Yoga, Tai Chi, and Meditation Provide Physical and Emotional Relief for Veterans

Update: As of January 17, 2023 all US veterans are eligible to receive emergency mental health care at no cost. This applies even if the individual isn’t enrolled in the VA system. The policy also includes the cost of ambulance rides, up to 30 days of inpatient care, and up to 90 days of outpatient care.

Establishing effective and sustainable treatment programs for veterans is an incredibly important public health issue—one that is particularly challenging, as their conditions frequently require life-long intervention. Because of this, doctors and mental health professionals alike continue to investigate innovative therapies that might allow former (and current) military personnel to thrive without dependence on prescription medication.

The physical and neurological benefits of complementary and integrative (CIH) therapies are widely known, but their application in the treatment of the veteran population is only beginning to be understood. A recent study published in a special issue of Medical Care found that yoga, tai chi chuan, and meditation likely improve the mental and physical health of veterans receiving care through the Department of Veterans Affairs (VA).

This study is only one example out of numerous research initiatives investigating the usefulness of these therapies in the promotion of veteran well-being. Such findings could inform new strategies and treatment protocols for veteran care, thus promoting the widespread use of complementary and alternative therapies at VA centers across the country.

As Veteran’s Day approaches, it's important to highlight the value and necessity of making therapy and new treatment options more widely available for those who’ve dedicated their lives to protecting this country.

The Veteran Dilemma

Veterans make up approximately 6% of the US population, or around 20 million people, and that doesn’t even include the nearly 1.3 million people who are active duty service members. Each and every one of these individuals carries with them an entirely unique set of injuries or traumas—often hindering their ability to lead normal lives.

Some of the most prevalent medical conditions affecting this population are post-traumatic stress disorder (PTSD) and chronic pain, but due to the distinct nature of each individual case, the path to recovery is rarely clear cut. Currently, too many veterans struggle with an over-reliance on prescription medication, which can lead to various adverse health consequences in the long term.

Fighting Pharmaceutical Dependency

This problem factors squarely in the middle of America's broader opioid epidemic, in which addiction and overdose pose very real threats. Thus, the investment in research for alternative treatments, namely complementary and integrative health (CIH) therapies, has become a top priority.

As an attempt to address this multi-layered issue, in 2016 the U.S. government signed the Comprehensive Addiction and Recovery Act (CARA) into law. This act prioritizes the allocation of federal resources into various evidence-based recovery programs for veterans, particularly at the local and community level.

The goal is to discourage any sort of lifelong dependency on opiates and anti-anxiety medication by incorporating supplemental strategies for chronic pain and PTSD. A key goal is to implement a Whole Health approach which emphasizes the creation of clinical policy that is non-pharmacological in nature. This is where the potential of alternative therapies like yoga, meditation, and tai chi comes into play.

Notable Research

Much of the medical research on the subject is centered around one type of CIH therapy, but the most recent notable study allowed veterans to participate in one or more CIH therapies from a list of 26 options. Researchers conducted 401 surveys over a 12-month period with 119 veterans who were instructed to regularly self-report on their health and well-being. 

Did a regular regimen of yoga, meditation, tai chi, and other mind-body practices improve their quality of life? The answer was a heartening and optimistic "yes."

Study authors write, “We found that veterans who participated in tai chi, yoga, and meditation reported significant improvements in patient-reported outcomes over time. Specifically, yoga practice was associated with decreases in perceived stress, and tai chi involvement was associated with improvements in overall physical and mental health functioning, anxiety, and increased ability to participate in social role activities.”

Even more enlightening was the fact that study participants were not being held accountable by researchers, and they were consistently partaking in these therapies on their own accord. It’s a seemingly small detail that can make all the difference to the longevity of these programs.

Scientific findings like these support a growing consensus that integrative therapies should be made more widely available to the veteran population. And while the evidence supporting the use of CIH therapies is becoming increasingly clear, it’s worth diving into the specifics of each therapeutic modality to better understand how they could help veterans, perhaps even someone you know and love. 

Yoga

The practice of yoga has numerous proven health benefits on both a physical and psychological level, so it’s easy to imagine why it might be a valuable treatment option for veterans.

A veteran with PTSD is constantly coping with a permanent nervous system change, one that keeps them in fight or flight mode even when there is no longer immediate danger in their lives.

The consequences of this constant state of physiological arousal include intrusive thoughts, lack of sleep, intense emotional pain, and an inability to concentrate. Yoga—trauma-informed yoga in particular—strives to alleviate some of those symptoms by reducing stress and restoring homeostasis within the autonomic nervous system.

The integrative use of posture and breathwork can help ease the practitioner back into their own body and slowly cultivates a self-regulatory toolkit they can take with them even after they leave the mat.

Annie Okerlin, RYT 200-certified yoga instructor and founder of the Exalted Warrior Foundation, has dedicated her life to working with veterans and active duty service members at every stage of their recovery journey. Okerlin’s organization represents a small piece of the much broader coalition of veteran-focused yoga teachers all striving for the same goal.

According to Okerlin, one of the best things about yoga is its functional adaptability. “Yoga can be modified for anything; it doesn’t matter what limbs you're missing. A guy walked in without any hands, so we did things on his forearms.” Yoga is also surprisingly well-suited to veterans due to the regimented nature of the practice. The methodical manner in which poses are performed offers an element of familiarity for those who are comfortable receiving instructions as part of a larger group.

Active military duty also requires a similar type of mental discipline, in which troops must stay calm and continue breathing under pressure—and challenging yoga poses require the same. “When you’re in the military you’re trained to shoot a weapon. One of the main things about shooting a weapon is breath control, so yoga makes perfect sense. They are physically ready to go, even those who are amputees, the nervous system holds onto that preparedness.” says Okerlin.

But yoga’s benefits aren’t limited to the realm of mental health; research shows yoga can have dramatic effects on the physical body as well. A January 2020 study published in the International Journal of Yoga Therapy found that veterans with chronic low back pain who participated in a program involving 12 weeks of twice-weekly yoga classes reported a clear reduction in symptoms.

“Nobody in their right mind wants to be on pain or sleep meds their entire life; it’s true there are people with backpacks full of meds, and the lifelong experience of it is incredibly damaging,” says Oklerlin.

The Nuance of Teaching Veterans

When it comes to leading a class for veterans, there are very different protocols than your average yoga session. A yoga teacher must be prepared for whatever mental or physical state someone is in when they walk through the door, and with veterans that can vary drastically.

Nevertheless, Okerlin highlights some core rules she sticks to in all of her classes: “Always ask before adjusting, and even if they said yes the first time, ask again. You don’t know what kind of trauma someone has gone through, and that second touch without permission could be highly triggering.”

It’s also important in a trauma-informed class to create an especially calming environment and keep external stimuli to a minimum. “If someone is in their jacked-up sympathetic nervous system state and their senses are on high, you don’t want to add information, you want to remove complexity. Environment, lighting, sound...need to be pretty calm, in my book,” says Okerlin. Even the wrong music choice can have a triggering effect.

Yoga can ultimately give veterans a renewed sense of control over their lives, and one of the most important aspects of recovery is self-acceptance. Deeply rooted trauma is extremely difficult to overcome, especially when some of that trauma is rooted in shame. Yoga gives veterans permission to show up exactly as they are, and it’s that constant reiteration of self-acceptance that can create space for self-forgiveness.

“Yoga allows them to be OK regardless of what they’ve been through, and I think that’s one of the biggest pointers towards healing for veterans,” says Okerlin. “Because for so many people it’s the moral injury of whatever they’ve done for the service of other people they don’t even know. They put themselves in harm's way so that we didn’t have to.”

Mindfulness and Meditation

Meditation utilizes a variety of breathwork, visualization, and mindfulness techniques to help ground the individual in the body, within a space, in a particular moment in time. This practice allows the nervous system to calm down and creates space to both process and accept the complexity of life with greater ease.

Individuals who have experienced trauma have triggers that cause a stress response, which often leads to embarrassment and ultimately a vicious shame spiral that only further increases that person’s suffering. And veterans with PTSD may feel this almost every day.

Brandon Yabko, PhD and Director of Salt Lake City VA Mindfulness Center, explains how mindfulness meditation can help regulate that response. “Mindfulness is all about being present in our life so that we can see ways that we are stuck and habitual patterns that we may be caught in. It also helps us to view things in a non-judgmental way with openness and acceptance.”

Yabko continues, “By practicing mindfulness meditation, we are literally training the mind to be in this state more often and to settle, which tends to create a sense of feeling centered and grounded.” In other words, no matter what a veteran has been through, mindfulness can help create mental space required for healing.

And there’s plenty of research to support these statements. A 2019 study published in the journal Psychiatric Research & Clinical Practice used large-scale randomized controlled trials to explore the efficacy of mindfulness-based stress reduction therapies in the treatment of veterans. After 16 weeks, all participants reported a significant decrease in symptoms of PTSD. The challenge lies in broadening awareness of how well these therapies work and expanding accessibility to treatment programs.

“The reason for CIH is that there are many non-traditional approaches that have not been integrated or are underutilized within traditional mental health services. My hope is that we eventually stop looking at approaches as 'traditional' or 'conventional' versus CIH and instead use what works while also using research to support our decisions.” Yabko says.

Tai Chi Chuan

When most people think of tai chi chuan (TCC), it conjures up images of elderly people performing slow flowing movements in the park. But in reality, this traditional form of martial arts has become an essential form of mind-body therapy within veteran and broader health culture and is beneficial at any age.

Originally a style of fighting, tai chi has evolved into a form of moving meditation. And similar to yoga, it involves a system of sequential movements that promote physical fitness and mental resilience. According to the National Center for Complementary and Integrative Health (NCCIH), tai chi can ease symptoms in individuals with a variety of chronic health conditions.

A 2019 study published in Nature compared tai chi and conventional aerobic exercise in the context of neuroplasticity. Researchers found that eight weeks of tai chi lead to higher rates of brain plasticity and increased growth of grey matter, which is promising data when viewed through the lens of a persistent psychological condition like PTSD.

One of the most important figures in the therapeutic tai chi community is Zibin Guo, PhD, professor of medical anthropology at the University of Chattanooga and lifelong tai chi instructor. Guo is also the inventor of wheelchair tai chi, which after years of research he created as a way to make this martial art accessible to people living with physical limitations.

“A key feature of my adaptive program is that it integrates wheelchair motion (the rolling and turning the chair) with the dynamic, gentle, and flowing movements of tai chi chuan,” says Guo. “The intention is to transform the image of the wheelchair from an assistive device, like a cane, to a tool of empowerment and artistic expression, like ice skates.” Guo’s wheelchair tai chi chuan initially premiered in 2008 at the Beijing Paralympic Games and has since garnered massive acclaim and recognition from the broader medical community.

It’s groundbreaking modifications like these that make tai chi so appealing to veterans, and thanks to ongoing funding from the U.S. Department of Veterans Affairs, he has been able to work with veterans to combat PTSD and other disability-related symptoms across the United States.

Many of Guo’s program participants have reported significant positive improvements in their overall health and mental outlook. One of his students, a retired Army Command Sergeant Major with three campaigns in Desert Storm, Enduring Freedom, and Iraqi Freedom, notes, “Since I began tai chi, I’ve learned to relax and reduce stress. I’ve noticed my legs are much stronger and I have very little back trouble.” Others even reported less reliance on prescription pain medications.

The Importance of Integrative Health

One of the best things about CIH therapy is that while all these different modalities of healing have the same goals in mind, they offer multiple avenues for veterans who have entirely unique experiences and needs. There is no one-size-fits-all solution to the complexity of trauma these individuals are coping with, and providing options can help them regain a sense of agency over their lives and their recovery.

And it’s worth acknowledging the individuals who are doing the research and making the effort to communicate the necessity of funding for these programs, because it’s not easy.

“The VA is just the VA. It’s like trying to turn an aircraft carrier on a dime; it takes a really long time,” says Okerlin. “But the community is stepping in, and all of these organizations have been slogging away because more and more people are finally saying 'I need help, and I don’t want it to be in a pill.' ”

When these therapies are prescribed in conjunction with necessary medication and other mainstream treatment protocols, they have the power to change people’s lives for the better.

“For now, I believe that as long as this distinction between conventional and CIH exists, the CIH clinics will not only be necessary in the VA but a mandatory part of VA’s mission to provide every veteran with the Whole Health model of treatment,” says Yabko. There’s a vital need for these programs because the men and women who serve our country deserve to feel OK in their own skin.