VA EMBRACING ALTERNATIVE THERAPIES
More studies will determine effectiveness of treatments JEANETTE STEELE U-T Published: January 9, 2012Mike Hanes, a 35-year-old former combat Marine, sometimes closes his eyes and murmurs to himself when life gets tense.
He repeats one word over and over, and it works as a "pause button" for his mind. It's a form of meditation, one learned at the Department of Veterans Affairs hospital in La Jolla.
Nationally, the VA is embracing alternative therapies to help returning waves of veterans deal with combat stress and the physical pain that's sometimes a memento of military service.
Veterans can be referred to yoga classes, acupuncture, tai chi and meditation and, in other parts of the nation, music therapy, energy healing and even sweat lodge sessions.
Some patients report that these therapies have allowed them to rely less on pain medication and sleeping pills. However, a VA research conference in May concluded that evidence on the effectiveness of these therapies for post-traumatic stress disorder — possibly the signature wound of the Iraq and Afghanistan wars — is still thin.
Now VA researchers in San Diego, which has the largest population of post-9/11 military veterans in the nation, have received funding to conduct more studies.
"We've done a lot of work in many areas of PTSD research that has produced effective treatments, but we are not done," VA Deputy Secretary W. Scott Gould said at the May conference in Washington, D.C.
"That is why we need to keep our curious minds open and receptive to new ideas."
Dr. Stephen Ezeji-Okoye, a Palo Alto physician who chairs the VA's alternative medicine committee, said the effort began after a 2002 White House Commission report that encouraged the VA to look at the topic. To naysayers, he responds that the VA is moving slowly and carefully.
"We're looking at it not as, 'Is it alternative medicine or Western medicine?' We're looking at it as, 'Is it effective medicine?'?" he said.
Hanes, who was in elite Marine force reconnaissance during the Iraq War and came to the VA to deal with combat stress, is a believer in meditation. He also is taking the La Jolla VA's yoga series for back pain.
"I noticed before, it was easier to fly off the handle," said Hanes, who chose the word "shalom" as his meditation mantram, or mantra, as it's more commonly known. "But now, you take that 10 seconds of saying your mantram, and it puts you back in focus instead of doing something that you can really regret.
"I was very surprised to see the VA is offering this, and I think they should do a lot more of this type of stuff."
With some young male veterans, meditation, tai chi and other New Age therapies are a harder sell.
Joe Qualls, an Army infantryman in Iraq, said he has witnessed some of his tough-guy friends balk a bit when asked to do deep-breathing exercises for relaxation. He would like to see the VA focus on offering recreational sports programs year-round, such as basketball leagues.
"The physical piece is the key, at least for this generation," said Qualls, 31.
"Exercise allows us to focus on one thing, nothing else. We burn off the extra adrenaline and anxiety."
That's one step toward being in the right state of mind for traditional sit-down therapy for PTSD, he said. And, "there's less the medication has to work on."
Jill Bormann, a VA nurse researcher in La Jolla, has pioneered the institution's work on word-repetition meditation.
"Compared to case management alone, we have seen significantly greater reductions in PTSD-related depression and hypervigilance, and improvements in quality of life," she said, referring to the results of two pilot studies and one large randomized trial.
Bormann has received approval to do two new projects on meditation and post-traumatic stress.
In the hope of attracting young veterans — a previously elusive group for any VA research — she plans to hold the sessions in the evening and on weekends. Another tactic she uses is rebranding. She calls meditation a "pause button" for the mind.
The VA isn't the only group doing work on meditation. Last year, film director David Lynch's nonprofit foundation launched Operation Warrior Wellness with $1 million in funding to teach transcendental meditation to veterans.
Yoga is another popular alternative therapy at the VA and elsewhere. For example, the group Yoga For Vets NYC is offering free weekly yoga sessions in the Big Apple.
The La Jolla VA began offering yoga for lower-back pain in 2003.
According to questionnaires filled out by students between 2005 and 2007, people who attended the once-a-week class — and stretched at home — showed significant improvement in pain, depression, energy level and general mental outlook.
VA psychologist Erik Groessl and others published a paper about the results, but they were stunted by the informality of the study. Groessl is hopeful that he will be successful this year in securing funding for a more scientific trial, after years of applying.
Navy veteran Silas Cochran, 50, was one of nine men in a recent yoga class, held in a VA classroom with the desks pushed back. Cochran's military-style combat boots were lined up neatly next to his yoga mat.
He rode a bus from Escondido to attend the session, so he really wanted to be there — despite being the leading jokester when the teacher gave commands such as "curl back like you are a beautiful flower."
Seriously, though, as someone with bipolar disorder, he doesn't want to take medication for his back pain.
"I notice a difference here when I leave the class," Cochran said. "It helps me relax and get in touch with my body, and maybe even get in touch with my mind."
On any given week at the Oceanside VA clinic, veterans get needles poked in their ears for pain relief.
Dr. Kristin Bell, a VA primary care physician, has been offering acupuncture for chronic pain since 2003. Veterans are referred to her for chronic pain, most often in their backs and necks. But Bell said she gets patients who also have post-traumatic stress, and they report some relief, too.
"I have quite a number of patients who have PTSD, both new and old veterans, who say it really helps them be calm and improves nightmares," Bell said. "Frequently people report improved well-being, mood and sleep even before they get pain relief."
She asks patients about how acupuncture affects the need for medication.
"I have a lot of patients who have been able to lower their meds, or even go off chronic narcotics altogether," Bell said.
As attractive as that might sound, Bell said she has room for more patients.
And Bormann, the meditation researcher, is looking for veterans for her PTSD studies. Anyone interested in participating, call the La Jolla VA at (858) 642-1616.
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Copyright 2012, U-T San Diego