The problem of war veterans with PTSD is a national crisis. Group therapy is said to be the cornerstone of treatment for Veterans with PTSD within the VA and is expected to remain a top priority at the VA within the years to come. Groups are efficient and cost-effective, can be integrated with a variety of techniques, and serve to “counteract and confront the socially avoidant and isolative tendencies common in PTSD” (DeLucia-Waak, 2004, p. 326).
One group technique that is gaining a presence at the VA is the Native American sweat lodge ceremony. According to a VA directory of Native Veteran Services, sweat lodge ceremonies are available through VA medical facilities in nine states including Idaho, Kansas, Maryland, Minnesota, Montana, North Dakota, Oregon, South Dakota, and Washington. Sweat rituals include multiple factors that produce positive effects on the body, mind, and spirit. The health benefits of sweat rituals have been well documented through research on saunas. Benefits include the prevention and treatment of lung, heart, and skin problems, and in promoting deeper sleep, pain relief, muscle relaxation, and helpful in treating insomnia, arthritis, and improving vascular endothelial functioning. The most frequently found psychological effects of sweat rituals are relaxation and stress relief.
More recent research indicates a benefit to combining sweating with psychotherapy. Baseline research comparing sweat and non-sweat groups showed that sweat groups accelerated and intensified group dynamics. In other words, participants in sweat groups opened up quicker and self-disclosed more. They also showed stronger group cohesion than participants in an office setting.
The first psychologist to investigate the use of a sweat ritual as a psychotherapeutic intervention was John P. Wilson, Ph.D. Dr. Wilson is an internationally recognized expert in the field of Post-Traumatic Stress Disorder (PTSD) who has authored eight books and over 20 articles on traumatic stress syndromes. He is a founding member and past president of the International Society for Traumatic Stress Studies (ISTSS). Included among his numerous awards and honors are a Presidential Commendation from President Jimmy Carter for his work with Vietnam Veterans.
In 1985, Dr. Wilson incorporated the sweat lodge ceremony as part of a comprehensive treatment program for Vietnam Veteran’s with PTSD and examined how the Native American sweat lodge can function as a form of treatment for anxiety, depression, and stress-related disorders (1989). He explained how sweat rituals work to help people with PTSD, (1989, p. 69-70):
In summary, it appears that the neurophsyiological mechanisms of PTSD may be altered by the sweat lodge ritual in several ways that are theoretically discernable. First, the extreme temperature of the lodge and the conditions present to induce an altered state of consciousness, point to a changed state of neurophysiology in the brain. Catecholaminergic (NE, 5-HT, DA) and cholinergic (Ach, cortisol) levels are reduced to promote a neurological condition that results in a greater balance in the ergotropic and trophotropic subsystems. The psychological and behavioral result is a reduction in both intrusive and avoidance symptoms of PTSD. Specifically, there is a positive mood state; a greater sense of emotional stability and expressiveness; low levels of anger, anxiety, fear, and depression; and an increased sense of well-being that is experienced as being calm and relaxed and having a greatly enhanced sense of ego vitality. More important, the traumatized individual is able at this point to begin new forms of integration of previously traumatic affect and imagery. In this way the effect of the ritual is allosteric and a form of natural healing.
While there has been a greater acceptance of traditional medicine in healthcare in recent years, the use of the sweat lodge ceremony is still limited. Expanding the use of the sweat lodge ceremony may be inappropriate and impractical. The Native American sweat lodge ceremony is a religious ceremony. Incorporating a religious ceremony into a healthcare facility can be controversial to many Natives and non-Natives. Sweat lodges should be built and ceremonies be led only by qualified Native traditional healers, which can be hard to find.
One way to expand the use of this powerful technique is to combine psychotherapy/counseling with the sweating process with the use of a sauna. Saunas have been manufactured and promoted for secular use for more than half a century. They are especially practical as they can be installed in any facility, can be used regardless of the weather and can be brought up to temperature within 30-minutes. Saunas are also designed with an air circulation system, lighting for monitoring, and the components are UL Listed.
Having a sauna for sweat therapy in a healthcare facility would be useful in working with multiple populations and conditions including mental health, substance abuse, physical therapy and for people with lifestyle-related illnesses. A unique quality of sauna that makes it particularly useful to these areas is that sauna is one of the only cardio exercises that does not require movement and can therefore accommodate a wider range of patients based on ambulatory ability. Knee, hip or other joint problems are not a problem with sauna and in fact may aid in pain relief.
Below is a floor plan of a sauna that would fit well with group work.
The next step to pursuing the use of sweat therapy for VA medical facilities is to explore sweat therapy with specific group populations and issues. Research questions should include basic questions such as optimal dosing, duration, and frequency of treatment and incorporate both quantitative and qualitative research methods. There is a need for both descriptive case studies for specific issues as well as larger clinical studies for different disorders. Veteran’s Health Administration, Research & Development, may be the best resource for supporting future research on sweat therapy with Veterans. The National Center for Complementary and Alternative Medicine through the National Institutes of Health is also a likely funding resource.
DeLucia-Waak, J.L. (2004). Handbook of Group Counseling and Psychotherapy, Sage Publications, Thousand Oaks, CA.
Wilson, J.P. (1989). Trauma, Transformation, and Healing: An Integrative Approach to Theory, Research, and Post-Traumatic Therapy. Brunner/Mazel, New York.
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