Posttraumatic stress disorder (PTSD) is among the most common Axis I disorders, with an estimated lifetime prevalence in the U.S. of approximately 7%. PTSD is often chronic and is associated with significant adverse consequences, including high rates of depression and other psychiatric comorbidities; substance abuse; suicidality; impaired social, occupational, and family functioning; decreased quality of life; and increased rates of medical morbidity, health risk behaviors, and health service use. PTSD is the emotional disorder most frequently associated with combat and other potentially traumatic experiences that may occur during the course of military service (e.g., sexual assault, motor vehicle injury). Over 2.2 million U.S. troops have deployed in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). One anticipated consequence of this sustained period of military operations is the increased incidence of PTSD among Veterans. Among OEF/OIF Veterans who received Department of Veterans Affairs (VA) care between 2002 and 2008, 22% were diagsed with PTSD. In addition to increased mental health service use among this newest generation of Veterans, the VA has witnessed the sharpest increase in mental health service use among Vietnam-era Veterans. As the VA strives to anticipate and serve the treatment needs of the Veteran population, including those returning from current Middle East conflicts as well as Veterans of previous service eras, identifying and implementing effective PTSD treatment approaches remains a critical priority. Complementary and alternative medicine (CAM) interventions are popular among consumers and are widely employed to treat diverse physical and mental health conditions. The results of a recent national survey show that nearly 38% of U.S. adults use CAM approaches to manage a range of physical and emotional health concerns, including pain, anxiety, and depression. Such widely used practices deserve careful evaluation and may hold promise as either adjunctive or primary PTSD therapies. Thus, this evidence synthesis was requested by VA Research and Development to inform decisions on the need for research in this area. This report reviews the evidence for common CAM approaches for PTSD and examines mind-body therapies, manipulative and body-based practices, and practices that are movement-based or involve energy therapies. PTSD is often chronic and may be associated with significant comorbidities and functional impairments. Current first-line PTSD therapies include trauma-focused cognitive behavioral psychotherapies, stress iculation training, and pharmacotherapies. CAM interventions include a range of therapies that are t considered standard to the practice of medicine in the U.S. CAM therapies are widely used by mental health consumers, including Veterans, and numerous stakeholders have expressed strong interest in fostering the evidence base for these approaches in PTSD. Thus, this evidence synthesis was requested by VA Research and Development to inform decisions on the need for research in this area. Four key questions guided this systematic review: KQ 1. In adults with PTSD, are mind-body complementary and alternative medicine therapies (e.g., acupuncture, yoga, meditation) more efficacious than control for PTSD symptoms and health-related quality of life? KQ 2. In adults with PTSD, are manipulative and body-based complementary and alternative medicine therapies (e.g., spinal manipulation, massage) more efficacious than control for PTSD symptoms and health-related quality of life? KQ 3. In adults with PTSD, are complementary and alternative medicine therapies that are movement-based or involve energy therapies more efficacious than control for PTSD symptoms and health-related quality of life? KQ 4. For treatments evaluated in KQs 1-3 that lack randomized controlled trials, is there evidence from other study designs that suggests the potential for treatment efficacy?
Health Services Research Service, U S Department of Veterans Affairs