Brief Report on the Outcomes of an Integrated Approach on Stress, Anxiety, and Persistent Pain for Veterans; Mindful Yoga and Auricular Acupuncture

Research article

Ann Yoga Phys Ther. 2021; 5(1): 1047.

Brief Report on the Outcomes of an Integrated Approach on Stress, Anxiety, and Persistent Pain for Veterans; Mindful Yoga and Auricular Acupuncture

Brosmer J1* and Gibson J2,3

¹8061 Mallard Landing, Indianapolis, Roudebush VA, USA

²8100 Cardinal Street, Avon, Roudebush VA, USA

³Richard L. Roudebush VA Medical Center Indianapolis, USA

*Corresponding author: Jayme Brosmer, 8061 Mallard Landing, Indianapolis, Roudebush VA, USA

Received: April 13, 2021; Accepted: May 15, 2021; Published: May 22, 2021


Objective: The aim of this study was to pilot test an integrated treatment approach, including mindful yoga and auricular acupuncture, for Veterans with overlapping mental health disorders and persistent pain.

Design: A single-arm, quasi-experimental study with a 12-week intervention period.

Methods: Veterans were referred to the program through their established mental health provider, which was marketed as a trauma sensitive mindful yoga program with optional auricular acupuncture for Veterans currently undergoing mental health treatment. The program consisted of 12 weekly 90-minute group yoga sessions that included mindful breathing, mindful movement, and guided relaxation. Auricular acupuncture was also offered but not required prior to each yoga session, where five acupuncture points were targeted for relaxation and stress relief. Stress, pain, and anxiety were assessed pre and post intervention using the Perceived Stress Scale, the PEG scale, and the Generalized Anxiety Disorder-7 Scale.

Results: Out of fifty-five Veterans entering the program with a mental health diagnosis, twenty-seven Veterans completed the 12-week Mindful Yoga program. For those that completed the program, the average attendance was 9.5 out of 12 sessions.

Means scores show improvement in perceived stress, pain, and anxiety compared with baseline scores. Statistically significant improvements were noted in both perceived stress (P = 0.0007) and anxiety (P = 0.0093).

Conclusions: This study suggests that combining mindful yoga with auricular acupuncture can reduce symptoms of stress, pain, and anxiety in Veterans that commit to the program. Although this was a small sample, mean scores showed statistically significant improvements in perceived stress and anxiety and modest improvements in pain, warranting further study.

Keywords: Mindful yoga; Auricular acupuncture; Integrated approach; Stress; Anxiety


Stressors have a major influence on mood, sense of well-being, behavior, and health [1]. Research shows positive associations between stress and the development of psychological conditions such as major depressive disorder and Post Traumatic Stress Disorder (PTSD), as well as health disorders such as cardiovascular and inflammatory disease [2].

Research shows there is a high prevalence and severe impairment associated with Generalized Anxiety Disorder (GAD) in Veterans [3]. Studies have found Veterans to have an elevated rate of generalized anxiety disorder, with 9.7% of Vietnam Veterans and up to 15% of Iraq and Afghanistan Veterans reporting symptoms consistent with GAD, compared to 1.6% to 3.5% in the general population [4-6].

Post-traumatic stress disorder affects approximately 5-8% of the general population [7,8], but it is estimated that approximately 30% of Vietnam theater Veterans have PTSD during their lifetime [9] and 18-20% of Veterans that served in Iraq met screening criteria for PTSD [10]. The incident rate of PTSD in deployed Veterans is more than three times the rate of those not previously deployed [11]. Research also shows that the prevalence of mental health disorders in the Veteran population increase over time [12].

An important aspect of healing from trauma is to find ways to better regulate the nervous system, by reducing the hyperexcitability of the autonomic nervous system associated with PTSD. Studies have demonstrated that not all trauma survivors benefit from conventional psychotherapy [13] or medication [14]. Hence the scope of available treatments needs to broaden for Veterans diagnosed with PTSD and other mood disorders.

Yoga has been used for thousands of years to help calm the mind and body by teaching self-regulation skills through guided breathing, mindful movement, and meditation. Mind-body practices, such as yoga, are increasingly used in the treatment of PTSD and are associated with positive impacts on stress-inducing illnesses such as depression and PTSD [15]. Research also shows that yogabased interventions have a statistically significant effect as an adjunct treatment for major psychiatric disorders [16].

Auricular Acupuncture (AA) has been used for approximately 2500 years [17], but has been studied more thoroughly in recent decades since Dr. Nogier published his research in 1956 [18,19]. As a subset of traditional acupuncture, AA follows the basic principles of the traditional Chinese medicine model. Acupuncture treats various conditions or disorders by stimulating specific points on the body including points on the ear [20]. AA has proven to be a convenient method of treatment that is particularly effective for pain and anxiety [21-23].

The purpose of this clinical program was to provide an integrated treatment approach, including mindful yoga and auricular acupuncture, for Veterans that may complement their current mental health treatments. We hypothesized that Veterans that completed the program would report decreased levels of stress, anxiety, and pain.


Setting and participants

Participants were Veterans who met the following inclusion criteria: 1) Currently being treated by a mental health provider in the Roudebush VA Medical Center (RVAMC) for any mental health disorder; 2) Agreement to participate in weekly sessions for 12 weeks; 3) Ability to get up and down independently and safely from a chair or the floor determined by chart review and patient interview. Participants were excluded if they were unable to be in a group setting as determined by their mental health provider or if they had any cognitive impairment or medical illness that could interfere with treatment (Table 1).

Citation:Brosmer J and Gibson J. Brief Report on the Outcomes of an Integrated Approach on Stress, Anxiety, and Persistent Pain for Veterans; Mindful Yoga and Auricular Acupuncture. Ann Yoga Phys Ther. 2021; 5(1): 1047.