by Dr. Samantha Case, Psy.D. and Dr. Tyler Meade, Ed.D.
Most veterans diagnosed with Post-Traumatic Stress Disorder (PTSD) have experienced more than one traumatic event during combat and training. Complex PTSD (C-PTSD) is the diagnosis for individuals with long-term or repetitive traumas, similar to being in an active combat zone.
The normal healthy response to trauma is fear and excitement, more commonly referred to as the fight or flight response. These touch points or triggers in the brain become an appropriate response to everyday events and cues, which can lead to maladaptive behaviors such as dealing with intrusive memories, flashbacks or bad dreams, avoidance of people or places that remind the person of the trauma, and being detached from family/friends and a general feeling of being emotionally numb. Trauma also alters how the world is perceived and tolerated, including using drugs or alcohol to deal with the day or hypervigilance, progressing to obsessive impulses.
Additionally, while serving in the military or other tactical populations (e.g., firefighters, law enforcement, emergency medical technicians), these symptoms might be non-existent or suppressed due to a sense of purpose, mission, and being close to a trusted support network. The presentation of these symptoms is gradual, making previous neutral situations now anxiety provoking. The body’s response to perceived or actual threats to life is survival, a learned response that serves a purpose. The problem is that when that same response is cued in everyday scenarios such as sitting in traffic or standing in a crowd, the response that once saved the individual’s life becomes a detriment.
Evidence-based researchers have been studying the quantitative reduction of symptoms relating to PTSD, anxiety, and depression when integrating programmable physical activity. Studies done in 2019 showed that aerobic exercise will desensitize the immediate arousal cues of hypervigilance and aggression. Regular exercise increases cognitive functioning and reduces chronic Traumatic Brain Injury (TBI) symptoms such as difficulty with concentration and attention. These changes can impact cognitive control, which is having the ability to differentiate between neutral stimuli and the perception of being a threat to a life situation.
Similar studies differentiate that cardiorespiratory fitness, as in endurance sports like distance running, swimming, cycling, and strength-based programs, is an effective treatment for depression and anxiety in which the physiological and psychological mechanisms produce similar benefits as psychotherapy and pharmacology. Cardiorespiratory fitness is when the body is engaged in a movement that engages the circulatory and respiratory systems to supply oxygen to the skeletal muscle mitochondria for energy production needed in physical activity.
A 2022 systematic review found that using a combined exercise intervention with various intensities and modalities (e.g., strength training, yoga, high-intensity interval training, and cardiorespiratory fitness) can positively influence perceived symptoms of PTSD. This means that one size does not need to fit all, and multiple approaches can positively impact symptoms as long as a physiological response is created.
A review of comprehensive literature summarized that a 12-week moderate-intensity exercise program (Moderate: 64-76% of maximal heart rate) with three 1-hour sessions per week showed a reduction in avoidance symptoms and hyperarousal symptoms with a secondary gain of increased self-reported mindfulness and interoceptive awareness, which is being aware of what is happening in the body.
When physical activity is used in conjunction with either group or individual psychotherapy, research showed a significant reduction of depression, anxiety, and self-reported stress compared to groups who only participated in one or the other. Physical activity allows the individual to control symptoms to a manageable level, allowing sufficient emotional tolerance to address the underlying issues, ultimately reducing the severity and frequency of symptoms.
One of the most common effects of transitioning out of the service is the increase of a sedentary lifestyle. While serving, the body adapts to being active and has ongoing stress, which fuels the profession’s purpose. Prolonged exposure to intense situations puts the body in a consistent sense of vigilance, ready to fight off any threats. As the individual transitions out of the service, the brain interprets the cessation of specific scenarios and activity levels, mimicking depression and anxiety symptoms. This is when there is no specific trauma-based event to warrant the emotion. As depression and anxiety develop, so does difficulty with concentration, memory, and flexibility of learning.
So, what is the next step? Should you start working out? The answer is “yes.” When compared to other methods of treatment, physical activity has a relatively low amount of side effects, increases psychological well-being, can be performed anywhere, is highly cost-effective when compared to other therapies, can be performed by every age group and gender, and can be continued indefinitely while also benefiting other areas of life (e.g., increasing quality of sleep, positively influencing body image, positively influencing perceptions of well-being, prolonging independence later in life). Strategies at all levels can be adapted to current physical strengths, weaknesses, and limitations for virtually any fitness level when paired with a competent fitness programmer/educator.
Where do you start? If you need additional motivation, you can get tied into a local gym community near you. These communities can act as accountability and social support while giving you a reason to show up each week. While a single effort of aerobic activity has demonstrated the ability to decrease symptoms relating to anxiety, to see a prolonged effect on symptoms relating to PTSD, a consistent activity level is needed each week.
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Samantha Case, Psy.D. represents the CSRT Foundation, a 501c3 non-profit using a comprehensive approach to mental health by integrating a strength & conditioning program focused on rehab designed by Christian Lopez along with individual psychotherapy which now holds a national platform, able to help Veterans and first responders across the country. Learn more about CSRT Foundation at www.CSRTFoundation.org. Army Ranger Christian Lopez, (founder of American Savage https://www.americansavage.co/ )
Tyler Meade, Ed.D. is the co-founder and CEO of Operation RSF, a 501c3 non-profit using physical activity and community to combat PTSD while developing a community of accountability, motivation & encouragement, and social support. He is a veteran of the U.S. Army with over 11 years in SOF. Learn more about Operation RSF at www.OperationRSF.org.
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