The integrative management of PTSD: A review of conventional and CAM approaches used to prevent and treat PTSD with emphasis on military personnel

Post-traumatic stress disorder (PTSD) may be the most urgent problem the U.S. military is facing today. Pharmacological and psychological interventions reduce the severity of some PTSD symptoms however these conventional approaches have limited efficacy. This issue is compounded by the high rate of co-morbid traumatic brain injury (TBI) and other medical and psychiatric disorders in veterans diagnosed with PTSD and unresolved system-level problems within the Veterans Administration and Department of Defense healthcare services that interfere with adequate and prompt care for veterans and active duty military personnel. This paper is offered as a framework for interdisciplinary dialogue and collaboration between experts in biomedicine and CAM addressing three primary areas of need: resiliency training in high risk military populations, prevention of PTSD following exposure to combat-related trauma, and treatment of established cases of PTSD. The evidence for widely used conventional pharmacological and psychological interventions used in the VA/DOD healthcare systems to treat PTSD is reviewed. Challenges and barriers to adequate assessment and treatment of PTSD in military personnel are discussed. A narrative review of promising CAM modalities used to prevent or treat PTSD emphasizes interventions that are not widely used in VA/DOD clinics and programmes. Interventions reviewed include virtual reality graded exposure therapy (VRGET), brain–computer interface (BCI), EEG biofeedback, cardiac coherence training, EMDR, acupuncture, omega-3 fatty acids and other natural products, lucid dreaming training, and energy therapies. As meditation and mind-body practices are widely offered within VA/DOD programmes and services addressing PTSD the evidence for these modalities is only briefly reviewed. Sources included mainstream medical databases and journals not currently indexed in the mainstream medical databases. Although most interventions discussed are applicable to both civilian and military populations the emphasis is on military personnel. Provisional integrative guidelines are offered with the goal of providing a flexible and open framework when planning interventions aimed at preventing or treating PTSD based on the best available evidence for both conventional and CAM approaches. The paper concludes with recommendations on research and policy within the VA and DOD healthcare systems addressing urgent unmet needs associated with PTSD.