) said, “Team strength is emphasized within the units and nobody wants to feel like the loose link. Sometimes a cry for help is confused with being weak, instead of taken for the serious disorder it is. Understand that PTSD needs proper medical treatment and sometimes intervention.” Runnels found that massage and alternative medicine were a real compliment to his conventional treatment. However, for a long time he had a hard time with doctors touching him, let alone someone that he was not comfortable with. Ultimately, at the right time with the correct counseling resources, he was able to control his reactions and unwind enough to the point where he was able to receive massage. “Massage helped me to learn to relax, let my guard down, and begin to feel safe and comfortable within my body and mind,” said Runnels.

Treatment

Traditional treatment includes pharmacology and psychotherapies, cognitive behavioral programs, exposure therapies, and eye movement desensitization and reprocessing (EMDR). Cognitive behavioral treatments include: psychoeducation, anxiety management, exposure and cognitive restructuring. According to the National Center of PTSD,4 specific cognitive behavioral therapies including prolonged exposure, cognitive processing therapy and EMDR are best used as initial treatments of PTSD. Group and family therapies along with alternative methods continue to be studied.4

Treatment is provided by TRICARE Prime, a health care plan for active duty military personnel, the Veterans Administration and the U.S. Department of Defense (DoD). Since 1998, the DoD has required soldiers to complete a pre-and post-deployment health assessment, and more recently has mandated a post-deployment health reassessment to be completed six months after the service member returns home.5

Based on the combined screening, clinicians identified 20.3 percent of active duty and 42.4 percent of reserve soldiers as requiring mental health treatment, according to a 2007 study.6 Mental health treatment by the Veterans Administration is helping those with PTSD; 49-59 percent of those who had PTSD symptoms identified after the first assessment, report improvements six months later.6 However, those who didn't initiate treatment at that time, tend to get worse. Several community health programs are also becoming more readily available, one being a DE-STRESS program (Delivery of Self-Training and Education for Stressful Situations), that utilizes an interactive Web site to complete an eight-week program designed to help manage and treat PTSD.5

Holistic Help

A revolutionary change in the treatment of PTSD has begun with a holistic approach at the Fort Bliss Restoration and Resilience Center in Texas.7 The program, created by clinical psychologist John Fortunato, was launched in the summer of 2007 after a long struggle for funding. His six- to nine-month program includes a rigorous 35-hour treatment week that combines group and individual therapies that include alternative therapies such as: massage, reiki, qigong, tai qi, meditation, yoga, acupuncture, chiropractic, exercise, games, hot-stone therapy treatments and "rehearsal therapy", which includes telling your most painful memories over and over until they lose their power.

Fortunato uses acupuncture in the treatment of anxiety, panic and tension-induced pain. Reiki treatments are used to assist in treating hyperarousal symptoms. According to Fortunato, "In order to stay alive, their bodies have been hyperaroused for so long, that they come back and cannot turn it off. Their body doesn't even remember how to relax again, and because of that they don't sleep and are irritable. ... The massage has helped soldiers sleep."

And the holistic healing approach for soldiers is paying off: 12 of the 37 soldiers have returned to their units and only two have ended up having to take medical discharges from the army.

According to a 2005 study,8 positive changes have been shown in biochemistry following massage therapy including reduced cortisol and increased serotonin and dopamine. By decreasing the clients' cortisol levels with bodywork, a client can reduce the constant feelings of hyperarousal and danger. By increasing serotonin and dopamine in the brain, an ease of suffering and anxiety is felt.8

A study on sexual abuse victims suffering from PTSD conducted by Cynthia Price, concluded victims of PTSD showed a significant decrease in physiological and physical symptoms, after massage and body-oriented therapy (in addition to psychotherapy).9

Alternative medicine, massage and bodywork, along with traditional methods, can help victims of PTSD in the recovery process. With PTSD numbers on the rise, and more troops coming home every day, there are plenty of sufferers in need. In the hands of a well-intentioned therapist, massage for clients with PTSD acknowledges and helps to restore the most basic human needs of safety, trust, control, self-worth and intimacy. When these needs are satisfied in the context of a healthy therapeutic relationship, an individual may not only succeed but re-learn or discover for the first time how to thrive.2

For a comprehensive list of PTSD resources go to: http://ptsdcombat.blogspot.com/2007/01/need-transition-help-free-resources.html.

References

  1. Tanielian T, Jaycox LH. "Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery." Santa Monica, Calif.: RAND Corporation, MG-720-CCF, 2008:23.
  2. Dryden T, Fitch P. "Recovering Body and Soul From Post-Traumatic Stress Disorder." Massage Therapy Journal, Winter 2007;46:133-19.
  3. Hoge CW, Castro CA. "Impact of Combat Duty in Iraq and Afghanistan on the Mental Health of U.S. Soldiers: Findings From the Walter Reed Army Institute of Research Land Combat Study." In Strategies to Maintain Combat Readiness During Extended Deployments - A Human Systems Approach, 2005:11-1 - 11-6.
  4. Hamblen JL, Schnurr PP, Rosenberg A, Eftekhari A. "Overview of PTSD Treatment Research." National Center for PTSD, U.S. Dept. of VA. www.ptsd.va.gov.
  5. "Invisible Wounds: Serving Service Member and Veterans with PTSD and TBI." National Council on Disability Mar. 4, 2009.
  6. Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning From the Iraq War. JAMA 2007;298:2141-8.
  7. Miles D. "Center Creates 'Little Miracles' in Treating Combat Stress." News Article, May 9, 2008. American Forces Press Service, U.S. Dept of Defense. www.defense.gov
  8. Field T, Hernandez-Reif M, Diego M, Schanberg S, Kuhn C. Cortisol Decreases and Serotonin and Dopamine Increase Following Massage Therapy. Inter J Neuroscience, 2005;115:1397-1413.
  9. Price C. "Body-Oriented Therapy in Sexual Abuse Recovery: A Pilot-Test Comparison." JBMT, Jan 2006;10(1):58-64.

Other Resources

  1. Collinge W, Wentworth R, Sabo S. "Integrating Complementary Therapies Into Community Mental Health Practice: An Exploration." JACM June 2005;11(3):569-74
  2. Meagher I. PTSD Combat: Winning the War Within. http://ptsdcombat.blogspot.com/2007/01/need-transition-help-free-resources.html.
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