The Use of iRest/Yoga Nidra as an Intervention for Treatment of PTSD in Active Duty Service Members and Veterans SYTAR 2009 The views, opinions, and/or findings contained in this presentation are the authors’ and do not necessarily represent the views of Miami VA, Washington DC VA, Walter Reed Army Medical Center, Deployment Health Clinical Center, or the Department of Defense. The authors have declared that no competing interests exist.

Our Presentation Overview & Introductions The Scope of Need What is iRest? A Typical iRest Session Particpants’ Experiences Why iRest for the Wounds of War? Considerations for Working in a Military Setting Real Life Stories How to Get Involved

What is PTSD? Post Traumatic Stress Disorder An anxiety disorder that can occur after a person has been through a traumatic event. A traumatic event -- something horrible and scary that you see or that happens to you. You think that your life or others' lives are in danger. Symptoms include: intense guilt, avoidance of trigger situations, numbing, anger, anxiety, depression, insomnia, hyper-vigilance, and chronic physical pain.

Robin Carnes Deployment Health Clinical Walter Reed Site of 2006 iRest and PTSD pilot study Since 2006, daily iRest sessions included as part of 3-week multi-disciplinary Specialized Care Program Active Duty servicemembers (all branches) with PTSD and/or Medically Unexplained Physical Symptoms Multiple deployments (sometimes up to 4x ) 2x weekly asana and pranayama classes with focus on body awareness and mindfulness

Karen Soltes Washington DC VA iRest taught in War Related Injuries and Illnesses Study Center as part of CAM Weekly classes to Outpatients with variable diagnosis and acute care inpatients Director of Therapeutic Yoga Programs at Circle Yoga, Washington, DC

Molly Asebey-Birkholm Miami VA Dept. of Defense Centers of Excellence Clinical Research- “The Impact of Meditation on Veterans with Post-Traumatic Stress Disorder” Weekly Meditation Classes: Inpatient PTSD, Inpatient Substance Abuse, Acute Psychiatric Care Unit and Nursing Home 50% Vietnam & Gulf War Vets / 50% Returning Vets Director of Research for Center of Timeless Being

Need/Scope in the Military Since 9/11, 1.8 million troops deployed in Iraq & Afghanistan 19% return with PTSD and/or TBI – an estimated 300,000 with major depression &/or PTSD and 320,000 with brain injuries 800K of those deployed are parents For each person deployed, 8-10 family members are affected Rates of divorce, spousal and child abuse, & mental illness (depression, anxiety, etc.) rise significantly after each successive deployment

Need/Scope among Veterans of all Wars Military experts agree that problems often worsen with time when unaddressed, rather than improve Effects of churning increase the risk of serious psychological consequences Average 18 suicides a day among the 25 million U.S. veterans 7% veterans (estimated 1.8 million) met the criteria for substance abuse disorder Many veterans of previous wars still suffering from mental illness Mental health resources unequipped to handle the need for care among veterans and families

Introduction to iRest Form of Yoga Nidra Guided Meditation Integrative Restoration (iRest) Background Being used to treat PTSD, sleep disorders, chronic pain, depression, as well as anxiety, fear and anger management

Structure of Class A typical 1 to 1.5 hour class includes: Brief orientation to practice (5 min.) Focus on particular stage of 10-part practice (10 min.) iRest Session (20-45 min.)- lying down, sitting up Gentle transition to wakefulness (5 min.) Discussion of Practice (5-10 min.)

Why iRest for the Wounds of War? Common responses to Trauma Dissociation- splitting off the emotional response Fusion- merging with the experience How iRest impacts the effect of trauma Disidentification: Begin to disidentify with their experience and integrate their experiences into the whole of who they are

Participants Report: Decreases in:  Insomnia  Depression and anxiety  Irritability and angry outbursts  Chronic pain Increases in:  Energy level  Comfort with situations they can’t control  Sense of control in their lives  Greater sense of ease and well-being

#1 Consideration for Working with Military Population Be Culturally Sensitive Don’t Assume Be Curious Respect Differences

Cultural Sensitivity is Key!

Considerations for Working with Active Duty Military/ Vets Know the common physical and psychological challenges soldiers & families face Expose yourself to the realities of war: movies, books, listen to soldier’s experiences Seek clinically-oriented training Keep it secular, simple & practical

Considerations for Working with Active Duty Military/ Vets Don’t underestimate their potential Trust the protocol – it works Build a clinical and collegial support network

What They Say… “When I heard we were going to do yoga, I laughed so hard I peed my pants. I thought that soldiers doing yoga was ridiculous.” After two weeks of practice, “Who would have ever thought you could get so chill? I want to find a class to do with my wife, something we could share.” Jim, 3 Iraq deployments “This (iRest yoga nidra) will never work for me. I have been on guard duty for the last 3 years, and for the last 18 months I’ve been home from Iraq.” On about the 5 th class he was softly snoring. When the practice was over, he got up and triumphantly said “I went off guard duty!” “I feel great!”. Joe, 3 Iraq deployments “Instead of feeling like there is something wrong with us, meditation makes us feel like there is something right with us.” Gilbert, Iraq Vet “Meditation brought out the 10-year old boy that I didn’t even know existed anymore. I was so happy to know that a part of me is still innocent. I want to find him again and learn to laugh again.” Ralph, Vietnam Vet “I used to feel like I didn’t trust other people. In meditation, I realized that I didn’t trust myself. It is helping me feel more calm. The more calm I feel, the more I see that people are trying their best.” Jose, Afghanistan Vet

How to Get Involved Expanding openness to ‘complementary and alternative medicine/therapies’ Contact the mental health department of your local military base or VA Be organized & informed…patient and PERSISTENT! Come armed with research Be willing to volunteer, at least in the beginning Connect with other yoga/ meditation instructors working with the military/VA Attend Yoga Corps’ “Teaching Yoga/Meditation to the Military Teleconference” for more info contact