Veterans with PTSD and Yoga — How Do They Mix and Does Yoga Help.

Jim Geddes is a Yoga Teacher, a Yoga Therapist, a veteran and the father of an Afghanistan War Veteran with combat based Post Traumatic Stress Disorder (PTSD). Jim has an interest in helping those with mental health issues and those in society who are marginalised, in particular veterans. Jim teaches therapy based yoga at a private hospital’s mental health ward, a NDIS mental health and wellness centre, Triggerpoint Natural Health Centre and community classes that are free to veterans. Jim also offers free one on one yoga therapy sessions to veterans.

Jim also rides with a military motorbike group that is focused on helping homeless and marginalised veterans and their families

If you are considering teaching yoga to the veteran community, thank you! It can be both a rewarding and a frustrating experience, so be ready for a rollercoaster ride as you join the battle to help bring these young men and women home from the war they continue to wage in their own mind and body. It can be frustrating because it is so difficult to get those, who are in the early stages of PTSD recovery, to embrace yoga and the benefits it can bring.

I would like to give a huge shout out to Frontline Yoga. Their ongoing, Australia wide program, offers free Trauma Aware Yoga to first responders, doctors, nurses and the military; giving back to those who give so much to us. The Frontline Yoga community classes offer an excellent opportunity for veterans with PTSD to continue their yoga journey in the later stages of their recovery.

There is a myriad of considerations when teaching veterans who are early in their recovery from combat PTSD; so it may be best to know where we are starting from and who they are.

What is a Veteran — The Returned Service League (RSL) considers anyone who has served in the Australian Military as a Veteran; those who have deployed to a warzone are classified as War Veterans. Defence has recognised the broad impact of military service on all defence member’s mental health, whether they served in a warzone or not, by providing access to a white card (claim card) for mental health treatment for all ex-defence members.

Combat related Post Traumatic Stress Disorder — Several or all of the following associated symptoms may be presenting with someone suffering combat PTSD — anxiety, depression, panic attacks, substance abuse, anger issues, disassociation, avoidance, lack of feelings, lack of sleep, night mares, hypervigilance, self- harm, disconnected from their body, being stuck in the past with fear of the future, suicidal thoughts and suicide attempts. This, on top of a myriad of physical conditions from hearing loss, problems with eye sight, brain trauma, back, knee or shoulder issues, loss of limbs or any other number of problems related to combat, exacerbate both mental and physical trauma issues.

The Veteran Mindset — Many of our veterans have a strong bond and trust with fellow Veterans, they are usually conservative and can be seen as somewhat old school. From my experience, veterans with PTSD have a distrust of government institutions, do-gooders, random people doing mental health surveys, and many doctors /psychologists. For many of them, a big part of their recovery is the feelings of worth and community relationships they gain from helping other Veterans.

Physical Issues –Many Veterans have significant back issues (through trauma and the loads they carry in operation), a disconnection with their body due to trauma, hearing loss and a sensitivity to light.

Treatment / Management

Conventional — Heavy use of medication — mood stabilisers, anti-depressants, sleeping tablets, psychiatric treatment, CBT, aversion therapy etc.

Complementary therapies — Service dogs, equine therapy, EFT (tapping), IRest nidra and the right kind of yoga. There have been a number of studies supporting the positive impact of ‘Yoga’ on veterans with PTSD. A recent (Feb 2018) meta-analysis review of Mind Body Therapy for veterans with PTSD[1] concluded that mind body therapy is considered ‘effective in reducing the severity of PTSD symptoms associated with combat’, they also found that it ‘reduced anxiety, depression and increased mindfulness and sleep quality’. To my mind ‘Mind Body Therapy’ is yoga.

From my experience, what works and what does not, and what to expect when a veteran with PTSD walks into your yoga studio or comes to a private yoga therapy session. Note: This may be completely different depending on the veteran is and their experiences, it just depends!

The Veteran — They have come to a class or private session, the first and perhaps one of the most difficult hurdle is over, if you are lucky they may be accompanied by their service dog[2]. This is a major step out of their comfort zone, what is similar and comforting to you and yoga students is likely to be confronting and triggering for them.

What may happen when they arrive and during class

  • They will scan the room for entry points and exits.
  • They will find the safest place for their mat, at the back of the room in a corner.
  • Their eyes will remain open at all times, including during meditation, being constantly vigilant.
  • They may seem detached but vigilant.
  • They may just sit or lay on their mat.
  • They may leave during the class (and that’s ok).

Things that don’t seem to work and may trigger veterans

  • The chatter between students and congestion at the start of the yoga class — may be stressful and distracting, bringing dark thoughts and memories.
  • Sanskrit will be a strange language and bring memories of Afghanistan or Iraqi.
  • Hands on adjustment — take care there could be an abrupt physical reaction.
  • Unknown noises will be disturbing and make them anxious.
  • Movement that they are not warned about and on the edge of their peripheral vision.
  • General body scan Nidra.
  • Silent meditation or Shavasana.
  • Abstract concepts or analogies.
  • Certain music.
  • Unachievable poses or transitions.

Things that tend to work in most cases

  • Most Trauma sensitive yoga protocols (straps are ok, clear direction).
  • Gradual connecting the breath to movement (where they are comfortable with it) and bringing the focus into the body not just positional but internal, and through this process bringing the first steps towards mindfulness.
  • Eventually through mindfulness, by sitting with and not reacting to the thoughts and noticing the associated somatic impact, the veterans may build resilience and create a pause before an automatic adverse reaction, therefore allowing a change to the usual pattern.
  • Invitational language.
  • Offering choice.
  • Offering the option to not do poses that they don’t want to or causes pain.
  • Somatic movement bringing connection with the body.
  • Simple warrior poses that are strong linked with movement.
  • Achievable poses and transitions.
  • Repetition.
  • Clear direction verbal and demonstration.
  • Tension and release.
  • Simple pranayama.
  • Moving meditation.
  • Irest Nidra.

Again thank you and good luck, and be ready for the roller coaster. Although the veteran may seem to be enjoying the class or private sessions and saying it is beneficial and helping them they may suddenly stop turning up. That’s ok, it’s just the way it is when you are helping people with mental health issues it’s just a resilience you need to work on.

By Jim Geddes

[1] Mind Body Therapy for Military Veterans with Post Traumatic Stress Disorder: A systematic review. Cushing Robin E PA DrPH; Braun Kathryn L DrPH- 1 Feb 2018

[2] Service dogs that have public access licence have a legal right to access any public place (bus, restraint aircraft etc). When in the company of their handler and wearing their identifying jacket the dogs are working please do not touch them or disturb them.