American 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.”
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