Hills 1

Efficacy of Mind Body Medicine in

Treatment of Post Traumatic Stress Disorder
Grace Hills
Independent Research G/T I
10 May 2019

Advisor: Eleonora Gafton

Instructor: E. Leila Chawkat
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Grace Hills
GT Independent Research pd 2
10 May 2018

Efficacy of Mind Body Medicine in Treatment of Post Traumatic Stress Disorder

I. Abstract

The standard treatment for Post Traumatic Stress Disorder consists primarily of

medications with little focus on alternative treatments or therapies. The default for many

medical professionals is to prescribe drugs which can be harmful to the patient, as

patients may develop an addiction to the drug. It is important for medical professionals to

consider alternative and complementary treatment options in order to prevent their

patients from developing an addiction. A relatively new complementary medicine is

Mind Body Medicine, in which a trained practitioner utilizes the influence the mind has

over the body to treat both psychological and physiological conditions with relaxation

techniques, such as meditation. This research seeked to evaluate the benefits of treating

PTSD with complimentary medicine, specifically Mind Body Medicine. Multiple Mind

Body Medicine modalities were examined for their efficacy in treating PTSD. This paper

also analyzed published data that demonstrates the benefits of Mind Body Medicine in

treating PTSD in two post-war communities, Kosovo and Gaza, and described the

necessity of alternative health care in those areas.

Table of Contents

Introduction-------------------------------------------------------------------------page 3

Literature Review------------------------------------------------------------------page 4

Mind Body Medicine Techniques--------------------------------------page 4

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Conditions of Post-War Communities---------------------------------page 6

Post Traumatic Stress Disorder------------------------------------------page 7

Impact of Mind Body Medicine on Post-War Communities--------page 9

Rationale----------------------------------------------------------------------------page 10

Data Collection---------------------------------------------------------------------page 10

Analysis--------------------------------------------------------------------page 14

Data Conclusions---------------------------------------------------------page 16

Conclusion--------------------------------------------------------------------------page 16

References--------------------------------------------------------------------------page 18

II. Introduction

Mind Body Medicine is a type of alternative modality that utilizes the connection

between the brain and the body to improve mental and physical health. A variety of

techniques are used to accomplish this connection, such as meditation, yoga,

biofeedback, autogenic training, and guided imagery, etc. Each of these modalities is

proved to have positive effects on an individual's physical and mental health. Recent

research indicates that Mind Body Medicine is especially useful to treat conditions such

as Post Traumatic Stress Disorder (PTSD), in which both the physical body and the mind

are affected. PTSD is characterized by unpleasant memories and emotions of a traumatic

event, often experienced through flashbacks in the form of sleep disturbances (“Post

Traumatic Stress Disorder,” 2007). Left untreated, PTSD can be a debilitating condition,

due to its unpredictableness. While wealthy countries have access to the needed

medicines that can cure most psychological and physiological diseases like PTSD, areas
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that don’t have access to good healthcare are in desperate need of Mind Body Medicine,

as it does not require a medical professional. According to data collected in 2014, the

United States designates 17.10% of its GDP to health expenditures, while Middle Eastern

Countries, such as Bangladesh and Indonesia, designate 2.80% of their GDP (The World

Factbook, 2019). Similarly, countries in Africa devote little of their GDP to healthcare

despite their large populations. Data collected from a cross country study for African

countries found that the “population of individuals over the age of 65 had no impact on

total health expenditure,” (Xu, Saksena, & Holly, 2011) indicating that African

governments do not satisfy all of their citizens health needs, due to lack of money

designated to health care. The CMBM leads a national training program that is designed

to teach self-awareness and self-care techniques to impoverished communities with

limited access to basic needs. Many of these impoverished areas are also areas that are

impacted by war. Such areas, like Gaza and Kosovo, are known to be home to many

people living with PTSD. The CMBM works with organizations such as the Red Cross

and various school systems to share and teach Mind Body Medicine techniques, in order

to treat conditions induced by trauma (Gustafson, 2016). Participating in Mind Body

Medicine improves PTSD symptoms, depression, quality of life, sleep, anxiety, and stress

in individuals with PTSD.

III. Literature Review

Mind Body Medicine Techniques:

Meditation is one of the most commonly used Mind Body Medicine modalities,

due to its relaxation benefits. Meditation activates the parasympathetic nervous

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system, thus slowing down the level of arousal the individual is experiencing.

Simultaneously, the sympathetic nervous system will slow down, creating a sense

of calmness for the individual. Meditation is defined as the “conscious mental

process that induces a set of integrated physiological changes termed the

relaxation response” ("Mind-Body Medicine: An Overview." 2019). Meditation

activates regions in the brain involved with attention, the autonomic nervous

system and the left-sided anterior brain, which is associated with positive

emotional states. Immune function also improves during meditation because more

antibodies are produced ("Mind-Body Medicine: An Overview." 2019). Another

technique commonly used to decrease stress is guided imagery. Guided imagery is

centralized around the idea that thought influences psychological states. By

focusing on and imagining a calm surrounding, the individual can create a ‘mental

escape’ that allows them to cope with the present issues in their life (“Guided

Imagery,” 2019). Guided imagery decreases anxiety and is used to shorten the

recovery process for surgical patients (Tusek, Church, Strong, Grass, & Fazio,

1997). During autogenic training, another Mind Body Medicine technique, the

individual learns to “concentrate on the physical sensations of warmth, heaviness,

and relaxation in different parts of [their] body” (“Relaxation Techniques for

Health,” 2016). Essentially, the autogenic training participant tricks their brain

into believing that they are experiencing certain pleasant sensations based on what

they are thinking of. Biofeedback is another useful tool that can “measure body

functions and give… information about them so that [the individual] can learn to
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control them… [it is the use of] electronic devices to teach [the individual] to

produce changes in [their] body that are associated with relaxation, such as

reduced muscle tension” (“Relaxation Techniques for Health,” 2016). In

summary, these Mind Body Medicine modalities are all especially useful in areas

that don’t have access to medicine, such as communities impacted by war.

Conditions of Post-War Communities

Gaza, a densely populated strip surrounded by Israel, frequently experiences

unpredictable attacks. The entire population of 1.8 million has been affected by

political violence to some degree. Unemployment and poverty levels are high, and

access to basic needs (clean, sanitation, power, feed, and health care) is limited.

Since 2005, The Center for Mind Body Medicine (CMBM) has trained 600

Palestinian clinicians, educators, and community leaders about self-care and

group support. These trained leaders have spread the knowledge of Mind Body

Medicine to more than 150,000 children and adults. Currently, there are 40,000

people participating in the mind body skills group in Gaza, thanks to the CMBM

efforts to work with organizations such as the Ministries of Health, Education and

Social Welfare, the United Nations Relief and Work Agency, and 200

international and local NGOs (Staples, Atti, Ahmed, & Gordon, 2011). Mind

Body Medicine has also been shared with other post war communities, such as

Kosovo. War in the Balkans has led to many reports of PTSD in adolescent, as the

Kosovo conflict lasted from 1998 to 1999 in which many students lost one or both

parents. The CMBM traveled to Kosovo to teach relaxation techniques, guided

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imagery, autogenic training, quiet and active meditations, and biofeedback. These

Mind Body Medicine modalities were shown to enhance the student’s sense of

control, lower sympathetic arousal, decrease anxiety, and improve mood (Gordon,

Staples, Blyta, & Bytyqi, 2004). These Mind Body Medicine interventions have

greatly impacted communities with inadequate access to healthcare by educating

them on how to practice and share alternative treatments that do not require a

professional with a degree in medicine.

Post Traumatic Stress Disorder

People exposed to live-threatening events such as war, rape, or motor-vehicle

accidents are commonly affected by PTSD, as they regularly experience

flashbacks, nightmares, depression, and increased physiological arousal (“At the

back of the mind,” 2001). Repeated traumas and traumas in early childhood make

the individual more susceptible to developing PTSD. When children are exposed

to environmental stressors, like abuse, while their brain is still developing, they

may develop a greater constant fear of their surroundings. The support of friends

and family the individual receives while working through their conditions is

crucial to healing, otherwise the PTSD symptoms may increase in severity due to

the perceived skepticism from loved ones. Those who live with PTSD are at a

much higher risk of developing other conditions such as diabetes, coronary artery

disease, depression, and addiction. Sleep disturbances are another major symptom

of PTSD. The DSM-IV-TR (Diagnostic and Statistical Manual of Mental

Disorders) states that nightmares and difficulty remaining asleep is experienced in

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up to 90 percent of PTSD patients. In a desperate effort to sleep, some will

attempt to self-medicate in order to avoid the distress associated with sleep

disturbance, frequently leading to substance abuse (Halper, 2008). PTSD greatly

affects the social lives of trauma victims as well, since they frequently have

trouble connecting with friends and maintaining stable relationships. PTSD does

not only have social and psychological effects, but can also be studied from a

biological perspective. The amygdalae produce fear, reading signals and sending

messages to other parts of the brain, which filter the signals before reacting.

However, for individuals with PTSD, these filters frequently fail to distinguish

between real threats and those that can be safely ignored, leading to a constant

state of arousal (“Fear itself; Post-traumatic stress disorder,” 2015). Selective

serotonin reuptake inhibitors, and other PTSD medications, are effective in

improving mood; however, not everybody uses or has access to these drugs. Data

collected from the US in 2019 shows that of the veterans returning from Iraq and

Afghanistan, 20% suffer from major depression or PTSD, 19.5% have

experienced brain injury, 25% show signs of substance abuse, but only 50% have

received treatment (StateStats, 2019). The fact that only half of the veterans with

PTSD have received treatment suggests that a more affordable and accessible

treatment option would be beneficial. Mind Body Medicine and other alternative

therapies are not only a safer and more affordable treatment option in the US, but

are also extremely beneficial in areas without access to standard health care.
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Impact of Mind Body Medicine on Post-War Communities

A series of publications done by the the CMBM has shown that Mind Body

Medicine decreases PTSD symptoms, improves overall mood, and improves sleep

quality and duration. A study conducted in Gaza, on 92 Palestinian adults with

PTSD, found that participating in mind body skills groups reduced PTSD

(Gordon, Staples, He, & Atti, 2016). These results were consistent with a pilot

study conducted to evaluate the impact of yoga on PTSD in veterans, which found

a significant improvement in PTSD hyperarousal symptoms (Staples, Hamilton,

& Uddo, 2013). The study conducted in Gaza also found that participating in

mind body skills group improves overall mood, reducing depression and anxiety

(Gordon et al. 2016). Gordon’s data was verified with a randomized control trial

evaluating the effect of Kundalini Yoga on people with PTSD, which found that

yoga participants improved in positive affect, perceived stress, anxiety, stress, and

resilience (Jindani, Turner, & Khalsa, 2015b). A qualitative descriptive study

evaluating a Kundalini yoga program found that yoga participants were much

more emotionally stable, aware, and positive (Jindani & Khalsa, 2015a). With

decreased depression and anxiety, humans are less susceptible to sleep

disturbances, which are also associated with PTSD. The randomized control trial

evaluating the effect of Kundalini Yoga on people with PTSD also found that

yoga participants showed greater improvements in sleep (Jindani et al. 2015b).

Jindani’s findings were confirmed by the pilot study that evaluated the impact of

yoga on improving PTSD in veterans, which also found a significant

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improvement in sleep quality and daytime dysfunction (Staples et al. 2013). Since

many post-war communities do not have access to, or are not able to afford drugs

that help with sleeping, such as melatonin and benzodiazepines, they rely on

alternative therapies.

IV. Rationale

Meta-analysis was the most realistic approach for data collection because

reaching countries impacted by war to conduct an experiment/questionnaire on how Mind

Body Medicine impacts PTSD would be challenging. While conducting an authentic

experiment was unlikely, access to raw and descriptive data through the CMBM

published journals would allow for a meta-analysis. The four data sets were found from

scholarly sources with similar methodology. The data was analyzed in a new way

because it consisted of multiple types of research methods which allowed for new insight,

indicating a correlation between perceived efficacy and numerical evidence.

V. Data Collection

# Name Authors Date Summary Comparison

1 Mind–Body James S. 11 The study evaluated the effects of a (w/2)​ While both studies
Skills Gordon, August 10-session mind-body skills group on evaluated the effects of
Groups for Julie K. 2016 level of depression, anxiety, and Mind Body Medicine on
Post- Staples, quality of life. The study was PTSD, study 1 used a mind
traumatic David Y. conducted on 92 Palestinian adults with body skills group as the
Stress He, Jamil PTSD, in Gaza. The paper found that modality, while study 2 used
Disorder in Ahmed those participating in the MBSG had Kundalini Yoga as the
Palestinian Abdel Atti significantly reduced PTSD, modality. Both studies
Adults in depression, anxiety, and improvements evaluated the efficacy of
Gaza in quality of life. treating depression with
Mind Body Medicine, but
See Figure A only Gordon’s study found
an improvement. Both
showed an improvement in
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anxiety and PTSD

symptoms.
(w/3) ​While both studies
evaluated the effects of
Mind Body Medicine on
PTSD, study 1 used a Mind
Body Medicine skills group
as the modality, while study
3 used Kundalini Yoga as
the modality. Study 1 was a
quantitative study, while
study 3 was qualitative.
Both studies found that the
participants reported having
a significantly improved
quality of life.
(w/4) ​While both studies
evaluated the effects of
Mind Body Medicine on
PTSD, study 1 used a Mind
Body Medicine skills group
as the modality, while study
4 used yoga as the
modality.Study 1 found that
mind body skills group
improved quality of life,
while study 4 found no
effect on quality of life.

2 A Yoga Farah 3 A pilot randomized control trial was (w/3) ​While both studies
Interventio Jindani, August conducted to evaluate the impact of evaluated the effects of
n for Post- Nigel 2015 Kundalini Yoga treatment on PTSD Kundalini yoga, study 2 was
traumatic Turner, symptoms and overall well being. The quantitative, while 3 was
Stress: Sat Bir S. study involved participants with PTSD qualitative. Both studies
A Khalsa who were randomly assigned into an 8 found that Kundalini yoga
Preliminary session Kundalini Yoga treatment and improved stress and anxiety.
Randomize the control group. The data shows that (w/4) ​Study 2 focused on
d Control both groups had improved PTSD treating PTSD with
Trial symptoms, but yoga participants Kundalini yoga, while study
showed greater improvements in sleep, 4 focused on treating PTSD
positive affect, perceived stress, in veterans with yoga, in
anxiety, stress, and resilience. general. Study 2 found that
PTSD symptoms improved,
See Figure B while study 4 found that
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PTSD hyperarousal
symptoms improved but
total PTSD score did not.
Study 2 showed that the
participants overall well
being improved, while study
4 found that yoga had no
improvement on quality of
life. Both studies found that
the participant’s sleep
quality improved.

3 A Yoga Farah A. 2015 A qualitative descriptive study was (w/4) ​Study​ ​3 was a
Interventio Jindani, conducted to understand how qualitative study that was
n Program G.F.S. individuals with PTSD perceive a conducted to evaluate the
for Patients Khalsa Kundalini yoga program. Jindani and effects of Kundalini yoga on
Suffering Khalsa recorded telephone interviews PTSD, while study 4
from of 40 individuals for 30-60 minutes evaluated the effect of yoga
Symptoms after participating in an 8-week on PTSD in veterans. Study
of Post- Kundalini yoga treatment. 4 found that there were no
traumatic improvements in quality of
Stress 1)‘I would say my biggest benefit has life, while study 3 found that
Disorder: been that I am more emotionally the participants were much
A balanced. Often after class, I would feel more emotionally stable,
Qualitative really strong and balanced and really, aware, and positive.
Descriptive really alert, but like deep calm. I would
Study be able to return to that feeling the days
I wasn’t in class.’’
2)‘‘I feel stronger.also more, gentle.just
a lot more hope. A lot of my.thinking
was very.stunted. This was very
empowering. I do not feel so small
anymore.
3)‘‘With yoga, I had a connection of
mind, body, and spirit. During the
practice and when you become aware
of those three things, or be aware of
them, it seems like things
are more possible. I had more peace,
the idea of finding increased peace of
mind.
I mean what could be richer than a
sense of you know a spirit; my spiritual
self.’’
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4)‘‘Emotional shifts were coming from

the practice. I would have emotional
patterns
come up especially like kind of the
middle point of the class. I would be
more aware
and could then think more clearly how
best to respond. When I would do that
I’d feel
really peaceful after and just be able to
work with my emotions and
experiences
in a healthier way.’’

4 A Yoga Julie K. 5 A pilot study was conducted to

Program for Staples, October evaluate the impact of a 6 week yoga
the Michelle 2013 intervention on improving PTSD in
Symptoms F. Veterans. The study showed a
of Post- Hamilton, significant improvement in PTSD
Traumatic Madeline hyperarousal symptoms, sleep quality,
Stress Uddo and daytime dysfunction. However,
Disorder in yoga had no improvement on total
Veterans PTSD score, anger, or quality of life
outcome.

See Figure C

Figure A
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Figure B

Figure C

Analysis

The results showed that participating in Mind Body Medicine (specifically

mind body skills groups, kundalini yoga, and yoga) improves PTSD, depression,
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quality of life, sleep, anxiety, and stress. While most of these findings were

consistent, there were a few conflicting results. For instance, Study 4 found that

there were no improvements in quality of life, while study 2 and 3 found that

there was an improvement, as the participants were much more emotionally

stable, aware, and positive. Additionally, Study 2 found that PTSD symptoms

improved, while study 4 found that PTSD hyperarousal symptoms improved but

the total PTSD score did not.This discrepancy in results was largely due to the

fact that the compiled data consisted of multiple Mind Body Medicine

modalities.The data examines the effects of a mind body skills group, kundalini

yoga, and regular yoga on PTSD. The effects of these modalities may be too

different to generalize all three techniques as “Mind Body Medicine.” The results

indicate that Mind Body Medicine improves PTSD, however this improvement is

dependent upon the modality used, and furthermore the participant. For instance,

the first three studies were done on participants with PTSD, but their experience

was unspecified. The fourth study used was on veterans, which were consistently

less affected by the Mind Body Medicine modalities. This may be because the

PTSD in veterans was much more severe than the participants in the other three

studies who were unspecified. This concludes that Mind Body Medicine

significantly improves PTSD in individuals with relatively low PTSD scores,

however individuals, such as veterans, who have a higher PTSD score may need

conventional medicine/drugs for treatment. The studies used in my meta-analysis

have some limitations. Data was only gathered on a few different types of Mind
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Body Medicine modalities (mind body skills group, kundalini yoga, and yoga)

when in reality there are dozens of other modalities considered Mind Body

Medicine. Also, not all of the studies used had specified participants (ie. veterans)

which make my results limited in evaluating the effect of Mind Body Medicine on

different types of people. When compiling data, a greater variety of modalities,

and narrowing of the participants in order to get results that were (1) more

indicative of Mind Body Medicine as a whole, and (2) more accurate pertaining to

one group of people with PTSD would improve the clarity of the findings.

Data Conclusion:

These results will lead future researchers to investigate the effect of Mind

Body Medicine on specified types of people with PTSD because my results

indicated that Mind Body Medicine efficacy is dependent upon the severity of

PTSD. Overall, these results indicate that Mind Body Medicine improves PTSD

symptoms, depression, quality of life, sleep, anxiety, and stress in individuals with

PTSD. New information provided by the meta-analysis is that Mind Body

Medicine does improve PTSD, but it is also dependent upon the modality used

and the severity of the individual’s PTSD.

VI. Conclusion

Mind Body Medicine techniques such as meditation, guided imagery, autogenic

training, biofeedback, yoga, and mind body skills groups improve the mental state of an

individual. Meditation increases attention and is associated with an increase in emotional

state due to the activation of the left-sided anterior portion of the brain. Guided imagery
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allows individuals to cope with issues in their life by imaging a ‘mental escape.’

Biofeedback measures bodily movement and impulses which allow the individual to have

a greater awareness and control over their body. Mind Body Medicine is especially

beneficial to post-war communities because of the amount of psychological harm

violence has imposed on the community. As Gaza frequently experiences unpredictable

attacks, the CMBM has traveled to Gaza to teach various Mind Body Medicine

modalities. Research conducted in Gaza shows that participating in mind body skills

groups reduced PTSD, depression,and anxiety. After the conflict in Kosovo,

communities in the Balkans were reported to have a large amount of individuals

experiencing PTSD. The CMBM traveled to Kosovo to teach relaxation techniques,

guided imagery, autogenic training, quiet and active meditations, and biofeedback that

enhanced sense of control, lowered sympathetic arousal, decreased anxiety, and improved

mood. (Gordon et al.) Other techniques such as yoga found a significant improvement in

sleep quality and daytime dysfunction in veterans experiencing PTSD (Staples et al.)

When comparing studies in the meta-analysis, it is clear that Mind Body Medicine

had an overall positive effect on PTSD; however the improvement of PTSD is dependent

upon the modality used and the participant. Mind Body Medicine is seen to improve

PTSD in individuals who have low PTSD scores, rather than those, such as veterans, who

have higher PTSD scores. This finding suggests medications may be more effective for

individuals with more advanced PTSD. Additional research is necessary to investigate the

effect of Mind Body Medicine on specified types of people with PTSD, such as veterans,

to get more indicative results.

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