Where's the T.R.Y in the P.T.S.D. Pocket Guide?

I was reviewing the PTSD pocket guide from the Department of Veterans affairs (http://www.healthquality.va.gov/guidelines/MH/ptsd/PTSDPocketGuide23May2013v1.pdf) and came across the current guidance to treat those who suffer ASD and PTSD. Step A: Initiate Treatment Using Effective Interventions for PTSD which are Psychotherapy interventions for treatment of PTSD and Pharmacotherapy for PTSD. The guidance in Step B of treatment: Initiate Adjunctive Therapy as Indicated. As I read further into Step B, I noticed this bolded statement There is insufficient evidence to recommend CAM approaches as first-line treatments for PTSD. Now…why does this matter? These guideline steps, at no point, advise a physiological (somatic) therapy as an adjunct to Step A  pharmacotherapy or psychotherapies. Interesting enough, reviewing one of the Step A treatments I found the pharmacotherapy treatments (SNRIs – venlafaxine) has these and quite a few more side effects: High blood pressure, lack or loss of strength, severe headache, sweating, and suicidal thoughts. When we consider yoga, which would be an insufficient evidence therapy, there are no negative side effects! But yoga does have a profound impact one ones ability to breath deeply,  relax a stressed body, and calm a chattering mind during savasana. Ironically the same pocket guide in the Stress Inoculation Training guidelines “Places more emphasis on breathing retraining and muscle relaxation, but also includes cognitive elements (self dialogue, thought stopping, role playing) and, often, exposure techniques (in-vivo exposure, narration of traumatic event)”. 

As I close……..Anyone who’s experienced a situation which caused your adrenaline to rise, knows it ends with the physical effect of shakiness and breath shortness. Now when you escalate that to a traumatic event(s) the physical effects will be even more profound and definitely more lingering. Without helping this individual to work “with their body, through yoga, breathing and meditation” we still aren’t addressing the first guidance of the V.A.’s Stress inoculation training (SIT)  which are considered of “Significant Benefit” in the V.A. Psychotherapy Intervention Guidelines. I highlight this interesting information not to single out the V.A. but to acknowledge we still have a gap to close when helping those who’ve suffered trauma. We either need more research or take a leap of faith a centuries-old practice of centering and mind-body connection is the right thing to do in all levels of trauma treatment.

 

Darwin