Healing Post-Traumatic Stress Disorder with Kundalini Yoga and Cognitive-Behavioral Therapy

Post Traumatic Stress Disorder [PTSD] is a body/mind illness diagnosed in military and civilian populations worldwide. It develops in the aftermath of many kinds of traumatic events including military combat, physical or sexual assault, and natural disaster. PTSD symptoms cluster into four separate categories: 1] recurrent distressing memories of the traumatic event, including nightmares and flashbacks; 2] avoidance of stimuli associated with the event, including physical environments, thoughts and emotions; 3] exaggerated negative beliefs and feelings about oneself, others and the world; and 4]  a set of aversive physiologic states including hypervigilance, physical tension and disturbed sleep.

I and my colleagues developed an integrative PTSD treatment protocol that combines two evidence-based practices, Kundalini Yoga and cognitive-behavioral therapy [CBT] to address both the physical and psychological expressions of PTSD. Our pilot study found the protocol significantly reduced PTSD symptoms in all four symptom clusters, and that these gains were maintained at follow-up.1

Integrative Medicine: Healing The Body/Mind

Language differentiates “body” from “mind.” And while these two are distinct they are never separate. Psychological experience always has correlates throughout our physical structure. When we think a stressful thought or have a distressing memory our bodies participate in such activities every bit as much as our minds. Our emotions too occur not only in such brain structures as the amygdalae but throughout our bodies. It is impossible to experience feelings like fear, anger or joy “from the neck up.”  Our psychological lives are intimately bound up with activity in our endocrine, cardiac, respiratory and immune systems.

So too the state of our physical structure gains expression in our thought patterns, emotions and memory processes. Research has demonstrated that the body’s incline,2 temperature3 and muscle tonus4 influence such things as our perception of others, our altruism, and orientation toward either the past or the future. Seeing a person walk timidly or confidently into a roomful of people we understand much about their psychological state. And this body/mind sphere of influence is always bidirectional: how we are in one dimension impacts how we are in the other. Body and mind comprise a reciprocal feedback loop that creates our total experience of ourselves, other people and the world.

Thus integrative medicine is not adding one thing [body-based practices] to “something else” [psychological approaches]. It is, rather, skillfully utilizing both pathways to healing, with an appreciation that each offers complete access to the suffering and wellness of the whole person. Working with the body, by means of yoga therapy, we heal the mind. Working with cognitive-behavioral therapy tools we sooth and restore the body to a state of vitality, equilibrium and wellness.

Cognitive-Behavioral Therapy

CBT has roots in humanity’s earliest written records. A twelfth-century account of Buddha’s enlightenment quotes the sage as declaring that all people are already enlightened, “Yet simply because of their delusions and preoccupations they cannot bear witness to this endowment.” 5 The Greek Stoic philosophers wrote at length about how negative thinking is the root of all emotional suffering. Arrian, a second-century disciple of the Stoic philosopher Epictetus, quoted his teacher as saying that people “are disturbed not by what happens to them, but by the principles and notions they form concerning what happens to them.”

Since the 1950’s clinicians and researchers worldwide have been building a modern science of the mind based on these ancient teachings. We now understand in a more granular way than ever before the relationships between different aspects of our mental, emotional and physical lives. And while CBT references cognition and behavior, both are grounded in our beliefs about ourselves, other people and the world at large. Resetting faulty beliefs is the ultimate aim of CBT.

Post trauma a person’s belief structure may experience a hard reset. A woman who has been sexually assaulted may begin to believe that most men are dangerous predators. Approaching an unknown man walking the opposite direction up the street this belief might be triggered and produce the thought “That man wants to hurt me.”  This thought will produce a fear response with expressions in both body and mind. The fear will likely drive an avoidant behavior – crossing to the other side of the street – that reinforces the belief. This woman would not be avoiding men if they were simply other human beings like herself. Her avoidant behavior reminds her she must maintain physical and emotional hypervigilance in a world that is very dangerous at all moments. And her safe arrival home will register as data that confirms her entire belief/thought/behavior structure.

As this example makes clear, dealing only with cognition, emotion, or behavior we miss the root of an illness like PTSD. It is only by bringing into awareness the faulty beliefs that give rise to negative thoughts, feelings and behaviors – and providing patients the tools to reset these beliefs – that CBT opens the doorway to healing, peace, self confidence and joy.

Kundalini Yoga

Sometimes referred to as the “yoga of awareness” Kundalini yoga utilizes physical posture, pranayama, mudra and mantra to unify the practitioner’s body and mind – with the final goal of yoking the human and the divine. Kundalini Yoga kriyas are being investigated by modern medical science to understand the physical and psychological effects of these practices. Our research and that of colleagues is creating a body of data in support of these kriyas efficacy in addressing sleep disorders,6 PTSD,7,8 addiction, 9 anxiety 10 and other parameters of mental health.11

Mantra, a key component of Kundalini practice, has been shown to decrease physical risk factors including high blood pressure, chemoreflex sensitivity and low brain oxygen saturation.12 In PTSD veteran populations mantra practice has correlated with significant reductions in hyperarousal symptoms and disturbed sleep.13 Kundalini Yoga’s Kirtan Kriya, which includes a mantra component, decreased depression symptoms and improved mental health and cognitive function in family caregivers of dementia patients.14

Over the last two decades yoga of many schools has been studied better to understand the cognitive effects of this ancient practice. In our clinical work we see the kriyas resetting patients’ negative thoughts and the negative feelings that flows from them. While we also offer CBT tools to effect these changes, yoga in and of itself appears capable of producing such healing in PTSD patients. Colleagues’ research has demonstrated that yoga practice correlates with overall improvement in a number of cognitive functions. These include working memory,15 long term memory,16 visual attention17 and executive function.18  This data strongly recommends yoga practice as both a stand-alone and a complementary approach to PTSD treatment.

Physiologic Effects of PTSD

PTSD is correlated with structural and functional changes throughout the brain and body. These changes are often coequal with changes in belief, cognition and emotion in producing patients’ experience of illness. Our outline above of the interdependence of body and mind explains how this will likely be the case. PTSD is also comorbid with a wide range of disease states including cardiovascular, respiratory and autoimmune illness. PTSD is correlated with changes in the immune response19 and gut biome20 and many of these comorbidities may be driven by inflammation. A number of inflammatory markers are significantly increased in PTSD patients relative to controls.21

The amygdalae are twin structures that together comprise the seat of emotional processing in the brain. The amygdalae are overactive in PTSD which may account for the hypervigilance found in many patients.22 The hippocampi are twin structures associated with memory formation and processing of long-term memories. Hippocampal volume is reduced in PTSD and this reduction is likely implicated with the memory disturbances [both memory loss and intrusion of unwanted memories] experienced by patients.22 The anterior cingulate cortex [ACC] is another brain structure affected by PTSD. The ACC helps regulate emotion and the stress response and is reduced both in size23 and activity24 in PTSD patients.

PTSD-related structural and function changes are not limited to the brain. FKBP5 is a gene that helps moderate the stress response; the expression of FKBP5 is reduced in PTSD.25 PTSD is associated with increased pro-inflammatory and decreased anti-inflammatory cytokines.26 Heart rate variability [HRV], the variance in time intervals between heartbeats, is a marker for nervous system balance and health; higher variability correlates with better health. PTSD is correlated with decreased HRV,27 an indication of sympathetic nervous system dominance, a state sometimes referred to as “fight or flight.”

Physiologic Effects of Yoga and CBT

Yoga and CBT have been shown to produce effects that lie opposite the structural and functional changes that travel with PTSD, restoring physical wellness right down to the molecular level. CBT increases FKBP5 expression in PTSD patients 28 and decreases overactivity of the amygdala.29 Both CBT28 and yoga30 increase hippocampal volume and CBT improves memory.28 CBT31 and yoga32 also raise heart rate variability in PTSD patients to the level of healthy controls and regulate genes associated with the inflammatory response.33-35

In reviewing the literature my colleagues and I are struck by the similar structural and functional repair produced by such apparently divergent therapies as yoga and CBT. We hypothesize that there are as-yet-unrecognized mechanisms common to both therapies. Discovering these underlying mechanisms – and better understanding the interactive effects of an integrative approach  – constitute promising areas for further research.

Conclusion

PTSD is a mind/body illness that our research and that of colleagues suggests can be healed by patients’ skillful use of their own bodies and minds. The combination of CBT and Kundalini yoga offers an evidence-based approach that is drug-free, low-tech and suitable for either individual or group treatment. Via self-help books like Reclaiming Life After Trauma, this protocol can be made available to remote or displaced populations without access to financial resources, medical facilities or even electricity. It is our hope that this combination of ancient Eastern wisdom and modern cognitive science will bring healing to PTSD patients worldwide and further our understanding of the essential unity of the human body, mind and spirit.

Citations

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