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Treating PTSD With the Fear Reducing Effects of Exercise

23 Nov

By Jessica Glenza

mexico-88768_1920American psychologists are hoping to treat veterans with post-traumatic stress disorder (PTSD) with a recommendation so well-worn by family physicians, it almost seems mundane: exercise.

The nascent field of research has found reason to hope that physical activity can improve outcomes for those diagnosed with the persistent psychiatric disorders. Doctors hope that physical activity will eventually become part of the widely accepted psychotherapy and medication routines used to treat the condition synonymous with war that causes flashbacks, nightmares and hypervigilance.

“We’ve been studying exercise for the treatment of depression for maybe about 10 years,” said Jasper Smits, a licensed psychologist and professor at the University of Texas at Austin. His studies, as well as others by doctors such as Michael Otto, a Boston University researcher studying the impact of exercise on mood, eventually veered from studying depression and exercise to PTSD.

“It’s not always possible to go see someone who practices [cognitive behavioral therapy],” said Smits about a form of psychotherapy. “So, we thought maybe exercise has some of the same ingredients as this kind of psychotherapy.”

Some of the most widely accepted treatments for PTSD include cognitive behavioral therapy and prolonged exposure, where patients are gradually exposed to more stressful experiences. But residual symptoms of PTSD can persist even after “successful” treatment, a cause for serious concern among clinicians because PTSD can severely affect marriage and employment, and increases the likelihood that people are diagnosed with other psychiatric disorders.

“If we had people exercise for three times each week for six exercise sessions over the course of two weeks … we found that the reduction in fear in bodily sensations was about the same as we see in 12 weekly sessions for [cognitive behavioral therapy],” said Smits. “That encouraged us to do more work in this area.”

The National Institutes of Health estimates that PTSD affects 7.7 million Americans, including 11% of veterans of the war in Afghanistan and 20% of Iraq war veterans. For the Veterans Administration, this has translated to a tsunami of new PTSD cases. Between 2001 and 2007 the administration experienced a 60% increase in new cases.

Most current therapy includes a combination of psychotherapy and exposure treatment. For example, a PTSD sufferer with panic attacks might be asked to complete increasingly challenging runs, the idea being to raise the body’s overall stress tolerance.

The most prominent recent study on exercise’s impact on PTSD therapy was conducted at the US Department of Veterans Affairs itself. Dr Kimberly Babson, a researcher at the Palo Alto VA hospital in California, asked a group of 217 male veterans to cycle on stationary bikes while they underwent between 60 and 90 days of psychotherapy.

The obvious flaws of the study are worth pointing out. Patients self-reported their sleeping patterns, level of depression and PTSD symptoms. Data about cycling was collected from odometers, meaning intensity didn’t factor into findings.

In other words, the study is observational, not a clinical trial, the way most studies for new medication are conducted.

Some nonprofit groups have already incorporated this exercise research into their mission. Team Red, White and Blue, an athletics club that seeks to reconnect veterans to their communities, specifically references the power of exercise in its mission.

“At the end of the day, we want to be able to grow, but grow in a way to show we are truly impacting, enriching veterans’ lives,” said Dan Brostek, spokesman for Team RWB. “To do that we’re going to base it on science, and base it on data.”

Researchers maintain a mood of cautious optimism about the results, which found those who cycled had less severe PTSD symptoms both when they went into treatment, and when they left. “Exercise,” researchers wrote, “holds both empirical and theoretical promise.”

Theories for why positive impacts on PTSD symptoms have been observed by multiple researchers are manifold – exercise could stimulate the endocannabinoid endorphin system, and thus stimulate better sleep.

That would mean exercise triggers the same receptors as marijuana, another PTSD treatment currently being investigated. Others, such as Otto, have theorized that exercising in a team setting is therapeutic. In Babson’s study, cycling was done in a group setting, for example, and she theorized that it may have been the connections, not the actual exercise, that improved outcomes. Still others have wagered that it is exercise’s impact on sleep that aids PTSD sufferers.

“An important next step is to look at randomized controlled trials of exercise for sleep, as well as for anxiety disorders among veterans and among community members as well,” said Babson.

“The mechanism by which exercise may be impacting symptoms is something that we don’t know right now, so a lot more research needs to be done to find out what is it about exercise that might be making a difference.”

Related Continuing Education Courses

Providers, and those who listen empathically to the trauma stories of others, are at risk for reactions known collectively as vicarious traumatization (VT). This course outlines some of the basic differences between primary traumatization, secondary traumatization, VT, and compassion fatigue; discusses many of the signs and symptoms of VT; provides questions for self-assessment of VT; and provides coping suggestions for providers who are involved in trauma work or those who may have VT reactions. This course offers providers and others who listen empathically to the trauma stories of others, a basic understanding of the possible effects of “caring for others” and discusses ways to monitor oneself and engage in positive self-care.

 

Part I of this course provides an overview of cognitive-behavioral interventions for PTSD. It describes some basic aspects of CBT, outlines cognitive-behavioral theories of PTSD, discusses key trauma-focused CBT interventions, and provides some tips for using CBT to encourage behavior change. Additional resources related to the topic are identified. Part II has two principal objectives. First it will review the psychobiology of the human response to stress in order to establish the pathophysiological rationale for utilizing different classes of medications as potential treatments for PTSD. Second it will review the current literature on evidence-based pharmacotherapy for PTSD. New medications currently being tested will also be discussed. The speakers’ original lectures included in this course are transcribed verbatim with minor editorial modifications.

 

Substance abuse problems are commonly experienced by those who have experienced trauma. This course discusses the complex relationship between trauma/PTSD and substance use disorders and provides a background for understanding comorbid PTSD and substance abuse. Topics covered include assessment, practice guidelines, common issues and their implications for treatment, and empirically-based treatment considerations in traumatized/PTSD individuals.

Professional Development Resources is approved to offer continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; and by the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners.

 

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